Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis

Background and Purpose We sought to compare the safety and efficacy of direct urokinase thrombolysis with systemic heparin anticoagulation for superior sagittal sinus thrombosis (SSST). Methods At University at Buffalo (NY) and University of Texas (Dallas, Houston), we reviewed 40 consecutive patients with SSST, treated with local urokinase (thrombolysis group) or systemic heparin anticoagulation (heparin group). The thrombolysis group (n=20) received local urokinase into the SSS followed by systemic heparin anticoagulation. The heparin group (n=20) received systemic heparin anticoagulation only. Neurological dysfunction was rated as follows: 0, normal; 1, mild (but able to ambulate and communicate); 2, moderate (unable to ambulate, normal mentation); and 3, severe (unable to ambulate, altered mentation). Results Age (P=0.49), sex (P=0.20), baseline venous infarction (P=0.73), and predisposing illnesses (P=0.52) were similar between the thrombolysis and heparin groups. Pretreatment neurological function was worse in the thrombolysis group (normal, n=5; mild, n=8; moderate, n=4; severe, n=3) than in the heparin group (normal, n=8; mild, n=8; moderate, n=3; severe, n=1) (P=NS). Discharge neurological function was better in the thrombolysis group (normal, n=16; mild, n=3; moderate, n=1; severe, n=0) than in the heparin group (normal, n=9; mild, n=6; moderate, n=5; severe, n=0) (P=0.019, Mann-Whitney U test). Hemorrhagic complications were 10% (n=2) in the thrombolysis group (subdural hematoma, retroperitoneal hemorrhage) and none in the heparin group (P=0.49). Three of the heparin group patients developed complications of the underlying disease (status epilepticus, hydrocephalus, refractory papilledema). No deaths occurred. Length of hospital stay was similar between the groups (P=0.79). Conclusions Local thrombolysis with urokinase is fairly well tolerated and may be more effective than systemic heparin anticoagulation alone in treating SSST. A randomized, prospective study comparing these 2 treatments for SSST is warranted

Shifting the paradigm - Applying universal standards of care to Ebola virus disease

As the Democratic Republic of Congo’s (DRC’s) 10th outbreak of Ebola virus disease (EVD) rages in this resource-limited, wartorn region, advances in the delivery of supportive care and the introduction of investigational therapies provide a glimmer of hope amid the mounting infections. In the absence of effective therapies or vaccines, EVD outbreak response has centered around the most basic of public health principles — identification and isolation of patients with suspected and confirmed EVD and tracking of all the contacts of the confirmed patients, who are then rapidly isolated if they show signs of disease. This strategy of “identify, isolate, and track” allows public health responders to curtail and eventually eliminate virus transmission in the community and has been the foundation of EVD outbreakcontrol efforts since the disease was first described in 1976

Bilateral papillitis and unilateral focal chorioretinitis as the presenting features of syphilis

BACKGROUND: Syphilis is a multisystem bacterial infection caused by Treponema pallidum. The incidence of infection in the United States has risen by more than 75% since the year 2000, when it was at a low of 2.1 per 100,000 people. Ocular involvement may occur in any stage of infection and may present in a variety of ways, with posterior uveitis being the most common manifestation. We report a case of ocular syphilis infection with an unusual presentation of bilateral non-granulomatous panuveitis with papillitis and unilateral focal chorioretinitis. FINDINGS: This is a retrospective case report with literature review. A 39-year-old Caucasian female presented with a 2-week history of bilateral ocular flashes and left eye pain. Dilated fundus examination revealed mild optic disc edema in both eyes, the right eye more than the left. In the left eye, there was an area of retinal elevation and whitening involving the peripheral retina. Fluorescein angiography, B-scan ultrasonography, and ocular coherence tomography were performed, and laboratory tests were ordered based on the clinical presentation. After rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) were positive, syphilitic uveitis was confirmed, and the patient was admitted for a 14-day course of high-dose intravenous penicillin G. CONCLUSIONS: The first signs and symptoms of syphilis may be ocular, which can lead to a diagnostic challenge. A high index of suspicion is the key for early diagnosis of ocular syphilis. Prompt treatment with intravenous penicillin G is highly effective in resolving the infection

Emergency out-of-home placements in Norway: Parents' experiences

The number of emergency placements of children has increased rapidly in Norway over the recent years. Nevertheless, there is little knowledge about how parents experience the processes involved in emergency placements. We conducted 64 survey interviews with parents who have experienced this kind of placement of their children. One third of the participants' children had received interventions prior to the emergency placement. Another third were known by Child Welfare Services (CWS) through reports of concern, which were dismissed without interventions and, in some cases, without investigation. The final third had no prehistory from CWS ahead of the emergency placement. A large proportion of the participants emphasized that they had experienced problems for a long time and had earlier requests for help unmet. Another large group of parents notified CWS themselves, and some of them wanted their child emergency placed. On the basis of parents' experiences, we suggest different implications for practice: (a) CWS should be more thorough in their investigation and assessment of the families, both when it comes to reports of concern and evaluation of initiated interventions. (b) Planned placement should be promoted to a greater degree, wherever possible. (c) A greater emphasis on follow-up of parents after emergency placements is needed

Norwegian child welfare workers' perceptions of emergency placements

Emergency placements in child welfare services have increased during the last 10 years in Norway. At the time of placement, some of these children have been in the child welfare system for several years. Based on qualitative interviews, our study explores Norwegian child welfare workers' perceptions of long‐term cases resulting in emergency placements. The participants reported that they felt they had intervened too late, as it took them too long to understand the severity of the situation. This occurred mainly due to three factors: (a) The work had mainly been based on the parents' premises; (b) having too much distance to the child, as they talked too little with the child, too late in the process; (c) an experience of lacking methodological skills needed and sufficient opportunities to conduct proper observations and assessments; (d) supportive measures were tried for too long, and these measures were not properly evaluated. Giving other professionals' assessments considerable weight in the decision‐making process, and the use of legal language rather than independent, professional assessments, can be seen as another way of distancing themselves from both the family and the decisions being made

Child and family support policies across Europe: National reports from 27 countries

Il volume ricostruisce e analizza le politiche di supporto alla famiglia e alla genitorialità in 27 Paesi europe

The prevalence of primary headache disorders in Saudi Arabia: a cross-sectional population-based study

Background The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include most of Eastern Mediterranean Region (EMR). Following a nationwide population-based study in Pakistan, we present here a similar study from Kingdom of Saudi Arabia (KSA). Both were conducted as projects within the Global Campaign against Headache The two purposes of this study were to inform national health policy and contribute to global knowledge of headache disorders. Methods We surveyed Arabic-speaking adults aged 18–65 years in all 13 regions of KSA. While previous Global Campaign studies have engaged participants by calling at randomly selected households, the culture of KSA made this unacceptable. Participants were, instead, contacted by cell-phone (since cell-phone coverage exceeded 100% in KSA), using random-digit dialling. Trained interviewers used a culturally adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, with diagnostic enquiry based on ICHD-II. We estimated 1-year prevalences of the headache disorders of public-health importance (migraine, tension-type headache [TTH] and probable medication-overuse headache [pMOH]) and examined their associations with demographic variables. Results A total of 2316 participants (mean age of 32.2 ± 10.7 years; 62.3% male; 37.7% female) were included (participation proportion 86.5%). Gender and age distributions imperfectly matched those of the national population, requiring adjustments for these to prevalence estimates. Observed 1-year prevalence of all headache was 77.2%, reducing to 65.8% when adjusted. For headache types, adjusted 1-year prevalences were migraine 25.0%, TTH 34.1%, pMOH 2.0% and other headache on ≥15 days/month 2.3%. Adjusted 1-day prevalence of any headache was 11.5%. Migraine and pMOH were associated with female gender (ORs: 1.7 and 4.7; p  45 years (OR: 0.4; p = 0.0143) while pMOH was most prevalent in those aged 46–55 years (OR: 2.7; p = 0.0415). TTH reportedly became more common with increasing level of education. Conclusion Prevalences of migraine and TTH in KSA are considerably higher than global averages (which may be underestimated), and not very different from those in Pakistan. There is more pMOH in KSA than in Pakistan, reflecting, probably, its higher-income status and greater urbanisation (facilitating access to medication)

Assessing appeals against emergency placements in Norway: A balancing act

This article explores what the County Social Welfare Boards (CSWBs) emphasize in their decisions on appeals against emergency placements due to concerns of violence. A qualitative document analysis of 23 appeal cases focused on how the CSWBs assess the cause and context of the violence, parents’ potential for change, and how children’s statements were weighted in decisions. The results show a zero-tolerance attitude toward violence. Exceptions are found in cases where parents have an immigrant background, and where parents are described as resourceful. The child’s subjective experience and emotions related to the violence are given due weight in assessments