Cervical Intramedullary Epidermoid Cyst with Liquid Contents

Intramedullary spinal epidermoid cysts are benign ectopic embryological growths with reported incidence of less than 1% of intramedullary tumors. In this case we report an unusual cervical intramedullary epidermid with liquid contents. A 40-year-old patient presented with progressive weakness of all four limbs of four months duration, bowel and bladder disturbances of two days duration, pain and paresthesias in all four limbs. Magnetic resonance imaging (MRI) revealed a well defined intramedullary lesion extending from C2-C3 level with widening of the cord. The lesion was hypointense on T1W images, hyperintense on T2W and fluid attenuation and inversion recovery images with thin rim of enhancement after contrast administration. Histopathological examination of the excised specimen revealed epidermal lining and keratinous material features of an epidermoid cyst. As in present case, rarely epidermoid cyst can have clear contents, and an MRI finding can closely mimic the features of arachnoid cyst, findings not classical and is different than described in literature

Assessment of children presenting with rheumatic complaints to a tertiary center in Turkey: differences in an Eastern Mediterranean population

PubMe

Does the Use of Multiplex PCR Contribute to the Management of Paediatric Emergency Physicians in <2-Year-old Children with Acute Respiratory Infections?

Multiplex polymerase chain reaction (PCR) is used to detect respiratory viruses in pediatric emergency departments, but its indications and interpretation of results must still be clear. In the present study, we examined the effect of detecting a viral agent with multiplex PCR on patient management. Infants and toddlers, aged between 1-24 months, who presented to the pediatric emergency department with respiratory tract infection complaints and underwent multiplex-PCR between 1 January 2014 and 28 February 2020 were included in the study. Patients with at least one agent detected were considered as the study group, and patients without detection were considered as the control group. The same design was implemented only for patients with chronic diseases. A total of 1106 patients were recruited [median age: 6.7 months (range: 2.9-13.0 months)]. Seven hundred and eighty-nine in the study group and 317 in the control group. There were no significant differences between the groups in hospital admissions (study group: 271 admissions; control group: 89 admissions; p=0.055), length of hospital stay duration [mean ± standard deviation: 3.09±7.87 days (study group) and 2.6±7.79 days (control group); p=0.045], or antibiotic use [234 patients (study group) and 77 patients (control group); p=0.078]. When these variables were examined only for those with chronic diseases, there was no difference again. Although multiplex PCR is an ideal method with high sensitivity, specificity, and cost-effectiveness, the limits of its clinical application need to be clarified. We did not observe significant differences in the treatment of patients with detected viral agents

Factors influencing citrus fruit scarring caused by Pezothrips kellyanus

[EN] Kelly s citrus thrips (KCT) Pezothrips kellyanus (Bagnall) (Thysanoptera: Thripidae) is a recently recorded cosmopolitan citrus pest, causing fruit scarring that results in downgrading of fruit. Due to the detrimental effects caused on fruits by KCT, we wanted to study some of the factors influencing fruit scarring. Specifically, the objectives were: (1) to determine the fruit development stage when citrus fruits are damaged by KCT and the population structure of KCT during this period, (2) to study the influence of temperature on intensity of damage, and finally, (3) to identify alternative host plants. KCT populations on flowers and fruitlets and alternate plant hosts were sampled in four citrus orchards from 2008 to 2010. The percentage of damaged fruits was also recorded. The exotic vine Araujia sericifera (Apocynaceae) was recorded as a new host for KCT. Thrips scarring started to increase at 350 650 degree-days (DD) above 10.2 C, coinciding with a peak abundance of the second instar larval stages over all 3 years of the study. The maximum percentage of larval stages of KCT was observed in the 3 years at about 500 DD, a period which corresponds to the end of May or early June. Variation in the severity of fruit scarring appeared to be related to air temperature. Temperature likely affects the synchronisation between the peak in abundance of KCT larvae, and the period when fruitlets are susceptible to thrips damage. Temperature can also influence the survival and development of KCT populations in citrus and other host plants in the citrus agro-ecosystem.The authors thank Alejandro Tena for his valuable suggestions and two anonymous referees for their careful review and helpful comments. We also extend our thanks to the owners of the commercial orchards for giving us permission to use their citrus orchards. The first author was awarded an FPI fellowship from the Polytechnic University of Valencia to obtain her PhD degree.Navarro Campos, C.; Pekas, A.; Aguilar Martí, MA.; Garcia Marí, F. (2013). Factors influencing citrus fruit scarring caused by Pezothrips kellyanus. Journal of Pest Science. (86):459-467. doi:10.1007/s10340-013-0489-7S45946786Baker GJ (2006) Kelly citrus thrips management. Fact sheet. Government of South Australia, primary industries and resources SA. http://www.sardi.sa.gov.au/__data/assets/pdf_file/0010/44875/kctfact_sheet.pdf . Accessed 16 July 2012Baker GJ, Jackman DJ, Keller M, MacGregor A, Purvis S (2002) Development of an integrated pest management system for thrips in Citrus. HAL Final Report CT97007. http://www.sardi.sa.gov.au/pestsdiseases/horticulture/horticultural_pests/kelly_citrus_thrips/research_report_1997-2000 . Accessed 16 July 2012Bedford ECG (1998) Thrips, wind and other blemishes. Citrus pests in the Republic of South Africa. In: Bedford ECG, van den Berg MA, de Villiers EA (eds) ARC-Institute for tropical and subtropical crops, Nelspruit, South Africa, pp 170–183Blank RH, Gill GSC (1997) Thrips (Thysanoptera: Terebrantia) on flowers and fruit of citrus in New Zealand. N Z J Crop Hortic Sci 25:319–332Chellemi D, Funderburk F, Hall D (1994) Seasonal abundance of flower-inhabiting Frankliniella species (Thysanoptera: Thripidae) on wild plant species. Environ Entomol 23:337–342Conti F, Tuminelli R, Amico C, Fisicaro R, Frittitta C, Perrotta G, Marullo R (2001) Monitoring Pezothrips kellyanus on citrus in eastern Sicily, Thrips and tospoviruses. In: Proceedings of the 7th international symposium on Thysanoptera, Reggio Calabria, 1–8 July 2001, Italy, pp 207–210Costa L, Mateus C, zurStrassen R, Franco JC (2006) Thrips (Thysanoptera) associated to lemon orchards in the Oeste region of Portugal. IOBC/WPRS Bull 29:285–291European Plant Protection Organisation Reporting Service [EPPO] (2006) Pezothrips kellyanus. http://www.eppo.org/QUARANTINE/Pest_Risk_Analysis/PRAdocs_insects/06-12760%20DS%20PEZTKE.doc. Accessed 18 June 2012European Plant ProtectionOrganisation Reporting Service [EPPO] (2005) Scirtothrips aurantii, Scirtothrips citri, Scirtothrips dorsalis. EPPO Bull 35:353–356Franco JC, Garcia-Marí F, Ramos AP, Besri M (2006) Survey on the situation of citrus pest management in Mediterranean countries. IOBC/WPRS Bull 29:335–346Froud KJ, Stevens PS, Steven D (2001) Survey of alternative host plants for Kelly’s citrus thrips (Pezothrips kellyanus) in citrus growing regions. N Z Plant Prot 54:15–20Gomez-Clemente F (1952) Un tisanóptero causante de daños en las naranjas de algunas zonas de Levante. Boletín de Patología Vegetal y Entomología Agrícola 19:135–146Grout TG, Morse JG, O’Connell NV, Flaherty DL, Goodell PB, Freeman MW, Coviello RL (1986) Citrus thrips (Thysanoptera: Thripidae) phenology and sampling in the San Joaquin Valley. J Econ Entomol 79:1516–1523Horton J (1918) The citrus thrips. US Dep Agric Bull 616:1–42Kirk WDJ (1987) A key to the larvae of some common Australian flower thrips (Insecta: Thysanoptera), with a host-plant survey. Aust J Zool 35:173–185Lacasa A, Llorens JM, Sánchez JA (1996) Un Scirtothrips (Thysanoptera: Thripidae) causa daños en los cítricos en España. Bol San Veg Plagas 22:79–95Lewis HC (1935) Factors influencing citrus thrips damage. J Econ Entomol 28:1011–1015Lewis T (1997) Distribution, abundance and population dynamics. In: Lewis T (ed) Thrips as crop pests. CAB International, Wallingford, pp 217–258Lovatt C, Streeter S, Minter T, O’connell N, Flaherty D, Freeman M, Goodell P (1984) Phenology of flowering in Citrus sinensis (L.) Osbeck, cv. Washington navel orange. Proc Int Soc Citric 1:186–190Marullo R (1998) Pezothrips kellyanus, un nuovo tripide parassita delle colture meridionali. Informatore Fitopatologico 48:72–75Milne JR, Milne M, Walter GH (1997) A key to larval thrips (Thysanoptera) from Granite Belt stonefruit trees and a first description of Pseudanaphothrips achaetus (Bagnall) larvae. Aust J Entomol 36:319–326Mound LA, Jackman DJ (1998) Thrips in the economy and ecology of Australia, In: Zalucki MP, RAI Drew RAI, White GG (eds) Pest Management: future challenges, Proceedings of the sixth Australian applied entomological research conference, University of Queensland, St. Lucia, pp 472–478Mound LA, Marullo R (1996) The thrips of Central and South America (Insecta: Thysanoptera): an introduction. Mem Entomol Int 6:1–487Mound LA, Walker AK (1982) Terebrantia (Insecta: Thysanoptera). Fauna N Z 1:1–113Navarro-Campos C, Marzal C, Aguilar A, GarciaMarí F (2010) Presencia del microlepidóptero Anatrachyntisbadia en cítricos: descripción, comportamiento y daños al fruto. Levante Agrícola 402:270–276Navarro-Campos C, Aguilar A, Garcia-Marí F (2011) Population trend and fruit damage of Pezothrips kellyanus in citrus orchards in Valencia (Spain). IOBC/WPRS Bull 62: 285–292Navarro-Campos C, Aguilar A, Garcia-Marí F (2012) Aggregation pattern, sampling plan and intervention threshold for Pezothrips kellyanus in citrus groves. Entomol Exp Appl 142:130–139Northfield TD, Paini DR, Funderburk JE, Reitz SR (2008) Annual cycles of Frankliniella spp. (Thysanoptera: Thripidae) thrips abundance on North Florida uncultivated reproductive hosts: predicting possible sources of pest outbreaks. Ann Entomol Soc Am 101:769–778Orphanides G (1997) Thrips on citrus. Annual Review for 1997. Agricultural Research Institute, Nicosia, CyprusPerrotta G, Conti F (2008) A threshold hypothesis for an integrated control of thrips infestation on citrus in South-Eastern Sicily. IOBC/WPRS Bull 38:204–209Reitz S, Yu-lin G, Zhong-ren L (2011) Thrips: pests of concern to China and the United States. Agric Sci China 10:867–892Rhodes AA, Morse JG (1989) Scirtothrips citri sampling and damage prediction on California navel oranges. Agric Ecosyst Environ 26:117–129Schellhorn NA, Glatz RV, Wood GM (2010) The risk of exotic and native plants as hosts for four pest thrips (Thysanoptera: Thripinae). Bull Entomol Res 100:501–510Schweizer H, Morse JG (1997) Estimating the level of fruit scarring by citrus thrips from temperature conditions prior to the end of bloom. Crop Prot 16:743–752Smith D, Beattie GAC, Broadley R (eds) (1997) Citrus pests and their natural enemies: integrated pest management in Australia. Information series Q197030. 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Ann Entomol Soc Am 102:835–841Varikou K, Birouraki A, Tsitsipis I, Sergentani CHR (2012) Effect of temperature on the fecundity of Pezothrips kellyanus (Thysanoptera: Thripidae). Ann Entomol Soc Am 105:60–65Vassiliou VA (2007) Chemical control of Pezothrips kellyanus (Thysanoptera: Thripidae) in citrus plantations in Cyprus. Crop Prot 26:1579–1584Vassiliou VA (2010) Ecology and behavior of Pezothrips kellyanus (Thysanoptera: Thripidae) on Citrus. J Econ Entomol 103:47–53Vierbergen G, Kucharczyk H, Kirk WDJ (2010) A key to the second instar larvae of the Thripidae of the Western Palearctic region. Tijdschr Entomol 153:99–160Webster KW, Cooper P, Mound LA (2006) Studies on Kelly’s citrus thrips, Pezothrips kellyanus (Bagnall) (Thysanoptera: Thripidae): sex attractants, host associations and country of origin. Aust J Entomol 45:67–74Wiesenborn W, Morse JG (1986) Feeding rate of Scirtothripscitri (Moulton) (Thysanoptera: Thripidae) as influenced by life stage and temperature. Environ Entomol 15:763–76

Research priorities for European paediatric emergency medicine

Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects. Design and Setting We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic. Results Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions 'fever', 'sepsis' and 'respiratory infections', and the processes/interventions 'biomarkers', 'risk stratification' and 'practice variation' as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research. Conclusions While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.publishersversionPeer reviewe

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

BACKGROUND: During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS: Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS: Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION: ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2·26, 95% CI 1·90 to 2·70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0·86, 95% CI 0·84 to 0·89; 2 to <5 years IRR 0·80, 95% CI 0·78 to 0·82; 5 to <12 years IRR 0·68, 95% CI 0·67 to 0·70; 12 to 18 years IRR 0·72, 95% CI 0·70 to 0·74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1·30, 95% CI 1·16 to 1·45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1·10, 95% CI 1·08 to 1·12; emergent and very urgent triage IRR 1·53, 95% CI 1·49 to 1·57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258

Cerebral malaria in children: using the retina to study the brain

Cerebral malaria is a dangerous complication of Plasmodium falciparum infection, which takes a devastating toll on children in sub-Saharan Africa. Although autopsy studies have improved understanding of cerebral malaria pathology in fatal cases, information about in vivo neurovascular pathogenesis is scarce because brain tissue is inaccessible in life. Surrogate markers may provide insight into pathogenesis and thereby facilitate clinical studies with the ultimate aim of improving the treatment and prognosis of cerebral malaria. The retina is an attractive source of potential surrogate markers for paediatric cerebral malaria because, in this condition, the retina seems to sustain microvascular damage similar to that of the brain. In paediatric cerebral malaria a combination of retinal signs correlates, in fatal cases, with the severity of brain pathology, and has diagnostic and prognostic significance. Unlike the brain, the retina is accessible to high-resolution, non-invasive imaging. We aimed to determine the extent to which paediatric malarial retinopathy reflects cerebrovascular damage by reviewing the literature to compare retinal and cerebral manifestations of retinopathy-positive paediatric cerebral malaria. We then compared retina and brain in terms of anatomical and physiological features that could help to account for similarities and differences in vascular pathology. These comparisons address the question of whether it is biologically plausible to draw conclusions about unseen cerebral vascular pathogenesis from the visible retinal vasculature in retinopathy-positive paediatric cerebral malaria. Our work addresses an important cause of death and neurodisability in sub-Saharan Africa. We critically appraise evidence for associations between retina and brain neurovasculature in health and disease, and in the process we develop new hypotheses about why these vascular beds are susceptible to sequestration of parasitized erythrocytes