The role of multimodality imaging in calcified valves with infective endocarditis

A 68-years old woman presented with ahistory of recurrent fever of 38-39°ac-companied by chills and weakness over the past month.Her physical examination was unremarkable except for an audible 3/6 ejection murmur at the 2nd right intercostal space.Her vital signs were normal with no fever at presentation.Laboratory tests showed elevated white blood count of 11,800cells/mm3 with a remarkable neutrophilia and elevated C-reactive protein of 14 mg/dL.Blood glucose,renal and liver function tests were all normal.

Clinical presentation predicts the outcome of patients with colon cancer

AIM: To elucidate the relationship between clinical presentation and outcome. METHODS: A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality. An odds ratio based clinical score was created to evaluate the contribution of the quality of symptoms to outcome. Primary measure of outcome was survival. RESULTS: During the study period, 236 patients met the inclusion criteria. Overall survival was 60.6%, mean follow-up 3.0 years. A bivariate analysis showed that increasing number of symptoms is not associated with mortality. However, a symptom-specific analysis performed using a logistic regression model controlling for age, stage and the duration of complaints revealed that the presence of melena was independently associated with mortality [P = 0.04, odds ratio (OR) 7.4],while rectal bleeding was associated with survival (P = 0.004, OR 3.9). Applying the proposed clinical score to an receiver operating characteristic curve showed that score > 1 had a strong association with mortality. The same logistic regression model was applied. The results showed that a score > 1 was an independent predictor of mortality (P < 0.001) and associated with node-positive disease (P = 0.008). CONCLUSION: The quality of symptoms rather than quantity is correlated with outcome among patients with colon cancer. The proposed clinical scoring system may correctly predict the patient's outcome.

Importance of 3-D image reconstruction of spectraldomain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema

AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.

Pancreatic cyst dilemma: Between physical and biochemical markers

Physical analysis of the pancreatic cystic lesions(PCLs)fluid as expressed by the rheological behavior(“string sign”)can improve the diagnostic yield and should be integrated in every multimodal PCLs workup.

Impact of rotavirus vaccine implementation on Israeli children:a comparison between pre-and post-vaccination era

Background Worldwide rotavirus vaccination has resulted in a substantial decrease in rotavirus-induced severe gastroenteritis and related hospitalizations among children.Still,the characterization of patients warranting hospitalization needs to be further elucidated.The purpose of the study is to compare the clinical and laboratory features of children hospitalized with acute rotavirus infection before and after the introduction of routine vaccination.Methods This is a retrospective observational study.Participants were pediatric patients who presented to the Bnai Zion Medical Center pediatric emergency department and were diagnosed with rotavirus acute gastroenteritis between 2017 and 2019.Results During the pre-vaccination period(2007–2009),114 infants and young children(median age:14 months,range:1–72 months;59 male,55 female)were hospitalized for rotavirus-induced acute gastroenteritis with a rate of 11.71 positive rotavirus tests per 1000 emergency room visits.In the post-vaccination period(2012–2019),168 infants and young children(median age:17 months,range:0–84 months;90 male,78 female)were hospitalized with a rate of 4.18 positive rotavirus tests per 1000 emergency room visits.There were no statistical differences between the two groups in gender,breast-feeding rates and sibling(s).The proportion of cases with moderate-to-severe dehydration was higher in the post-vaccination children than in the pre-vaccination children.Conclusions Rates of rotavirus-attributed acute gastroenteritis hospitalizations declined from the pre-to the post-vaccination period.Higher rates of dehydration were found in the post-vaccination children.Ongoing surveillance is warranted to better understand the implications of the vaccine.

Low Friction Traction for Cervical Spine Dislocation

In order to reduce the magnitude of the force applied to skull for treatment of acute cervical spine dislocation, we developed a method of skeletal traction based on reduction of friction forces under the patient’s head. Traction force was applied to sculls of five patients with cervical fracture-dislocations. A difference in friction interface between the patient’s head and shoulder girdle was created. The traction weight required for the reduction of the vertebral dislocation was significantly lower than an expected minimal traction weight in the commonly used techniques (p = 0.013). The presented method permits an effective and safe reduction of dislocated cervical vertebra by a relatively low traction force.