Vessel diameter is objectively measured by a lead ruler positioned in the fluoroscopic field and software calibration during angioplasty. We conducted a prospective study to evaluate the accuracy of lead ruler determination of vessel diameter. Chronic hemodialysis patients undergoing an angioplasty procedure were included in this study (n = 37). Vessel diameter was determined by calibrating the fluoroscopy machine to a ruler with lead markers placed in the fluoroscopic field. The same calibration was used to measure the fully effaced angioplasty balloon in its intravascular location. We compared the measured balloon diameter with the actual (manufacturer's) diameter. The approximate depth of the ruler from the measured vessel was also determined. Angioplasty balloons appeared 13.75-40.83% (mean 25.8% ± 7.015) smaller than the actual size of the balloon (p < 0.0001) when measured using a calibrated fluoroscopic machine. There was a tendency toward the fact that the bigger the distance between the ruler and the vessel (that contained the angioplasty balloon), the more likely the technique underestimated the size of the angioplasty balloon. Lead ruler method underestimates the diameter of the vessel. Recognizing such a discrepancy is important when determining the size of an angioplasty balloon or endovascular stent.
Introduction: Staphylococcus aureus is considered one of the most important human pathogens, and its levels of resistance to methicillin have increased even in strains isolated from people without nosocomial risk factors. Molecular analysis is essential for understanding the patterns of dissemination. The objective of this study was to identify community-acquired methicillin-resistant S. aureus (CA-MRSA) clones that infected Paraguayan children patients in two periods of time.
Methodology: An observational, descriptive study was designed to determine the genetic variability of 115 isolates of CA-MRSA recovered from children who attended four reference centers in Paraguay between 2009-2010 and 2012-2013.
Results: The combined use of Pulsed Field Gel Electrophoresis (PFGE), Multi-Locus Sequencing Typing, Multi-Locus Variable Analysis (MLVA) and Spa typing techniques allowed the identification of two dominant clones: ST30-IV-t019 (77%) and ST5-IV-t311 (10%), and the establishment of the former as the leading cause of CA-MRSA infections in children during the study period.
Conclusions: This is the first study that provides epidemiological information as well as microbiological and molecular characteristics of CA-MRSA isolates recovered from children from Asunción and the Central Department of Paraguay.
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