bluuebunny/crossref_metadata_2025 huggingface dataset:
Routine Laser-assisted Indocyanine Green Angiography in Immediate Breast Reconstruction: Is It Worth the Cost?
Authors: Mirhaidari Shayda , Azouz Vitali , Wagner Douglas S.
Published: April 2019

Background:

Laser-assisted indocyanine green angiography (LAIGA) has been proven to accurately detect mastectomy skin flap necrosis (MSFN) intraoperatively and prevent postoperative complications in breast reconstruction. The purpose of this study was to examine the cost-effectiveness of the routine use of LAIGA in immediate breast reconstruction and to perform a break-even point analysis.

Methods:

This is a retrospective review of prospectively gathered data from all patients who underwent immediate breast reconstruction from January 2014 to January 2015. LAIGA was routinely used in all cases. Patients were followed for at least 90 days to capture postoperative complications. Costs were calculated by reviewing itemized bills and Medicare Reimbursement Current Procedural Terminology codes to assess surgeon fees. Outcomes and costs were compared with a historical cohort of patients who underwent breast reconstruction before the implementation of LAIGA.

Results:

Two-hundred-and-six immediate breast reconstructions (126 patients) were performed using LAIGA for a total cost of $210,700. The average cost of MSFN in our LAIGA cohort was $30,496. The routine use of LAIGA decreased the MSFN rate from 12.4% to 6.3% and prevented MSFN on 13 breasts resulting in a gross cost savings of $396,453, and net savings of $185,753. Break-even point analysis demonstrated that number of cases needed to break even decreases as the average MSFN cost and MSFN reduction rate increase.

Conclusion:

The routine use of LAIGA in immediate breast reconstruction is cost-effective in reducing the incidence of MSFN, implant loss, and overall unexpected reoperation rate.
Outcomes of a Modified Trabeculectomy Closure Technique
Authors: Lee Moon Jeong , Bajaj Rohan P. , Mihailovic Aleksandra , Iyer Jayant V. , Jampel Henry D. , Friedman David S.
Published: April 2019

Precis:

A modified closure for trabeculectomy in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 nylon sutures, provided similar surgical outcomes to the standard trabeculectomy closure technique.

Purpose:

To examine the surgical outcomes of a modified trabeculectomy closure technique in which the conjunctiva is incised posterior to the limbus and reapproximated using 2 sutures, burying the posterior conjunctiva under an anterior lip of conjunctiva.

Materials and Methods:

This retrospective review included 73 eyes that underwent trabeculectomies between 2015 and 2017 at Johns Hopkins Hospital by a single surgeon. We analyzed traditional closures used from January 2015 to May 2016, and modified closures used from July 2016 to March 2017. The main outcome measures were a reduction in intraocular pressure at 3, 6, and 12 months, reduction in the number of medications at 12 months, and total number of postoperative complications.

Results:

There was no difference in reduction of intraocular pressure at 3 months (9.9±8.2 vs. 10.5±8.7 mm Hg), 6 months (10.8±9.6 vs. 10.6±8.3 mm Hg), or 12 months (12.2±8.9 vs. 10.0±9.3 mm Hg) in the standard (n=44) and modified groups (n=29), respectively. There was a similar reduction in the use of glaucoma medications in the standard group (1.2±1.5 vs. 1.0±1.1) compared with the modified group and no difference in the number of postoperative complications (25.0% vs. 17.2%, respectively) (P>0.05 for all).

Conclusions:

The modified closure provided similar results to the standard closure for trabeculectomy. Further studies are needed to determine whether the 2 techniques differ in surgical outcomes over a longer follow-up or other surgical parameters (eg, ease, surgical time, learning curve).
Glaucoma in Phacomatosis Pigmentovascularis in a Young African Adolescent Boy: A Case Report
Authors: van der Merwe Ernst B. , Bhika Raquel E. , Meyer David
Published: April 2019

Background:

Phacomatosis pigmentovascularis (PPV) has previously almost exclusively been reported in Asians and in dermatological journals. In this report, we present a case of a young black South African adolescent boy referred to our eye clinic.

Case Report:

A 15-year-old male patient presented with gradual, painless loss of vision in his right eye. Clinical examination revealed a port-wine stain with ocular involvement on the right as well as a nevus of Ota. Fundoscopy on the right revealed an advanced glaucomatous optic disc and raised intraocular pressure. A diagnosis of glaucoma associated with PPV was made.

Conclusion:

We present the first case of PPV in an African male individual with associated glaucoma seen at our tertiary hospital.
The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients
Authors: Raman Pushpa , Khy Ching Yeap , Sivagurunathan Premala D. , Ramli Norlina , Mohd. Khalid Khairul H.
Published: April 2019

Precis:

This prospective cross-sectional study found that patients with cognitive impairment (CI) are more likely to produce unreliable visual field (VF) tests, especially with higher false-negative (FN) responses and consequent overestimation of mean deviation (MD).

Aim:

Aging-associated CI can impair the ability of individuals to perform a VF test and compromise the reliability of the results. We evaluated the association between neurocognitive impairment and VF reliability indices in glaucoma patients.

Methods:

This prospective, cross-sectional study was conducted in the Ophthalmology Department, Hospital Kuala Pilah, Malaysia, and included 113 eyes of 60 glaucoma patients with no prior diagnosis of dementia. Patients were monitored with the Humphrey Visual Field Analyzer using a 30-2 SITA, standard protocol, and CI was assessed using the clock drawing test (CDT). The relationships between the CDT score, MD, pattern standard deviation, Visual Field Index (VFI), fixation loss (FL), false-positive values, and FN values were analyzed using the ordinal regression model.

Results:

Glaucoma patients older than 65 years had a higher prevalence of CI. There was a statistically significant correlation between CDT scores and glaucoma severity, FL, FN, and VFI values (rs=−0.20,P=0.03;rs=−0.20,P=0.04;rs=−0.28,P=0.003;rs=0.21,P=0.03, respectively). In a multivariate model adjusted for age and glaucoma severity, patients with lower FN were significantly less likely to have CI (odds ratio, 0.91; 95% confidence interval, 0.89-0.93) and patients with higher MD were more likely to have CI (odds ratio, 1.10; 95% confidence interval, 1.05-1.16); false positive, FL, pattern standard deviation, and VFI showed no significant correlation.

Conclusion:

Cognitive decline is associated with reduced VF reliability, especially with higher FN rate and overestimated MD. Screening and monitoring of CI may be important in the assessment of VF progression in glaucoma patients.
Photodistributed Rash on the Upper Extremities and Chest
Authors: Tao Joy , Lake Eden Pappo
Published: April 2019

This is a case of a pruritic, photodistributed rash on the arms and chest of an adult patient who recently started a new medication. A multiple-choice question is presented, and readers will be challenged to identify the correct drug that triggered this rash based on case presentation and patient history. An answer is given followed by a discussion of causes, clinical features, and appropriate management of the rash.
A Case of Folliculitis Decalvans With Concomitant Acne Keloidalis Nuchae, Androgenic Alopecia, and Profound Postinflammatory Hyperpigmentation
Authors: Gleed Mitchell , Carlson Kim
Published: April 2019

Folliculitis decalvans is a cicatricial alopecia of the parietal scalp and vertex characterized by erythematous, scarred, confluent patches of alopecia with scattered peripheral pustules and scale. It is most common among middle-aged men and is frequently associated with acne keloidalis nuchae. The pathogenesis of folliculitis decalvans is not completely understood, but it likely involves an inappropriate inflammatory response to components of Staphylococcus aureus. Folliculitis decalvans is a chronic disease characterized by periods of remission and exacerbation. Patients with long-standing, undertreated disease can experience severe hair loss and postinflammatory hyperpigmentation. Treatment is focused on reducing inflammation and bacterial load using oral antibiotic therapy. Early recognition and treatment is paramount to alleviate symptoms and limit irreversible hair loss.
Canadian Centre for Mental Health and Sport (CCMHS) Position Statement: Principles of Mental Health in Competitive and High-Performance Sport
Authors: Van Slingerland Krista J. , Durand-Bush Natalie , Bradley Lindsay , Goldfield Gary , Archambault Roger , Smith Danika , Edwards Carla , Delenardo Samantha , Taylor Shaunna , Werthner Penny , Kenttä Göran
Published: April 2019

The brave decision made by many Canadian athletes to share their experience with mental illness has fed a growing dialogue surrounding mental health in competitive and high-performance sport. To affect real change for individuals, sport culture must change to meet demands for psychologically safe, supportive, and accepting sport environments. This position statement addresses mental health in competitive and high-performance sport in Canada, presenting solutions to current challenges and laying a foundation for a unified address of mental health by the Canadian sport community. The paper emerged from the first phase of a multidisciplinary Participatory Action Research (PAR) project, in which a sport-focused mental health care model housed within the Canadian Centre for Mental Health and Sport (CCMHS) is currently being designed, implemented, and evaluated by a team of 20 stakeholders, in collaboration with several community partners and advisors.
Optimal Retention Force of Audio Processor Magnets
Authors: Wagner Luise , Hönig Elisabeth , Fröhlich Laura , Plontke Stefan , Rahne Torsten
Published: April 2019

Hypothesis:

Audio processor magnets used in transcutaneous active hearing implants vary in retention force. We hypothesized that a range of optimal magnetic retention forces could be derived, based on objective in-situ measurements of individual retention forces.

Background:

The magnetic force required to retain the proper placement of transcutaneous active hearing implants varies among patients. Currently, audiologists rely on personal experience in deciding which magnet to use. Insufficient force causes frequent loss of the single-unit processors or external coils of behind-the-ear devices, and excessive force causes pain and skin irritations.

Methods:

We experimentally determined magnetic retention force as a function of the distance between two magnets for different processor-implant magnet combinations. In addition, we studied individual in situ retention forces in 100 patients with hearing devices. Skin status was evaluated by a physician and assessed by patient self-reporting and a questionnaire.

Results:

Force–distance functions showed that different magnet strengths had differential effects only at distances less than 6 mm. Examiner and patient skin status assessments and comfort scores showed that optimal retention force range was 0.23 to 0.4 N.

Conclusion:

We found that the currently available magnet types restrict the range of feasible skin flap thicknesses to a maximum of 6 mm. Further we conclude that retention forces between 0.23 and 0.4 N could provide the appropriate trade-off between the risk of losing device fixation and of causing skin irritations. We recommend measuring the retention force in all patients.
Intracochlear Electrocochleography: Influence of Scalar Position of the Cochlear Implant Electrode on Postinsertion Results
Authors: Riggs William J. , Dwyer Robert T. , Holder Jourdan T. , Mattingly Jameson K. , Ortmann Amanda , Noble Jack H. , Dawant Benoit M. , Valenzuela Carla V. , O’Connell Brendan P. , Harris Michael S. , Litvak Leonid M. , Koka Kanthaiah , Buchman Craig A. , Labadie Robert F. , Adunka Oliver F.
Published: April 2019

Hypothesis:

Electrocochleography (ECochG) recorded during cochlear implant (CI) insertion from the apical electrode in conjunction with postinsertion ECochG can identify electrophysiologic differences that exist between groups with and without a translocation of the array from the scala tympani (ST) into the scala vestibuli (SV).

Background:

Translocation of the CI electrode from ST into SV can limit performance postoperatively. ECochG markers of trauma may be able to aid in the ability to detect electrode array-induced trauma/scalar translocation intraoperatively.

Methods:

Twenty-one adult CI patients were included. Subjects were postoperatively parsed into two groups based on analysis of postoperative imaging: 1) ST (n = 14) insertion; 2) SV (n = 7) insertion, indicating translocation of the electrode. The ECochG response elicited from a 500 Hz acoustic stimulus was recorded from the lead electrode during insertion when the distal electrode marker was at the round window, and was compared to the response recorded from a basal electrode (e13) after complete insertion.

Results:

No statistically significant change in mean ECochG magnitude was found in either group between recording intervals. There was a mean loss of preoperative pure-tone average of 52% for the nontranslocation group and 94% for the translocation group.

Conclusions:

Intraoperative intracochlear ECochG through the CI array provides a unique opportunity to explore the impact of the CI electrode on the inner ear. Specifically, a translocation of the array from ST to SV does not seem to change the biomechanics of the cochlear region that lies basal to the area of translocation in the acute period.
Comparison of Satisfaction Between Patients Using Percutaneous and Transcutaneous Bone Conduction Devices
Authors: Svagan Matija , Povalej Brzan Petra , Rebol Janez
Published: April 2019

Background:

Bone conduction devices are widely used to treat conductive and mixed hearing loss as well as single-sided deafness (SSD). A transcutaneous system was introduced recently with the clear advantage of fewer local reactions. Our goal was to evaluate and compare the satisfaction of patients with percutaneous and transcutaneous bone conduction devices.

Methods:

We divided a cohort of 72 patients into groups by type of hearing loss and their relation to the use of the percutaneous or transcutaneous system. The Glasgow Benefit Inventory (GBI) questionnaire, adapted for hearing aids, was employed to assess patient satisfaction, along with an additional questionnaire covering the general usefulness of the devices.

Results:

Overall median daily wearing time was 12 hours for the percutaneous and seven for the transcutaneous groups (p < 0.001). We found no correlation between the bone conduction level at any frequency and the GBI satisfaction score. The median total GBI score of the entire patient cohort was 30.1; median values for general, social support, and physical health subscales were 0, 37.5, and 16.7, respectively. People suffering from SSD had the lowest satisfaction rates, and these were significantly lower for the patients who used transcutaneous aids than for those with percutaneous devices (p = 0.033). Similarly, the percutaneous system brought more satisfaction to combined hearing loss patients than did the transcutaneous (p = 0.010).

Conclusion:

Both types of bone conduction devices provide a safe and efficient way to improve hearing for candidates within correct indications. Our study revealed that patients wore the transcutaneous device less than they did the percutaneous. Satisfaction was the lowest among SSD patients who used the transcutaneous device; hence it is especially important to carry out preoperative counseling for such patients.
The Effect of a Bone Groove Against Cochlear Implant Electrode Migration
Authors: Leinung Martin , Helbig Silke , Adel Youssef , Stöver Timo , Loth Andreas G.
Published: April 2019

Hypothesis:

The risk of electrode migration in cochlear implant (CI) surgery can be reduced by securing the electrode lead in a bone groove in the chorda-facial angle.

Background:

Electrode migration is an important complication in CI surgery, which affects hearing performance, may induce pain and facial nerve stimulation, and requires surgical revision. A potential method to secure the electrode is to use a bone groove created in the facial recess to fixate the electrode lead. This surgical measure is a standard procedure for lateral wall electrodes (LWE) in our clinic since 2013.

Methods:

Retrospective analysis of consecutive CI cases of a tertiary referral center from 2006 to 2016 and comparison of incidence rates between group A (without bone groove, years 2006–2012) and group B (with bone groove fixation, years 2013–2016). Clinical cases were reviewed with respect to electrode type, migration length, time interval to migration, and findings during revision surgery.

Results:

Seventeen cases of electrode migration were found in a total of 1,603 cochlear implantations. Only LWE designs were affected by migration. The cumulative incidence for LWE in group B (0.5%) was significantly lower than in group A (3.7%, p < 0.01). The two migration cases in group B revealed insufficient geometric design of the bone grooves. Only one patient experienced a remigration after revision surgery.

Conclusion:

The fixation in a bone groove in the chorda-facial angle is an effective measure against migration of LWE. Proper surgical execution is mandatory to ensure a tight and enduring fit.
[18F]fluorothymidine and [18F]fluorodeoxyglucose PET Imaging Demonstrates Uptake and Differentiates Growth in Neurofibromatosis 2 Related Vestibular Schwannoma
Authors: Anton-Rodriguez Jose M. , Lewis Daniel , Djoukhadar Ibrahim , Russell David , Julyan Peter , Coope David , King Andrew T. , Lloyd Simon K. L. , Evans D. Gareth , Jackson Alan , Matthews Julian C.
Published: April 2019

Objective:

To investigate whether [18F]fluorothymidine (FLT) and/or [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate growth in neurofibromatosis 2 (NF2) related vestibular schwannomas (VS) and to evaluate the importance of PET scanner spatial resolution on measured tumor uptake.

Methods:

Six NF2 patients with 11 VS (4 rapidly growing, 7 indolent), were scanned with FLT and FDG using a high-resolution research tomograph (HRRT, Siemens) and a Siemens Biograph TrueV PET-CT, with and without resolution modeling image reconstruction. Mean, maximum, and peak standardised uptake values (SUV) for each tumor were derived and the intertumor correlation between FDG and FLT uptake was compared. The ability of FDG and FLT SUV values to discriminate between rapidly growing and slow growing (indolent) tumors was assessed using receiver operator characteristic (ROC) analysis.

Results:

Tumor uptake was seen with both tracers, using both scanners, with and without resolution modeling. FDG and FLT uptake was correlated (R2 = 0.67–0.86, p < 0.01) and rapidly growing tumors displayed significantly higher uptake (SUVmean and SUVpeak) of both tracers (p < 0.05, one tailed t test). All of the PET analyses performed demonstrated better discriminatory power (AUCROC range = 0.71–0.86) than tumor size alone (AUCROC = 0.61). The use of standard resolution scanner with standard reconstruction did not result in a notable deterioration of discrimination accuracy.

Conclusion:

NF2 related VS demonstrate uptake of both FLT and FDG, which is significantly increased in rapidly growing tumors. A short static FDG PET scan with standard clinical resolution and reconstruction can provide relevant information on tumor growth to aid clinical decision making.
Diagnostic accuracy of different noninvasive scores for detecting advanced fibrosis in chronic hepatitis B
Authors: Hamidi Aziz A. , Oncul Ahsen , Ozguven Banu Y. , Sevgi Dilek Y. , Gunduz Alper , Uzun Nuray , Dokmetas Ilyas
Published: April 2019

Objectives

The liver biopsy is the gold standard for determining the level of fibrosis in chronic hepatitis B infection (CHBI). Nonetheless, it is possible to predict liver fibrosis through some noninvasive methods such as noninvasive scoring (NIS) of some serum biomarkers obtained from routine blood tests. We aimed to evaluate the diagnostic accuracy of nine NIS for detecting advanced fibrosis in CHBI.

Patients and methods

We reviewed the hospital records of CHBI cases with liver biopsy between January 2011 and December 2016 retrospectively. Using Ishak scoring method, we classified fibrosis stage 1–2 as mild and 3–6 as advanced fibrosis. We calculated the NIS by considering the age, platelet count, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, platelet, and international normalized ratio values at the time of the biopsy.

Results

The mean age of 202 patients was 37.69± 11.33 years. In cases with advanced fibrosis, the age, gammaglutamyltransferase, and international normalized ratio values were higher and platelet count was lower (P < 0.05). Mean platelet volume was not different between the two groups (P = 0.499). The median values of γ-glutamyl peptidase-platelet ratio (GPR), FibroQ, Goteborg University Cirrhosis Index, fibrosis-4 (FIB-4), aspartate aminotransferase-platelet ratio index, age-platelet index, and King scoring were significantly higher in the advanced fibrosis group. The highest area under the curve value was in GPR [AUC = 0.731 (0.639–0.788); P = 0.000] in the receiver operating characteristic curve analysis. Cirrhosis Discriminant Score and Aspartate aminotransferase-to-alanine aminotransferase ratio tests were not valuable in detecting advanced fibrosis. FIB-4 had the highest (0.678) diagnostic accuracy rate.

Conclusion

We found that the calculation of NIS before liver biopsy, especially GPR and FIB-4, may be useful for predicting advanced fibrosis in cases with CHBI.
Role of chromosomal architecture in germinal center B cells and lymphomagenesis
Authors: Rivas Martin A. , Melnick Ari M.
Published: April 2019

Purpose of review

Chromatin organization during interphase is nonrandom, and dictated by a delicate equilibrium between biophysics, transcription factor expression, and topological regulators of the chromatin. Emerging evidence demonstrate a role for chromosomal conformation at different stages of B-cell development. In the present review, we provide an updated picture of the current knowledge regarding how chromosomal conformation regulates the B-cell phenotype and how disruption of this architecture could lead to B-cell lymphoma.

Recent findings

B-cell development requires proper assembly of a rearranged VDJ locus, which will determine antigen receptor specificity. Recently, evidence pointed to a role for topological regulators during VDJ recombination. Research studies also demonstrated a link between shifts in nuclear chromosomal architecture during B-cell activation and in formation of germinal centers, which is required for immunoglobulin affinity maturation. Class-switch recombination was shown to be dependent on the presence of topology regulators. Loss of topological insulation of enhancers may lead to oncogene activation, suggesting that misfolding of chromatin may constitute a new epigenetic mechanism of malignant transformation. Finally, CCCTC-binding factor and cohesin binding sites have shown a higher probability of mutations and translocations in lymphomas, lending further support to the potential role of chromatin architecture in cancer development.

Chromosomal conformation is now recognized as a key feature in the development of a robust humoral immune response. Several examples from the literature show that dysregulation of chromosomal architecture may be a foundational event during malignancy. Therefore, understanding the mechanisms that regulate chromosomal folding and drive gene activation are instrumental for a better understanding of immune regulation and lymphomagenesis.
Toll-like receptor signaling in hematopoietic stem and progenitor cells
Authors: Capitano Maegan L.
Published: April 2019

Purpose of review

The innate immune system is essential in the protection against microbial infection and facilitating tissue repair mechanisms. During these stresses, the maintenance of innate immune cell numbers through stress-induced or emergency hematopoiesis is key for our survival. One major mechanism to recognize danger signals is through the activation of Toll-like receptors (TLRs) on the surface of hematopoietic cells, including hematopoietic stem cell (HSC) and hematopoietic progenitor cell (HPC), and nonhematopoietic cells, which recognize pathogen-derived or damaged-induced compounds and can influence the emergency hematopoietic response. This review explores how direct pathogen-sensing by HSC/HPC regulates hematopoiesis, and the positive and negative consequences of these signals.

Recent findings

Recent studies have highlighted new roles for TLRs in regulating HSC and HPC differentiation to innate immune cells of both myeloid and lymphoid origin and augmenting HSC and HPC migration capabilities. Most interestingly, new insights as to how acute versus chronic stimulation of TLR signaling regulates HSC and HPC function has been explored.

Recent evidence suggests that TLRs may play an important role in many inflammation-associated diseases. This suggests a possible use for TLR agonists or antagonists as potential therapeutics. Understanding the direct effects of TLR signaling by HSC and HPC may help regulate inflammatory/danger signal-driven emergency hematopoiesis.
Recent advances in lip reconstruction
Authors: Vanison Christopher , Beckmann Nicholas , Smith Aaron
Published: April 2019

Purpose of review

This article reviews recently described techniques used to reconstruct lip defects. Emphasis is placed on the ability of these flaps to restore function and appearance of the lips as well as their limitations.

Recent findings

The focus of recent advances in lip reconstruction has been to achieve better oral competence, speech and improved cosmetic appearance. New modifications to the traditional Karapandzic and Abbé flaps have expanded their uses. A host of novel local tissue transfer techniques has become available with improved outcomes and less morbidity. Similarly, new free tissue transfer methods have allowed for the creation of a more normal appearing lip with improved sensory and motor function. Although still experimental, tissue engineering of a mucocutaneous junction shows promise in its ability to recreate a normal vermillion.

Lip reconstruction techniques have continued to become more sophisticated in order to achieve better functional and cosmetic outcomes after resection. Several new local tissue and free tissue transfer techniques have recently been described and can be included in contemporary reconstruction algorithms.
Geographic inequity in transplant access
Authors: Lynch Raymond J. , Patzer Rachel E.
Published: April 2019

Purpose of review

Scarcity is a defining feature of the modern transplant landscape, and in light of chronic shortages in donor organs, there is cause for concern about geographic inequities in patients’ access to lifesaving resources. Recent policy changes designed to ameliorate unequal donor supply and demand have brought new interest to measuring and addressing disparities at all stages of transplant care. The purpose of this review is to describe an overview of recent literature on geographic inequities in transplant access, focusing on kidney, liver, and lung transplantation and the impact of policy changes on organ allocation.

Recent findings

Despite a major change to the kidney allocation policy in 2014, geographic inequity in kidney transplant access remains. In liver transplantation, the debate has centered on the median acuity score at transplantation; however, a more thorough examination of disparities in access and survival has emerged.

Geographic differences in access and quality of transplant care are undeniable, but existing disparity metrics reflect disparities only among candidates who are waitlisted. Future research should address major gaps in our understanding of geographic inequity in transplant access, including patients who may be transplant-eligible but experience a wide variety of barriers in accessing the transplant waiting list.
Zinc Absorption and Endogenous Fecal Zinc Losses in Bangladeshi Toddlers at Risk for Environmental Enteric Dysfunction
Authors: Mondal Prasenjit , Long Julie M. , Westcott Jamie E. , Islam M. Munirul , Ahmed Mondar , Mahfuz Mustafa , Ahmed Tahmeed , Miller Leland V. , Krebs Nancy F.
Published: April 2019

Objectives:

Environmental enteric dysfunction (EED) impairs zinc absorption from food, and zinc deficiency may contribute to the poor growth associated with EED. We examined zinc absorption from a standardized aqueous zinc dose, and habitual daily endogenous fecal zinc excretion (EFZ) and compared these outcomes between children grouped by the lactulose to mannitol ratio (L:M).

Methods:

Bangladeshi toddlers (18–24 months) with low (<0.09) and high (≥0.09) L:M were administered isotope‐labeled 3 mg aqueous zinc in the fasted state. Fractional absorption of zinc (FAZ) and EFZ were measured by dual stable isotope tracer method and an isotope dilution method, respectively. Secondary aims included examining relationships of biomarkers of systemic and intestinal inflammation and gut function with FAZ and EFZ.

Results:

Forty children completed the study; nearly all had evidence of EED. No differences in zinc homeostasis measurements (mean ± SD) were observed between high and low L:M groups: FAZ was 0.38 ± 0.19 and 0.31 ± 0.19, respectively; both figures were within estimated reference range. Means of EFZ were 0.73 ± 0.27 and 0.76 ± 0.20 mg/day for high and low L:M, respectively, and were 10% to 15% above estimated reference range. Regression analyses indicated that biomarkers of systemic inflammation were directly associated with increasing FAZ, consistent with increased gut permeability. Biomarkers of intestinal inflammation were negatively associated with EFZ, consistent with low‐zinc intake and chronic deficiency.

Conclusions:

In these children at risk of EED, endogenous zinc losses were not markedly increased. Results suggest that efforts to improve zinc status in EED should focus on substantially improving zinc intakes.
Systemic Lupus Erythematosus, Evans Syndrome, and Neurofibromatosis: An Unusual Combination in Pediatric Patient
Authors: Moskop Amy , Dalrymple Austin , Dolatshahi Leili
Published: April 2019

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organ systems. Patients can have hematologic manifestations, including Evans syndrome (ES), which is characterized by immune-mediated thrombocytopenia and anemia. The association of neurofibromatosis 1 (NF1) with autoimmune disorders is rarely reported. We will review the literature for this combination of disorders and describe a case of a 16-year-old girl who presents with immune-mediated cytopenias and is diagnosed with SLE, ES, and NF1. There are 7 reported cases of SLE and NF1 and only 2 are pediatric cases. There are no reports of the combination of SLE, ES, and NF1.
Demographics and Outcome of Philadelphia-positive ALL in a Pediatric Population in North India: a Single-center Experience
Authors: Pant Gitika , Kumar Archana , Verma Nishant , Pooniya Vishal , Sharma Anil , Gupta Bhvya
Published: April 2019

Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL) in children had a worse outcome before the use of tyrosine kinase inhibitors. We have evaluated the demographics and outcome of Ph+ ALL patients treated with imatinib without blood marrow transplantation. Of the 206 children with ALL registered for treatment, the demographic data of 15 Ph+ ALL patients were compared with the remaining Ph− patients. Imatinib (340 mg/m2) was started on day 5 (D5) of induction in Ph+ patients, and their overall survival was compared with Ph− high-risk patients treated on similar protocols. Statistical analysis was carried out by the Fisher exact test and the t test. The Kaplan-Meier test was used for survival analysis. Philadelphia positivity noted in 15/206 (7.28%) ALL patients was higher than reported earlier. Median initial total leukocyte count and central nervous system positivity were significantly higher in Ph+ patients. Myeloid markers, CD13 and CD33, were also positive in 33.3% Ph+ patients. D15 and D35 marrow showed remissions in a larger proportion of Ph+ ALL, as compared with Ph− patients, but chemotherapy interruptions and neutropenic deaths were significantly higher after starting imatinib, as compared with Philadelphia high-risk patients. Overall survival was similar in Ph+ and Ph− high-risk ALL patients. Ph+ ALL, noted in 7.28%, presented with high initial white blood cell counts, high central nervous system positivity, poor steroid response, and higher induction deaths, as compared with high-risk Ph− ALL, and raised the question about the appropriate dose and time of introduction of imatinib to prevent toxicity.
Differentiated Thyroid Cancer in the Pediatric/Adolescent Population: Evolution of Treatment
Authors: Remiker Allison S. , Chuang Janet , Corathers Sarah , Rutter Meilan M. , Rutter Michael J. , Myer Charles M. , Gelfand Michael J. , Trout Andrew T. , Geller James I.
Published: April 2019

Differentiated thyroid cancer (DTC) is the most common cancer in adolescents and young adults. In 2015, the American Thyroid Association published guidelines for management of pediatric DTC. We report our institutional experience and highlight changing practices and new opportunities. A retrospective analysis of all patients diagnosed with DTC from 2001 to 2016 was performed. Among 59 eligible patients, 31 (53%), 15 (25%), and 13 (22%) had low-risk, intermediate-risk, and high-risk disease, respectively. Half (15/31) of low-risk and all intermediate-risk/high-risk patients received radioactive iodine (I-131) ablation. For low-risk patients, average I-131 dose decreased from 80 to 42.05 mCi, and the percentage of patients who received I-131 decreased over time. Eleven of 16 patients with tumor genomic data were found to have somatic targetable (n=6) or germline (n=5) mutations. Persistent/recurrent disease was only present in high-risk (n=8) and intermediate-risk (n=1) patients. Two patients with iodine-refractory disease received trametinib to enhance radioiodine uptake. All patients were alive at follow-up (median, 5 y; range, 1 to 15 y). Coincident with the recent American Thyroid Association guidelines, the use of I-131 in low-risk patients has decreased over time in our practice. Tumor sequencing and cancer genetic evaluation may help redefine opportunities for treatment of high-risk patients and family counseling.
Langerhans’ Cell Histiocytosis Masquerading as Caroli’s Disease
Authors: Narayanasamy Rajavelu Thiagarajan , Abimannane Anitha , Chinnaiah Govindhareddy Delhi Kumar , Kayal Smita , Kar Rakhee
Published: April 2019

Langerhans’ cell histiocytosis is an uncommon disease in children with varied clinical presentation. Multisystem form of this disorder usually affects organs like the bones, skin, liver, spleen, lungs, and the central nervous system. We describe here the clinical details of a 2-year-old girl with involvement of unusual sites like the parotid glands and the nails. This child also had multiple cystic lesions in the liver leading to a misdiagnosis of Caroli’s disease. Knowledge about the uncommon manifestations of this rare disorder helps in early diagnosis and treatment.
Probiotic Supplementation Decreases Chemotherapy-induced Gastrointestinal Side Effects in Patients With Acute Leukemia
Authors: Reyna-Figueroa Jesus , Barrón-Calvillo Elsa , García-Parra Cecilia , Galindo-Delgado Patricia , Contreras-Ochoa Carla , Lagunas-Martínez Alfredo , Campos-Romero Freya H. , Silva-Estrada Jorge A. , Limón-Rojas Ana E.
Published: April 2019

Introduction:

In children with acute leukemia, gut microbiota is modified secondary to chemotherapy administration, leading to gastrointestinal side effects. Probiotics are microorganisms that can restore gut microbiota and may help alleviate gastrointestinal symptoms. The aim of this pilot study was to assess the effects of probiotic supplementation on chemotherapy-induced gastrointestinal side effects in children with acute leukemia (AL).

Methods:

In this randomized pilot study, patients under 17 years of age diagnosed with AL who were on remission induction or remission reinduction chemotherapy were randomly assigned to receive probiotic supplementation (a concentration of 5×109 CFU per sachet was administered at a standard dose twice daily, by mouth) or no probiotic supplementation. The primary endpoint was the prevalence of gastrointestinal side effects. Vomiting, nausea, flatulence, dyspepsia, diarrhea, constipation, abdominal pain, and abdominal distention were assessed in both groups.

Results:

Gastrointestinal side effects were less prevalent in the probiotic group, and 3 of the 8 gastrointestinal side effects (nausea, vomiting, and abdominal distension) significantly decreased in the probiotic group (P<0.05). We found for diarrhea a relative risk of 0.5 (95% confidence interval [CI], 0.2-1.2;P=0.04); for nausea an RR of 0.5 (95% CI, 0.4-0.8;P=0.04) and for vomiting an RR of 0.4 (95% CI, 0.2-0.9;P=0.04).

Conclusions:

Daily supplementation withLactobacillus rhamnosusreduced chemotherapy-induced gastrointestinal side effects in children with AL.
The Value of 18F-FDG PET/CT in Detecting Bone Marrow Involvement in Childhood Cancers
Authors: Yağci-Küpeli Begül , Koçyiğit-Deveci Emel , Adamhasan Fulya , Küpeli Serhan
Published: April 2019

Background:

The aim of this study was to assess the utility of 18F-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared with bone marrow biopsy (BMB) in the initial staging of pediatric patients with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), Ewing sarcoma (ES), and neuroblastoma (NB).

Procedure:

A total of 94 patients (57 boys, 37 girls, median age 7 y, range 1 to 18 y) with newly diagnosed NHL, HL, ES, and NB between July 2014 and December 2017, who underwent BMB and 18F-FDG PET/CT before chemotherapy were included in this study. There were 36 patients with NHL, 27 HL, 16 ES, and 15 NB. 18F-FDG PET/CT and BMB results were reviewed and compared retrospectively.

Findings:

Retrospective analysis of data from 94 pediatric patients (57 boys, 37 girls, median age 7 y, range 1 to 18 y) was performed. Of the 94 patients, 29 had BMI on 18F-FDG PET/CT. BMB was positive in 14, negative in 13, and insufficient in 2 of these 29 patients. In 65 patients negative on 18F-FDG PET/CT, BMB was also negative in 54 and insufficient in 7. For the whole group, sensitivity, specificity, and positive and negative predictive values of 18F-FDG PET/CT in detecting bone marrow metastasis at the time of diagnosis were 90.6%, 100%, 100%, and 95.4% and those of BMB were 53.1%, 87.1%, 94.4%, and 80.6%, respectively.

Conclusion:

Our study demonstrates that 18F-FDG PET/CT predicts BMI better than BMB. 18F-FDG PET/CT may be used at initial staging of pediatric patients with NHL, HL, ES, and NB.
Safety of Over-the-Counter Medications in Pregnancy
Authors: Stanley Angela Y. , Durham Catherine O. , Sterrett James J. , Wallace Jerrol B.
Published: April 2019

Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medications can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have documented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiarrheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions.
An Authentic Poverty Simulation for Health Care Profession Students Using Community Volunteers Experiencing Poverty
Authors: Hartman Sheri A. , Kidd Lori I. , Resler Rose M. , Lax Greta A.
Published: April 2019

Background

Poverty is a harsh reality for more than 40 million Americans, which can lead to detrimental health outcomes.

Problem

Considering health professionals encounter clients of low-income status, increasing awareness and empathy toward this population is essential.

Approach

This article describes a novel approach to conducting poverty simulations by using community volunteers that are currently living or have recently lived in poverty, lending to a more authentic experience for students. The community volunteers acted as resource workers during the simulation.

Outcomes

Five lessons were learned as part of this authentic approach including the importance of orientation, consistent volunteer recruitment, volunteer appreciation, simulation role ownership, and importance of incentives.

Conclusion

This approach is an effective initial step in increasing awareness and empathy among health care profession students toward individuals living in poverty. Use of community volunteers with personal experience with poverty enhances the realism of this experience for students.
A Multigroup Analysis of the Effect of Cognitive Appraisal on Nurses' Psychological Distress
Authors: Simães Clara , Gomes António R. , Costa Patrício
Published: April 2019

Background

Cognitive appraisal constitutes an important mechanism in the process of human adaptation to work environment and occupational stress. In this domain, nursing professionals are one of the occupational groups most affected by job stress, suffering high levels of psychological distress.

Objectives

The aims of this study were to analyze the moderator effect of shift work and the type of job contract on the relationship between work cognitive appraisal and nurses' psychological distress and to explore the interaction effect of the two moderator variables on that relationship.

Methods

A sample comprised of 2,310 Portuguese registered nurses completed a sociodemographic and professional questionnaire: the Primary and Secondary Cognitive Appraisal Scale and the General Health Questionnaire-12. Data were analyzed through structural equation modeling and multigroup analyses considering the following groups: (a) “shift” versus “nonshift work”; (b) “precarious job contract” versus “nonprecarious job contract”; and (c) “shift and precarious” versus “shift and nonprecarious” versus “nonshift and precarious” versus “nonshift and nonprecarious.”

Results

Data confirmed the invariance for the measurement model, but the structural model presented a significantly worse adjustment for all grouping variables, showing the moderator effect of shift work and job contract and of their interaction. Difference tests in structural path coefficients revealed that shift work moderated the relationship between challenge perception and psychological distress—which was stronger for shift work nurses—and that a higher threat perception was related to greater psychological distress, especially in nurses with a precarious job contract. Among the four categories of interaction between job contract and shift work, cognitive appraisal became central in predicting nurses' mental health, explaining more variance in the group that did shift work and had a nonprecarious job contract.

Discussion

The study results highlight the need to develop occupational health intervention programs to promote nurses' mental health, focusing on reducing work perception as a threat and on making nurses' jobs more challenging and controllable.
Limited availability of global health opportunities in US orthopaedic trauma fellowship programs
Authors: Shaw Jordan , Siy Alexander , Dahm James , Lins Laura , Simske Natasha , Whiting Paul
Published: April 2019

Purpose:

Orthopaedic residents are increasingly seeking international health electives (IHEs) during training, and many such experiences involve providing orthopaedic trauma care. However, little is known about the availability of IHEs during orthopaedic trauma fellowship training. The purpose of our study is to assess the global health opportunities available to US orthopaedic trauma fellows.

Method:

We conducted an online, Research Electronic Data Capture (REDCap)-based survey of orthopaedic trauma fellowship program directors (PDs) in the United States. The survey link was sent by the Orthopaedic Trauma Association (OTA) Fellowship Committee to all US OTA-approved orthopaedic trauma fellowship PDs. Follow-up reminder e-mails were delivered at set time intervals from baseline over a period of 4 weeks.

Results:

The overall response rate was 80% (43/54). Only 3 of 43 responding programs (7%) offer a structured global health program, but over the last 10 years, 12.5% of the remaining programs (5/40) have had a fellow participate in an IHE during fellowship training. Around 100% of PDs reported fellow satisfaction with their IHEs, and all PDs agreed that the educational experience provided by their fellows’ IHE participation was valuable. Among programs with no recent fellow IHE participation and without a structured global health program, 9% of PDs (3/35) expect to institute such a program. Lack of funding, lack of established international partner sites, and fellow time away were the most common perceived barriers to IHE participation. A total of 54% of PDs agree that participation in an IHE during training plays a major role in shaping fellows’ future professional and volunteer activities.

Conclusion:

There are limited global health opportunities among US orthopaedic trauma fellowship programs, with only 7% (3/43) offering a structured global health program. Perceived barriers include lack of funding, lack of established partner sites, and concerns related to clinical/call coverage. Greater efforts to establish sustainable funding and international partnerships may increase opportunities for IHEs during orthopaedic trauma fellowship training.