bluuebunny/crossref_metadata_2025 huggingface dataset:
Second phase structure analysis and wear behavior of the ultra-high manganese steel
Authors: Wang Zhenghui , Xie Jingpei , Li Qian , Wang Wenyan , Wang Aiqin , Liu Pei
Published: June 2021

The high manganese steel is widely used in wear-resisting parts of the cone crusher, such as the grinding mill wall and crushing wall. In this work, the microstructure and wear resistance of an ultra-high manganese steel (Mn18Cr2Mo) were analyzed by electron diffraction and high-resolution transmission electron microscope (HRTEM) observation and impact abrasive wear test. The results show that there are spherical or block Mo2C and strip-like (Fe, Cr)3C phases in Mn18Cr2Mo manganese steel. The orientation of the Mo2C phase and the austenite matrix are [001]austenite//

10

1

¯

Mo2C, (020)austenite//(020)Mo2C,

2

¯

00

austenite//(202)Mo2C and

2

¯

20

austenite//(242)Mo2C. The that of the (Fe, Cr)3C phase and the austenite matrix are [011]austenite//

12

1

¯

(Fe, Cr)3C and

11

1

¯

austenite//(210)(Fe, Cr)3C. Besides,

1

¯

1

1

¯

austenite is approximately parallel to

1

1

¯

3

(Fe, Cr)3C. The interface relation of (002)austenite is approximately parallel to

1

¯

2

¯

3

(Fe, Cr)3C. Owing to high density dislocations, deformation bands, microcrystal and non-crystalline, the wear resistance of the Mn18Cr2Mo manganese steel is 1.83 times that of the Mn13 manganese steel under the impact abrasive wear test.
Time between diagnosis and achievement of virologic suppression in people living with HIV
Authors: Ilagan Danica Joy C , Eitniear Lindsey , Cole Kelli , Duggan Joan , Sahloff Eric
Published: June 2021

Purpose

Data support the individual and public health advantages of shortened time intervals between HIV diagnosis, initiation of antiretroviral therapy (ART), and virologic suppression. The time from HIV diagnosis to linkage to care, initiation of ART, and virologic suppression was evaluated in newly diagnosed, ART-naive individuals after structured programmatic changes were implemented to reduce time to virologic suppression (TVS).

Methods

The retrospective cohort included newly diagnosed, ART-naive adult patients receiving care in a Midwestern Ryan White Clinic. Study periods were between January 1, 2015, and December 31, 2015 (delayed treatment group) and January 1, 2017, and December 31, 2017 (rapid treatment group). Changes during the intervention time period were related to access to care and ART. The primary outcome of time from HIV diagnosis to virologic suppression was compared between the groups. Secondary outcomes included the time from diagnosis to linkage to care and the time to initiation of ART.

Results

Twenty-four and 35 individuals were included in the control and intervention groups, respectively. Median (interquartile range) time from diagnosis to viral suppression was 137 (77-318) days in the delayed treatment group vs 76.5 (51-151) days in the rapid treatment group (P = 0.021). Time from diagnosis to first clinic visit remained similar (median of 13.5 vs 15 days, P = 0.859), while time from first clinic visit to initiation of ART decreased significantly (median of 15 vs 0 days, P < 0.001).

Conclusion

Time from first clinic visit to ART initiation was significantly shortened in this intervention and was the driving force to decreasing TVS. Additional research into barriers impacting time from diagnosis to linkage to care are needed to further shorten TVS.
Synthesizing Indirect Effects in Mediation Models With Meta-Analytic Methods
Authors: Cheung Mike W-L
Published: June 2021

Aims

A mediator is a variable that explains the underlying mechanism between an independent variable and a dependent variable. The indirect effect indicates the effect from the predictor to the outcome variable via the mediator. In contrast, the direct effect represents the predictor's effort on the outcome variable after controlling for the mediator.

Methods

A single study rarely provides enough evidence to answer research questions in a particular domain. Replications are generally recommended as the gold standard to conduct scientific research. When a sufficient number of studies have been conducted addressing similar research questions, a meta-analysis can be used to synthesize those studies' findings.

Results

The main objective of this paper is to introduce two frameworks to integrating studies using mediation analysis. The first framework involves calculating standardized indirect effects and direct effects and conducting a multivariate meta-analysis on those effect sizes. The second one uses meta-analytic structural equation modeling to synthesize correlation matrices and fit mediation models on the average correlation matrix. We illustrate these procedures on a real dataset using the R statistical platform.

Conclusion

This paper closes with some further directions for future studies.
BioVLAB-Cancer-Pharmacogenomics: tumor heterogeneity and pharmacogenomics analysis of multi-omics data from tumor on the cloud
Authors: Park Sungjoon , Lee Dohoon , Kim Youngkuk , Lim Sangsoo , Chae Heejoon , Kim Sun
Published: June 2021

Motivation

Multi-omics data in molecular biology has accumulated rapidly over the years. Such data contains valuable information for research in medicine and drug discovery. Unfortunately, data-driven research in medicine and drug discovery is challenging for a majority of small research labs due to the large volume of data and the complexity of analysis pipeline.

Results

We present BioVLAB-Cancer-Pharmacogenomics, a bioinformatics system that facilitates analysis of multi-omics data from breast cancer to analyze and investigate intratumor heterogeneity and pharmacogenomics on Amazon Web Services. Our system takes multi-omics data as input to perform tumor heterogeneity analysis in terms of TCGA data and deconvolve-and-match the tumor gene expression to cell line data in CCLE using DNA methylation profiles. We believe that our system can help small research labs perform analysis of tumor multi-omics without worrying about computational infrastructure and maintenance of databases and tools.

Availability and implementation

http://biohealth.snu.ac.kr/software/biovlab_cancer_pharmacogenomics.

Supplementary information

Supplementary data are available at Bioinformatics online.
Pain, No Gain: Acute Pain Interrupts Motor Imagery Processes and Affects Mental Training-Induced Plasticity
Authors: Neige Cécilia , Lebon Florent , Mercier Catherine , Gaveau Jérémie , Papaxanthis Charalambos , Ruffino Célia
Published: June 2021

Pain influences both motor behavior and neuroplastic adaptations induced by physical training. Motor imagery (MI) is a promising method to recover motor functions, for instance in clinical populations with limited endurance or concomitant pain. However, the influence of pain on the MI processes is not well established. This study investigated whether acute experimental pain could modulate corticospinal excitability assessed at rest and during MI (Exp. 1) and limit the use-dependent plasticity induced by MI practice (Exp. 2). Participants imagined thumb movements without pain or with painful electrical stimulations applied either on digit V or over the knee. We used transcranial magnetic stimulation to measure corticospinal excitability at rest and during MI (Exp. 1) and to evoke involuntary thumb movements before and after MI practice (Exp. 2). Regardless of its location, pain prevented the increase of corticospinal excitability that is classically observed during MI. In addition, pain blocked use-dependent plasticity following MI practice, as testified by a lack of significant posttraining deviations. These findings suggest that pain interferes with MI processes, preventing the corticospinal excitability facilitation needed to induce use-dependent plasticity. Pain should be carefully considered for rehabilitation programs using MI to restore motor function.
Fine Mapping without Phenotyping: Identification of Selection Targets in Secondary Evolve and Resequence Experiments
Authors: Langmüller Anna Maria , Dolezal Marlies , Schlötterer Christian
Published: June 2021

Evolve and Resequence (E&R) studies investigate the genomic selection response of populations in an Experimental Evolution setup. Despite the popularity of E&R, empirical studies in sexually reproducing organisms typically suffer from an excess of candidate loci due to linkage disequilibrium, and single gene or SNP resolution is the exception rather than the rule. Recently, so-called “secondary E&R” has been suggested as promising experimental follow-up procedure to confirm putatively selected regions from a primary E&R study. Secondary E&R provides also the opportunity to increase mapping resolution by allowing for additional recombination events, which separate the selection target from neutral hitchhikers. Here, we use computer simulations to assess the effect of different crossing schemes, population size, experimental duration, and number of replicates on the power and resolution of secondary E&R. We find that the crossing scheme and population size are crucial factors determining power and resolution of secondary E&R: A simple crossing scheme with few founder lines consistently outcompetes crossing schemes where evolved populations from a primary E&R experiment are mixed with a complex ancestral founder population. Regardless of the experimental design tested, a population size of at least 4,800 individuals, which is roughly five times larger than population sizes in typical E&R studies, is required to achieve a power of at least 75%. Our study provides an important step toward improved experimental designs aiming to characterize causative SNPs in Experimental Evolution studies.
Parity predicts allonursing in a cooperative breeder
Authors: Brachet Morgane A A , Vullioud Philippe , Ganswindt Andre , Manser Marta B , Keller Matthieu , Clutton-Brock Tim H
Published: June 2021

In some mammals that breed cooperatively, nonbreeding female helpers nurse offspring born to the breeding female in their group, a process known as allonursing. Previous laboratory studies have suggested that primiparous and multiparous females (those that have successfully given birth once or more, respectively) are more likely to contribute to allonursing than nulliparous females (those that have not given birth). In contrast, few field studies have been able to demonstrate whether breeding experience, or parity, affects the likelihood or duration of allonursing. In this study, we investigated whether the likelihood and duration of allonursing by subordinate female meerkats (Suricata suricatta) were associated with variations in their parity (number of pregnancies reaching a viable gestational age) and their immediate pregnancy status. Comparisons showed that nonpregnant nulliparous females were less likely to allonurse than nonpregnant primiparous and multiparous females, although parity was not related to variation in allonursing duration. Parity may enhance the expression of maternal behavior when exposed to foster pups, especially since mammary gland development has been shown to be directly associated with parity in other mammals.
First Record of Established Populations of the Invasive Pathogen Vector and Ectoparasite Haemaphysalis longicornis (Acari: Ixodidae) in Connecticut, United States
Authors: Molaei Goudarz , Little Eliza A H , Williams Scott C , Stafford Kirby C
Published: June 2021

A number of invasive tick species capable of transmitting pathogens have been accidentally introduced into the U.S. in recent years. The invasion and further range expansion of these exotic ticks have been greatly facilitated by frequent global travel and trade as well as increases in legal and illegal importation of animals. We describe the discovery of the first established populations of Haemaphysalis longicornis Neumann and the first fully engorged human parasitizing specimen documented through passive tick surveillance in Fairfield County, Connecticut, U.S. We also report several individual specimens of this invasive arthropod and vector of multiple pathogens of medical and veterinary importance collected through active tick surveillance from three counties (Fairfield, New Haven, and New London). Considering the potential for invasive ticks to transmit numerous native and emerging pathogens, the implementation of comprehensive surveillance programs will aid in prompt interception of these ticks and reduce the risk of infection in humans and wildlife.
#20: Modeling Zika virus tissue tropism in rhesus macaques to define the risk of donor derived transmission
Authors: Treadway Taylor A , Shepherd Phoenix M , Newman Christina M , Mohr Emma L , Dudley Dawn M , Breitbach Meghan E , Yamamoto Keisuke , Stewart Laurel M , Koenig Michelle R , Bliss Mason , Rybarczyk Sierra L , Weiler Andrea M , Semler Matthew R , Mitzey Ann , Razo Elaina , Schotzko Michele , Peterson Eric , Simmons Heather A , Mejia Andres , Golos Thaddeus G , Friedrich Thomas C , O’Connor David H
Published: June 2021

Background

Almost 115,000 people in the United States are currently on a transplant waitlist, which vastly exceeds the number of organ donors every year. This discrepancy emphasizes the need for retention of all possible donors. Those who have recently traveled to an area with an active outbreak of Zika virus (ZIKV) are often disqualified as a donor because immunosuppressed recipients would be at risk of a donor-derived ZIKV infection. Therefore, we define ZIKV tissue tropism and the risk of donor derived transmission.

Methods

We subcutaneously inoculated 15 Indian-origin rhesus macaques (RM) with a Puerto Rican isolate of ZIKV (PRVABC59). All RMs were inoculated in mid to early gestation.We inoculated during pregnancy because plasma viremia is typically prolonged in pregnancy and we wanted to model tissue tropism for donor derived transmission in the worst scenario of prolonged viremia. At 30, 65, and 105 days post-infection (dpi), the animals were euthanized and comprehensive necropsies were performed, which evaluated a minimum of 60 tissues per animal. ZIKV RNA was quantified in tissues via qRT-PCR.

Results

Plasma viremia duration was >10 days in 13 of 15 RMs. ZIKV RNA was most commonly detected in lymph nodes, with 19/45 lymph nodes that were vRNA positive in 5 RMs at 30 dpi. There were 15/45 vRNA positive lymph nodes at 60 dpi and 8/38 at 105 dpi. Reproductive and maternal fetal-interface (MFI) tissues were the second most commonly positive tissues. Twenty-five MFI tissues, including the amniotic/chorionic membrane, decidua, placenta, uterus, and placental bed, were positive, with 10/53 positive at 30 dpi, 14/24 positive at 60 dpi and 1/47 positive at 105 dpi. Other vRNA positive tissues included the primary bronchus, femoral vein, kidney, thyroid, lung, colon, mammary gland, pericardium, hand nerve, and sciatic nerve in 1–2 RMs at one of the three timepoints.

Conclusions

We found ZIKV RNA most frequently within lymph nodes. Lymph nodes are included in lung and small bowel transplants, indicating that these transplants could pose a risk of donor-derived ZIKV transmission. Virus detection within other commonly transplanted tissues, such as the kidney and blood vessels was much less common. We did not determine what fraction of vRNA comes from replication-competent virus in each tissue; some tissues with vRNA might not contain virions that could initiate new infections. Donor-derived Zika virus transmission from other commonly transplanted organs, such as liver, seems unlikely since no viral RNA was detected in this organ.
#52: Clinical Features and Management of Pediatric Patients Presenting with New Onset Acute Leukemia and Concomitant COVID-19
Authors: Patel Pratik A , Lapp Stacey A , Hussaini Laila , Lu Austin , Anderson Evan J , Rostad Christina A , Stokes Claire L , Pauly Melinda G
Published: June 2021

Background

Infections represent a significant cause of morbidity and mortality in pediatric patients undergoing treatment for hematologic malignancies. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led to a worldwide pandemic of coronavirus disease 2019 (COVID-19) and pediatric patients with cancer appear to be at higher risk of severe disease than reported in the general pediatric population. Data are limited on the optimal management of children infected with SARS-CoV-2 and a new diagnosis of leukemia. The objective of this study was to describe our experience of six children who presented with a new diagnosis of acute leukemia and concurrent COVID-19.

Methods

The study was IRB approved and children were enrolled following informed consent and assent as appropriate for age. The clinical presentations, serologic responses, treatments, and outcomes of patients who presented with acute leukemia and concurrent SARS-CoV-2 infection were abstracted. Residual blood was tested by ELISA for quantitative IgG to the SARS-CoV-2 spike protein receptor binding domain (RBD).

Results

From March 1, 2020 to Dec 31, 2020, 6 patients were identified with a new diagnosis of acute leukemia and SARS-CoV-2 infection including 3 with acute myeloid leukemia (AML) and 3 with acute lymphoblastic leukemia (ALL). The median age of our cohort was 9 years old (range 1 to 19 years old), 5 of 6 were male, and 4 of 6 patients were Hispanic. All 6 patients presented with symptoms that could be attributed to COVID-19 or acute leukemia, with fever being the most common. All 3 of the AML patients presented with hyperleukocytosis (white blood cell count > 50 x 109/L) and required oxygen therapy and intensive care. At the time of presentation, all patients with specimens available (n=5) had IgG antibodies to SARS-CoV-2 RBD. All patients received COVID-19 directed therapy, with remdesivir (n=5) and convalescent plasma (n=5) being the most common. Chemotherapy was modified or delayed in 5 of the 6 patients. The patient who received standard AML chemotherapy without awaiting COVID-19 directed treatment had delayed serologic response, delayed viral clearance from the nasopharynx, protracted respiratory failure, and ultimately died. For patients with a 12-week follow-up (n=5), 2 patients with AML had died, and the ALL patients were in remission and continuing their leukemia treatment.

Conclusion

COVID-19 may present concurrently in children with new onset leukemia resulting in severe morbidity and mortality. Our experience adds to growing evidence that children with AML and SARS-CoV-2 infection are at risk for severe COVID-19. Screening for SARS-CoV-2 infection with subsequent delay in chemotherapy and administration of COVID-19 directed therapies should be considered for pediatric patients with newly diagnosed acute leukemia and COVID-19.
#16: Enterovirus D68 Visualized in the Anterior Horn of the Spinal Cord of a Pediatric Patient with Flaccid Paralysis
Authors: Vogt Matthew R , Wright Peter F , Hickey William F , Boyd Kelli L , Crowe James E
Published: June 2021

Background

Acute flaccid myelitis (AFM) is a polio-like paralyzing illness of children. AFM incidence is increasing during every other year outbreaks that occur in the United States simultaneously with outbreaks of enterovirus D68 (EV-D68) infection. Demonstrating that EV-D68 directly causes AFM has been challenging due to rare detection of the virus in the cerebrospinal fluid (CSF) of patients despite frequent detection at nonsterile sites. Murine studies have shown that EV-D68 can infect spinal cord anterior horn motor neurons and cause paralysis, similar to poliovirus. However, a key outstanding question is whether EV-D68 causes AFM in humans by direct viral pathogenesis or by indirect host immunopathogenesis.

Methods

We investigated the pathogenesis of AFM using tissues from a previously reported case of a 5-year-old boy who presented in fall 2008 with four days of progressive limb and voice weakness followed by incontinence, apnea, and death. He had a CSF pleocytosis of 2094/µL with EV-D68 identified in the CSF by sequencing of the VP1 gene. We designed probes for in situ hybridization (ISH) based on this sequence to stain formalin fixed paraffin embedded tissues from his autopsy. For immunohistochemistry (IHC) we used both commercial polyclonal anti-EV-D68 antibodies and our own human monoclonal antibodies that stain virus infected cells in vitro. Immunophenotyping was done by IHC. To analyze gene transcription in the inflammatory transcriptome of these infected areas of spinal cord we used the GeoMx platform from Nanostring.

Results

We identified EV-D68 in the anterior horn of the patient’s spinal cord, corresponding to the location of motor neuron cell bodies. This area was highly inflamed, with an infiltrate of CD8 T cells and many macrophages. Viral RNA (see figure) and viral protein was visualized in motor neurons but not supporting cells using ISH and IHC, respectively. Viral RNA but not viral protein was detected rarely in the lungs in macrophages, which had extensive inflammatory infiltrate. The infiltrate was predominantly composed of macrophages with a CD8 T cell component as well. The transcriptome of cells in the inflamed tissue was enriched for genes involved in antigen presentation on MHC.

Conclusions

Deaths in AFM patients are rare and often distant from initial presentation, but this patient died four days after onset of weakness, allowing us to directly demonstrate that EV-D68 can infect the human spinal cord. Motor neurons but not neural support cells are directly infected by EV-D68 with a corresponding infiltrate of macrophages and CD8 T cells. Antigen presentation processes are upregulated in inflamed tissues. Therefore, both direct viral pathology and immune factors likely contribute to AFM disease in EV-D68 infection.
#6: High Diagnostic Accuracy of Automated Rapid Strep A Test Reduces Antibiotic Prescriptions for Children in the United Arab Emirates.
Authors: Hendi Salama Bin , Malik Zainab A , Khamis Amar Hassan , Al-Najjar Fadil Y A
Published: June 2021

Background

Diagnosis of Group A Streptococcus (GAS) pharyngitis in children is hindered by variable sensitivity of clinical criteria and rapid Strep A tests (SAT), resulting in reliance on throat cultures as the gold standard for diagnosis. Delays while awaiting culture reports result in unnecessary antibiotic prescriptions among children, contributing to the spread of antimicrobial resistance (AMR).

Methods

Diagnostic accuracy study of an automated SAT (A-SAT) in children up to 16 years of age presenting to an emergency room with signs and symptoms of pharyngitis between March and June 2019. Paired throat swabs for A-SAT and culture were collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for A-SAT were calculated.

Results

Two hundred and ninety-one children were included in this study. 168 (57.7%) were boys and the mean age was 4.2 years. A-SAT was positive in 94 (32.3%) and throat culture was positive in 90 (30.9%) children. A-SAT and throat culture results showed a high level of consistency in our cohort. Only 6 (2%) children had inconsistent results, demonstrating that the A-SAT has a high sensitivity (98.9%), specificity (97.5%), PPV (94.7%) and NPV (99.5%) for the diagnosis of GAS pharyngitis in children. Only 92 (32%) children were prescribed antibiotics while the vast majority (68%) were not.

Conclusions

A-SAT is a quick and reliable test with diagnostic accuracy comparable to throat culture. Its widespread clinical use can help limit antibiotic prescriptions to children presenting with pharyngitis, thus limiting the spread of AMR.
#11: Post-malarial Hemolysis is Rare in Malawian Children with Cerebral Malaria
Authors: Guenther Geoffrey , Izem Rima , Saidi Alexuse , Seydel Karl , Postels Douglas
Published: June 2021

Background

In severe malaria, artesunate decreases mortality compared to quinine. Artesunate’s introduction into clinical use in malaria-endemic areas revealed a unique adverse effect: severe hemolysis appearing several weeks after treatment completion. Though initial reports of post-artesunate hemolysis (PAH) were gathered from adult returning travelers, studies of African children revealed that PAH was less common in this semi-immune population. There are no published studies establishing the incidence and severity of PAH in several severe malarial syndromes in African children, including cerebral malaria (CM). We determined the incidence and severity of post-treatment hemolysis in Malawian children surviving CM by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis.

Methods

Children aged 6 months to 14 years admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) with a clinical diagnosis of CM were enrolled in a retrospective cohort study. Children admitted before 2014 and treated with quinine (n=258) were compared to those admitted in 2014 and after and treated with artesunate (n=235). Hematocrit and parasite density were obtained at admission and every 6 hours until parasite clearance. The last hematocrit obtained during hospitalization was compared with the one-month post-hospitalization hematocrit value.

Results

The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (4.7% for quinine, 5.8% for artesunate, p value for difference= 0.582); no patients with a hematocrit decrease were symptomatic; none required transfusion. Of the 26 children with a decrease in hematocrit at one month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit on admission, lower quantitative histidine rich protein 2 level, and splenomegaly were independently associated with a post-treatment decrease in hematocrit.

Conclusions

In African survivors of CM, post-treatment hemolysis is rare, mild, and unassociated with the antimalarial treatment received.
#24: Neutropenic Enterocolitis in the Pediatric Patient with Hematological Cancer at Centro Medico Nacional 20 de Noviembre, from June 2019 to May 2020
Authors: Martínez María E , Galán Elizabeth
Published: June 2021

Background

Neutropenic Enterocolitis is a life-threatening condition which occurs in patients presenting neutropenia (absolute neutrophil count <500 / mm3), where secondary to the use of chemotherapy there is an aggressive destruction of tumor cells, which alters the rapid replication phase, in which different types of epithelia are also involved, this is why they decrease their turnover rate, evolving into injury in the intestinal mucosa, especially at the level of the terminal ileus and cecum, although it can affect any part of the intestine. Clinically manifested by fever, pain, and abdominal distension; it is more frequently associated with hematological cancer, although it can occur in other types of cancer. CT is the Gold Standard for diagnosis. Ultrasonography may also be useful, however, this diagnostic tool is operator dependent so its sensitivity and specificity decrease. Medical treatment is usually sufficient, but surgical intervention may be necessary in patients with perforation or deterioration.

Methods

The incidence of Neutropenic Enterocolitis cases in the pediatric population was identified by means of a descriptive, cross-sectional and retrospective study. We used clinical records of patients admitted with a diagnosis of leukemia. Data analysis was carried out by means of a non-probability sampling for convenience, creating the database in electronic system followed by the data analysis obtained by the JASP software version 0.13.1.0.

Results

we took into account a total of 1019 patients with leukemia, from which 95.58 % (n=974) were ALL (Acute Lymphoblastic Leukemia) and 4.41 % (n=45) AML (Acute Myeloblastic Leukemia); the Neutropenic Enterocolitis diagnostic, gave us 49 files, from which we eliminated 12 with a different diagnosis, obtaining a total sample of 37 clinical records. The most affected population was the group of between 10–17 years with an incidence of 51.35 %, the most common type of hematologic cancer was ALL representing 86.4 % of the cases, from which 40.54 % were in the induction phase of treatment when they started with the clinical symptoms of neutropenic enterocolitis, being fever, abdominal pain and diarrhea the most common symptoms. The diagnosis was made based on clinical presentation, and radiology tests being abdominal ultrasound the most common diagnostic tool. The most efficacious treatment because there were no complications and there was no need for escalation, was Piperacillin/Tazobactam, followed by Meropenem.

Conclusions

Neutropenic Enterocolitis was more frequently diagnosed in patients with ALL and in those who were receiving the induction phase of treatment; a total of 28 % presented with sepsis or septic shock. The antibiotic scheme Piperacillin/Tazobactam suffered less modifications unlike Cefepime/Metronidazole which had to be scaled to carbapenem and just 10.81 % of the patients had the Gold Standard diagnostic tool (Abdominal Computed Tomography).
#60: Attention Deficit Hyperactive Disorder and Oppositional Defiant Disorder in Adolescents Living with HIV/AIDS - A Cross Sectional Study
Authors: Bhat Kamalakshi G , Nalwalla Zahabiya , Joseph Nitin
Published: June 2021

Introduction

Perinatally HIV infected neonates are surviving into adulthood with an impact on mental and emotional health. Attention deficit hyperactive disorder (ADHD) and Oppositional Defiant disorder (ODD) are few of the common behavioral disorders, which have been found to have a higher prevalence amongst HIV infected children.

Objectives

The objectives were to assess the proportion of ADHD and ODD in adolescents living with HIV/AIDS and to find its association with various factors.

Materials and Methods

88 adolescents aged 10–19 years living with HIV/AIDS were included in the study. The Swanson, Nolan Pelham (SNAP-IV) scale was administered to the caretakers and children were assessed for the proportion of ADHD/ODD. Association between those who scored positive with duration of treatment, CD4 counts, stage of disease and socio-demographic variables were done using statistical tests.

Results

Our study included 88 participants, of whom 9 scored positive in the inattention subset resulting in a proportion of 10.2%. 5 participants had symptoms of hyperactivity/impulsivity resulting in a proportion of 5.6% and 1 had combined symptoms with a proportion of 1.1%. 13 scored positive in the opposition/defiant subset resulting in a proportion of 14.7%. No statistical significance was found between duration of treatment, CD4 count, stage of disease, socio-demographic variables and ADHD/ODD.

Conclusion

The proportion of ADHD and ODD in this study was found to be comparable to the general population. A holistic approach to improve the long-term health of these youth is needed to ensure that our success in achieving survival of HIV-infected children from infancy is maintained into adulthood.
Molecular Epidemiology of Clostridioides difficile Infections in Children
Authors: Perumalsamy Sicilia , Riley Thomas V
Published: June 2021

Clostridioides difficile is a prominent cause of health care-related gastrointestinal illness in adults. C. difficile infection (CDI) has been researched for over 40 years; however, research on pediatric CDI specifically has lagged behind for various reasons. Over the past decade, C. difficile has been increasingly reported as a cause of a broad spectrum of gastrointestinal diseases in children, ranging from mild self-limiting diarrhea to severe conditions such as pseudomembranous colitis and toxic megacolon. Recent publications have shown a rise in CDI incidence in children in different parts of the world, especially in patients with particular comorbidities such as hematological malignancies and inflammatory bowel disease. In addition, rising CDI rates have been reported in children in the community without traditional risk factors for CDI. Due to the extensive use of sensitive molecular detection methods to diagnose CDI in many countries, differentiating children who require treatment from those colonized with toxigenic strains remains a problem. Consequently, the molecular epidemiology of pediatric CDI is poorly understood. Even though well-known C. difficile strains causing CDI in children have been described (including hypervirulent strains such as ribotypes 027 and 078), there is a paucity of information about specific C. difficile strains. This mini-review summarizes the information that is currently available on the molecular epidemiology of CDI in children.
A novel fixation method for unstable ankle fractures in the elderly using dual percutaneous tibiotalar cannulated screws
Authors: Hancock Daniel W , Hainsworth Louis , Pentlow Alanna K
Published: June 2021

Ankle fractures in the elderly are often complicated by osteoporosis and poor skin quality, resulting in poorer outcomes. This retrospective case-series describes a novel minimally invasive fixation method for managing unstable ankle fractures in the high-risk elderly patient. Six elderly patients who underwent dual tibiotalar cannulated screw fixation for unstable ankle fractures between January 2019 and 2020 were identified. Data on post-operative pain scores, mobility and complications were collected. Pre- and post-operative radiographs were analysed for fracture type and complications. Functional outcomes were excellent with 83.3% of patients pain free, and 100% ambulatory with walking-aids at 10.25 months follow-up. Four of the six patients (66.7%) had satisfactory post-operative radiographs, and there were no soft tissue injury or infections due to the surgery. Dual percutaneous tibiotalar cannulated screws can be used to manage unstable ankle fractures in the low demand elderly patient, resulting in excellent functional outcomes.
Update in the World of COVID-19
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

This brief chapter incorporates some of our team’s observations about practicing TFPP during the COVID-19 pandemic. For many of our patients, access to care became more fractured, whereas for other patients, session attendance became easier and even resulted in better access to their inner lives. The impact of the necessity to switch to telehealth is discussed, as well as the effects of isolation on the one hand and tensions surrounding quarantine situations on the other. The chapter discusses one case of a Vietnam war Veteran for whom the experience of the lockdown exacerbated anger and mistrust he had experienced during the war. In a second case the patient experienced being infected with COVID as yet another experience of abuse, and struggled with his angry response. Patients’ responses are necessarily filtered through their developmental histories, traumatic experiences, and individual dynamics. TFPP helps to delineate how patients’ symptoms and relationships are affected, creating opportunities for further therapeutic work.
Young boy with social impairment and repetitive behaviors
Authors: Ozdemir Sirin , Donnelly Craig L.
Published: June 2021

Autism spectrum disorder (ASD) is a lifelong, highly heterogeneous neurodevelopmental disorder characterized by deficits in social communication and interaction as well as restricted, repetitive patterns of behavior, interests, or activities. The symptoms begin early in development but may not become apparent until social demands exceed abilities. The diagnostic assessment should include a medical assessment; evaluation by a clinician familiar with the signs/symptoms of ASD such as a developmental pediatrician, child psychiatrist, or child neurologist; neuropsychological testing to assess for comorbid intellectual disability; a speech and language evaluation; and an occupational therapy evaluation. There is no cure for ASD, but early diagnosis and intervention are associated with better functional outcomes. The treatment approach should be multidisciplinary and may include behavioral therapy, speech therapy, occupational therapy, and educational interventions. Pharmacologic treatment may be used to manage psychiatric comorbidities and maladaptive behaviors.
Below-average intellectual and adaptive functioning
Authors: Ross Cordelia Y.
Published: June 2021

Intellectual disability (ID) is a neurodevelopmental disorder characterized by deficits in intellectual and adaptive functioning that begins during the developmental period. The case describes a child with Fragile X syndrome, the most common inherited cause of ID. Adaptive functioning deficits include difficulty acquiring age-appropriate conceptual, social, and practical skills. There are many causes of ID including genetic, environmental, and idiopathic etiologies. The assessment of ID includes evaluating for underlying and/or associated medical conditions and neuropsychological testing to evaluate the child’s cognitive and functional abilities. The severity of ID is determined by the child’s functional abilities. Components of treatment may include speech and language therapy, occupational therapy, physical therapy, family counseling and respite care, behavioral interventions, and educational interventions. Families should also be educated on transition-to-adulthood topics including guardianship. Pharmacologic treatments can be used to treat behavioral symptoms, sleep difficulty, or comorbid psychiatric disorders.
Trouble being away from mother
Authors: Sharma Sumita
Published: June 2021

Separation anxiety disorder is characterized by developmentally inappropriate and excessive fear or anxiety that occurs when the child is separated from major attachment figures. The disorder may manifest with challenging behaviors such as school refusal, temper tantrums, or somatic complaints. Worries typically center around fear of untoward events that may occur when separated from loved ones, such as accidents, kidnapping, or death. Cognitive behavioral therapy (CBT) is the initial treatment of choice for separation anxiety disorder. Pharmacotherapy including selective serotonin reuptake inhibitors (SSRIs) may be used as an adjunct to behavioral or psychotherapeutic interventions.
Excessive, uncontrollable worries
Authors: Pereira Joseph A.
Published: June 2021

Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control. The worry is accompanied by at least one of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance. Anxiety may present with crying episodes, temper tantrums, and irritability in children. Compared to adults, youth are also more likely to report somatic complaints associated with anxiety such as gastrointestinal upset, headaches, and sweating. Psychotherapies for GAD include cognitive behavioral therapy (CBT) and parent guidance to decrease accommodating behaviors. Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).
A boy who could not be comforted
Authors: Epstein Katherine A.
Published: June 2021

Reactive attachment disorder (RAD) is a rare disorder occurring in young children who have experienced extremely insufficient care and have been deprived of the opportunity to form a secure attachment with a reliable caregiver. Children with RAD exhibit inhibited, emotionally withdrawn behavior toward caregivers, rarely seeking and responding to comfort when distressed. They may also have minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness. Symptoms must begin prior to the age of five years. There are no medication treatments for RAD; however, psychiatric comorbidities may benefit from psychopharmacology. The single effective treatment for RAD is placing the child in an environment where they have the opportunity to form a selective attachment to a caregiver. Symptoms of RAD may completely resolve if this occurs.
Sad mood and changes in behavior after exposure to a traumatic reminder
Authors: Smith Joshua R.
Published: June 2021

Posttraumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that may affect individuals who have experienced a traumatic event. Symptoms of PTSD include intrusion symptoms, avoidance of stimuli associated with the traumatic event, negative alterations in cognition and mood, and alterations in arousal and reactivity. Intrusion symptoms in children may manifest as repetitive play in which themes from the trauma are expressed. Children are often unaware of the connection between their repetitive play and the trauma. Additionally, children may experience frightening dreams without recognizable content. Compared to adults, youth may be less able to describe traumatic events and complex emotional states. It is not uncommon to be unable to recall specific events about the trauma. The evidence supporting the use of selective serotonin reuptake inhibitors (SSRIs) in youth with PTSD is mixed. Trauma-focused cognitive behavioral therapy (TF-CBT) has the greatest empirical support for pediatric PTSD.
A teenage girl with low body mass index due to restricting food intake
Authors: Czepiel Kathryn S.
Published: June 2021

Anorexia nervosa (AN) is an eating disorder that is characterized by restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in the way one’s body weight or shape is experienced. Because many patients with AN attempt to conceal their efforts to lose weight and minimize their symptoms, obtaining information from a caregiver is an important part of the assessment. A medical history and physical examination must be completed to assess medical stability, including review of vital signs, electrocardiogram, and laboratory studies. Medically unstable patients require a medical admission for refeeding and stabilization, including monitoring for refeeding syndrome. Pharmacotherapy should not be used as the primary treatment for patients with AN. The most evidence-based psychotherapy approach for children and adolescents is family-based treatment (Maudsley family therapy).
Families and pain
Authors: Higgins Kristen S. , Chambers Christine T. , Birnie Kathryn A. , Boerner Katelynn E.
Published: June 2021

The family has long been acknowledged as an important social context where children learn and receive support for experienced pain. When a child is in pain, the family is responsible for identifying pain and seeking appropriate evaluation and care. Families’ responses may inadvertently encourage or discourage the expression of pain and play a critical role in influencing children’s ability to cope with pain, both positively and negatively. Having a child in pain can pose significant personal, familial, and economic strains to parents, and parents’ health can impact pain and psychological symptoms in their offspring. Therefore, consideration of the family is critical in understanding children’s pain. This chapter describes relevant theoretical models and summarizes current major research themes regarding the role of the family in both acute and chronic pediatric pain. Two illustrative case examples and a parent perspective are provided and key areas for future research are identified.
Chronic pain syndromes in childhood
Authors: Schechter Neil L.
Published: June 2021

Though this volume is replete with detailed discussions about specific pain problems, the focus of this chapter is on a discussion of the commonalities in etiology, associated symptoms, and treatment of many of the frequent chronic pain problems, primarily those categorized as Chronic Primary Pains in the International Classification of Diseases, 11th Revision, and traditionally known as “functional.” We will explore, in brief, the data that demonstrate the co-occurrence of many of the common chronic pain problems in children and the epidemiological similarities that exist between affected individuals. Then, we will review the concept of central sensitization and the physiological evidence that supports its presence in many of the functional pain problems. We will briefly review some of the symptoms associated with these entities (orthostatic intolerance, sleep disturbance, depression, anxiety, hypermobility, and family distress). Finally, we will discuss briefly a general approach to these problems, emphasizing the collection of specific information in the history and physical examination, the critically important presentation of the formulation to the family, and the treatment modalities that appear to be effective for many of these conditions. In-depth discussion of each of these pain problems is available in chapters specifically designated to review them in detail.
Noninflammatory musculoskeletal pain
Authors: Clinch Jacqui
Published: June 2021

Noninflammatory musculoskeletal pain is common in children and adolescents, and when persistent or widespread, can have a negative impact on physical and psychological well-being. Diagnostic labels and criteria are not uniform in the current literature, but musculoskeletal pain may present as widespread pain or juvenile fibromyalgia, complex regional pain syndrome, or in association with joint hypermobility. Chronic musculoskeletal pain, irrespective of its trigger, can bring persistent and recurrent distress, disability, and widespread family disruption. Once serious medical causes have been excluded by history, examination, and relevant investigations, the focus should be on rehabilitation. Multidisciplinary team management to facilitate cohesive working and the introduction of psychological and physical therapies can improve outcome. Further research is required to define the role of pharmacological interventions.
Chronic pelvic pain in children and adolescents
Authors: Sager Susan L. , Laufer Marc R.
Published: June 2021

Pelvic pain is a broad term encompassing pain from viscera within the pelvic cavity, and from the bony and myofascial structures of the pelvis. In children and adolescents, pain due to pelvic pathology may be described as abdominal pain, and is frequently overlooked owing to co-occurrence with gastrointestinal symptoms. Dysmenorrhea is highly prevalent among adolescents and associated with central sensitization of pain pathways and other chronic pain syndromes. Dysmenorrhea is also a risk factor for pelvic pathology; two-thirds of adolescents with dysmenorrhea or chronic pelvic pain who undergo laparoscopy are diagnosed with endometriosis. Other overlooked causes of chronic pelvic pain include pelvic myofascial pain, pelvic floor dysfunction, neuralgias, and nerve entrapment. The importance of obtaining a menstrual history, indications for referral to an adolescent gynecologist, and a multidisciplinary approach to pain management are discussed.
Headaches
Authors: Hershey Andrew D.
Published: June 2021

This chapter discusses recurrent headaches, especially when episodic, which are much more likely to represent primary headache disorders. Primary headaches are intrinsic to the nervous system and are the disease itself. Early recognition of the primary headaches in patients should result in improved response and outcome, minimizing the impact of the primary headaches and disability. Primary headaches can be grouped into migraine, tension-type headaches, and trigeminal autonomic cephalalgia, and an additional grouping of rarer headaches without a secondary cause. The primary headache that has the greatest impact on a child’s quality of life and disability is migraine, and subsequently is the most frequent primary headache brought to the attention of parents, primary care providers, and school nurses.