bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Intraocular Pressure Responses to Reading: The Influence of Body Position
Authors: Vera Jesús , Redondo Beatriz , Molina Rubén , Cárdenas David , Jiménez Raimundo 
Published: April 2020

Précis:
Greater intraocular pressure (IOP) values are observed when reading in the supine position in comparison with the sitting position, and thus, it should be considered by eye care specialists for the management of glaucoma patients or those at risk.

Purpose:
IOP is sensitive to near work and body position, however, the influence of the body position adopted while performing near tasks remains unknown. This study aimed to assess the IOP changes induced by reading on a smartphone in sitting and supine position, and to explore whether these IOP changes differ between men and women.

Methods:
Twenty-four healthy young adults (12 men and 12 women) read a text on a smartphone placed at 30 cm for 25 minutes while lying down and sitting in 2 different days. A rebound tonometer, which allows assessing IOP in the supine position, was used to measure IOP before reading, during reading (5, 15, and 25 min), and after 5 minutes of recovery. Complementarily, the authors checked the level of sleepiness/alertness before reading, and the perceived levels of fatigue and discomfort after reading.

Results:
The data showed that reading induces an IOP rise [P<0.001, partial eta squared (ηp
2)=0.44]. These effects were more accentuated when reading in the supine position in comparison with the sitting position (P=0.019, ηp
2=0.23) with an increment of 2.4 mm Hg (14%) and 1.3 mm Hg (8%) after 25 minutes of reading, respectively. The IOP rises associated with reading did not differ between men and women (P=0.127). Participants reported greater levels of discomfort in the neck and back when reading in the sitting position (P=0.012, ηp
2=0.25).

Conclusions:
The IOP rises associated with reading are greater when it is performed in the supine position in comparison with the sitting position. The present findings indicate that reading in the supine position should be discouraged in individuals who should avoid IOP increments or fluctuations.
Is Carbon Dioxide Insufflation During Endoscopy in Children as Safe and as Effective as We Think?
Authors: Dike Chinenye R. , Rahhal Riad , Bishop Warren P. 
Published: April 2020

ABSTRACTObjectives:Distension of the gastrointestinal lumen is crucial for visualization and advancement during endoscopic procedures. An increasing number of pediatric centers now use carbon dioxide (CO2) preferentially over air as many adult studies and a few pediatric studies have concluded that CO2 is better tolerated than air, especially for colonoscopy.Aims:The aim of the study was to determine if CO2 is as safe and as effective as air and if it reduces abdominal discomfort and distension in children undergoing upper endoscopy and colonoscopy.Methods:Double blinded, prospective, randomized clinical study. Patient‐ and nursing‐reported outcomes of pain and distension were recorded. End tidal CO2 (EtCO2) was monitored continuously with a CO2‐sampling nasal cannula for patients undergoing procedural sedation and via the endotracheal tube for those who were intubated.Results:One hundred seventy‐eight patients with 180 procedures were enrolled, 91 procedures were randomized to receive CO2, and 89 to air. Groups did not differ significantly with respect to nursing‐assessed abdominal discomfort, change in girth from baseline, or endoscopist‐perceived ease of inflation. Use of CO2 was associated with transient spikes in the EtCO2 (≥60 mmHg) in a significant number of patients during sedated upper endoscopy without endotracheal intubation. There was a reduction of bloating and flatulence for all procedures in the CO2 group.Conclusions:The benefits of using CO2 for insufflation were minimal in our patients. The observed transient elevations of EtCO2 during sedated upper endoscopy raise concerns of possible systemic hypercarbia. The wisdom of its routine use for all pediatric endoscopic procedures is questioned.
Family‐centered Outcomes that Matter Most to Parents
Authors: Simione Meg , Dartley Anna Nicole , Cooper‐Vince Christine , Martin Victoria , Hartnick Christopher , Taveras Elsie M. , Fiechtner Lauren 
Published: April 2020

ABSTRACTObjective:The purpose of this study was to examine the perspectives of caregivers of children with feeding disorders. We sought to understand their child's feeding impairment through the lens of caregivers, including the impact impairments had on daily life and social participation, what outcomes matter most to caregivers, contextual determinants that affect achieving desired outcomes, and how treatment approaches can optimally support families.Methods:We interviewed caregivers of children, ages 2 to 5 years, who received care at the Center for Feeding and Nutrition at MassGeneral Hospital for Children in Boston, MA. All children had a feeding disorder diagnosis, defined as an impairment in oral intake. We analyzed interview transcripts using principles of immersion‐crystallization.Results:We reached thematic saturation after interviewing 30 caregivers (25 female). 66.7% of the children were white, 13.3% Asian, 10.0% black, and 10.0% were more than 1 race. Thirty percent were Hispanic. We identified four themes: feeding impairments impact the daily life and social participation of children; improving their child's health and quality of life is most important to caregivers; child, caregiver, and community factors are facilitators of achieving desired outcomes; whereas time, financial, access, and knowledge factors are barriers; and caregivers prefer treatment approaches that incorporate principles of family‐centered care.Conclusions:Given the daily life and social participation impacts of pediatric feeding disorders, treatment approaches should be family‐centered, focus on functional and meaningful outcomes to improve the health and quality of life of children and their families, and address modifiable sociocontextual determinants.
Routine Screening for Celiac Disease in Children With Down Syndrome Improves Case Finding
Authors: Liu Edwin , Wolter‐Warmerdam Kristine , Marmolejo Juana , Daniels Dee , Prince Garrett , Hickey Fran 
Published: April 2020

ABSTRACTObjectives:Children with Down syndrome have an estimated 6‐fold increased risk of developing celiac disease in the United States compared with the general population, yet the determination to screen for celiac disease in this population is not agreed upon. The objectives of this study are to assess the prevalence of celiac disease in children with Down syndrome in our center and compare features from this population identified clinically and through screening.Methods:This is a retrospective chart review of 1317 children with Down syndrome who received treatment at a single institution from 2011 to 2017. All participants (n = 90; 53.3% boys) met inclusion criteria of celiac disease diagnosis between 1 month and 22 years of age and Down syndrome. Clinical details were collected, which included the results from celiac disease screening tests, reason for diagnosis and/or testing, symptoms, nutrition notes, demographics, comorbidities, and outcomes.Results:Prevalence of celiac disease in our population of children with Down syndrome ages 3 years or older was 9.8%. Mean age at diagnosis was 9.24 years (SD = 4.98) with an average of 2.85 years (SD ± 3.52) lag from the onset of symptoms to diagnosis for children clinically identified in comparison with 1.69 years (SD ± 2.09) for children identified through routine screening. Eighty‐two percentage of clinic patients received a diagnosis of celiac disease because of routine screening compared with clinical testing based on identified symptoms alone.Conclusion:Our results suggest the need for routine celiac disease screening in children with Down syndrome to improve case‐finding and avoid diagnostic delay.
Pediatric Endoscopy in the Era of Coronavirus Disease 2019
Authors: Walsh Catharine M. , Fishman Douglas S. , Lerner Diana G. ,   NASPGHAN Endoscopy and Procedures Committee
Published: April 2020

ABSTRACTThe delivery of endoscopic care is changing rapidly in the era of Coronavirus Disease 2019 (COVID‐19). The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Endoscopy and Procedures Committee has formulated this statement to offer practical guidance to help standardize endoscopy services for pediatric patients with the aim of minimizing COVID‐19 transmission to staff, patients, and caregivers and to conserve personal protective equipment (PPE) during this critical time. Appropriate use of PPE is essential to minimize transmission and preserve supply. Pediatric endoscopic procedures are considered at high risk for COVID‐19 transmission. We recommend that all pediatric endoscopic procedures are done in a negative pressure room with all staff using proper airborne, contact, and droplet precautions regardless of patient risk stratification. This includes appropriate use of a filtering face‐piece respirator (N95, N99, FFP2/3, or PAPR), double gloves, facial protection (full visor and/or face shield), full body water‐resistant disposable gown, shoe covers and a hairnet. In deciding which endoscopic procedures should proceed, it is important to weigh the risks and benefits to optimize healthcare delivery and minimize risk. To inform these decisions, we propose a framework for stratifying procedures as emergent (procedures that need to PROCEEED), urgent (PAUSE, weigh the benefits and risks in deciding whether to proceed) and elective (POSTPONE procedures). This statement was based on emerging evidence and is meant as a guide. It is important that all endoscopy facilities where pediatric procedures are performed follow current recommendations from public health agencies within their jurisdiction regarding infection prevention and control of COVID‐19.
A Novel PUS1 Mutation in 2 Siblings with MLASA Syndrome: A Review of the Literature
Authors: Oncul Ummuhan , Unal-Ince Elif , Kuloglu Zarife , Teber-Tiras Serap , Kaygusuz Gulsah , Eminoglu Fatma T. 
Published: April 2020

Abstract:
Myopathy, lactic acidosis, and sideroblastic anemia (MLASA) is a rare mitochondrial disorder characterized by MLASA. Variable features of this condition include failure to thrive, and developmental delay or intellectual disability. Additional symptoms consist of cognitive impairment, skeletal and dental abnormalities, delayed motor milestones, cardiomyopathy, dysphagia, and respiratory insufficiency. MLASA has previously been associated with mutations in pseudouridylate synthase 1 (PUS1) and YARS2. PUS1 encodes the nuclear PUS1 enzyme, which is located in both the nucleus and the mitochondria. PUS1 converts uridine into pseudouridine in several cytosolic and mitochondrial transfer RNA positions and increases the efficiency of protein synthesis in both compartments.
In the present report, we report on 2 Turkish sisters 4 and 11 of years with an MLASA plus phenotype. Both patients have sideroblastic anemia, lactic acidosis, failure to thrive, developmental delay, and chronic diarrhea; in addition, the older sister has strabismus and skeletal anomalies. The sequencing of the PUS1 gene revealed a novel homozygous p.Glu311* mutation. The phenotype of the older sibling is also unique because of the strabismus and skeletal anomalies, when compared with her sister and other previously reported patients with MLASA. The structural differences in the nuclear versus mitochondrial isoforms of PUS1 and modifier genes may be implicated in the variability of the clinical presentations in MLASA.

Conclusion:
This report adds to the growing number of mutations causing complex clinical manifestations of MLASA including lactic acidosis, sideroblastic anemia, chronic diarrhea, and myopathy.
Clinical Utility of Anaerobic and Fungal Blood Cultures in the Pediatric Oncologic Population
Authors: Kumar Madan , Campos Joseph , Hanisch Benjamin 
Published: April 2020

Background:
If there is a concern for sepsis in a pediatric patient an aerobic blood culture is obtained. A febrile or ill oncology patient will often be evaluated with aerobic, anaerobic, and fungal blood cultures. There is to our knowledge little evidence to confirm the added benefit of broadly obtaining these cultures.

Methods:
A retrospective analysis of blood cultures from patients in the oncology and hematopoietic stem cell transplant wards at Children’s National Medical Center between January 2010 and April 2017. Positive anaerobic and fungal cultures were evaluated for corollary positive aerobic cultures from the same time frame (+/−24 h). Unique isolates were designated as those positive anaerobic and fungal cultures without positive aerobic cultures and evaluated with detailed chart review.

Results:
A total of 10,950 cultures were evaluated during the study period: 6579 aerobic, 2391 anaerobic cultures, 1980 fungal. In total, 419 positive aerobic, 140 positive anaerobic, and 43 positive fungal cultures were reviewed. Among these, 22 unique anaerobic cultures and 21 unique fungal cultures met case criteria. Only 7 cultures of obligate anaerobes were observed: 4 Clostridial spp., 2 Propionobacterium acnes, and 1 Peptostreptococcus spp. Thirteen of 21 fungal isolates consisted of a single colony and were regarded as probable contaminants. Penicillium, Cladosporium, and dematiaceous molds were in greatest frequency. Potential risk factors for patients with breakthrough isolates were evaluated and described.

Conclusions:
There is little increased yield from the use fungal and anaerobic blood cultures in addition to aerobic blood cultures in the routine evaluation of pediatric oncology and bone marrow transplant patients. Fungal and anaerobic blood cultures and should be reserved for cases with high clinical suspicion.
Quantitative HIV-1-specific antibodies as predictors of peripheral blood cell-associated HIV-1 DNA concentrations
Authors: McManus Margaret , Karalius Brad , Patel Kunjal , Persaud Deborah , Luzuriaga Katherine 
Published: April 2020

Objective:
This study evaluated HIV-1 antibody levels as predictors of cell-associated HIV-1 DNA levels in perinatally infected (PHIV) children with long-term viral suppression on antiretroviral therapy (ART).

Design:
HIV-1 antibody and HIV-1 DNA levels were measured in blood specimens from 61 children and adolescents from the Pediatric HIV/AIDS Cohort Study: Adolescent Master Protocol. Twenty perinatally HIV-1-exposed, uninfected children studied through 2 years served as controls.

Methods:
HIV-1 IgG antibodies to six HIV-1 proteins were measured by quantitative ELISA; HIV-1 DNA levels were measured by droplet digital PCR.

Results:
Among 13 children with viral suppression at less than 1 year, antibodies to gp160 and gp41 were low but stable longitudinally; antibodies to p17, p24, and RT decreased, and antibodies to p31 were low or undetectable. Among 48 children with viral suppression between 1 and 5 years, antibody levels to all six HIV-1 proteins were higher than in children with earlier viral suppression and remained high over time. A receiver operator curve approach identified gp41 and gp160 as useful predictors of HIV-1 DNA less than 10 or less than 100 copies per million PBMC (cpm); C-statistics including all antibodies ranged from 0.75 to 0.77. An ensemble learning approach also identified gp41 and gp160 as important predictors of HIV-1 DNA less than 10 or less than 100 cpm; area under the curve estimates utilizing all HIV-1 antibodies ranged from 0.70 to 0.81.

Conclusion:
Quantitative HIV-1 gp41 and gp160 antibody levels may serve as rapid, inexpensive screening tools for low PBMC HIV-1 DNA levels in children with viral suppression on ART, facilitating inclusion into remission protocols.
Psychiatric trajectories across adolescence in perinatally HIV-exposed youth: the role of HIV infection and associations with viral load
Authors: Nguyen Nadia , Choi C. Jean , Robbins Reuben , Korich Rehema , Raymond Jeanette , Dolezal Curtis , Leu Cheng-Shiun , Wiznia Andrew , Abrams Elaine J. , Mellins Claude A. 
Published: April 2020

Objective:
Identify factors associated with trajectories of psychiatric disorder among 340 adolescents and young adults (AYA) living with perinatal HIV infection (PHIV) and perinatal HIV-exposure but not infection (PHEU).

Design:
Longitudinal cohort study of AYA in New York City, 9–16 years at enrollment.

Methods:
We used multivariate longitudinal latent class analysis to identify trajectories of psychiatric disorder, and logistic regression to examine predictors of trajectories (e.g. PHIV status) and associations between trajectories and viremia in young adulthood (AYA with PHIV only).

Results:
Among all AYA, we identified three psychiatric trajectories: relatively ‘low disorder’ (63%), ‘consistent anxiety’ (26%), and ‘escalating comorbidity’ (11%). Compared with AYA with ‘low disorder’, AYA with ‘escalating comorbidity’ were significantly older, reported more neighborhood stress, and lived with a caregiver with alcohol use disorder, whereas AYA with ‘consistent anxiety’ were more likely female individuals. Although we found no statistically significant HIV status differences, among AYA with PHIV, nearly half (48%) were viremic in young adulthood, with higher odds of viremia among AYA with ‘escalating comorbidity’ (OR: 3.88, 95% CI: 0.93–16.26) and ‘consistent anxiety’ (OR: 2.41, 95% CI: 1.011–5.75) compared with ‘low disorder’.

Conclusion:
Despite significant adversity, AYA with PHIV and PHEU had relatively low prevalence of psychiatric disorder over time, although one-third had consistent or escalating psychiatric disorders. Among AYA with PHIV, psychiatric trajectories were associated with viremia in young adulthood. Given the growing population of AYA living with PHIV and PHEU worldwide, addressing the substantial and evolving mental health needs of both groups as they reach young adulthood is critical.
Incident infection in high-priority HIV molecular transmission clusters in the United States
Authors: Wertheim Joel O. , Panneer Nivedha , France Anne Marie , Saduvala Neeraja , Oster Alexandra M. 
Published: April 2020

Objective:
To identify correlates of incident HIV infection in rapidly growing HIV molecular clusters.

Design:
Phylogenetic analysis of HIV public health surveillance data.

Methods:
High-priority HIV genetic transmission clusters with evidence of rapid growth in 2012 (i.e. clusters with a pairwise genetic distance ≤0.005 substitutions/site and at least three cases diagnosed in 2012) were identified using HIV-TRACE. Then, we investigated cluster growth, defined as HIV cases diagnosed in the following 5 years that were genetically linked to these clusters. For clusters that grew during the follow-up period, Bayesian molecular clock phylogenetic inference was performed to identify clusters with evidence of incident HIV infection (as opposed to diagnosis of previously infected cases) during this follow-up period.

Results:
Of the 116 rapidly growing clusters identified, 73 (63%) had phylogenetic evidence for an incident HIV case during the 5-year follow-up period. Correlates of an incident HIV case arising in clusters included a greater number of diagnosed but virally unsuppressed cases in 2012, a greater number of inferred undiagnosed cases in the cluster in 2012, and a younger time of most recent common ancestor for the cluster.

Conclusion:
These findings suggest that incident infections in rapidly growing clusters originate equally from diagnosed but unsuppressed cases and undiagnosed infections. These results highlight the importance of promoting retention in care and viral suppression as well as partner notification and other case-finding activities when investigating and intervening on high-priority molecular transmission clusters.
Effectiveness of dolutegravir-based antiretroviral therapy in a real-world setting in a Belgian cohort of 4101 HIV patients
Authors: Nasreddine Rakan , Florence Eric , Vandercam Bernard , Moutschen Michel , Goffard Jean-Christophe , De Munter Paul , Delforge Marc , Marinus Wouter , De Wit Stéphane 
Published: April 2020

Objective:
To describe the treatment outcomes of patients receiving dolutegravir (DTG) in a ‘real-world setting’ in Belgium.

Design:
Retrospective, observational, multicenter cohort.

Methods:
Inclusion criteria: HIV-1 patients at least 18 years old having received DTG as part of their combined antiretroviral therapy (cART) between 1 April 2014 and 1 December 2017. Primary endpoint: rate of virologic suppression, defined as plasma HIV-1 viral load less than 50 copies/ml, at weeks 24, 48, and 96. Secondary endpoints: durability, expressed as probability of experiencing loss of virologic suppression by week 96 (defined as two consecutive HIV-1 viral load measurements of at least 200 copies/ml after having initially achieved virologic suppression); immunological response at weeks 24, 48, and 96; incidence of and reasons for DTG discontinuation; and change in weight at week 96.

Results:
Four thousand, one hundred and one patients were included. Through 96 weeks, virologic suppression rate was 96% (on-treatment analysis), probability of experiencing loss of virologic suppression was 7%, and mean increase in CD4+ cell count was 100 cells/μl (SD 220). There were 785 (19.1%) discontinuations of DTG (8.9 discontinuations per 100 patient-years). The most common cause of discontinuation was an adverse drug reaction (ADR; 9.5%) with neuropsychiatric toxicity being the most prevalent (5.2%; 2.4 discontinuations per 100 patient-years). By week 96, the median change in weight for the study population was +2.0 kg (IQR −1 to 5).

Conclusion:
In this large cohort, DTG showed excellent virologic efficacy and was generally well tolerated. Whether DTG results in undesirable weight gain or rather statistically significant results, remains a debate.
Monocyte and CD4+ T-cell antiviral and innate responses associated with HIV-1 inflammation and cognitive impairment
Authors: Sharma Vishakha , Bryant Christopher , Montero Maria , Creegan Matthew , Slike Bonnie , Krebs Shelly J. , Ratto-Kim Silvia , Valcour Victor , Sithinamsuwan Pasiri , Chalermchai Thep , Eller Michael A. , Bolton Diane L. 
Published: April 2020

Objective:
Mechanisms underlying immune activation and HIV-associated neurocognitive disorders (HAND) in untreated chronic infection remain unclear. The objective of this study was to identify phenotypic and transcriptional changes in blood monocytes and CD4+ T cells in HIV-1-infected and uninfected individuals and elucidate processes associated with neurocognitive impairment.

Design:
A group of chronically HIV-1-infected Thai individuals (n = 19) were selected for comparison with healthy donor controls (n = 10). Infected participants were further classified as cognitively normal (n = 10) or with HAND (n = 9). Peripheral monocytes and CD4+ T cells were phenotyped by flow cytometry and simultaneously isolated for multiplex qPCR-targeted gene expression profiling directly ex vivo. The frequency of HIV-1 RNA-positive cells was estimated by limiting dilution cell sorting.

Results:
Expression of genes and proteins involved in cellular activation and proinflammatory immune responses was increased in monocytes and CD4+ T cells from HIV-1-infected relative to uninfected individuals. Gene expression profiles of both CD4+ T cells and monocytes correlated with soluble markers of inflammation in the periphery (P < 0.05). By contrast, only modest differences in gene programs were observed between cognitively normal and HAND cases. These included increased monocyte surface CD169 protein expression relative to cognitively normal (P = 0.10), decreased surface CD163 expression relative to uninfected (P = 0.02) and cognitively normal (P = 0.06), and downregulation of EMR2 (P = 0.04) and STAT1 (P = 0.02) relative to cognitively normal.

Conclusion:
Our data support a model of highly activated monocytes and CD4+ T cells associated with inflammation in chronic HIV-1 infection, but impaired monocyte anti-inflammatory responses in HAND compared with cognitively normal.