Prevalence of chronic otitis media with effusion in a pediatric tracheotomy population: a retrospective review.

The prevalence of chronic otitis media with effusion (COME) was investigated in a 4-year retrospective study of a pediatric tracheotomy population followed in the outpatient Tracheotomy-Ventilation Clinic of Children's Hospital of Wisconsin. After exclusions, 83 patients comprised the study population. In a given patient, COME was defined by the presence of middle ear effusion in more than 50% of ear evaluations during the 4-year study period, or tympanostomy tube placement. The prevalence of COME was 60% in the study population as a whole. Special population groups had prevalence as follows: 90% in craniofacial anomaly patients, 79% in chronically ventilated patients, and 48% in nonventilated patients. Chronically ventilated patients had a statistically significant higher prevalence of COME than the nonventilated group (P < 0.025). These data indicate that COME is a prevalent condition in the pediatric tracheotomy population.     

Bacterial colonisation withXanthomonas maltophilia — A retrospective study in a cystic fibrosis patient population

Summary Xanthomonas maltophilia was isolated from 25 of 150 patients with cystic fibrosis during a period of 10 years (1983–1992). Twelve patients harbouredX. maltophilia chronically, i.e. repeatedly for more than 6 months. No predisposing factors for the colonisation could be identified by studying the clinical and laboratory data of the patients, including preceding and concurrent bacterial colonisation with other bacteria, antibacterial treatments, pulmonary function and biochemical markers. Up to 2 years after the chronic colonisation was established no clinical deterioration could be verified, but the patients withX. maltophilia generally had a worse lung function at the latest follow-up (2–7 years after colonisation) than controls colonised withPseudomonas aeruginosa (p<0.05). Our data imply thatX. maltophilia is a pathogen and the colonisation appears to follow the same pattern as the colonisation byP. aeruginosa. The development of resistance to different antibiotics, as revealed by analysis of the inhibition zones, was related to antibacterial treatment courses.X. maltophilia showed reduced sensitivity to the most commonly used antibiotics, ceftazidime and tobramycin.

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Bakterielle Kolonisierung mitXanthomonas maltophilia bei Patienten mit zystischer Fibrose — Eine retrospektive Studie

Zusammenfassung Xanthomonas maltophilia wurde bei 25 von 150 Patienten während eines Zeitraumes von 10 Jahren (1983–1992) isoliert. 12 Patienten hatten eine chronische Kolonisierung, das heißt bestehend während mehr als 6 Monaten. Prädisponierende Faktoren konnten bei der Analyse der klinischen Daten und Labordaten nicht festgestellt werden, frühere und gleichzeitige Kolonisierung mit anderen Bakterien, Lungenfunktion und biochemische Parameter inbegriffen. Bis zu 2 Jahre nachdem die chronische Kolonisierung etabliert worden war, fanden wir keine klinische Verschlechterung. Die langfristige Verlaufskontrolle (2–7 Jahre) zeigte, daß Patienten mitX. maltophilia meistens eine schlechtere Lungenfunktion hatten als Kontrollfälle, die mitPseudomonas aeruginosa kolonisiert worden waren (p<0,05). Unsere Daten deuten an, daß bei Patienten mit zystischer FibroseX. maltophilia ein pathogener Erreger ist und die Kolonisierung nach demselben Muster zu erfolgen scheint wie die Kolonisierung mitP. aeruginosa. Die Entwicklung der Antibiotikaresistenz wurde durch Bestimmung der Hemmzonen im Verhältnis zu Antibiotikabehandlungen verfolgt.X. maltophilia zeigte eine herabgesetzte Empfindlichkeit gegen die meisten Antibiotika. In unserer Serie gab es eine markante Resistenzentwicklung gegen Ceftazidim und Tobramycin während der chronischen Kolonisierung.

     

A family study of lymphedema of the leg in a lymphatic filariasis-endemic area

The risk of filarial lymphedema may not be equivalent for all members of filaria-exposed populations. While evidence for a genetic factor that influences acquisition of infection has been growing, very little work has addressed whether there is a genetic basis to the development of disease due to lymphatic filariasis. We designed a family study of lymphedema in a rural community in Haiti to assess disease aggregation. Three hundred sixty-eight female patients sixteen years of age or older were enrolled at a lymphedema treatment clinic between June 1995 and December 1999. After applying additional eligibility criteria, 172 probands were enrolled into the family study for detailed pedigree collection between September 1998 and December 1999. Fifty-three lymphedema cases were identified among the probands' parents, full-siblings, children, half-siblings, and mating partners of the parents. Twelve of the 53 cases were among males. The proportion of cases occurring in a biologic parent of the proband was higher than in unrelated individuals married into the proband's family (P = 0.0010). This is the first large family study based on pedigrees to assess the familial aggregation of lymphedema due to filariasis. This family study will be useful to investigate the role of genes and environment in the development of filarial-related lymphedema.     

Percentage of coronary anomalies in a population of patients undergoing coronary angiography: a retrospective study.

Coronary artery anomalies, although less frequent than congenital anomalies of the heart chambers and valve morphology, should be considered in a wide range of ages, in both sexes and as a possible etiology in myocardial ischemia, infarction, and sudden death, as well as in the planning of heart surgery for coronary revascularization, correction of congenital heart malformations or valve replacement. Between January 1996 and June 2002 we reviewed our catheterization database and carried out a retrospective study of the 3660 angiographies performed in our cardiology department. The patients were referred for positive ischemic test, acute coronary syndrome and/or valvular heart disease. From the 3660 angiographies we identified 25 patients (0.68%) with coronary artery anomalies and report the prevalence and types of these anomalies in the population studied. We also assessed the presence of coronary artery disease.     

Access to pediatric subspecialty care: a population study of pediatric rheumatology inpatients in California

Objective

To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.

Methods

This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of pediatric rheumatology hospitalizations in California between 1999 and 2007. We used logistic regression to examine the relationship between hospitalization in specialty care centers with a pediatric rheumatologist and nonclinical patient characteristics.

Results

A total of 18,641 pediatric discharges revealed that 57% were discharged from a specialty care center with a pediatric rheumatologist. Multivariate analysis showed that the factors associated with increased utilization of specialty care centers with a pediatric rheumatologist were public insurance (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.51–1.74; P < 0.0001), being Hispanic (OR 1.29, 95% CI 1.19–1.40; P < 0.0001) or Asian non‐Hispanic (OR 1.39, 95% CI 1.26–1.54; P < 0.0001), and high pediatric rheumatology specialty care bed supply (OR 2.79, 95% CI 2.49–3.14; P < 0.0001). A decreased utilization of specialty care centers with a pediatric rheumatologist was seen for patients ages <1 year (OR 0.45, 95% CI 0.40–0.52; P < 0.0001), ages 1–4 years (OR 0.50, 95% CI 0.46–0.55; P < 0.0001), ages 5–9 years (OR 0.68, 95% CI 0.62–0.75; P < 0.0001), ages 15–18 years (OR 0.51, 95% CI 0.47–0.56; P < 0.0001), males (OR 0.75, 95% CI 0.70–0.80; P < 0.0001), and patients residing farther away from a specialty care center with a pediatric rheumatologist (OR 0.57, 95% CI 0.51–0.63; P < 0.0001).

Conclusion

Nonclinical factors play an increasingly important role in the hospitalization patterns of pediatric rheumatology patients in California. Understanding these factors is crucial if we are to ensure that the variation in access to care reflects clinical need.     

Thyroglobulin reference values in a pediatric infant population.

Few reports have addressed normal serum thyroglobulin (Tg) values in newborns and infants. In the present study, serum Tg was measured in 228 normal children (110 females and 118 males) aged from 3 to 180 days of life, all presenting normal age-related serum thyrotropin (thyroid-stimulating hormone [TSH]) values and negative anti-Tg and antithyroperoxidase antibodies. Serum Tg was measured by Radioimmunoassay (RIA) (two methods) and Immunometricassay (IMA) (three methods). Mean Tg values measured by the five methods exhibited among-method biases, although a significant positive correlation was observed. Serum Tg levels measured by the five methods showed a correlation with age, but not with TSH or gender. During the first days of life, relatively high mean Tg levels were observed, which progressively decreased until they reached a plateau. Therefore, with the aim of establishing reference values, the population was separated into two age groups: from 3 to 15 days of life (group A) and from 16 to 180 days of life (group B). Mean Tg concentration in group A was statistically higher than in group B. Tg centile distributions were calculated with the aim of establishing the normal levels of serum Tg for each method. We conclude that for a correct interpretation of serum Tg levels, the age and the methods used should be considered.     

A retrospective study for the analysis of collateral effects of amiodarone

We analyzed retrospectively 130 patients treated with amiodarone. They were seen at the Arrhythmias Clinic of this Institute from march 1981 until may 1988 with the purpose of evaluate the frequency of the side effects of the drug. The group of patients consisted of 67 men and 63 women, the mean age was 32 years and they were followed for about 32 months. The average dose of the drug was 1.069 gr per week. All of them had a physical and radiological examination, an ECG and laboratory tests. Besides, 86 patients went through an electrophysiological study at least once. One hundred and eighteen patients had periodical tests for thyroid function. All of the patients had a check up every 3 or 6 months. Results: the response to the drug was good or even excellent in 83% of patients. They did not show electrocardiographic changes of statistic significance (duration of the PR, QRS or QT). The ophthalmologic examination showed corneal deposits in 48% of patients, but in no case there was indication to stop the treatment. Ten patients had a spontaneous regression of these deposits. Alterations of the thyroid function were seen in 33.8% of patients, 14 had hypothyroidism and seven hyperthyroidism, the others simple goitre. In four of these cases the drug was discontinued. Dermatologic lesions were seen in only 4% of patients. Despite the high frequency of side effects the need for stopping the treatment was low, with a high percentage of drug efficacy.     

Cardiovascular risk and the COVID-19 pandemic: A retrospective observational study in a population of healthcare professionals

Background and aimTo contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly causing an increase in unhealthy habits. We investigated changes in cardiovascular (CV) risk assessed by the SCORE-2 in a healthy population of healthcare workers during the COVID-19 pandemic; an analysis by subgroups was also conducted (sportspeople vs sedentary subjects).Methods and resultsWe compared medical examination and blood tests in a population of 264 workers aged over 40, performed yearly before (T0) and during the pandemic (T1, T2). We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile at T0 (2.35%) to a mean high-risk profile at T2 (2.80%). Furthermore, in sedentary subjects was observed a greater and early increase in SCORE-2 compared to sportspeople.ConclusionsSince 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines.     

A nomogram for estimating the probability of nonalcoholic fatty liver disease in a Chinese population: A retrospective cohort study

Studies have showed that dyslipidemia is closely related to nonalcoholic fatty liver disease (NAFLD). However, less attention has been paid to the relationship between early dyslipidemia and long-term risk of NAFLD. Therefore, we aimed to develop a simple-to-use nomogram to predict early dyslipidemia and long-term risk of NAFLD onset.A retrospective cohort study including 3621 employees (including retirees) from 7 companies was conducted between 2012 and 2019. Anthropometric, potential laboratory parameters and abdominal ultrasound were performed at baseline and after a 5-year follow-up. Cox proportional hazards model was used to determine predictors for NAFLD onset. The effects of lipids, age, body mass index (BMI), and serum uric acid (UA) on NAFLD were evaluated with the use of Kaplan–Meier curves (log-rank test). A nomogram was developed based on the Cox proportional hazard model and a 2-piecewise linear regression model. The accuracy of model was evaluated according to the area under the receiver operating characteristic curves.A total of 1545 subjects were included in the final analysis. The mean follow-up time was 52 ± 6.6 months. Of the total subjects, 77.61% were male and 22.39% were female. The mean age at the time of initial visit was 45.21 ± 11.20 years. Five hundred fifty-five subjects (35.92% of all subjects) were finally diagnosed with NAFLD. Variables in the nomogram included age, BMI, triglycerides, high-density lipoprotein, low-density lipoprotein, and UA. The accuracy of the nomogram for predicting 5-year cumulative occurrence of NAFLD was 0.8135 (95% confidence interval: 0.7921–0.8349), and the sensitivity and specificity were 0.8108 and 0.6960, respectively.The combination of age, BMI, triglycerides, high-density lipoprotein, low-density lipoprotein, and UA translated into a nomogram can reliably estimate the incidence of NAFLD within 5 years. It may serve as a decision support tool to determine whether to intervene at an early stage.     

Severe hypoglycemia and ketoacidosis over one year in Italian pediatric population with type 1 diabetes mellitus: A multicenter retrospective observational study

Background and aimsEvaluation of incidence and correlates of severe hypoglycemia (SH) and diabetes ketoacidosis (DKA) in children and adolescents with T1DM.Methods and resultsRetrospective study conducted in 29 diabetes centers from November 2011 to April 2012. The incidence of SH and DKA episodes and their correlates were assessed through a questionnaire administered to parents of patients aged 0–18 years. Incidence rates and incident rate ratios (IRRs) were estimated through multivariate Poisson regression analysis and multilevel analysis. Overall, 2025 patients were included (age 12.4 ± 3.8 years; 53% males; diabetes duration 5.6 ± 3.5 years; HbA1c 7.9 ± 1.1%). The incidence of SH and DKA were of 7.7 and 2.4 events/100 py, respectively. The risk of SH was higher in females (IRR = 1.44; 95%CI 1.04–1.99), in patients using rapid acting analogues as compared to regular insulin (IRR = 1.48; 95%CI 0.97–2.26) and lower for patients using long acting analogues as compared to NPH insulin (IRR = 0.40; 95%CI 0.19–0.85). No correlations were found between SH and HbA1c levels. The risk of DKA was higher in patients using rapid acting analogues (IRR = 4.25; 95%CI 1.01–17.86) and increased with insulin units needed (IRR = 7.66; 95%CI 2.83–20.74) and HbA1c levels (IRR = 1.63; 95%CI 1.36–1.95). Mother's age was inversely associated with the risk of both SH (IRR = 0.95; 95%CI 0.92–0.98) and DKA (IRR = 0.94; 95%CI 0.88–0.99). When accounting for center effect, the risk of SH associated with the use of rapid acting insulin analogues was attenuated (IRR = 1.48; 95%CI 0.97–2.26); 33% and 16% of the residual variance in SH and DKA risk was explained by center effect.ConclusionThe risk of SH and DKA is mainly associated with treatment modalities and strongly depends on the practice of specialist centers.     

A retrospective observational study of biomarker levels and severity assessment in pediatric community-acquired pneumonia

Multiple studies have investigated the role of biomarkers in predicting pneumonia severity in adults but minimal conclusive research exists for children. This study aimed to determine if the following biomarker levels, collected within 72 hours of hospital arrival: white blood cell count (WBC), platelet count, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-lymphocyte ratio, neutrophil count, or band count associated with community-associated pneumonia (CAP) severity in children.Methods:A retrospective chart review was conducted on children (aged 60 days to 18 years) diagnosed with CAP, and admitted to a regional, tertiary hospital (Charleston, WV, USA) for 3 years (2015–2018). Patients were stratified into 2 severity cohorts, mild (no ICU care), and moderate/severe (required ICU care). Biomarker values were then compared between the severity cohorts and area under the curve (AUC), and cut-off values and performance characteristics were calculated.Results:A total of 108 patients met inclusion criteria with 46% having moderate/severe CAP. Elevated levels of CRP (51.7 mg/L in mild vs. 104.8 mg/L in moderate/severe, P = .003, PCT (0.29 ng/ml in mild vs. 4.02 ng/mL in moderate/severe, P = .001) and band counts (8% in mild vs. 15% moderate/severe, P = .009) were associated with increased pneumonia severity. In predicting moderate/severe CAP, PCT had the highest AUC of 0.77 (P = .001) followed by bands AUC of 0.69 (P = .009) and CRP AUC of 0.67 (P = .003). Cut-off for PCT of 0.55 ng/mL had a sensitivity of 83% and a specificity of 65%. Cut-off level of 53.1 mg/L for CRP had a sensitivity of 79% and specificity of 52%. Cut off level of 12.5% bands had a sensitivity of 61% and specificity of 71%. In a multivariable model controlled for patient demographics and other biomarker levels, only PCT levels significantly predicted moderate/severe CAP (adjusted odds ratio: 1.40 [95% CI, 1.14–1.73], P = .002).Conclusion:Biomarkers, in particular PCT, obtained early in hospitalization may perform as possible predictors for CAP severity in children and be beneficial in guiding CAP management. However, biomarkers in pneumonia should not drive severity assessment or patient management independent of clinical presentation.     

Myocarditis in the pediatric population: A review

Myocarditis has a variable clinical presentation and there is still debate regarding accurate diagnostic criteria. Adding to the controversy surrounding this diagnosis, there is no clear consensus for the treatment or ongoing follow‐up of patients with myocarditis. All of this makes the diagnosis and management of myocarditis a particular challenge in the pediatric population. Furthermore, the literature with respect to this topic is dynamic and ever‐changing. In this review article, we aim to review and summarize the common clinical presentations of myocarditis, along with the latest recommendations for diagnostic criteria, treatment, and follow‐up of patients with myocarditis.     

Risk of metastasis in adenocarcinoma of the esophagus: a multicenter retrospective study in a Japanese population

Journal of Gastroenterology - Little is known about the specific risks of metastasis in esophageal adenocarcinoma in relation to invasion depth or other pathologic factors. We conducted a...