Months-18 Years Research Articles

Successful Treatment of Pediatric Generalized Pustular Psoriasis (GPP) with Spesolimab: 5 Case Reports and Evaluations of Circulating IL-36 Levels.

Generalized pustular psoriasis (GPP) is a rare, severe, and potentially life-threatening inflammatory cutaneous disease. IL-36 is a key treatment target in GPP. Spesolimab, a humanized monoclonal antibody of the IL-36 receptor, has demonstrated a good efficacy and a favorable safety profile in adults with GPP. However, data on its use in children are scarce. We treated patients aged 4-12 years with GPP with a single dose of spesolimab. The Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) total score, GPPGA pustulation sub-score, Generalized Pustular Psoriasis Area and Severity Index (GPPASI), and the Japanese Dermatological Association severity index for GPP were evaluated. The levels of IL-36α, IL-36β, and IL-36γ were detected by the magnetic bead-based immunoassays, and the levels of IL-17A, IL-17C, IFN-γ, TNF, IL-6, and IL-8 were measured by the Olink proximity extension assay technology. We included five patients (four boys and one girl) with a median age was 6.9 years old (range: 4.8 to 10.6 years), and a median age of onset of 1.7 years (range: 3 months-10 years and 5 months). After 1week of spesolimab administration, all patients had a total GPPGA score of 0/1 and pustulation subscore of 0, all patients had a GPPASI of 50, and four patients had a GPPASI of 75. Meanwhile, plasma levels of IL-36α, IL-36β, IL-36γ, IL-17A, IL-17C, IFN-γ, TNF, IL-6, IL-8 all decreased, and those of IL-36α, IL-36β, IL-17A, IL-17C, and IL-6 were statistically significant. There was no recurrence after 2 to 8 months of treatment. No other adverse event was recorded apart from one patient who experienced an upper respiratory infection in the first week. Spesolimab might be a prospective option for children aged 4 to 12 years.

Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital.

Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess. This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions. Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars. Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.

A systematic review of surgical and interventional radiology procedures for pediatric idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is defined as elevated intracranial pressure and consequent symptoms (mainly headache and visual deterioration) occurring in the absence of secondary causes. Surgical and interventional radiology procedures should be considered for refractory IIH and mainly include cerebrospinal fluid (CSF) diversion techniques, optic nerve sheath fenestration (ONSF), and venous sinus stenting (VSS). Our study aims to review the current literature on the application of these techniques in clinical practice. A systematic literature review on the surgical and interventional radiology treatment of IIH was conducted, focusing on ONSF, VSS, and CSF diversion techniques. According to PRISMA guidelines, all reports published in PubMed in the last 30 years (1993-2023) were considered, and among 722 papers, 48 were included in the present study, resulting in a total study population of 454 children or adolescents (11 months-17 years old). Among 454 patients, 193 underwent an invasive approach, divided into CSF diversion (115/193), ONSF (65/193), VSS (11/193), cranial subtemporal decompression (8/193), and internal cranial expansion (9/193). Sixteen of the 193 patients (8%) required reintervention due to relapsing symptoms or surgical complications, particularly those who underwent CSF diversion. Furthermore, 9/115 required shunt revision due to shunt obstruction or malfunction. We extracted data on the outcome of each procedure: of the 193 patients, 71 experienced a positive outcome with symptom resolution or improvement, while 27 demonstrated a negative outcome. Severe and refractory cases of IIH are eligible for invasive treatments. CSF diversion is the most frequently used technique, despite its high failure risk and need for reintervention. ONSF has shown good results in terms of outcome and safety, particularly in children with visual symptoms. VSS is the most recent approach, indicated in children with stenosis of the venous sinus. In our study population, VSS demonstrated good results in terms of symptom resolution and need for reintervention, but its use remains limited to a few centers. https://www.crd.york.ac.uk/, PROSPERO (CRD42024504244).

Prediction of depressive symptoms in young adults by polygenic score and childhood maltreatment: Results from a population-based birth cohort.

Childhood maltreatment is linked with later depressive symptoms, but not every maltreated child will experience symptoms later in life. Therefore, we investigate whether genetic predisposition for depression (i.e., polygenic score for depression, PGSDEP) modifies the association between maltreatment and depressive symptoms, while accounting for different types of maltreatment and whether it was evaluated through prospective and retrospective reports. The sample included 541-617 participants from the Quebec Longitudinal Study of Child Development with information on maltreatment, including threat, deprivation, assessed prospectively (5 months-17 years) and retrospectively (reported at 23 years), PGSDEP and self-reported depressive symptoms (20-23 years). Using hierarchical linear regressions, we found that retrospective, but not prospective indicators of maltreatment (threat/deprivation/cumulative) were associated with later depressive symptoms, above and beyond the PGSDEP. Our findings also show the presence of gene-environment interactions, whereby the association between maltreatment (retrospective cumulative maltreatment/threat, prospective deprivation) and depression was strengthened among youth with higher PGSDEP scores. Consistent with the Diathesis-Stress hypothesis, our findings suggest that a genetic predisposition for depression may exacerbate the putative impact of maltreatment on later depressive symptoms, especially when maltreatment is retrospective. Understanding the gene-environment interplay emerging in the context of maltreatment has the potential to guide prevention efforts.

Safety and efficacy of perventricular device closure of ventricular septal defects in children

Abstract Objectives To evaluate safety and efficacy of perventricular device closure techniques for the closure of ventricular septal defects (VSD) in children in United Arab Emirates. Methods In the year 2023-24, 13 children underwent per-ventricular device closures of VSD under the guidance of transesophageal echocardiography without cardiopulmonary bypass(CPB). The mean age at operation was 3.76 years (range 3 months-14 years). The ventricular septal defect sizes ranged from 2.7-6 mm. The device sizes ranged from 5-12mm. All patients except two required symmetrical device. Eight defects were peri membranous, 3 were sub-aortic and 2 were muscular. Ventricular septal defect occlusion device (Memoport, Beijing, China) were used through a 3-cm skin incision in the lower third of the sternum. Results All patients underwent VSD device closure successfully. The mean procedural duration was 42 minutes. None of the patients required CPB. The mean ventilation time and ICU stay was 3 hrs. and 24 hrs. respectively. None of the patients required inotropic support or blood transfusions. There were no residual shunt (except small shunt through the device), arrhythmias including heart block post operatively. At follow up, (3 months-7 months) there were no residual shunts, conduction disturbances, device dislodgement or major aortic or tricuspid valve complications. There was no mortality. Conclusions Perventricular device closure of VSD is highly successful, less invasive, safe and effective. It is associated with quick recovery, short length of stay and better cosmetic incision. Moreover, it avoids CPB.

Factors associated with the intention to vaccinate children: a Finnish population survey on influenza

Abstract Background Influenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences. Our aim was to assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children in Finland. Methods We conducted a survey among parents (n = 17,844) of eligible children (aged 6 months-6 years), selected randomly from five Finnish municipalities. Children and their parents were selected from high and low coverage areas, and the study was conducted in February-March 2022. Logistic regressions were used to determine associations between vaccination intention and e.g., sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study. Results Participation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent’s education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64% and realised vaccination 51%. Conclusions Despite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating. Key messages • Parental vaccine decision-making in settings where the vaccination is given free of charge is complex, and not always driven by intention to vaccinate. • Most parents had the intention to vaccinate, but some children still ended up not receiving their influenza vaccine.

The Role of GERD Diagnosis and Treatment in Preventing Lung Function Decline After Pediatric Lung Transplantation.

Gastroesophageal reflux disease (GERD) after lung transplantation (LuTx) can lead to chronic lung allograft dysfunction. Our aim was to assess the prevalence of GERD in pediatric LuTx recipients and to investigate the impact of medical and surgical GERD treatment on lung function. Ethical approval was obtained. Data of all consecutive patients who underwent LuTx from 2013 to 2023 and aged < 18 years at the time of the study were prospectively collected. A GERD diagnostic algorithm was established, including assessment of symptoms (vomiting, heartburn, regurgitation, cough, recurrent airway infections), bronchoscopy, forced expiratory volume in 1 second, and pH impedance. Further investigations included upper gastrointestinal series and esophagogastroduodenoscopy. Patients with GERD underwent medical treatment or fundoplication. Lung function was monitored. Thirty-six patients (2 months-18 years, 50% male) were included. Twenty-nine (80%) underwent spirometry, 16 (45%) pH impedance study, and 14 (39%) esophagogastroduodenoscopy. Twenty-two (61%) had no GERD symptoms and 12 (33%) showed normal pH impedance study or esophagogastroduodenoscopy. Fourteen (39%) patients had GERD symptoms, all 9 tested symptomatic patients (25%) had pathological GERD-specific diagnostics. Three (8%) patients underwent fundoplication after a median of 1.6 years (range 1.1-5.7 years) post-LuTx without surgical complications. After a median follow-up of 2.3 years (range 1.3-2.8 years) post-fundoplication, all (n = 3) had complete remission of GERD symptoms and lung function improvement. Lung function decline was observed in 6 (67%) of the tested symptomatic patients on proton-pump inhibitors (PPIs) treatment. Over one-third of our patients presented with GERD symptoms after LuTx. Symptoms and lung function may be reliable GERD indicators. Given the high prevalence of GERD, we suggest a routine posttransplant diagnostic algorithm including pH impedance study. Eighty percent of all symptomatic patients had a lung function decline despite PPI. Fundoplication is safe and may improve long-term outcome in pediatric LuTx recipients.

Longitudinal Structural and Functional Evaluation of Dark-without-Pressure Fundus Lesions in Patients with Autoimmune Diseases.

The main objective of this study was to report and investigate the characteristics and longitudinal changes in dark-without-pressure (DWP) fundus lesions in patients with autoimmune diseases using multimodal imaging techniques. In this retrospective observational case series, five patients affected by ocular and systemic autoimmune disorders and DWP were examined. DWP was assessed by multimodal imaging, including color fundus photography (CFP), near-infrared reflectance (NIR), blue reflectance (BR), blue autofluorescence (BAF), optical coherence tomography (OCT), OCT-angiography (OCT-A), fluorescein angiography (FA) and indocyanine green angiography (ICGA), and functional testing, including standard automated perimetry (SAP) and electroretinography (ERG). Follow-up examinations were performed for four out of five patients (range: 6 months-7 years). DWP fundus lesions were found in the retinal mid-periphery and were characterized by the hypo-reflectivity of the ellipsoid zone on OCT. DWP appeared hypo-reflective in NIR, BR and BAF, and exhibited hypo-fluorescence in FA in two patients while showing no signs in one patient. ICGA showed hypo-fluorescent margins in one patient. SAP and ERG testing did not show alterations attributable to the DWP lesion. Follow-up examinations documented rapid dimensional changes in DWP even in the short term (1 month). This study suggests a possible association between autoimmune diseases and DWP. New FA and ICGA features were described. The proposed pathogenesis hypotheses may operate as a basis for further investigation of a lesion that is still largely unknown. Large population studies would be necessary to confirm whether there is a higher incidence of DWP in this patient category.

7503 Light Composition Alters Feline Stress in a Shelter Environment

Abstract Disclosure: A.M. Yaw: None. M.E. Gardella: None. J. Jacobs: None. H.M. Hoffmann: None. Millions of cats enter animal shelters each year. Unfortunately, due to high numbers of cats entering shelters and limited physical housing space, over 50% of healthy and adoptable cats with extended shelter stays are euthanized yearly. While animal shelters are essential for keeping cats safe from unfit living conditions, they are a stressful environment. High stress in cats increases health risks and undesirable behaviors and is associated with reduced adoptions. Given the role of light in regulating hormonal stress responses and behavior, we partnered with a Midwestern animal control and shelter to evaluate how light intensity and light composition impact feline behavior and urinary cortisol levels in 123 domestic cats (Felis catus; 65 male and 58 female). The impact of three lighting conditions, white, dim, and orange (blue-depleted) light, were evaluated for the first 5-6 days following admittance into the shelter. Individually housed adults (8 months-10 years) were outfitted with PetPace Smart Collars to evaluate locomotor activity, and cat stress was evaluated daily through urine samples and a behavioral approach test. All data were analyzed by experimenters who were blind to the groups and tested via one or two-way ANOVA or repeated measures mixed-effects model with Geisser-Greenhouse correction. Urinary cortisol levels were dependent on both light quality and day in shelter, where cats under orange light had reduced cortisol on days 4-5 in the shelter compared to cats in standard lighting. Light quality also altered cat hiding behavior, such that the percentage of cats hiding was increased on dim light compared to both standard and orange light. A novel behavioral approach task found reduced cat stress on days 4-5 in standard and orange light; however, dim light increased cat stress on day 5 in shelter. All cats exhibited circadian rhythms in locomotor activity with periods ranging from 21.33-35.67h independent of light condition and day in shelter, and locomotor activity increased on days 3-4 compared to day 2 in the shelter, with no effect of light condition. There were no sex differences in in hiding, PetPace activity, or cat stress scores under any light condition; however, females displayed increased urinary cortisol levels compared to males in standard, but not dim or orange, light. This shows for the first time that room light manipulation can help shelters enact easy and inexpensive changes that make the adjustment period shorter and less stressful for incoming cats which will improve animal wellbeing. Presentation: 6/1/2024

Incidence of an Identifiable Organism in Children Who Underwent a Surgical Procedure for Granulomatous Cervical Lymphadenopathy.

Objectives: The incidence of cervical lymphadenopathy due to nontuberculous mycobacteria is rising in the pediatric population. Our goal with this study was to review the number of pediatric patients with granulomatous cervical adenitis and determine the incidence of identification of a specific organism as both healthcare providers and parents are interested in identifying the causative pathogen. Methods: A retrospective chart review was conducted of patients at a high-volume tertiary care children's hospital between 2017 and 2023. Children were included if they underwent a surgical procedure for lymphadenopathy. Pathology, microbiology, and other laboratory reports were reviewed to document the presence of granulomatous cervical adenitis and the incidence of identification of a specific organism. Additional data collected included patient demographics and type of procedure. Results: Of the 1538 charts reviewed, 163 patients underwent an inclusionary procedure. Mean patient age was 10.7 years (range 2.4 months-20 years), 70 (43%) were female, 25 (15%) had granulomatous cervical adenitis, and a specific organism was identified in 9 of these. Conclusion: Despite the availability of a number of ancillary tests, our data demonstrate that the identification of a specific pathogen in cases of granulomatous cervical lymphadenitis is rare. As a result, physicians should be prepared to rely primarily on the history and physical exam findings to determine a working diagnosis as well as a medical and/or surgical treatment plan.

Surface Electromyography and Gait Features in Patients after Anterior Cruciate Ligament Reconstruction.

An important reason for the poor recovery of anterior cruciate ligament (ACL) injuries is the poor recovery of muscle function. Therefore, we used surface electromyography (sEMG) and gait analysis to explore the muscle activation patterns and gait characteristics between lower limbs under different exercise states in patients, following anterior cruciate ligament reconstruction (ACLR). Forty-one adults with unilateral ACL injuries in Binzhou Medical University Hospital from October 2022 to June 2023 were allocated to three groups according to the time after ACL reconstruction: group A (≤3 months, 16), group B (3 months-1 year, 13), and group C (>1 year, 12). Patients were tested by sEMG and gait, while straight leg raising (SLR), walking at normal speed, fast walking, and walking up and down the stairs. Two related sample tests were performed for the normalized root mean square (RMS) values and gait parameters. Muscle function changes varied in different training tasks. The RMS value of the involved side was more than the uninvolved side in biceps femoris and semitendinosus of group A (p < 0.010), and for the bilateral rectus femoris (RS), vastus medialis (VM), and vastus lateralis in group B, only the comparison of the RS was significant in group C during fast walking and going up and down the stairs. The ground impact (0.90 [0.63, 1.33] vs. 0.71 [0.43, 1.02], p = 0.035) of the uninvolved side was significantly decreased compared to those of the involved side in patients with ACLR when going down the stairs. Different muscles need to be focused on at different stages of the postoperative period. sEMG and gait analysis can guide the development of a rehabilitation program.

Prevalence and associated risk factors of myocardial ischemia in children living with sickle cell anemia in Lagos, Nigeria.

Myocardial ischemia (MI) in children living with sickle cell anemia (SCA) is rarely reported. MI among children living with this disease could portend untoward outcomes on their quality of life and survival. This study evaluated the prevalence and associated risk factors of MI in children living with SCA during a vaso-occlusive crisis (VOC) compared with those with SCA who had no symptoms nor an MI in the past (those in "steady state") in Lagos, Nigeria. This comparative cross-sectional study was conducted over 10 months (between March and December 2019) among 250 children living with SCA aged 6 months-18 years (125 in VOC and 125 age and sex-matched controls in steady state). The assessment of MI was determined by measuring cardiac troponin T (cTnT) and electrocardiography (ECG). The prevalence of MI measuring cTnT alone in children with SCA during VOC and steady state was 42.4% and 23.2%, respectively. Comparatively, measuring ECG alone, the prevalence of MI in VOC and steady state was 40.8% and 20.8%, respectively. The prevalence of MI measuring cTnT and ECG in children with SCA in VOC and steady state was 38.4% and 20%, respectively. Older age, severity of pain, longer duration of illness, frequent crises per year, elevated white blood cells, and platelet count were significantly associated with MI in participants with SCA. However, with multivariate analysis, age, severity of pain, and elevated platelet counts remained significantly associated with the occurrence of MI. This study affirms the high prevalence of MI in children with SCA irrespective of the diagnostic criteria. Routine evaluation should be done in this cohort to avert MI-associated sequelae.

Primary Anterior Sagittal Anorectoplasty Shift from Staged to Single-stage Procedure for Low Anorectal Malformations in Female Children: Our Initial Experience in Single Centre.

Anorectal malformation (ARM) is a common congenital anomaly found in the paediatric age group. Previously, the repair of the vestibular fistula (VF) was performed as three-stage procedure with initial colostomy followed by a definite procedure and, lastly, colostomy closure. At present, a single-stage procedure is preferred, especially in lower anomalies owing to the convenient and time-saving approach. The clinical profile and outcome of ASARP for treatment of ARM in females (vestibular anus and perineal fistula). A retrospective analytical study was conducted at Government Medical College, Jammu. A total of 60 patients were included in the study. Most of the patients were in the age group of 1-5 years (30%), followed by 6 months-1 year age group (25%). Forty-five (75%) females had VF while 15 (25%) had perineal fistula. Intraoperative complication was vaginal tear seen in 6 (10%) patients followed by rectal tear seen in 3 (5%) patients. Early post-operative complications were seen in 9 (15%) patients. Wound infection was the most common complication seen in 5 (8.3%) patients, wound dehiscence in 3 (5%) patients and retraction of rectum in 1 (1.6%) patient. Late post-operative complications were seen in 24 (40%) patients. Perineal excoriation was the most common complication seen in 6 (10%) patients, constipation seen in 5 (8.3%) patients, anal stenosis in 4 (6.6%) patients and mucosal prolapse in 4 (6.6%) patients. The single-staged ASARP procedure resulted in satisfactory outcomes. It is an excellent procedure for females with VF and perineal fistula. Appropriate selection, preparation of patient, optimal correction with minimal sphincter damage and needful post-operative care of wound give excellent cosmetic and functional outcomes in terms of continence. It also decreases the burden on treating the surgeon, family and psychological stress on the patients and parents.

A Comparison of the Use of Propofol versus Midazolam for Pediatric Magnetic Resonance Imaging Sedation: Retrospective Cohort Study.

The aim of the present study was to do a comparison of the recovery profiles and airway-related adverse events of pediatric magnetic resonance imaging (MRI) sedation patients who received propofol alone to those who received midazolam alone. This retrospective cohort study was approved by the Mutah University Ethical Approval Committee (No. 2378). A search of the patients' medical records was performed between September 2021 and April 2022 to identify children aged 4 months-11 years who received propofol or midazolam for MRI sedation. The patients were subdivided into two groups: Those who had propofol alone (propofol group) and those who received midazolam (midazolam group) for pediatric MRI sedation. In propofol group, a 1-2 mg/kg of propofol bolus was given to have a deep sedation (Ramsay Sedation Scale score of 5). Patients in midazolam group received 0.05 mg/kg of midazolam. During the maintenance state of sedation, the patient received 150 µg/kg/min of propofol, and the infusion rate was adjusted in 25 μg/kg/min increments up or down at the discretion of the anesthesiologists to maintain a state of deep sedation. The major targets of this study were recovery profiles (time to awake and time to discharge) and airway-related intervention ratios in pediatric MRI sedation patients. Patient demographics, MRI sedation, and recovery data, including propofol induction dose, airway intervention, and sedation-related adverse events from the pediatric sedation recovery unit were also collected. The mean (standard deviation [SD]) propofol induction dose was higher compared to midazolam group (2.4 [0.7] mg vs. 1.3 [0.5] mg; mean difference, 1.1 mg; P < 0.001). The mean (SD) infusion rate was higher in propofol group compared to midazolam group (161.3 [37.6] μg/min/kg vs. 116.2 [25.6] μg/min/kg; mean difference 45.1 μg/min/kg; P < 0.001). The mean (SD) propofol total dose was higher in propofol group compared to midazolam group (236.3 [102.4] mg vs. 180.7 [80.9] mg; mean difference, 155.4 mg; P < 0.001). The mean (SD) time to awake was longer in midazolam group compared to propofol group (21.2 [5.6] min vs. 23.0 [7.1] min; mean difference, 1.8 min; P < 0.001). The mean (SD) time to discharge was longer in midazolam group compared to propofol group (34.5 [6.9] min vs. 38.6 [9.4] min; mean difference, 4.1 min; 95% confidence interval, 3.0-5.1; P < 0.001). The administration of midazolam during pediatric MRI sedation can decrease the frequency of airway complications without prolonging the clinically significant recovery profile.

SP2.7 - A Consultant General Surgeon's approach to evaluating malnutrition in emergencies: a qualitative study

Abstract Background Patients undergoing an emergency laparotomy are often malnourished. Identifying malnourished patients is a prerequisite to offering targeted nutritional support. This study explores how consultants identify malnourished patients, why they use that approach and the barriers experienced. Methods General surgical consultants involved in emergency surgery were invited. We used purposive sampling to ensure a broad representation of consultant experience across different practice settings. Following ethical approval (UREC 050436), semi-structured interviews were conducted online, audio-visually recorded and transcribed verbatim. Interviews were coded and analysed in NVivo. A framework was developed and reviewed by an independent researcher and supervising team. Interviews continued until saturation. Results Eighteen interviews were conducted (14 male, consultant experience 6 months-23 years) across three hospital settings (4 district general, 10 teaching, 4 intestinal failure unit). Identifying malnutrition consisted of three themes: ‘surgeon’ (knowledge, experience, planning ahead); ‘patient’ (selection, composition, clinical progress, operative considerations); and ‘institution’ (collaboration, extended surgical team). Three themes also encompass the barriers experienced: ‘surgeon’ (understanding, culture, ownership, time constraints); ‘institution’ (provision, staffing, conflict, hospital setting); and ‘wider context’ (research, external factors). These influenced clinical decision making, which had two themes; ‘to join or not to join’ (risk taking, site of anastomosis) and ‘nutritional support’ (timing, delivery). Discussion This study highlights a range of barriers that consultants experience when assessing patients for malnutrition, which affects operative and clinical decision making. It provides a framework upon which issues can be addressed by surgeons and policy makers in order to improve outcomes for malnourished patients.

COVID-19 immunization status in children compared to their parents: a retrospective review at an upstate NY medicine/pediatrics practice

BackgroundThis study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records.MethodsA cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5–11 years and 6 months-4 years cohorts. Chi square or Fisher’s exact test was used where appropriate.ResultsAcross both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child’s race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5–11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038).ConclusionsThis study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker.

Second primary malignancies in women with breast cancer.

Increased screening and treatment advancements have resulted in improved survival rates in women with breast cancer (BC). However, recent data suggests these women have elevated risk of developing a second primary malignancy (SPM) compared to the general population. Limited data exists on factors associated with BC patients developing a SPM. A retrospective review of a prospective single institution database (1990-2016) identified 782 patients with a history of BC. One hundred and ninety-four BC patients developed a SPM. Clinicopathologic and treatment characteristics were analyzed. Of the 194 patients (24.8%) who developed a SPM, 56 (28.9%) BC patients were <50 years old (range: 24-87 years). Two-thirds (64.9%) had at least one first or second degree relative with a malignancy (no relatives-35.1%; ≥1 relative-62.9%). Most patients had invasive ductal carcinoma (n = 117, 60.3%) or ductal carcinoma in situ (n = 39, 20.1%). Twenty-two patients (11.3%) had pathogenic genetic mutations. Mean time to developing a SPM was 8.9 years (range: 4 months-50 years). Eighty (47.6%) patients received chemotherapy with 91 (54.5%) completing radiation. The most common SPMs were breast (22%), melanoma (17.8%), gynecologic (14.1%), colorectal (12.6%), hematologic (8.9%), and sarcoma (6.5%). Most breast tumors were estrogen receptor (ER) (n = 99, 78.0%) or progesterone receptor (PR) positive (n = 87, 73.1%) but not HER2-neu positive (n = 13, 14.0%). Most BC patients who developed a SPM had ER/PR positive tumors and a family history of malignancy, with most <50 years old. Although chemotherapy and radiation increase cancer risk, there were an equal number of patients with SPMs who did or did not receive either treatment. Most SPMs were breast, soft tissue, gynecologic, hematologic, or colorectal. BC patients should be followed closely given an elevated propensity for developing SPMs.

Population-Based Influenza Vaccine Effectiveness Against Laboratory-Confirmed Influenza Infection in Southern China, 2023-2024 Season.

In China, the 2022-2023 influenza season began earlier and was characterized by higher levels of influenza activity and co-circulation of various respiratory pathogens compared with seasons before the coronavirus disease 2019 (COVID-19) pandemic. Timely and precise estimates of influenza vaccine effectiveness (IVE) against infections can be used to guide public health measures. A test-negative study was conducted to estimate IVE against laboratory-confirmed influenza using data from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study that prospectively integrated laboratory, vaccination, and health administrative data in Yinzhou, southern China. We included patients who presented influenza-like illness and received nucleic acid tests and/or antigen tests between October 2023 and March 2024. Estimates of IVE were adjusted for age, gender, month of specimen submitted, chronic comorbidities, and hospitalization status. A total of 205 028 participants, including 96 298 influenza cases (7.6% vaccinated) and 108 730 influenza-negative controls (13.4% vaccinated), were eligible for this analysis. The estimates of IVE were 49.4% (95% CI, 47.8%-50.9%), 41.9% (95% CI, 39.8%-44.0%), and 59.9% (95% CI, 57.9%-61.9%) against overall influenza, influenza A, and influenza B, respectively. A lower IVE was observed for individuals aged 7-17 years (38.6%), vs 45.8% for 6 months-6 years, 46.7% for 18-64 years, and 46.1% for ≥65 years. Vaccination reduced the risk of infection by 44.4% among patients with chronic comorbidities. IVEs varied by epidemic weeks with the changes in influenza activity levels and the switch of dominant influenza strains. Influenza vaccination in the 2023-2024 season was protective against infection for the entire population.

Radiosurgery for Facial Pain: A Narrative Review.

The surgical treatment of pain has been an integral part of neurosurgery since the early 20th century when Harvey Cushing pioneered ganglionectomy for trigeminal neuralgia. Over the ensuing years, as anatomic and physiologic knowledge of pain systems grew, new techniques aimed at new targets were developed for various pain conditions. Our objective was to provide an informative and up-to-date summary of radiosurgery for chronic facial pain, emphasizing trigeminal neuralgia and discussing the advantages and challenges of this modality. A PubMed search with keywords ("trigeminal neuralgia" or "cluster headache" or "glossopharyngeal neuralgia") and ("radiosurgery") and ("systematic review" or "review") was conducted. Relevant publications in English published from January 2000 to May 2022 were screened manually for their title, abstract, and even full text to determine their relevance. References from the searched articles were also searched as other supplementary articles. We excluded original articles and personal series from the analysis and only considered systematic reviews to maintain the transparency in the record. A total of 19 studies for trigeminal neuralgia (n > 100), 52 cases of cluster headache, and 42 cases of glossopharyngeal neuralgia were found. Radiosurgery remains the safest among various treatment options with equitable pain control with other percutaneous procedures. MVD remains the gold standard for long-term pain control. There is no difference in efficacy or tolerance between patients treated with gamma knife, linear accelerator, or CyberKnife. The minimum recommended prescription dose was 70 Gy (level of evidence II), and the maximum dose was 90 Gy (level of evidence III) in a single fraction. Radiosurgery provides 5-year pain control in 50% of patients without medication (85% of patients with/without medication) with an average latency period of 1-3 months. Approximately 8-15% of patients will experience a recurrence of pain after an average period of 1 year. Prospective pain relief will be about 60% at 3 years, 40% at 7 years, and 37% in 10 years. The main complication was facial hypoesthesia occurring in 25-50% of patients within 6 months-3 years and disabling in 10% of cases. Cluster headache and glossopharyngeal neuralgia are emerging conditions for treatment with GKRS, although long-term efficacy remains to be studied. Having searched PubMed and other databases and summarized the application of radiosurgery for facial pain, we concluded that radiosurgery is undoubtedly a promising tool for chronic facial pain, but further studies are needed to realize its long-term efficiency and advanced applications of the same.

Combined generalized and focal epilepsy with reflex features in Adaptor protein complex 4-associated hereditary spastic paraplegias: A cohort observational study

BackgroundPatients with genetic deficiency of the adaptor protein complex 4 (AP-4) exhibit earlyonset developmental delay, spastic diplegia, intellectual disability, speech impairment. The phenotype overlaps with other hereditary spastic paraplegias and cerebral palsies. Febrile seizures are common at onset. Epilepsy has been described in more than half of cases, arising in early infancy often with status epilepticus, but no typical seizure semiology or electroencephalographic features have been identified thus far. PurposeWe aimed to specifically investigate the epileptological characteristics of the syndrome to unveil possible biomarkers of seizure development and prognosis in AP-4 deficiency. MethodsObservational cohort study on patients with bi-allelic pathogenic variants in AP-4 subunits and epilepsy. We focused on the seizure semiology, electroencephalographic characteristics and response to antiseizure medications. ResultsPatients harboured pathogenic variants in AP4S1 (n = 5) or AP4M1 (n = 1). The phenotype included spastic paraparesis, intellectual disability, speech/language impairment, microcephaly, and MRI evidence of hypoplasia of the corpus callosum. In 66 % of the patients, febrile seizures preceded the onset of epilepsy, which spanned from infancy to adolescence (range=14 months-13 years). Absences (66 %) and focal motor seizures (50 %) were common. No patient met the criteria for drug-resistance. Peculiar electroencephalographic features arose after the epilepsy onset and persisted at long-term follow-up: bilateral and asynchronous focal discharges combined with independent diffuse spike-wave-discharges (100 %) and reflex abnormalities (66 %). ConclusionIn AP-4 complex disease, epilepsy could arise beyond early infancy, until adolescence, with variable combination of generalized and focal seizures. The prognosis was favourable. We observed a common electroencephalographic signature - combined focal/generalized and reflex abnormalities - which may constitute a biomarker of AP-4 deficiency with epilepsy, applicable to inform genetic testing and disentangle the differential diagnosis.