Retrospective Clinical Record Review Research Articles

Protocol for the development and validation of a trigger tool for antiretroviral ADE detection among adult HIV/AIDS patients: A short communication

Antiretroviral therapy (ART) is a lifelong combination therapy which has been very promising in managing HIV/AIDs but reported to have several adverse events on the recipients, affecting the desired antiretroviral therapeutic goals. Adverse drug event detection and prevention therefore become very important safety culture maintenance tools among patients living with HIV/AIDS. The designed protocol provided step by step approaches to develop and validate a trigger tool for detection of adverse drug events (ADE) among adult HIV/AIDS patients. The approaches involved include a baseline (Pre-trigger tool development) retrospective clinical record review to establish a baseline ADE detection capacity of a conventional non-trigger tool method; the Delphi panel process to develop the trigger tool in question; Face and content validity approach for validation of the developed trigger tool; Pilot test of the trigger tool using small clinical record sample; determining the effectiveness of the developed trigger tool through the retrospective clinical record review of same samples reviewed at the baseline. Finally, the protocol described the process of determining the feasibility of the developed trigger tool through the survey of the clinical record review team members.

Development of working memory, processing speed, and psychosocial functions in patients with pediatric cancer.

Many patients after pediatric cancer suffer from long-term cognitive difficulties. This study investigates the development of cognitive and psychosocial functions between diagnosis and one year after cancer treatment and reveals insight into the association between cognitive and psychosocial development and various risk factors. This retrospective clinical record review included fifty-seven patients, aged 4-16 years, that were examined at the beginning of the cancer treatment (T1) and one year after cancer treatment (T2) to evaluate the development of working memory (WM), processing speed (PS), psychosocial functions, and quality of life (QoL). About half of the patients showed stable/favorable cognitive development (PS 51.9%; WM 41.4%). The other half exhibited a non-favorable cognitive development, with a decrease of performance between T1 and T2. In 51.6-77.4%, psychosocial functions remained stable/increased between T1 and T2 and QoL scores remained stable in 42.9-61.9%. Changes in prosocial behavior correlated with the development of PS (r = 0.472, p = 0.010). Age at T1 predicted PS at T2 (p = 0.020) and sex predicted peer relations at T2 (p = 0.046). About half of the patients showed stable/favorable whereas the other half experiencing non-favorable cognitive development. The observed disparities in initial and subsequent cognitive performances highlight the importance of early individualized patient monitoring and interventions. IMPACT: We investigated the cognitive and psychosocial development of pediatric cancer patients between diagnosis and one year after termination of cancer treatment. About half of the patients showed stable or favorable cognitive development in processing speed and working memory. The other half exhibited a non-favorable cognitive development, with decreasing performance. Baseline working memory and processing speed was negatively correlated with the respective change score. Changes in prosocial behavior were positively correlated with the development of processing speed. Early individualized patient monitoring and intervention is of crucial importance after pediatric cancer and its treatment.

Liver cystic echinococcosis: A retrospective study on the demographics and clinical profile of patients managed at a single tertiary institution in central Eastern Cape Province, South Africa.

Cystic echinococcosis (CE) is a zoonotic disease with an Africa-wide prevalence of 1.7%. CE is caused by the tapeworm Echinococcus granulosus sensu lato, with the liver being the most commonly affected organ. In South Africa (SA), there is a paucity of data on liver CE demographics and management. To describe the demographics and clinical profile of patients with liver CE in a single tertiary hospital in Eastern Cape Province, SA. A 4-year (2019 - 2022) retrospective clinical record review study was conducted on patients presenting with liver CE to the Department of Surgery at Frere Hospital. The demographics, clinical characteristics and management of patients with liver CE are reported. A total of 56 patients diagnosed with and managed for liver CE were included in the study. The mean age of the patients was 37.5 years. Abdominal pain (n=39; 69.6%) was the most common presenting symptom, and a palpable abdominal mass (n=36; 64.3%) was the predominant presenting sign. Most patients had disease confined to the liver (n=35; 62.5%). The right lobe of the liver was most commonly affected (n=38; 67.9%), and most patients had a single liver cyst on imaging (n=32; 57.1%). The majority of the patients (n=36; 64.3%) were managed with surgical partial cystectomy, with a perioperative bile leak being the most common complication. In our setting, liver CE contributes to a significant local burden of the disease. The disease often has a nonspecific clinical presentation, necessitating imaging for the diagnosis. We observed good short-term outcomes in patients managed with combined partial cystectomy and medical therapy, although there is a risk of perioperative bile leak.

Improving hospice delirium guideline adoption through an understanding of barriers and facilitators: A mixed-methods study.

This study seeks to understand and address barriers to practitioners' optimal assessment and management of people with delirium in hospices. Retrospective clinical record review to identify areas of low concordance with guideline-adherent delirium care; Survey of healthcare practitioners to identify barriers and facilitators to optimal care; Qualitative interviews with health care practitioners to explore and develop strategies to address barriers or optimise facilitators; Meeting with senior clinical staff to refine identified strategies. Eighty clinical records were reviewed. Elements of poor guideline concordance were identified. Delirium screening on admission was conducted for 61% of admissions. Non-pharmacological management was documented for 59% of those we identified as having delirium from the clinical records. Survey and interview data identified key barriers to delirium assessment as competing priorities, poor knowledge and skills and lack of environmental resources (staff and guidelines, environment). Consultation with staff resulted in strategies to address barriers and enhance facilitators including champions, educational meetings, audit and feedback, and environmental changes (including careful consideration of the staff skills mix on shift and tools to support non-pharmacological management). We conducted a theoretically underpinned, internationally relevant study in a hospice in England, UK. Implementation of strategies should result in greater guideline-adherent delirium care. Further work should test this in practice and include both process and clinical outcomes (e.g., reduction in delirium days).

Outcome and racing performance following standing fracture repair in 245 horses.

Repair of sagittal proximal phalanx (P1) and parasagittal metacarpal/metatarsal III (MC/MTIII) fractures has evolved over recent decades from a procedure carried out solely under general anaesthesia, to one commonly performed under standing sedation. To date, standing fracture repair has not been evaluated for large cohorts. To determine short-term (survival to discharge) and long-term (return to racing) outcomes of horses undergoing standing repair of MC/MTIII and P1 fractures, and to compare pre-surgical and post-surgical racing performance. Single-centre retrospective cohort study. Retrospective clinical record review of 245 cases undergoing standing repair of MC/MTIII or P1 fractures, 1 January 2007-30 June 2021. Data on signalment, fracture configuration and complications were collected and full race records were retrieved from the Racing Post Database (wwww.racingpost.com). Chi-squared and Mann-Whitney U tests were used to determine any difference in variables between horses that raced after surgery compared to those that did not. McNemar change and Wilcoxon signed-rank tests were used to compare pre- and post-surgical racing performance, p ≤ 0.05. Ninety-eight percent [95% confidence interval (CI): 96.2%-99.7%] of horses survived hospital discharge, and 75.1% (95% CI: 68.9%-81.4%) raced after surgery, a median of 241 days later. Horses that raced post-surgery were significantly less likely to have suffered from complications during hospitalisation than those that did not race again [17.3% (95% CI: 11%-24%) vs. 36.5% (95% CI: 23%-50%), p = 0.005]. Comparing pre- and post-operative racing performance, there was no significant difference in earnings per start [median £628.00, interquartile range (IQR) 115.90-1934.80 vs. £653.20, 51.00-1886.40, p = 0.7] or proportion of horses winning [51% (95% CI: 41%-61%) vs. 54% (95% CI: 44%-64%), p = 0.8] or being placed first-third [77% (95% CI: 68%-85%) vs. 71% (95% CI: 62%-80%, p = 0.5] in at least one race. Retrospective nature of study with reliance on clinical records and public databases, limiting data available for analysis. Standing fracture repair is a viable treatment option for MC/MTIII or P1 fractures that returns horses to the racetrack within an acceptable time frame and is capable of restoring pre-surgical athletic ability.

Single use Negative Pressure Wound Therapy (NPWT) system in the management of knee arthroplasty

BackgroundWound complication, skin blister formation in particular, causes devastating consequences after total knee arthroplasty (TKA). Negative Pressure Wound Therapy (NPWT) tries to improve wound management leading to decrease length of hospital stay and better clinical outcomes. Low body mass index (BMI) could play a part in wound recovery management although lacking evidence. This study compared length of hospital stay and clinical outcomes between NPWT and Conventional groups, and factors affected and how BMI affected.MethodsThis was a retrospective clinical record review of 255 (160 NPWT and 95 Conventional) patients between 2018 and 2022. Patient demographics including body mass index (BMI), surgical details (unilateral or bilateral), length of hospital stay, clinical outcomes including skin blisters occurrence, and major wound complications were investigated.ResultsMean age of patients at surgery was 69.95 (66.3% were female). Patients treated with NPWT stayed significantly longer in the hospital after joint replacement (5.18 days vs. 4.55 days; p = 0.01). Significantly fewer patients treated with NPWT found to have blisters (No blisters: 95.0% vs. 87.4%; p = 0.05). In patients with BMI < 30, percentage of patients requiring dressing change was significantly lower when treated with NPWT than conventional (0.8% vs. 33.3%).ConclusionPercentage of blisters occurrence in patients who underwent joint replacement surgery is significantly lower using NPWT. Patients using NPWT stayed significantly longer in the hospital after surgery because significant proportion received bilateral surgery. NPWT patients with BMI < 30 were significantly less likely to change wound dressing.

Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing.

BackgroundThe HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served.ObjectiveThis study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines.MethodsA mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design.ResultsKey issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed.ConclusionsThe mobile phone–based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance.

Short and Medium-term Outcomes of Omphalocele and Gastroschisis: A Survey from a Tertiary Center.

To characterize and compare the outcomes of omphalocele and gastroschisis from birth to 2 years of follow-up in a recent cohort at a tertiary center. This is a retrospective clinical record review of all patients with gastroschisis and omphalocele admitted to the Neonatal Intensive Care Unit between January 2009 and December 2019. There were 38 patients, 13 of whom had omphalocele, and 25 of whom had gastroschisis. Associated anomalies were present in 6 patients (46.2%) with omphalocele and in 10 (41.7%) patients with gastroschisis. Compared with patients with omphalocele, those with gastroschisis had younger mothers (24.7 versus 29.6 years; p = 0.033), were born earlier (36 versus 37 weeks, p = 0.006), had lower birth weight (2365 ± 430.4 versus 2944.2 ± 571.9 g; p = 0.001), and had a longer hospital stay (24 versus 9 days, p = 0.001). The neonatal survival rate was 92.3% for omphalocele and 91.7% for gastroschisis. Thirty-four patients were followed-up over a median of 24 months; 13 patients with gastroschisis (59.1%) and 8 patients with omphalocele (66.7%) had at least one adverse event, mainly umbilical hernia (27.3% vs 41.7%), intestinal obstruction (31.8% vs 8.3%), or additional surgical interventions (27.3% vs 33.3%). Despite the high proportion of prematurity, low birth weight, and protracted recovery, gastroschisis and omphalocele (without chromosomal abnormalities) may achieve very high survival rates; on the other hand, complications may develop in the first years of life. Thus, a very positive perspective in terms of survival should be transmitted to future parents, but they should also be informed that substantial morbidity may occur in the medium term.

Skiing and snowboarding head injury: A retrospective centre-based study and implications for helmet test standards

BackgroundHead injury occurs in up to 47% of skiing or snowboarding injuries and is the predominant cause of death in these sports. In most existing literature reporting injury type and prevalence, head injury mechanisms are underreported. Thus, protective equipment design relies on safety evaluation test protocols that are likely oversimplified. This study aims to characterize severity and mechanism of head injuries suffered while skiing and snowboarding in a form appropriate to supplement existing helmet evaluation methods. MethodsA 6-year, multicentre, retrospective clinical record review used emergency databases from two major trauma centres and Coroner's reports to identify relevant cases which indicated head impact. Records were investigated to understand the relationships between helmet use, injury type and severity, and injury mechanism. Descriptive statistics and odds ratios aided interpretation of the data. FindingsThe snow sport head injury database included 766 cases. “Simple fall”, “jump impact” and “impact with object” were the most common injury mechanisms while concussion was observed to be the most common injury type. Compared to “edge catch”, moderate or serious head injury was more common for “fall from height” (OR = 4.69; 95% CI = 1.44–16.23; P = 0.05), “jump impact” (OR = 3.18; 95% CI = 1.48–7.26; P = 0.01) and “impact with object” (OR = 2.44; 95% CI = 1.14–5.56; P = 0.05). Occipital head impact was associated with increased odds of concussion (OR = 7.46; 95% CI = 4.55–12.56; P = 0.001). InterpretationSnow sport head injury mechanisms are complex and cannot be represented through a single impact scenario. By relating clinical data to injury mechanism, improved evaluation methods for protective measures and ultimately better protection can be achieved.

Influence of prior illness on exertional heat stroke presentation and outcome.

IntroductionPrecipitating factors that contribute to the severity of exertional heat stroke (EHS) are unclear. The purpose of this study was to determine the effect of prior illness (PI) on EHS severity.MethodsWe performed a retrospective clinical record review of 179 documented cases of EHS at the Marine Corps Base in Quantico, Virginia.ResultsApproximately 30% of EHS cases had a medically documented PI. Anthropometrics (height, weight, body mass index) and commonly associated risk factors for EHS (age, number of days in training, wet bulb globe temperature, sleep patterns) did not differ between PI and no illness (NI) groups. PI patients presented with higher maximal rectal core temperatures (40.6 ± 1.0°C vs. 40.3 ± 1.2°C; P = 0.0419), and elevated pulse rates (118.1 ± 16.7 bpm vs. 110.5 ± 24.2 bpm; P = 0.0397). At the point of care, biomarker values were similar between PI and NI groups, with the exception of a trend toward elevated monocytes in those with PI (7.9 ± 2.9% vs 6.7± 2.7%; P = 0.0521). Rate and duration of cooling were similar between PI and NI patients.ConclusionThis study indicates that PI has a minimal effect on the patient presentation, severity and treatment outcome of EHS. The results of this study have important implications for military, civilian, and occupational populations who are at risk for EHS.

Bilateral full tenectomy of the superior oblique muscle for the treatment of A-pattern strabismus

Superior oblique full tenectomy close to the scleral insertion was originally described as a treatment for moderate A-pattern strabismus. The purpose of this study is to evaluate the efficacy of this technique for A patterns of all magnitudes in a large retrospective clinical record review.

A 4-year review of surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy in salvaging locally recurrent nasopharyngeal carcinoma.

To study the surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy (EETN) in salvaging locally recurrent nasopharyngeal carcinoma (NPC). This was a retrospective clinical record review study carried out at a tertiary centre from June 2013 until May 2017. A total of 55 locally recurrent NPC patients (rT1-rT4) underwent EETN performed by single skull base surgeon with curative intention with postoperative adjuvant chemotherapy but without postoperative radiotherapy. There were 44 (80.0%) males and 11 (20.0%) females, with mean age of 52.5years. The mean operating time was 180min (range 150-280min). 85% (47/55) of patients achieved en bloc tumour resection. 93% (51/55) of patients obtained negative microscopic margin based on postoperative histopathological evaluation. Intraoperatively, one (1.8%) patient had internal carotid artery injury which was successfully stented and had recovered fully without neurological deficit. There were no major postoperative complications reported. During a mean follow-up period of 18-month (range 12-48months) postsurgery, five patients (9.1%) had residual or recurrence at the primary site. All five patients underwent re-surgery. One patient at rT3 passed away 6months after re-surgery due to distant metastasis complicated with septicaemia. The 1-year local disease-free rate was 93% and the 1-year overall survival rate was 98%. EETN is emerging treatment options for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. Long-term outcome is yet to be determined with longer follow-up and bigger cohort study. However, a successful surgical outcome required a very experienced team and highly specialised equipment.

Management of suspected sepsis and staphylococcal bacteraemia in Cape Town, South Africa

Background:Clinical guidelines are designed to improve appropriate empiric management of suspected and confirmed sepsis, thereby improving clinical outcomes and promoting antimicrobial stewardship. We performed a sub-analysis describing the management of patients with suspected sepsis and confirmed S. aureus bacteraemia (SAB), as part of a larger diagnostic study. Methods & Materials:We prospectively ascertained clinical information for 184 patients with Gram positive cocci in clusters on blood culture from January to June 2016 by means of clinician interviews, and compared the information to recommended local clinical guidelines for empiric management of community-acquired (CA) and hospital-acquired (HA) sepsis. We performed a retrospective clinical record review for patients with SAB and reported on adherence to local SAB recommendations. Results:Of the 184 patients, 102 had CA sepsis; the majority (75.5%) were appropriately treated. Less than half (41.5%) of the 82 patients with HA sepsis were on appropriate empiric therapy. 57 patients had SAB and the crude all-cause 30-day mortality rate was 31.6%. Blood cultures were repeated in only 35/57 (61.4%), with the first repeat on average 3.8 days after availability of the initial culture result. Infectious diseases consult was performed in 27 of the 49 (55.1%) where this could be determined; additionally, 7/49 demised prior to consultation. No identifiable or presumed source was found in 10 patients (20.4%). The majority of the patients with SAB in this cohort (36/49, 73.5%) were classified as complicated SAB. Only 53.8% (21/39) who survived were treated for a suitable duration based on the source and classification of their infection. Conclusion: These findings highlight the limited adherence to clinical guidelines, for both empiric treatment of sepsis and management of SAB. Quality improvement interventions, such as clinician education programmes and redistributing and regular updating of existing guidelines, should be undertaken. These interventions will complement and augment the role of antibiotic stewardship programmes. Particular attention should be focussed on the serious entity of SAB. Newer diagnostic modalities that reduce the time-to-final result should be considered.

Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study.

IntroductionTuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia.MethodsA retrospective clinical record review was conducted for 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of tuberculosis clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome were collected using standardized report format of National Tuberculosis and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16.ResultsThe overall treatment success rate was 78.3%. Of the total TB-HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equals to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), extra pulmonary tuberculosis (Adjusted Odds Ratio = 1.51, 95% Confidence Interval = 1.12, 3.42), on antiretro viral therapy (Adjusted Odds Ratio = 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts.ConclusionThe rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.

Autism presenting to two child mental health clinics at a tertiary care center in central Sri Lanka: A retrospective clinical record review

Background: Although clinical and demographic patterns in presentation of autism in the developed world have been extensively studied, comparable data from developing countries remain scarce. While a few attempts have been made previously to describe autistic children in some areas in Sri Lanka (SL), there are gaps in the understanding of autism in the local setting. Methods: Data on all patients diagnosed with autism in two child mental health clinics at a tertiary care center in central SL were abstracted retrospectively from clinic records over a period of 30 years since the inception of the clinics. Diagnosis of autism in these clinics has been based on criteria in the International Classification of Diseases-10th version. Results: Autism had been diagnosed in 77 patients. Of them, 58.4% were male. The mean age at first presentation was 6.7 years. While the number of autistic patients presenting to the clinic has increased over time, the age of presentation has remained largely unchanged. Delayed speech (23.4%) and poor social interactions (23.4%) were the two common primary concerns of parents leading to referral. Among medical comorbidities, epilepsy was the commonest (19.5%). The majority of patients (85.7%) had needed help with activities of daily living. In 62.3% of patients, no therapeutic interventions were documented. Conclusions: There are a substantial dearth and delay in presentation of autism in SL. Multiple deficiencies noted in the management of these patients indicate the need to improve awareness as well as resources and services dispensed for autism in SL.

Screening for latent tuberculous infection in people living with HIV infection in Auckland, New Zealand.

New Zealand, which has a low incidence of tuberculosis (TB), has historically taken a risk-based approach to screening for latent tuberculous infection (LTBI) in adult people living with the human immunodeficiency virus infection (PLHIV). To evaluate LTBI screening, treatment and outcomes in an adult PLHIV population. This was a retrospective clinical record review of an initial cohort of adult PLHIV attending the Auckland City Hospital HIV clinic in 2011, and a second cohort of adult PLHIV newly attending the clinic in 2014. We analysed high-risk (born in or acquiring HIV in a high TB incidence country) and low-risk patients using descriptive statistical methods. Of the 752 patients from the initial cohort, 416 (55%) had documentation of LTBI screening, which was positive in 74 (10%): 19/461 (4%) low-risk and 55/291 (19%) high-risk patients. LTBI treatment was received in 13 low-risk and 44 high-risk patients. Of 73 patients in the second cohort, 68 (93%) were screened. LTBI screening was incomplete in our clinic, but improved between 2011 and 2014. A significant number of patients with LTBI did not originate from a high TB incidence country.

Umbilical hernia following gastroschisis closure: a common event?

To assess incidence and natural history of umbilical hernia following sutured and sutureless gastroschisis closure. With audit approval, we undertook a retrospective clinical record review of all gastroschisis closures in our institution (2007-2013). Patient demographics, gastroschisis closure method and umbilical hernia occurrence were recorded. Data, presented as median (range), underwent appropriate statistical analysis. Fifty-three patients were identified, gestation 36weeks (31-38), birth weight 2.39kg (1-3.52) and 23 (43%) were male. Fourteen patients (26%) underwent sutureless closure: 12 primary, 2 staged; and 39 (74%) sutured closure: 19 primary, 20 staged. Sutured closure was interrupted sutures in 24 patients, 11 pursestring and 4 not specified. Fifty patients were followed-up over 53months (10-101) and 22 (44%) developed umbilical hernias. There was a significantly greater hernia incidence following sutureless closure (p=0.0002). In sutured closure, pursestring technique had the highest hernia rate (64%). Seven patients underwent operative hernia closure; three secondary to another procedure. Seven patients had their hernias resolve. One patient was lost to follow-up and seven remain under observation with no reported complications. There is a significant umbilical hernia incidence following sutureless and pursestring sutured gastroschisis closure. This has not led to complications and the majority have not undergone repair.

Pediatric Uveitis: Experience in Colombia

ABSTRACTPurpose: To describe the clinical features of uveitis in children treated at two ophthalmologic centers in Bogotá, Colombia, in a 13 year-period.Methods: Retrospective observational clinical record review of pediatric children with diagnosis of uveitis.Results: In total, 310 children were evaluated, 51.9% were female, mean age of 10.1 years. Posterior uveitis was the most common location (58.7%), of insidious onset (87.4%) and chronic course (78.1%). The most common etiology was infection (58.4%) caused by toxoplasmosis (76.8%). There was a statistically significant difference in visual acuity between anterior (20/68) and intermediate uveitis (20/70), compared with posterior uveitis (20/434) (p<0.05).Conclusions: This is the first study to report the clinical features of pediatric uveitis in Colombia, where infectious etiologies are the leading cause. It will improve awareness and knowledge of pediatric uveitis in developing countries, and contribute to the development of public health policies of pediatric visual health.Received 12 September 2015; revised 23 February 2016; accepted 25 February 2016; published online 18 May 2016

Safety and tolerability of diazoxide in Japanese patients with hyperinsulinemic hypoglycemia.

Diazoxide is a non-diuretic benzothiadiazine derivative, one of a group of substances introduced into clinical practice in the 1950s for the treatment of hypertension. Fajans reported the use of diazoxide for the treatment of insulinoma in 1979. Although patients with hyperinsulinemic hypoglycemia worldwide have been treated with diazoxide for more than 30 years, there are no recent reports about the adverse effects of this drug in Asian patients, including Japanese patients. Herein, we report the results of our retrospective clinical record review of 6 Japanese patients (3 females and 3 males, ranging in age from 58 to 91 years) with hyperinsulinemic hypoglycemia and inoperable insulinoma treated with diazoxide. Diazoxide improved control of hypoglycemic symptoms and maintained normoglycemia in 5 of the 6 patients, and was ineffective in one patient. Surprisingly, although all 6 patients received diazoxide according to the treatment strategy recommended in Western patients, 5 of the 6 patients developed edema and two developed congestive heart failure. Thus, when starting treatment with diazoxide in Japanese patients, the symptoms and signs of fluid retention should be evaluated carefully. Also, appropriate protocols for treatment with diazoxide should be evaluated by means of clinical trials in Japanese patients with hyperinsulinemic hypoglycemia.

Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes.

A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas. We performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital. Of 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments. Few patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively.