Markussenjernigan8350

OBJECTIVE The objective of this study was to assess the association of plasma dipeptidyl peptidase-4 (DPP4) activity, brain-derived neurotrophic factor (BDNF), and the DPP4/BDNF ratio (DBR) with moderate to severe depressive symptoms in patients with type 2 diabetes mellitus. Increased DPP4 activity and decreased BDNF in peripheral circulation have been implicated in the pathophysiology of depression. METHODS We performed a cross-sectional study using data from 1535 patients with type 2 diabetes mellitus. The main outcome measures were plasma DPP4 activity, BDNF levels, DBR, inflammation markers and oxidative stress parameters. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9). RESULTS DPP4 activity and BDNF were negatively correlated in patients with and without moderate to severe depressive symptoms (P less then 0.001). Oxidative stress partially mediated the inverse correlation between DPP4 and BDNF. Nitrotyrosine, 8-iso-PGF2a, interleukin-6, C-reactive protein and the PHQ-9 score increased significantly with rising quartiles of DBR. Patients in the highest quartile of DPP4 activity and DBR and lowest quartile of BDNF more often had moderate to severe depressive symptoms compared with those in the lowest quartile of DPP4 activity and DBR and highest quartile of BDNF, respectively (P less then 0.05). The likelihood of having moderate to severe depressive symptoms increased more with higher DPP4 activity and lower BDNF. CONCLUSIONS Our hypothesis-generating study demonstrates that oxidative stress might partially play a mediating role in the negative relationship between DPP4 activity and BDNF. DBR is positively related to moderate to severe depressive symptoms and thus might be used as a novel biological measure associated with depressive symptoms in patients with type 2 diabetes mellitus.Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.Increased antimicrobial resistance to Salmonella species threatens successful treatment of typhoid and other infectious diseases. Consequently, rare complications arising from incompletely treated typhoid could increase in frequency. We describe a case of enteric encephalopathy caused by Salmonella enterica serovar Typhi and the utility of adjunct treatment with corticosteroids.BACKGROUND Infectious Diseases Society of America guidelines defines febrile neutropenia (FN) patients as high risk, if they have an absolute neutrophil count (ANC) ≤100 cells/µL anticipated to last >7 days. However, data evaluating the clinical significance of the depth and duration of neutropenia are limited. METHODS We conducted a retrospective cohort study of pediatric oncology patients presenting with FN to examine whether the effects of the depth and duration of neutropenia prior to presentation were predictive of blood stream infection (BSI), invasive fungal disease (IFD), pediatric intensive care unit (PICU) admission or length of stay. RESULTS A total of 585 FN episodes (FNEs) were identified in 265 patients. ANC at the time of presentation was 500 cells/mL after recent chemotherapy if continued decline is expected as patients in this group are at high risk of IFD, BSI and PICU admission.BACKGROUND Viral acute respiratory tract infections (vARTI) are a frequent source of inappropriate antibiotic prescribing. We describe the prevalence of antibiotic prescribing for vARTI in the pediatric emergency department (ED) and urgent care (UC) within a health system, and identify factors associated with overall and broad-spectrum antibiotic prescribing. METHODS Retrospective chart review within a single pediatric referral health system. Visits of patients, 3 months- 17 years old, with a discharge diagnosis of a vARTI from 2010 to 2015. Data collected included specific vARTI diagnosis, site type (ED or UC), provider type [pediatric emergency medicine subspecialist or physicians, nurse practitioners, physician assistants (non-PEM)] and discharge antibiotics. https://www.selleckchem.com/ Odds ratios and 95% confidence intervals (CI) were calculated where appropriate. RESULTS There were 132,458 eligible visits, mean age 4.1 ± 4.3 years. Fifty-three percent were treated in an ED. Advanced practice providers, a term encompassing nurse practitioners and physician assistants, were the most common provider type (47.7%); 16.5% of patients were treated by a pediatric emergency medicine subspecialist. Antibiotics were prescribed for 3.8% (95% CI 3.72-3.92) of children with vARTI; 25.4% (95% CI 24.2-26.6) of these were broad-spectrum, most commonly first-generation cephalosporins (11%; 95% CI 10.2-11.9). Patients treated in an ED or by a non-PEM and those receiving chest radiograph (CXR) received antibiotics most frequently. Prescribing rates varied by specific vARTI diagnosis. CONCLUSIONS Patients discharged from the pediatric ED or UC with vARTI receive inappropriate antibiotics at a lower rate than reported in other community settings; however, they frequently receive broad-spectrum agents.BACKGROUND California Senate Bill 277 (SB277) eliminated non-medical immunization exemptions. Since its introduction on February 19, 2015, the rate of medical exemptions in the state has increased. Filing a report to Vaccine Adverse Event Reporting System (VAERS) may be perceived as helpful in applying for a medical exemption. Our objective was to describe trends in reporting to VAERS from California coincident with introduction of SB277. METHODS This was a retrospective study of Californian children 6 months after immunization. CONCLUSIONS These recent changes in reporting patterns coincident with the introduction of SB277 may indicate that more parents are using VAERS to assist in applying for a medical exemption for their child.BACKGROUND The World Health Organization Pneumonia Expert Group (WHO-PEG) defined a standardized radiologic endpoint for childhood community-acquired alveolar pneumonia (RD-CAAP), as the most likely to be pneumococcal, not ruling out other bacteria or coinfecting viruses. We aimed to determine the characteristics associated with hospitalization among children less then 5 years old presenting to the pediatric emergency room (PER) with RD-CAAP. METHODS This study was a part of an ongoing prospective population-based surveillance on hospital visits for RD-CAAP. RD-CAAP was determined according to the WHO-PEG. The study was conducted in the prepneumococcal conjugate vaccine era (2004-2008). RESULTS Of 24,432 episodes with chest radiographs, 3871)15.8%) were RD-CAAP 2319 required hospitalization and 1552 were discharged (outpatients). Compared to outpatients, hospitalized children had lower temperature, peripheral white cell and absolute neutrophil counts and C reactive protein serum levels, but higher rates of hypoxemia, rhinorrhea, cough and respiratory virus detection. PER visits during the respiratory virus season presented a 1.83 times higher risk of hospitalization than visits during nonrespiratory season. CONCLUSIONS Although RD-CAAP is most often a bacterial infection, the unique characteristics of those visiting the PER and subsequently hospitalized suggest a frequent involvement of respiratory viruses, potentially as viral-bacterial coinfections, compared to outpatients.BACKGROUND Data on integrase strand transfer inhibitor (INSTI) use in children, adolescents and young adults with HIV are limited. We evaluated virologic and safety outcomes following INSTI initiation among treatment-experienced children, adolescents and young adults. METHODS The DC Cohort is a multicenter observational study of individuals receiving HIV care in Washington, DC. This analysis included treatment-experienced participants 0-24 years of age who initiated an INSTI during 2011-2017. Viral suppression (VS) and safety outcomes were quantified. Differences in VS by age, sex and CD4 count were assessed using Kaplan-Meier curves. RESULTS Of 141 participants (median age 20 years; 35% 500) cells/μL were less likely to achieve VS (P less then 0.001). Among participants with VS at INSTI initiation, 51% sustained VS through a median of 11.0 months of follow-up; of the 49% with transient viremia, 77% later achieved VS again. There were no safety concerns associated with the use of INSTIs. CONCLUSIONS More than half of treatment-experienced children, adolescents and young adults with detectable viremia at INSTI initiation did not achieve VS, while half of those with prior VS experienced transient viremia. Further evaluation of long-term outcomes associated with INSTI use among children, adolescents and young adults is warranted.BACKGROUND Shock Index Pediatric-Adjusted (SIPA) has been used to predict injury severity and outcomes after civilian pediatric trauma. We hypothesize that SIPA can predict the need for blood transfusion and emergent surgery among pediatric patients injured in warzones, where resources are limited and accurate triage is essential. METHODS Retrospective review of the DoD Trauma Registry for all patients ≤17years, from 2008-2015. SIPA was determined using vital signs recorded upon arrival to the initial level of care. Patients were classified into two groups (normal v. elevated SIPA) using age-specific threshold values. Need for blood product transfusion (BPT) within 24 hours and emergent surgical procedures (ESP) was compared between groups. ICU admission, injury severity, and mortality were also compared. Regression analysis was performed to evaluate the relationship between SIPA and primary outcomes. RESULTS 2121 patients were included with mean ISS 12±10. The mechanism of injury was penetrating (63%), blunt (25%), and burns (12%). Patients with an elevated SIPA (43%) had significantly greater need for BPT (49.2% v. 25.0%) and ESP (22.9% v. 16.0%), as well as mortality (10.3% v. 4.8%) and ICU admission (49.9% v. 36.1%), all p less then 0.001. Regression analysis confirmed an elevated SIPA as independently associated with both BPT (OR=2.36, 95% CI 1.19-2.94, p less then 0.001) and ESP (OR=1.29, 95% CI 1.01-1.64, p=0.044). CONCLUSION This is the first study of SIPA in pediatric warzone trauma. Elevated SIPA is associated with significantly increased need for blood product transfusion and emergent surgery, and may therefore serve as a valuable tool for planning and triage in austere settings. LEVEL OF EVIDENCE Prognostic/epidemiological, level III.BACKGROUND The Emergency Surgery Score (ESS) was recently developed and retrospectively validated as an accurate mortality risk calculator for Emergency General Surgery (EGS). We sought to prospectively validate ESS, specifically in the high-risk non-trauma emergency laparotomy (EL) patient. METHODS This is an EAST multicenter prospective observational study. Between April 2018 and June 2019, 19 centers enrolled all adults (age >18 years) undergoing EL. Preoperative, intraoperative, and postoperative variables were prospectively and systematically collected. ESS was calculated for each patient and validated using c-statistic methodology by correlating it with three postoperative outcomes 1) 30-day mortality, 2) 30-day complications (e.g. respiratory/renal failure, infection), and 3) postoperative ICU admission. RESULTS A total of 1,649 patients were included. The mean age was 60.5 years, 50.3% were female, and 71.4% were white. The mean ESS was 6, and the most common indication for EL was hollow viscus perforation.