scholarly journals 1161. Increasing incidence of Sinogenic Intracranial Infections in Utah Children 2004-2019

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S672-S672
Author(s):  
Isabella McNamara ◽  
Nicole L Pershing ◽  
Jacob Wilkes ◽  
Anne Bonkowsky
Keyword(s):  
Chart Review ◽  
Panel Member ◽  
Intracranial Extension ◽  
Resistant Bacteria ◽  
University Of Utah ◽  
Presenting Symptoms ◽  
Neurologic Sequelae ◽  
The University ◽  
Intracranial Infections

Abstract Background Intracranial extension of sinusitis is a rare complication. Non-specific presentations are a diagnostic challenge, and complications include long-term neurologic sequelae. Early recognition is critical, although optimal management remains poorly characterized. Methods We conducted a retrospective chart review of 123 patients admitted to Primary Children’s Hospital between 2004-2019 with ICD9 and ICD10 codes for sinusitis and intracranial suppurative infection. Chart review confirmed cases in patients < 18 years with evidence of sinusitis and intracranial extension. Variables collected included: demographic data, clinical presentation, microbial profile, clinical management, and outcomes. Results We observed 84 pediatric sinogenic intracranial infections between 2004-2019. Incidence significantly increased over the interval. Median patient age was 12.8 years (IQR 10.5-14.7 years); most were male (n=52). The most common presenting symptoms were headache and fever. Most patients (n=80) required surgical management; 62 required neurosurgery. All but one patient survived. Most infections were polymicrobial (n=47). Streptococcus anginous group were most frequently identified (n=32). All patients were started on vancomycin empirically; only 10 required use for definitive management. Most patients were treated with a carbapenem (n=42) or ceftriaxone plus metronidazole (n=32). Average duration of antibiotics was 44 days (IQR 38-55 days). The most common complication was epilepsy (n=11). Patients with Streptococcus sp. infections were more likely to experience adverse outcomes (p= 0.04). We observed significantly decreased carbapenem use following introduction of an antimicrobial stewardship program in 2012, with no change in clinical outcomes. Annual incidence of Sinogenic Intracranial Infections Shown is the increasing incidence of sinogenic intracranial infections annually in the state of Utah/100,000 children. Conclusion Sinogenic intracranial infections are increasingly frequent severe pediatric infections with associated long term neurologic sequelae. Most patients require both surgical and long-term IV antibiotic treatment. Most infections are polymicrobial. Streptococcus sp. are commonly identified. Antibiotic resistant bacteria are rare. The combination ceftriaxone and metronidazole is appropriate for treatment of most infections. Disclosures Anne Bonkowsky, MD/PhD, BioFire Diagnostics (Consultant, Grant/Research Support, Other Financial or Material Support, I have intellectual property through the University of Utah in BioFire Diagnostics and the FilmArray and receive royalties through the University of Utah.)Merck (Advisor or Review Panel member)

The Total Artificial Heart

1991 ◽  
Vol 2 (3) ◽  
pp. 587-597
Author(s):  
Lawrence E. Barker
Keyword(s):  
Artificial Heart ◽  
Total Artificial Heart ◽  
Thromboembolic Events ◽  
Bridge To Transplant ◽  
University Of Utah ◽  
Cardiac Assistance ◽  
Permanent Implants ◽  
Mechanical Devices ◽  
The University

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device

scholarly journals Does Autoimmunity in Family Members of Children with Immune Thrombocytopenia Help Identify Patients at Higher Risk of Chronic Immune Thrombocytopenia?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3168-3168
Author(s):  
Michell Lozano Chinga ◽  
Mark Fluchel ◽  
Jessica Meznarich
Keyword(s):  
Immune Thrombocytopenia ◽  
Chart Review ◽  
Family Members ◽  
Immune Dysregulation ◽  
University Of Utah ◽  
Autoimmune Conditions ◽  
History Of ◽  
Autoimmune Condition ◽  
The University ◽  
Chronic Immune Thrombocytopenia

Abstract Background Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia during childhood. Approximately 10-30% of pediatric patients will develop chronic ITP (cITP), which is defined as thrombocytopenia lasting over 12 months, and constitutes a significant burden for patients and their caregivers. Patients with cITP may require ongoing medications to treat symptomatic thrombocytopenia, may have asymptomatic thrombocytopenia not requiring medical interventions, or may experience complete resolution of their ITP. There are not specific patient nor disease characteristics that can help us predict how cITP may progress, and which patients are more likely to require ongoing treatments. ITP can be a manifestation of immune dysregulation in patients with other autoimmune conditions or primary immunodeficiency disorders (PIDDs). We aimed to assess the characteristics of patients with cITP including the presence of autoimmune or allergic disorders in the patients and in first-, second-, and third-degree family members. We hypothesized that patients with cITP may have a higher incidence of immune dysregulation in family members in contrast to patients with acute aITP. Methods The study was approved by the institutional review and ethics boards at the University of Utah. We queried the Primary Children's Hospital database for cases of "immune thrombocytopenia" from January 1 st, 2001 to January 1 st,2021. Retrospective chart review was done to confirm the diagnosis. Patient demographics, clinical presentation, and family history of patients were reviewed. Data was collected in RedCap at the University of Utah. Descriptive summaries of data were done. Results Medical charts from 266 ITP patients diagnosed during the study period were reviewed; 182/266 (68.5%) had acute ITP (aITP) and 84/266 (31.5%) patients had cITP, defined as platelet count <150 K/µl for >12 months. Resolution of ITP occurred in 28/84 (33.3%) patients with cITP (resolved cITP), while 56/84 (66.7%) had ongoing thrombocytopenia (unresolved cITP). Mean duration of ITP in patients with resolved cITP was 2.9 years, and 4.6 years in patients with unresolved cITP at the time of the last known platelet count. Mean age at diagnosis was 7.4 years in the cITP group and 5.1 years in the aITP group. Concurrent allergic conditions were identified in 10/84 (12%) of patients with cITP and 5/182 (2.7%) of patients with aITP. Autoimmune conditions were identified in 3 patients (3.5%) with cITP, and 4 patients (2.2%) with aITP. First-degree family members of cITP patients were more likely to be reported with an autoimmune condition than first-degree family members of aITP patients (15.5% vs. 5.5%, p=0.007 using Chi-square test); this effect was not seen amongst second- or third-degree relatives. The most common autoimmune condition reported in family members was autoimmune thyroid disease in both cohorts (2.7% in aITP and 9.5% in cITP). Common variable immunodeficiency (CVID) was reported in second degree relatives of 3/84 (3.6%) patients with cITP; no relatives of patients with aITP had a report of PIDD. Additionally, we identified 14 patients with Evans syndrome (ES), all with chronic immune thrombocytopenia and all patients had been followed for over a year at the time of the chart review. Four ES patients were previously diagnosed with 22q11.2 deletion, and one with CVID. In patients with ES, 4/14 (28.6%) and 5/14 (35.7%) had first- and second-degree family members with a reported autoimmune condition, respectively. No PIDDs were identified in first, second-, or third-degree relatives of patients with ES. Conclusions There is increasing evidence that patients with chronic ITP may exhibit polyautoimmunity or other signs of immune dysregulation, suggesting that ITP may be the initial manifestation of another autoimmune process or PIDD. We evaluated medical histories of patients with ITP and their family members. Patients with cITP have a history of autoimmunity in their family stronger than in patients with aITP. This association was even stronger in patients with ES. Disclosures No relevant conflicts of interest to declare.

scholarly journals 77. Opportunity for Improved Use of a Commercially Available Meningitis/Encephalitis Panel in Pediatric Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S155-S156
Author(s):  
Marilyn E Valentine ◽  
Jared Olson ◽  
Emily A Thorell ◽  
Anne Bonkowsky ◽  
Jason Lake
Keyword(s):  
Age Groups ◽  
Panel Member ◽  
High Power Field ◽  
Patient Age ◽  
Viral Pathogens ◽  
University Of Utah ◽  
Csf Analysis ◽  
Cell Counts ◽  
Patient Âgé ◽  
The University

Abstract Background The BioFire® FilmArray Meningitis/Encephalitis (ME) panel delivers timely CSF analysis when meningitis or encephalitis is suspected and has the potential for earlier optimization of patient care. It is unclear if the M/E panel provides incremental benefit over standard microbiologic methods such as culture and cell counts, especially in the absence of significant pleocytosis. We evaluated the clinical utility of the ME panel with respect to CSF white blood cell count per high power field (WBC/hpf) and patient age. Methods We identified paired CSF ME panels and CSF cultures collected throughout a large healthcare system from 2016–May 2021 in children < 18 years of age. CSF results from the same calendar day were included in the dataset. We reviewed standalone HSV and Enterovirus (EV) CSF studies to determine frequency of duplicative testing. Results were stratified by CSF WBC/hpf and patient age (< 14 days, 14–60 days, > 60 days and < 5 years, and > 5 years). Results 1045 paired cultures and ME panels were identified. Of those, 921 (88%) ME panels were negative, but 5 of those cultures grew bacteria. Of 124 (12%) positive ME panel results, 66% were viral: 46 (37%) EV, 22 (18%) HHV-6 and 6 (5%) parechovirus. In 498 cases, ME panels were sent when CSF had < 10 WBC/hpf, resulting in only 2 (0.4%) PCRs positive for bacteria, one which was gram stain positive and the other was considered a false positive (Table 1). In addition to a ME panel, standalone PCRs for enterovirus and HSV were sent in 134 (13%) and 213 (20%) of cases, respectively, with < 2% discordance. Pathogen distribution by ME panel did not vary with age (Table 2). Meningitis and encephalitis panel, standalone PCR and culture results overall and by age group. Conclusion In our cohort, the ME panels were overwhelmingly negative. Only 12% of ME panels were positive, mostly with self-limited viral pathogens (e.g., EV, parechovirus). Performance was worse when samples had < 10 WBC/hpf. Duplicative testing was common and had no benefit. Performance was similar across age groups. More targeted use of the ME panel could improve the utility and efficacy of this test. Disclosures Anne Bonkowsky, MD/PhD, BioFire Diagnostics (Consultant, Grant/Research Support, Other Financial or Material Support, I have intellectual property through the University of Utah in BioFire Diagnostics and the FilmArray and receive royalties through the University of Utah.)Merck (Advisor or Review Panel member)

scholarly journals Clinical Spectrum of West Nile Virus Neuroinvasive Disease

2019 ◽  
Vol 10 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Andrew Yu ◽  
Emily Ferenczi ◽  
Kareem Moussa ◽  
Dean Eliott ◽  
Marcelo Matiello
Keyword(s):  
Risk Factors ◽  
West Nile Virus ◽  
Febrile Illness ◽  
The United States ◽  
Ocular Involvement ◽  
West Nile ◽  
Presenting Symptoms ◽  
Neuroinvasive Disease ◽  
Neurologic Sequelae

West Nile virus (WNV) is the most common arbovirus infection in the United States. The diagnosis requires consideration of not only a broad spectrum of presenting symptoms, ranging from a mild febrile illness to severe encephalitis and acute flaccid paralysis, but also public health risk factors and seasonality. There is no approved targeted therapy for WNV, so treatment relies on supportive care, management of neurologic sequelae and airway, treatment of other systems including the eye, and aggressive rehabilitation. Here, we describe a series of 3 cases of WNV encountered in September 2018 at one institution. First, we describe a case of WNV encephalitis with worsened dyskinesias and a relatively good recovery. Second, we describe a severe WNV encephalitis with overlying motor neuron involvement with a poor outcome. Finally, we describe a case of a WNV meningitis with significant bilateral chorioretinitis, an underappreciated complication of WNV infections. Through these cases, we review the epidemiology of WNV, risk factors for infection, the neurologic sequalae and long-term outcomes, and the importance of recognizing ocular involvement to prevent ophthalmologic complications.

scholarly journals Neurosarcoidosis

2020 ◽  
Vol 7 (4) ◽  
pp. e743
Author(s):  
Jennifer Lord ◽  
M. Mateo Paz Soldan ◽  
Jonathan Galli ◽  
Karen L. Salzman ◽  
Jacob Kresser ◽  
...  
Keyword(s):  
Healthcare System ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Infliximab Treatment ◽  
First Line ◽  
University Of Utah ◽  
Classification Of Diseases ◽  
The University

ObjectiveTo characterize patients with neurosarcoidosis within the University of Utah healthcare system, including demographics, clinical characteristics, treatment, and long-term outcomes.MethodsWe describe the clinical features and outcomes of patients with neurosarcoidosis within the University of Utah healthcare system (a large referral center for 10% of the continental United States by land mass). Patients were selected who met the following criteria: (1) at least one International Classification of Diseases Clinical Modification, 9th revision code 135 or International Classification of Diseases Clinical Modification, 10th revision code D86* (sarcoidosis) and (2) at least one outpatient visit with a University of Utah clinician in the Neurology Department within the University of Utah electronic health record.ResultsWe identified 56 patients meeting the study criteria. Thirty-five patients (63%) were women, and most patients (84%) were white. Twelve patients (22%) met the criteria for definite neurosarcoidosis, 36 patients (64%) were diagnosed with probable neurosarcoidosis, and 8 patients (14%) were diagnosed with possible neurosarcoidosis. A total of 8 medications were used for the treatment of neurosarcoidosis. Prednisone was the first-line treatment in 51 patients (91%). Infliximab was the most effective therapy, with 87% of patients remaining stable or improving on infliximab. Treatment response for methotrexate and azathioprine was mixed, and mycophenolate mofetil and rituximab were the least effective treatments in this cohort.ConclusionsThis is a comprehensive characterization of neurosarcoidosis within a single healthcare system at the University of Utah that reports long-term response to treatment and outcomes of patients with neurosarcoidosis. Our results suggest the use of infliximab as a first-line therapy for neurosarcoidosis.

From Volunteering to Academic Programming: A Case Example

2016 ◽  
Vol 1 (17) ◽  
pp. 7-11 ◽  
Author(s):  
Cindy Gill ◽  
Sneha Bharadwaj ◽  
Nancy Quick ◽  
Sarah Wainscott ◽  
Paula Chance
Keyword(s):  
Special Needs ◽  
Cultural Relevance ◽  
Master's Program ◽  
Speech Language Pathology ◽  
Community Based ◽  
Charitable Organization ◽  
Language Pathology ◽  
The University

A speech-language pathology master's program that grew out of a partnership between the University of Zambia and a U.S.-based charitable organization, Connective Link Among Special needs Programs (CLASP) International, has just been completed in Zambia. The review of this program is outlined according to the suggested principles for community-based partnerships, a framework which may help evaluate cultural relevance and sustainability in long-term volunteer efforts (Israel, Schulz, Parker, & Becker, 1998).

Integration of Digital Preservation Knowledge, Skills and Competencies in the Teaching Curricula of Library and Information Studies at the University of Botswana

Mousaion ◽  
2019 ◽  
Vol 37 (1) ◽  
Author(s):  
Thatayaone Segaetsho ◽  
Julie Moloi
Keyword(s):  
Digital Preservation ◽  
Records Management ◽  
Structured Interviews ◽  
University Of Botswana ◽  
Current Trends ◽  
Teaching Content ◽  
Library And Information Studies ◽  
Information Studies ◽  
The University

In the past few decades, digital technology has found a place in the acquisition, arrangement, description, preservation, and dissemination of information. However, heritage institutions are perturbed by the challenges of digital preservation strategies particularly for education. Despite continuous investment in digital preservation, there are limited skilled professionals to equip learners with the knowledge, skills and competencies required to drive digital preservation in Botswana. Therefore, this paper investigated the knowledge, skills and competencies related to digital preservation in the teaching curricula of the Department of Library and Information Studies (DLIS) at the University of Botswana. Data collection was done through intensive structured interviews with specific educators who teach courses on digital preservation in the archives and records management stream. The study revealed that despite the fact that the educators in preservation courses are aware of current trends in digital preservation, most of them have not obtained formal degree certification specific to digital preservation. The findings further revealed that minimal digital preservation competencies are observed in the teaching curricula. A significant number of challenges observed illustrated mainly a lack of resources and limited skills in terms of practical demonstrations by educators. The curricula mostly lacked clarity on long-term and short-term digital preservation. The study recommends that DLIS and other institutions should conduct surveys or curriculum auditing on digital preservation in order to improve the teaching content. A significant number of shortcomings regarding digital preservation that could motivate further studies are also discussed under the conclusion and recommendations section of this study.

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