Pediatric tizanidine toxicity reversed with naloxone: a case report

Background Tizanidine, an α-2 adrenoceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports on pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone. Case presentation A 3-year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness and respiratory and heart rates were observed after two intravenous administrations of naloxone at a dose of 0.05 and 0.1 mg/kg, respectively. Conclusions This case report provides further evidence regarding the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists and presents additional epidemiologic data on childhood tizanidine poisoning.

Epidemiology of Candidemia in Children over 7 Years in a Medical Center in Turkey

In our study, the changing epidemiology of Candida species in candidemia in children was evaluated. The dominance of Candida parapsilosis species in the changing epidemiology was remarkable. We found that fluconazole resistance was high in both parapsilosis and nonparapsilosis groups. Updating local epidemiologic data at certain intervals in candidemia cases is important in determining both the changing epidemiology and empirical antifungal agents.

521Performance of doubly-robust, machine learning effect estimators in realistic epidemiologic data settings and practical recommendations

Background Flexible, data-adaptive algorithms (machine learning; ML) for nuisance parameter estimation in epidemiologic causal inference have promising asymptotic properties for complex, high-dimensional data. However, recently proposed applications (e.g. targeted maximum likelihood estimation; TMLE) may produce biases parameter and standard error estimates in common real-world cohort settings. The relative performance of these novel estimators over simpler approaches in such settings is unclear. Methods We apply double-crossfit TMLE, augmented inverse probability weighting (AIPW), and standard IPW to simple simulations (5 covariates) and “real-world” data using covariate-structure-preserving (“plasmode”) simulations of 1,178 subjects and 331 covariates from a longitudinal birth cohort. We evaluate various data generating and estimation scenarios including: under- and over- (e.g. excess orthogonal covariates) identification, poor data support, near-instruments, and mis-specified biological interactions. We also track representative computation times. Results We replicate optimal performance of cross-fit, doubly robust estimators in simple data generating processes. However, in nearly every real world-based scenario, estimators fit with parametric learners outperform those that include non-parametric learners in terms of mean bias and confidence interval coverage. Even when correctly specified, estimators fit with non-parametric algorithms (xgboost, random forest) performed poorly (e.g. 24% bias, 57% coverage vs. 10% bias, 79% coverage for parametric fit), at times underperforming simple IPW. Conclusions In typical epidemiologic data sets, double-crossfit estimators fit with simple smooth, parametric learners may be the optimal solution, taking 2-5 times less computation time than flexible non-parametric models, while having equal or better performance. No approaches are optimal, and estimators should be compared on simulations close to the source data. Key messages In epidemiologic studies, use of flexible non-parametric algorithms for effect estimation should be strongly justified (i.e. high-dimensional covariates) and performed with care. Parametric learners may be a safer option with few drawbacks.

Delta variants of SARS-CoV-2 cause significantly increased vaccine breakthrough COVID-19 cases in Houston, Texas

Genetic variants of SARS-CoV-2 have repeatedly altered the course of the COVID-19 pandemic, and disease in individual patients. Delta variants (B.1.617.2, AY.2, and AY.3) are now the focus of international concern because they are causing widespread COVID-19 disease globally. Vaccine breakthrough cases caused by SARS-CoV-2 variants also are of considerable public health and medical concern worldwide. As part of a comprehensive project, we sequenced the genomes of 3,913 SARS-CoV-2 from patient samples acquired March 15, 2021 through July 3, 2021 in the Houston Methodist hospital system and studied vaccine breakthrough cases. During the study period Delta variants increased to cause 58% of all COVID-19 cases and spread throughout the metropolitan Houston area. In addition, Delta variants caused a significantly higher rate of vaccine breakthrough cases (19.7% compared to 5.8% for all other variants). Importantly, only 6.5% of all COVID-19 cases occurred in fully immunized individuals, and relatively few of these patients required hospitalization. Our genomic and epidemiologic data emphasize that vaccines used in the United States are highly effective in decreasing severe COVID-19 disease, hospitalizations, and deaths.

Management Approach to Acute Myeloid Leukemia Leveraging the Available Resources in View of the Latest Evidence: Consensus of the Saudi Society of Blood and Marrow Transplantation

PURPOSE Acute myeloid leukemia (AML) is the most prevalent acute leukemia in adults and is responsible for the majority of cancer-related mortality. In Saudi Arabia, leukemia is ranked the fifth most prevalent type of malignancy in adults. Our aim is to review existing epidemiologic data in Saudi Arabia and develop consensus guidelines for management of AML. METHODS We review literature related to AML epidemiology, treatment patterns, and outcomes in Saudi Arabia, as well as literature related to the current advances in AML treatment. A panel of 10 experts from eight institutions in Saudi Arabia reviewed the literature and developed a consensus statement. RESULT We provide an update of the available AML epidemiologic data in Saudi Arabia and describe recent developments in the diagnostic workup, risk stratification, and treatment algorithm. The consensus recommendations for the management of AML in Saudi Arabia were developed. CONCLUSION The recommendations are in parallel with the recent international guidelines for the diagnosis and management of AML.

Pediatric Tizanidine Toxicity Reversed with Naloxone a case report

BackgroundTizanidine, an α-2 adrenoreceptor agonist, is widely prescribed for the management of spasticity in adults. Case reports for pediatric tizanidine overdose are limited. Here, we report a case of pediatric tizanidine toxicity that was reversed with naloxone.Case presentationA three year-old male presented to the emergency department with lethargy, bradycardia, and bradypnea after accidental ingestion of multiple tizanidine tablets. Improvements in the level of consciousness, respiratory and heart rates were observed post intravenous naloxone administration of 0.05 and 0.1 mg/kg respectively.ConclusionsThis case report provides additional epidemiologic data on childhood tizanidine poisoning and further documentation on the use of naloxone as a viable antidote for centrally acting α-2 receptor agonists.

Epidemiology of colorectal cancer in Barbados: A short report

Barbados is a Caribbean island with a high incidence of colorectal cancer. This study collected epidemiologic data from Barbadian patients with colorectal cancer. There was an opportunity for targeted screening in patients actively enrolled in clinics for management of chronic diseases, accounting for 72% of cases. We also identified areas of high incidence where resources should be directed in a screening programme.

Description of a University COVID-19 Outbreak and Interventions to Disrupt Transmission, Wisconsin, August - October 2020.

University settings have demonstrated potential for COVID-19 outbreaks, as they can combine congregate living, substantial social activity, and a young population predisposed to mild illness. Using genomic and epidemiologic data, we describe a COVID-19 outbreak at the University of Wisconsin (UW)-Madison. During August - October 2020, 3,485 students tested positive, including 856/6,162 students living in residence halls. Case counts began rising during move-in week for on-campus students (August 25-31, 2020), then rose rapidly during September 1-11, 2020. UW-Madison initiated multiple prevention efforts, including quarantining two residence halls; a subsequent decline in cases was observed. Genomic surveillance of cases from Dane County, where UW-Madison is located, did not find evidence of transmission from a large cluster of cases in the two residence halls quarantined during the outbreak. Coordinated implementation of prevention measures can effectively reduce SARS-CoV-2 spread in university settings and may limit spillover to the community surrounding the university.