1
|
Tang K, Rajeh A, Shaw KS, Nguyen N, Wan G, Hashemi KB, Castillo RL, Kwatra SG, LeBoeuf NR, Vleugels RA, Semenov YR. De novo autoimmune connective tissue disease and mortality in patients treated with anti-PD-1 and anti-PD-L1 therapy: a population-level cohort study. Br J Dermatol 2024:ljae184. [PMID: 38676955 DOI: 10.1093/bjd/ljae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 04/29/2024]
Abstract
Using a population-level cohort analysis, our study demonstrates that though rare, de novo autoimmune cutaneous connective tissue disorders (AiCTD) in the setting of immune checkpoint inhibitors (ICI) are not associated with a greater risk of mortality and are overall approaching a statistically significant decrease in mortality when compared to ICI-treated patients without cutaneous immune-related adverse events. These findings are significant and highly relevant to dermatologists and oncologists caring for ICI recipients as it adds to the limited information on development of cutaneous AiCTD following ICI administration, for which enhanced understanding is critical to improving the care for this challenging patient population.
Collapse
Affiliation(s)
- Kimberly Tang
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmad Rajeh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharina S Shaw
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nga Nguyen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guihong Wan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole R LeBoeuf
- Dana Farber Cancer Institute, Department of Dermatology, Boston, MA, USA
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Smith NA, Shaw KS. Response to "Safety of dermatologic medications in pregnancy and lactation: An Update - Part 1: Pregnancy & Part 2: Lactation". J Am Acad Dermatol 2024:S0190-9622(24)00627-3. [PMID: 38614251 DOI: 10.1016/j.jaad.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
3
|
Chen GF, Shaw KS, Xu S, Hashemi KB, Castillo RL, Vleugels RA, Cohen JM. Depression in patients with Raynaud's phenomenon: A case-control study in the National Institutes of Health's All of Us Research Program. J Am Acad Dermatol 2024; 90:857-859. [PMID: 38128831 DOI: 10.1016/j.jaad.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Xu
- Yale School of Medicine, New Haven, Connecticut
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
4
|
Pineider JL, Rangu SA, Shaw KS, Cipriano SD, Oza VS. Pediatric consultative dermatology: A survey of the Society for Pediatric Dermatology workforce reveals shortcomings in existing practice models of pediatric dermatology consult services in the United States. Pediatr Dermatol 2024; 41:270-274. [PMID: 38239057 DOI: 10.1111/pde.15520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/16/2023] [Indexed: 03/19/2024]
Abstract
The rate of pediatric hospitalization for cutaneous pathology has been increasing in recent years, often requiring the expertise of consulting pediatric dermatologists; however, the infrastructure of inpatient pediatric dermatology consultative services remains poorly characterized. We sought to assess the structure, consult volume, physician compensation, and utilization of teledermatology in pediatric dermatology inpatient services to better understand the current care model. Our survey of 118 pediatric dermatologists revealed that 89% of respondents see between 1 and 10 new consults per week, 39% perform all inpatient consults including evening and weekends without assistance from other providers, 71% do not have protected time during the week to provide inpatient consultations, and only 10% receive financial compensation via stipend. By highlighting both the high demand for pediatric consultative dermatology as well as the significant burden placed on these providers by existing practice models, we hope to encourage a reappraisal of the current infrastructure of pediatric inpatient dermatology to increase structural and financial support for this vital service.
Collapse
Affiliation(s)
- Juliana L Pineider
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sneha A Rangu
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Katharina S Shaw
- Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah D Cipriano
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York, USA
| |
Collapse
|
5
|
Shaw KS, Reusch DB, Castillo RL, Hashemi KB, Sundel R, Dedeoglu F, Vleugels RA. Rapid Improvement in Recalcitrant Cutaneous Juvenile Dermatomyositis With Anifrolumab Treatment. JAMA Dermatol 2024; 160:237-238. [PMID: 37950917 DOI: 10.1001/jamadermatol.2023.4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
This case report describes a 14-year-old girl with juvenile dermatomyositis who presented with a 6-year history of a pruritic, photosensitive eruption involving her face, neck, trunk, and extremities and was successfully treated with anifrolumab.
Collapse
Affiliation(s)
- Katharina S Shaw
- Section of Dermatology, Department of Dermatology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diana B Reusch
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert Sundel
- Rheumatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
6
|
Shaw KS, Nguyen TT, Rajeh A, Cohen SM, Semenov YR, Reusch DB, Dedeoglu F, Vleugels RA, Ganske IM. Use of 3-Dimensional Stereophotogrammetry to Detect Disease Progression in Craniofacial Morphea. JAMA Dermatol 2023; 159:1232-1239. [PMID: 37819665 PMCID: PMC10568443 DOI: 10.1001/jamadermatol.2023.3649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023]
Abstract
Importance Objectively determining disease progression in craniofacial morphea (CM) is challenging, as clinical findings of disease activity are often lacking. Objective To evaluate the utility of 3-dimensional (3D) stereophotogrammetry in detecting disease progression in CM over time. Design, Setting, and Participants This prospective cohort study included 27 pediatric and adult patients with CM from 2 hospitals in Boston (Boston Children's Hospital and Brigham & Women's Hospital) consecutively enrolled from April 1, 2019, to March 1, 2023. Review of 3D stereophotogrammetry images and data analysis occurred from March 1 to April 1, 2023. Main Outcomes and Measures Clinical and 3D stereophotogrammetry assessments were performed at 2- to 12-month intervals, depending on the clinical context. The 3D stereophotogrammetry images were then qualitatively rated as demonstrating no progression or definitive progression by an expert (board-certified plastic craniofacial surgeon) and nonexpert (board-certified dermatologist) in 3D stereophotogrammetry. In addition, κ coefficients were calculated for interrater reliability. Results Of 27 patients with CM (19 female; median age, 14 [range, 5-40] years) and 3D stereophotogrammetry images obtained from a minimum of 2 time points (median, 4 [range, 2-10] images) spaced a median of 3 (range, 2-12) months apart, 10 experienced progression of their disease based on clinical assessments performed during the study period. In all cases in which clinical progression was favored, blinded qualitative assessment of 3D stereophotogrammetry images also favored progression with substantial interrater reliability (κ = 0.80 [95% CI, 0.61-0.99]). Furthermore, review of 3D stereophotogrammetry detected occult progression of asymmetry not noted on clinical examination in 3 additional patients. Conclusions and Relevance In this prospective cohort study, blinded assessment of sequential 3D stereophotogrammetry images in patients with CM not only corroborated clinical assessment of disease progression but also detected occult progression of facial asymmetry not appreciable on clinical examination alone. Therefore, 3D stereophotogrammetry may serve as a useful adjunct to clinical examination of patients with CM over time. Future investigations are warranted to validate 3D stereophotogrammetry as an outcome measure in CM.
Collapse
Affiliation(s)
- Katharina S. Shaw
- Section of Dermatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tyler T. Nguyen
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Ahmad Rajeh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephanie M. Cohen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yevgeniy R. Semenov
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - Diana B. Reusch
- Dermatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ingrid M. Ganske
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
7
|
Chen GF, Shaw KS, Sanchez-Melendez S, Vleugels RA, Cohen JM. Increased risk of depression in patients with discoid lupus erythematosus: a nested, case-control study in the All of Us Research Program. Br J Dermatol 2023; 189:628-629. [PMID: 37461222 DOI: 10.1093/bjd/ljad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 10/27/2023]
Abstract
In this nested case–control study, we found a twofold increased risk of major depressive disorder in patients with discoid lupus erythematosus (DLE) vs. controls without DLE, using the All of Us database, a National Institutes of Health (USA) research programme that prioritizes recruitment from demographic groups under-represented in biomedical research. This is the first large-scale study of this association in a heterogeneous population and highlights the importance vigilance regarding the increased risk of depression in patients with DLE.
Collapse
Affiliation(s)
| | - Katharina S Shaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
8
|
Shaw KS, Rajeh A, Le T, Kahn PJ, Oza VS, Arkin LM, Vleugels RA. Anifrolumab for Adolescent Discoid Lupus Erythematosus. JAMA Netw Open 2023; 6:e2338200. [PMID: 37851448 PMCID: PMC10585408 DOI: 10.1001/jamanetworkopen.2023.38200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/01/2023] [Indexed: 10/19/2023] Open
Abstract
This case series describes the outcomes among adolescent patients with systemic lupus erythematosus and refractory discoid lupus erythematosus treated with anifrolumab.
Collapse
Affiliation(s)
- Katharina S. Shaw
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ahmad Rajeh
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Todd Le
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Philip J. Kahn
- Division of Pediatric Rheumatology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone Health, New York University Grossman School of Medicine, New York
| | - Vikash S. Oza
- Division of Pediatric Rheumatology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone Health, New York University Grossman School of Medicine, New York
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Lisa M. Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
9
|
Sanchez-Melendez SN, Shaw KS, Pan CX, Taylor DL, Shahriari N, Mazori DR, Vleugels RA. Mepolizumab for refractory eosinophilic fasciitis: a retrospective analysis from two tertiary care centres. Clin Exp Rheumatol 2023; 41:1721-1722. [PMID: 37246772 DOI: 10.55563/clinexprheumatol/j7gexb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/17/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Stephanie N Sanchez-Melendez
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, and Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Katharina S Shaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherina X Pan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dustin L Taylor
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neda Shahriari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel R Mazori
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
10
|
Shaw KS, Sanchez-Melendez S, Vleugels RA. Diffuse Cutaneous Eruption. JAMA 2023:2806233. [PMID: 37306991 DOI: 10.1001/jama.2023.7322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Katharina S Shaw
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
|
12
|
Abstract
1. Hosts and their parasites exist within complex ecological communities. However, the role that non-focal community members, species which cannot be infected by a focal pathogen, may play in altering parasite transmission is often only studied in the lens of the "diversity-disease" relationship by focusing on species richness. This approach largely ignores mechanistic species interactions and risks collapsing our understanding of the community ecology of disease down to defining the prominence of "amplification" vs. "dilution" effects. 2. However, non-focal species vary in their traits, densities, and types of interactions with focal hosts and parasites. Therefore, a community ecology approach based on the mechanisms underlying parasite transmission, host harm, and dynamic species interactions may better advance our understanding of parasite transmission in complex communities. 3. Using the concept of the parasite's basic reproductive ratio, R0, as a generalizable framework, we examine several critical mechanisms by which interactions among hosts, parasites, and non-focal species modulate transmission and provide examples from relevant literature. 4. By focusing on the mechanism by which non-focal species impact transmission, we can emphasize the similarities among classic paradigms in the community ecology of disease, gain new insights into parasite invasion and persistence, community traits correlated with disease dilution or amplification, and the feasibility of biocontrol for parasites of conservation, agricultural, or human health concern.
Collapse
Affiliation(s)
- KS Shaw
- Department of Biology, Emory University, Atlanta, GA USA 30322
| | | |
Collapse
|
13
|
Sally R, Shaw KS, Pomeranz MK. Benign "lumps and bumps" of the vulva: A review. Int J Womens Dermatol 2021; 7:383-390. [PMID: 34621949 PMCID: PMC8484947 DOI: 10.1016/j.ijwd.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
Vulvar dermatology represents a challenge for many providers. Given that the vulva is both a gynecologic and dermatologic organ, patients with cutaneous lesions involving the vulva may present to primary care, gynecology, or dermatology. Particularly within dermatology, the vulva remains understudied, which can lead to anxiety among providers regarding appropriate next steps in the diagnosis and management of vulvar lesions. Thus, the purpose of this review is to highlight commonly encountered anatomic variants and benign neoplasms of the vulva, distinguish them from key pathologic mimickers, and provide guidance to practicing dermatologists on what may constitute normal vulvar variations.
Collapse
Affiliation(s)
- Rachel Sally
- The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
| | - Katharina S Shaw
- The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
| |
Collapse
|
14
|
Young TK, Shaw KS, Shah JK, Noor A, Alperin RA, Ratner AJ, Orlow SJ, Betensky RA, Shust GF, Kahn PJ, Oza VS. Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic. JAMA Dermatol 2021; 157:207-212. [PMID: 33295957 DOI: 10.1001/jamadermatol.2020.4779] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance To date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms. Objective To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020. Design, Setting, and Participants A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C. Main Outcomes and Measures Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists. Results Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity. Conclusions and Relevance In this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.
Collapse
Affiliation(s)
- Trevor K Young
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Katharina S Shaw
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Jinal K Shah
- Department of Biostatistics, New York University School of Global Public Health, New York
| | - Asif Noor
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Risa A Alperin
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Adam J Ratner
- Department of Pediatrics, New York University Grossman School of Medicine, New York.,Department of Microbiology, New York University Grossman School of Medicine, New York
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York
| | - Rebecca A Betensky
- Department of Biostatistics, New York University School of Global Public Health, New York
| | - Gail F Shust
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Philip J Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York.,Department of Pediatrics, New York University Grossman School of Medicine, New York
| |
Collapse
|
15
|
Karagounis TK, Shaw KS, Caplan A, Lo Sicco K, Femia AN. Acrofacial purpura and necrotic ulcerations in COVID-19: a case series from New York City. Int J Dermatol 2020; 59:1419-1422. [PMID: 32966592 PMCID: PMC7537226 DOI: 10.1111/ijd.15181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/15/2020] [Accepted: 08/26/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Theodora K Karagounis
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Katharina S Shaw
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Avrom Caplan
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
16
|
Shaw KS, Karagounis TK, Yin L, Svigos K, Gibbon GT, Betensky RA, Lo Sicco KI. Exchanging Dermatoscopes for Stethoscopes: Has the COVID-19 Pandemic Highlighted Gaps in US Dermatology Residency Training? J Drugs Dermatol 2020; 19:905-906. [PMID: 33026742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
17
|
Shaw KS, Karagounis TK, Yin L, Gibbon G, Betensky RA, Lo Sicco KI, Femia AN. Comment on "Patient preference for cellulitis treatment: At-home care is preferred to hospital-based treatment". J Am Acad Dermatol 2020; 85:e157-e158. [PMID: 32777319 PMCID: PMC7413198 DOI: 10.1016/j.jaad.2020.07.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Katharina S Shaw
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Theodora K Karagounis
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Lu Yin
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Grace Gibbon
- Department of Biostatistics, New York University School of Global Public Health, New York, New York
| | - Rebecca A Betensky
- Department of Biostatistics, New York University School of Global Public Health, New York, New York
| | - Kristen I Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
18
|
Lopez AT, Shaw KS, Yamany T, Husain S, Geskin L. Immunophenotypic CD56 Variation Within a Single Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm. JAMA Dermatol 2018; 154:492-494. [PMID: 29490374 DOI: 10.1001/jamadermatol.2017.6061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adriana T Lopez
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Katharina S Shaw
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Tarek Yamany
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Sameera Husain
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Larisa Geskin
- Department of Dermatology, Columbia University Medical Center, New York, New York
| |
Collapse
|
19
|
Affiliation(s)
- Katharina S. Shaw
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Giang H. Nguyen
- Department of Dermatology, Anschultz Medical Campus, University of Colorado, New York, New York
| | - Mario Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liang Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
20
|
Luna JM, Scheel TKH, Danino T, Shaw KS, Mele A, Fak JJ, Nishiuchi E, Takacs CN, Catanese MT, de Jong YP, Jacobson IM, Rice CM, Darnell RB. Hepatitis C virus RNA functionally sequesters miR-122. Cell 2015; 160:1099-110. [PMID: 25768906 DOI: 10.1016/j.cell.2015.02.025] [Citation(s) in RCA: 257] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/26/2014] [Accepted: 01/30/2015] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) uniquely requires the liver-specific microRNA-122 for replication, yet global effects on endogenous miRNA targets during infection are unexplored. Here, high-throughput sequencing and crosslinking immunoprecipitation (HITS-CLIP) experiments of human Argonaute (AGO) during HCV infection showed robust AGO binding on the HCV 5'UTR at known and predicted miR-122 sites. On the human transcriptome, we observed reduced AGO binding and functional mRNA de-repression of miR-122 targets during virus infection. This miR-122 "sponge" effect was relieved and redirected to miR-15 targets by swapping the miRNA tropism of the virus. Single-cell expression data from reporters containing miR-122 sites showed significant de-repression during HCV infection depending on expression level and site number. We describe a quantitative mathematical model of HCV-induced miR-122 sequestration and propose that such miR-122 inhibition by HCV RNA may result in global de-repression of host miR-122 targets, providing an environment fertile for the long-term oncogenic potential of HCV.
Collapse
Affiliation(s)
- Joseph M Luna
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA; Laboratory of Molecular Neuro-Oncology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065, USA
| | - Troels K H Scheel
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA; Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Disease and Clinical Research Centre, Copenhagen University Hospital, Hvidovre, and Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Tal Danino
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA; Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Katharina S Shaw
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA
| | - Aldo Mele
- Laboratory of Molecular Neuro-Oncology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065, USA
| | - John J Fak
- Laboratory of Molecular Neuro-Oncology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065, USA
| | - Eiko Nishiuchi
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA
| | - Constantin N Takacs
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA; Laboratory of Cellular Biophysics, The Rockefeller University, New York, NY 10065, USA
| | - Maria Teresa Catanese
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA
| | - Ype P de Jong
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA; Center for the Study of Hepatitis C, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Ira M Jacobson
- Center for the Study of Hepatitis C, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, Center for the Study of Hepatitis C, The Rockefeller University, New York, NY 10065, USA.
| | - Robert B Darnell
- Laboratory of Molecular Neuro-Oncology and Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10065, USA; New York Genome Center, 101 Avenue of the Americas, New York, NY 10013, USA.
| |
Collapse
|
21
|
Kraus MH, Parrish NF, Shaw KS, Decker JM, Keele BF, Salazar-Gonzalez JF, Grayson T, McPherson DT, Ping LH, Anderson JA, Swanstrom R, Williamson C, Shaw GM, Hahn BH. A rev1-vpu polymorphism unique to HIV-1 subtype A and C strains impairs envelope glycoprotein expression from rev-vpu-env cassettes and reduces virion infectivity in pseudotyping assays. Virology 2009; 397:346-57. [PMID: 20003995 DOI: 10.1016/j.virol.2009.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/05/2009] [Accepted: 11/10/2009] [Indexed: 11/24/2022]
Abstract
Functional studies of HIV-1 envelope glycoproteins (Envs) commonly include the generation of pseudoviruses, which are produced by co-transfection of rev-vpu-env cassettes with an env-deficient provirus. Here, we describe six Env constructs from transmitted/founder HIV-1 that were defective in the pseudotyping assay, although two produced infectious virions when expressed from their cognate proviruses. All of these constructs exhibited an unusual gene arrangement in which the first exon of rev (rev1) and vpu were in the same reading frame without an intervening stop codon. Disruption of the rev1-vpu fusion gene by frameshift mutation, stop codon, or abrogation of the rev initiation codon restored pseudovirion infectivity. Introduction of the fusion gene into wildtype Env cassettes severely compromised their function. The defect was not due to altered env and rev transcription or a dominant negative effect of the expressed fusion protein, but seemed to be caused by inefficient translation at the env initiation codon. Although the rev1-vpu polymorphism affects Env expression only in vitro, it can cause problems in studies requiring Env complementation, such as analyses of co-receptor usage and neutralization properties, since 3% of subtype A, 20% of subtype C and 5% of CRF01_A/E viruses encode the fusion gene. A solution is to eliminate the rev initiation codon when amplifying rev-vpu-env cassettes since this increases Env expression irrespective of the presence of the polymorphism.
Collapse
Affiliation(s)
- Matthias H Kraus
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Salazar-Gonzalez JF, Salazar MG, Keele BF, Learn GH, Giorgi EE, Li H, Decker JM, Wang S, Baalwa J, Kraus MH, Parrish NF, Shaw KS, Guffey MB, Bar KJ, Davis KL, Ochsenbauer-Jambor C, Kappes JC, Saag MS, Cohen MS, Mulenga J, Derdeyn CA, Allen S, Hunter E, Markowitz M, Hraber P, Perelson AS, Bhattacharya T, Haynes BF, Korber BT, Hahn BH, Shaw GM. Genetic identity, biological phenotype, and evolutionary pathways of transmitted/founder viruses in acute and early HIV-1 infection. ACTA ACUST UNITED AC 2009; 206:1273-89. [PMID: 19487424 PMCID: PMC2715054 DOI: 10.1084/jem.20090378] [Citation(s) in RCA: 602] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Identification of full-length transmitted HIV-1 genomes could be instrumental in HIV-1 pathogenesis, microbicide, and vaccine research by enabling the direct analysis of those viruses actually responsible for productive clinical infection. We show in 12 acutely infected subjects (9 clade B and 3 clade C) that complete HIV-1 genomes of transmitted/founder viruses can be inferred by single genome amplification and sequencing of plasma virion RNA. This allowed for the molecular cloning and biological analysis of transmitted/founder viruses and a comprehensive genome-wide assessment of the genetic imprint left on the evolving virus quasispecies by a composite of host selection pressures. Transmitted viruses encoded intact canonical genes (gag-pol-vif-vpr-tat-rev-vpu-env-nef) and replicated efficiently in primary human CD4+ T lymphocytes but much less so in monocyte-derived macrophages. Transmitted viruses were CD4 and CCR5 tropic and demonstrated concealment of coreceptor binding surfaces of the envelope bridging sheet and variable loop 3. 2 mo after infection, transmitted/founder viruses in three subjects were nearly completely replaced by viruses differing at two to five highly selected genomic loci; by 12–20 mo, viruses exhibited concentrated mutations at 17–34 discrete locations. These findings reveal viral properties associated with mucosal HIV-1 transmission and a limited set of rapidly evolving adaptive mutations driven primarily, but not exclusively, by early cytotoxic T cell responses.
Collapse
|
23
|
Van Heuverswyn F, Li Y, Bailes E, Neel C, Lafay B, Keele BF, Shaw KS, Takehisa J, Kraus MH, Loul S, Butel C, Liegeois F, Yangda B, Sharp PM, Mpoudi-Ngole E, Delaporte E, Hahn BH, Peeters M. Genetic diversity and phylogeographic clustering of SIVcpzPtt in wild chimpanzees in Cameroon. Virology 2007; 368:155-71. [PMID: 17651775 DOI: 10.1016/j.virol.2007.06.018] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 06/07/2007] [Accepted: 06/13/2007] [Indexed: 11/19/2022]
Abstract
It is now well established that the clade of simian immunodeficiency viruses (SIVs) infecting west central African chimpanzees (Pan troglodytes troglodytes) and western gorillas (Gorilla gorilla gorilla) comprises the progenitors of human immunodeficiency virus type 1 (HIV-1). In this study, we have greatly expanded our previous molecular epidemiological survey of SIVcpz in wild chimpanzees in Cameroon. The new results confirm a wide but uneven distribution of SIVcpzPtt in P. t. troglodytes throughout southern Cameroon and indicate the absence of SIVcpz infection in Pan troglodytes vellerosus. Analyzing 725 fecal samples from 15 field sites, we obtained partial nucleotide sequences from 16 new SIVcpzPtt strains and determined full-length sequences for two of these. Phylogenetic analyses of these new viruses confirmed the previously reported phylogeographic clustering of SIVcpzPtt lineages, with viruses related to the ancestors of HIV-1 groups M and N circulating exclusively in southeastern and south central P. t. troglodytes communities, respectively. Importantly, the SIVcpzPtt strains from the southeastern corner of Cameroon represent a relatively isolated clade indicating a defined geographic origin of the chimpanzee precursor of HIV-1 group M. Since contacts between humans and apes continue, the possibility of ongoing transmissions of SIV from chimpanzees (or gorillas) to humans has to be considered. In this context, our finding of distinct SIVcpzPtt envelope V3 sequence clades suggests that these peptides may be useful for the serological differentiation of SIVcpzPtt and HIV-1 infections, and thus the diagnosis of new cross-species transmissions if they occurred.
Collapse
Affiliation(s)
- Fran Van Heuverswyn
- UMR145, Institut de Recherche pour le Développement, Department of International Health, University of Montpellier 1, 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Buchmiller-Crair TL, Kim CS, Won NH, Chopourian HL, Shaw KS, Fonkalsrud EW. Effect of acute anemia on the healing of intestinal anastomoses in the rabbit. J Trauma 2001; 51:363-8. [PMID: 11493801 DOI: 10.1097/00005373-200108000-00024] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considering the potential deleterious effects of transfusion, the effect of severe, acute anemia on small intestine (SI) and large intestine (LI) anastomoses was evaluated. METHODS Thirty-six rabbits underwent segmental resection of the midileum and distal colon. Half underwent preanastomotic removal of 30% of their blood volume with crystalloid resuscitation. At 1 or 2 weeks, the anastomotic bursting pressure (ABP) and histologic grade of white blood cell influx, blood vessel ingrowth, fibroblast proliferation, and collagen deposition were assessed. RESULTS SI ABP was decreased in anemic rabbits at 2 weeks (190 +/- 6 mm Hg vs. 257 +/- 17 mm Hg). LI ABP was decreased at 1 week in anemic rabbits. In the test rabbits, histologic parameters were altered in both the SI and LI with decreased white blood cell infiltration, attenuated blood vessel ingrowth, and decreased collagen content at both 1 and 2 weeks. Decreased SI fibroblast proliferation was present at 1 week. CONCLUSION Acute anemia in the rabbit undergoing intestinal resection decreases the SI ABP at 2 weeks and alters histologic parameters of wound healing in both the SI and LI.
Collapse
|
25
|
Emil S, Mikhail P, Laberge JM, Flageole H, Nguyen LT, Shaw KS, Baican L, Oudjhane K. Clinical versus sonographic evaluation of acute appendicitis in children: a comparison of patient characteristics and outcomes. J Pediatr Surg 2001; 36:780-3. [PMID: 11329589 DOI: 10.1053/jpsu.2001.22960] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Abdominal sonography has gained popularity in establishing the diagnosis of appendicitis in children with equivocal clinical presentations. However, no clear outcome benefits have been demonstrated to date. The authors conducted a retrospective study to compare the characteristics and outcomes of patients undergoing appendectomy after clinical evaluation only with those undergoing the procedure after sonography. METHODS The charts of 454 consecutive patients undergoing appendectomy for acute appendicitis between January 1, 1998 and December 4, 1999 were reviewed. Patients operated on after clinical evaluation only were compared with patients operated on after abdominal sonography. RESULTS Forty-two percent of patients (n = 191) constituted the sonography group. When compared with the clinical group, these patients had higher prevalence of female gender (52% v 38%; P =.004), longer symptom duration (2.2 +/- 2.5 v 1.6 +/- 1.6 days; P =.003), higher incidence of preoperative in-patient observation (19% v 4%; P <.001), longer duration between evaluation and operation (8.0 +/- 3.9 v 4.9 +/- 2.9 hours; P <.001), higher incidence of normal appendices on pathologic examination (13% v 6%; P =.006), and higher incidence of postoperative abscesses or phlegmons (4.4% v 1.2%; P =.04). The groups did not differ significantly in age, hospital stay, incidence of complicated appendicitis, or incidence of wound infection. CONCLUSIONS Patients undergoing sonography before appendectomy have a longer delay before operation, a higher rate of misdiagnosis, and more postoperative complications. Limiting sonography to truly equivocal cases and using it early in the diagnostic workup may improve outcomes in this group of patients.
Collapse
Affiliation(s)
- S Emil
- Division of Pediatric General Surgery and the Department of Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
PURPOSE The aim of this study was to better define the mode of presentation, rate of volvulus, and surgical findings in children younger than 2 versus older than 2 years of age with malrotation. METHODS The authors reviewed the charts of all patients with malrotation admitted to their hospital between January 1980 and December 1998, excluding patients having malrotation as a secondary finding. RESULTS An upper gastrointestinal series was done in 90 patients (6% falsely negative) and a barium enema in 20 patients (40% read as normal). Fifty-eight patients had 114 associated congenital anomalies. Volvulus was found at the time of surgery in 28 patients, 5 of whom were older than 2 years. Three presented with acute symptoms and 2 with chronic symptoms. Surgery was performed by laparotomy in 103 patients and by laparoscopy in 3. Mean length of stay was 13.6 days. Mean follow-up was 19 months. Death occurred in 4 patients; postoperative bowel obstruction was seen in 3 patients (only 1 required surgery). CONCLUSIONS Children with malrotation who are older than 2 years old have a significant risk of volvulus that is difficult to predict radiologically. They require surgical attention even if asymptomatic. Laparoscopy allows evaluation of the base of the mesentery and completion of the Ladd's procedure.
Collapse
Affiliation(s)
- P Prasil
- Montreal Children's Hospital, McGill University Health Center, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
Omphalocele is the most common congenital abdominal wall defect; its reported incidence is 1 in 4,000 to 5,000 live births. With large defects, the liver is a median organ and lies within the sac (extracorporeal liver [ECL]). With small defects, only bowel or stomach is found outside the abdominal cavity (intracorporeal liver [ICL]). The goal of this study was to determine whether a relationship exists between the sac contents or the timing of diagnosis and the incidence of chromosomal abnormalities or survival among fetuses and newborns with omphalocele. From 1985 to 1995, 83 cases of omphalocele were managed at the authors' institution. In 50 cases the diagnosis was made using prenatal ultrasonography. All patients underwent fetal cardiac echography and amniocentesis. Twenty-four pregnancies were terminated electively because of severe associated anomalies. Of the 59 live births, 41 patients (69%) survived. The incidences of cardiac, chromosomal, and other anomalies were 24% (14), 10% (6), and 21% (16), respectively. Omphalocele with ICL is associated with a better survival rate than omphalocele with ECL (82% v 48%; P < .01) despite the significantly higher rate of karyotype abnormalities (16% v 0%; P < .05). The prognosis was poorer for patients with prenatally diagnosed omphalocele than for those with a postnatal diagnosis (mortality rate, 42% v 21%) because the former group had a higher percentage (70% v 9%) of ECL. Although the incidence of cardiac anomalies was similar for the ECL and ICL groups (33% v 18%), the former had more complex malformations. Death usually occurred in newborns who had neonatal respiratory distress owing to prematurity, or in those with chromosomal or cardiac anomalies. Chromosomal anomalies occurred mainly in cases of small omphaloceles that contained gut only, and it was the major cause of death among this group. In ECL cases, survival was primarily affected by the associated complex cardiac anomalies.
Collapse
Affiliation(s)
- D St-Vil
- Department of Radiology, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Recurrent intussusception (RI) occurs in 5% to 8% of patients with intussusception. The authors reviewed their 15-year experience to better define the management of RI. Among 258 patients, 28 (10.8%) had episodes of RI (37 episodes altogether). Twenty-two patients had a single recurrence, four had double recurrence, one had triple recurrence, and one had quadruple recurrence. RI and non-RI patients were compared with respect to symptoms. The incidence of vomiting and bloody stools was significantly lower in the RI group. Ten percent of RI patients had lead points. Thirty percent of RI episodes occurred within 24 hours, and 74% occurred within 6 months. The success rate of hydrostatic enema reduction for recurrent episodes was 62.8%, which is comparable to that for the initial episode (68.9%). Among patients with previous surgery, 36.3% of enemas were successful; after previous enema reduction, 75% were successful. There was no complication related to the enema. Enema reduction is safe and has a good success rate in cases of RI, even after previous surgical reduction.
Collapse
Affiliation(s)
- A Fecteau
- Department of Pediatric General Surgery, Montreal Children's Hospital, McGill University, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
29
|
Shaw KS, Filiatrault D, Yazbeck S, St-Vil D. Improved survival for congenital diaphragmatic hernia, based on prenatal ultrasound diagnosis and referral to a combined obstetric-pediatric surgical center. J Pediatr Surg 1994; 29:1268-9. [PMID: 7807365 DOI: 10.1016/0022-3468(94)90821-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Between January 1990 and January 1993, 36 patients with antenatal ultrasound (US) diagnosis and/or postnatal diagnosis of congenital diaphragmatic hernia (CDH) were referred to the authors' high-risk obstetric and pediatric hospital. Among the 36, there were four spontaneous abortions (11%), five deaths after live births (14%), one false-positive US examination, and 26 patients who underwent surgery, 23 of whom survived (66% overall, 74% of live births, and 89% postoperatively). Only one survivor had extracorporeal membrane oxygenation (ECMO). Thirty-five ultrasound examinations were performed in 24 patients; there were 18 true-positives results (51%), one false-positive (3%), and 16 false-negatives (46%). In this series, there were 25 left-sided CDHs, eight right-sided, one bilateral, and one central. Of the four right-sided hernias having antenatal US, only one was diagnosed prenatally; 15 of the 17 left-sided CDHs were diagnosed correctly (88%). All 19 babies with the prenatal diagnosis were born at the authors' institution. US diagnosis before 25 weeks' gestation and polyhydramnios separately resulted in a mortality rate of only 50%. Patients born at this institution tend to be sicker than those transferred from elsewhere, as reflected by the lower 1- and 5-minute Apgar scores (3.7 v 6.9, P < .001, and 5.4 v 6.9, P < .16, respectively), lower gestational ages (37.0 v 39.2 weeks, P < .007), and lower birth weights (2,525 v 3,049 g, P < .02). Nevertheless, transferred patients had a mortality rate (3 of 15 patients, 20%) similar to that of nontransferred patients (5 of 20 patients, 25%).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- K S Shaw
- Division of Pediatric General Surgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada
| | | | | | | |
Collapse
|
30
|
Buchmiller TL, Shaw KS, Lam ML, Stokes R, Diamond JS, Fonkalsrud EW. Effect of prenatal dexamethasone administration: fetal rabbit intestinal nutrient uptake and disaccharidase development. J Surg Res 1994; 57:274-9. [PMID: 8028335 DOI: 10.1006/jsre.1994.1144] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To examine the effect of prenatal steroids on fetal intestinal maturation, eight pregnant rabbits received either dexamethasone (Dex) or saline (Cont) on Days 25-27 of a 31-day gestation. As the rabbit provides a model of growth retardation based on uterine position, fetuses were identified as favored (Fav) or runt (Runt), generating four study groups: ContFav, ContRunt, DexFav, and DexRunt. On Day 31 the small intestinal uptake of glucose and proline was measured by an everted sleeve technique. Additionally, lactase and maltase activity was determined. Small intestinal length and nutrient uptake was significantly increased in the Dex fetuses. Control runts had a trend to decreased levels of nutrient uptake when compared to their favored counterparts. This trend reversed in the Dex fetuses with runt nutrient uptake surpassing that of the favored fetus. A trend to increased enzyme activity of both lactase and maltase was demonstrated. This report provides the first description of maternal steroid administration causing a marked increase in fetal small intestinal length and glucose and proline absorption in an in vivo model of intrauterine growth retardation.
Collapse
|
31
|
Abstract
OBJECTIVE This study analyzed the factors influencing the postoperative results after the repair of gastroschisis defects during the past 27 years. SUMMARY BACKGROUND DATA The clinical results after the repair of gastroschisis abdominal defects have improved appreciably during the past 25 years, with the long-term survival rate in most large children's centers currently being approximately 90%. The improvement in survival has been largely attributed to advances in perioperative care, frequent use of parenteral nutrition, and better techniques of surgical repair. METHODS Between 1965 and 1992, 84 infants with gastroschisis underwent surgical repair. The management of 52 infants after 1979 was compared with that of 32 during the previous 14 years. Associated anomalies were present in 29%. The average birth weight was 2412 g. In 31%, primary fascial closure was performed. In another 31% with moderate visceroabdominal disproportion (VAD), a silastic chimney was used initially, and complete repair was performed at a second operation. For 25% who had severe VAD, more than two operative reconstructions were necessary. Seven of 52 infants with moderate VAD underwent initial skin-flap closure and secondary repair within 12 days. RESULTS Almost all complications (27%) and deaths (4%) occurred in infants with severe VAD and were largely unrelated to associated malformations or birth weight. The length of postoperative mechanical ventilation, need for parenteral nutrition, need for multiple operations, and length of hospitalization were all directly related to the severity of the VAD. CONCLUSIONS Complete repair of gastroschisis at the initial operation is the optimal goal; however, the severity of VAD has permitted this approach in only one third of patients in this study. Delayed repair with a silastic chimney and one or more reconstructive procedures has provided excellent long-term survival with low morbidity and mortality rates. Although skin-flap closure is no longer used initially, this technique has been helpful for the residual defect in infants with severe VAD who have had multiple silon chimney repairs (Applied Biomaterial, Silverdale, WA).
Collapse
Affiliation(s)
- E W Fonkalsrud
- Division of Pediatric Surgery, University of California, Los Angeles School of Medicine
| | | | | | | | | |
Collapse
|
32
|
Buchmiller TL, Shaw KS, Chopourian HL, Lloyd KC, Gregg JP, Rivera FA, Lam ML, Diamond JM, Fonkalsrud EW. Effect of transamniotic administration of epidermal growth factor on fetal rabbit small intestinal nutrient transport and disaccharidase development. J Pediatr Surg 1993; 28:1239-44. [PMID: 8263680 DOI: 10.1016/s0022-3468(05)80305-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
As fetal swallowing is documented in utero, supplementation of the ingested amniotic fluid with nutrients or hormones has been postulated as a potential prenatal treatment for intrauterine growth retardation (IUGR). To study the effect of epidermal growth factor (EGF) on the developing fetal small intestine, 12 pregnant rabbits underwent operation on day 24 of a normal 31-day gestation. Bilateral ovarian end fetuses underwent catheterization of their respective amniotic cavities with attachment to a miniosmotic pump. Study fetuses received recombinant human EGF at approximately 300 micrograms/kg/d for 1 week; controls received carrier solution only at an equivalent rate. On gestational day 31, fetuses were delivered by cesarean section and somatic measurements were recorded. The small intestine was harvested and proximal, middle, and distal regions were analyzed for lactase and maltase enzyme activity. Additionally, the uptake of radiolabeled glucose and proline was measured by a standard everted mucosal sleeve technique for each segment. Results were analyzed by Student's paired t test and reported as mean +/- SEM. Nine fetal pairs survived (75%). Small intestinal (SI) length was increased in EGF fetuses (54.8 +/- 1.9 cm) versus control (50.4 +/- 2.7 cm) (P = .02). Lactase activity, reported as UE/g protein, was significantly increased in the proximal segments in the EGF-infused fetuses; maltase was significantly increased in both the proximal and middle segments (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- T L Buchmiller
- Department of Pediatric Surgery, UCLA Medical Center 90024
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Buchmiller TL, Fonkalsrud EW, Kim CS, Chopourian HL, Shaw KS, Lam MM, Diamond JM. Upregulation of nutrient transport in fetal rabbit intestine by transamniotic substrate administration. J Surg Res 1992; 52:443-7. [PMID: 1619911 DOI: 10.1016/0022-4804(92)90309-n] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Delivery of nutrients to the developing fetal gastrointestinal tract has been advocated as a potential prenatal treatment for intrauterine growth retardation. To examine the effect of intrauterine nutrient administration on the uptake capacity of the intestine, 16 maternal rabbits underwent bilateral ovarian-end transamniotic catheter placement on gestational Day 24. Study fetuses received a galactose solution; the contralateral controls received mannitol, a physiologically inert carbohydrate. Infusions were continued until Day 30 when an everted sleeve technique was used to measure radiolabeled uptake of both galactose and glucose in the proximal, middle, and distal small intestine. Mucosal scrapes were obtained, weighed, and the percentage of weight was calculated. Results were analyzed by ANOVA and Student's t test with P less than 0.05 being considered significant. There were 2 maternal deaths with 11 fetal pairs surviving (79%). There was increased uptake of galactose in the study fetuses compared to controls reaching significance in the middle and distal segments. Similarly, glucose uptake was significantly increased in the proximal and distal segments. Mucosal weight was increased in all regions, reaching significance in the proximal segment. Total intestinal uptake of galactose and glucose was significantly increased in the study fetuses compared to controls. Intraamniotic galactose infusion caused not only upregulation of its own mucosal transport but also that of glucose, along the entire fetal small intestine, achieving statistical significance particularly in distal segments. Fetal implications for transamniotic feeding are under investigation.
Collapse
|