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American Society of Hematology/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients
Get PDFBackground: The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials. Objective: The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH). These ASH/ISTH evidence-based guidelines are intended to support patients, clinicians, and other health care professionals in the management of pediatric patients with VTE. Methods: ASH/ISTH formed a multidisciplinary guideline panel to minimize potential bias from conflicts of interest. An unconflicted patient representative was not identified. The University of Kansas Health System supported the guideline development process, updating or performing systematic evidence reviews up to 2024. The panel focused specifically on the 2018 questions for which there was the greatest amount of interim data. The panel used the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 20 recommendations and also provided implementation guidance on the optimal use of anticoagulants in pediatric patients. Key recommendations of these guidelines include the role of DOACs in the treatment of a variety of pediatric VTEs. Conclusions: Further research is required. Key priorities are understanding the natural history of clinically unsuspected thrombosis across a range of patient subpopulations and obtaining real-world data on the use of DOACs in children
Real-world clinical burden of patients presenting with vaginitis symptoms in the United States
Get PDFBackground: While vaginitis is a leading cause of primary care visits among women with a gynecologic-related diagnosis, there are limited contemporary data on the healthcare burden. This study describes the real-world healthcare resource utilization (HCRU) of patients presenting with vaginitis symptoms in the United States (US) at symptom presentation and over long-term follow-up. Methods: This retrospective study utilized IQVIA\u27s Longitudinal Prescription (LRx) and Medical Claims (Dx) databases to capture patients presenting with vaginitis symptoms from January 1, 2018 to September 30, 2022. The date of the first diagnosis code for vaginitis or related symptoms was considered the first clinical presentation (“index visit”). Healthcare visits, diagnostic testing, and treatments were assessed for patients at presentation (index date +2 days) and 12-month follow-up, stratified by pregnancy status at index. In a subset of patients with linkage to IQVIA Ambulatory EMR – US (AEMR), multivariable models were used to evaluate associations between insurance type, patient characteristics, diagnostic test(s) performed at presentation, and HCRU outcomes (subsequent vaginitis-related healthcare visits and ≥2 vaginitis treatment dates) over follow-up. Results: A total of 18,745,351 people were documented with vaginitis symptoms or vaginitis in the study selection window, of which 4,000,615 patients met all selection criteria for analysis: 3,787,354 were not pregnant and 213,261 had evidence of pregnancy. About one-fourth (23.8%) of the non-pregnant cohort and half (47.6%) of the pregnant cohort had claims for at least 1 diagnostic test at symptom presentation, with traditional methods being most commonly used (44.1% and 36.4% for non-pregnant and pregnant patients, respectively), followed by direct probe (20.0% and 24.1%), and lastly nucleic acid amplification test (NAAT) panel (including bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis; 6.6% and 8.3%). Despite low diagnostic testing rates, 50.1% of the non-pregnant and 60.9% of the pregnant cohort received prescribed vaginitis treatment, most frequently metronidazole or fluconazole, and 28.8% of the non-pregnant and 30.9% of the pregnant cohort had subsequent vaginitis-related visits within 12 months. Among both the non-pregnant and pregnant cohorts, patients with Medicaid insurance had significantly higher odds of repeat healthcare visits and ≥2 treatment dates during follow-up relative to patients with commercial insurance. Conclusion: This study demonstrated that vaginitis poses a high clinical burden in the US, possibly attributed to low diagnostic testing rates, use of tests with poor performance, and high rates of empiric treatment. There is an unmet need for rapid, accurate vaginitis diagnostic testing at the point-of-care to reduce empiric prescribing and improve diagnostic and treatment accuracy and efficiency
A Rare Encounter of Cervical Tuberculous Lymphadenitis (Scrofula) in an Immunocompetent Adolescent Female: A Case Report
No full textTuberculosis (TB) remains a major global health concern. While it primarily affects the lungs, TB can also present in extrapulmonary forms, with cervical tuberculous lymphadenitis (CTL) or scrofula being the most common. Herein, we report a case of a 19-year-old female with a six-month history of progressively enlarging left-sided neck swelling. The patient was diagnosed with CTL. Diagnosing extrapulmonary TB can be challenging. In cases like ours, excisional biopsy or fine-needle aspiration (FNA) cytology with acid-fast bacilli (AFB) smear, culture, or polymerase chain reaction (PCR) analysis is critical for diagnosis. Our case highlights the importance of maintaining a high index of suspicion to differentiate mycobacterial infection from other causes of lymphadenopathy, particularly in immunocompetent adolescent patients
Morphological and Immunohistochemical Support for the Origin of the Carcinoid Component in Strumal Carcinoids: A Case Report and Literature Review
Get PDFStrumal carcinoid tumors of the ovary are rare neoplasms composed of an intimate mixture of thyroid and carcinoid tissues. Although various theories regarding their histogenesis have been proposed, evidence confirming the origin of the carcinoid component has been lacking. We report a case of a 40-year-old female with an ovarian strumal carcinoid arising in the background of a mature cystic teratoma. Morphological and immunohistochemical findings support the hypothesis that the carcinoid component originates from the thyroid follicular epithelium, undergoing neuroendocrine differentiation. A single-cell growth pattern was also identified, expanding the known histological spectrum of strumal carcinoids. Our case provides additional immunohistochemical support for the histogenetic origin of strumal carcinoids, offering new insights into their pathogenesis. Recognizing these distinct patterns of staining and unusual morphology is critical for accurate diagnosis and differentiation from metastatic disease
Arthur Arseneaux Interview
Get PDFThis interview of Arthur A. Arseneaux was conducted by Chandler Smith on July 7, 2025. Interview transcribed by Sabrina Caston.https://digitalscholar.lsuhsc.edu/oral_hist/1000/thumbnail.jp
Comprehensive resolution and classification of the Epstein Barr virus transcriptome
Get PDFVirus genomes harbor compacted repertoires of genes and regulatory elements. Through long-read sequencing, we provide a comprehensive Epstein Barr virus (EBV) transcriptome analysis, identifying 1453 transcript isoforms and resolving the major isoform of all but one lytic reading frame. Further, we categorize each transcript according to their dependence on viral DNA replication. We show that the late gene viral preinitiation complex, vPIC also activates early promoters/genes, we identify active alternate promoters with distinct dependencies on viral DNA replication, we discover biphasic promoters with embedded features of both early and late promoters. Genetic and chromatin interaction studies identify an enhancer function for the viral lytic origin of replication (OriLyt). We also observe substantial viral read-through transcription that likely causes transcriptional interference and fine tuning of viral promoter activity. In some loci with same direction overlapping gene configurations, polyA read-through is necessary to facilitate transcription through entire ORFs while also giving rise to highly abundant viral lncRNAs due to the partial nature of read-through. Altogether, this study identifies extensive viral transcriptome diversity, it resolves the major isoforms for nearly all lytic ORFs, and it identifies the alternative regulatory modes driving the temporal regulation of EBV lytic gene expression
Bennet deBoisblanc Interview
Get PDFThis interview with Dr. Bennett deBoisblanc was conducted by Chandler Smith on July 29, 2025. Interview transcribed by Sabrina Caston.https://digitalscholar.lsuhsc.edu/oral_hist/1001/thumbnail.jp