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Navigating Formula Shortages: Associations of Parental Perspectives on Transitioning to Alternative Infant Formulas for Cow\u27s Milk Protein Allergy During the 2022 National Formula Shortage
No full textThe COVID-19 pandemic led to supply chain disruptions causing a severe shortage of infant formula. The shortage impacted parents of infants with cow’s milk protein allergy (CMPA) who rely on specialized formulas. However, research on parent perspectives during formula shortages is limited. We aimed to understand the factors guiding parents’ decisions when transitioning to alternative amino acid formula (AAF) or extensively hydrolyzed formula (eHF) during the national formula shortage. We conducted a survey using the ZSMoments platform and found that before the shortage, parents valued safety (83%), tolerability (78%), and reputability (78%) as primary factors in selecting eHFs and AAFs. Post-shortage, formula tolerability (86%), assurance (84%), and safety (80%) gained more importance. Among those switching eHF (n = 54), health care provider recommendations (81%), reputability (78%), taste (78%), and tolerability (78%) were rated as “extremely important.” Among those switching AAF (n = 26), top factors included tolerability (77%), assurance (73%), safety (73%), cost-effectiveness (73%), and formula trustworthiness (73%). These data suggest that parents carefully weigh various factors when managing their child’s CMPA and transitioning to different AAF or eHF options
Oblique Anterior Column Realignment With a Mini-Open Posterior Column Osteotomy for Minimally Invasive Adult Spinal Deformity Correction: Illustrative Case
No full textBACKGROUND Adult spinal deformity (ASD) occurs from progressive anterior column collapse due to disc space desiccation, compression fractures, and autofusion across disc spaces. Anterior column realignment (ACR) is increasingly recognized as a powerful tool to address ASD by progressively lengthening the anterior column through the release of the anterior longitudinal ligament during lateral interbody approaches. Here, we describe the application of minimally invasive ACR through an oblique antepsoas corridor for deformity correction in a patient with adult degenerative scoliosis and significant sagittal imbalance.
OBSERVATIONS A 65-year-old female with a prior history of L4–5 transforaminal lumbar interbody fusion and morbid obesity presented with refractory, severe low-back and lower-extremity pain. Preoperative radiographs showed significant sagittal imbalance. Computed tomography showed a healed L4–5 fusion and a vacuum disc at L3–4 and L5–S1, whereas magnetic resonance imaging was notable for central canal stenosis at L3–4. The patient was treated with a first-stage L5–S1 lateral anterior lumbar interbody fusion with oblique L2–4 ACR. The second-stage posterior approach consisted of a robot-guided minimally invasive T10–ilium posterior instrumented fusion with a mini-open L2–4 posterior column osteotomy (PCO). Postoperative radiographs showed the restoration of her sagittal balance. There were no complications.
LESSONS Oblique ACR is a powerful minimally invasive tool for sagittal plane correction. When combined with a mini-open PCO, substantial segmental lordosis can be achieved while eliminating the need for multilevel PCO or invasive three-column osteotomies
Pediatric Vulvodynia: A Retrospective Analysis of Comorbidities Using the TriNetX Global Health Research Network
No full textBackground Vulvodynia is vulvar pain of at least 3 months duration, without an identifiable cause. In adults, vulvodynia is associated with urogenital symptoms, immunological issues, and other chronic pain conditions. In children and adolescents, only one published case series described an association with urinary symptoms. Associations with other conditions and immunologic issues remain unknown. This study aims to evaluate the association of urogenital symptoms, immunological issues and chronic pain disorders with vulvodynia in children and adolescents using a large research network database (TriNetX). Methods This IRB exempt retrospective cohort study utilized de-identified patient medical records between January 2015 and July 2023 from TriNetX, a HIPAA compliant health research network driven by Children\u27s Mercy Hospital Oracle Cerner Millennium data. Statistical analysis was performed using TriNetX and SPSS Version 28.0 (IBM Corp, Armonk, NY). Results A single vulvodynia cohort (n=1,410) consisting of females aged 0-18 years-old was identified from TriNetX. Figure 1 shows the development of four further sub cohorts to evaluate associated genitourinary symptoms, chronic pain, immune, and autoimmune disorders with relevant immunological markers. Conditions most commonly associated with vulvodynia included dermatitis and eczema (n=470, 33.3%), pain in joint (n=370,26.2%), pain with micturition (n=310,22%) and migraine (n=160,11.3%). Table 1 shows the comparison of immunological markers between the four sub-cohorts. C-reactive Protein (CRP) was significantly higher in the genitourinary (1198.9 ± 391.3 mg/L) and chronic pain cohorts (145.7 ± 160 mg/L) (p=0.03) compared to the immune disorders and autoimmune cohorts. Eosinophil levels approached statistical significance with levels highest in the autoimmune cohort (4.2 ± 2.5%) (p=0.05) as compared to the genitourinary, immune disorders and chronic pain sub-cohorts. Conclusions In children and adolescents, vulvodynia is associated not only with genitourinary symptoms but also with chronic pain disorders (migraine headache) and immune disorders (dermatitis and eczema). Elevated CRP in children with vulvodynia, although nonspecific, suggests a possible inflammatory component as etiology. Further research is needed to clarify the etiology of vulvodynia in the pediatric population
Pediatric Posterior Fossa Tumor Treatment Affects Thalamic Volume, Memory, and Processing Speed (S27.004)
No full textObjective:
We investigated changes in brain volume in the putamen, thalamus, and hippocampus amongst patients who received surgery and patients treated with surgery, chemotherapy, and cranial irradiation (SC-CRT) compared to healthy sibling controls. Neuropsychological assessments determined cognitive outcomes associated with the different treatment modalities.
Background:
Survivors of childhood brain tumors, the most common type of cancer in children, have the poorest quality of life compared to those surviving other cancers. Cognitive deficits related to brain injury from the tumor and treatment may cause difficulty with memory, attention, processing speed and social skills.
Design/Methods:
Thirty-six children, aged 6 to 17, with a history of posterior fossa tumor (17 treated with surgery; 19 with SC-CRT) underwent neuroimaging and neuropsychological assessment at least 1 year post-treatment, along with 15 healthy sibling controls. All had magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) and neuropsychological evaluation done (n=51). The putamen, thalamus, and hippocampus were manually segmented on each participant’s MRI and in the radiation treatment group, the radiation dose for each structure was calculated.
Results:
Block Design scores of both patient groups were lower than those of the controls, with the group who underwent SC-CRT scoring lowest (p\u3c0.001). Scores on Memory for Designs content were lower in the patient surgery group than the SC-CRT group (p=0.03), and Symbol Search scores were lower in the SC-CRT group than in the surgery group (p=0.01). Patients who underwent SC-CRT had the lowest thalamic volumes when controlled for age (p=0.02). DTI values did not reflect microstructural brain injury in patient groups compared to controls.
Conclusions:
Posterior fossa tumor treatment alters thalamic volume - patients who received SC-CRT had the greatest affected volume. Neuropsychological assessments demonstrated decreased processing speed, visuoconstruction, and visual learning scores between patient groups and in all patients compared to healthy sibling controls
The Impact of Historical Redlining on Neurosurgeon Distribution and Reimbursement in Modern Neighborhoods
Get PDFBackground: This study examines the lasting impact of historical redlining on contemporary neurosurgical care access, highlighting the need for equitable healthcare in historically marginalized communities.
Objective: To investigate how redlining affects neurosurgeon distribution and reimbursement in U.S. neighborhoods, analyzing implications for healthcare access.
Methods: An observational study was conducted using data from the Center for Medicare and Medicaid Services (CMS) National File, Home Owner’s Loan Corporation (HOLC) neighborhood grades, and demographic data to evaluate neurosurgical representation across 91 U.S. cities, categorized by HOLC Grades (A, B, C, D) and gentrification status.
Results: Of the 257 neighborhoods, Grade A, B, C, and D neighborhoods comprised 5.40%, 18.80%, 45.8%, and 30.0% of the sample, respectively. Grade A, B, and C neighborhoods had more White and Asian residents and less Black residents compared to Grade D neighborhoods (p \u3c 0.001). HOLC Grade A (OR = 4.37, 95%CI: 2.08, 9.16, p \u3c 0.001), B (OR = 1.99, 95%CI: 1.18, 3.38, p = 0.011), and C (OR = 2.37, 95%CI: 1.57, 3.59, p \u3c 0.001) neighborhoods were associated with a higher representation of neurosurgeons compared to Grade D neighborhoods. Reimbursement disparities were also apparent: neurosurgeons practicing in HOLC Grade D neighborhoods received significantly lower reimbursements than those in Grade A neighborhoods (142,999.88, p \u3c 0.001), Grade B neighborhoods (131,459.02, p \u3c 0.001), and Grade C neighborhoods (129,070.733, p \u3c 0.001).
Conclusion: Historical redlining continues to shape access to highly specialized healthcare such as neurosurgery. Efforts to address these disparities must consider historical context and strive to achieve more equitable access to specialized care
Emerging Biochemical and Immunologic Mechanisms in the Pathogenesis of IgA Nephropathy
No full textIgA nephropathy is a mesangioproliferative glomerular disease with significant morbidity and mortality. Most patients with IgA nephropathy develop kidney failure in their lifetime, reducing their life expectancy by a decade. Since its first description in 1968, it has been established that kidneys of IgA nephropathy patients are injured as innocent bystanders by nephritogenic IgA1-containing immune complexes. Results from clinical, biochemical, immunologic, and genetic studies suggest a multistep pathogenetic mechanism. In genetically predisposed individuals, this process results in formation of circulating immune complexes due to the binding of IgG/IgA autoantibodies to the polymeric IgA1 molecules with incomplete O-glycosylation. This event is followed by the addition of other proteins, such as complement C3, resulting in the formation of nephritogenic immune complexes. These complexes are not effectively removed from the circulation, and some of them pass through the fenestration of glomerular endothelial cells to enter the mesangial space and activate mesangial cells. It is thought that the process is initiated by soluble immune complexes and that their accumulation results in the formation of immunodeposits that further amplify glomerular injury. Here we summarize current understanding of the pathogenesis of IgA nephropathy and discuss experimental model systems that can inform development of new therapeutic strategies and targets