Pediatrics & Women's Health

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    Focal Nodular Hyperplasia in a Pediatric Cancer Survivor
    (2020) Chor, Holy; Bowman, William
    Background: Focal nodular hyperplasia (FNH) are benign hepatic nodules that rarely occur in the pediatric population. Although pathogenesis of FNH is not elucidated, alteration in hepatic blood flow by vascular injury associated with chemotherapy and radiation therapy is thought to play a role. Differential diagnosis of hepatic nodules in the general population is wide and encompasses benign and malignant conditions. Discovery of hepatic nodules at follow-up in patients treated for pediatric malignancy raises a diagnostic dilemma. Case Information: In this case report, we discuss a 21-year-old Caucasian male who presented in 2006 at the age of 8-years with neuropathic leg pain and was diagnosed with embryonal rhabdomyosarcoma of the pelvis. Patient underwent protocol-directed chemotherapy with vincristine, actinomycin D, and cyclophosphamide, and radiation therapy. He completed therapy one year later in 2007 and has remained in continuous complete remission. Follow-up radiological imaging performed from year 2007 through 2020 include 3 computed tomography (CT) scans, 5 abdominal ultrasounds (US), and 2 abdominal magnetic resonance imaging (MRI). The initial diagnosis of FNH was suspected in 2015 by abdominal US and confirmed by MRI. Subsequent MRI and US imaging remained stable and consistent with FNH. No biopsy has been done. Conclusions: The discovery of FNH in follow-up post treatment may pose a diagnostic dilemma in pediatric cancer survivors. A systematic approach to radiological imaging will reduce the exposure of pediatric cancer survivors to unnecessary radiation, adverse effects, and invasive diagnostics.
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    Expecting the Unexpected: An Unusual Presentation of Pelvic Inflammatory Disease
    (2020) Cameron, Benjamin; Dowell, Katherine; Elete, Kunal
    Background: Pelvic Inflammatory Disease (PID) is an acute infection of the female upper reproductive organs that can also involve neighboring abdominal and pelvic organs. Case Information: A 36-year-old female with a PMH of bipolar disorder and polysubstance use disorder, but no known history of STIs, presented to the ER with abdominal pain of 1 day. The pain was constant, diffuse, not worse with eating, and without relieving factors. She denied fever, chills, nausea, vomiting, diarrhea, urinary frequency or urgency, and vaginal discharge. However, she did complain of dysuria. Patient also used methamphetamines and marijuana 3 days prior to pain onset. On physical exam, she was tachycardic and diffusely tender to palpation in all quadrants but worse across the epigastrium; Murphy's and McBurney's signs were negative, but rebound tenderness was positive. General surgery performed an exploratory laparotomy during which a right tubo-ovarian abscess (TOA) was discovered along with diffuse adhesions, leading to a diagnosis of PID. OB-GYN was consulted because of salpingitis, but excision was not recommended, and the TOA was managed with IV antibiotics. Post-operatively, the patient opened up about, a recent sexual assault, and consuming a drugged alcoholic drink the previous night. Her symptoms improved and she was discharged on post-op day 4. Conclusion: This case demonstrates that PID, at advanced stages, can be difficult to distinguish from similarly presenting conditions. Current substance abuse, poor nutrition, and psychiatric conditions can prove challenging to obtaining a focused history and developing the differential diagnosis.
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    Chronic Disease Presentations found in Elementary School Children
    (2020) Khan, Urooj; Robinson, Christina; Madina, Revanth
    Purpose: For the past few decades, chronic illnesses in children have been increasing. Chronic conditions generally lasts more than three months, affects everyday activities, and can require extensive medical care. In the United States, approximately 18% of children live with a chronic health condition. Common chronic childhood diseases include asthma, obesity, food allergies, and ADHD. Catch-1 is a health program which offers free health screenings to elementary students. It features a team of health providers including physicians, nurses, dental hygienists, audiologists, and speech pathologists, as well as their respective students. Through this program, health screenings are provided to the children of Morningside Elementary school in Fort Worth, Texas, while fostering an interprofessional learning environment. In this study, the investigators discovered the prevalence of common chronic diseases in the school's pediatric population. Methods: The investigators conducted a retrospective chart analysis to illustrate a statistical overview of the chronic diseases of Catch-1 participants during the years 2015 - Spring of 2019. The participants were aged three to twelve, from Pre-K to 5th grade. Results: The primary diagnoses were obesity (32%), dental carries (21%), and BMI > 85%ile (18%). Most of the participants had one diagnosis (68%), while 22% had two, 2% had three, and 32% had none. Conclusion: The results of the Catch-1 program highlight the need for regular medical screenings for children. Ideally, these results will encourage policy makers to expand school nursing and medical partnerships so that chronic conditions may be screened, and interventions may occur earlier.
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    Absolute Quantification of Mitochondrial DNA in Peripheral Blood from Women with Preeclampsia
    (2020) Silzer, Talisa; Phillips, Nicole; Goulopoulou, Styliani; Reid, Danielle; Sun, Jie; Scroggins, Sabrina; Santillan, Mark; Santillan, Donna; Cushen, Spencer
    Introduction Mitochondrial DNA (mtDNA) in maternal blood has been proposed as a potential predictor of preeclampsia (PE). The objective of this study was to use an absolute PCR (abPCR) quantification protocol to determine concentrations of mtDNA in maternal plasma and peripheral blood mononuclear cells (PBMC) from normal and PE pregnancies. Methods Blood samples were collected from pregnant women with uncomplicated pregnancies and pregnancies with PE (University of Iowa IRB#200910784). abPCR quantification of mtDNA and nDNA was performed on DNA extracts from plasma (in the presence or absence of lysis buffer) and PBMCs using TaqMan(TM) probes and chemistry. Results When plasma DNA was extracted using lysis buffer, mtDNA concentrations were lower in women with PE than in controls (Control: 4.83 ± 1.09 vs. PE: 1.72 ± 0.38 pg/uL, n=19, P=0.017), while concentrations of nDNA did not differ (P=0.39). Without lysis buffer, plasma mtDNA remained lower in women with PE compared to controls (Control: 0.0106 ± 0.0019 vs PE: 0.0019 ± 0.0003 pg/uL, n=16-20, P< 0.0001). There were no group differences in PBMC mtDNA (P=0.66) and nDNA (P=0.13) concentrations. Conclusion mtDNA concentrations were lower in plasma of pregnant women with PE compared to controls. A significant amount of mtDNA was membrane bound as indicated by a 480-fold greater concentration in DNA isolated from plasma with lysis buffer vs. without. Use of this improved method of quantification of mtDNA in multiple blood fractions may allow for its development as a biomarker to detect PE prior to the onset of organ damage.
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    PFAPA: A Pediatric Case Study
    (2020) Naylor, Debra; Thapar, Prachi
    Background: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is an autoinflammatory condition theorized to be due to cytokine dysfunction. The presentation of PFAPA is commonly characterized by recurrent fevers in pediatric patients usually between the ages of 1 and 4. Case Information: A 2-year-old Caucasian male accompanied with his mother presented to the pediatric clinic due to high fever. The fever started the morning before and persisted till the next day, reaching a maximum temperature of 105.1°F. The patient was given Motrin and Tylenol in addition to a lukewarm bath, all of which helped abate the fever to 102°F. The patient has a past history of unexplained high fever episodes three times within the past year. At the clinic, the influenza and strep test were negative. The patient was sent home with advised rest and continued Tylenol or Motrin to help control fevers. Patient returned to clinic four days later with persistent fever. The ESR and CRP returned elevated at 19 and 97.6 respectively. Patient was sent home with steroids due to suspected PFAPA. A chest X-ray, urine analysis and culture, and a respiratory PCR were ordered but all returned negative. The next morning, patient went to the ED due to a low temperature of 94.3°F reported by mother. The temperature normalized upon arrival to the ED. Patient was subsequently discharged due to resolution of fevers. Conclusions: This case presents a case of recurrent fevers of unknown etiology suspected to be secondary to PFAPA.
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    Very Premature and Very Low Birth Weight Children's Academic Outcomes: The Impact of Sensitive Parenting
    (2020) White, Annesha; Hussain, Salma
    Purpose: Very premature/very low birth weight (VP/VLBW) children come into this world with a great risk for many developmental issues, some of which only appear during the school years. Consequently, VP/VLBW children tend fall behind full-term and normal birth weight children in academic performance. It would be beneficial to identify protective factors that can improve academic outcomes in these children. The objective of this study was to provide a comprehensive examination of the literature on sensitive parenting as a protective influence on VP/VLBW children's academic outcomes. Methods: A systematic review of the literature was conducted using PubMed, PsycINFO (2009-2019) with keywords such as "very preterm," "very low birth weight," "sensitive parenting" and, "academic outcomes". Studies that did not focus on sensitive parenting and cognitive/academic outcomes were excluded. Data was categorized in a table based on author, publication year, design, intervention, and findings. A PRISMA diagram was used to evaluate the process. Results: Seven longitudinal observational studies met inclusion criteria. All studies showed a strong relationship between sensitive parenting and significantly better long-term cognitive and academic outcomes of VP/VLBW children (> 4 years). Sensitive parenting was shown to boost children's self-control and attention regulation for school success. Additionally, low sensitive parenting was shown to be detrimental to VP/VLBW children. Conclusions: Further research is warranted on sensitive parenting and academic/cognitive outcomes to empower parents with the tools needed to give their children the best chance at reaching their full developmental potential.
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    Addressing Substance Abuse During the Pregnancy and Postpartum Period
    (2020) Raines-Milenkov, Amy; Fadeyi, Oluwatosin; Davis, Ambriale; Ghosh, Shanalyn; Le, Christine
    Purpose: The purpose of this study is to identify the best practices to combat substance abuse in both the pregnancy and postpartum period. Methods: The research was conducted using a web-based search of peer-reviewed journal articles and state reports. Results: Our results demonstrate that there is a need for increased drug abuse screening during both the antepartum and postpartum period. Because opioids are a major contributor to maternal death, providers need to administer a tailored plan of care for pain relief to ensure the necessity of prescription painkillers. The Wisconsin Drug Monitoring Program saw a 7% decrease in opioid prescriptions from cesarean delivery and 6% decrease from vaginal delivery through effective monitoring prior to discharge. From 2012 to 2015, drug overdose accounted for 17% of all maternal deaths between the time of delivery and one-year postpartum in Texas. Conclusion: Although many states have taken initiatives to combat the growing rate of maternal mortality, research and interventions that addresses the role of substance abuse is still minute. California's maternal mortality rate tremendously decreased as a result of healthcare recommendations from their Pregnancy-Associated Mortality Review, but drug overdose still ranks as the second leading cause of maternal deaths from pregnancy to one-year postpartum. This underscores the necessity for increased awareness of how substance abuse can affect mothers one-year past delivery in both outpatient and hospital-settings.
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    The Risk Factors Associated with Ectopic Pregnancies
    (2020) Vats, Pulkit; Hannay, Nathan
    Background: Ectopic pregnancy occurs in approximately 1.97% of pregnancies in North America. Although the most common site for an ectopic pregnancy is in the uterine tube, they can also occur in other places throughout the body, including the diaphragm and abdominal wall. Some of the most common risk factors associated with ectopic pregnancy are smoking, previous pelvic surgeries or infections, and maternal age. Ectopic pregnancies are the most common cause of first trimester bleeding. Because the implantation of the embryo is not in the correct location, there are various risk factors involved: including the bursting of the uterine tube resulting in hemorrhage, sepsis, and even death. Furthermore, the fertilized egg is not able to receive the proper nutrients when implanted outside the endometrial lining of the uterus. Case Information: During dissection of the reproductive system of our 83-year old female cadaver, we noticed evidence of possible risk factors that could have contributed to her tubal pregnancy. Scar tissue was present in her uterus and ovaries, which may suggest previous surgeries associated with the pregnancy. She also was an avid smoker for 30+ years. A strong correlation exists between smoking and ectopic pregnancies. Goal: We hope to understand further the correlation that exists between some of the pathologies we found in our cadaver, including a history of smoking, cirrhosis, and cancers in the lungs, tongue, and skin. This would be an excellent opportunity to apply our knowledge beyond the barriers of the classroom.
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    Clinical drug drug interactions between antiepileptic drugs and hormonal contraceptives: pharmacist considerations
    (2020) White, Annesha; Tran, Elizabeth
    Objective: More than 50 years ago hormonal contraceptive agents (HCAs) were introduced and are used by 100 million women. However, investigation of the effects of antiepileptic drugs (AEDs) is lacking. The objective of this study was to provide a comprehensive review of the evidence on the relationship between antiepileptic use and hormonal contraceptive failure. Methods: A systematic review concerning HCAs and AEDs was performed, 2000-2019, using PubMed. PRISMA guidelines were used to document key search terms. Outcomes were categorized into: effectiveness of therapy, toxicity, and pharmacokinetics. The selected articles were summarized by year, author, title, design, methods, findings, and source. Articles were graded using the Oxford for Evidence-based Medicine scale. Preliminary Results: Thirteen articles met the inclusion criteria. An interaction between AEDs and the combined oral contraceptive pill was first proposed when estradiol was reduced from 100 to 50 microg. Studies report a higher incidence of breakthrough bleeding and contraceptive failure among women with epilepsy. Phenobarbital, phenytoin, carbamazepine, oxcarbazepine, felbamate and topiramate have been shown to increase the metabolism of ethinylestradiol and progestogens. There were no studies showing an interaction between the combined oral contraceptive pill, progesterone-only pill, medroxyprogesterone injections or levonorgestrel implants and the AEDs valproic acid, vigabatrin, lamotrigine, gabapentin, tiagabine, levetiracetam, zonisamide, ethosuximide and benzodiazepines. Conclusions: Considerations for pharmacists when counseling women taking AEDs: preparation containing at least 50 microg of ethinylestradiol is needed. This is an important study as access for HCAs expands. Eight states and D.C. allow pharmacist HCA prescribing.
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    Resources for Women's Reproductive Health in Tarrant County
    (2020) Holbrook, Hayley; Biben, Emily; McDonald, Rebecca; Gaudet, Ellen; Reynolds, Holli
    The purpose of this research was to explore resources for women's reproductive health in Tarrant County. The population of interest in this presentation is women of reproductive age, which is defined as women aged 18-44. There is a myriad of topics enveloped in the scope of women's reproductive health including infertility, maternal mortality, access to prenatal care, access to contraception, and alternative options in the case of unwanted pregnancy. Each topic encompasses its own set of information and concerns. Some of these concerns include lack of insurance, access to clinics, and health disparities. Although there are many issues and concerns when it comes to women's reproductive health, the women of Tarrant County have many resources they can utilize to help them. The resources covered in this research include: Planned Parenthood, Healthy Texas Women, Collins Family Planning Clinic, Center for Assisted Reproduction, JPS Health Center for Women, and Texas Pregnancy Care Network. These resources provide several services to the women of Tarrant County, however, there are barriers that were observed. Some of these barriers include income restrictions, the need for patients to be Texas and/or U.S. citizens, and limited hours. Overall, the resources available to women of reproductive age in Tarrant County are promising and encouraging, though it is important to understand that health disparities and barriers do exist. While many of the resources are striving to reduce barriers and health disparities, more work needs to be done.
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    Do autopsies and perimortem testing still have a place in today's world of medicine?
    (2020) Wilson, Don; Hamilton, Luke; Eng, Ryan
    Background: Autopsies and perimortem testing have previously been a staple for improving patient care and expanding the field of medicine. In recent decades, autopsy rates have dropped dramatically, with current estimates of autopsy rates at 5%, yet data shows that clinical diagnoses are significantly less accurate than autopsy findings. In this case report, we aim to demonstrate the continued importance of autopsies using the case of a boy who passed away due to undiagnosed adrenoleukodystrophy (ALD). Case Information: An 8-year old male with a long history of severe headaches, emesis, and dehydration presented to Cook Children's Medical Center ICU after undergoing cardiac arrest. Workup of the patient did not find an etiology of these symptoms and the patient expired. Prior to expiration, a discussion was had with the parents about collecting samples for peri-mortem testing to determine cause of death. Whole exome sequencing (WES) of a peri-mortem blood sample revealed an ABCD1 variant, allowing the diagnosis of ALD. The patient's family members were recommended for genetic testing. Conclusions: Autopsy and perimortem testing were necessary to determine the patient's cause of death, which was not detected by routine pediatric screening or workup upon admission to the ICU. The patient's diagnosis proved especially important as it allowed family members to be referred to genetic counseling. Despite advances in diagnostic techniques, perimortem testing remains beneficial in cases of unknown or uncertain diagnoses, as seen in this case report.
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    Gestational Diabetes Systems
    (2020) Moore, Jessica
    Purpose: Gestational diabetes is one of the most common metabolic disorders and medical complications of pregnancy, and trends show rates increasing over time. Mismanagement of gestational diabetes can lead to adverse effects for both mother and infant, indicating the importance of prevention and proper prenatal care. Both prevention and management of gestational diabetes may require a complex interaction between many organizations. The aim of this study is to use systems-thinking to identify organizations that provide services related to either prevention or management of gestational diabetes. Methods: A web-based search was conducted to identify organizations related to gestational diabetes. Organizations were categorized and organized by the population served, including national level, state level, and local level. Connections between organizations were made based on services provided by each organization. Results: Ten organizations were identified that serve women with gestational diabetes. Organizations identified include The American Diabetes Association (ADA), the Texas Department of Health and Human Services, and John Peter Smith (JPS) Hospital. Organizations provide services such as health education, access and connection to health care resources, and delivery of health care itself. Conclusion: Access to health care resources can greatly improve the outcomes of a pregnancy affected by gestational diabetes. Applying systems-thinking to the prevention and treatment of gestational diabetes may help achieve improved outcomes. The identification of and connections between organizations that aide in the prevention and treatment of gestational diabetes may greatly increase access to information and resources and reduce the adverse effects of such a disease.
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    Treated prevalence of Austism Spectrum Disorder (ASD), Developmental Coordination Disorder (DCD), and Autism Spectrum Disorder with co-occurring DCD is significantly less than estimated prevalence in Tarrant County
    (2020) Kata, Karolina; Chang, Shannon; Ganesh, Abhinaya; Mauk, Joyce; Bowman, William; Bailey, Laurie; Hamby, Tyler; Miller, Haylie; Pruitt, Blake
    Aim: Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) commonly co-occur in pediatric patients. However, few studies have assessed the circumstances under which this co-diagnosis is assigned, in order to develop best-practice recommendations. Our multi-center retrospective chart review at Cook Children's Medical Center (CCMC) network, the Child Study Center (CSC), and the University of North Texas Health Science Center (UNTHSC) aims to identify common and differing elements along the diagnostic pathway for individuals with ASD, DCD, and ASD+DCD. Method: Using the electronic medical record of UNTHSC Health, we retrospectively evaluated charts from 2008-present for patients aged 0-21 at first entry. At UNTHSC, the number of patients since 2008 with ASD was 455, DCD was 677, and ASD+DCD was 21. These data were pooled with data previously collected from the other two sites. A maximum of 50 patients per site with ASD+DCD were age- and sex-matched to patients with ASD and patients with DCD. The final sample consisted of 121 non-duplicate ASD+DCD charts, 150 ASD charts, and 150 DCD charts. Results: In-depth analysis of charts is ongoing, and will aid in identifying whether patterns of patient- and provider-based variables differ across sites or diagnostic groups for the final sample Significance: The prevalence of DCD and ASD+DCD was strikingly low across all sites. Notable variability in EMR coding likely contributes to difficulty achieving diagnostic consistency and standardizing care. Undiagnosed or misdiagnosed children are susceptible to reduced access to resources and intervention.
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    Assessing Women's Knowledge of HPV and Willingness to Undergo At-Home HPV Self-Testing
    (2020) Thompson, Erika; Nazim, Asad
    Purpose: At-home self-testing for human papillomavirus (HPV) may be a strategy for increasing access to cervical cancer screening. This project aimed to examine the correlation between women's knowledge of HPV and willingness to self-test for HPV. Methods: An online survey (n=725) of women aged 30-65 who had not had a hysterectomy was conducted in June 2018. Survey items assessed HPV knowledge using 16 items (α=0.82) and willingness to undergo HPV self-testing. The participants were categorized into a willing or unwilling to self-test group according to their willingness score. Correct responses to the true/false HPV knowledge questions were used to create knowledge scores. Results: Most women (59.59%) were either very willing or somewhat willing to have at-home self-testing. The mean HPV knowledge of the willing group was 9.38 (out of 16), and the mean HPV knowledge of the unwilling group was 8.62, meaning the willing group was more knowledgeable. There was a significant association between HPV knowledge and willingness to self-test (p< 0.05). The largest differences in HPV knowledge between the willing and unwilling groups pertained to HPV characteristics, such as symptoms, modes of transmission, and risk factors. Conclusions: The results indicate that HPV knowledge and willingness to self-test are statistically associated. Knowledge of HPV may be a needed first-step in promoting HPV self-testing for cervical cancer screening in rural areas. Increasing HPV education efforts could increase the willingness to self-test and reduce the number of cervical cancer cases.
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    Severe Salt-Wasting in 16-day-old Male
    (2020) Hamilton, Luke; Wilson, Don; Sun Bae, Mi
    Severe salt-wasting X-linked Adrenal Hypoplasia Congenita(X-AHC) is a rare cause of severe salt-wasting in affected males. We present a 16-day-old non-Hispanic male experiencing marked hyponatremia and hyperkalemia, initially thought to have 11-hydroxylase congenital adrenal hyperplasia(CAH). A 16-day-old male was born at term following an uncomplicated pregnancy, labor and delivery. Because of poor feeding, electrolytes were ordered revealing severe electrolyte imbalance. The child was assumed to have CAH due to elevation of cortisol precursors. He was treated with IV glucocorticoid and remained on IV fluids until his electrolyte balance and acidosis were corrected. These were replaced by oral glucocorticoid and mineralocorticoid, and salt supplementation was given orally. Once able to tolerate oral intake, IV fluids were tapered and subsequently discontinued. Based upon his family history, genetic testing was ordered, revealing a mutation in NROB1, consistent with a diagnosis of X-AHC. X-AHC may be misdiagnosed as CAH, but it is a rare disorder caused by a genetic mutation on the NR0B-1 (Nuclear Receptor B1) gene estimated to occur in 1:140,000 to 1:1,200,000 live births. Initial treatment of CAH and X-AHC are similar, requiring mineralocorticoid and glucocorticoid replacement. However, misdiagnosis may lead to life threatening electrolyte abnormalities following withdrawal of mineralocorticoid therapy in infants thought to have 11-OH-lase deficiency. Although less common than CAH, corrected identification of X-AHC allows proper management, appropriate genetic counseling, and anticipation of concomitant and future co-morbidities associated with X-AHC.
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    Efficacy of Medial Branch Blocks for Pain Control and Functionality in Pediatric Patients with Spinal Pain
    (2020) Reichert, Ryan; Holbrook, Hayley
    Purpose: While medial branch blocks (MBB) are relatively common for pain relief in adults with spinal pain, they are rarely performed on children. To our knowledge, this is the largest study examining the effectiveness and safety of using MBB as an intervention for spinal pain in pediatrics. Methods: A retrospective chart review was conducted on a population of pediatric patients who underwent MBB at Cook Children's Medical Center between June 1, 2012 and May 31, 2019. Demographics, diagnoses, overall functional improvement, complications, and pre-/post-intervention pain scores on 0-10-point scales were reviewed. Only the first MBB was analyzed. Patients missing a pain score or lost to follow-up were excluded from analyses. Change in pain scores was assessed with Wilcoxon's signed-rank test. Results: There were 52 patients (39 females; 42 white; median age 15.84 years, range 9.36-18.86) with a total of 66 MBB; 17 patients had repeat interventions. Common diagnoses included back pain (48%), spondylolysis (31%), lumbago (29%), and facet pain (23%). Pain scores improved for 87% of patients, 12% were unchanged, and 2% worsened. The pain score change was statistically significant (median= -4.5, range= -9 to 5, p< 0.0001). Post-intervention, 81% of patients had overall improvement in functionality. Procedural complications (e.g., weakness, numbness) occurred in 12% of patients; side effects (e.g., muscle spasms, bruising) occurred in 12% of patients. Conclusions: These results suggest that MBB may improve pain and function in pediatric patients with spinal pain.
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    Postnatal Education through a Health Literacy Lens
    (2020) Wagner, Teresa; Thompson, Erika; Raines-Milenkov, Amy; Stark, Marie; Bush, Kim; Gadson, Amber
    Purpose: Globally, approximately 830 women die every day from preventable causes related to pregnancy and childbirth. Few studies have looked at the effect of health literacy on maternal morbidity and mortality. The purpose of this study was to examine health literacy of postpartum education from the perspective of new moms using the Integrated Model of Health Literacy (Sorensen, 2012). Methods: This study assessed readability, understandability and cultural sensitivity of postnatal information. We measured the ability of postpartum mothers to access, understand, appraise and apply postnatal care instructions at home through semi-structured, one-on-one interviews analyzed using qualitative methods. Results: Gaps were identified in the Access domain due to a lack of consistency and comprehensiveness of the information provided to new moms. Gaps represented reports of too much information, lack of time to read and lack of cultural sensitivity of postnatal education particularly in regard to postpartum depression. Conclusion: Findings suggest a need for standardized, concise, health literate and culturally sensitive postpartum education and materials to assist new moms in identifying postpartum warning-signs, take appropriate action and help reduce maternal morbidity and mortality.
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    Is Adrenal Insufficiency of Concern in Children with Disorders of Lipid and Lipoprotein Metabolism?
    (2020) Wilson, Don; Hamilton, Luke; Lammers, Cara
    Background: Genetic mutations and newer lipid-lowering medications often result in very low plasma levels of LDL cholesterol. Low plasma cholesterol has the potential to negatively impact physiological processes, including steroidogenesis, but the adrenal employs several redundant mechanisms to minimize disparities. Although the likelihood of very low cholesterol impairing production of adrenocortical steroids is unlikely, our knowledge of adrenal function in affected patients is limited. Several genetic diseases including X-linked adrenoleukodystrophy have been reported to impact cholesterol metabolism leading to altered adrenal function. The case outlined below raises the question as to what extent impaired cholesterol transport could affect steroid hormone synthesis. We consider this question in the context of other disorders of cholesterol metabolism and their potential implications in adrenal insufficiency. Case Information: A 27-month-old male was referred to Endocrinology for evaluation of adrenal function following his diagnosis of X-linked adrenoleukodystrophy. Several labs were obtained including plasma ACTH, baseline cortisol, and peak cortisol. Monitoring over several years revealed impaired cholesterol metabolism and confirmed progressive failure of the adrenal cortex. Conclusions: Decreased intracellular cholesterol impaired adrenal function leading to decreased cortisol production. Several genetic disorders are characterized by abnormalities in cholesterol synthesis or metabolism, potentially limiting this key metabolite in providing proper adrenal hormone production and release. Due to the redundant mechanisms for utilizing cholesterol, it seems unlikely that hypocholesterolemia, secondary to genetic disorders and use of lipid-lowering medication that result in very low levels of LDL cholesterol, is of major concern.
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    Prescribing oral contraceptives: A new pharmacist role in family planning services
    (2020) White, Annesha; Khanani, Kiran
    Purpose: The Guttmacher Institute defines unintended pregnancy as mistimed or unwanted. In 2011, 45% of pregnancies were reported as unintended. Pharmacists are one of the most trusted and accessible professionals and prescribing oral contraceptives offers a new role. The objective of this study was to examine the literature on the role of pharmacists in family planning services. Increasing pharmacists' role can increase the accessibility to effective and proper use of contraception. Methods: A systematic review was conducted via PubMed, Google Scholar, 2010-2019, with key terms "role of pharmacists services and unintended pregnancies." A PRISMA flow diagram was used to document the process. Articles were summarized in a table organized by year, author(s), title, design, intervention, findings, source and quality grade. Results: A total of 15 articles were retrieved. The majority were observational studies. Findings revealed there are ten states along with Washington D.C. in which pharmacists are allowed to prescribe oral contraceptives. In four states pharmacists prescribe under a collaborative agreement. Allowing pharmacists to prescribe oral contraceptives is being used as a strategy to increase accessibility and reduce unintended pregnancies. Conclusions: The expanded role of pharmacist prescribing offers potential to decrease the rate of unintended pregnancies leading to better maternal health outcomes.
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    Catheter Directed Thrombolytic therapy for Pediatric Cerebral Sinus Vein Thrombosis
    (2020) Hamby, Tyler; Tilley, Jo; Torres, Marcela; Philip, Sarah
    Purpose: Cerebral sinus vein thrombosis (CSVT) involves the thrombosis of the dural sinus and/or cerebral veins and is considered a form of stroke. No randomized clinical trials have been conducted on pediatric CSVT so current guidelines for treatment have been extrapolated primarily from adult studies. Method: This is a retrospective case review of patients treated with MT (Mechanical thrombectomy)/Catheter Directed Thrombolysis (CDT) for their CSVT at Cook Children's Medical Center. Results: Five children (aged 4 to 14 years) diagnosed with CSVT of multiple sinuses were treated with MT/CDT after failing anticoagulation treatment. Three patients had systemic bleeding prior to initiation of anticoagulation. All children were treated with UFH (unfractionated heparin) and due to neurologic deterioration and/or worsening of imaging findings needed MT/CDT. All cases had partial resolution of the sinus vein thrombosis, although 1 had quick re-occlusion. Post procedure bleeding happened in 1 patient and 2 patients developed petechial brain hemorrhages. Four patients had great neurologic recovery and minimal deficits, but 1 had significant neurologic deficits. One patient died from lupus complications. Conclusion: Endovascular therapy including MT and CDT with tPA (tissue plasminogen activator) in conjunction with systemic UFH, may have a role in pediatric patients with CSVT who have deterioration despite initial anticoagulation. In our series, after procedures, all patients had partial resolution of their CSVT (but 1 had quick re-occlusion) and 4 out of 5 patients had good neurologic outcomes despite coma or extensive CSVT.