1
|
Alkhayyat M, Bachour S, Abou Saleh M, Abureesh M, Almomani A, Simons-Linares CR, Mansoor E, Sandhu D, Bhatt A, Chahal P. The Epidemiology of Annular Pancreas in the United States: A Population-based Study. J Clin Gastroenterol 2022; 56:186-191. [PMID: 33769394 DOI: 10.1097/mcg.0000000000001531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/13/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database. METHODS A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "MRI, CT, EUS and/or ERCP" between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of "annular pancreas" was identified. RESULTS There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction. CONCLUSIONS This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Emad Mansoor
- Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | | |
Collapse
|
2
|
Bermejo M, Mestrallet S, Servettaz A, Pannet LA, Lebrun D, N'Guyen Y, Andreoletti L, Reynes JM, Hentzien M, Bani-Sadr F. Eosinophilia during Hantavirus infection: a cohort study. Infect Dis (Lond) 2021; 54:277-282. [PMID: 34846983 DOI: 10.1080/23744235.2021.2009129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND There are emerging eosinophil-related considerations concerning viral infections. The role of eosinophils has poorly been evaluated during Hantavirus infection. METHODS The aim of this study was to determine the prevalence of eosinophilia (defined as an eosinophil count above 500 cells/mm3) during haemorrhagic fever with renal syndrome (HFRS) in a large cohort of patients, and to identify factors associated with eosinophilia. RESULTS Among 387 patients hospitalized for HFRS, 98 (25.3%) had eosinophilia. By univariate analysis, eosinophilia was significantly associated with more severe thrombocytopenia, high C-reactive protein level, white blood cell count and neutrophil count and lower nephrotoxic drug intake. As there was a collinearity between white blood cell count and C-reactive protein level, only C-reactive protein level with platelet count and nephrotoxic drug intake were entered in the multivariable analysis. Elevated C-reactive protein concentrations remained independently associated with eosinophilia. CONCLUSION Eosinophilia during HFRS affects one quarter of patients, and supports the role of eosinophils in antiviral immunity against hantavirus infection.
Collapse
Affiliation(s)
- Messaline Bermejo
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Stéphanie Mestrallet
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Amélie Servettaz
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Laure-Anne Pannet
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Delphine Lebrun
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mézières, France
| | - Yohan N'Guyen
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Laurent Andreoletti
- Department of Virology, Reims Teaching Hospitals, Reims, France.,Reims Champagne-Ardenne University, EA-4684/SFR CAP-SANTE, Reims, France
| | - Jean-Marc Reynes
- Centre national de référence des Hantavirus, Unité Environnement et Risques Infectieux, Institut Pasteur, Paris, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Reims, France.,Reims Champagne-Ardenne University, EA-4684/SFR CAP-SANTE, Reims, France
| |
Collapse
|
3
|
Mitri EJ, Zheng DX, Garg V, Crifase CC, Herrera NM, Espinola JA, Hasegawa K, Camargo CA. Blood eosinophils, specific immunoglobulin E, and bronchiolitis severity. Pediatr Pulmonol 2021; 56:2997-3004. [PMID: 34156171 PMCID: PMC8373702 DOI: 10.1002/ppul.25543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/24/2021] [Accepted: 06/12/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bronchiolitis is the leading cause of hospitalization for United States infants. Blood eosinophil and serum specific IgE (sIgE) levels are separately linked to clinical severity but few studies have examined these biomarkers together. OBJECTIVE Among infants hospitalized for bronchiolitis, we investigated the association between (1) blood eosinophilia and severity, (2) sIgE sensitization and severity, and (3) interaction between the two biomarkers on severity. METHODS We enrolled 1016 infants hospitalized for bronchiolitis between 2011 and 2014 across 17 U.S. hospitals into a prospective cohort study. Of those, 873 (86%) had eosinophils measured and all had sIgE levels from blood collected at hospitalization. We investigated higher bronchiolitis severity using intensive care therapy as the outcome (i.e., intensive care unit admission, intubation, and/or receipt of continuous positive pressure ventilation). RESULTS Among 873 infants in the analytic cohort, 18% had blood eosinophilia of ≥3%, and 20% were positive for sIgE. With regard to bronchiolitis severity, 15% received intensive care therapy. In unadjusted analyses, eosinophils ≥3% was not associated with intensive care therapy, while sIgE was associated with a significantly higher risk (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.08-1.92; p = .01). In a multivariable model for intensive care therapy, eosinophilia remained unassociated with severity, and sIgE remained associated (OR: 1.60, 95% CI: 1.05-2.45; p = .03). Also, sIgE did not modify the association between eosinophil level and intensive care therapy (pinteraction = .14). CONCLUSION Blood eosinophilia of ≥3% was not associated with bronchiolitis severity. By contrast, sIgE was independently associated with bronchiolitis severity and did not modify the association between eosinophil level and severity.
Collapse
Affiliation(s)
- Elie J. Mitri
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - David X. Zheng
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Vebhav Garg
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Nicole M. Herrera
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A. Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
4
|
Hancock DG, Cavallaro EC, Doecke E, Reynolds M, Charles-Britton B, Dixon DL, Forsyth KD. Immune biomarkers predicting bronchiolitis disease severity: A systematic review. Paediatr Respir Rev 2019; 32:82-90. [PMID: 31128878 DOI: 10.1016/j.prrv.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/25/2018] [Accepted: 11/23/2018] [Indexed: 12/23/2022]
Abstract
Bronchiolitis is one of the leading causes of hospitalisation in infancy, with highly variable clinical presentations ranging from mild disease safely managed at home to severe disease requiring invasive respiratory support. Identifying immune biomarkers that can predict and stratify this variable disease severity has important implications for clinical prognostication/disposition. A systematic literature search of the databases Embase, PubMed, ScienceDirect, Web of Science, and Wiley Online Library was performed. English language studies that assessed the association between an immune biomarker and bronchiolitis disease severity among children aged less than 24 months were included. 252 distinct biomarkers were identified across 90 studies. A substantial degree of heterogeneity was observed in the bronchiolitis definitions, measures of disease severity, and study designs. 99 biomarkers showed some significant association with disease severity, but only 18 were significant in multiple studies. However, all of these candidate biomarkers had comparable studies that reported conflicting results. Conclusion: The heterogeneity among included studies and the lack of a consistently significant biomarker highlight the need for consensus on bronchiolitis definitions and severity measures, as well as further studies assessing their clinical utility both in isolation and in combination.
Collapse
Affiliation(s)
- David G Hancock
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
| | - Elena C Cavallaro
- Intensive and Critical Care Unit, Flinders University and Flinders Medical Centre, Bedford Park, Australia.
| | - Elizabeth Doecke
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
| | - Molly Reynolds
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
| | - Billie Charles-Britton
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
| | - Dani-Louise Dixon
- Intensive and Critical Care Unit, Flinders University and Flinders Medical Centre, Bedford Park, Australia.
| | - Kevin D Forsyth
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, Australia.
| |
Collapse
|
5
|
Respiratory Viral Coinfections in the PICU: More Is Not Better...But Is It Worse? Pediatr Crit Care Med 2017; 18:816-817. [PMID: 28796712 DOI: 10.1097/pcc.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Shein SL, Slain K, Martinez Schlurmann N, Speicher R, Rotta AT. Hyponatremia and Hypotonic Intravenous Fluids Are Associated With Unfavorable Outcomes of Bronchiolitis Admissions. Hosp Pediatr 2017; 7:263-270. [PMID: 28408388 DOI: 10.1542/hpeds.2016-0205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hyponatremia has been associated with unfavorable outcomes when present at admission in children with bronchiolitis. Delayed hyponatremia may be a modifiable risk factor for severe disease that is influenced by intravenous fluid (IVF) tonicity. We hypothesized that both hyponatremia and prescription of severely hypotonic IVF are associated with unfavorable outcomes, and that prescription of severely hypotonic IVF is associated with subsequent hyponatremia. METHODS Data were retrospectively extracted for 1557 pediatric inpatients with bronchiolitis. Any day on which a subject was prescribed IVF with sodium <70 mEq/L was termed "IVF <70." All other days on which IVF was prescribed were termed "IVF ≥70." Any blood sodium ≤135 mEq/L defined hyponatremia for that day. All other days with sodium available were labeled normonatremia. Variables were compared with Spearman correlation, Wilcoxon rank test, or χ2. Significant results had P < .05. RESULTS Blood sodium levels correlated negatively with hospital length of stay (r = -0.477, P < .0001). On each of the first 4 days of hospitalization, significantly increased hospital length of stay was observed in patients with hyponatremia (n = 134 [25.7% of subjects with available sodium data]) versus patients with normonatremia (n = 387 [74.3%]), and in patients prescribed IVF <70 (n = 348 [46.3% of subjects prescribed IVF]) versus patients prescribed IVF ≥70 (n = 403 [53.7%]). Patients prescribed IVF <70 had increased rates of hyponatremia on the subsequent day versus patients prescribed IVF ≥70 (50.0% vs 26.9%, P < .001). CONCLUSIONS In children hospitalized with bronchiolitis, hyponatremia may be a modifiable risk factor for severe disease that may be mitigated by avoiding use of severely hypotonic IVF.
Collapse
Affiliation(s)
- Steven L Shein
- Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Katherine Slain
- Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | | | - Richard Speicher
- Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Alexandre T Rotta
- Division of Pediatric Critical Care, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| |
Collapse
|
7
|
Zeiger RS, Schatz M, Dalal AA, Chen W, Sadikova E, Suruki RY, Kawatkar AA, Qian L. Blood Eosinophil Count and Outcomes in Severe Uncontrolled Asthma: A Prospective Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:144-153.e8. [PMID: 27665383 DOI: 10.1016/j.jaip.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine eosinophil count and other atopic biomarkers. The relationship of blood eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. RESULTS A blood eosinophil cutoff point of greater than or equal to 400 cells/mm3 compared with less than 400 cells/mm3, but not 150 cells/mm3 or 300 cells/mm3, was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, -286 to 691). CONCLUSIONS A high blood eosinophil count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.
Collapse
Affiliation(s)
- Robert S Zeiger
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif.
| | - Michael Schatz
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | | | - Wansu Chen
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Ekaterina Sadikova
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | | | - Aniket A Kawatkar
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| | - Lei Qian
- Kaiser Permanente Southern California Region, San Diego and Pasadena, Calif
| |
Collapse
|
8
|
Auten R, Schwarze J, Ren C, Davis S, Noah TL. Pediatric Pulmonology year in review 2015: Part 1. Pediatr Pulmonol 2016; 51:733-9. [PMID: 27124279 DOI: 10.1002/ppul.23423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 02/04/2023]
Abstract
Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection. Pediatr Pulmonol. 2016;51:733-739. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Jurgen Schwarze
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, United Kingdom
| | - Clement Ren
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephanie Davis
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
9
|
Dosanjh A. Commentary: Blood Eosinophilia Is Associated with Unfavorable Hospitalization Outcomes in Children with Bronchiolitis. Front Pediatr 2016; 4:123. [PMID: 27965947 PMCID: PMC5127386 DOI: 10.3389/fped.2016.00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/01/2016] [Indexed: 11/15/2022] Open
|