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Kalluri AL, Jiang K, Abu-Bonsrah N, Ammar A, Reynolds R, Alomari S, Odonkor MN, Bhimreddy M, Ram N, Robinson S, Akbari SHA, Groves ML. Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles. Childs Nerv Syst 2024; 40:1177-1184. [PMID: 38133684 DOI: 10.1007/s00381-023-06254-y] [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] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair. METHODS Patients who underwent myelomeningocele repair at our institution were stratified based on prenatal or postnatal timing of repair. Baseline characteristics and outcomes were compared. Multivariate analysis was performed to identify whether prenatal repair was a predictor of outcomes independent of socioeconomic measures. RESULTS 49 patients underwent postnatal repair, and 30 underwent prenatal repair. Patients who underwent prenatal repair were more likely to have private insurance (73.3% vs. 42.9%, p = 0.03) and live farther from the hospital where they received their repair (251.5 ± 447.4 vs. 72.5 ± 205.6 miles, p = 0.02). Patients who underwent prenatal repair had shorter hospital stays (14.3 ± 22.7 days vs. 25.3 ± 20.1 days, p = 0.03), fewer complications (13.8% vs. 42.9%, p = 0.01), fewer 30-day ED visits (0.0% vs. 34.0%, p < 0.001), lower CSF diversion rates (13.8% vs. 38.8%, p = 0.02), and better functional status at 3-months (13.3% vs. 57.1% delayed, p = 0.009), 6-months (20.0% vs. 56.7% delayed, p = 0.03), and 1-year (29.4% vs. 70.6% delayed, p = 0.007). On multivariate analysis, prenatal repair was an independent predictor of inpatient complication (OR(95%CI): 0.19(0.05-0.75), p = 0.02) and 3-month (OR(95%CI): 0.14(0.03-0.80) p = 0.03), 6-month (OR(95%CI): 0.12(0.02-0.73), p = 0.02), and 1-year (OR(95%CI): 0.19(0.05-0.80), p = 0.02) functional status. CONCLUSION Prenatal repair for myelomeningocele is associated with better outcomes and developmental functional status. However, patients receiving prenatal closure are more likely to have private health insurance and live farther from the hospital, suggesting potential barriers to care.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA.
| | - Adam Ammar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Rebecca Reynolds
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Michelle N Odonkor
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Natasha Ram
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Syed Hassan A Akbari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
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Sannes D, Espinosa NM, Merrick E, Austell PJ, Sidle DM, Collar RM, Wang JC. Geographic Distribution of Facial Plastic and Reconstructive Surgeons. Facial Plast Surg Aesthet Med 2024; 26:141-147. [PMID: 37462730 DOI: 10.1089/fpsam.2022.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: Distribution of the general otolaryngology workforce has been described, but not specifically for the facial plastic and reconstructive surgeon (FPRS) workforce. Objective: To describe the distribution of FPRS within the United States. Methods: The 2022 American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) registry was used to identify active FPRSs. Member addresses were converted into coordinates and overlayed onto a geographic representation of 2020 census data within ArcGIS software. A centroid model of U.S. counties was constructed to determine the average distances residents were from the nearest FPRS. Results: In total, 1312 AAFPRS active members practiced in 373 counties. Thirty-three percent of all residents (115 million) resided in counties without an FPRS and 15.3% of FPRSs practiced in New York City or the Greater Los Angeles Area, which accounted for 8% of the total U.S. population. The mean and median distances a resident in a county without an FPRS was from the nearest FPRS are 63 and 49 miles (101 and 79 kilometers), respectively. Conclusions: Metropolitan areas have greater concentrations of FPRSs than the national average and the distances U.S. residents are from FPRS services are quantifiable.
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Affiliation(s)
- Dane Sannes
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
| | - Nicolas M Espinosa
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
| | - Emily Merrick
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
| | - Paris J Austell
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
| | - Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
| | - Ryan M Collar
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James C Wang
- Department of Otolaryngology-Head and Neck Surgery, Northwestern McGraw Medical Center, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Ghabash G, Wilkes J, Bonkowsky JL. National U.S. Patient and Transplant Data for Krabbe Disease. Front Pediatr 2021; 9:764626. [PMID: 34900869 PMCID: PMC8660087 DOI: 10.3389/fped.2021.764626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Krabbe disease (KD) is a leukodystrophy caused by mutations in the galactosylceramidase gene. Presymptomatic hematopoietic stem cell transplantation (HSCT) is associated with improved outcomes, but most data are from single-center studies. Our objective was to characterize national patterns of HSCT for KD including whether there were disparities in HSCT utilization and outcomes. We conducted a retrospective study of KD patients ≤ age 18 years from November 1, 2015, through December 31, 2019, using the U.S. Children's Hospital Association's Pediatric Health Information System database. We evaluated outcomes for HSCT, intensive care unit days, and mortality, comparing age, sex, race/ethnicity, rural/urban location, and median household income. We identified 91 KD patients. HSCT, performed in 32% of patients, was associated with reduced mortality, 31 vs. 68% without HSCT (p < 0.003). Trends included the fact that more males than females had HSCT (39 vs. 23%); more Asian and White patients had HSCT compared to Black or Hispanic patients (75, 33, 25, and 17%, respectively); and patients from households with the lowest-income quartile (< $25,000) had more HSCT compared to higher-income quartiles (44 vs. 33, 30, and 0%). Overall, receiving HSCT was associated with reduced mortality. We noted trends in patient groups who received HSCT. Our findings suggest that disparities in receiving HSCT could affect outcomes for KD patients.
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Affiliation(s)
- Gabrielle Ghabash
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jacob Wilkes
- Intermountain Healthcare, Salt Lake City, UT, United States
| | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
- Primary Children's Center for Personalized Medicine, Primary Children's Hospital, Salt Lake City, UT, United States
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Bradbury AM, Ream MA. Recent Advancements in the Diagnosis and Treatment of Leukodystrophies. Semin Pediatr Neurol 2021; 37:100876. [PMID: 33892849 DOI: 10.1016/j.spen.2021.100876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
Leukodystrophies and genetic leukoencephalopathies comprise a growing group of inherited white matter disorders. Diagnostic rates have improved with increased utilization of next generation sequencing. As treatment options continue to advance for leukodystrophies, so will candidacy for inclusion in the United States' newborn Recommended Universal Screening Panel as was achieved for X-linked adrenoleukodystrophy. Stem cell therapies have become standard of care for selected leukodystrophies. However, transplantation-related risks remain high and outcomes are not fully satisfactory. Transduction of autologous hematopoietic stem cells with lentiviral vectors, referred to as ex vivo gene therapy, circumvents some, but not all, of the risks of traditional transplantation and has recently been demonstrated to be safe and efficective in clinical studies of X-linked adrenoleukodystrophy and metachromatic leukodystrophy. Gene therapy, through direct infusion of adeno-associated virus vectors, has emerged as a safer alternative for many monogenetic pediatric neurological disorders. Numerous preclinical studies have shown safety and efficacy of adeno-associated virus gene therapy in leukodystrophies allowing expanded access treatment for Canavan disease prior to initiation of a clinical trial. For inherited white matter disorders resulting from overexpression of a protein, such as Pelizaeus-Merzbacher disease, emerging RNA therapies have shown success in preclinical studies and promise for rapid translation to the clinic. Lastly, small molecule and protein therapies remain a long-term treatment option for a number of leukodystrophies, including intrathecal enzyme replacement therapy for metachromatic leukodystrophy. Herein we review recent advances in diagnosis and treatment of inherited white matter disorders.
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Affiliation(s)
| | - Margie A Ream
- Division of Neurology, Nationwide Children's Hospital, Columbus, OH.
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