1
|
Litvin R, Dasgupta M, Deenadayalan V, Cuartas-Mesa MC, Olafimihan AG, Park DY, Zia M, Shaka H. Trends in outcomes and racial disparities in adult hospitalizations for immune thrombocytopenia over a decade. Ann Hematol 2023:10.1007/s00277-023-05249-8. [PMID: 37147362 DOI: 10.1007/s00277-023-05249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
Immune thrombocytopenia (ITP) is a diagnosis of exclusion characterized by a low platelet count in patients for whom other etiologies have been ruled out. It occurs due to autoimmune-mediated platelet destruction and thrombopoietin deficiency. ITP is a rare hematologic disorder in adults, and scarce information exists on the hospitalization outcomes among these patients. To address this knowledge gap, we conducted a nationwide population-based study from 2010 to 2019 using the National Inpatient Sample. We found a trend toward an increase in the annual admissions for ITP (from 392.2 to 417.3, p = 0.07). There was a decrease in mortality exclusively for White patients over the period studied (p = 0.03), which was not seen in Black or Hispanic patients. There was an increase in total charges adjusted for inflation for all subgroups (p < 0.01). Length of stay decreased during the decade analyzed (p < 0.01) for the total population and most subgroups. The rates of epistaxis and melena increased (p < 0.01), while rates of intracranial hemorrhage and hematemesis did not change significantly. Advances have been made in the ITP management over the past decade. However, this has not resulted in a decrease in the number of hospitalizations or total healthcare charges during hospitalization. Furthermore, a decrease in mortality was observed in White patients but not in other races. Prospective studies are needed to better characterize the financial burden of the disease, as well as to investigate racial variability in access to care, disease behavior, and response to treatment.
Collapse
Affiliation(s)
- Rafaella Litvin
- Department of Medicine, Cook County Health, Chicago, IL, USA.
| | - Mona Dasgupta
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | | | | | | | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Maryam Zia
- Department of Hematology and Oncology, Cook County Health, Chicago, IL, USA
| | - Hafeez Shaka
- Department of Medicine, Cook County Health, Chicago, IL, USA
| |
Collapse
|
2
|
Jiao Y, Moll K, Dores GM, Tworkoski E, Zhou CK, Scott D, Wong HL, Fingar K, Burrell T, McEvoy R, Hobbi S, Chillarige Y, Obidi J, MaCurdy T, Kelman J, Shoaibi A. Immune globulin usage trends in commercially insured and Medicare populations, 2009-2019. Transfusion 2023; 63:516-530. [PMID: 36808746 DOI: 10.1111/trf.17261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Longitudinal patterns of immune globulins (IG) use have not been described in large populations. Understanding IG usage is important given potential supply limitations impacting individuals for whom IG is the sole life-saving/health-preserving therapy. The study describes US IG utilization patterns from 2009 to 2019. STUDY DESIGN AND METHODS Using IBM MarketScan commercial and Medicare claims data, we examined four metrics overall and by condition-specific categories during 2009-2019: (1) IG administrations per 100,000 person-years, (2) IG recipients per 100,000 enrollees, (3) average annual administrations per recipient, and (4) average annual dose per recipient. RESULTS In the commercial and Medicare populations respectively: IG administrations per 100,000 person-years increased by 120% (213-470) and 144% (692-1693); IG recipients per 100,000 enrollees grew by 71% (24-42) and 102% (89-179); average annual administrations per recipient rose by 28% (8-10) and 19% (8-9); and average annual dose (grams) per recipient increased by 29% (384-497) and 34% (317-426). IG administrations associated with immunodeficiency (per 100,000 person-years) increased by 154% (from 127 to 321) and 176% (from 365 to 1007). Autoimmune and neurologic conditions were associated with higher annual average administrations and dose than other conditions. DISCUSSION IG use increased, coinciding with a growth in the IG recipient population in the United States. Several conditions contributed to the trend, with the largest increase observed among immunodeficient individuals. Future investigations should assess changes in the demand for IVIG by disease state or indication and consider treatment effectiveness.
Collapse
Affiliation(s)
| | | | - Graça M Dores
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Cindy Ke Zhou
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Dorothy Scott
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Hui-Lee Wong
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | | | | | | | - Shayan Hobbi
- IBM Consulting, Bethesda, Maryland, USA
- Accenture Federal Services, Arlington, Virginia, USA
| | | | - Joyce Obidi
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| | - Thomas MaCurdy
- Acumen LLC, Burlingame, California, USA
- Department of Economics, Stanford University, Stanford, California, USA
| | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, Washington, DC, USA
| | - Azadeh Shoaibi
- Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, Maryland, USA
| |
Collapse
|
3
|
Modi ZJ, Waldo A, Selewski DT, Troost JP, Gipson DS. Inpatient Pediatric CKD Health Care Utilization and Mortality in the United States. Am J Kidney Dis 2021; 77:500-508. [PMID: 33058964 PMCID: PMC8485635 DOI: 10.1053/j.ajkd.2020.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 07/15/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The impact of chronic kidney disease (CKD) on inpatient health care use is unknown. This study aimed to describe the prevalence of pediatric CKD among children hospitalized in the United States and examine the association of CKD with hospital outcomes. STUDY DESIGN Cross-sectional national survey of pediatric discharges. SETTING & PARTICIPANTS Hospital discharges of children (aged>28 days to 19 years) with a chronic medical diagnosis included in the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2006, 2009, 2012, and 2016. PREDICTOR Presence of primary or coexisting CKD as identified by diagnosis codes. OUTCOMES Length of stay (LOS), cost, and mortality. ANALYTICAL APPROACH Multivariable analysis using Poisson, gamma, and logistic regressions were performed for LOS, cost, and mortality, respectively. RESULTS A chronic medical condition was present in 6,524,745 estimated discharges during the study period and CKD was present among 3.9% of discharges (96.1% without CKD). Those with CKD had a longer LOS (median of 2.8 [IQR, 1.4-6.0] days compared with 1.8 [IQR, 1.0-4.4] days for those without a CKD diagnosis; P<0.001). Median cost was higher in the CKD group compared with the group without CKD, at $8,755 (IQR, $4,563-18,345) and $5,016 (IQR, $2,860-10,109) per hospitalization, respectively (P<0.001). Presence of CKD was associated with a longer LOS (29.9% [95% CI, 27.2%-32.6%] longer than those without CKD), higher cost (61.3% [95% CI, 57.4%-65.4%] greater than those without CKD), and higher risk for mortality (OR, 1.51 [95% CI, 1.40-1.63]). LIMITATIONS Lack of access to and adjustment for confounders including patient readmission and laboratory data. CONCLUSIONS Pediatric CKD was associated with longer LOS, higher costs, and higher risk for mortality compared with hospitalizations with other chronic illnesses. Further studies are needed to better understand the health care needs and delivery of care to hospitalized children with CKD.
Collapse
Affiliation(s)
- Zubin J Modi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI; Susan B. Meister Child Health Research and Evaluation Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
| | - Anne Waldo
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| |
Collapse
|
4
|
Park SH, Kwak SG, Kim JY. Incidence and prevalence of immune thrombocytopenia under the copayment waiver policy for pediatric patients in Korea: Data from the National Health Claims Database. Lupus 2021; 30:655-660. [PMID: 33593162 DOI: 10.1177/0961203321995247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to investigate the epidemiology of immune thrombocytopenia (ITP) under the copayment waiver policy for pediatric patients in Korea. The data were collected from the National Health Insurance Claims Database of Korea. ITP was identified based on the diagnostic code D69.38 from the Korean Standard Classification of Diseases. Patients between one and 18 years old, who had at least one health insurance claim for ITP as a final diagnosis, from 1 January 2016, to 31 December 2017, were analyzed. Prevalent cases were defined as patients who used, at least one time, any medical services coded as D69.38. Incident cases were defined as patients who did not use D69.38 coded medical services during the prior year and were newly registered in 2017. The prevalence and incidence of ITP were 24.53 and 13.39 per 100,000 persons. The peak rates were observed in 1-year-old patients. The gender-specific prevalence of ITP was significantly higher in one-year-old males than females. According to the change-point analysis, we found that the prevalence and incidence diminished rapidly at the ages of four and three, respectively. This Korean population-based epidemiological study of ITP provided meaningful insights into the current epidemiology of ITP and demonstrated the implications of interpreting epidemiologic studies to reflect age categorizing and health care system characteristics.
Collapse
Affiliation(s)
- Sung-Hoon Park
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
5
|
Finianos A, Mujadzic H, Peluso H, Mujadzic T, Taher A, Abougergi MS. Temporal trends and outcome of splenectomy in adults with immune thrombocytopenia in the USA. Ann Hematol 2021; 100:941-952. [PMID: 33560468 DOI: 10.1007/s00277-021-04449-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8-27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.
Collapse
Affiliation(s)
- Antoine Finianos
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Hata Mujadzic
- Department of Medicine, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Heather Peluso
- Division of Surgery, Prisma Health Upstate, Greenville, SC, USA
| | - Tarik Mujadzic
- Division of Plastic Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA. .,Catalyst Medical Consulting, Simpsonville, SC, USA.
| |
Collapse
|
6
|
Hayakawa I, Okubo Y, Nariai H, Michihata N, Matsui H, Fushimi K, Yasunaga H. Recent treatment patterns and variations for pediatric acute encephalopathy in Japan. Brain Dev 2020; 42:48-55. [PMID: 31522789 DOI: 10.1016/j.braindev.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatments for pediatric acute encephalopathy are largely empiric with limited evidence to support. This study investigated recent trends in clinical practice patterns for pediatric acute encephalopathy at a national level. METHOD Discharge records were extracted for children with acute encephalopathy for the fiscal years 2010-2015 using a national inpatient database in Japan. We ascertained the secular trends in medications, diagnostic and therapeutic procedures, healthcare costs, in-hospital mortality, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also ascertained variations and clustering of the practice patterns across different hospitals using hierarchical cluster analyses. RESULTS A total of 4692 eligible inpatients were identified. From 2010 to 2015, we observed increasing trends in hospitalization costs, corticosteroid and edaravone use and a decreasing trend in LOS. Despite changes in treatments, the rates of home respiratory support and in-hospital mortality were constant during the study period. Hierarchical cluster analyses showed that 6 hospital groups showed largely different therapeutic strategies to the same disease regardless of mortality rates. Hospitals with more intensive treatment practices were likely to have higher mortality, while hospitals with less intensive treatment practices were likely to have the lower mortality. However, hospitals in one group (group 1) had less intensive treatment practice even though they had the highest mortality. CONCLUSIONS We provided novel insights into the recent trends in treatments for pediatric acute encephalopathy. Therapeutic strategies varied between hospitals, suggesting the importance of pursuing evidence-based treatment strategy and promoting standardized practices to pediatric acute encephalopathy.
Collapse
Affiliation(s)
- Itaru Hayakawa
- Division of Neurology, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Okubo
- Department of Epidemiology, UCLA Fielding School of Public Health, LA, CA, USA; Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Medical Center, LA, CA, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| |
Collapse
|
7
|
Investigation of Dynamic Thiol/Disulfide Homeostasis in Children With Acute Immune Thrombocytopenia. J Pediatr Hematol Oncol 2019; 41:463-467. [PMID: 31033791 DOI: 10.1097/mph.0000000000001494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oxidative stress may play a role in the pathogenesis of immune thrombocytopenia (ITP), but the role of dynamic thiol/disulfide homeostasis has not been studied. The objective of this study was to assess whether there is a change in thiol/disulfide homeostasis in children with acute ITP. A total of 40 children with acute ITP and 50 healthy age-matched and sex-matched controls were included in this study. Serum total thiol and native thiol levels have been measured with a novel automatic spectrophotometric method. The amount of dynamic disulfide bonds and related ratios were calculated from these values. The average total thiol and native thiol levels of the patient group were found to be significantly lower than those levels of controls (P<0.01). However, intravenous immunoglobulin (IVIG) treatment with 1 g/kg/d prevented these reductions. disulfide level was slightly, but not significantly, depressed in ITP patients, but it recovered following IVIG treatment. We detected no marked changes in disulfide/total thiol, disulfide/native thiol, and native thiol/total thiol ratios between groups. These results are the first to demonstrate that thiol/disulfide homeostasis plays a role in ITP pathogenesis, and IVIG treatment can prevent the reduced thiol levels in children.
Collapse
|
8
|
Recent practice patterns in diagnostic procedures anticonvulsants, and antibiotics for children hospitalized with febrile seizure. Seizure 2019; 67:52-56. [DOI: 10.1016/j.seizure.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/13/2019] [Indexed: 11/18/2022] Open
|
9
|
National survey of factors associated with repeated admissions due to febrile seizure. Seizure 2018; 61:149-152. [PMID: 30153626 DOI: 10.1016/j.seizure.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/03/2018] [Accepted: 08/12/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Several studies reported recent trends in febrile seizure (FS) in terms of prevalence, incidence, and hospitalization rates at a national level in the USA. However, no studies have revealed risk factors for repeated admissions due to FS. METHOD We extracted discharge records of patients with FS aged < 6 years for the years 2010-14 using the Nationwide Readmission. Data were weighted to estimate the readmission rates and ascertain the factors associated with readmission due to FS, using multivariable negative binomial regression and Cox proportional hazard models. RESULTS The readmission rate of FS is approximately 3.45 cases per 1000 person-months after hospital discharge. Children aged 1-3 years had elevated rate of FS readmission with a peak age of 2 (adjusted IRR, 5.09; 95%CI, 2.25-11.5). Boys had 1.75 times higher rates of FS readmission than girls (95%CI, 1.13-2.70). Children with very-low income levels were more likely to be readmitted, compared to those with very-high income levels (adjusted IRR, 2.57; 95%CI, 1.39-4.76). CONCLUSIONS We provided novel insights into the current epidemiology of children with FS and risk factors associated with FS readmissions.
Collapse
|
10
|
Bhatt NS, Bhatt P, Donda K, Dapaah-Siakwan F, Chaudhari R, Linga VG, Patel B, Lekshminarayanan A, Bhaskaran S, Zaid-Kaylani S, Badawy SM. Temporal trends of splenectomy in pediatric hospitalizations with immune thrombocytopenia. Pediatr Blood Cancer 2018; 65:e27072. [PMID: 29637697 DOI: 10.1002/pbc.27072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Splenectomy is considered an effective treatment for immune thrombocytopenia (ITP) with 70-80% response rate. However, its current use is limited in children with ITP. It is unclear if the rates of splenectomy have changed over time. Using a large nationally representative database, we aimed to study the trends of splenectomy in pediatric hospitalizations with ITP, and the factors associated with splenectomy during these encounters. METHODS Using National (Nationwide) Inpatient Sample (NIS), and international classification of diseases (9th revision), clinical modification (ICD-9-CM) codes, we studied pediatric ITP hospitalizations with occurrence of total splenectomy between 2005 and 2014. RESULTS Out of 37,844 weighted ITP hospitalizations from 2005 to 2014; total splenectomy was performed in 954 encounters. Splenectomy rate declined over time (3.4% [2005-2006] to 1.6% [2013-2014], P < 0.001) with the younger age (≤5 years) having the most notable decline (0.91% [2005-2006] to 0.14% [2013-2014], P < 0.001). Splenectomy had higher odds of being performed electively than non-electively (odds ratio [OR]: 19.34, 95% confidence interval [CI]: 12.06-31.02, P < 0.001). Encounters with intracranial bleed were associated with the occurrence of splenectomy (OR: 17.87, 95% CI: 5.07-62.97, P < 0.001). Intracranial bleed (P < 0.001), gastrointestinal bleed (P < 0.01), sepsis (P < 0.001), and thrombosis (P < 0.001) were associated with longer length of stay and higher cost of hospitalization. CONCLUSIONS Overall, splenectomy rates consistently declined over time. Intracranial hemorrhage during hospitalizations with ITP was associated with occurrence of splenectomy. Future studies should continue to reevaluate the rates of splenectomy in pediatric ITP in the presence of various second-line pharmacologic agents.
Collapse
Affiliation(s)
- Neel S Bhatt
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parth Bhatt
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Keyur Donda
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Fredrick Dapaah-Siakwan
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Riddhi Chaudhari
- Department of Pediatrics, University of Connecticut, Farmington, CT, USA
| | - Vijay Gandhi Linga
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Bhumi Patel
- Division of Infection Prevention, Florida Hospital, Orlando, FL, USA
| | | | - Smita Bhaskaran
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Samer Zaid-Kaylani
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|