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Pittman A, Paloian N, Pan AY, Zhang L, Moyer A, Medairos R, Thakrar P, Ellison J. Use of Low-Dose Computed Tomography in Children With Nephrolithiasis: An Analysis From 2 Tertiary Pediatric Centers. Urol Pract 2024; 11:164-169. [PMID: 37914228 DOI: 10.1097/upj.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Although ultrasound (US) is the preferred first-line imaging for pediatric nephrolithiasis, CT may be necessary in cases of a nondiagnostic US or when US in not available. Utilization of dose reduction strategies in children undergoing CT for nephrolithiasis is not well described. We compared use of low-dose CT (LDCT) in children presenting to 2 pediatric centers. METHODS We performed a retrospective chart review of children ≤ 17 years of age presenting with suspected nephrolithiasis to 2 tertiary children's hospitals, inclusive of those referred to these centers from nonpediatric facilities between 2013 and 2019. Children were included with an index CT scan from either the pediatric or referring center while those who had prior documented CT for nephrolithiasis within the study period or missing radiation dose assessment were excluded. The primary outcome was LDCT as defined as radiation dose < 3 mGy. The primary comparator was pediatric vs outside referral center. Exploratory analysis evaluated other factors associated with LDCT, including radiation dosage as a continuous variable. RESULTS A total of 155 individuals met inclusion criteria, with 126 (81.3%) receiving standard dose and 29 (18.7%) receiving LDCT. Pediatric facilities were more likely to utilize LDCT as compared to referral centers (P < .05). Older age and higher BMI were also found to be associated with increased radiation dose exposure. CONCLUSIONS Pediatric facilities utilized LDCT more frequently, although age and BMI may also influence imaging choices. An understanding of the factors associated with dose reduction in CT will impact future efforts to explore optimum imaging stewardship in pediatric nephrolithiasis.
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Affiliation(s)
- Ashley Pittman
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Neil Paloian
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy Y Pan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrea Moyer
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Medairos
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Pooja Thakrar
- Division of Pediatric Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jonathan Ellison
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of Pediatric Urology, Children's Wisconsin, Milwaukee, Wisconsin
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2
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Rafferty BA, Thakrar P. Chronic Recurrent Multifocal Osteomyelitis. Med Clin North Am 2024; 108:227-239. [PMID: 37951653 DOI: 10.1016/j.mcna.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an underrecognized autoinflammatory disease affecting the skeletal system. Its vague symptoms are often first attributed to growing pains, infection, or malignancy, which can lead to a delay in diagnosis for days to years. Untreated CRMO has the potential to cause debilitating skeletal deformities, arthritis, and chronic pain; hence early recognition and treatment are paramount. MRI is the gold standard for diagnosis. Treatment consists of various antiinflammatory medications and may also include bisphosphonates if vulnerable skeletal sites are involved. Even when treated, the disease may have a relapsing course lasting years.
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Affiliation(s)
- Bridget A Rafferty
- Medical College of Wisconsin, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Pooja Thakrar
- Medical College of Wisconsin/Children's Wisconsin, 9000 W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, USA.
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3
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Swartz S, Thakrar P, Kolinski J, Hadjiev J, Chou E, Zhang J, Yan K, Havens P. Imaging Practices and Implications in Young Infants With Urinary Tract Infection. Hosp Pediatr 2022; 12:922-932. [PMID: 36278285 DOI: 10.1542/hpeds.2021-006507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Management of infants aged ≤60 days with urinary tract infections (UTI) is challenging. We examined renal imaging in infants aged ≤60 days with UTI at a tertiary care children's hospital to identify the impact of standardizing renal ultrasound (RUS) interpretation. METHODS We retrospectively studied infants aged ≤60 days hospitalized for UTI or fever with urine culture and renal imaging obtained and final diagnosis of UTI. RUS initially had noncriterion-based (NCB) interpretation by experienced pediatric radiologists. For this study, a single pediatric radiologist used a criterion-based (CB) hydronephrosis grading system to reinterpret films initially classified as "abnormal" on the NCB reading. We compared final renal imaging results between NCB and CB groups. RESULTS Of 193 infants, 180 (93%) had inpatient RUS with 114 (63%) abnormal NCB interpretation. Of those with initially abnormal NCB interpretation, 85 OF 114 (75%) had minor and 29 OF 114 (25%) had significant abnormality by CB reinterpretation. In follow-up, the CB "minor abnormality" group showed 25% abnormal renal imaging, whereas the "significant abnormality" group showed 77% abnormal renal imaging with 54% having high-grade reflux on a voiding cystourethrogram (VCUG). Patients with CB inpatient RUS minor abnormality showed 3% abnormal RUS at follow-up, but 13% showed high-grade reflux on VCUG. CONCLUSIONS Standardized RUS interpretation in young infants with UTI improved the accuracy of identification of abnormalities on follow-up renal imaging. In patients with CB minor abnormality on inpatient RUS, our results suggest limited utility of follow-up RUS; however, follow-up VCUG remained useful to identify high-grade reflux.
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Moskop A, Pommert L, Thakrar P, Talano J, Phelan R. Chimeric antigen receptor T-cell therapy for marrow and extramedullary relapse of infant acute lymphoblastic leukemia. Pediatr Blood Cancer 2021; 68:e28739. [PMID: 33009894 DOI: 10.1002/pbc.28739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022]
Abstract
Chimeric antigen receptor (CAR) T-cells, engineered autologous T-cells that target antigens found in leukemia, have shown durable remissions in relapsed acute lymphoblastic leukemia (ALL). Infant ALL with KMT2A rearrangements (KMT2Ar) is a rare, aggressive form of leukemia associated with extramedullary disease both at diagnosis and at relapse, and overall outcomes for these patients are dismal. Here we report the successful use of tisagenlecleucel, a CAR T-cell product approved for relapsed/refractory ALL, in a patient with KMT2Ar infant ALL who was treated for combined marrow and extramedullary (renal) relapse.
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Affiliation(s)
- Amy Moskop
- Department of Pediatrics, Division of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
| | - Lauren Pommert
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pooja Thakrar
- Department of Pediatric Radiology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
| | - Julie Talano
- Department of Pediatrics, Division of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
| | - Rachel Phelan
- Department of Pediatrics, Division of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI
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Gumm AJ, Basel DG, Thakrar P, Suchi M, Telega G. Liver failure and x-linked immunodeficiency type 47. Pediatr Transplant 2020; 24:e13808. [PMID: 32790950 DOI: 10.1111/petr.13808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022]
Abstract
Patients with defects in the ATP6AP1 gene have rarely been described. ATP6AP1-related disorders are a subtype of CDG, which result in enzyme deficiencies affecting multiple organ systems ranging from mild to life-threatening. Of the 13 patients described, all had hepatopathy, but this is the first case to be successfully transplanted. We describe two brothers who developed hyperbilirubinemia shortly after birth and progressed to liver failure, case 1 by 12 months of age, with successful transplant 2 years later, and case 2 by 4 months of age, who passed away while awaiting liver transplant. Both boys were found to have a new variant in the ATP6AP1 gene: c.932/p.Leu311Gln. Although the identified ATP6AP1 gene variant was classified as unknown significance at the time, both children's phenotypes fit with what has been described for ATP6AP1-related disorders. Therefore, this result appears to have been diagnostic for both boys. This rare type of CDG, X-linked immunodeficiency type 47 (OMIM #300972), particularly in patients who progress to liver failure requiring transplant, should be included on the differential of liver failure in infants and toddlers, and its gene should be added to the diagnostic workup for such cases.
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Affiliation(s)
- Alexis J Gumm
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Donald G Basel
- Division of Pediatric Genetics, Department of Genetics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pooja Thakrar
- Division of Pediatric Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mariko Suchi
- Division of Pediatric Pathology, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grzegorz Telega
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Carroll BJ, Kim M, Hemyari A, Thakrar P, Kump TE, Wade T, De Vela G, Hall J, Diaz CD, D'Andrea LA. Impaired lung function following e-cigarette or vaping product use associated lung injury in the first cohort of hospitalized adolescents. Pediatr Pulmonol 2020; 55:1712-1718. [PMID: 32320538 DOI: 10.1002/ppul.24787] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Beginning June 2019, Children's Wisconsin was the first hospital to identify a cohort of adolescent patients hospitalized with symptoms likely associated with e-cigarette use. Our report adds to the growing literature describing the radiographic, gross and cytopathologic bronchoscopic findings, and short-term lung function outcomes in this cohort of adolescents with e-cigarette or vaping product use associated lung injury (EVALI). METHODS We present 15 adolescents hospitalized from June to September, 2019 with confirmed EVALI. We abstracted data from inpatient hospitalization and first outpatient pulmonary clinic visit. RESULTS There were 15 patients (11 male, 12 White) with a mean age of 17.1 years. All patients presented with subacute pulmonary, gastrointestinal and constitutional complaints. Diagnostic workup was guided by the Centers for Disease Control criteria for confirmed EVALI case surveillance. Flexible bronchoscopy was performed in 13/15 patients with 10/13 demonstrating gross pathologic abnormalities. Seven of 15 patients required intensive care and 2 met criteria for pediatric Acute Respiratory Distress Syndrome. Patients had dramatic improvement with systemic glucocorticoid therapy and 14/15 were discharged on room air. Eleven patients were seen as outpatients. Despite 11/11 patients reporting resolved or improved symptoms, 7/11 had abnormalities on pulmonary function testing. We initiated inhaled corticosteroids for 5/11 patients and 4/11 patients remained on their corticosteroid wean. CONCLUSIONS AND RELEVANCE We report short-term outcomes of the first cohort of adolescent patients hospitalized with EVALI. An association is observed between clinical improvement and treatment with systemic corticosteroids. However, residual airway reactivity or diffusion abnormalities persisted when patients were re-evaluated in the short-term period (mean 4.5 weeks).
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Affiliation(s)
- Brian J Carroll
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Kim
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ali Hemyari
- Department of Pediatrics, Division of Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pooja Thakrar
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Theresa E Kump
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas Wade
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gabriel De Vela
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jaimee Hall
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christina D Diaz
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lynn A D'Andrea
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ormond M, McParland H, Thakrar P, Donaldson ANA, Andiappan M, Cook RJ, Escudier ME, Higham J, Hullah E, McMillan R, Taylor J, Shirlaw PJ, Challacombe SJ, Setterfield JF. Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid. Br J Dermatol 2019; 183:78-85. [PMID: 31571192 DOI: 10.1111/bjd.18566] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit. OBJECTIVES The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA). METHODS Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h. RESULTS In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took < 5 s. CONCLUSIONS This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform. What's already known about this topic? There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP). Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP. What does this study add? The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP. Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies. What are the clinical implications of this work? We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.
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Affiliation(s)
- M Ormond
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - H McParland
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - P Thakrar
- Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, U.K
| | - A N A Donaldson
- Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K
| | - M Andiappan
- Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K
| | - R J Cook
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K.,Centre for Oral Clinical and Translational Sciences, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K
| | - M E Escudier
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K.,Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K
| | - J Higham
- Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, U.K
| | - E Hullah
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - R McMillan
- Department of Oral Medicine, Eastman Dental Hospital, UCLH/Eastman Dental Institute, UCL, London, U.K
| | - J Taylor
- Department of Oral Medicine, Glasgow Dental Hospital and School, Glasgow, U.K
| | - P J Shirlaw
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - S J Challacombe
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K.,Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K
| | - J F Setterfield
- Department of Oral Medicine, St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K.,Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral& Craniofacial Sciences, London, U.K.,St John's Institute of Dermatology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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Kumbhar S, Siddiqui S, Thakrar P. Avoiding misdiagnosis in postnatal presentation of congenital diaphragmatic hernia: A report of two cases and review of radiologic features. Radiol Case Rep 2019; 14:1288-1292. [PMID: 31462953 PMCID: PMC6706528 DOI: 10.1016/j.radcr.2019.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Diagnosis of a congenital diaphragmatic hernia after the first day of life can be challenging. The clinical symptoms are often nonspecific, and initial radiographic findings in these patients may mimic many other acute chest conditions, including pneumonia, pleural effusion, and pneumothorax. In turn, diagnostic uncertainty may expose the patient to unnecessary and even potentially harmful interventions such as thoracostomy tube placement. As such, it is imperative that radiologists remain aware of this uncommon entity and recognize imaging findings which may provide clues to its diagnosis.
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Affiliation(s)
- Sachin Kumbhar
- Department of Pediatric Radiology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., MS-721 Milwaukee, WI 53226 USA
| | - Sabina Siddiqui
- Department of Pediatric Surgery, Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., C-320, Milwaukee, WI 53226 USA
| | - Pooja Thakrar
- Department of Pediatric Radiology, Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., MS-721 Milwaukee, WI 53226 USA
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Thakrar P, Aclimandos W, Goldmeier D, Setterfield J. Vegetating lesions in secondary syphilis. Reply from authors. Clin Exp Dermatol 2019; 44:469-470. [DOI: 10.1111/ced.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- P. Thakrar
- Department of Oral Medicine Guy's and St Thomas’ NHS Foundation Trust London UK
| | - W. Aclimandos
- Department of Ophthalmology King's College Hospital London UK
| | - D. Goldmeier
- Department of Genitourinary Medicine Imperial College NHS Healthcare Trust London UK
| | - J.F. Setterfield
- Department of Oral Medicine Guy's and St Thomas’ NHS Foundation Trust London UK
- Centre for Host‐Microbiome Interactions King's College London Faculty of Dentistry, Oral and Craniofacial Sciences London UK
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Thakrar P, Aclimandos W, Goldmeier D, Setterfield JF. Oral ulcers as a presentation of secondary syphilis. Clin Exp Dermatol 2018; 43:868-875. [PMID: 30039628 DOI: 10.1111/ced.13640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/01/2022]
Abstract
The incidence of syphilis is increasing, and it typically presents in patients with known risk factors, often to genitourinary physicians. Patients presenting to a dermatologist or ophthalmologist will more likely have secondary syphilis, with the potential for having the associated complications. Early recognition is therefore vital to limit both the disease and risk of further contact spread. In this review, we include two case histories demonstrating the value of recognizing oral signs. Additionally, we review the currently accepted diagnostic and therapeutic recommendations.
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Affiliation(s)
- P Thakrar
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - W Aclimandos
- Department of Ophthalmology, King's College Hospital, London, UK
| | - D Goldmeier
- Department of Genitourinary medicine, Imperial College NHS Healthcare Trust, London, UK
| | - J F Setterfield
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Mucosal and Salivary Division, Dental Institute, King's College, London, UK
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Shephard MK, Nova CV, Thakrar P, Hodgson T. Checklists for safe prescribing in oral medicine clinics. Br Dent J 2017; 223:693-698. [DOI: 10.1038/sj.bdj.2017.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
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12
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Hullah E, Thakrar P, Cook R. CR0299 Herpes zoster virus–associated erythema multiforme in a child. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.01.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Shephard M, Thakrar P, Venda Nova C, Pinder D, Wilson C, Hodgson T. OI0265 Demographic changes in oral squamous cell carcinoma diagnoses over a 9-year period. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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