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Barker CK, Ghera P, Hsu B. The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury. Pediatrics 2024; 153:e2023063484. [PMID: 38629169 DOI: 10.1542/peds.2023-063484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 05/02/2024] Open
Abstract
E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.
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Affiliation(s)
| | - Princy Ghera
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benson Hsu
- University of South Dakota, Sioux Falls, South Dakota
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Stephenson N, Forno E, Laguna TA, Lovinsky-Desir S, Moore PE, Sheares BJ, Kazmerski TM, Udoko MN, Lypson ML, Harding LRW, Wilkes DS, Adair DJ, Afolabi F, Balasubramaniam V, Ale GJB, Castner LM, Ghera P, Heras A, Jordan K, Ly NP, Martinez-Fernandez TM, Mishra PE, Narang I, Palla JB, Rivera-Sanchez YM, Tapia IE, Toprak D, Torres-Silva CA, Cohen RT. Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1373-1388. [PMID: 37772940 PMCID: PMC10559131 DOI: 10.1513/annalsats.202306-583st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.
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Hanson A, Sato Y, Ghera P. Intrathoracic hybrid lesion: an incidental finding in a patient with PHACE syndrome. BMJ Case Rep 2019; 12:12/11/e231409. [DOI: 10.1136/bcr-2019-231409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hybrid lesions (HLs) are unique, congenital lung malformations with both cystic and solid components and vascular supply consistent with bronchopulmonary sequestration. Increase of HLs reported in recent literature suggest a common pathological mechanism occurring during embryogenesis, leading to occurrence of both malformations within a single lesion. Due to the unusual nature of HLs, gold standard approach for diagnosis is not very well-defined in the literature. We report a novel case of a 3-year-old girl with posterior fossa anomalies-haemangioma-arterial lesions-coarctation of the aorta-eye anomalies syndrome, who was found, on CT angiography, to have a previously missed HL diagnosis which was confirmed after surgical resection.
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Ludka-Gaulke T, Ghera P, Waring SC, Keifer M, Seroogy C, Gern JE, Kirkhorn S. Farm exposure in early childhood is associated with a lower risk of severe respiratory illnesses. J Allergy Clin Immunol 2017; 141:454-456.e4. [PMID: 28870458 DOI: 10.1016/j.jaci.2017.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | - Princy Ghera
- Marshfield Clinic Department of Medicine-Pediatrics, Marshfield, Wis
| | | | - Matthew Keifer
- Marshfield Clinic Research Foundation, National Farm Medicine Center, Marshfield, Wis
| | - Christine Seroogy
- University of Wisconsin School of Medicine and Public Health Department of Pediatrics, Madison, Wis.
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health Department of Pediatrics, Madison, Wis
| | - Steven Kirkhorn
- Marshfield Clinic Research Foundation, National Farm Medicine Center, Marshfield, Wis; Department of Occupational Medicine, Marshfield Clinic, Marshfield, Wis
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Kopp BT, Hayes D, Ghera P, Patel A, Kirkby S, Kowatch RA, Splaingard M. Pilot trial of light therapy for depression in hospitalized patients with cystic fibrosis. J Affect Disord 2016; 189:164-8. [PMID: 26433764 DOI: 10.1016/j.jad.2015.08.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depression is common in cystic fibrosis (CF) and linked with worse outcomes during hospitalization. Bright-light therapy during hospitalizations augments antidepressant regimens and reduces length of stay (LOS) in depressed non-CF patients, but has not been examined in CF METHODS: Thirty subjects used a light box emitting 10,000lx for 30min each day for 7 straight days following hospital admission for pulmonary exacerbation. Depressive symptom severity (QIDS-C) and quality of life factors (CFQ-R) were recorded pre/post light therapy. RESULTS Eighty percent of subjects had at least mild depressive symptoms upon admission. Hospitalized CF patients had a significantly lower mean LOS of 11.0±3.6 days compared to a historical cohort from the year prior (13.3±4.4 days, p value=0.038). There was a significant decrease in depressive symptoms for all subjects receiving light therapy (p value<0.0001). There was no relation between depressive symptoms and lung function or vitamin D. Six out of twelve quality of life indicators improved with light therapy including the domains of vitality, emotion, and health perceptions. There were no adverse events reported. LIMITATIONS As a pilot study, the design was limited by a lack of a control group and possible confounding effects of hospitalization treatment on systemic symptoms. CONCLUSIONS Light therapy was well tolerated by hospitalized CF patients and resulted in improved depressive symptoms and quality of life. Light therapy was associated with a reduced length of stay. Large, randomized trials of light therapy may be indicated for hospitalized CF patients.
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Affiliation(s)
- Benjamin T Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Center for Microbial Pathogenesis, Nationwide Children's Hospital, Columbus, OH, United States.
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Princy Ghera
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alpa Patel
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Kirkby
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Robert A Kowatch
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital/Ohio State Medical Center, Department of Psychiatry, Columbus, OH, United States
| | - Mark Splaingard
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States; The Sleep Disorders Center, Nationwide Children's Hospital, Columbus, OH, United States
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Racioppi M, Cappa E, D'Agostino D, Filianoti A, Pugliese D, Cadeddu C, De Wore C, Sacco E, Pinto F, D'Addessi A, Ghera P, Bassi P. Size of Bladder Cancers: Correlation among Different Types of Measurement. Urol Int 2013; 90:191-4. [DOI: 10.1159/000343666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
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Abstract
Nephrogenic systemic fibrosis (NSF) is a scleroderma-like systemic fibrosing condition of unknown etiology described in patients with renal insufficiency. Gadolinium exposure has been strongly associated with the development of NSF though the mechanism of such injury is not known. There are only few reported cases of NSF in the setting of acute renal failure and fewer reported cases where skin lesions developed after kidney function had returned to normal. We report a case of NSF in a young Hispanic woman with lupus nephritis but normal creatinine, who received gadolinium during a brief episode of prerenal acute kidney injury not requiring dialysis, secondary to sepsis.
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Affiliation(s)
- Archana Bhaskaran
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
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Ghera P, Kasirye Y, Choudhry MW, Shaw GR, Ejercito VS. Acute transient sensorineural hearing loss due to Anaplasma phagocytophilum. WMJ 2011; 110:288-290. [PMID: 22324206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report the case of a patient who presented with a 3-month history of random epistaxis and recent onset of acute hearing loss associated with fever, chills, and myalgias. Pure tone audiometry revealed bilateral sensorineural hearing loss. Complete blood cell count showed an abnormal neutrophil count of 700/uL (normal >1900/microL) and platelet count of 25 x 10(3)/microL (normal >175 x 10(3)/microL). Giemsa-stained peripheral blood smear revealed neutrophilic intracytoplasmic inclusion consistent with anaplasma morulae. Polymerase chain reaction confirmed Anaplasma phagocytophilum. The patient was treated with oral doxycycline, and, after 14 days of treatment, the hearing loss had improved markedly. Therefore, we concluded that the patient's acute transient bilateral sensorineural hearing loss was associated with anaplasmosis.
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Affiliation(s)
- Princy Ghera
- Department of Medicine-Pediatrics, Marshfield Clinic, Marshfield, WI 54449, USA.
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