Dynamics of magnetization at infinite temperature in a Heisenberg spin chain

Understanding universal aspects of quantum dynamics is an unresolved problem in statistical mechanics. In particular, the spin dynamics of the one-dimensional Heisenberg model were conjectured as to belong to the Kardar-Parisi-Zhang (KPZ) universality class based on the scaling of the infinite-temperature spin-spin correlation function. In a chain of 46 superconducting qubits, we studied the probability distribution of the magnetization transferred across the chain's center, [Formula: see text]. The first two moments of [Formula: see text] show superdiffusive behavior, a hallmark of KPZ universality. However, the third and fourth moments ruled out the KPZ conjecture and allow for evaluating other theories. Our results highlight the importance of studying higher moments in determining dynamic universality classes and provide insights into universal behavior in quantum systems.

Stable quantum-correlated many-body states through engineered dissipation

Engineered dissipative reservoirs have the potential to steer many-body quantum systems toward correlated steady states useful for quantum simulation of high-temperature superconductivity or quantum magnetism. Using up to 49 superconducting qubits, we prepared low-energy states of the transverse-field Ising model through coupling to dissipative auxiliary qubits. In one dimension, we observed long-range quantum correlations and a ground-state fidelity of 0.86 for 18 qubits at the critical point. In two dimensions, we found mutual information that extends beyond nearest neighbors. Lastly, by coupling the system to auxiliaries emulating reservoirs with different chemical potentials, we explored transport in the quantum Heisenberg model. Our results establish engineered dissipation as a scalable alternative to unitary evolution for preparing entangled many-body states on noisy quantum processors.

Efficacy and Safety of Eculizumab in Enteroaggregative E. coli Associated Hemolytic Uremic Syndrome

BACKGROUND

Hemolytic uremic syndrome (HUS) may present atypically without the full triad of classical HUS. Eculizumab has been shown to be efficacious in complement-mediated atypical HUS and some cases of Shiga-toxin (ST) associated HUS. We report the utility of eculizumab in enteroaggregative E. coli (EAEC) associated HUS.

CASE SUMMARY

A female toddler presented with hemolytic anemia, oliguric acute kidney injury (AKI) without thrombocytopenia, and peripheral schistocytes. The stool examination for ST was negative but positive for EAEC. She required several hemodialysis sessions and received one dosage of eculizumab with rapid reversal of AKI and hemolytic markers. A kidney biopsy revealed acute tubular injury and segmental glomerular basement membrane splitting. Genetic testing was negative for complement mutations or deficiencies. A follow-up six months later showed persistently normal renal function and hematological markers.

CONCLUSION

The clinical and histological manifestations of non-ST-associated diarrheal HUS and the role of eculizumab in this condition warrant future larger studies.

Short-Term Outcome of Isolated Kidney Transplantation in Children with Autosomal Recessive Polycystic Kidney Disease: A Case Series and Literature Review

Autosomal recessive polycystic kidney disease (ARPKD) is often associated with hepatobiliary disease in the form of hepatic fibrosis and/or Caroli disease. Combined liver-kidney transplantation (CLKT) is a transplant modality of choice in children with both end-stage renal disease (ESRD) and severe hepatic disease. However, there is no consensus on whether children with ARPKD-associated ESRD without severe hepatic disease can be treated with isolated kidney transplantation (KT) without the need for CLKT. We retrospectively studied the efficacy of isolated KT in children with ARPKD without severe hepatic disease, and followed the course of hepatic disease post KT. This is a single-center study of three children with ARPKD and ESRD who underwent isolated KT. None of them had severe hepatic disease at the time of KT. All children were clinically diagnosed with ARPKD in the immediate postnatal period. All had hepatic fibrosis of varying degrees and two had intrahepatic biliary duct (IHBD) dilatation. None had gastrointestinal (GI) bleed, portal hypertension or cholangitis. Two children had preemptive KT. Pre-transplant unilateral or bilateral native nephrectomy were performed for two children, and one underwent unilateral native nephrectomy at the time of KT. The median creatinine clearance at a median post-KT follow-up of 24 months was 60.3 mL/min/1.73 m2. The two-year graft and patient survival were both 100%. Post KT, all three patients continued to demonstrate evidence of hepatic fibrosis and IHBD on sonogram; however, none of them were either evaluated for or required liver transplantation given normal synthetic liver function and absence of portal hypertension or other severe hepatobiliary disease. There were no adverse events observed such as cholangitis, GI bleed, or multiorgan failure. Hence, an excellent short-term graft and patient survival was demonstrated in this study of children with ARPKD and mild to moderate hepatic disease who received isolated KT. Long-term follow-up and larger studies are important to assess the efficacy of isolated KT in this subset of children with ARPKD.

Situs inversus totalis in an asymptomatic adolescent - importance of patient education: A case report

BACKGROUND

Situs inversus totalis (SIT) may be an incidental finding in asymptomatic children. Patients may not understand the implications of this condition and the importance of relaying the diagnosis to their healthcare providers.

CASE SUMMARY

We report an asymptomatic seventeen-year-old adolescent with previously-diagnosed SIT who presented for a routine well-child visit. During history taking, he denied any past medical conditions, including cardiovascular conditions. Only when physical exam revealed point of maximal impulse and heart sounds on the right side, did he convey that he had been diagnosed with SIT incidentally at age of 12 years. He was not aware of associated conditions or the potential implications of his diagnosis, nor did he realize it is pertinent medical history to be relayed to healthcare providers. Chest X-ray confirmed dextrocardia and abdominal X-ray showed right-sided stomach. Abdomen sonogram showed left-sided liver and right-sided spleen. Echocardiogram showed normal valvular structure and function. A comprehensive discussion was provided to address the patient's lack of understanding that SIT is a medical diagnosis with potential implications.

CONCLUSION

While SIT is rare and mostly asymptomatic, affected patients may not comprehend the importance of the diagnosis and its potential ramifications. Recognition of the patient's lack of awareness allows the healthcare provider to educate the patient and hopefully can prevent potential medical and surgical complications.

Measurement-induced entanglement and teleportation on a noisy quantum processor

Measurement has a special role in quantum theory1: by collapsing the wavefunction, it can enable phenomena such as teleportation2 and thereby alter the 'arrow of time' that constrains unitary evolution. When integrated in many-body dynamics, measurements can lead to emergent patterns of quantum information in space-time3-10 that go beyond the established paradigms for characterizing phases, either in or out of equilibrium11-13. For present-day noisy intermediate-scale quantum (NISQ) processors14, the experimental realization of such physics can be problematic because of hardware limitations and the stochastic nature of quantum measurement. Here we address these experimental challenges and study measurement-induced quantum information phases on up to 70 superconducting qubits. By leveraging the interchangeability of space and time, we use a duality mapping9,15-17 to avoid mid-circuit measurement and access different manifestations of the underlying phases, from entanglement scaling3,4 to measurement-induced teleportation18. We obtain finite-sized signatures of a phase transition with a decoding protocol that correlates the experimental measurement with classical simulation data. The phases display remarkably different sensitivity to noise, and we use this disparity to turn an inherent hardware limitation into a useful diagnostic. Our work demonstrates an approach to realizing measurement-induced physics at scales that are at the limits of current NISQ processors.

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report

BACKGROUND

Warts are common in recipients of kidney transplantation (KT). Resistant warts which are not amenable to conventional therapies may lead to significant morbidity. Limited data exists on safety and efficacy of local immunotherapy among immunocompromised KT recipients.

CASE SUMMARY

We report a seven-year-old child who presented with recalcitrant plantar periungual warts in the early KT period. Immunosuppression consisted of tacrolimus, mycophenolate and steroid. Due to failure of conventional anti-wart therapies, he was treated with two sessions of intralesional (IL) candida immunotherapy along with liquid nitrogen cryotherapy leading to complete resolution of the warts. Interestingly, de novo BK viremia was seen about three weeks following the last candida immunotherapy. This required reduction of immunosuppression and other anti-BK viral therapies. Allograft function remained stable but there were donor specific antibodies detected. There also was elevated level of plasma donor derived cell-free DNA. A pneumocystis jirovecii pneumonia occurred ten months following completion of immunotherapy that was successfully treated with trimethoprim-sulfamethoxazole. During this ten-month follow-up period, there have been no recurrence of warts, and transplant kidney function has remained stable.

CONCLUSION

Stimulation of cell-mediated immunity against the human papilloma virus induced by the IL candida immunotherapy is thought to be a cause for wart resolution. With this therapy, whether it is necessary to augment the immunosuppression to prevent rejection is unclear as that may come with a risk of infectious complications. Larger, prospective studies in pediatric KT recipients are needed to explore these important issues.

Non-Abelian braiding of graph vertices in a superconducting processor

Indistinguishability of particles is a fundamental principle of quantum mechanics¹. For all elementary and quasiparticles observed to date-including fermions, bosons and Abelian anyons-this principle guarantees that the braiding of identical particles leaves the system unchanged^2,3. However, in two spatial dimensions, an intriguing possibility exists: braiding of non-Abelian anyons causes rotations in a space of topologically degenerate wavefunctions^4-8. Hence, it can change the observables of the system without violating the principle of indistinguishability. Despite the well-developed mathematical description of non-Abelian anyons and numerous theoretical proposals^9-22, the experimental observation of their exchange statistics has remained elusive for decades. Controllable many-body quantum states generated on quantum processors offer another path for exploring these fundamental phenomena. Whereas efforts on conventional solid-state platforms typically involve Hamiltonian dynamics of quasiparticles, superconducting quantum processors allow for directly manipulating the many-body wavefunction by means of unitary gates. Building on predictions that stabilizer codes can host projective non-Abelian Ising anyons^9,10, we implement a generalized stabilizer code and unitary protocol²³ to create and braid them. This allows us to experimentally verify the fusion rules of the anyons and braid them to realize their statistics. We then study the prospect of using the anyons for quantum computation and use braiding to create an entangled state of anyons encoding three logical qubits. Our work provides new insights about non-Abelian braiding and, through the future inclusion of error correction to achieve topological protection, could open a path towards fault-tolerant quantum computing.

Early recurrence of focal segmental glomerulosclerosis in a kidney transplant recipient with APOL1 one risk variant

Apolipoprotein 1 (APOL1) risk variants (G1 and G2) are associated with focal segmental glomerulosclerosis (FSGS) in patients of African ancestry. The prevalence of APOL1 two risk variants is lower in Hispanics and very rare in European and Asian populations. APOL1 two risk variants in donor kidneys is associated with recipient kidney graft loss, however the effect of recipient risk variant in the kidney transplant outcome is unclear. Here, we present a late adolescent male with FSGS and end stage renal disease with one APOL1 risk variant (G2) who had immediate recurrence of FSGS in the post-KT period. There was an excellent response to few sessions of plasmapheresis and Rituximab with no further recurrence of FSGS in the 1 year follow-up period. It needs to be seen whether the recipient APOL1 single risk variant causes increased susceptibility to kidney graft loss on a long run via recurrent or de novo pathologies.

Synthetic cannabinoid-associated acute interstitial nephritis: An emerging cause of pediatric acute kidney injury?

Synthetic cannabinoid (SCB) usage among children is a rapidly emerging public health concern in the United States. Acute kidney injury (AKI) is an uncommon manifestation of SCB usage, with acute tubular necrosis (ATN) as the predominant histology. Here we describe a 16-year-old adolescent who sustained severe non-oliguric AKI in association with SCB usage. Emesis, right flank pain, and hypertension were the presenting clinical features. There was no uveitis, skin rash, joint pains, or eosinophilia. Urinalysis showed absence of proteinuria or hematuria. Urine toxicology was negative. Renal sonogram showed bilateral echogenic kidneys. Renal biopsy demonstrated severe acute interstitial nephritis (AIN), mild tubulitis, and absence of ATN. AIN responded with pulse steroid followed by oral steroid. Renal replacement therapy was not required. Although the exact pathophysiology of SCB-associated AIN is not known, immune response elicited by the renal tubulointerstitial cells against the antigens present in the SCB is the most likely mechanism. A high index of suspicion for SCB-induced AKI is necessary in adolescents who present with AKI of unclear etiology.

Severe hypertriglyceridemia in an infant on chronic hemodialysis

Severe hyperlipidemia is a risk factor for cardiovascular disease. Children with chronic kidney disease and end stage renal disease are at risk for development of hyperlipidemia. In this report, we describe a 7-month-old male infant with Denys-Drash syndrome who was found to have a "milky-layer" floating on the deaerator of the hemodialysis machine. Investigations showed severe hypertriglyceridemia of >1000 mg/dl. The patient had been on chronic continuous manual peritoneal dialysis until 6 months of age and recently had been switched to hemodialysis. Management included lowering of caloric intake and addition of medium chain triglyceride with reduction of the serum triglyceride levels to 300-400 mg/dl. Close monitoring of serum lipids and timely intervention is important to prevent serious complications associated with dyslipidemia. Observation of the "milky layer" in the deaerator of the hemodialysis machine may be an interesting visual clue of underlying severe hypertriglyceridemia.

Formation of robust bound states of interacting microwave photons

Systems of correlated particles appear in many fields of modern science and represent some of the most intractable computational problems in nature. The computational challenge in these systems arises when interactions become comparable to other energy scales, which makes the state of each particle depend on all other particles1. The lack of general solutions for the three-body problem and acceptable theory for strongly correlated electrons shows that our understanding of correlated systems fades when the particle number or the interaction strength increases. One of the hallmarks of interacting systems is the formation of multiparticle bound states2-9. Here we develop a high-fidelity parameterizable fSim gate and implement the periodic quantum circuit of the spin-½ XXZ model in a ring of 24 superconducting qubits. We study the propagation of these excitations and observe their bound nature for up to five photons. We devise a phase-sensitive method for constructing the few-body spectrum of the bound states and extract their pseudo-charge by introducing a synthetic flux. By introducing interactions between the ring and additional qubits, we observe an unexpected resilience of the bound states to integrability breaking. This finding goes against the idea that bound states in non-integrable systems are unstable when their energies overlap with the continuum spectrum. Our work provides experimental evidence for bound states of interacting photons and discovers their stability beyond the integrability limit.

Noise-resilient edge modes on a chain of superconducting qubits

Inherent symmetry of a quantum system may protect its otherwise fragile states. Leveraging such protection requires testing its robustness against uncontrolled environmental interactions. Using 47 superconducting qubits, we implement the one-dimensional kicked Ising model, which exhibits nonlocal Majorana edge modes (MEMs) with ℤ 2 parity symmetry. We find that any multiqubit Pauli operator overlapping with the MEMs exhibits a uniform late-time decay rate comparable to single-qubit relaxation rates, irrespective of its size or composition. This characteristic allows us to accurately reconstruct the exponentially localized spatial profiles of the MEMs. Furthermore, the MEMs are found to be resilient against certain symmetry-breaking noise owing to a prethermalization mechanism. Our work elucidates the complex interplay between noise and symmetry-protected edge modes in a solid-state environment.

Hyperinsulinemic Hypoglycemia Due to PMM2 Mutation in Two Siblings with Autosomal Recessive Polycystic Kidney Disease

Background: Hyperinsulinemic hypoglycemia (HH) is an important cause of persistent hypoglycemia in newborns and infants. Recently, PMM2 (phosphomannomutase 2) mutation has been associated with HH, especially in conjunction with polycystic kidney disease (PKD). PMM2 deficiency is one of the most common causes of congenital disorder of glycosylation (CDG). Renal involvement in PMM2-CDG manifests as cystic kidney disease, echogenic kidneys, nephrotic syndrome or mild proteinuria. Case Summary: Here, we describe a pair of siblings with HH associated with autosomal recessive polycystic kidney disease (ARPKD) and PMM2 mutation. Two siblings with ARPKD presented during infancy and early toddler years with severe hypoglycemia. Both had inappropriately elevated serum insulin, low β-hydroxybutyrate, a need for a high glucose infusion rate, positive glycemic response to glucagon, positive diazoxide response and PMM2 mutation. Conclusions: Although this combination of HH and PKD was recently described in patients of European descent who also had PMM2 mutation, our report is unique given that these non-consanguineous siblings were not exclusively of European descent. PMM2 mutation leading to abnormal glycosylation and causing cystic kidneys and the alteration of insulin secretion is the most likely pathogenesis of this clinical spectrum.

Prevalence and Associated Factors of Cesarean Section in Dhulikhel Hospital, Kathmandu University Hospital

Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pregnancy and childbirth complications. Cesarean sections are becoming more popular across the world, as well as in Nepal. Objective To assess the prevalence of cesarean section and its associated factors among women in Dhulikhel, Nepal. Method A cross-sectional study was conducted where 1246 pregnant women of age 15-45 years, admitted and delivered in hospital, were selected through purposive sampling technique and interviewed using structured questionnaires in Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. Result The prevalence of cesarean section among women was 39.7% where the most common indication was previous cesarean section with scar tenderness, 27.9%. Half of the participants, i.e. 50.6%, were primigravida. Majority of women, 97.5% had done their antenatal checkup and among them 74.8% had their checkup in Dhulikhel Hospital, Kathmandu University Hospital. Most of them, i.e.76.2% had emergency cesarean section and 69.5% had primary cesarean section. Women of the age group 30-45 years (AOR=2.23) and women with higher secondary education level (AOR=2.03) were two times more likely to perform cesarean section. Women involved in service (AOR=1.37) and business (AOR=1.23) had greater odds of performing cesarean section than homemakers. Women giving birth to infants weighing 3.51- 5.00 kg were more likely to perform cesarean section (AOR=1.33). Conclusion The prevalence of cesarean section is noticeably high where the educated, employed and higher aged women are more inclined to cesarean section. More obstetric factors could be explored to determine the rise in cesarean section in Nepal which can help in decision making for clinicians.

Polyethylene Glycol 3350 Crystal Nephropathy in Association With Glomerular Mesangial Immunoglobin A Deposition

Polyethylene glycol (PEG) 3350, an active ingredient of over-the-counter MiraLAX, is a commonly used laxative in children and is produced by polymerization of ethylene glycol (EG). Masked EG toxicity secondary to contamination of PEG 3350 could occur. We present a 7-year-old child with developmental delay who presented with altered mental status and acute kidney injury (AKI) following intake of generic PEG 3350 for few days prior to presentation. There was high anion gap metabolic acidosis, hypernatremia, elevated osmolar gap, lactic acidosis, and AKI. Urinalysis showed tubular proteinuria, microscopic hematuria, and calcium oxalate crystals. Prior urinalyses were normal without hematuria or proteinuria. Renal biopsy revealed evidence of mesangial dominant immunoglobulin A (IgA) and complement 3 (C3) deposits along with dense tubular deposition of calcium oxalate crystals. He subsequently developed worsening oliguric AKI and required hemodialysis (HD) for several sessions. The AKI resolved within 2 weeks and further HD was not required. Mental status improved in few days. Follow-up urinalyses showed resolution of microscopic hematuria and crystalluria. We hypothesized that the generic PEG 3350 most likely was contaminated with EG leading to the presentation. A high index of suspicion of contamination of PEG 3350 with EG is required in patients presenting with unexplained high anion gap metabolic acidosis, elevated osmolar gap, lactic acidosis, AKI, calcium oxalate crystalluria, and oxalate crystals on renal biopsy. Further studies are needed to determine whether there is an association between transient glomerular mesangial IgA deposition and crystal nephropathy.

Optimization of external (in air) particle induced gamma-ray emission (PIGE) methodology for rapid, non-destructive, and simultaneous quantification of fluorine, sodium, and phosphorus in nuclear waste immobilization matrices

External (in air) PIGE methodology has been optimized for rapid quantification of fluorine, sodium, and phosphorus in fluorapatite waste immobilization matrices for Molten Salt Reactor (MSR).

Efficacy of Eutectic Mixture of Local Anesthetic Cream and Vibrator Device in Pain Reduction during Peripheral Venous Cannulation in a Tertiary Care Center of Central Nepal

Background Venous cannulation is a commonly performed procedure which often leads to patient anxiety. Application of a vibrator device and or prior use of topical anesthetics are proven methods to decrease associated pain. Objective To compare the clinical efficacy of prior use of Eutectic Mixture of Local Anesthetic (EMLA) cream and vibrator device in pain reduction during peripheral venous cannulation. Method A true experimental study was conducted in November 2019 among 78 patients aged 20-60 years receiving peripheral cannulation at operation theatre. They were included using consecutive sampling and sorted to interventional and noninterventional group using simple random sampling lottery method. Participants in the non-interventional group received peripheral cannulation using routine technique whereas participants in the interventional group received topical Eutectic Mixture of Local Anesthetic cream or vibrator device prior to cannulation. Perceived post cannulation pain intensity was measured using numerical pain rating scale. Kruskal-Wallis test was used for data comparison. Result The mean age of the participants was 40.57 ± 12.5 years. The median pain score of Eutectic Mixture of Local Anesthetic cream, vibrator and no intervention was 3, 3 and 6 respectively. The reduction in median pain intensity was significantly greater with topical anesthetic cream and vibrator device when compared to the noninterventional group (p < 0.05). Conclusion Prior interventions with Eutectic Mixture of Local Anesthetic or vibrator device are useful in reducing pain intensity during peripheral venous cannulation. Routine use of these in day to day practice could be a part of standard nursing care practice.

Preterm Birth, Exasperation to the South Asian Countries

When a child is born before 37 weeks or 259 days of pregnancy, it is termed as preterm birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing preterm births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth.

Mapping of a novel major effect Hessian fly field partial-resistance locus in southern soft red winter wheat line LA03136E71

Hessian fly resistance has centralized around resistance loci that are biotype specific. We show that field resistance is evident and controlled by a single locus on chromosome 7D. Hessian flies (Mayetiola destructor Say) infest and feed upon wheat (Triticum aestivum L) resulting in significant yield loss. Genetically resistant cultivars are the most effective method of Hessian fly management. Wheat breeders in the southern USA have observed cultivars exhibiting a "field resistance" to Hessian fly that is not detectable by greenhouse assay. The resistant breeding line "LA03136E71" and susceptible cultivar "Shirley" were crossed to develop a population of 200 random F_4:5 lines using single seed descent. The population was evaluated in a total of five locations in North Carolina during the 2019, 2020, and 2021 seasons. A subsample of each plot was evaluated for the total number of tillers, number of infested tillers, and total number of larvae/pupae. From these data, the percent infested tillers, number of larvae/pupae per tiller, and the number of larvae/pupae per infested tiller were estimated. In all within and across environment combinations for all traits recorded, the genotype effect was significant (p < 0.05). Interval mapping identified a single large effect QTL distally on the short arm of chromosome 7D for all environment-trait combinations. This locus was identified on a chromosome where no other Hessian fly resistance/tolerance QTL has been previously identified. This novel Hessian fly partial-resistance QTL is termed QHft.nc-7D. Fine mapping must be conducted in this region to narrow down the causal agents responsible for this trait, and investigation into the mode of action is highly suggested.

Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study

INTRODUCTION

Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients.

METHODS

This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS.

RESULTS

On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8-13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1-19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001).

CONCLUSION

There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.

Collapsing Focal Segmental Glomerulosclerosis and Acute Kidney Injury Associated With Chimeric Antigen Receptor T-Cell (CAR-T) Therapy: A Case Report

Chimeric antigen receptor T (CAR-T) cell treatment is a rapidly emerging therapy for relapsed/refractory hematologic malignancies. Although cytokine release syndrome is a common complication, a concomitant development of biopsy-proven collapsing glomerulopathy and acute kidney injury (AKI) has not been described with CAR-T cell therapy. We report a man in his early 20s with relapsed/refractory pre–B-cell acute lymphoblastic leukemia and compensated liver cirrhosis who received 3 courses of CD19-directed CAR-T cells. After the third CAR-T cell therapy, he developed severe cytokine release syndrome accompanied by new onset of nephrotic syndrome and AKI. Cytokine release syndrome was treated with tocilizumab. His kidney biopsy showed collapsing glomerulopathy, glomerulitis, and interstitial nephritis along with complete podocyte foot-process effacement. Due to disease progression, he was subsequently treated with bispecific CD19-directed CD3 T-cell engager antibody, blinatumomab, during which he developed another episode of cytokine release syndrome with exacerbation of nephrotic-range proteinuria and his AKI progressed to stage 3 chronic kidney disease. Excess cytokine-induced podocyte and renal tubulointerstitial injury and/or “on-target off-tumor” direct renal cell toxicity are the probable mechanisms of kidney injury. Further such reports will increase our understanding of the pathophysiologic basis of kidney injury with CAR-T treatment.

End-stage renal disease in a child with focal segmental glomerulosclerosis associated with a homozygous NUP93 variant

This report highlights that the genetic causes of FSGS, including NUP93 gene variant, such as the one described in this report, progress to end-stage renal disease rapidly and that the risk of recurrence post-renal transplantation is less likely.

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

SETTING

Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).

OBJECTIVE

In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.

DESIGN

A cohort study using hospital data, January 2018-January 2020.

RESULTS

Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.

CONCLUSION

Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

Delayed Onset Minimal Change Disease as a Manifestation of Lupus Podocytopathy

Lupus podocytopathy (LP) is an uncommon manifestation of systemic lupus erythematosus (SLE) and is not included in the classification of lupus nephritis. The diagnosis of LP is confirmed by the presence of diffuse foot process effacement in the absence of capillary wall deposits with or without mesangial immune deposits in a patient with SLE. Here we describe a 13-year-old female who presented with nephrotic syndrome (NS) seven years after the diagnosis of SLE. The renal function had been stable for seven years since the SLE diagnosis, as manifested by the normal serum creatinine, serum albumin and absence of proteinuria. Renal biopsy showed evidence of minimal change disease without immune complex deposits or features of membranous nephropathy. Renal function was normal. The patient had an excellent response to steroid therapy with remission within two weeks. The patient remained in remission five months later during the most recent follow-up. This report highlights the importance of renal histology to determine the accurate etiology of NS in patients with SLE. Circulating factors, including cytokines such as interleukin 13, may play a role in the pathophysiology of LP and needs to be studied further in future larger studies.

Disparities in Pediatric Patient Portal Activation and Feature Use

Objective

Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics.

Materials and methods

We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use).

Results

Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern.

Conclusions

Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study

Background Thrombocytopenia is a common haematological abnormality noted in clinical practice, however, it can be missed in cases where specific investigations are not asked for. Acute Febrile Illness with thrombocytopenia is a diagnostic and therapeutic challenge, as thrombocytopenia has an inverse relation to mortality and morbidity in various febrile illnesses. Vector-borne and zoonotic diseases (like malaria, dengue, scrub typhus, and leptospirosis), infections and sepsis are some of the common causes of fever with thrombocytopenia. Objective To identify the causes of fever with thrombocytopenia, assess the clinical complications associated with febrile thrombocytopenia, and overall study the clinical profile of thrombocytopenia in a tertiary care hospital Method Medical records of all adult patients, admitted to a tertiary level hospital, with fever and thrombocytopenia (platelet count < 1,00,000 /mm3 ) were assessed (from October 2009 to March 2011). Detailed case history, general physical examination findings, routine and specific examinations were recorded according to a pre-decided format. Data were analysed using SPSS 16.0 Result Acute febrile illness with thrombocytopenia was most commonly seen in Dengue patients. Headache and arthralgia were more commonly encountered in scrub typhus. Platelet transfusions were necessitated in a large number of patients, especially in scrub typhus. Malaria patients had the highest mortality rate. Conclusion Acute Febrile Illnesses (AFI) are of varied origins, and proper diagnosis is imperative. The degree of thrombocytopenia in infections has a prognostic value. It can also help in differential diagnosis and clear identification of aetiology of acute febrile illnesses. Timely identification and management of thrombocytopenia in acute febrile illness can positively impact the overall patient outcome.

Renal Transplant Hydroureteronephrosis as a Manifestation of Rejection: An Under-Recognized Entity?

Hydroureteronephrosis (HUN) of the renal transplant (RT) can be obstructive or non-obstructive, refluxing or non-refluxing, and can cause allograft dysfunction. HUN of the RT as a manifestation of rejection is uncommon and has not been described in children. We describe two pediatric RT recipients who presented with late-onset HUN, 5 and 10 years after transplantation. Both had new-onset HUN which occurred at the time of rejection; HUN resolved in both patients after treatment of rejection. Renal function stabilized in both patients without the need for stent or nephrostomy tube placement. There was no obstruction or vesicoureteral reflux (VUR). Edema of the uroepithelial cells leading to transient obstruction causing HUN is a most likely explanation. We conclude that treatment of rejection in patients without obstruction or VUR may lead to resolution of HUN without the need for urological interventions.

Concomitant nephrotic syndrome and tubulointerstitial nephritis in a child with Epstein-Barr virus mononucleosis

Acute kidney injury (AKI) and nephrotic syndrome (NS) are uncommon manifestations of Epstein-Barr virus (EBV) mononucleosis. We report a 4-year-old boy with Infectious mononucleosis (IM) who presented with dialysis-requiring AKI and NS. Renal biopsy showed severe acute tubular necrosis, mild chronic interstitial nephritis and focal podocyte foot processes effacement. EBV early RNA was not detected in the renal tissue. However, immunophenotyping of peripheral lymphocytes showed increased cytotoxic T cell activity and increased memory B cells. Treatment with steroid led to rapid resolution of NS within 3 weeks. Renal function stabilised. EBV viral capsid antigen (VCA) IgM remained elevated until 4 months before starting to decline when VCA IgG and nuclear antigen started appearing. B lymphocytes are the predominant target cells in EBV infection and additionally may also act as antigen presenting cells to T lymphocytes, thereby eliciting the strong immune response and leading to podocyte and tubulointerstitial injury.

Hereditary hemorrhagic telangiectasia presenting as a recurrent epistaxis in an adolescent: A case report

BACKGROUND

Epistaxis can be an isolated finding or a manifestation of a systemic disease. Some of the potential etiologies are usage of anticoagulants, bleeding disorders, vascular aneurysms, nasal neoplasm, hypertension and nasal steroids. Hereditary hemorrhagic telangiectasia (HHT) as a cause of recurrent epistaxis is uncommon.

CASE SUMMARY

In this report, we describe an 18-year-old adolescent with recurrent epistaxis, mucocutaneous telangiectasia and family history of HHT, consistent with HHT.

CONCLUSION

Timely diagnosis is needed not only to treat the epistaxis but also to be vigilant for other serious manifestations of this condition.

Probing the solute-drag effect and its role in stabilizing the orthorhombic phase in bulk La-doped HfO2 by X-ray and gamma ray spectroscopy

The recent observation of ferroelectricity in ultra thin films of hafnium oxide (HfO2) has been attributed to the orthorhombic (o) phase of HfO2 with space group Pca21. Although this oxide is polymorphic in nature, this polar o-phase is known to be stabilized in the doped thin film oxide. The objective of the present experiment is to stabilize the o-phases in La doped bulk polycrystalline HfO2 and investigate their evolution with the doping concentration through Time Differential Perturbed Angular Correlation (TDPAC), X-ray Absorption Near Edge Structure (XANES) and Extended X-ray Absorption Fine Structure (EXAFS) measurements. The present work reports the presence of both the polar Pca21 phase and the antipolar Pbca phase at different La-concentrations. Two o-phases of HfO2 with space groups Pca21 and Pbca, difficult to distinguish by other complimentary methods, could be unambiguously identified by utilizing the atomic scale sensitivity of the electric field gradient (EFG) embedded in TDPAC spectroscopy. The determination of the oxidation state and the local environment of La-atoms by XANES and EXAFS measurements illuminates the microscopic role of the dopant in stabilizing the o-phase. The "solute drag model" proposes a critical crystallite size for the nucleation of the o-phase in bulk HfO2 and explains the role of the La-dopant in stabilizing the o-phase. Thus the present study shows the possibility of stabilizing the polar o-phase and hence attaining ferroelectricity in bulk HfO2 to augment the scope of future application for this ferroelectric device.

Persistent viral shedding despite seroconversion in a kidney transplant recipient with severe extrapulmonary COVID-19

Renal transplant (RT) recipients are at increased risk for infectious complications. The clinical course of COVID-19 has been described in several RT recipients with varying clinical outcomes. Most present with pulmonary manifestations, however extrapulmonary presentations are not uncommon. Also, the timing and efficacy of seroconversion in transplant recipients is not well known. This report describes the duration of viral shedding and timing of seroconversion in a young adult RT recipient with COVID-19 who presented with severe diarrhoea and acute kidney injury requiring dialysis. She developed anti‐SARS‐CoV‐2 IgG antibody after 5 weeks despite persistently shedding the virus in the nasopharynx until 6 weeks after symptom onset. Further studies are needed to determine if immunosuppressed patients have prolonged viral shedding and are still contagious despite seroconversion.

The use of internet sources for nutritional information is linked to weight perception and disordered eating in young adolescents

The internet serves as an accessible and confidential resource for young adolescents seeking nutritional information. However, the quality of information retrieved online is mixed and could have serious implications for users. Young adolescents who perceive themselves as overweight may be disproportionately affected as they are at greater risk for disordered eating. The current study aimed to (1) assess whether the frequency of use of different internet sources to obtain nutritional information differs between healthy weight young adolescents and those with overweight/obesity based on both objective and perceived weight status and (2) evaluate the relationships between different internet sources utilized for nutritional information and disordered eating. Young adolescents (n = 167; 10-15 years) completed the Children's Eating Attitudes Test (ChEAT; total disordered eating), indicated their perceived weight status, and reported how often they obtained nutritional information from the following internet sources: professional websites, personal websites, social media, commercial weight loss websites, and forums. Objective height and weight measurements were obtained. Young adolescents that perceived themselves to be a little overweight or overweight reported greater use of personal websites (p = .012), commercial weight loss websites (p = .011), and social media (p = .019) for nutritional information than those that did not perceive themselves to be a little overweight or overweight. The frequency of use of internet sources for nutritional information did not differ based on objective weight status. Greater use of each of the internet sources for nutritional information was related to greater disordered eating (p's < 0.05). While longitudinal research is needed to further examine these relationships, healthcare providers and teachers should provide young adolescents with guidance for interpreting and using online nutritional information to encourage valid and reliable health recommendations.

Mild COVID-19 in a pediatric renal transplant recipient

As of mid-April 2020, the coronavirus disease of 2019 (COVID-19) pandemic has affected more than 2 million people and caused 135 000 deaths worldwide. Not much is known about the effect of this disease in immunosuppressed children with renal transplantation (RT). Here we report a 13-year-old child with multiple comorbidities who acquired COVID-19 5 years post-RT in the United States. Maintenance immunosuppression (IS) consisted of sirolimus and mycophenolate. There was no history of travel or exposure to sick contacts. The presenting features were fever, cough, rhinorrhea, and hypoxemia. Diarrhea was the only extrapulmonary manifestation. Chest X-ray was normal. He did not require intensive care unit care or ventilation. There was a transient rise in his serum creatinine without change in urine output; dialysis was not required. Slight reduction in IS was done. He had an excellent clinical recovery within 4 days and was able to be discharged home. His respiratory symptoms resolved but the diarrhea persisted during a 4-week follow-up period. This report provides a brief perspective on the short-term COVID-19 clinical course in an immunosuppressed child. More reports will add valuable information on the potential variety of spectrum of the illness in this subset of children.

Adrenal Ganglioneuroma

Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facililate the diagnosis of adrenal ganglioneuroma.

Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature

Background: Fibromuscular dysplasia (FMD) is one of the important etiologies of renovascular hypertension in children. It is usually resistant to multiple antihypertensive agents and can cause extreme elevation in blood pressures, which can lead to end organ damage if not promptly diagnosed and treated. Treatment options include medical management with antihypertensive agents, balloon or stent angioplasties, surgical revascularization, and nephrectomy. The aim of the study was to review the efficacy of antihypertensive therapy only in the management of FMD in a very young child. Methods: This is a retrospective chart study with review of literature. Results: Here, we report a 22-month-old toddler who presented with severe resistant hypertension and cardiomyopathy who was found to have focal FMD of the right renal artery. She also presented with proteinuria, hyponatremia that was probably secondary to pressure natriuresis, hypokalemia, hyperaldosteronism, and elevated plasma renin activity. The stabilization of blood pressures was done medically with the usage of antihypertensive medications only, without the need for angioplasty or surgical revascularization. Conclusions: We demonstrate that surgical intervention may not always be necessary in the treatment of all cases of FMD, especially in a small child where such intervention may be technically challenging and lead to potential complications. Hence, medical management alone may be sufficient, at least for the short-term, in small children with controlled hypertension and normal renal function, with surgical intervention reserved for FMD with medication-refractory hypertension and/or compromised renal function.

Renal dysplasia masquerading as a renal mass in a child on hemodialysis

Pathological renal mass is uncommon in children. It is important to differentiate this from a benign mass or mass-like lesion (pseudomass) for proper management. Renal dysplasia is a common finding in patients with end stage renal disease and can mimic a renal mass. Here, we report a 16-year-old girl on hemodialysis who was found to have a nodular right renal mass in the sonogram. Magnetic resonance imaging confirmed the nodular mass. She underwent right nephrectomy and the histopathology revealed features of renal dysplasia and end stage kidney disease without any evidence of malignancy. No further treatments were necessary. This case demonstrates that a nodular renal mass in dialysis patients does not always mean malignancy and could be a pseudomass from severe renal dysplasia. Since a sonogram may not be able to clearly define the etiology of solid mass in these patients, further evaluations including a renal histology and/or other imaging modalities are often necessary.