Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease.

Infliximab (IFX) is a recombinant DNA-derived chimeric IgG monoclonal antibody protein that inhibits tumor necrosis factor alpha (TNF-α). IFX, like other agents derived from foreign proteins, can cause infusion reactions both during and after the infusion. The incidence of infusion reactions ranges between 0% and 15% in pediatric patients.

Non-selective Aortic Root Angiographic Contrast Injection in a Case of Anomalous Right Coronary Artery Ostium.

Anomalous origin of the right coronary artery (RCA) is a rare congenital cardiovascular anomaly that can pose significant diagnostic challenges during cardiac evaluation. We present a case of a 54-year-old male patient with chest pain and a syncopal episode and subsequently diagnosed with non-ST-elevated myocardial infarction (NSTEMI). Coronary angiography revealed an anomalous origin of the RCA, making it difficult to precisely locate the artery's point of origin with selective contrast injection.

Don't Go Vaping My Heart: A Case of Vaping-Associated Cardiomyopathy and Lung Injury.

The potential adverse effects of electronic cigarette (e-cigarette) use or vaping on pulmonary function have been previously well documented, with the diagnosis of e-cigarette- or vaping-use-associated lung injury (EVALI) has become increasingly common. The potential effects in terms of cardiovascular function and vaping is an area that is less well understood. We present a case of acute respiratory distress and newly onset reduced systolic function in a previously healthy young male.

Acne characteristics in Latin American patients and the potential role of trifarotene.

Background: Individualization of treatment based on acne type and severity, location, disease burden, and patient preference is required to maximize efficacy, safety, and adherence to therapy. Latin American populations have unique attributes that must be considered as part of this process to improve clinical success and achieve patient goals. Acne is more common among patients with darker skin phototypes, in whom it is often associated with postinflammatory hyperpigmentation and scarring-the most important acne sequelae-potentially due to more frequent and more severe underlying inflammatory processes in this population.

Pediatric Hepatitis C Quality Improvement Project Improves Healthcare Access.

Objectives: Incidence of hepatitis C virus (HCV) infection is increasing in women of reproductive age, leading to increased prevalence of HCV infection in children via vertical transmission. This quality improvement (QI) project aimed to increase referrals to and appointments scheduled with a specialty pediatric gastroenterology HCV clinic and the number of eligible children with HCV who completed treatment.

Methods: From July 2020 to August 2021, the QI team designed a project using the Model for Improvement and completed Plan Do Study Act cycles to test change ideas to improve HCV awareness and education for medical providers and families; standardize the referral process; track patients; increase clinic capacity; and connect families with community resource care coordination.

Analysis of STEMI and NSTEMI in a Community Cohort of Marijuana Users.

Background: Marijuana is the most commonly used illicit drug in the United States. Current research has yet to come to a consensus on its association with acute coronary syndrome (ACS). Herein, we aimed to analyze how marijuana use relates to acute ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).

Aspiration thrombectomy for inferior vena cava tumor thrombus arising from hepatocellular carcinoma.

Pharmacomechanical therapy and catheter-directed thrombolysis have been shown to be very effective in the treatment of venous thromboembolism; however, there is much less data regarding inferior vena cava thrombi. Tumor thrombi pose an even greater clinical challenge as anti-coagulation and thrombolysis are not effective. We present the case of a 61-year-old male who presented with an inferior vena cava thrombus emanating from an accessory right hepatic vein, treated with aspiration thrombectomy.

Giant Left Main Coronary Artery Aneurysm Presenting as Multiple Implantable Cardioverter Defibrillator Shocks.

Giant aneurysms of the left main coronary artery are one of the rarest findings in cardiology, encountered in less than 0.02% of patients. The presentation is usually the same as coronary artery disease since most coronary aneurysms in the western world are associated with atherosclerosis.

Prenatal treatment of ornithine transcarbamylase deficiency.

Purpose Of Study: Patients with neonatal urea cycle defects (UCDs) typically experience severe hyperammonemia during the first days of life, which results in serious neurological injury or death. Long-term prognosis despite optimal pharmacological and dietary therapy is still poor. The combination of intravenous sodium phenylacetate and sodium benzoate (Ammonul®) can eliminate nitrogen waste independent of the urea cycle.

Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis.

Of adolescents in the United States, 20% have obesity and current treatment options prioritize intensive lifestyle interventions that are largely ineffective. Bariatric surgery is increasingly being offered to obese adolescent patients; however, large-scale effectiveness data is lacking. We used MEDLINE, Embase, and Cochrane databases, and a manual search of references to conduct a systematic review and meta-analysis on overall weight loss after gastric band, gastric sleeve, and gastric bypass in obese adolescent patients (age ≤19) and young adults (age ≤21) in separate analyses.

The challenges of closing an ileostomy in patients with total intestinal aganglionosis after small bowel transplant.

We present the case of a 14-year-old male with a history of small bowel transplantation for long segment Hirschsprung's disease who underwent Duhamel ileorectal pull-through procedure. In post-transplant, the patient had no restrictions and was not TPN-dependent. To improve his quality of life, he and his family were interested in closing the ileostomy and undergoing pull-through surgery.

Mass cytometry reveals a distinct immunoprofile of operational tolerance in pediatric liver transplantation.

Long-term IS in transplant patients has significant morbidity, poorer quality of life, and substantial economic costs. TOL, defined as graft acceptance without functional impairment in the absence of IS, has been achieved in some pediatric LT recipients. Using mass cytometry, peripheral blood immunotyping was performed to characterize differences between tolerant patients and patients who are stable on single-agent IS.

[Reactivity and evolution of 4022 patch tests in Chilean patients with contact dermatitis].

Background: Allergic Contact Dermatitis is a classic delayed hypersensitivity reaction.

Aim: To study the reactivity and evolution in Chilean patients by gender, using the standard European patch test.

Materials And Methods: The results of the European standard patch test applied to 4,022 patients aged 1 to 93 years (64% female) with Allergic Contact Dermatitis, diagnosed between January 1995 and August 2011, were retrospectively analyzed.

Focal Atrial Tachycardia in a Patient With Surgically Corrected Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease which, without corrective surgery, has a poor prognosis. These patients have an increased incidence of arrhythmias both supraventricular and ventricular post surgical correction. The supraventricular arrhythmias are usually related to the scar tissue at the surgical repair site.

Treatment of recurrent posttransplant lymphoproliferative disorder of the central nervous system with high-dose methotrexate.

Posttransplant lymphoproliferative disorder (PTLD) is a frequent complication of intestinal transplantation and is associated with a poor prognosis. There is currently no consensus on optimal therapy. Recurrent PTLD involving the central nervous system (CNS) represents a particularly difficult therapeutic challenge.

Successful treatment of recurrent primary sclerosing cholangitis after orthotopic liver transplantation with oral vancomycin.

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disease of the liver that is marked by inflammation of the bile ducts and damage to the hepatic biliary tree. Approximately 60-70% of patients also have inflammatory bowel disease and progression of PSC can lead to ulcerative colitis and cirrhosis of the liver. Due to limited understanding of the etiology and mechanism of PSC, the only existing treatment option is orthotopic liver transplantation (OLT); however, recurrence of PSC, after OLT is estimated to be between 5% and 35%.

Aborted sudden cardiac death (SCD) in a patient with hypertrophic cardiomyopathy (HCM) with low-risk factors for SCD.

Remarkable advancements have been made in understanding the pathophysiology of hypertrophic cardiomyopathy (HCM), since the first implantable cardioverter defibrillator (ICD) was placed in a human, more than 25 years ago to prevent sudden cardiac death (SCD). ICD has become the cornerstone in the management of HCM, with an ability to change the natural course of this complex disease. American College of Cardiology/American Heart Association guidelines have been charted out to help risk stratify asymptomatic or minimally symptomatic adults with HCM, in order to prevent SCD in such individuals.

The power of collateral circulation: a case of asymptomatic chronic total occlusion of the left main coronary artery.

Total occlusion of the left main coronary artery predominantly presents with recurrent angina or myocardial infarction. Long-term survival and myocardial function depends on the well-developed right to left collaterals. We report a case of a 46-year-old man who was referred because of incidental finding of low ejection fraction during work-up for syncope 5 months prior.

Incidental Finding of Malpositioned Pacing Lead in the Left Ventricle in a Patient With Subacute Subdural Hematoma.

Malposition of the right ventricular lead into the left ventricle is an unusual complication of challenging management. We report a case of an elderly woman with a dual chamber permanent pacemaker implanted 2 months before admission because of high grade AV block, who presented to our institution with sub acute subdural hematoma along the left fronto-parietal area. Incidental ventricular pacemaker lead in the left ventricle was found on chest CT scan.

Toll-like receptor 4 contributes to small intestine allograft rejection.

Background: Although outcomes for small intestine transplantation (SIT) have improved in recent years, allograft rejection rates remain among the highest of solid organ grafts. The high load of commensal bacteria in the small intestine may contribute through activation of the toll-like receptor (TLR) pathway. In this study, we examine the participation of TLR4 in acute allograft rejection in an orthotopic mouse model of SIT.

Analysis of clinical variables associated with tolerance in pediatric liver transplant recipients.

Tolerance has been defined as stable graft function off IMS. We reviewed the data of 369 pediatric liver transplant patients to examine demographic differences that may have a PV of pediatric LT tolerance. Of the 369 patients, 280 patients were stable with detectable blood levels of IMS agents and with good graft function without biopsy proven REJ > 1 yr posttransplantation, 18 patients were noted to be TOL off IMS, 27 patients were taking MIS with drug levels below detectable range by standard laboratory parameters, and 44 patients developed one or more episodes of biopsy proven acute or chronic REJ > 1 yr post-transplantation.

Relationship between aortic atherosclerosis and dental loss in an inner-city population.

Prior studies have suggested an association between atherosclerosis and periodontal disease, both of which are more prevalent in certain minority and economically disadvantaged groups. Few studies have addressed the relationship between cardiovascular disease and dentition among ethnically diverse populations. We studied 131 subjects (60% females, age 59 +/- 15 years) who were referred for clinically indicated transesophageal echocardiography.

Factors affecting survival to intestinal transplantation in the very young pediatric patient.

Background: Very young pediatric patients awaiting intestinal transplantation have a high mortality rate due to long waiting times, scarcity of appropriate size donor organs, and mortality due to sepsis and liver failure. To investigate specific risk factors impacting survival to intestinal transplantation, we performed a 4-year institutional retrospective study comparing children who received grafts by age 18 months with children 18 months or younger who died while on the waiting list.

Patients And Methods: Twelve children comprised the transplanted group and had the underlying diagnoses: necrotizing enterocolitis, gastroschisis, Hirschsprung's disease, and omphalocele.