Our experience of delivering Schwartz Rounds in a dental setting.

Schwartz Centre Rounds are designed to support staff to reflect on the social and emotional aspects of working in healthcare. Providing healthcare in highly pressurised environments is a common climate in which many healthcare professionals find themselves. To deliver the very best care to patients, both clinical and non-clinical members of the workforce need to be supported to reflect, share their experiences and have a safe space in which they can be heard safely.

Chronic Recurrent Multifocal Osteomyelitis.

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.

Use of Low-Dose Computed Tomography in Children With Nephrolithiasis: An Analysis From 2 Tertiary Pediatric Centers.

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.

Trichobezoar: A Rare Cause of Protein-losing Enteropathy.

Protein-losing enteropathy (PLE) is caused by protein loss through the gastrointestinal tract which results in hypoalbuminemia. The most common causes of PLE in children include cow milk protein allergy, celiac disease, inflammatory bowel disease, hypertrophic gastritis, intestinal lymphangiectasia, and right-sided heart dysfunction. We present a case of a 12-year-old male with bilateral lower extremity edema, hypoalbuminemia, elevated stool alpha-1-antitrypsin, and microcytic anemia.

Imaging Practices and Implications in Young Infants With Urinary Tract Infection.

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.

Transanal rectopexy for external rectal prolapse.

Purpose: The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance.

Methods: Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope.

Clinical utilization of whole-body PET/MRI in childhood sarcoma.

Hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI) has emerged as a useful tool that combines the superior tissue contrast of MRI with the targeted functional imaging of PET. In the assessment of sarcomas in children, PET/MRI has the potential to serve as a single point of service, allowing superior anatomical imaging and evaluation of metabolic uptake during one imaging session. In this pictorial essay, we review our preliminary experience with PET/MRI in the evaluation of pediatric sarcoma.

Chimeric antigen receptor T-cell therapy for marrow and extramedullary relapse of infant acute lymphoblastic leukemia.

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.

Liver failure and x-linked immunodeficiency type 47.

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.

E-cigarette, or Vaping, Product Use-Associated Lung Injury-Lessons Learned: A Case Series.

E-cigarette, or vaping, product use has been declared an epidemic, and a new disease has emerged from their use. We describe 4 patients with significant acute lung injury related to e-cigarette use who underwent bronchoscopy and bronchoalveolar lavage. All cases posed anesthetic challenges, including increased airway reactivity, hypoxia, increasing oxygen requirements, and, in 2 severe cases, the need for continued postprocedural mechanical ventilatory support.

Impaired lung function following e-cigarette or vaping product use associated lung injury in the first cohort of hospitalized adolescents.

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.

E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features.

Background: There has been a recent increase in recognition of lung disease related to the use of electronic cigarettes (called "vaping"). These patients present with acute respiratory illness following exposure to vaporized cannabis or nicotine products and sometimes require hospitalization and intensive care. We describe the imaging findings of this disease entity in the pediatric population.

Complications of percutaneous gastrostomy and gastrojejunostomy tubes in children.

Percutaneous feeding tubes are generally considered a safe option for enteral feeding and are widely used in children who require long-term nutritional support. However, complications are not infrequent and can range from bothersome to life-threatening. Radiologists should be familiar with the imaging appearances of potential complications for optimal patient care.

Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid.

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.

Avoiding misdiagnosis in postnatal presentation of congenital diaphragmatic hernia: A report of two cases and review of radiologic features.

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.

Oral ulcers as a presentation of secondary syphilis.

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.

Checklists for safe prescribing in oral medicine clinics.

Introduction Prescribing checklists are a means of managing risk related to systemic medications in oral medicine practice.Methods Checklists for workup and monitoring for azathioprine, mycophenolate mofetil (MMF) and dapsone were introduced to an oral medicine clinic. Compliance with the checklists was audited at six and 12-24 months post introduction, and compared to previous clinical practice.

Stratosphere Conditions Inactivate Bacterial Endospores from a Mars Spacecraft Assembly Facility.

Every spacecraft sent to Mars is allowed to land viable microbial bioburden, including hardy endospore-forming bacteria resistant to environmental extremes. Earth's stratosphere is severely cold, dry, irradiated, and oligotrophic; it can be used as a stand-in location for predicting how stowaway microbes might respond to the martian surface. We launched E-MIST, a high-altitude NASA balloon payload on 10 October 2015 carrying known quantities of viable Bacillus pumilus SAFR-032 (4.

Oral Ulceration: An Overview of Diagnosis and Management.

Mouth ulcers are a common complaint by patients, with individuals regularly presenting to primary care practitioners for diagnosis and treatment. The aetiology and pathogenesis of oral ulceration is, however, both varied and complex. This article highlights the importance of differentiating recurrent aphthous stomatitis (RAS) in otherwise healthy individuals from recurrent oral ulceration (ROU) secondary to known or unknown systemic disease.

Intravascular ultrasound for transvenous interventions.

Since the development of intravascular ultrasound in the late 1980s, the modality has been used both to image the vascular system and to direct interventions in target vessels. Intravascular ultrasound (IVUS) was initially used to image atherosclerosis and aid in its treatment, but it has more recently been employed within the venous system, allowing for both intravenous and transvenous image-guided interventions. IVUS is now used for both direct and transjugular intrahepatic portosystemic shunt placement, for transcaval liver biopsy and transcaval puncture of type II endoleaks, and for cardiac mass biopsy, among other interventions.

Amiloride, frusemide and urinary kallikrein excretion.

Intravenous administration of the loop diuretic frusemide caused a rapid but short-lived increase in the urinary excretion of kallikrein-like activity in healthy volunteers. Indomethacin alone did not alter urinary electrolyte or kallikrein excretion, but when given concurrently with frusemide it blunted the natriuresis without altering the urinary kallikrein excretion. A single oral dose of amiloride, a distal tubular diuretic, caused a natriuresis but no significant change in urinary kallikrein excretion.