Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis.

Hemosuccus pancreaticus (HP) is a rare, life-threatening cause of upper gastrointestinal bleeding, often linked to chronic pancreatitis and pseudoaneurysm rupture into the pancreatic duct. However, its occurrence in acute necrotizing pancreatitis with decompensated cirrhosis is exceedingly rare and poses significant diagnostic and treatment challenges. We report a case of a 34-year-old male with decompensated alcoholic cirrhosis who developed hemorrhagic shock from HP following acute necrotizing pancreatitis.

The utility of a sensitive genitourinary exam in the management of pediatric bowel and bladder dysfunction.

Introduction: Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family.

Objective: This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management.

Methods: A cross-sectional, descriptive, correlational research design was used to study the relationship between GU examination findings and management of pediatric BBD.

Suboptimal care factors and stillbirths during the COVID-19 pandemic in Victoria: A state-wide linkage study of stillbirths and Consultative Council on Obstetric and Paediatric Mortality and Morbidity case reviews.

Problem: The COVID-19 pandemic affected perinatal outcomes globally, with some regions reporting an increase in stillbirths.

Background: Melbourne, Australia, experienced one of the longest and most stringent pandemic lockdowns.

Aim: To compare stillbirth rates for singleton pregnancies > 20 weeks' gestation before and during the pandemic and examine differences in suboptimal care factors.

Association Between COVID-19 Pandemic Phases and the Risk of Maternal Intensive Care Unit Admission: A Retrospective Analysis of 215,363 Victorian Hospital Admissions.

Background: There are no published Australian population-based data on serious COVID-19-associated maternal morbidity before and after widespread vaccination.

Aims: To compare COVID-19 infection rates, intensive care unit (ICU) admissions, and length of stay in hospitalised pregnant patients before and after achieving 70% state-wide maternal COVID-19 vaccination coverage.

Material And Methods: Population-based retrospective cohort study involving all hospital-admitted episodes for pregnant patients over 15-years-old with COVID-19 in Victoria from 1 March 2020 to 31 March 2022.

Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic prophylaxis-a systematic review including meta-analysis of all comparative studies.

Background: Despite the relatively low infection rate following transperineal prostate biopsy (TPB), it remains unresolved whether periprocedural antibiotic prophylaxis (PAP) can be omitted. Our aim was to compare infectious complications (genitourinary infections/GUI, fever, sepsis, readmission rate, 30-day-mortality) following TPB, considering all studies of varying levels of evidence that enable a direct comparison between patients with and without PAP.

Methods: We performed a comprehensive search in PubMed/Medline, Embase, Web of Science, and Cochrane databases, as well as grey literature sources, to identify reports published until January 2024.

A Call to Action: Healthcare Professionals to Become Independent of the Commercial Milk Formula Industry.

Health-care professionals (HCP) have a responsibility to protect and promote maternal and infant health and breastfeeding is one of the most effective measures to support this. Increasing breastfeeding rates in Australia is crucial to improving population health, but the absence of robust policies, programmes and education for HCP undermines this effort. The pervasive marketing of commercial milk formulas (CMF), including sponsorship of HCP and their organisations, has introduced significant conflicts of interest that distort clinical practice, education, research and guidelines developed in the infant feeding domain.

Whip It Good: A Case of Vitamin B12 Deficiency and Subacute Combined Degeneration of the Spinal Cord.

A 40-year-old male patient with no significant past history presented to the emergency room with bilateral upper and lower extremity numbness and difficulty walking for three weeks. MRI of the thoracic spine revealed cord signal abnormalities in the dorsal columns consistent with selective degeneration. This was congruent with the patient's presentation and symptoms of myelopathy with dorsal column involvement along with peripheral polyneuropathy.

Association of frailty and chronic limb-threatening ischemia in patients on maintenance hemodialysis: a prospective cohort study.

Chronic limb-threatening ischemia (CLTI) is a prevalent yet unpredictable complication among patients undergoing hemodialysis, and frailty is linked to adverse outcomes in this population. This study examined the influence of clinical factors on vascular events in patients undergoing hemodialysis. This multicenter prospective cohort study included patients undergoing maintenance hemodialysis since January 2008.

Over 100 Fontan Patients on Systemic Ventricular Assist Device Support: An ACTION Update.

As the Fontan population grows, understanding successful strategies for ventricular assist device (VAD) support of the failing Fontan circulation is needed. We performed a retrospective analysis of patients with Fontan circulation and systemic VAD support in the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry. Competing outcomes and Kaplan-Meier estimated survival methods were used.

Comparative analysis of neural crest development in the chick and mouse.

A core framework of the gene regulatory network (GRN) governing neural crest (NC) cell development has been generated by integrating separate inputs from diverse model organisms rather than direct comparison. This has limited insights into the diversity of genes in the NC cell GRN and extent of conservation of newly identified transcriptional signatures in cell differentiation and invasion. Here, we address this by leveraging the strengths and accessibility of the avian embryo to precise developmental staging by egg incubation and use an integrated analysis of chick (HH13) and mouse (E9.

Epilepsy Therapies Symposium | Do We Really "Outgrow" Seizures?

Initiation and maintenance of antiseizure therapy can be relatively straightforward in most patients. Depending on epilepsy type, patients may be more or less likely to enter remission or a resolution of their epilepsy and the International League Against Epilepsy developed clinically guiding definitions in this regard. The mechanisms by which resolution or remission are achieved are poorly understood which complicates clinical decision making and risk estimate for future seizure relapse.

Opioid prescribing patterns and the effect of chronic kidney disease in pediatric urology population: A retrospective cohort analysis.

Background: Significant efforts have been undertaken to decrease opioid prescribing, but there is little research into patient-specific factors presenting as barriers in the pediatric surgical population. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be a safe and effective alternative to opioids for pain control, however, concerns about their impact on renal function limit their use in patients with chronic kidney disease (CKD). Data is limited on the interplay of CKD on opioid prescribing.

Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women.

Background: Pelvic floor muscle training (PFMT) is a recommended treatment for female stress, urgency, and mixed urinary incontinence. Training varies in exercise type (pelvic floor muscles contracting with and without other muscles), dose, and delivery (e.g.

Etiologies of Bloody Diarrhea in Children Presenting With Acute Gastroenteritis to US Emergency Departments.

We used molecular testing to examine the causes of bloody diarrhea in a multicenter study of pediatric gastroenteritis. Pathogens typically associated with bloody diarrhea were detected in less than half of cases, and inappropriate antibiotic use was common, supporting the use of stool testing in patients with bloody diarrhea.

Stem Cell Markers LGR5, LGR4 and Their Immediate Signalling Partners are Dysregulated in Preeclampsia.

Leucine-rich repeat-containing G protein-coupled receptors 5/4 (LGR5/LGR4) are critical stem cell markers in epithelial tissues including intestine. They agonise wingless-related integration site (WNT) signalling. Until now, LGR5/LGR4 were uncharacterised in placenta, where analogous functions may exist.

Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study.

Background: Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children.

Methods: We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network.

The Relationship Between the Type of ST-Segment Elevation in Acute Anterior Wall Myocardial Infarction and Left Ventricular Ejection Function.

Introduction: Acute anterior wall myocardial infarction (AWMI), when presenting with ST-segment elevation on an electrocardiogram (ECG), represents a form of ST-elevation myocardial infarction (STEMI) caused by a significant reduction in coronary blood flow to the heart muscle. The shape of the ST-segment elevation, whether it is concave, convex, or straight, has been associated with different levels of left ventricular ejection fraction (LVEF), which is an important indicator of cardiac function and prognosis.

Objective: To investigate the relationship between the type of ST-segment elevation on ECG and LVEF measured 48 hours after the onset of myocardial infarction in patients with AWMI.

Antibiotic Management and Imaging Practices of Sinusitis-Related Epidural Empyema among Pediatric Centers.

A survey of pediatric infectious diseases clinicians from 49 children's hospitals demonstrated variability across institutions in the treatment of epidural empyema from sinus extension, including antibiotic route, selection, and impact of neuroimaging on determining duration of therapy.

Multilevel factors influence the use of a cardiovascular disease assessment tool embedded in the electronic health record in oncology care.

Digital health tools are positive for delivering evidence-based care. However, few studies have applied rigorous frameworks to understand their use in community settings. This study aimed to identify implementation determinants of the Automated Heart-Health Assessment (AH-HA) tool within outpatient oncology settings as part of a hybrid effectiveness-implementation trial.

Pre-operative imaging for inguinal hernia: routine or waste? A single institution perspective.

Introduction: Inguinal hernia is a very common surgical problem in Australia. This study aims to assess at a single institution the perioperative use of imaging for these patients, and the accuracy of that imaging.

Methods: Data were collected retrospectively for 215 adult patients who underwent inguinal hernia repair at a single public hospital.

Lymphovascular Tumoral Emboli in Inflammatory Breast Cancer Result from Haptotaxis-Mediated Encircling Lymphangiogenesis.

Inflammatory breast cancer (IBC) is characterized by numerous tumor emboli within lymphatics. In a recent study, we observed tumor embolic budding both in vitro and in vivo within lymphovascular spaces and proposed this to account for the plethora of tumor emboli seen in IBC. These observations did not address, however, how lymphovascular invasion is initiated or the mechanisms involved.

Evaluating the diagnostic accuracy of reduced lead paediatric electrocardiograms.

Introduction: Alternate electrocardiogram acquisition with fewer leads lacks systematic evaluation in children. This study aims to determine if electrocardiograms with fewer leads maintain diagnostic accuracy in paediatrics.

Methods: This is a single-centre review of 200 randomly selected standard 12-lead electrocardiograms from our hospital database (2017-2020) for patients aged 2 weeks to 21 years.

Outcomes Following Fecal Diversion for Intractable Hirschsprung Associated Enterocolitis: A Study From the Pediatric Colorectal and Pelvic Learning Consortium.

Background: Hirschsprung associated enterocolitis (HAEC) is a challenging problem in a subset of children with Hirschsprung disease (HD). In refractory cases, fecal diversion may be required. The aim of this study was to characterize patients who require fecal diversion for HAEC management and examine their long-term outcomes.

Respiratory Syncytial Virus Disease Burden and Nirsevimab Effectiveness in Young Children From 2023-2024.

Importance: During the 2023-2024 respiratory syncytial virus (RSV) season in the United States, 2 new RSV prevention products were recommended to protect infants in their first RSV season: nirsevimab and Pfizer's maternal RSV vaccine. Postlicensure studies are needed to assess prevention product impact and effectiveness.

Objective: To compare the epidemiology and disease burden of medically attended RSV-associated acute respiratory illness (ARI) among children younger than 5 years during the 2023-2024 RSV season with 3 prepandemic RSV seasons (2017-2020), estimate nirsevimab effectiveness against medically attended RSV-associated ARI, and compare nirsevimab binding site mutations among circulating RSV in infants with and without nirsevimab receipt.