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Dayton, OH, United States

Ulman C.A.,Wright State University | Trevino J.J.,Wright State University | Miller M.,Dayton Childrens Medical Center | Gandhi R.K.,Wright State University
Dermatology Online Journal | Year: 2014

Trimethylaminuria is a rare, autosomal recessive, metabolic disorder that results in accumulation of trimethylamine (TMA), which smells like rotten fish. The chemical is excreted in sweat and urine owing to a deficiency in the enzyme flavin monooxygenase 3 (FMO3). We report a case of trimethylaminuria in a 12-year-old girl. The patient failed treatment with diet and hygiene modification, but achieved symptomatic improvement after a four-month course of metronidazole. © 2014 by the article author(s). Source

The Tigecycline Evaluation and Surveillance Trial (TEST) was designed to monitor global longitudinal changes in bacterial susceptibility to a panel of antimicrobial agents, including tigecycline. In this study, we examine susceptibility among Gram-positive isolates collected from pediatric patients globally between 2004 and 2011. A total of 9,422 Gram-positive isolates were contributed by 1,255 centers, predominantly from Europe and North America. One-third of Staphylococcus aureus isolates were methicillin resistant, peaking in prevalence in 2007. All S. aureus isolates (n=3,614) were susceptible to linezolid, tigecycline, and vancomycin; minocycline, imipenem, and meropenem were also highly active (>92% susceptibility). Ampicillin and penicillin susceptibility increased significantly during the study period (P < 0.0001 for both). Streptococcus pneumoniae isolates (n = 3,373) were highly susceptible to vancomycin (100%), linezolid (>99%), and levofloxacin and tigecycline (both>96%); imipenem susceptibility was low (32%) in Africa while minocycline susceptibility was low in Asia-Pacific Rim (38%). Penicillin resistance occurred in one-fifth of all S. pneumoniae isolates, with penicillin susceptibility ranging from 14% in Africa to 65% in Europe. Streptococcus agalactiae isolates (n = 1,056) were highly susceptible to most antimicrobials, although only 16% were susceptible to minocycline. Enterococcus faecalis isolates (n = 1,112) were highly susceptible (>97%) to ampicillin, linezolid, penicillin, tigecycline, and vancomycin globally, but only 34% were minocycline susceptible; minocycline susceptibility decreased significantly from 2004 to 2011 (P<0.001). Tigecycline and linezolid were highly active against Enterococcus faecium (n = 267) globally (100% and 98% susceptible, respectively). Tigecycline and linezolid were highly active against Gram-positive pathogens from pediatric patients in TEST 2004 to 2011, with vancomycin and the carbapenems performing well against most pathogens. © 2013, American Society for Microbiology. Source

Albert M.C.,Dayton Childrens Medical Center | Lafleur B.C.,Dayton Childrens Medical Center
Journal of Pediatric Orthopaedics | Year: 2015

BACKGROUND:: Segmental spinal instrumentation with Luque wire fixation has been the standard treatment of neuromuscular scoliosis for >30 years. More recently, pedicle screw constructs have become the most widely utilized method of posterior spinal fixation; however, they are associated with complications such as implant malposition. We report the use of polyester bands and clamps utilized with pedicle screws in a hybrid fixation construct in the treatment of neuromuscular scoliosis. METHODS:: A retrospective review was conducted of 115 pediatric spinal deformity cases between 2008 and 2010 at a single center performed by a single surgeon. Intraoperative and postoperative complications were recorded. Radiographs were reviewed preoperatively and at the latest follow-up. A systematic review of the literature was conducted. Data from case series reporting outcomes of sublaminar wires and all-pedicle screw constructs in the treatment of neuromuscular scoliosis were compared with outcomes of the present study. RESULTS:: Twenty-nine patients with neuromuscular scoliosis who underwent segmental spinal instrumentation with a hybrid construct including sublaminar bands and pedicle screws were included. There was an average follow-up of 29 months (range, 12 to 40 mo). The average postoperative correction of coronal balance was 69% (range, 24 to 71 degrees). Sagittal balance was corrected to within 2 cm of the C7 plumbline in 97% of patients. The loss of coronal and sagittal correction at latest follow-up was 0% and 2%, respectively. There were 2 intraoperative clamp failures of the 398 implants (0.5%). There were 2 major (6.9%) and 7 minor (24%) complications in 7 patients (24% overall). These results compared favorably to previous case series of sublaminar wire and all-pedicle screw fixation techniques. CONCLUSIONS:: The polyester band technique is an excellent adjunct in the correction of spinal deformity in patients with neuromuscular scoliosis. Sublaminar bands utilized in a hybrid construct appear to be safe, can achieve corrections equivalent to all-pedicle screw constructs, and may decrease the potential complications associated with every level transpedicular fixation in the patient with a highly dysmorphic and osteoporotic spine. LEVEL OF EVIDENCE:: Level IV: cohort study. Source

Adams D.M.,University of Cincinnati | Trenor C.C.,Harvard University | Hammill A.M.,University of Cincinnati | Vinks A.A.,University of Cincinnati | And 20 more authors.
Pediatrics | Year: 2016

BACKGROUND AND OBJECTIVES: Complicated vascular anomalies have limited therapeutic options and cause significant morbidity and mortality. This Phase II trial enrolled patients with complicated vascular anomalies to determine the efficacy and safety of treatment with sirolimus for 12 courses; each course was defined as 28 days. METHODS: Treatment consisted of a continuous dosing schedule of oral sirolimus starting at 0.8 mg/m2 per dose twice daily, with pharmacokinetic-guided target serum trough levels of 10 to 15 ng/mL. The primary outcomes were responsiveness to sirolimus by the end of course 6 (evaluated according to functional impairment score, quality of life, and radiologic assessment) and the incidence of toxicities and/or infection-related deaths. RESULTS: Sixty-one patients were enrolled; 57 patients were evaluable for efficacy at the end of course 6, and 53 were evaluable at the end of course 12. No patient had a complete response at the end of course 6 or 12 as anticipated. At the end of course 6, a total of 47 patients had a partial response, 3 patients had stable disease, and 7 patients had progressive disease. Two patients were taken off of study medicine secondary to persistent adverse effects. Grade 3 and higher toxicities attributable to sirolimus included blood/ bone marrow toxicity in 27% of patients, gastrointestinal toxicity in 3%, and metabolic/ laboratory toxicity in 3%. No toxicity-related deaths occurred. CONCLUSIONS: Sirolimus was efficacious and well tolerated in these study patients with complicated vascular anomalies. Clinical activity was reported in the majority of the disorders. Copyright © 2016 by the American Academy of Pediatrics. Source

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