Metabolic evaluation of urolithiasis and obesity in a midwestern pediatric population.

PURPOSE: The incidence of urolithiasis has been proved to be increasing in the adult population, and evidence to date suggests that the same holds true for the pediatric population. While adult urolithiasis is clearly linked to obesity, studies of pediatric patients have been less conclusive. We hypothesized that a population of otherwise healthy children with stones would have an increased body mass index compared to a control population, and that obese pediatric stone formers would have results on metabolic assessment that are distinct from nonobese stone formers. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients 10 to 17 years old with upper tract urolithiasis without comorbidities treated between 2006 and 2011. Mean body mass index of our population was compared to state data, and 24-hour urine collection results were compared between obese and nonobese patients with stones. RESULTS: The obesity rate in 117 patients with urolithiasis did not differ significantly from the obesity rate derived from the 2007 National Survey of Children's Health (observed/expected ratio 1.11, 95% CI 0.54-1.95). Using t-test and chi-square comparisons, overall 24-hour urine collection data did not show statistically significant differences. CONCLUSIONS: Our results do not confirm obesity as a risk factor for pediatric urolithiasis in otherwise healthy patients. We also found no substantial metabolic differences between healthy nonobese stone formers and obese patients. While the pediatric literature is mixed, our study supports the majority of published series that have failed to establish a link between pediatric urolithiasis and obesity.

Urolithiasis in patients on high dose felbamate.

PURPOSE: We report 4 cases of felbamate urolithiasis. We identified only 1 prior case report of a felbamate stone. Felbamate is an antiepileptic drug used to treat refractory seizures and has minor side effects when given in recommended doses. We analyzed the characteristics, evaluation, treatment and outcomes in this challenging group of patients. MATERIALS AND METHODS: Following institutional review board approval, we conducted a retrospective chart review of all patients who presented with a diagnosis of urolithiasis, were on felbamate and had stone analysis consistent with a felbamate origin. RESULTS: All 4 patients had refractory seizures and 3 had severe developmental delay. Presentation ranged from an incidental finding to gross hematuria to agitation and pain. Stones were not visible on plain x-ray except in 1 case involving mixed stone composition. Decrease or cessation of the drug has not been feasible in 2 patients, and 3 patients have had recurrent stones. Initial stone analysis did not correctly identify the stone composition as felbamate in 2 cases, suggesting that the origin of these stones may not always be recognized. CONCLUSIONS: We report the occurrence of felbamate stones in a series of patients on high dose felbamate therapy. Accurate diagnosis is made more difficult by the clinical complexity of the patient population (including severe developmental delay), the radiolucent nature of the stones and the possibility of inaccurate analysis of stone composition.

Safety and reliability of artificial CO2 augmentation method in comparison with standard apneic oxygenation method for brain death determination.

INTRODUCTION: The most commonly used apnea test for determination of brain death is the apneic oxygenation method. While all the commonly used apnea tests have associated complications, artificial CO2 augmentation has been reported to have fewer complications. However, data supporting the use of the latter method is limited. METHODS: We identified 102 patients who underwent brain death testing during the last ten years. Artificial CO2 augmentation apnea testing was used in 50 of these patients while 52 patients underwent standard apneic oxygenation apnea testing. RESULTS: No significant differences between the two groups were noted in any previously considered clinical outcomes, including hypoxemia, acidemia, or shock. However, shorter duration of apnea testing was observed in the artificial CO2 augmentation method suggesting its feasibility to the standard apneic oxygenation method in terms of convenience and reduction of the risk surrounding prolonged hypercapnia and hypoxemia. CONCLUSION: This retrospective cohort study provides further observational evidence to support the safety of alternate apnea testing techniques with the standard apnea method for determination of brain death in adults.

Prone positioning for severe ARDS in a postpartum COVID-19 patient following caesarean section.

A 31-year-old pregnant woman presented with symptomatic COVID-19, which was complicated by progressive hypoxaemia requiring intensive care and emergent delivery by caesarean section. Afterward, she was successfully supported with mechanical ventilation and prone positioning and ultimately recovered. We review literature regarding complications of COVID-19 affecting pregnancy and evidence-based treatment strategies.

Anthropomorphism of Robots: Study of Appearance and Agency.

BACKGROUND: As the prevalence of robots increases each year, understanding how we anthropomorphize and interact with them is extremely important. The three-factor theory of anthropomorphism, called the Sociality, Effectance, Elicited agent Knowledge model, guided this study. As anthropomorphism involves a person making attributions of human likeness toward a nonhuman object, this model implies that anthropomorphism can be influenced either by factors related to the person or the object. OBJECTIVE: The aim of this study was to explore factors influencing the anthropomorphism of robots, specifically the robot's appearance (humanoid vs nonhumanoid) and agency (autonomous vs nonautonomous). We expected a humanoid robot would be anthropomorphized to a greater extent than one that was nonhumanoid. In addition, we expected that inducing an agency belief to the effect that a robot was making its own decisions would increase anthropomorphism compared with a nonagency belief that the robot was being remotely controlled by a human. We also sought to identify any role gender might play in anthropomorphizing the robot. METHODS: Participants (N=99) were primed for agency or nonagency belief conditions and then saw a brief video depicting either a humanoid or nonhumanoid robot interacting with a confederate. After viewing the video, they completed 4 measures: perception to humanoid robots scale (PERNOD), the Epley anthropomorphic adjectives measure, the Fussel anthropomorphic adjective checklist, and the Anthropomorphic Tendencies Scale (ATS). RESULTS: Findings with the PERNOD scale indicated subjects did perceive the 2 robots differently, F6,86=6.59, P<.001, which means the appearance manipulation was effective. Results with the Epley adjectives indicated that participants were more willing to attribute humanlike behavioral traits to the nonhumanoid rather than the humanoid robot, F1,91=5.76, P=.02. The Fussel adjective checklist results showed that subjects were more willing to attribute humanlike social qualities to the remote controlled than the autonomous robot, F1,91=5.30, P=.02. Finally, the ATS revealed the only gender effects in this study, with females reporting more endorsement of anthropomorphism for pets (P=.02) and less for showing negative emotions toward anthropomorphized objects (P<.001) if they had witnessed the humanoid rather than the nonhumanoid robot. CONCLUSIONS: Contrary to our expectations, participants were less willing to make humanlike attributions toward a robot when its morphology was more humanlike and were more willing to make those attributions when they were told that the robot was being remotely controlled by a person rather than acting on its own. In retrospect, these outcomes may have occurred because the humanoid robot used here had a smaller overall stature than the nonhumanoid robot, perhaps making it seem more toylike and because subjects made attributions toward the person behind the remote-controlled robot rather than toward the robot itself.