Congenital anomalies and predisposition to severe COVID-19 among pediatric patients in the United States.

BACKGROUND AND OBJECTIVE: Congenital heart defects are known to be associated with increased odds of severe COVID-19. Congenital anomalies affecting other body systems may also be associated with poor outcomes. This study is an exhaustive assessment of congenital anomalies and odds of severe COVID-19 in pediatric patients. METHODS: Data were retrieved from the COVID-19 dataset of Cerner® Real-World Data for encounters from March 2020 to February 2022. Prior to matching, the data consisted of 664,523 patients less than 18 years old and 927,805 corresponding encounters with COVID-19 from 117 health systems across the United States. One-to-one propensity score matching was performed, and a cumulative link mixed-effects model with random intercepts for health system and patients was built to assess corresponding associations. RESULTS: All congenital anomalies were associated with worse COVID-19 outcomes, with the strongest association observed for cardiovascular anomalies (odds ratio [OR], 3.84; 95% CI, 3.63-4.06) and the weakest association observed for anomalies affecting the eye/ear/face/neck (OR, 1.16; 95% CI, 1.03-1.31). CONCLUSIONS AND RELEVANCE: Congenital anomalies are associated with greater odds of experiencing severe symptoms of COVID-19. In addition to congenital heart defects, all other birth defects may increase the odds for more severe COVID-19. IMPACT: All congenital anomalies are associated with increased odds of severe COVID-19. This study is the largest and among the first to investigate birth defects across all body systems. The multicenter large data and analysis demonstrate the increased odds of severe COVID19 in pediatric patients with congenital anomalies affecting any body system. These data demonstrate that all children with birth defects are at increased odds of more severe COVID-19, not only those with heart defects. This should be taken into consideration when optimizing prevention and intervention resources within a hospital.

Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review.

BACKGROUND: Urinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques. METHODS: MEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders. RESULTS: Three randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress. DISCUSSION: The results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.

Heterotopic ossification in the orbit.

BACKGROUND: While calcification of orbital hemangiomas has been reported previously, no reports exist of heterotopic ossifications occurring within the orbit. CASE DESCRIPTION: A 30-year-old male presented with spontaneous onset of painless progressive proptosis of the left eye, with diplopia. The preoperative radiologic findings are presented. The lesion was excised completely. The pathologic features and probable causes are discussed. CONCLUSIONS: Heterotopic ossification of the orbit should be considered in the differential diagnosis of an orbital lesion showing radiologic features of calcification or ossification.

The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study.

STUDY DESIGN: A retrospective descriptive assessment of the clinical and radiologic outcomes of 11 patients who underwent transpedicular decompression for thoracic spine tuberculosis. OBJECTIVES: To study the neurologic and radiologic outcomes in patients who underwent transpedicular decompression for thoracic spine tuberculosis. SUMMARY OF BACKGROUND DATA: Several approaches have been used in the management of thoracic spine tuberculosis to achieve the goals of decompression of the cord followed by immobilization and antituberculous therapy. These range from conservative regimens of computed tomography-guided biopsy followed by bed rest and drug therapy to radical surgeries that involve extensive debridement of the vertebral body followed by instrumentation. The authors report their experience with a "middle path" regimen of transpedicular decompression followed by external immobilization and antituberculous therapy. METHODS: The charts of 11 patients were reviewed retrospectively for clinical outcome, and kyphotic angle was measured on the follow-up radiographs to ascertain progression of kyphosis. RESULTS: There was no worsening of the neurologic status in any patient, and 10 of the 11 patients returned to functional activity. There was no significant progression of kyphosis. CONCLUSIONS: Our results show that the transpedicular approach is a viable and safe surgical option for ventral decompression in thoracic spine tuberculosis, followed by chemotherapy for 18 months and immobilization in an alkathene shell for 3 months.