Norwegian scabies in HIV/AIDS.

This case describes a patient presenting with significant crusting on his upper and lower extremities found to be Norweigan scabies, which led to a diagnosis of HIV and then AIDS. Norweigan scabies should be considered in the setting of an atypical dermatologic presentation that has failed multiple outpatient therapies.

Candida parapsilosis endocarditis in an immunocompetent host.

This case describes an 83-year-old immunocompetent woman who presented to the emergency department with complaints of nausea, vomiting, and dizziness. She was found to have evidence of embolic stroke secondary to Candida parapsilosis endocarditis. This case emphasizes the challenge of diagnosing fungal endocarditis, as it can be difficult to culture, and the importance of broad differentials even in patients with no obvious risk factors.

Imaging in pediatric bilateral sensorineural hearing loss: Diagnostic yield with computed tomography versus magnetic resonance imaging.

OBJECTIVES: To evaluate the findings and compare the diagnostic yield of computed tomography (CT) versus magnetic resonance imaging (MRI) in children with bilateral sensorineural hearing loss (BSNHL). STUDY DESIGN: Multi-institutional retrospective review. SETTING: Three tertiary referral centers. METHODS: A multi-institutional retrospective chart review was performed in patients under the age of 18 years with BSNHL (diagnosis codes 389.00-389.22) who underwent both CT and MRI from 2010 to 2012. An abnormal imaging finding was defined as an abnormality of the cochleovestibular or central nervous system known to directly correlate with sensorineural hearing loss. Diagnostic yield of CT versus MRI was compared by McNemar's test. RESULTS: Of 2081 charts reviewed, 313 patients met inclusion criteria. The diagnostic yield of CT and MRI were 25% and 18%, respectively. Approximately one-quarter of patients had an abnormal finding on CT or MRI. The concordance rate was 92%. CT was more likely to yield an abnormal finding versus MRI (p-value = 0.0001). The most common findings on CT were cochlear and semicircular canal abnormalities. On MRI, the most common findings were cochlear nerve aplasia/hypoplasia and semicircular canal abnormalities. CONCLUSIONS: This study evaluates and directly compares the diagnostic yield of CT versus MRI for pediatric BSNHL. While both modalities have important and often complementary diagnostic utility, CT had superior diagnostic yield in identifying abnormalities associated with BSNHL.

Effects of socioeconomic status on children with hearing loss.

OBJECTIVE: Health care disparities are noted between different socioeconomic groups; it is crucial to recognize and correct disparities, if present, that extend to children with hearing loss. The objective of the study is to evaluate the effect of socioeconomic status (SES) on access to hearing rehabilitation and speech and language therapy and outcomes in children with hearing loss. METHODS: Retrospective Chart Review of children diagnosed with hearing loss at 3 tertiary care academic centers from 2010 to 2012. Two hundred patients were then randomly selected from each institution for analysis. International and self-pay patients were excluded. They were separated into two groups based on SES using insurance coverage as proxy for financial status (private insurance versus Medicaid). Main outcome measures included number of hearing aid evaluations recommended andcompleted, compliance with hearing aids use, diagnosis on speech therapy evaluations, participation in speech therapy, and outcomes noted on the last speech therapy session in patients' medical record at time of study completion. RESULTS: 600 patients were identified by random selection out of total of 3679 patients. 18 were excluded because they were international pay or self-pay. Of 582 patients, 299 (51.4%) had private insurance and 283 (48.6%) had Medicaid. The pure tone average (PTA) at initial diagnosis did not differ between the two populations (left ear p = 0.74, right ear p = 0.68). There was no significant difference in the number of hearing aid evaluations recommended (p = 0.49), hearing aid evaluation completed (p = 0.68), or documented hearing aid compliance (p = 0.68) between the two populations. Similarly, there was no significant difference in the presence of speech delay (p = 0.62), the receipt of speech therapy (p = 0.49), or speech language outcomes between the two groups (p = 0.45). CONCLUSIONS: This study suggests that despite lower socioeconomic status, in children with hearing loss, Medicaid allows equivalent access to hearing rehabilitation and speech therapy as their privately insured counterparts and children achieve similar speech and language outcomes.

Evaluating diagnostic yield of computed tomography (CT) and magnetic resonance imaging (MRI) in pediatric unilateral sensorineural hearing loss.

INTRODUCTION: Options for imaging for evaluation of pediatric patients with unilateral sensorineural hearing loss (USNHL) include computed tomography (CT) and magnetic resonance imaging (MRI). Although both CT and MR imaging provide valuable information in the evaluation of pediatric patients with USNHL, debate remains regarding which imaging modality is most ideal and should be the preferred study for these children. The objective of this study is to evaluate and compare the diagnostic yield of CT versus MRI in children with USNHL. METHODS: A multi-institutional retrospective chart review was conducted. Pediatric patients with hearing loss (diagnosis codes 389.00-389.22) seen between 2010 and 2012 at three tertiary care centers were identified. Only patients with USNHL and imaging studies were reviewed and results of CT and MRI for each patient were examined and compared. Cochleovestibular or central nervous system findings known to directly correlate to SNHL were noted as positive findings on imaging. McNemar's test was used to compare patients with positive CT and MRI results. RESULTS: A total of 219 patients between the ages of 0-18 years with USNHL who underwent CT and/or MRI were identified. Imaging abnormalities were found in 41/96 patients who underwent MRI with overall diagnostic yield of 42.7% and 69 of 188 patients who underwent CT with overall diagnostic yield of 36.7%. For patients who underwent both imaging modalities (n = 65), there was no statistically significant difference in positive findings detected by CT vs MRI (p > 0.05). CONCLUSIONS: Both CT and MR imaging have similar overall diagnostic yield when used to evaluate children with USNHL. Parents and patients should be counseled regarding cost, test duration, radiation exposure, need for sedation, and diagnostic accuracy associated with each imaging modality and these factors should be considered to select the appropriate diagnostic study.