A 6-month-old Female with Fever and Increased Head Circumference.

Brain abscesses, while a fairly rare occurrence in the pediatric population, can be associated with significant morbidity and mortality. Staphylococcus aureus is a rare cause of intracranial abscess that is generally seen in pediatric patients who have had traumatic injury or neurosurgical intervention. We present the case of a 6-month-old patient who was found to have a large brain abscess secondary to methicillin-sensitive Staphylococcus aureus (MSSA), despite no clear precipitating factors. She underwent percutaneous drainage and IV antibiotic treatment with gradual recovery but as-of-yet undetermined developmental sequelae.

Long-term pharmacotherapy for elevated low density lipoprotein levels in children: A retrospective analysis.

BACKGROUND: There is limited research detailing low-density lipoprotein cholesterol (LDL-C) trends over the long term in children on various lipid-lowering medications. OBJECTIVES: This study sought to assess factors associated with stability of LDL-C levels in children on long-term pharmacotherapy and their ability to reach the LDL-C goal of ≤130 mg/dL while on pharmacotherapy. METHODS: Medical records of children seen in a university pediatric cholesterol clinic between 1998 and 2012 treated with a statin, ezetimibe, or both were reviewed. Aggregate data were obtained to determine the number of children able to reach an LDL-C level of ≤130 mg/dL while on pharmacotherapy. Kaplan-Meier curve and proportional hazard regression analysis were used to examine the propensity for LDL-C levels to stabilize over time while on pharmacotherapy as well as factors affecting this propensity. RESULTS: Overall, 76 patients who contributed 864 total visits were included. Of the 76 patients, 56 developed a stable LDL-C with median time to stability of 28 months on pharmacotherapy. Younger age at first visit and higher medication potencies/doses were associated with an increased propensity to stabilize. Only 36 patients were able to reach an LDL-C of ≤130 mg/dL, with only 11 of 38 patients with probable familial hypercholesterolemia reaching this goal. CONCLUSIONS: Most children reached LDL-C stability on pharmacotherapy after a median 28-month interval. However, most children had difficulty in reaching the LDL-C goal of ≤130 mg/dL even with aggressive medication titration. This was specifically true for those with probable familial hypercholesterolemia.

In vitro effects of pentosan polysulfate against malignant breast cells.

BACKGROUND: Pentosan polysulfate (Elmiron); (Alza Pharmaceuticals, Mountain View, CA) is the only Food and Drug Administration-approved oral therapy for interstitial cystitis (IC). Women with IC and breast cancer are often in the same age range; therefore, we hypothesize that pentosan polysulfate may also have a therapeutic effect on breast cancer cells in vitro. METHODS: Breast cancer lines MCF-7, ZR75-1, and HTB26 were treated with pentosan polysulfate at various concentrations. Cell viability was measured at 24 hours by MTT. Annexin V assay was used to determine the effect of pentosan polysulfate on apoptotic and necrotic activity. RESULTS: Pentosan polysulfate significantly inhibited the growth of the ZR75-1 cells; however, significant cellular proliferation was observed in the MCF-7 cells. A significant change in late apoptotic activity was observed with pentosan polysulfate treatment in vitro. CONCLUSIONS: Caution should be used in prescribing pentosan polysulfate for the treatment of IC in patients who are both in high-risk groups for breast cancer and premenopausal females.

Identifying multiple risks of low birth weight using person-centered modeling.

OBJECTIVES: Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome. METHODS: Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820). Ten risks were examined including marital status, stress, mother's age, parity status, reported smoking and drug use during pregnancy, delayed prenatal care, Medicaid coverage, uninsurance, and low education. RESULTS: Six latent classes were identified that ranged from a low-risk referent group to higher risk classes characterized by unique constellations of risk factors. Compared with the low-risk referent, all of the remaining five latent classes were significantly associated with increased odds of low birth weight. However, one class was at especially high risk; this class was characterized by unmarried women in the Medicaid program who reported drug use, smoking, stress, and late prenatal care (odds ratio, 4.78; 95% confidence interval, 4.07-5.61). CONCLUSIONS: The person-centered approach identified subgroups of women with unique risk profiles. The results suggest that eliminating a single risk would not resolve the low birth weight problem. Smoking, for example, co-occurs with higher stress and higher levels of drug use among a Medicaid population. It may be beneficial to develop and test tailored interventions to groups with specific co-occurring risks to reduce low birth weight outcomes. Programs targeted to women in the Medicaid program who also engage in substance use and experience stress are especially indicated.