A Retrospective Review of Patient-reported Outcomes after Postaxial Polydactyly Ligation and Surgical Excision.

Background: Interventions for type B postaxial polydactyly include suture ligation and surgical excision, yet there is a paucity of literature comparing the outcomes of these procedures. This study sought to compare patient-reported long-term outcomes of postaxial digit excision. Methods: A six-question survey was distributed from January 2021 to March 2022 to patients who underwent treatment for type B postaxial polydactyly at a single pediatric institution from 2010 to 2016. Patients were queried about the incidence of pain sensitivity, keloid healing, and/or persistent presence of bump ("nubbin") at the treatment site. Results: A total of 158 responses accounting for 258 digits were attained for a 53% response rate. The majority of digits (67.4%, n = 174) were surgically excised. Median age at procedure was 49 days: 13.0 days for ligation, 63.0 days for surgical excision. Median age at survey was 8 [IQR 5.4-10.2] years. Short-term (<30 days after procedure) complications rate was 1.6%. The rate of a raised or sensitive scar was 39.5% (ligation 51.5% versus surgery 35.4%, P < 0.05). The likelihood of postoperative sensitivity (P = 0.80) was similar among groups. However, the odds of a residual bump or raised scar at the surgical site was significantly higher in the ligation group (P = 0.001). These findings remained significant in the adjusted analysis. Conclusion: This study suggests that suture ligation can be used in select cases without increasing the prevalence of long-term pain or sensitivity, albeit with greater risk of a bump or raised scar at the excision site compared with surgical excision.

Kawasaki Disease in the Time of COVID-19 and MIS-C: The International Kawasaki Disease Registry.

BACKGROUND: Patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) have overlapping clinical features. We compared demographics, clinical presentation, management, and outcomes of patients according to evidence of previous SARS-CoV-2 infection. METHODS: The International Kawasaki Disease Registry (IKDR) enrolled KD and MIS-C patients from sites in North, Central, and South America, Europe, Asia, and the Middle East. Evidence of previous infection was defined as: Positive (household contact or positive polymerase chain reaction [PCR]/serology), Possible (suggestive clinical features of MIS-C and/or KD with negative PCR or serology but not both), Negative (negative PCR and serology and no known exposure), and Unknown (incomplete testing and no known exposure). RESULTS: Of 2345 enrolled patients SARS-CoV-2 status was Positive for 1541 (66%) patients, Possible for 89 (4%), Negative for 404 (17%) and Unknown for 311 (13%). Clinical outcomes varied significantly among the groups, with more patients in the Positive/Possible groups presenting with shock, having admission to intensive care, receiving inotropic support, and having longer hospital stays. Regarding cardiac abnormalities, patients in the Positive/Possible groups had a higher prevalence of left ventricular dysfunction, and patients in the Negative and Unknown groups had more severe coronary artery abnormalities. CONCLUSIONS: There appears to be a spectrum of clinical features from MIS-C to KD with a great deal of heterogeneity, and one primary differentiating factor is evidence for previous acute SARS-CoV-2 infection/exposure. SARS-CoV-2 Positive/Possible patients had more severe presentations and required more intensive management, with a greater likelihood of ventricular dysfunction but less severe coronary artery adverse outcomes, in keeping with MIS-C.

Disparities in colorectal cancer screening among breast and prostate cancer survivors.

BACKGROUND: Colorectal cancer (CRC) screening is recommended as an integral part of cancer survivorship care. We compared the rates of CRC screening among breast and prostate cancer survivors by primary cancer type, patient, and geographic characteristics in a community-based health-care system with a mix of large and small metro urban areas. MATERIALS AND METHODS: Data for this retrospective study were abstracted from medical records of a multi-specialty practice serving about 250,000 individuals in southern Maryland. Breast (N = 1056) and prostate (N = 891) cancer patients diagnosed prior to 2015 were followed up till June 2018. Screening colonoscopy within the last 10 years was considered to be guideline concordant. Multivariate logistic regression was used to determine the prevalence odds ratios of being concordant on CRC screening by age, gender, race, metro area type, obesity, diabetes, and hypertension. RESULTS: Overall 51% of survivors had undergone a screening colonoscopy. However, there was a difference in CRC screening rate between prostate (54%) and breast (44%) cancer survivors. Older age (≥65 years), being a breast cancer survivor compared to prostate cancer, and living in a large compared to small metropolitan area were associated with a lower probability of receiving CRC screening. Having hypertension was associated with higher likelihood of being current on colonoscopy screening guidelines among survivors; but diabetes and obesity were not associated with CRC screening. CONCLUSIONS: Low levels of CRC screening utilization were found among breast and prostate cancer survivors in a single center in Southern Maryland. Gender, comorbidities, and residential factors were associated with receipt of CRC screening.