A Comparison of Pediatric- and Adult-Onset Aquaporin-4 Immunoglobulin G-Positive Neuromyelitis Optica Spectrum Disorder: A Review of Clinical and Radiographic Characteristics.

BACKGROUND: The identification of immunoglobulin G antibodies against the aquaporin-4 channel (AQP-IgG) in the majority of adult patients differentiates neuromyelitis optica as a distinct disease entity. The high specificity of AQP4-IgG for neuromyelitis optica has allowed the identification of seropositive patients with atypical presentations of this disease. Neuromyelitis optica spectrum disorder has been increasingly recognized in children who demonstrate patterns of clinical involvement beyond the traditional boundaries of the optic pathways and spinal cord. METHODS: This is a single-center, retrospective review comparing demographic, clinical/paraclinical, and laboratory features of children and adults with a serologically confirmed diagnosis of AQP4-IgG-positive neuromyelitis optica spectrum disorder. RESULTS: Of 151 reviewed patient charts, 12 pediatric-onset and 31 adult-onset patients had AQP4-IgG-positive neuromyelitis optica spectrum disorder. The mean age of pediatric-onset neuromyelitis optica spectrum disorder was 12 ± 3.58 years with a female predilection (3:1). Pediatric patients showed more frequent involvement of the brainstem (6/12 [50%]); P = .008) and diencephalon (3/12 [25%]; P = .018). A preceding infection was identifiable in only 3 of 12 (25%) pediatric-onset patients. Moreover, disability as calculated on the expanded disability status scale was less severe in pediatric-onset cases compared to adult-onset cases in their most recent assessment (0 [0-9]) vs 6.5 [0-10]; P = .005). Pediatric-onset patients were also more likely to respond to treatment of acute episodes with corticosteroids ± intravenous immunoglobulin and/or plasmapheresis (Clinical Global Impression-Change scale: 2.5 [1-4] vs 4 [1-6], P = .009). INTERPRETATION: This retrospective study was able to compare and contrast pediatric- and adult-onset neuromyelitis optica spectrum disorder. Relative to their adult counterparts, pediatric-onset neuromyelitis optica spectrum disorder patients were more likely to respond to treatment and less likely to be disabled from their disease at follow-up. Therefore, pediatric-onset disease may represent a less virulent form of neuromyelitis optica spectrum disorder.

Polarization and angular insensitive bendable metamaterial absorber for UV to NIR range.

Broadband absorbers are required for solar energy harvesting because they efficiently absorb the incident photon in the wide-ranging solar spectrum. To ensure high absorption of photons, metamaterial absorbers (MMAs) have been a growing area of interest in recent years. In this article, an MMA is proposed using a metal-insulator-metal (MIM) structure (Ni-SiO2-Ni) that shows a near-unity broadband absorption of wavelengths from 300 to 1600 nm, with a 95.77% average absorption and a peak absorption of 99.999% at 772.82 nm. The MMA is polarization insensitive as well as wide incident angle stable. Analysis of the effects of mechanical bending on the absorption of the proposed structure shows that absorption holds satisfactory values at different degrees of mechanical loading. The suggested MMA unit cell structure was computationally simulated using the Finite Integration Technique (FIT) and verified using the Finite Element Method (FEM). To analyze the feasibility of the proposed MMA as a solar cell, it is investigated with the universal AM 1.5 solar spectrum characteristics. Besides solar energy harvesting, the proposed MMA unit cell may be employed in a variety of diverse optical applications, including sensors, detectors, and imaging.

Vitamins are Indeed Vital Amines: A Discussion of 3 Deficiencies With Neurologic Manifestations.

Optimal functioning of the human nervous system depends on a constant supply of nutrients, vitamins, and minerals. In the developed world, nutritional deficiencies are relatively rare and infrequently present with neurologic manifestations. These neurologic disorders can be mistaken for inflammatory and/or autoimmune phenomena. This manuscript describes 2 pediatric cases with neurologic signs/symptoms arising from vitamin deficiencies-(1) optic neuropathy and (2) Wernicke encephalopathy associated with a Guillain-Barre-like pattern of weakness. The 2 cases and the subsequent discussion of vitamin A, B1, and B12 deficiencies underscore the value of taking a thorough dietary history and emphasize risk factors for these 3 nutritional deficiencies.

An Unusual Visit from an Old Foe: Oral Presentation of Syphilis in a Teenage Patient.

The authors report an atypical case of secondary syphilis in an adolescent female presenting to a tertiary-care center with fever, weight loss, oral sores, painful inguinal lymphadenopathy, and transient macular rash. Given the lower prevalence of syphilis in adolescent females, this infection was not included on the initial differential diagnosis. The evolving presentation of syphilis over time complicates the diagnosis and management of these infections, as it did for the patient in this report. The authors provide a detailed discussion of the patient's clinical findings, including the protean features of syphilis infection. This case is particularly relevant to the fields of general pediatrics and pediatric hospital medicine.

Are There Racial Disparities in Family-Reported Experiences of Care in Inpatient Pediatrics?

Despite increased emphasis on patient satisfaction as a quality measure in health care, little is known about the influence of race in parent-reported experience of care in pediatrics. This study evaluates the association of race with patient satisfaction scores in an inpatient pediatric tertiary care hospital in one year. Risk-adjusted multivariable logistic regression was performed to evaluate the association of minority race with the likelihood to provide a top-box (=5) satisfaction score for 38 individual questions across 8 domains. Of the 904 participants, 269 (29.8%) identified as belonging to a minority race. Parents of minority children reported 30% to 50% lower satisfaction across questions related to well-established themes of interpersonal communication and cultural competency. Overall, minorities also reported lower satisfaction for the domain of nursing care (odds ratio 0.7, P = .016). These findings suggest a need for training and interventions to improve communication and mitigate disparities in how minority patients and their families perceive pediatric care.