Can magnetic resonance imaging replace computed tomography scans in the evaluation of pediatric post-appendectomy abscess?

BACKGROUND: Computed tomography scans have been used when cross-axial imaging is required to evaluate pediatric post-appendectomy abscesses. To reduce a source of radiation exposure, our institution converted to using contrast-enhanced magnetic resonance imaging to replace computed tomography scans in this clinical context. Our aim is to evaluate the performance of magnetic resonance imaging compared to computed tomography scans and associated clinical outcomes in this patient population. METHODS: A contrast-enhanced comprehensive magnetic resonance imaging protocol was implemented to evaluate a post-appendectomy abscess in 2018. A retrospective chart review was performed from 2015 to 2022 for pediatric patients (<18 years old) with prior appendectomy and subsequent cross-sectional imaging to evaluate for an intraabdominal abscess. Patient characteristics and clinical parameters between the 2 modalities were abstracted and compared using standard univariate statistics. RESULTS: There were a total of 72 post-appendectomy patients who received cross-axial imaging, which included 43 computed tomography scans and 29 magnetic resonance imaging during the study interval. Patient demographics were comparable between cohorts and rates of perforated appendicitis at the index operation (computed tomography: 79.1% vs magnetic resonance imaging: 86.2%). Missed abscess rate, abscess size, management technique, drainage culture results, readmission, and reoperation were similar between imaging modalities. Median request to scan time was longer for magnetic resonance imaging than computed tomography (191.5 vs 108 minutes, P = .04). The median duration of a comprehensive magnetic resonance imaging scan was 32 minutes (interquartile range 28-50.5 minutes). CONCLUSION: Contrast-enhanced magnetic resonance imaging provides an alternative cross-sectional imaging modality to computed tomography scans to evaluate pediatric post-appendectomy abscesses.

Trends in Positive, Negative, and Neutral Themes of Popular Music From 1998 to 2018: Observational Study.

BACKGROUND: Across the United States, the incidence of adolescent depression and suicide cases has risen in the past 10 years. Despite the risk factors and causes being multifactorial, the influence of popular culture on society and adolescents in this media-driven generation cannot be mitigated. Although the impact of social media and its effect on shaping self-identity in adolescents have been observed, the impact of music and its potential for subliminal negative messages to adolescents remains unclear. OBJECTIVE: This study analyzes the lyrics and music videos of the most popular music of multiple genres to quantify the frequencies of varying music theme trends. METHODS: The frequencies of themes of 1052 total American and Latin songs were collected from the Nielsen Music and Billboard's top 100 chart performance from 1998 to 2018 for hip hop/rhythm and blues (R&B), pop, Latin, country, and rock/metal genres. Themes from songs were identified, quantified, and categorized with a rubric into negative, neutral, and positive themes by 3 different reviewers. Analysis was performed using 2-tailed t tests and a generalized linear model. RESULTS: Popular songs were reviewed for positive, negative, and neutral themes in the following 3-year intervals for ease of analysis purposes: 1998 to 2000 (n=148), 2001 to 2003 (n=150), 2004 to 2006 (n=148), 2007 to 2009 (n=156), 2010 to 2012 (n= 150), 2013 to 2015 (n=150), and 2016 to 2018 (n=150). There was a significant 180% increase in the percentage of songs with negative themes between all the interval years and across all genres (P<.001), while there was no significant difference in the frequency of songs with positive (P=.54) or neutral (P=.26) themes by year. There were significant differences in the number of negative themes found across genres (P<.001), with hip hop/R&B having the highest frequency of 130 out of 208 (62.5%) of the negative themes when compared to each of the individual genres (P<.001). CONCLUSIONS: This study shows there is an increase in the frequency of negative themes over the span of 20 years across all genres, with hip hop/R&B having the highest frequency among the genres. These findings point to the potential impact that music may have in popular culture and on society. Furthermore, these results can help shape discussions between caregivers and their adolescent dependents and between primary care providers and their adolescent patients.

Evaluating for Racial Differences in Pain Management of Long-Bone Fractures in a Pediatric Rural Population.

OBJECTIVES: The aim of this study was to determine if a racial disparity exists in the administration of an analgesic, time to receiving analgesic, and type of analgesic administered to children with long-bone fractures. Prior studies have reported the existence of racial disparity but were mostly in adult and urban populations. METHODS: This is a retrospective chart review of 727 pediatric patients (aged 2-17 years) with International Classification of Diseases, Ninth Revision (or 10th revision) codes for long-one fractures in an emergency department that cares for a suburban and rural population between January 2013 and January 2016. Logistic regression was used to estimate the odds ratio of receiving no analgesic versus receiving an analgesic and receiving a nonopioid versus opioid drug. Linear regression analysis was performed to study the relationship between race and time to receive the analgesic, after adjusting for sex, age, insurance type, and mechanism of injury. RESULTS: Of the 727 children, 27% of them did not receive analgesics regardless of race. 27% (164/605) of white children, 25% (8/31) of African American children, and 24% (12/49) of Hispanic children did not receive analgesics. African Americans are 12% more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.48-2.61) to receive an analgesic compared with whites, and Hispanics are 22% more likely (OR, 1.22; 95% CI, 0.60-2.45) to receive an analgesic than whites. African Americans are 26% less likely (OR, 0.74; 95% CI, 0.31-1.75) to receive an opioid versus a nonopioid compared with whites, and Hispanics are 92% more likely (OR, 1.92; 95% CI, 0.91-4.17). Mean wait time across all races was 69 minutes, with no statistical difference between groups. CONCLUSIONS: This study showed no statistical significance in the receipt or type of analgesic or wait time for pediatric long-bone fractures between race in a major academic level 1 trauma children's hospital, despite previous literature citing otherwise. This study augments to the few studies conducted in a rural setting. It is also one of the few studies that analyzed pain management in a large pediatric population as well as used waiting time to receive analgesic as an outcome measure. Overall, we found a mean wait time of 69 minutes for analgesic administration regardless of race, suggesting the need for more prompt pain management across all races for the management of long-bone fracture in the pediatric population.

Positive and Negative Themes in Popular Video Games Based on Entertainment Software Review Board Ratings.

Video games have become a major part of a child's recreational time. The objective of this study was to determine whether or not the number of positive and negative themes in video games differ based on their Entertainment Software Review Board rating. Thirty of the most popular games in 2016 were reviewed and scored based on a rubric made a priori. Mature, Teen, and Everyone rated games did not show significant difference in the frequency of positive themes (3.7, 3.1, 3.2, respectively; P = .425). Mature and Teen games did not show significant difference in the frequency of negative themes (5.0, 4.0, respectively; P = .414), whereas Everyone games did have a significantly less number of negative themes than the Mature games (1.9, 5.0, respectively; P = <.001). Based on these data, parents should consider being more conscientious in buying games that are rated as T for Teen.

Rat Bite Fever: A Case Report and Review of the Literature.

Cases of rat-bite fever (RBF) were reported in the literature for more than 2000 years. Not until recently, however, were attempts made to differentiate between RBF and Streptobacillus moniliformis septic arthritis, 2 arguably different clinical entities. There are limited data regarding S moniliformis septic arthritis and the features that distinguish it from RBF, and most conclude that although clinically disparate diseases, it is difficult to differentiate between them. We report a case of a 17-year-old girl who presented with S moniliformis bacteremia and symptoms that spanned both RBF and S moniliformis septic arthritis. This case emphasizes the difficulty in differentiating the 2 clinical entities and the importance of early diagnosis, proper clinical suspicion, and prompt treatment to achieve positive outcomes.

Comparison of two approaches to observation therapy for acute otitis media in the emergency department.

OBJECTIVE: This study compared parental adherence to delayed antibiotic therapy for acute otitis media with and without a written prescription in a pediatric emergency department. PATIENTS AND METHODS: Children aged 2 to 12 years who met criteria for delayed antibiotic treatment were randomly assigned to observation therapy with or without a prescription. Patients randomly assigned to observation therapy without prescription were instructed to seek follow-up care if symptoms persisted for 2 to 3 days. Patients assigned to observation therapy with a prescription were discharged with an antibiotic prescription, and instructed to fill it if their child's symptoms persisted 2 to 3 days. A research assistant who was blinded to group assignment called parents 7 to 10 days after the visit to assess adherence to observation therapy. RESULTS: Of 117 children assigned to the observation therapy group, 100 completed follow-up; of 115 assigned to the observation therapy with a prescription group, 106 completed follow-up. In the observation therapy group, 87 parents reported no antibiotic use within the 3-day observation period compared with 66 parents in the prescription group. During the entire study period, 81% of the observation therapy group reported no use of antibiotics compared with 53% in the prescription group. These groups did not differ in satisfaction with the visit; 91% and 95% were very or extremely satisfied, respectively. No complications were reported. CONCLUSIONS: Observation therapy with and without a prescription were both well accepted by parents of children diagnosed with acute otitis media in an urban pediatric emergency department. Adherence to delayed antibiotic therapy was better for those not offered a prescription. These data suggest that, in the pediatric emergency department setting, observation therapy reduces antibiotic use without compromising satisfaction with the visit.

A post-marketing surveillance study of risperidone as adjunctive therapy to mood stabilizers in the treatment of manic phase bipolar I disorder

Objectives: The purpose of this study was to assess symptom improvement with, and safety (measured as tolerability) of, risperidone as adjunctive therapy to mood stabilizers in the treatment of bipolar I disorder, manic phase. Methods: Eight hundred sixty seven Filipino patients, recruited from 46 centers across the Philippines and diagnosed according to DSM-IV criteria as having bipolar disorder, current phase manic, completed an 8-week open trial of risperidone as add-on therapy to mood stabilizers. Doses of risperidone were started at 0.5 - 2 mg per day for the first 2 days, and escalated or reduced based on clinical judgment on succeeding days. Treatment was evaluated 1, 2, 4 and 8 weeks after baseline assessment. The Young Mania Rating Scale (YMRS), Hamilton Depression Scale (HAM-D), Clinical Global Impression Scale for Severity (CGI-S) and Clinical Global Impression Scale for Improvement (CGI-I) were used to measure symptom reduction with risperidone use, while the Extrapyramidal Symptoms Rating Scale and incidence of adverse events were employed to determine drug safety. Results: Results showed significant reduction in manic and depressive symptoms throughout the study as measured by statistically significant decreases in mean YMRS and HAM-D scores. CGI scores likewise showed significant improvement from baseline to study end with an increasing percentage of patients who showed steady improvement throughout the trial. There was a low incidence of extrapyramidal symptoms (EPS), majority of which were mild. Only 2 other non-EPS adverse events occurred in the study. Conclusion: This study demonstrated reductions in manic and depressive symptoms with risperidone use and showed that risperidone was safe as adjunct therapy to mood stabilizers for the treatment of manic phase bipolar disorder.

Comparison between primary care evaluation of mental disorders patient questionnaire and the self-reporting questionnaire as screening tools for psychiatric disorders at the UP-PGH Pain Clinic

OBJECTIVE: To compare the validities of two instruments- the Primary Care Evaluation of Mental Disorders Patient Questionnaire (PRIME-MD PQ) and the Self-Reporting Questionnaire (SRQ)- in terms of discriminating between patients with and without psychiatric disorders seen at the UP-PGH Pain Clinic. DESIGN: Cross-sectional, criterion standard SETTING: Pain Clinic at the Department of Outpatient Services SUBJECTS: A total of 102 adult patients assessed by three pain fellow physicians MAIN OUTCOME MEASURES: Positive or negative results for mental disorders using PRIME-MD PQ and SRQ as screening procedure plotted against psychiatric interview whether positive or negative using a two-by-two contingency table RESULTS: There was good agreement between PRIME-MD PQ and psychiatric interview (k=0.67) whereas poor correlation between SRQ and psychiatric interview (k=0.51). However, with the removal of one item eliciting grandiosity from the "psychotic" items, agreement with the SRQ rose to k=0.76 when all items on psychosis are eliminated (shorter version of SRQ), agreement was almost excellent (k=0.79). CONCLUSION: The modified version of SRQ is slightly superior to the PRIME-MD PQ in discriminating between patients with and without psychiatric disorders at the Pain Clinic.

Stomach cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries - the Philippine Cancer Society - Manila Cancer Registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and received continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period 1988-1992 the combined age-standardized incidence rate (ASR) was 9.9 per 100,000 for male stomach cancer (ranked fifth, 4.5% of all male cancers), and 5.9 per 100,000 among females (ranked ninth, 2.8% of all female cancers). Stomach cancer among Philippine residents had lower ASRs and age-specific rates compared to Japanese, Korean, Chinese, Singaporean Chinese and Vietnamese populations. Age-specific rates among Filipinos reached 10 per 100,000 or higher at age-group 50-54 years among males, and 55-59 years among females. Significant differences in incidence were observed in only few cities and municipalities. There were little differences in ASRs between 2 populations during 3 time periods between 1980-1992, in both males and females with an indication of a slight decrease. Incidence of male Philippine migrants to Hawaii, San Francisco and Los Angeles were comparable to those of white residents covered by the Manila registry. Among females, stomach cancer incidence of Philippine residents and Filipina migrants to Hawaii were similar, and were slightly higher than those of white residents in Hawaii and both migrants and white residents in San Francisco and Los Angeles

Pancreas cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries-the Philippine Cancer Society-Manila Cancer Registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period 1988-1992 the combined age-standardized incidence rates (ASR) of pancreas cancer in males was 4.2 per 100,000 (ranked eleventh) and 3.2 per 100,000 in females (ranked fourteenth). Pancreas cancer rates for both sexes were lower than those observed among North America and European populations. Within region, Philippine rates were lower than Japanese, Korean, Chinese and Singaporean Chinese, but were higher than Vietnamese and Thai populations. Among males, the increase in age-specific rates were highest among those 55 years and older, and at age-group 65 years and older among females. There were significant differences in rates between some cities and municipalities, with the rates in some highly urbanized cities two to three times those seen in rural areas. Average annual rates among males and females had hardly changed in the 13-year period between 1980-1992 but total cases had tripled. ASRs of Filipino male migrants of the U.S.A were similar to that observed among Filipinos residing in the Philippines. Female migrants to San Francisco and Los Angeles had higher rates than Philippine residents

Prostate cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries-the Philippine Cancer Society-Manila Cancer registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period of 1988-1992 the combined age-standardized incidence rate (ASR) was 17.0, prostate cancer ranked third and comprised 6.1 per cent of all male cancers. Prostate cancer rates were lower than those observed among North American and European populations, but within the Asian region, Philippine rates were higher than most Asian populations. Age-specific rates increased considerably at age-group 66-59 years and continued to increase with increasing age. There were significant differences in rates between cities and municipalities, with the rates in some highly urbanized cities double those seen in urbanizing areas, and triple those seen in rural areas. Rates had increased slightly in the 13-year period between 1980-1992 but total cases had triples. Incidence rates among Filipino migrants to Hawaii, San Francisco and Los Angeles were almost 3 times higher than rates seen in Philippines residents, but were still only half of those seen among the white populations.

Nasopharynx cancer incidence in Metro Manila and Rizal provinces: 1980-1992

Incidence was derived from published data from 2 population-based registries-the Philippine Cancer Society-Manila Cancer Registry and Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Covil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period of 1988-1992 the combined age-standardized incidence rates (ASR) were: 6.8 for male nasopharynx cancer (NPC) (ranked sixth) and 3.2 among females (ranked thirteenth). NPC for both sexes were highest among Asian populations. Within the region, Philippine rates were third highest, following the Singapore Chinese and Vietnamese. Age-specific rates in males reached 10 per 100,000 at age-group 40-49 years, and 5 per 100,000 females at age-group 45-49 years, continuing to rise with increasing age. There were some significant differences in ASRs between some cities and municipalities but the differences were more striking among males as female rates were lower. Rates had increased only very slightly in the 13-year period between 1980-1992 but total cases had triples. NPC ASRs among male Filipino migrants to the USA were only half of that observed in Philippine residents, but were still higher than the rates among White residents. A similar decrease was seen among female migrants, and in Los Angeles the rates of Filipinos and non-Hispanic White females were already similar

Liver cancer incidence in Metro Manila and Rizal province: 1980-1992

Incidence was derived from published data from 2 population-based registries-the Philippine Cancer Society-Manila Cancer Registry and the Department of Health-Rizal Cancer Registry, which covered 8.5 million residents (1990 census) of a 1,674 square kilometer area that comprises Metro Manila and Rizal province. Thirteen registry clerks actively sought new cancer cases in 96 hospitals and 30 Civil Registry offices. Both registries are members of the International Association of Cancer Registries and receive continuing professional assistance from the International Agency for Research on Cancer (IARC). For the period 1988-1992 the combined age-standardized incidence rates (ASR) were 21.2 for male liver cancer (ranked second), and 7.3 in females (ranked seventh). Liver cancer rates for both sexes were higher than those observed among North American and European populations. Within the region, high rates were observed in both males and females in Thailand, Japan, China, Korea, Philippines, Singapore and Viet Nam. The rate begins to rise steeply at age-group 40-44 years among males and females. There were significant differences in rates between some cities and municipalities, with the rates in some areas double those seen in low incidence areas. Rates observed among Filipino migrants to the USA had decreased by around half of those seen among Philippine residents