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Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.
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[This corrects the article DOI: 10.3389/fonc.2022.843741.].
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Background: Patients with inborn errors of immunity (IEI) have increased risk of developing cancers secondary to impaired anti-tumor immunity. Treatment of patients with IEI and cancer is challenging as chemotherapy can exacerbate infectious susceptibility. However, the literature on optimal cancer treatment in the setting of IEI is sparse. Objectives: We present a patient with specific antibody deficiency with normal immunoglobins (SADNI), immune dysregulation (ID), and stage III ovarian carcinoma as an example of the need to modify conventional treatment in the context of malignancy, IEI, and ongoing infections. Methods: This is a retrospective chart review of the patient's clinical manifestations, laboratory evaluation and treatment course. Results: Our patient is a female with SADNI and ID diagnosed with stage III ovarian carcinoma at 60 years of age. Her ID accounted for antinuclear antibody positive (ANA+) mixed connective tissue diseases, polyarthralgia, autoimmune neutropenia, asthma, autoimmune thyroiditis, and Celiac disease. Due to the lack of precedent in the literature, her treatment was modified with continuous input from infectious disease, allergy/immunology and oncology specialist using a multidisciplinary approach.The patient completed debulking surgery and 6 cycles of chemotherapy. The dosing for immunoglobulin replacement therapy was increased for prophylaxis. Chemotherapy doses were lowered for all cycles preemptively for IEI. The therapy included carboplatin, paclitaxel, bevacizumab, and pegfilgrastim. The patient completed six-months of maintenance medication involving bevacizumab.Her treatment course was complicated by Mycobacterium avium-complex (MAC) infection, elevated bilirubin and liver enzymes attributed to excessive immunoglobulin replacement therapy, and urinary tract infection (UTI) and incontinence.Cancer genetic analysis revealed no targetable markers and primary immunodeficiency gene panel of 407 genes by Invitae was unrevealing. Lab tests revealed no evidence of Epstein-Barr Virus (EBV) infection. Post-chemotherapy imaging revealed no evidence of cancer for 1 year and 4 months, but the disease relapsed subsequently. The patient's lung scarring requires vigilance. Conclusions: Our patient with ovarian cancer and IEI required modified treatment and prevention of complications. In cases of IEI, optimal chemotherapy should be titrated to minimize immunosuppression yet treat cancer aggressively while decreasing the risk of infection with prophylactic antibiotics and prolonged post-treatment surveillance, including pulmonary evaluation.
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In the Bay of Fundy, Atlantic sturgeon from endangered and threatened populations in the USA and Canada migrate through Minas Passage to enter and leave Minas Basin. A total of 132 sub-adult and adult Atlantic sturgeon were tagged in Minas Basin during the summers of 2010-2014 using pressure measuring, uniquely coded, acoustic transmitters with a four or eight year life span. The aim of this study was to examine spatial and seasonal distribution of sturgeon in Minas Passage during 2010-2014 and test the hypothesis that, when present, Atlantic sturgeon were evenly distributed from north to south across Minas Passage. This information is important as tidal energy extraction using in-stream, hydrokinetic turbines is planned for only the northern portion of Minas Passage. Electronic tracking data from a total of 740 sturgeon days over four years demonstrated that Atlantic sturgeon used the southern portion of Minas Passage significantly more than the northern portion. Sturgeon moved through Minas Passage at depths mostly between 15 and 45 m (n = 10,116; mean = 31.47 m; SD = 14.88). Sturgeon mean swimming depth was not significantly related to bottom depth and in deeper regions they swam pelagically. Sturgeon predominately migrated inward through Minas Passage during spring, and outward during late summer-autumn. Sturgeon were not observed in Minas Passage during winter 2012-2013 when monitoring receivers were present. This information will enable the estimation of encounters of Atlantic sturgeon with in-stream hydrokinetic turbines.
