Nonurgent Visits to the Pediatric Emergency Department before and during the First Peak of the COVID-19 Pandemic.

BACKGROUND: Nonurgent visits in pediatric Emergency Departments are a growing burden. In order to find predictors for those nonurgent visits, we performed a retrospective analysis of unscheduled visits at the Pediatric Emergency Department of the University Hospital of Bonn, Germany, in the year 2017. Additionally, we compared these findings to unscheduled visits during the first peak of the worldwide pandemic of the Coronavirus disease 2019, to see if there would be an effect on nonurgent pediatric Emergency Department attendances. METHODS: For our retrospective cohort study, we analyzed more than 5.000 visits at the pediatric Emergency Department of the University Hospital of Bonn, Germany, before and during the first peak of the ongoing worldwide pandemic of the Coronavirus disease 2019, particularly with regard to their urgency. Data included gender, age, zip code, urgency, and preexisting conditions. RESULTS: Our study shows that more than half of unscheduled pediatric Emergency Department visits (69%) at the University Hospital in Bonn are for nonurgent reasons, with short living distance being a factor to present children to a pediatric Emergency Department, even with minor complaints. During the first peak of the pandemic of the Coronavirus disease 2019, nonurgent visits decreased significantly, potentially due to hesitation to attend a pediatric Emergency Department with minor issues, fearing an infection with SARS-CoV-2 at the hospital. CONCLUSION: Many people use pediatric Emergency Departments for nonemergency complaints. In order to address the reasons for nonurgent visits to pediatric Emergency Departments and to prevent parents from doing so, further studies and targeted education concepts for parents are needed.

Aseptic Meningitis, Mucocutaneous Lesions and Arthritis after COVID-19 Vaccination in a 15-Year-Old Boy.

We report a 15-year-old boy who developed aseptic meningitis 10 days after administration of the second dose of the COVID-19 vaccine BNT162b2. Although accompanying aphthous mouth ulcers resembling herpetic stomatitis initially led us to suspect an underlying viral infection, broad virological and microbiological screening did not identify any causative pathogen. Gonarthritis and skin lesions, which both developed within three days after admission, extended the clinical presentation eventually resembling an acute Behçet's disease episode. This is the first description of a juvenile patient with aseptic and pathogen-negative meningitis occurring in close temporal association with vaccination against COVID-19, along with a few previously reported adult patients with isolated meningitis and a further case with meningitis and an accompanying Behçet's disease-like multisystem inflammation episode as seen in our patient. With billions of individuals being vaccinated worldwide so far and only a few cases of aseptic pathogen-negative meningitis reported in close temporal relation, causality is unclear. However, aseptic meningitis should be kept in mind in the differential diagnosis of patients with persistent or delayed onset of headache and fever following COVID-19 vaccination.

Ethnopharmacological exploration of medicinal mushroom from Pakistan.

BACKGROUND: The chief aim of this study was to enlist the ethnopharmacological aspect of mushrooms from four Provinces of Pakistan. Due to the seasonal variation and extreme geographical conditions, Pakistan has great mushroom diversity. Mushrooms have been used by the indigenous people for the treatment of different ailments in many regions of Pakistan. They still depend on the mushrooms for treatment of various ailments. Moreover, mushrooms are used as first aid to treat cold, cough, influenza, asthma, cancer, gastric and hepatic disorders. Traditional uses of medicinal mushrooms lead to the discovery of alternative source of synthetic medicines. This is basically the first quantitative ethnopharmcological documentation of medicinal mushrooms from Pakistan. MATERIALS AND METHOD: Ethnopharmacological information was collected from the 950 informants including male and female. The informative data was based on semi-structured interviews, group discussions, and field visits. Data was analyzed by applying different quantitative indices such as informant consent factor (ICF), Use value (UV), Relative Frequency of Citation (RFC), the Fidelity level (FL) and Jaccard Index (JI). RESULT: Almost 50 mushrooms belonging to 24 families were reported. Most-frequently cited families were Agaricaceae (13 species) and Morchellaceae (5 species). Extract was the common mode of preparation reported (63.33%), followed by Powder (36.67%). Mostly these medicinal mushrooms were present as wild (62.90%), followed by cultivated (37.10%). Among all 11.75% mushrooms were toxic and inedible, 75% were nontoxic, whereas the remaining 13.46% may be toxic or nontoxic because of their dual attitude. New medicinal uses of 23 mushrooms were explored in this study. CONCLUSION: This ethnopharmacological documentation revealed that the mushrooms are still used by natives of rural area in their day-to-day lives. This study provides the basis for the conservation of mushrooms. Mushrooms with high ICF, UV and FL were further used for phytochemical and pharmacological studies. This documentation is baseline information which can be used to develop new mushroom-based medicines.

Targeted Gene Panel Sequencing for Early-onset Inflammatory Bowel Disease and Chronic Diarrhea.

BACKGROUND: In contrast to adult-onset inflammatory bowel disease (IBD), where many genetic loci have been shown to be involved in complex disease etiology, early-onset IBD (eoIBD) and associated syndromes can sometimes present as monogenic conditions. As a result, the clinical phenotype and ideal disease management in these patients often differ from those in adult-onset IBD. However, due to high costs and the complexity of data analysis, high-throughput screening for genetic causes has not yet become a standard part of the diagnostic work-up of eoIBD patients. METHODS: We selected 28 genes of interest associated with monogenic IBD and performed targeted panel sequencing in 71 patients diagnosed with eoIBD or early-onset chronic diarrhea to detect causative variants. We compared these results to whole-exome sequencing (WES) data available for 25 of these patients. RESULTS: Target coverage was significantly higher in the targeted gene panel approach compared with WES, whereas the cost of the panel was considerably lower (approximately 25% of WES). Disease-causing variants affecting protein function were identified in 5 patients (7%), located in genes of the IL10 signaling pathway (3), WAS (1), and DKC1 (1). The functional effects of 8 candidate variants in 5 additional patients (7%) are under further investigation. WES did not identify additional causative mutations in 25 patients. CONCLUSIONS: Targeted gene panel sequencing is a fast and effective screening method for monogenic causes of eoIBD that should be routinely established in national referral centers.

An ethnopharmacological evaluation of Navapind and Shahpur Virkanin district Sheikupura, Pakistan for their herbal medicines.

BACKGROUND: The chief aim of this study was to enlist the ethnobotanical uses of wild plants in district Sheikhupura, province Punjab, Pakistan. Due to extreme geographical and climatic conditions, Pakistan has a great floral diversity. Plants have been used by the indigenous people for treatment of different ailments since long. They are still dependent on the plants for their domestic purposes. Moreover, plants are used as first aid to treat diverse ailments such as cold, cough, influenza, asthma, cancer, antidote, gastric and hepatic disorders. The traditional uses of medicinal plants lead to the discovery of natural drugs. This is first quantitative ethnobotanical documentation of medicinal plants in NavaPind and ShahpurVirkan district Sheikhupura, province Punjab, Pakistan. METHODS: This ethnobotanical information was collected from about 400 informants including male and female. Sample size was determined by statistical formula. The informative data was based on semi-structured interviews, group discussions, Questionnaire and field visits. Then the data was analyzed by applying different quantitative indices such as Informant Consent Factor (ICF), Use value (UV), Relative Frequency of Citation (RFC), the Fidelity level (FL) and Jaccard Index (JI). RESULTS: Almost 96 plants belonging to 34 families were reported. Most-frequently cited families were Poaceae (16 species) and Fabaceae (15 species). The most dominant life form was herbs (30.20%). The most-used plant parts were leaves (31.14%), followed by whole plant (24.59%), Most common mode of administration is extraction (81.25%). Generally herbal medicines were acquired from fresh plant material. Among all 54.16% plants were toxic, 31.25% were nontoxic, whereas the remaining 14.58% may be toxic or nontoxic because of their dual attitude. Almost 34 species were reported with their different medicinal uses as has been reported in literature. CONCLUSIONS: This ethnobotanical documentation revealed that the plants are still used by natives of rural areas in their day-to-day lives. This study provides basis for the conservation of local flora. Plants with high ICF, UV and FL can be further used for phytochemical and pharmacological studies. This documentation could provide baseline information which can be used to develop new plant-based commercial drugs.

Can teledermatology be a useful diagnostic tool in dermatology practice in remote areas? An Egyptian experience with 600 patients.

Introduction The paucity of studies evaluating teledermatology (TD) in developing countries was the impetus behind conducting this work. We aimed to evaluate the feasibility and reliability of TD in remote areas where medical facilities and consultant dermatologists are not available, through measurement of diagnostic concordance rates between face-to-face diagnosis and store-and-forward (SAF) TD diagnosis. Methods A total of 600 patients with dermatological ailments who attended Abshway Hospital were recruited into the study, examined by an on-site dermatology resident, and offered a diagnosis. The clinical images and patients' history were collected and transferred (through the Dropbox application) to two remote consultant dermatologists. The reliability of the three physicians' agreement rates was assessed. Results Diagnostic agreement rates between the face-to-face dermatologist and the two teledermatologists were 86.7% and 87% respectively. Of the cases, 97% had complete or partial agreement and 81.3% of cases showed complete agreement between the three physicians. The reliability of the three physicians' agreement rates was assessed statistically using Cohen's kappa coefficient (κ) and this showed a range of 0.46-0.52. Conclusion This study might aid in enhancing the utilization of this tool in our country, especially in remote areas with a lack of a proper dermatological service. The simplicity and low cost of the adopted technique might facilitate its use over large sectors. It opens the door for gaining the benefit of this technology in other aspects such as teaching and monitoring health care providers.

Assessing the utility of serum C-telopeptide cross-link of type 1 collagen as a predictor of bisphosphonate-related osteonecrosis of the jaw: A systematic review and meta-analysis.

BACKGROUND: The authors of this systematic review and meta-analysis assessed the utility of serum C-telopeptide cross-link of type 1 collagen (sCTX), a biomarker of bone resorption, as a predictor of the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). TYPES OF STUDIES REVIEWED: The authors searched for studies involving adult participants, written in English, and published through January 20, 2016, using the following electronic databases: the Cochrane Library, MEDLINE via PubMed, and Web of Science. They also searched Google Scholar and the reference lists of all eligible trials and reviews. They identified 16 articles that met their inclusion criteria (9 controlled studies and 7 case series). They applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. They independently extracted data in duplicate, including the characteristics of study participants, risk factors, control groups, and outcomes. They assessed risk of bias, and they resolved any disagreements between review authors through discussion. RESULTS: A meta-analysis with 9 controlled studies revealed no significant difference in mean sCTX values between patients with BRONJ and control participants (difference in means, -31.417; 95% confidence interval [CI], -91.560 to 28.726; P = .306). A second meta-analysis with 4 studies showed no significant difference in risk of having an sCTX value below 150 picograms per milliliter for patients with BRONJ compared with control participants (risk ratio, 1.892; 95% CI, 0.636-5.626; P = .251). CONCLUSIONS AND PRACTICAL IMPLICATIONS: A systematic review of the literature with meta-analysis does not support the use of sCTX levels as a predictor of the development of BRONJ. Further prospective large sample studies are needed to understand the role of sCTX as a predictor for BRONJ.

Prenatal diagnosis and postnatal management of meconium peritonitis.

BACKGROUND: Meconium peritonitis (MP) is a rare prenatal condition that leads to substantial neonatal morbidity and mortality. PATIENTS AND METHODS: All patients between 1998 and 2006 referred for prenatal diagnosis were retrospectively analyzed for diagnosis of MP. Prenatal ultrasound findings were compared with postnatal etiology, intraoperative findings, and postnatal outcome of the patients. RESULTS: Antenatal MP was diagnosed in 14 fetuses between 18 and 38 weeks' gestation. The prenatal diagnosis of MP was confirmed by clinical and radiological findings in 8 (62%) of 13 infants born alive. All patients were delivered preterm between 33 and 36 weeks' gestation by cesarean section. Urgent neonatal surgery for treatment of bowel obstruction was required in all eight infants. Prenatal ultrasound diagnosis of bowel dilatation was the only variable found to be associated with the need for subsequent surgical intervention (P=0.02). CONCLUSIONS: Clinical outcome of MP diagnosed antenatally can be either mild or severe form. The underlying cause of severe MP is heterogeneous and neonatal surgery was always required.

Liposomal methotrexate hydrogel for treatment of localized psoriasis: preparation, characterization and laser targeting.

BACKGROUND: Because systemic treatment of psoriasis is associated with several adverse effects, methotrexate (MTX), either topically or as targeted delivery, has become a more-interesting alternative. MATERIAL/METHODS: Methotrexate liposomes (LMTX) were prepared from DPPC, soy PC, egg yolk PC, and cholesterol. We studied the characterization, formulation of hydrogel (MTX 0.25%), and skin permeability, and compared LMTX gel with plain MTX gel and placebo for treating localized psoriasis in a double-blind study using albino mice. Gel formulations were applied daily, followed by irradiation with 80 joules from a 650-nm diode laser 3 times weekly for 12 weeks. Changes in disease signs and histopathological features were assessed. RESULTS: Drug release increased as laser energy increased following Higuchi's diffusion model and changed to zero order with energies > or = 80 J; significantly more MTX was released at all time intervals. Both LMTX and FMTX gels showed zero order kinetic release and antipsoriatic activity. During 8 months' follow-up, up to 60% of the patients treated with LMTX gel had no recurrence; this difference was statistically significant. No clinically significant changes were seen regarding blood or other laboratory variables. CONCLUSIONS: Application of an 80-J diode laser to 0.25% LMTX hydrogel was beneficial for relieving psoriasis and did not exert systemic toxicity.