Microbiology and Epidemiology of Orbital Cellulitis in Pediatric and Young Adult Patients.

INTRODUCTION: Using data from the large and geographically diverse Military Health System (MHS) beneficiary population, we aimed to characterize and update the epidemiology and microbiology of pediatric orbital cellulitis given previous data are limited to small, single-center studies. MATERIALS AND METHODS: Following institutional review board approval, we performed a retrospective analysis using the Military Health System admissions, microbiology, and pharmacy data between June 2009 and September 2019. Patients less than 22 years of age with radiological confirmation of orbital cellulitis were included. Demographic data, presence of sinusitis, advanced imaging reports, blood and wound culture results with antibiotic susceptibilities, and antibiotic prescriptions were collected. Descriptive statistics were used to summarize demographic characteristics. Imaging findings were grouped by Chandler's stage (CS), an imaging-based measure of the progressive severity of orbital involvement. A Cochran-Armitage trend test was used to evaluate the relationship between CS and likelihood of positive confirmatory culture. RESULTS: There was a male predominance (66.9%) and 55.5% of subjects had comorbid sinusitis. Of the 130 subjects included, 33.8% had one or more positive cultures, 30.8% had a positive wound culture, and 4.6% had a positive blood culture. The most identified organism was coagulase-negative staphylococci (23.3%), followed by Staphylococcus aureus (18.9%), Streptococcus intermedius (17.8%), and strict anaerobes as a group (13.3%). Gram-negative organisms were rare. Twenty-five percent of S. aureus were methicillin-resistant. Clindamycin resistance was identified in 9% of all S. aureus, 50% of coagulase-negative staphylococci, and 25% of S. intermedius. Clindamycin plus ceftriaxone was the most prescribed empiric antibiotic regimen (36.2%). Likelihood of a positive culture significantly increased with advancing CS. CONCLUSIONS: Orbital cellulitis occurs most frequently in males with sinusitis. Likelihood of positive wound culture is increased with a more advanced CS. Staphylococcus and Streptococcus spp. and anaerobes are the most identified pathogens in orbital cellulitis, while gram-negative organisms are rare. Empiric antibiotic selection should include an anti-methicillin-resistant S. aureus agent combined with a broad-spectrum beta-lactam and anaerobic coverage.

Aspects of Program Engagement in an Online Physical Activity Intervention and Baseline Predictors of Engagement.

PURPOSE: Participant engagement in an online physical activity (PA) intervention is described and baseline factors related to engagement are identified. DESIGN: Longitudinal Study Within Randomized Controlled Trial. SETTING: Online/Internet. SAMPLE: Primary care patients (21-70 years). INTERVENTION: ActiveGOALS was a 3-month, self-directed online PA intervention (15 total lessons, remote coaching support, and a body-worn step-counter). MEASURES: Engagement was measured across six outcomes related to lesson completion (total number and time to complete), coach contact, and behavior tracking (PA, sedentary). Self-reported baseline factors were examined from seven domains (confidence, environment, health, health care, demographic, lifestyle, and quality of life). ANALYSIS: General linear and nonlinear mixed models were used to examine relationships between baseline factors and engagement outcomes within and across all domains. RESULTS: Seventy-nine participants were included in the sample (77.2% female; 74.7% white non-Hispanic). Program engagement was high (58.2% completed all lessons; PA was tracked ≥3 times/week for 11.3 ± 4.0 weeks on average). Average time between completed lessons (days) was longer than expected and participants only contacted their coach about 1 of every 3 weeks. Individual predictors related to health, health care, demographics, lifestyle, and quality of life were significantly related to engagement. CONCLUSION: Examining multiple aspects of engagement and a large number of potential predictors of engagement is likely needed to determine facilitators and barriers for high engagement in multi-faceted online intervention programs.

Recruitment of population-based controls for ALS cases from the National ALS Registry.

Objective: In 2010, the United States Agency for Toxic Substances and Disease Registry (ATSDR) created the National ALS Registry (Registry) to examine the epidemiology of ALS and potential risk factors. We are currently recruiting population-based controls for an epidemiologic case-control study to examine ALS environmental risk factors using this Registry. To date, we have recruited 181 non-diseased, population-based controls for comparison to Registry cases (n = 280). Here we report our recruitment methods for controls and the associated response rates and costs. Methods: Eligible ALS cases had complete risk factor survey data, DNA analysis, and blood concentrations of persistent organic pollutants (POPs). Age, sex, and county-matched controls were identified from commercial/consumer databases using a targeted landline phone sample. Eligible controls were consented, surveyed, and mailed the POPs' blood analysis consent form. Once consented, phlebotomy was scheduled. Results: We mailed 3760 recruitment letters for 181 potential case-matches across 42 states between 9/2018 and 3/2020. After making phone contact and determining eligibility, 146 controls agreed to participate (response rate = 11.4%, cooperation rate = 22.8%). To date, 127 controls completed the survey and bloodwork. Though controls were matched to cases on age, sex, and county, unmatched characteristics (e.g. smoking) did not differ statistically. Interviewing and incentive costs are estimated at $211.85 per complete participation. Conclusions: Recruiting matched population-based controls for comparison to cases from the Registry for a study involving completion of a detailed survey and blood specimen provision is relatively feasible and cost effective. This recruitment method could be useful for case-control studies of other rare disorders.

Gender-based disparities in COVID-19 patient outcomes.

Studies reported to date suggest that men with COVID-19 have more severe disease and worse outcomes when compared with women. The explanation for this finding is not entirely clear. The goal of this study was to compare clinical characteristics, inflammatory biomarkers and clinical outcome between men and women. This retrospective study included patients with COVID-19 admitted to 10 Virginia hospitals from January 1, 2020, to June 15, 2020. Demographic data, comorbidities, and inflammatory markers, including C reactive protein (CRP), D-dimer, ferritin, and the neutrophil:lymphocyte ratio, as well as patient outcomes, were compared between men and women. During the study period, 701 patients with PCR-confirmed COVID-19 infection were admitted. The patient's mean age was 61±17 years. There were 370 men (52.8%). There was no difference in age, racial distribution, and comorbidities in the male patients compared with the female patients. However, both the baseline and peak levels of CRP and ferritin were significantly higher in men as compared with women. While the baseline D-dimer was similar between the sexes, men had a significantly higher maximal D-dimer. Men had evidence of greater disease severity, with a significantly greater admission to the intensive care unit and borderline higher hospital mortality. Our study supports the observation that COVID-19 causes more severe disease in men. The greater disease severity in men was not due to the effect of age or comorbidities; however, in keeping with experimental studies, men had evidence of a heightened inflammatory response, likely contributing to disease severity.

Outcomes of Two-Stage Interpolated Flaps Versus Single-Stage Techniques for Reconstruction of Intermediate Nasal Defects.

Objective: This study compares the results of patients undergoing reconstruction of intermediate nasal defects, measuring 1.5-2.5 cm, with single-staged techniques as opposed to the traditionally recommended staged interpolated flap reconstruction. Design: This is a retrospective review of patients who underwent reconstruction of a nasal defect by a single surgeon between 2010 and 2016. Methods: Postoperative results including revision surgery, treating persistent edema with Kenalog (triamcinolone acetonide), and perioperative complications were analyzed. Aesthetic outcomes were analyzed by a panel of experts and nonexperts, and compared using a 5-point Likert scale. Results: In total, 51 single-stage and 26 two-stage patients underwent evaluation, and of these, 40 single-stage and 15 two-stage patients underwent panel analysis of aesthetic outcomes. The odds of requiring a revision procedure were 6.69 times higher and odds of using Kenalog postoperatively were 29.67 times higher in the two-stage group than in the single-stage group. Aesthetic scores were consistently better for the single-stage group for both panels. Conclusion: Patients undergoing single-stage techniques for reconstruction of intermediate nasal defects showed improved appearance and reduced number of additional procedures relative to patients undergoing two-stage techniques with short-term follow-up.