Change in BMI in Children Over the First 30 Months After the Start of the SARS-CoV-2 Pandemic.

Our study aim was to assess body mass index (BMI) change in children in the immediate 6 months of the pandemic, to follow longitudinal BMI change up to 30 months after the pandemic start, and to identify sociodemographic factors associated with these changes. Our study included a retrospective chart review of 1298 children 2 to 18 years old with office visits at an Indianapolis primary care clinic. Body mass index and sociodemographic information were collected at visits during 3 time periods: Prepandemic (March 1, 2019-February 28, 2020), Early Pandemic (June 1, 2020-November 30, 2020), and Late Pandemic (December 1, 2020-September 30, 2022). Data analysis indicated statistically significant increases in BMI monthly rate of change from Prepandemic to Early Pandemic periods. Interestingly, BMI rate of change stabilized from Early Pandemic to Late Pandemic periods but remained positive, suggesting children had slower, but persistent, continued BMI increase after the pandemic initiation.

An outpatient critical care transition clinic model reduces admissions/readmissions in medically complex patients.

OBJECTIVES: Reducing hospital admissions in patients with multiple complex chronic conditions is both a quality indicator and cost-effective to health care systems. This study assesses and compares utilization rates and cost of encounters between patients referred and seen in an outpatient critical care transition clinic (Healthy Transitions Clinic [HTC]) and those referred and not seen. STUDY DESIGN: Retrospective cohorts. METHODS: Patients with complex chronic conditions discharged from a tertiary/quaternary acute care hospital or emergency department (March 1, 2015, to February 29, 2016) were referred to an outpatient critical care transition clinic. Comparative cohorts were those patients who attended this transition clinic and those who did not. Pre- and post-HTC referral visits, with health care utilization evaluations including admissions/readmissions, attention to social determinants of health, and cost assessments, were compared among the cohorts. RESULTS: Insurance coverage differed significantly in its distribution between the groups (χ2 = 22.99; P < .001); therefore, an adjusted relative risk model was used. Inpatient admissions significantly increased, by 31%, in the non-HTC cohort (P = .03); a significant increase in the rate of 30-day readmissions (69%) occurred in the HTC group (P < .001) at 6 months post index admission. Length of stay did not differ pre- and post HTC visit. Although not statistically significant, visits to the HTC reduced median all-cost and HTC cohort cost by more than $1 million. CONCLUSIONS: In patients with complex chronic medical conditions with recent hospital admissions, the HTC model appears to reduce both admissions and encounter costs. Further community/regional studies are needed to better define this observation on a longitudinal basis.

Sex Correlation to the Prevalence of Pedal Neuromas in Various Interspaces: A Retrospective Study.

BACKGROUND: Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex. METHODS: In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P < .05 indicating statistical significance. RESULTS: No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01). CONCLUSIONS: This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.

Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study.

BACKGROUND: Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and predominantly identified in females. The principal investigator observed Morton's neuromas commonly in both the 2nd and 3rd interspaces in both genders. To the best of our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each gender independently. The present study evaluates Morton's neuroma interspace location and if there is a variation between males and females. METHODS: In this retrospective study, 582 de-identified ProScan magnetic resonance imaging reports, with a diagnosis code for Morton's neuroma (ICD Code 355.6), were obtained from their centralized database. These reports were evaluated for patients scanned from January 2015-April 2016. Incomplete records and those where the radiologist findings were not consistent with Morton's neuroma were eliminated. For the remaining 379 patients, data was collected on several factors such as gender, laterality, history of trauma, plantar plate tear, age and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data was then evaluated statistically utilizing the Pearson Chi-Square and Independent Samples Mann-Whitney U Test with statistical significance deemed p<0.05. RESULTS: No statistically significant distribution between gender and second and third interspace Morton's neuromas were noted. Additionally, right vs left foot, age and history of trauma did not vary between genders in a significant way. Lastly, there was a statistically significant difference between the presence of plantar plate tears between genders. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (34/92, p=0.01). CONCLUSION: Our study found that there was not a statistically significant difference between female and male and Morton's neuromas location, laterality or age.

Transabdominal Cerclage.

The transabdominal cerclage procedure was first introduced 50 years ago as an approach in those patients who had failed transvaginal cerclage. We review the history, indications, surgical technique, complications, and reported outcomes of the procedure. The procedure has evolved over time in its application and risks appear to be less than previously perceived. Physicians have found additional patient situations in which the procedure may be beneficial outside the indications defined 50 years ago. This is a valuable surgical technique which is likely underused.