Search

ObjectiveThis randomized clinical trial tested the effectiveness of an addiction-based digital weight-loss intervention, focusing on withdrawal/abstinence from self-identified problem foods, snacking and excessive amounts at meals, and discomfort displacement, with and without coaching, compared to an in-person, multi-disciplinary, care model among adolescents with obesity. We hypothesized that the digital intervention with coaching would yield greater weight loss and lower delivery burden than the standard clinical arm, and greater participant engagement than the digital arm without coaching.MethodsAdolescents were randomized to app intervention, with or without coaching, or in-person multidisciplinary obesity intervention for 6 months. The primary outcome was change in %BMIp95 at weeks 12 and 24. A mixed-effects linear regression model was used to assess the association between change in %BMIp95 and intervention arm. We were also interested in assessing delivery burden, participant engagement and evaluating the relationships between weight change and demographic characteristics, mood, executive function and eating behaviours.ResultsAll adolescents (n = 161; BMI ≥95th%, age 16 ± 2.5 year; 47% Hispanic, 65% female, 59% publicly insured) lost weight over 24-weeks (-1.29%, [-1.82, -0.76], p

Rationale: Variants within the cystic fibrosis transmembrane conductance regulator gene (CFTR) that are of unknown significance or are categorized as non CF-causing may be observed in persons with CF. These variants are frequently detected in children with inconclusive newborn screen results and, in some cases, may be associated with a benign presentation in early childhood that progresses to a CF phenotype later in life.Objectives: To analyze data from individuals enrolled in the U.S. CF Foundation patient registry who have received a diagnosis of CF and who have variants found in a population of children with cystic fibrosis screen positive, inconclusive diagnosis (CFSPID).Methods: This retrospective review analyzed registry data from individuals with a diagnosis of CF who also harbor one or more variants of interest due to their frequency within a CFSPID population and/or their interpretation as non CF-causing. Three groups were defined by the number of CF-causing (CF-C) variants identified (CF-Cx2, CF-Cx1, and CF-Cx0), which were reported in addition to variant(s) of interest. Multivariate quantile regression modeling of FEV1 outcome generated a disease severity score for each person determined by six selected variables. Median scores were calculated for the three groups.Results: Patients carrying one CF-causing variant and at least one variant of interest (CF-Cx1) had higher median disease severity score compared to CF-Cx2, suggesting milder phonotype (p<0.05). However, there was no statistically significant difference in scores between CF-Cx2 and the two other groups combined (CF-Cx1 and CF-Cx0; p=0.33). Analysis revealed that the CF-Cx1 and CF-Cx0 groups, when compared to the CF-Cx2 group, had later median diagnoses (8 years vs. newborn; p<0.0001), lower median sweat chloride (48 vs. 94.5 mmol/L, p<0.0001), lower prevalence of pancreatic insufficiency (29% vs. 78%; p<0.0001), and higher median FEV1% predicted (95% vs. 87%; p=0.0002).Conclusions: Individuals with CF who have specific variants frequently identified in children with CFSPID have a similar range of disease severity scores compared to those who have two CF-causing variants, but a milder phenotype overall. Variants that should be given careful scrutiny due to their high prevalence are: G576A+R668C, T854T, R75Q, F1052V, R1070W, R31C, and L967S. [ABSTRACT FROM AUTHOR]

Objectives: Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay. Study Design: Case series with chart review. Setting: Patients undergoing stage 1 microtia reconstruction at a tertiary pediatric hospital. Methods: Data collected included demographics, opioid amounts, Wong-Baker FACES Pain Rating Scale scores, opioid-related side effects, and hospital length of stay. We used generalized estimating equations to examine the effect of erector spinae block use on total opioid use and pain scores and a linear regression model to assess the effect on hospital stay. Results: Forty-seven patients were included: 14 in the erector spinae block group and 33 in the continuous wound pump group. The mean age was 8.3 years (SD, 2; range, 6-13), and 13 (32%) were female. Patients in the erector spinae block group had a 65.44% decrease in adjusted total opioid use (95% CI, –79.72% to –41.10%; P <.0001), a decrease in length of hospital stay (β = −1.69 [95% CI, −2.11 to −1.26], P <.0001), and no difference in reported pain scores when compared with patients in the continuous wound pump group. Conclusions: This study demonstrates that early experience with an erector spinae block resulted in decreased opioid use and shorter hospital stay as compared with continuous wound infiltration with local anesthetic. [ABSTRACT FROM AUTHOR]

In this study, we investigated whether CBC profiles can be utilized to distinguish hospitalized children with EH from patients with AD and bacterial infections or AD exacerbation. Acyclovir, CBC, eczema herpeticum, leukopenia, lymphopenia, neutropenia Keywords: acyclovir; CBC; eczema herpeticum; leukopenia; lymphopenia; neutropenia EN acyclovir CBC eczema herpeticum leukopenia lymphopenia neutropenia 1 3 3 01/05/22 20220101 NES 220101 CONFLICT OF INTEREST The authors have no conflicts of interest to declare. [Extracted from the article]

Due to its simplicity, time-limited eating (TLE) may represent a more feasible approach for treating adolescents with obesity compared to other caloric restriction regimens. This pilot study examines the feasibility and safety of TLE combined with continuous glucose monitoring (CGM) in adolescents. Fifty adolescents with BMI ≥95th percentile were recruited to complete a 12-week study. All received standard nutritional counseling, wore a CGM daily, and were randomized to: (1) Prolonged eating window: 12 h eating/12 h fasting + blinded CGM; (2) TLE (8 h eating/16 h fasting, 5 days per week) + blinded CGM; (3) TLE + real-time CGM feedback. Recruitment, retention, and adherence were recorded as indicators of feasibility. Weight loss, dietary intake, physical activity, eating behaviors, and quality of life over the course of the intervention were explored as secondary outcomes. Forty-five participants completed the study (16.4 ± 1.3 years, 64% female, 49% Hispanic, 75% public insurance). There was high adherence to prescribed eating windows (TLE 5.2 d/wk [SD 1.1]; control 6.1 d/wk [SD 1.4]) and daily CGM wear (5.85 d/wk [SD 4.8]). Most of the adolescents (90%) assigned to TLE reported that limiting their eating window and wearing a CGM was feasible without negative impact on daily functioning or adverse events. There were no between-group difference in terms of weight loss, energy intake, quality of life, physical activity, or eating behaviors. TLE combined with CGM appears feasible and safe among adolescents with obesity. Further investigation in larger samples, with a longer intervention duration and follow-up assessments are needed. [ABSTRACT FROM AUTHOR]

Background: Sensitization to (meth)acrylates, the most common nail cosmetic allergens, is rising. In recent years, home acrylic nail kits have become easily available. Objective: To investigate the characteristics of individuals reporting skin reactions associated with acrylic nail cosmetics, particularly home kits. Methods: Cross-sectional survey of Facebook nail allergy support groups. Inclusion criteria were self-reported skin reactions associated with acrylic nails and age ≥18 years. Results: There were 199 respondents, nearly all female (99%), mostly white (83%), and 25-54 years old (83%). Seventy-eight percent reported using home acrylic kits, more than half for the first time during COVID-19. They predominantly learned about kits through social media (68%) and received training through websites/online videos (74%). Most home users (83%) first developed skin reactions after starting to use home kits. Compared with nonhome users, significantly more home users reported skin reaction onset within 1 year of use, as well as nail damage ( P  < 0.05). Conclusions: Among online nail allergy support group members, home acrylic nail kit use was common and associated with earlier development of skin reactions and more frequent nail damage than professional acrylic manicures. These findings raise important questions about the need to regulate home acrylic nail kits.

Background: Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources., Methods: To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D ( n  = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires., Results: Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance ( P  = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values ( P  = .003), less CGM use ( P  = .002), and more negative attitudes about technology (generally, P  = .003; and diabetes-specific, P  < .001) than either non-Latinx or Spanish-speaking Latinx participants. Barriers were encountered with equivalent frequency across groups., Conclusions: Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.