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* In the United States, cytomegalovirus is the most common congenital viral infection and the number 1 cause of nonhereditary sensorineural hearing loss. The vast majority of infants may be asymptomatic, especially if cytomegalovirus is contracted later in the pregnancy, and some symptoms may have a delayed onset. Therefore, it is important for the pathologist to identify the common histologic findings to help confirm the diagnosis so the child can be followed for late sequelae. Histologic examination of the placenta is important in live births and in cases of intrauterine fetal demise. Chronic lymphoplasmacytic villitis and fibrotic, avascular villi are the most common findings. When present, Cowdry A intranuclear and basophilic intracytoplasmic inclusions are characteristic. Immunohistochemistry for cytomegalovirus can highlight these inclusions as well as the associated eosinophilic debris. In addition, polymerase chain reaction or viral culture on placental or fetal samples can be performed for confirmation. doi: 10.5858/arpa.2017-0421-RS, Cytomegalovirus (CMV) is a member of the herpesvirus family, which includes other common viruses such as Epstein-Barr virus, herpes simplex viruses 1 and 2, and varicella-zoster virus. Although the exact [...]

Study Objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed‐dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti‐Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single‐center study. This study compared BMI‐, TBW‐, EBV‐based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti‐Factor Xa (anti‐Xa) levels in trauma patients. Design: Multicenter, retrospective review. Data Source: Electronic health records from participating institutions. Patients: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti‐Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital‐specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. Intervention: Dosing strategy used to determine initial prophylactic dose of enoxaparin. Measurements: The primary end point was percentage of patients with peak anti‐Xa levels within the target prophylactic range (0.2‐0.4 units/mL). Main Results: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti‐Xa levels (72.1%). Multiple logistic regression demonstrated EBV‐based dosing was significantly more likely to yield anti‐Xa levels at or above target compared to BMI‐based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29‐5.62, p < 0.001). EBV‐based dosing was also more likely than hybrid dosing to yield an anti‐Xa level at or above target (aOR 2.30, 95% CI 1.33‐3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. Conclusions: An EBV‐based dosing strategy was associated with higher odds of achieving anti‐Xa level within target range for enoxaparin VTE prophylaxis compared to BMI‐based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients. [ABSTRACT FROM AUTHOR]

Management of patients with salicylate toxicity frequently requires urine alkalinization to enhance excretion of salicylate. One strategy for determining when to stop urine alkalinization is to wait for two consecutive serum salicylate concentrations to be less than 300 mg/L (2.17 mmol/L) and declining. When alkalinization of the urine ceases, a rebound in serum salicylate concentration can occur from tissue redistribution or delayed gastrointestinal absorption. Whether this can lead to rebound toxicity is not well understood. This was a single-center, retrospective review of cases with a primary ingestion of acetylsalicylic acid reported to the local poison center over a five-year period. Cases were excluded if the product was not listed as the primary ingestion or if there was no serum salicylate concentration documented after discontinuation of intravenous sodium bicarbonate infusion. The primary outcome was the incidence of serum salicylate rebound to a concentration greater than 300 mg/L (2.17 mmol/L) after discontinuation of intravenous sodium bicarbonate infusion. A total of 377 cases were included. Of these, eight (2.1%) had a serum salicylate concentration increase (rebound) after stopping the sodium bicarbonate infusion. All these cases were acute ingestions. Five of the eight cases had rebound serum salicylate concentrations that were greater than 300 mg/L (2.17 mmol/L). Of these five patients, only one reported recurrent symptoms (tinnitus). Prior to stopping urinary alkalinization, the last or the last two serum salicylate concentrations were less than 300 mg/L (2.17 mmol/L) in three and two cases, respectively. In patients with salicylate toxicity, the incidence of rebound in serum salicylate concentration after cessation of urine alkalinization, is low. Even if serum salicylate rebounds to supratherapeutic concentrations, symptoms are often absent or mild. Routine repeat serum salicylate concentrations after urine alkalinization is stopped may be unnecessary unless symptoms recrudesce. [ABSTRACT FROM AUTHOR]

This study of 136 children (aged 2 to 10 years) found that children referred for medical evaluation of sexual abuse will use sexually explicit behavior to demonstrate what has happened to them with nonanatomical dolls as frequently as when they are interviewed with anatomically detailed ones. (Author/DB)

* BACKGROUND Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. * OBJECTIVE To compare the frequency of use of manually operated [...]

Objective: The aim of this study was to evaluate the effectiveness of a body mass index (BMI)‐based enoxaparin prophylaxis dosing protocol at achieving target anti‐factor Xa (anti‐Xa) concentrations in the trauma population. Methods: This retrospective chart review evaluated anti‐Xa concentrations in adult trauma patients who received prophylactic enoxaparin over a three‐month period. The primary outcome was the percentage of patients that achieved target anti‐Xa concentrations after ≥3 doses of enoxaparin. Secondary outcomes included correlations of anti‐Xa concentrations with enoxaparin dose per BMI, total body weight (TBW), and estimated blood volume (EBV). The prevalence of clinically relevant bleeding and venous thromboembolism was also recorded. Multivariable logistic regression was used to identify associated variables for target anti‐Xa concentration attainment. Results: Ninety‐nine consecutive patients were included in the study. Included patients were predominately male (69.7%) and Black (50.5%) with a mean age of 44.1 years. Target anti‐Xa concentrations were achieved in 62.6% of patients. Anti‐Xa concentrations were moderately correlated with enoxaparin dose per EBV (ρ = 0.57), followed by dose per TBW (ρ = 0.46), and dose per BMI (ρ = 0.20). Multivariable logistic regression demonstrated that categorization of enoxaparin dose per EBV and per TBW were the only statistically significant predictors of reaching target anti‐Xa concentrations (p = <0.001). Conclusions: In adult trauma patients, the rate of achieving target anti‐Xa concentrations remains suboptimal and provides room for further improvement. Enoxaparin dose per EBV was more closely correlated with anti‐Xa concentrations when compared to TBW and BMI. Dosing per EBV and TBW was the only variables associated with reaching target anti‐Xa concentrations within the study. Further investigation is warranted to elucidate optimal EBV‐ and TBW‐based dosing regimens. [ABSTRACT FROM AUTHOR]

Pulmonary capillary hemangiomatosis is a rare cause of pulmonary hypertension characterized by extensive proliferation of pulmonary capillaries within alveolar septae. Clinical presentation is nonspecific and includes dyspnea, cough, chest pain, and fatigue. Radiology shows diffuse centrilobular ground-glass opacities. Pulmonary capillary hemangiomatosis is clinically and radiographically indistinguishable from peripheral venoocclusive disease, making microscopic diagnosis essential. Histologically, pulmonary capillary hemangiomatosis shows an abnormal proliferation of small, thin-walled capillaries that expand the alveolar septae. The endothelial cells that comprise these lesions are cytologically bland and show no mitotic activity. Pulmonary capillary hemangiomatosis is important to recognize because prostacyclin therapy, a mainstay in the treatment of pulmonary hypertension, has been reported to cause sudden respiratory distress and death in these patients. Prognosis of this disease remains poor, and the only definitive treatment is lung transplantation. (Arch Pathol Lab Med. 2015; 139:274-277; doi: 10.5858/arpa.2013-0500-RS), Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension characterized by extensive proliferation of pulmonary capillaries within alveolar septae. First described by Wagenvoort et al (1) in 1978, [...]

This is the first article in a series on "Overcoming Overuse" in musculoskeletal health care. Overuse is the use of services that are unlikely to improve patient outcomes, result in more harm than benefit, and would not be desired by an informed patient. The Overcoming Overuse series explores the myriad ways diagnostic tests and treatments are overused in musculoskeletal health care, and proposes ways to ensure patients receive appropriate care. We focus on strategies to promote guideline-concordant care in rehabilitation practice and strategies to overcome overuse. [ABSTRACT FROM AUTHOR]