Miami, FL
July 25, 2018
Volume IX | Issue No. 30
Efficacy and safety of Dupilumab in corticosteroid dependent severe asthma
Dupilumab is a fully human anti-interleukin-4 monoclonal antibody for the treatment of allergic diseases (as of 2017 it cost approximately $37,000 per year!). Its efficacy in reducing oral corticosteroid use in patients with severe asthma, while maintain asthma control, is unknown.
A study randomized 210 severely asthmatic patients to receive add-on Dupilumab or placebo every 2 weeks for 24 weeks to assess efficacy to reduce steroid use (by adjusting steroid dose downward as appropriate).
Dupilumab reduces glucocorticoid use in severely asthmatic patients by 70.1%, with 80% having a dose reduction of at least 50% and 48% completely discontinuing corticosteroids, without reduction in asthma control (transient eosinophilia occurs in 1:7 treated patients).
Urinary NGAL (uNGAL) as a predictor of urinary tract infections (UTI) in children with neurogenic bladder
Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a novel biomarker expressed in neutrophils and certain epithelia which is normally found in low levels in the urine (and plasma) but rises quickly (within 2 hours) in response to kidney injury.
A study which examined uNGAL levels in 201 children with neurogenic bladders aimed at distinguishing UTI from urinary colonization (UTC), indicates that uNGAL levels are increased in (clean intermittent catherization-dependent) children with a UTI compared to those with urinary tract colonization.
Keystone virus isolated from a Florida teenager
Keystone virus, a California serogroup orthobunyavirus, was first isolated in 1964 from mosquitoes in Keystone Florida. There are no prior reports of its isolation in humans ...

The first patient to present clinically with a Keystone virus infection is a Florida teenager who presented with fever and rash. Another virus to worry about?
Clinical Infectious Diseases

See related video HERE.
Childhood Obesity Facts 
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Extra-renal manifestations of atypical hemolytic-uremic syndrome (aHUS) 
Hemolytic Uremic syndrome (HUS) is a condition which usually develops in a child 5-10 days after a bout of diarrhea (often bloody) from certain strains of E.coli, which results in abnormal destruction of red blood cells. These clog the filtering system of the kidneys which can lead to renal failure. Symptoms initially include abdominal pain, bloody or watery diarrhea, vomiting and fever with subsequent anemia, edema, hypertension and decreased urine output.

Atypical HUS is a rare life-threatening progressive disease that frequently has a genetic component and is the result of uncontrolled dysregulation of the complement system with a thrombotic microangiopathy that affects not only the renal vessels, but all the small blood vessels of the body.

Frequent extra renal organs involved include the Central nervous (27.2%-encephalopathy, seizures and coma), gastrointestinal (pancreatitis and liver necrosis), cardiovascular (hypertension, stroke) and respiratory systems.
Video Feature
What should I think about if I'm taking pain medicine during my pregnancy? IntermountainMoms
What should I think about if I'm taking pain medicine during my pregnancy? IntermountainMoms
Use of anti-inflammatory drugs during pregnancy and the risk of miscarriage

"Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the production of prostaglandin which is essential for successful embryonic implantation."

A cohort study 1097 pregnant women, (median gestational
age: 39 days) divided participants based on the use of NSAIDs or acetaminophen into three cohorts; 1. women who used NSAID's only, 2. those who used acetaminophen and 3. those that used neither. Miscarriages were ascertained from electronic medical record data and direct interview.

NASIDs used around the time of conception increases the risk of miscarriage.

Perinatal marijuana use and the developing child 

With the opioid epidemic causing wide spread issues and deaths, some authors suggest the use of marijuana as a safe alternative for pain management. Perceptions that cannabis is safe has led to the prevalence of marijuana use among pregnant women increasing by 62% between 2002 and 2014. This increased use may lead to an increase in risk to both fetus and child.
Delta-9-tetrahydrocannabinol (THC), the major psychoactive component of marijuana, crosses the placental barrier easily and its receptors in the developing fetal brain play a critical role in not only fetal and post-natal brain development, neuronal connectivity and glial differentiation but also in the neuro-transmitter systems.
Prenatal THC exposure adversely affects infant neurobehavior with dysregulated arousal and motor difficulties developing at 6 months, and disturbed sleep, memory impairment, aggression and other developmental and behavioral problems occurring in childhood.
Cannabis use among mothers during pregnancy and breast feeding should be strongly discouraged.
See related video HERE and HERE
Umbilical appearance and patient/parent satisfaction after umbilical hernia repair (UHR) in children

Umbilical hernias are common, occurring in 10-20% of children, with low birth weight, being African-American or male increasing the risk of development. A retrospective study of 128 children who underwent UHR assessed at 7.6 years (median) post- surgery follow up, parent and patient satisfaction.
78.9% of parents and 91.5% pf patients are satisfied with UHR results, however those with large defects or who are older at age of surgery are more likely to express dissatisfaction.
Meet Saoussen Salhi, MD - The Division of Plastic Surgery at Nicklaus Children's
Meet Saoussen Salhi, MD - The Division of Plastic Surgery at Nicklaus Children's
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