Quantity and duration of exposure to general anesthesia for pediatric patients with retinoblastoma.

PURPOSE: To quantify the duration of anesthesia required for optimal management of retinoblastoma (Rb), stratified by clinical factors. METHODS: The medical records of Rb patients treated at Phoenix Children's Hospital between January 2011 and January 2022 were reviewed retrospectively. Demographic, tumor, and treatment data were collected. Anesthesia time was recorded for procedures requiring general anesthesia, including intra-arterial chemotherapy (IAC), enucleation, brainstem auditory evoked response testing (BAER), port placement, magnetic resonance imaging (MRI), and examination under anesthesia (EUA). Descriptive statistics were used to summarize patient and clinical characteristics. RESULTS: Total anesthesia time was 48,991 minutes for 610 procedures in 43 patients. The median follow-up time was 36 months (range, 12-114 months). Average anesthetic durations per exposure were 274, 152, 81.8, 62.5, 60.7, and 45 minutes for IAC, enucleation, BAER, port placement, MRI, and EUA, respectively. Patients with bilateral Rb underwent a median of 1,659 minutes of total anesthesia, compared with 397 minutes for those with unilateral disease. In patients with unilateral Rb, median total anesthesia time was 2,651, 1681, 312, 397 minutes for International Classification of Retinoblastoma grades B, C, D, and E tumors, respectively. Patients who received IAC as their primary treatment had the highest median anesthesia duration (2,100 minutes), followed by systemic chemo (654 minutes) and enucleation (289 minutes). CONCLUSIONS: Treatment of Rb requires prolonged and repeated exposure to general anesthesia. Future studies are required to determine the potential effects of these childhood anesthetic exposures.

Ophthalmology and Social Media: An In-Depth Investigation of Ophthalmologic Content on Instagram.

Purpose: Social media has become a popular source of health information for patients. This study aimed to characterize the top-performing ophthalmologic posts on a large social media platform to better understand the spread of ophthalmic information via social media. Materials and Methods: This was a web-based study that searched for ophthalmology-related posts on Instagram, with subjects being users who posted ophthalmic content. A list of 36 ophthalmology-related hashtags, including the most common diagnoses and procedures identified from the IRIS Registry, was queried. For each hashtag, data were collected for "Top 9 posts" (as ranked by Instagram's engagement-based algorithm) at three different time points. Posts were analyzed for the poster's background, credentials, post format, content, caption length, and engagement level. Results: Of the top-performing posts analyzed (n = 972), the most frequent post format was a photo (82.2%), followed by video (8.8%) and graphic (8.4%). Ophthalmologists (35.8%) authored the highest number of posts, followed by patients (27.1%), optometrists (20.1%), and organizations (12.7%). The highest average engagement level ratios (ELRs) belonged to ophthalmologists-in-training (0.096), followed by patients (0.084), optometrists (0.070), all ophthalmologists (0.067) and organizations (0.051); p < 0.001. The most engaging type of content was self-promotional (0.118) and personal experience-related (0.091); educational content was the least engaging (0.059) even though it comprised the majority of posts (56%); (p < 0.001). Characteristics that predicted the highest ELRs (reaching 80th percentile) were captions and/or images that featured personal experiences (3.335 OR), whitecoats (3.259), and those authored by ophthalmologist trainees (3.172); (p < 0.01). The least engaging were those featuring fundus photos (0.281), educational content (0.359), and authored by organizations (0.428); (p < 0.05). Conclusion: The majority of ophthalmologic content on Instagram is authored by non-ophthalmologists, with educational content being the least engaging. Practicing ophthalmologists have an opportunity to reach more patients through social media by incorporating specific features known to drive post engagement and reach. Precis: Social media has become a popular source of health information for patients. Our study demonstrates that the majority of ophthalmology content on Instagram is authored by non- ophthalmologists, with educational content being the least engaging. Practicing ophthalmologists have an opportunity to reach a wider audience through social media by incorporating specific features known to drive post engagement and reach.

BRAF Immunohistochemical Studies of Pediatric Conjunctival Lesions.

PURPOSE: The purpose of this study was to analyze the prevalence of an activating mutation in the B-Raf proto-oncogene (BRAF) V600E immunoreactivity in pediatric conjunctival lesions. METHODS: This retrospective case-control study included 32 pediatric patients who underwent surgical excision of conjunctival lesions between Jan 2019 and May 2022. The collected data included demographic data, clinical features, and histopathologic characteristics of the lesion, including BRAF V600E positivity. The Student t test and the Fisher exact test were used to determine the significance of the associations between clinical variables and BRAF positivity. RESULTS: BRAF immunoreactivity was positive in 11/32 lesions (34%). Age at diagnosis did not correlate with BRAF positivity, with a mean age at diagnosis of 131.7 months for patients with BRAF+ lesions and 134.7 months for those with BRAF- lesions (P > 0.1). No clinical or pathological features were found to be significantly correlated with BRAF positivity, although there was a trend toward BRAF positivity in the presence of cysts (P = 0.072). CONCLUSIONS: BRAF reactivity was present in approximately one-third of pediatric conjunctival nevi but does not correlate significantly with unique clinical or histopathological features.

Virulence Role of the GlcNAc Side Chain of the Lancefield Cell Wall Carbohydrate Antigen in Non-M1-Serotype Group A Streptococcus.

Classification of streptococci is based upon expression of unique cell wall carbohydrate antigens. All serotypes of group A Streptococcus (GAS; Streptococcus pyogenes), a leading cause of infection-related mortality worldwide, express the group A carbohydrate (GAC). GAC, the classical Lancefield antigen, is comprised of a polyrhamnose backbone with N-acetylglucosamine (GlcNAc) side chains. The immunodominant GlcNAc epitope of GAC is the basis of all rapid diagnostic testing for GAS infection. We previously identified the 12-gene GAC biosynthesis gene cluster and determined that the glycosyltransferase GacI was required for addition of the GlcNAc side chain to the polyrhamnose core. Loss of the GAC GlcNAc epitope in serotype M1 GAS resulted in attenuated virulence in two animal infection models and increased GAS sensitivity to killing by whole human blood, serum, neutrophils, and antimicrobial peptides. Here, we report that the GAC biosynthesis gene cluster is ubiquitous among 520 GAS isolates from global sources, representing 105 GAS emm serotypes. Isogenic ΔgacI mutants were constructed in M2, M3, M4, M28, and M89 backgrounds and displayed an array of phenotypes in susceptibility to killing by whole human blood, baby rabbit serum, human platelet releasate, human neutrophils, and antimicrobial peptide LL-37. The contribution of the GlcNAc side chain to GAS survival in vivo also varied by strain, demonstrating that it is not a prerequisite for virulence in the murine infection model. Thus, the relative contribution of GAC to virulence in non-M1 serotypes appears to depend on the quorum of other virulence factors that each strain possesses.IMPORTANCE The Lancefield group A carbohydrate (GAC) is the species-defining antigen for group A Streptococcus (GAS), comprising ~50% of the cell wall of this major human pathogen. We previously showed that the GlcNAc side chain of GAC contributes to the innate immune resistance and animal virulence phenotypes of the globally disseminated strain of serotype M1 GAS. Here, we use isogenic mutagenesis to examine the role of GAC GlcNAc in five additional medically relevant GAS serotypes. Overall, the GlcNAc side chain of GAC contributes to the innate immune resistance of GAS, but the relative contribution varies among individual strains. Moreover, the GAC GlcNAc side chain is not a universal prerequisite for GAS virulence in the animal model.

Differences in alcohol brand consumption between underage youth and adults-United States, 2012.

BACKGROUND: The alcohol brand preferences of US underage drinkers have recently been identified, but it is not known whether youth are simply mimicking adult brand choices or whether other factors are impacting their preferences. This study is the first to compare the alcohol brand preferences of underage drinkers and adults. METHODS: The authors conducted a cross-sectional assessment of youth and adult alcohol brand preferences. A 2012 Internet-based survey of a nationally representative sample of 1032 underage drinkers, ages 13-20, was used to determine the prevalence of past-30-day consumption for each of 898 alcohol brands, and each brand's youth market share, based on the total number of standard drinks consumed. Data on the brand-specific prevalence of past-30-day or past-7-day consumption among older youth (ages 18-20), adults (ages 21+), and young adults (ages 21-34) was obtained from Gfk MRI's Survey of the Adult Consumer for the years 2010-2012. Overall market shares for each brand, also measured by the total number of standard drinks consumed, were estimated from national data compiled by Impact Databank for the year 2010. RESULTS: Although most alcohol brands popular among underage drinkers were also popular among adult drinkers, there were several brands that appeared to be disproportionately consumed by youth. CONCLUSIONS: This article provides preliminary evidence that youth do not merely mimic the alcohol brand choices of adults. Further research using data derived from fully comparable data sources is necessary to confirm this finding.

Hepatitis B awareness and knowledge in hepatitis B surface antigen-positive parturient immigrant women from West Africa in the Bronx, New York.

An increasing proportion of foreign-born residents in the Bronx, New York are African immigrants from West Africa, a region with a very high hepatitis B surface antigen (HBsAg) prevalence. Charts of 114 HBsAg positive parturients who gave birth between 2004 and 2008 in a community hospital in the Bronx were retrospectively reviewed. Most were of West-African origin (88%). Acute hepatic inflammation was rare (4%). Active viral replication (Hepatitis B e-antigen positivity) was noted in a minority (7%), but in 3/5 (60%) HIV co-infected women. Among the West-African immigrant women who agreed to be interviewed (n = 39), only half (54%) had ever heard of hepatitis B virus (HBV) infection, and their knowledge of HBV was mostly incomplete. This study shows that pregnancy-related health interventions may offer unique opportunities to link such women to specialist care and initiate culturally sensitive HBV-relevant education for the index case and her family.

Assessment of the average price and ethanol content of alcoholic beverages by brand--United States, 2011.

BACKGROUND: There are no existing data on alcoholic beverage prices and ethanol (EtOH) content at the level of alcohol brand. A comprehensive understanding of alcohol prices and EtOH content at the brand level is essential for the development of effective public policy to reduce alcohol use among underage youth. The purpose of this study was to comprehensively assess alcoholic beverage prices and EtOH content at the brand level. METHODS: Using online alcohol price data from 15 control states and 164 online alcohol stores, we estimated the average alcohol price and percent alcohol by volume for 900 brands of alcohol, across 17 different alcoholic beverage types, in the United States in 2011. RESULTS: There is considerable variation in both brand-specific alcohol prices and EtOH content within most alcoholic beverage types. For many types of alcohol, the within-category variation between brands exceeds the variation in average price and EtOH content among the several alcoholic beverage types. Despite differences in average prices between alcoholic beverage types, in 12 of the 16 alcoholic beverage types, customers can purchase at least 1 brand of alcohol that is under $1 per ounce of EtOH. CONCLUSIONS: Relying on data or assumptions about alcohol prices and EtOH content at the level of alcoholic beverage type is insufficient for understanding and influencing youth drinking behavior. Surveillance of alcohol prices and EtOH content at the brand level should become a standard part of alcohol research.