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  • 1
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    Presentation of Pediatric Celiac Disease in the United States: Prominent Effect of Breastfeeding
    SAGE Publications ; 2005
    In:  Clinical Pediatrics Vol. 44, No. 3 ( 2005-04), p. 249-258
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 44, No. 3 ( 2005-04), p. 249-258
    Kurzfassung: Childhood celiac disease (CD) is considered rare in the United States. Consequently there are few data concerning its clinical presentation. A validated questionnaire was distributed to families of children with CD. One hundred forty-one children with biopsy-proven CD were included in the study. We found significant differences in the clinical spectrum of children based on their infant feeding history. Exclusively breastfed children were significantly less likely to report failure to thrive (69% vs 88%, p 〈 0.05) and short stature (37% vs 62%, p 〈 0.05), and had a higher rate of “atypical” symptoms (p 〈 0.01). Breastfeeding alters the presentation and contributes to atypical presentations of CD and diagnostic delay. Pediatricians need to be aware of the diverse manifestations of celiac disease to reduce diagnostic delay.
    Materialart: Online-Ressource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/000992280504400309
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2005
    ZDB Id: 2066146-0
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  • 2
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    The association between socioeconomic status and the symptoms at diagnosis of celiac disease: a retrospective cohort study
    SAGE Publications ; 2016
    In:  Therapeutic Advances in Gastroenterology Vol. 9, No. 4 ( 2016-07), p. 495-502
    Details
    In: Therapeutic Advances in Gastroenterology, SAGE Publications, Vol. 9, No. 4 ( 2016-07), p. 495-502
    Kurzfassung: There are little data on patient factors that impact diagnosis rates of celiac disease. This study aims to evaluate the association between patient socioeconomic status and the symptoms at diagnosis of celiac disease. Methods: A total of 872 patients with biopsy-proven celiac disease were categorized based on the presence or absence of (1) diarrhea and (2) any gastrointestinal symptoms at diagnosis. Univariate and multivariate analyses were used to assess the association between socioeconomic status and symptoms. Results: Patients without diarrhea at presentation had a higher mean per capita income (US$34,469 versus US$32,237, p = 0.02), and patients without any gastrointestinal symptoms had a higher mean per capita income (US$36,738 versus US$31,758, p 〈 0.01) compared with patients having such symptoms. On multivariable analysis adjusting for sex, age, autoimmune or psychiatric comorbidities, and income, per capita income remained a significant predictor of diagnosis without gastrointestinal symptoms (odds ratio: 1.71, 95% confidence interval: 1.17–2.50, p 〈 0.01), and it showed a trend towards significance in diagnosis without diarrhea (odds ratio: 1.40, 95% confidence interval: 0.98–2.02, p = 0.06). Conclusions: Patients with nonclassical symptoms of celiac disease are less likely to be diagnosed if they are of lower socioeconomic status. Celiac disease may be under-recognized in this population due to socioeconomic factors that possibly include lower rates of health-seeking behavior and access to healthcare.
    Materialart: Online-Ressource
    ISSN: 1756-2848 , 1756-2848
    URL: Article
    DOI: 10.1177/1756283X16637532
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2016
    ZDB Id: 2440710-0
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  • 3
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    Review: New and developing therapies for celiac disease
    SAGE Publications ; 2009
    In:  Therapeutic Advances in Gastroenterology Vol. 2, No. 5 ( 2009-09), p. 303-309
    Details
    In: Therapeutic Advances in Gastroenterology, SAGE Publications, Vol. 2, No. 5 ( 2009-09), p. 303-309
    Kurzfassung: The treatment for celiac disease, a removal of gluten in the diet, is safe and effective for the vast majority of patients. There is a large body of evidence that the diagnosis and treatment of those with celiac disease ensures considerable health benefits. Although a gluten-free diet is the principal treatment for celiac disease, it is relatively expensive, inconvenient and difficult to adhere to. For these reasons, there is interest in developing alternative therapies. Emerging research for the treatment of celiac disease has focused on three areas: to decrease gluten exposure, to modify intestinal permeability and to modulate immune activation. Therapies developed thus far consist of enzymes designed to digest gluten and the use of inhibitors of paracellular permeability to decrease the migration of gluten peptides into the lamina propria. Other potential therapeutic maneuvers include the binding of gluten by polymers, the use of tissue transglutaminase (TTG) inhibitors and DQ2 or DQ8 blockers, or modulation of cytokine production. While all represent new and exciting therapies, an ideal therapy should have virtually no side effects similar to a gluten-free diet. A pharmaceutical agent may be used on an intermittent basis, such as following occasional gluten exposure or on a chronic basis to mitigate the effects of potential inadvertent ingestion of gluten.
    Materialart: Online-Ressource
    ISSN: 1756-2848 , 1756-2848
    URL: Article
    DOI: 10.1177/1756283X09342759
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2009
    ZDB Id: 2440710-0
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  • 4
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    Screening for celiac disease in average-risk and high-risk populations
    SAGE Publications ; 2012
    In:  Therapeutic Advances in Gastroenterology Vol. 5, No. 1 ( 2012-01), p. 37-47
    Details
    In: Therapeutic Advances in Gastroenterology, SAGE Publications, Vol. 5, No. 1 ( 2012-01), p. 37-47
    Kurzfassung: The prevalence of celiac disease is rising. As a result there is increasing interest in the associated mortality and morbidity of the disease. Screening of asymptomatic individuals in the general population is not currently recommended; instead, a strategy of case finding is the preferred approach, taking into account the myriad modes of presentation of celiac disease. Although a gluten-free diet is the treatment of choice in symptomatic patients with celiac disease, there is no consensus on whether institution of a gluten-free diet will improve the quality of life in asymptomatic screen-detected celiac disease patients. A review of the studies that have been performed on this subject is presented. Certain patient groups such as those with autoimmune diseases may be offered screening in the context of an informed discussion regarding the potential benefits, with the caveat that the data on this issue are sparse. Active case finding seems to be the most prudent option in most clinical situations.
    Materialart: Online-Ressource
    ISSN: 1756-2848 , 1756-2848
    URL: Article
    DOI: 10.1177/1756283X11417038
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2012
    ZDB Id: 2440710-0
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  • 5
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    A review of rifaximin and bacterial overgrowth in poorly responsive celiac disease
    SAGE Publications ; 2012
    In:  Therapeutic Advances in Gastroenterology Vol. 5, No. 1 ( 2012-01), p. 31-36
    Details
    In: Therapeutic Advances in Gastroenterology, SAGE Publications, Vol. 5, No. 1 ( 2012-01), p. 31-36
    Kurzfassung: A proportion of patients with celiac disease have a poor response to a gluten-free diet, which may be due to small-intestinal bacterial overgrowth (SIBO). Treatment with rifaximin is often used in the clinical setting, but there is limited literature to support this practice. In addition, challenges in the diagnosis of SIBO confound response interpretation. Our recent placebo-controlled trial did not demonstrate any improvement in gastrointestinal symptoms after treatment with rifaximin and casts doubt on the utility of lactulose–hydrogen breath testing for SIBO in this population.
    Materialart: Online-Ressource
    ISSN: 1756-2848 , 1756-2848
    URL: Article
    DOI: 10.1177/1756283X11422264
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2012
    ZDB Id: 2440710-0
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  • 6
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    Interest in medical therapy for celiac disease
    SAGE Publications ; 2013
    In:  Therapeutic Advances in Gastroenterology Vol. 6, No. 5 ( 2013-09), p. 358-364
    Details
    In: Therapeutic Advances in Gastroenterology, SAGE Publications, Vol. 6, No. 5 ( 2013-09), p. 358-364
    Kurzfassung: A gluten-free diet is the treatment for celiac disease, but pharmaceutical agents are being developed. The level of interest amongst patients in using a medication to treat celiac disease is unknown. This study examined the level of interest amongst patients in medication to treat celiac disease. Methods: A questionnaire was distributed to celiac disease patients and data were collected on demographics, presentation, and interest in medication. Three validated celiac disease-specific instruments were incorporated: Celiac Disease Associated Quality of Life, the Celiac Symptom Index, and the Celiac Dietary Adherence Test. Results: Responses were received from 365 individuals with biopsy-proven celiac disease. Respondents were 78% ( n = 276) female, 48% ( n = 170) over 50 years of age, and experienced a classical (diarrhea predominant) presentation in 44% ( n = 154). Of the 339 individuals answering the question regarding use of a medication to treat celiac disease, 66% were interested. Interest was greatest in older individuals (71% 〉 50 years of age versus 60% 〈 50 years of age, p = 0.0415), men (78% men versus 62% women, p = 0.0083), frequent restaurant customers (76% versus 58%, p = 0.0006), those dissatisfied with their weight (73% versus 51%, p = 0.0003) and those concerned with the cost of a gluten-free diet (77% versus 64%, p = 0.0176). Length of time since diagnosis, education, presentation, and symptoms with gluten exposure did not demonstrate any effect. Interest in medication was associated with a worse quality of life (CD-QOL 69.4 versus 80.1, p 〈 0.0001). Conclusions: Most individuals with celiac disease are interested in using a medication. Interest was highest among men, older individuals, frequent restaurant customers, individuals dissatisfied with their weight or concerned with the cost of a gluten-free diet, and those with a worse quality of life.
    Materialart: Online-Ressource
    ISSN: 1756-2848 , 1756-2848
    URL: Article
    DOI: 10.1177/1756283X13492580
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2013
    ZDB Id: 2440710-0
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  • 7
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    Association of Surge Conditions with Mortality Among Critically Ill Patients with COVID-19
    SAGE Publications ; 2022
    In:  Journal of Intensive Care Medicine Vol. 37, No. 4 ( 2022-04), p. 500-509
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 37, No. 4 ( 2022-04), p. 500-509
    Kurzfassung: To determine whether surge conditions were associated with increased mortality. Design Multicenter cohort study. Setting U.S. ICUs participating in STOP-COVID. Patients Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020. Interventions None Measurements and Main Results The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals). Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI] : 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43] , p  〈  .001). Conclusions Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.
    Materialart: Online-Ressource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/08850666211067509
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    ZDB Id: 2001472-7
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  • 8
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    Book Reviews
    SAGE Publications ; 1977
    In:  The Expository Times Vol. 88, No. 10 ( 1977-07), p. 311-319
    Details
    In: The Expository Times, SAGE Publications, Vol. 88, No. 10 ( 1977-07), p. 311-319
    Materialart: Online-Ressource
    ISSN: 0014-5246 , 1745-5308
    URL: Article
    DOI: 10.1177/001452467708801006
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 1977
    ZDB Id: 2117688-7
    SSG: 1
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  • 9
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    Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 4 ( 2021-04-01), p. 232596712199111-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 4 ( 2021-04-01), p. 232596712199111-
    Kurzfassung: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient’s skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy. Purpose: The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’ kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability. Results: Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements). Conclusion: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.
    Materialart: Online-Ressource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121991110
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2021
    ZDB Id: 2706251-X
    SSG: 31
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  • 10
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    Posterior Approach With Small Incision Is a Safe Alternative to Anterior Approach for Hamstring Autograft Harvest in Adolescents
    SAGE Publications ; 2022
    In:  HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery Vol. 18, No. 4 ( 2022-11), p. 498-503
    Details
    In: HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, SAGE Publications, Vol. 18, No. 4 ( 2022-11), p. 498-503
    Kurzfassung: There are potential drawbacks and complications associated with using the anterior approach to harvest the hamstring tendon as an autograft source for anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstruction. A posterior harvest technique has been described as an alternative to an anterior approach in skeletally mature patients. The 2 approaches have not been compared in adolescents. Purpose: We sought to compare the incision size and harvested tendon length produced by anterior and posterior hamstring harvest techniques in an adolescent population. Methods: After obtaining consent, we prospectively collected data on a consecutive series of 115 adolescents undergoing ACL or MPFL reconstruction, including the length of the incision and of the harvested hamstring tendon. Demographic information including age, sex, and body mass index (BMI) was collected at the time of surgery. Results: The mean age at the time of surgery was 14.3 ± 1.8 years (range: 9–21 years), and 43% (N = 50) of participants were male. Of the 115 hamstring autografts, 26 were harvested anteriorly and 89 were harvested posteriorly. Neither mean semitendinosus length nor mean gracilis length was significantly different when harvested anteriorly versus posteriorly. The posterior harvest group had a mean incision length that was significantly smaller than that of the anterior harvest group. No iatrogenic nerve injuries or neurovascular complications were observed in either group. Conclusion: A posterior incision for hamstring autograft harvest provided an alternative approach in adolescents, which resulted in a 20% smaller incision than an anterior approach. For procedures such as MPFL reconstruction that do not require concomitant anteromedial work, posterior hamstring harvest may be used to improve cosmesis while producing viable hamstring autograft tissue for surgical reconstruction.
    Materialart: Online-Ressource
    ISSN: 1556-3316 , 1556-3324
    URL: Article
    DOI: 10.1177/15563316221085262
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2022
    ZDB Id: 2210985-7
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