Remember the vessels! Craniofacial fracture predicts risk for blunt cerebrovascular injury

Purpose: The risk factors for blunt cerebrovascular injuries (BCVIs) are currently under intensive research, yet it is still controversial who should be screened. This study aimed to determine whether craniofacial fractures are associated with BCVI. Patients and Methods: This retrospective cohort study focused on patients with suspected polytrauma after whole-body computed tomographic angiography of the cervical arteries. Patients were reviewed for BCVI and craniofacial fractures. Exclusion criteria were hanging injury, gunshot injury or other penetrating injury to the neck, and a cervical fracture on any level. The outcome variable was BCVI, and the main predictor variable was a craniofacial fracture. A secondary predictor variable was a type of craniofacial fracture classified as a facial fracture, skull fracture, or a combination of facial and skull fracture. Other predictor variables were gender, age, and mechanism of injury In addition, specific craniofacial fractures were analyzed in more detail. The relevance of associations between BCVI and the predictors underwent chi(2) testing. Significance was set at .01. Results: Four hundred twenty-eight patients 13 to 90 years old during a 12-month period were included in the analysis. Craniofacial fractures occurred in 75 (17.5%). BCVI occurred significantly more frequently in those with than in those without a craniofacial fracture (18.6 vs 7.4%; P = .002). Patients with craniofacial fracture had a 4-fold increased risk for BCVI, whereas those 31 to 50 years old had 3.4-fold increased risk. Type of craniofacial fracture, gender, and mechanism of injury were not associated with BCVI. Conclusion: Craniofacial fractures are a serious risk factor for BCVI. This research suggests that in patients with any craniofacial fracture and suspected polytrauma, rigorous imaging of cervical arteries in search of BCVI is essential. (C) 2018 American Association of Oral and Maxillofacial SurgeonsPeer reviewe

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

Purpose BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. Methods Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. Results 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p <.0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. Conclusions The increase in detection rate for BCVI justifies more liberal screening protocols.Peer reviewe

Early probiotic supplementation and the risk of celiac disease in children at genetic risk

Abstract Probiotics are linked to positive regulatory effects on the immune system. The aim of the study was to examine the association between the exposure of probiotics via dietary supplements or via infant formula by the age of 1 year and the development of celiac disease autoimmunity (CDA) and celiac disease among a cohort of 6520 genetically susceptible children. Use of probiotics during the first year of life was reported by 1460 children. Time-to-event analysis was used to examine the associations. Overall exposure of probiotics during the first year of life was not associated with either CDA (n = 1212) (HR 1.15; 95%CI 0.99, 1.35; p = 0.07) or celiac disease (n = 455) (HR 1.11; 95%CI 0.86, 1.43; p = 0.43) when adjusting for known risk factors. Intake of probiotic dietary supplements, however, was associated with a slightly increased risk of CDA (HR 1.18; 95%CI 1.00, 1.40; p = 0.043) compared to children who did not get probiotics. It was concluded that the overall exposure of probiotics during the first year of life was not associated with CDA or celiac disease in children at genetic risk

Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity

Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection