Free-hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy and allows avoidance of radiation exposure encountered in fluoroscopic techniques. Image-guided assistance may be most valuable when placing screws between T4 and T6, where breach rates are highest.

Background.Infection causes 1 of every 5 neonatal deaths globally. Group B Streptococcus (GBS) is the most significant pathogen, although little is known about its epidemiology and risk in low-income countries.Methods.A cross-sectional study in 2015 at a public hospital in Guatemala City enrolled women ≥35 weeks’ gestation. Vaginal and rectal swabs were processed using Lim broth and GBS CHROMagar then agglutination testing. Risk factors were assessed using multivariate analysis. Vaginal microbiota were profiled by 16S ribosomal ribonucleic acid sequencing in a subset of 94 women.Results.Of 896 pregnant women, 155 (17.3%; 95% confidence interval [CI], 14.9–19.9) were GBS colonized. Colonization was associated with history of previous infant with poor outcome (odds ratio [OR], 1.94; 95% CI, 1.15–3.27) and increasing maternal age (OR, 1.05; 95% CI, 1.02–1.09). Multiparity was protective (OR, .39; 95% CI, .21–.72). Four (6%) GBS-exposed infants had early-onset neonatal sepsis. Vaginal microbiome composition was associated with previous antibiotic exposure (P = .003) and previous low birth weight infant (P = .03), but not GBS colonization (P = .72). Several individual taxa differed in abundance between colonized and noncolonized women.Conclusions.Group B Streptococcus is prevalent in pregnant women from Guatemala with different risk factors than previously described. Although the vaginal microbiome was not altered significantly in GBS-colonized women, use of antibiotics had an effect on its composition.

Objective In 2014, the US experienced an outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. The clinical characteristics associated with severe illness from EV-D68 during this outbreak compared with the 2009 H1N1 influenza virus outbreak are unknown. Design and Setting In this retrospective cohort study, we characterized the clinical features of children with EV-D68 admitted to the pediatric ICU between August 1-November 1, 2014 and compared them with critically-ill children infected with H1N1 influenza during the pandemic admitted between May 1, 2009-January 31, 2010. Patients pediatric ICU patients Interventions none Measurements and Main Results Ninety-seven severely-ill children with EV-D68 infections were compared with 68 children infected with H1N1 influenza during the 2009 pandemic. Children with EV-D68 were more likely to have asthma (62% vs 23%, P< 0.001) and present with reactive airway disease exacerbations, with greater receipt of albuterol (94% vs 49%) and steroids (89% vs 40%, P< 0.0001 for both). While more children with EV-D68 were admitted to the ICU compared with H1N1 influenza, they had a shorter hospital length of stay (4 vs 7 days, P< 0.0001), with lower intubation rates (7% vs 44%), vasopressor use (3% vs 32%), ARDS (3% vs 24%), shock (0% vs 16%) and death (0% vs 12 %, P< 0.05 for all). Compared with children with other enteroviruses and rhinoviruses, children with EV-D68 were more likely to have a history of asthma (64% vs 45%) or multiple prior wheezing episodes (54% vs 34%, P < 0.01 for both). Conclusions Critically-ill children with EV-D68 were more likely to present with reactive airway disease exacerbations, whereas children with H1N1 influenza were more likely to present with pneumonia. Compared to the pandemic H1N1 influenza outbreak, the EV-D68 outbreak resulted in more children requiring admission to the ICU, but was associated with less severe outcomes.

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Demand for potential DENV, CHIKV and Zika vaccines is high at 50% and 75% efficacy in this Guatemalan community. Associated factors could be leveraged to optimize arbovirus vaccine implementation. Overall low WTP given current cost of Dengvaxia (Sanofi Pasteur, Lyon, France) suggests that government subsidization may be necessary in resource-poor regions, though a small private market may be supported.

If larger studies confirm the trends observed in our study, consideration should be given to including women with known thyroid disease in the subset of women who should be offered screening for diabetes early in pregnancy and appropriate clinical surveillance.

A variety of microcephaly case definitions detect high background prevalence in rural Guatemala, which complicates congenital Zika screening efforts. In addition, gestational age is needed for most screening tools but is usually unknown in low-resource settings. Fenton growth curves, originally designed for use in preterm infants, offer a standardized approach to adjust for unknown gestational age and may improve screening efforts.

Background Pharyngitis due to group A Streptococcus (GAS) represents a major cause of outpatient visits and antibiotic use in the United States. A leading vaccine candidate targets 30 of the &gt; 200 emm types of GAS. We aimed to assess natural protection conferred by GAS against respiratory symptoms. Methods In a 5-year study among school-aged children in Pittsburgh, Pennsylvania, pharyngeal cultures were obtained from children at 2-week intervals, and active surveillance was conducted for respiratory illnesses. We assessed protection via the relative odds of previous detection of homologous strains (defined by field-inversion gel electrophoresis banding pattern), emm types, and emm clusters at visits where GAS was detected with symptoms, vs visits where GAS was detected without symptoms. We used a cluster bootstrap of children to adjust estimates for repeated sampling. Results At visits where previously detected GAS emm types were identified, we estimated 81.8% (95% confidence interval [CI], 67.1%–91.7%) protection against typical pharyngitis symptoms among children reacquiring the same strain, and 94.5% (95% CI, 83.5%–98.6%) protection among children acquiring a distinct strain. We estimated 77.1% (95% CI, 33.7%–96.3%) protection against typical symptoms among children acquiring partially heterologous emm types belonging to a previously detected emm cluster. Protection was evident after both symptomatic and asymptomatic detections of GAS. We did not identify strong evidence of protection against atypical respiratory symptoms. Conclusions Within a 5-year longitudinal study, previous detection of GAS emm types was associated with protection against typical symptoms when homologous strains were subsequently detected. Naturally acquired protection against partially heterologous types suggests that emm type–based vaccines may have broader strain coverage than what has been previously assumed.