Purpura fulminans (PF) is a rare, life-threatening disorder characterized by disseminated intravascular coagulation (DIC), circulatory collapse, and hemorrhagic cutaneous purpura. It typically occurs secondary to acute infections, usually meningococcal septicemia, although there are also congenital and acquired causes. We report a case of a 56-year old female who presented to our institution with clinical signs of PF in the setting of acetaminophen overdose and Klebsiella pneumoniae sepsis. Given the rarity of the disease, we also review cases of PF in similar clinical scenarios that have been described in the literature.
Objective To evaluate the role of postoperative nasal stenting in preserving nasal shape and preventing nostril stenosis in cleft rhinoplasty, and to develop a classification system for postoperative nasal stents. Design Systematic review. Methods Electronic and manual searches of scientific literature were conducted from 3 databases (PubMed, SCOPUS, OVID). Primary evidence that described postoperative nasal stenting in cleft rhinoplasty were included. Exclusion criteria included secondary evidence, non-English articles, and studies focusing on preoperative nasal stents. Patients and Participants Patients with cleft lip/nose of any type were included. Main Outcome Measure(s) Role in preservation of nasal shape & symmetry, role in prevention of nostril stenosis, complications with the use of postoperative nasal stent. Results Of the 13 articles, 9 papers described the preservation of nasal shape with nasal stents and three studies with a control group showed improved symmetry score. No studies evaluated the prevention of nostril stenosis; however, 2 studies reported improvement of nostril stenosis in secondary cleft rhinoplasty. The results of the included studies had significant heterogeneity. Nasal stents were classified into five types: Type I-spare parts assembled, Type II-prefabricated commercial, Type IIIa-patient specific 3D-printed static, Type IIIb-patient specific dynamic, and Type IV-internal absorbable. Total complications were 6.0%, including irritation (0.9%), infection (0.3%), and stent loss (4.6%). Conclusion Despite the lack of consensus with postoperative nasal stents, this review suggests its safety and role in preserving shape and improving stenosis. Our classification system highlights variability and the need for better quality studies to determine the efficacy of nasal stents.
Background/Objectives: The United States has experienced modest increase in HPV vaccination uptake in the last decade, but remain short of the goal of vaccinating 80% of eligible adolescents by the year 2020. One known factor (barrier) associated with vaccine uptake is cost. The Affordable Care Act (ACA) came into full effect in 2014 in the United States, with an overarching aim to increase access to preventive healthcare services, including recommended vaccines, such as the HPV vaccine. This study aimed at evaluating the association between the ACA and known HPV vaccination-enabling factors in the United States. Methods: The National Health Interview Survey was queried for individuals 18-26 years from 2011 to 2017. Changes in vaccination-enabling factors (regular physician visitation [defined as physician's visit within 12 months], and changes in health insurance status), and HPV vaccination status pre- (2011-2013) to post-ACA (2014-2017) were assessed using logistic regression models adjusted for poverty, education, marital status, comorbidities, sex, and geography. We defined HPV vaccine initiation as receiving a single vaccine dose, and completion as receiving ≥2 doses. Results: A total of 13,494 and 15,722 eligible individuals were identified pre- and post-ACA. There was a 43% increase in HPV vaccine initiation post-ACA (3.9% to 5.5%; OR 1.45, 95% CI 1.24, 1.70; p<.001), with increases primarily among non-Hispanic whites (OR 1.55, 95% CI 1.24, 1.94; p<.001) and blacks (OR 1.59, 95% CI 1.12, 2.29; p=.009). Additionally, both rate and odds of HPV vaccine completion (receiving ≥2 HPV vaccine doses) increased significantly post-ACA (12.5% to 17.8%; OR 1.62, 95% CI 1.47, 1.79; p<.001); and this increase was mostly associated with Hispanics (7.6% to 14.7%), compared with non-Hispanic whites (ORinteraction = 1.36, 95% CI 1.05, 1.77; p=.020). Post-ACA, there was significant decrease in uninsured rates, and increases in vaccination completion odds among individuals privately insured (OR 1.36, 95% CI 1.22, 1.52; p<.001), and those under Medicaid (OR 1.81, 95% CI 1.35, 2.43; p<.001). There was also a corresponding increase in the rate and odds of regular physician visitation post-ACA (53.1% to 57.1%, OR 1.17, 95% CI 1.09, 1.25; p<.001). Conclusions: The ACA is associated with increased HPV vaccination uptake, with significantly greater increases in HPV vaccination completion among ethnic minorities. These gains might be driven by an increase in vaccination-enabling factors such as decreased uninsured rates and increased physician visits. Citation Format: Nosayaba Osazuwa-Peters, Justin M. Barnes, Janine Myint, Yusuf Agamawi, Eric Adjei Boakye. The Affordable Care Act and rate of human papillomavirus (HPV) vaccine uptake in the United States [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4608.
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