Objective With the increasing interest in fetal repair of myelomeningoceles (MMCs) over the last decade, it is reasonable to anticipate the need for high quality and accessible educational materials for patients. Patients often look to the internet for details regarding medical topics and specifically to YouTube for informative health-related videos. This study aims to analyze the content and shortcomings of currently available videos on YouTube regarding prenatal repair of MMCs. Study Design A YouTube search was performed on December 15, 2018, using the terms “fetoscopic surgery for neural tube defect” and “fetal surgery for neural tube defect.” The first 50 videos from each search were sorted by relevance and evaluated for video source (i.e., professional, personal, or other), target audience (medical professionals or general public), general descriptive statistics (i.e., video length, number of views, number of comments), and for five areas of content determined by the authors to constitute basic patient information regarding a surgical procedure: (1) procedure details, (2) eligibility criteria, (3) alternatives to surgery, (4) surgical risks, and (5) success rate. Accuracy of videos was not assessed. Results Of the 16 videos that met inclusion criteria, only 1 discussed fetoscopic surgery. The majority (62.5%) of videos were produced by a professional source and 81.3% were targeted toward the general public rather than medical professionals. Of the 16 videos, 10 (62.5%) included details regarding the surgery, 3 (18.8%) discussed eligibility criteria, and 8 (50.0%) mentioned alternatives to surgery. Additionally, seven videos (43.8%) discussed risks of the procedure and six (37.5%) included surgical success rate. Conclusion Only 2 of the 16 videos included all five areas of content that were evaluated, and both were in regard to open fetal repair. This study not only calls attention to the initial shortcomings of YouTube videos regarding fetal surgery for neural tube defects but also demonstrates the need for further investigation and more comprehensive analysis.
Infantile pyknocytosis is a rare cause of neonatal hemolytic anemia, which presents in the first few weeks of life. We report a classic case of infantile pyknocytosis that presented to our institution with rebound hyperbilirubinemia after receiving phototherapy. The infant was found to have a hemoglobin of 5.8 g/dL, requiring a total of 15 mL/kg of red blood cells (in 2 separate transfusions) before discharge. The diagnosis was ultimately made by a review of the peripheral blood smear. We review the literature and suggest pediatricians consider infantile pyknocytosis on their differential when hemolytic anemia presents in the newborn period.
Objective As the awareness of the accompanying morbidity of placenta accreta spectrum (PAS) has increased over recent decades. We sought to analyze the precision and reliability of the currently available content regarding PAS on YouTube. Study Design A YouTube search was performed on June 17, 2019 by using the search terms “placenta accreta,” “PAS,” and “invasive placentation.” Search results were sorted by relevance, and up to 200 videos per search term were systematically evaluated by four independent reviewers. A quality assessment checklist relating to aspects of PAS was developed with a Likert's scale from 0 to 12 points to quantify video content. Videos were classified as poor educational quality (grade 0 to ≤4), moderate quality (grade >4–8), and high quality (grade >8–12). Results Of the 318 videos identified, 99 videos met inclusion criteria. The majority of videos (61.6%) were produced by a professional source, that is, appearing to be from a hospital, university, or educational service. Of the remaining videos, 16.2% were classified as personal, that is, posted from personal YouTube accounts and depicting a personal or family member experience, and 22.2% were classified as other. The majority of the “other” category consisted of news segments and short clips from talk shows. Overall, 60.6% of videos were of poor educational quality, 32.3% were of moderate quality, and 7.1% were deemed high quality. All seven of the high-quality videos were produced by a professional source and intended for an audience of medical professionals. There were neither high-quality videos intended for the general public nor the likely affected and relevant patient population. Conclusion This study suggests that the currently available videos on YouTube regarding PAS are poor educational sources for patients seeking information, and demonstrates a need for high-quality content videos produced by medical professionals specifically focused on meeting the needs of patient population. Key Points
tissue repair. At present, the specific nature of astrocyte reactivity after WMI (A1s, A2s, or other) remains obscure. Given recent findings that A1 formation is induced by reactive microglia and that these astrocytes delay oligodendrocyte differentiation and promote neuronal death, we hypothesize that A1s play a central role in WMI and may be an exciting therapeutic target for this disease. Here we report the results of experiments aimed to investigate the formation of A1 astrocytes in WMI. STUDY DESIGN: WMI was induced in 2 day-old rat pups using a combination of hypoxic-ischemic and inflammatory insults. In situ hybridization with A1especific probes was performed on brain tissue from injured and control neonatal rats. We used immunopanning to purify astrocytes from brains of injured and control rats. mRNA isolated from these cells was used for qRT-PCR analysis. RESULTS: In situ hybridization experiments demonstrate a significant increase in the prevalence of A1 astrocytes in subcortical white matter tracts after WMI in our model. An immunopanning protocol optimized for our disease model yields acutely purified viable primary astrocytes from injured and control rat brains. qRT-PCR using mRNA from these cells reveals regulation of A1-specific transcripts over time after injury. CONCLUSION: We demonstrate the formation of A1 reactive astrocytes in a rodent model of WMI. This result is an important step towards understanding astrocyte polarization in WMI. Should ongoing experiments demonstrate that A1 formation is a pivotal step in WMI pathophysiology, this finding will open the door to new therapeutic strategies for the treatment of WMI.
OBJECTIVE: To determine the relationship of Hemoglobin A1c (HbA1c) on universal screening to gestational diabetes (GDM) development. STUDY DESIGN: This is a retrospective cohort study of women undergoing universal HbA1c screening at first prenatal visit < 17 weeks' gestation between December 2016 and April 2018 at a single urban tertiary care center. Women with preexisting diabetes, multiple gestation, hemoglobinopathy, fetal demise, and no glucose tolerance screening were excluded. Women with HbA1c values < 5.7% did routine two-step GDM screening. Women with HbA1c of 5.7-6.4% were asked to do two-step GDM screening upon receipt of their HbA1c results. Positive screens were diagnosed with early GDM. Women with normal early screening underwent repeat screening in the third trimester. The primary outcome was development of GDM. The association between HbA1c and GDM was modeled using logistic regression with HbA1c as both a continuous predictor and dichotomized at the cutoff of 5.7%. RESULTS: 3072 women underwent universal HbA1c screening, and 1921 women met inclusion criteria. There were 237(12.3%) women with an elevated HbA1c. Women with elevated HbA1c were more likely to be older, Black, and obese compared with women with normal HbA1c values (Table 1). Of women with elevated HbA1c, 212(73.9%) women completed early screening, and 21/237(8.9%) were diagnosed with early GDM (Fig 1). 47(19.8%) of women with elevated HbA1c were diagnosed with GDM compared to 85(5.1%) of women with normal HbA1c (p < 0.001). There was no difference in need for insulin in women with GDM based on HbA1c. After adjusting for race, BMI, age, and insurance, the odds of GDM development are 3.50 (95%CI 2.27-5.40) times higher among women with HbA1c 5.7% compared to those with a normal HbA1c. The adjusted odds of GDM increase by 8.27 (95%CI 4.39-15.59) for every 0.1 unit increase in HbA1c. CONCLUSION: An elevated HbA1c on universal screening is associated with an increased risk of GDM. Independent of confounders, the odds of GDM increase by 8-fold for every 0.1 unit increase in HbA1c.
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