Children with ASD have small but measurable objective differences in their sleep parameters that are consistent with subjective reporting. Children with ASD have shorter TST, longer SL periods, and decreased SE as compared with TD peers. Concurrent ID, medication use, method of data collection, and age of subjects significantly moderated these results. The decrease in TST in children with ASD and normal intelligence was not significant as compared with TD peers, suggesting that ID may help explain the shortened TST in children with ASD.

Acute otitis media (AOM) symptoms can be masked by communication deficits, common to children with autism spectrum disorders (ASD). We sought to evaluate the association between ASD and otitis media. Using ICD-9-CM diagnostic codes, we performed a retrospective case-cohort study comparing AOM, and otitis-related diagnoses among children with and without ASD. Children with ASD had a significantly increased rate of AOM, otitis media with effusion, otorrhea, and PE tube placement. Children with ASD were more than twice as likely to develop mastoiditis, and to undergo mastoidectomy and tympanoplasty. Children with ASD are more likely to have middle ear infections and otitis-related complications, highlighting the importance of routine middle ear examinations and close attention to hearing impairment in this population.

Children with ASD are more likely to be given a sleep disorder diagnosis including SDB and are more likely to undergo related diagnostic and surgical procedures compared with controls without ASD.

Objective Following thyroid lobectomy, patients are at risk for hypothyroidism. This study sought to determine the incidence of postlobectomy thyroid hormone replacement as well as predictive risk factors to better counsel patients. Study Design Retrospective cohort study. Setting Patients aged 18 to 75 years treated in a single academic institution who underwent thyroid lobectomy from October 2006 to September 2017. Methods Patients were followed for an average of 73 months. Demographic data, body mass index, size of removed and remnant lobe, preoperative thyroid-stimulating hormone (TSH) level, final thyroid pathology, and presence of thyroiditis were collected and analyzed. Risk factors were evaluated with chi-square analyses, t tests, logistic regression, and Kaplan-Meier analysis. Results Of the 478 patients reviewed, 369 were included in the analysis, 30% of whom eventually required thyroid hormone replacement. More than 39% started therapy >12 months postoperatively, with 90% treated within 36 months. Patient age ≥50 years and preoperative TSH ≥2.5 mIU/L were associated with odds ratios of 2.034 and 3.827, respectively, for thyroid hormone replacement. Malignancy on final pathology demonstrated an odds ratio of 7.76 for hormone replacement. Sex, body mass index, volume of resected and remaining lobes, and weight of resected lobe were not significant predictors. Conclusion Nearly a third of patients may ultimately require thyroid hormone replacement. Age at the time of surgery, preoperative TSH, and final pathology are strong, clinically relevant predictors of the need for future thyroid hormone replacement. After lobectomy, patients should have long-term thyroid function follow-up to monitor for delayed hypothyroidism.

Disruptive behavior disordersCase You are seeing a previously healthy 4-year-old William in your office for behavior problems at preschool and at home. This is the third preschool he has attended after having been asked to leave his prior two for out of control behavior. His mother reports that he refuses to comply with her directions and will argue with her when confronted. He frequently is involved in physical altercations in his preschool class. He tells his teacher at school and his mother that they are Bstupid^and that he hates them. His mother has brought William in today because she feels that she is at her Bwit's end^and his teacher thinks Bhe needs to be medicated.^Vanderbilt scales from his mother and teacher indicate attention-deficit hyperactivity disorder, combined inattentive, and hyperactive type. You note that the oppositional defiant disorder (ODD) screen is positive for both mother and teacher. On further discussion, his mother states that she and William's father are divorced and that they differ significantly in their parenting styles. She admits she has mostly Bgiven up^on correcting her son's behavior, but his father is extremely strict and Bon him all the time.Ŷ ou discuss the importance of consistent parenting with the mother and recommend that the child and both parents establish care with a mental health professional for Parent Management Training (PMT). You also provide recommendations for parenting books. You discuss with William's mother that you would consider starting a stimulant attention-deficit hyperactivity disorder (ADHD) medication if behavioral interventions do not improve his functioning and plan to see him back in 3 months.

No abstract

In the COVID-19 era, preprocedural patients are almost uniformly screened for symptoms, asked to quarantine preoperatively, and then undergo a test of uncertain validity with very low pretest probability. A small percentage of these tests return positive. As a result, surgical procedures are delayed and patients are required to quarantine. Are these asymptomatic patients truly positive for COVID-19? What are the impacts of these test results on the patient and the health care system? In the following commentary, we review how the uncertain validity of reverse transcription polymerase chain reaction testing combined with a low-prevalence population predisposes for false-positive results. As a mitigation strategy, we ask that readers refocus on the fundamental principal of diagnostic testing: pretest probability.

Rajrgowda have disclosed no financial relationships relevant to these cases. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.