Lehigh Valley Hospital

Abstract Background Mycoplasma pneumoniae is a common cause of respiratory illness in children. During the COVID-19 pandemic, M. pneumoniae infections decreased globally. In the Fall of 2023, various countries identified a reemergence of this bacterium. At Lehigh Valley Health Network (LVHN), the emergency departments and the children’s hospital experienced an increase of Mycoplasma infections starting in late Spring of 2024. The aim of this study was to compare the percentage of positive M. pneumoniae PCR results to determine if there was a significant local increase in the number of Mycoplasma infections over the past year. Figure showing the total number of PCR multiplex tests performed (left axis) and the percentage of positive Mycoplasma pneumoniae PCR tests (right axis) from March 2022 through March 2025. Methods A retrospective review of M. pneumoniae PCR tests from the BIOFIRE RP2.1™ Panel (BioFire Diagnostics, Salt Lake City, Utah) was performed in patients younger than 18 years who had testing performed at LVHN emergency departments and inpatient pediatric units. Available test results were reviewed starting from March 2022, when the institution began using the multiplex panel that included M. pneumoniae, through March 2025. Results During 2022 and 2023, the weekly M. pneumoniae PCR positivity remained below 1%. The weekly PCR positivity rate started increasing in Spring 2024 and reached a peak of 7.1% in August 2024 despite a lower number of tests performed (182 tests). The percentage of positive PCR tests remained elevated until late October 2024, with a PCR positivity of 5.9%. From March 31, 2024 to March 29, 2025, 250 children tested positive for M. pneumoniae. This is compared to only 15 positive PCR tests during the same time period the year prior and 6 positive tests the year before that. The mean weekly positivity rate between March 31, 2024 and March 29, 2025 was 1.98 compared to 0.13 the prior year (p < 0.0001). Conclusion Following a period of minimal M. pneumoniae activity after the COVID-19 pandemic, the percentage of M. pneumoniae positive PCR test results significantly increased in our community over the last year. During a time with low testing and low circulation of other respiratory viruses, there was a notable peak of Mycoplasma infection during the Summer of 2024 which continued into the late Fall. Further monitoring is needed to evaluate the periodicity of Mycoplasma infection in the post-pandemic period. Disclosures All Authors: No reported disclosures

Central nervous system (CNS) tumors are associated with considerable morbidity and high mortality. Cyclin-dependent kinases (CDKs) regulate cell division in cancer, and CDK4/6 inhibitors are used for the treatment of breast cancer, representing an attractive therapy for different tumor types. Here, we report mature results of a multicenter basket trial exploring the CDK4/6 inhibitor abemaciclib in patients with recurrent CNS tumors, including patients with glioma, primary CNS lymphoma, meningioma, and ependymoma. We expanded our cohort of meningioma patients based on preliminary evidence for activity. Patients were treated with 200 mg oral abemaciclib twice daily for days 1-28, following FDA recommendations for breast cancer. Primary outcomes included radiographic response rates and progression-free survival (PFS) at 6 months post-treatment. We also evaluated overall survival (OS) and toxicity. Exploratory outcomes included next-generation sequencing of tumor biopsies. Most cohorts did not demonstrate activity with the exception of the cohort of patients with recurrent meningioma, including patients with grade 2 or 3 disease (19/22 meningioma patients). In that group, the median PFS was 15 months (95% CI: 6.5, not reached) and median OS was 32.9 months (95% CI: 10.7, not reached); the 6-month PFS was 68.2% (95% CI: 51.3%, 90.7%). All 22 patients were evaluable for radiographic response, showing stable disease in 16/22 (73%) and progressive disease in 6/22 patients (27%). Our data suggest that abemaciclib improves PFS and OS in patients with advanced meningioma. The 6-month PFS with abemaciclib in this study (68.2%) exceeded RANO proposed benchmarks for activity (49%). NCT03220646.

The use of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation is steadily increasing. However, the outcomes of TEER among patients with atrial fibrillation (AF), including readmission trends, remain unknown. The Nationwide Readmissions Database was queried between 2016 and 2020 to identify TEER patients with and without AF. The 2 groups were then compared using propensity score matching and multivariate regression models. The outcomes included inhospital mortality, ` (AKI), heart failure (HF), acute stroke, myocardial infarction, postprocedure bleeding, and cardiac tamponade. A total of 39,867 TEER procedure recipients were included over the study period, of which, 24,729 (62%) had AF compared to 15,138 (38%) with no AF diagnosis. On adjusted analysis, the AF group had a higher rate of inpatient mortality, AKI, HF, and postprocedural bleeding. On the contrary, TEER with AF group had lower odds of myocardial infarction. The risk of stroke and cardiac tamponade was similar between the 2 groups. The median length of stay (LOS) at index hospitalization was longer in the AF cohort in comparison with those without [2 days (interquartile range: 5-1) vs. 1 day (interquartile range: 3-1)]. AF in TEER procedure recipients was associated with worse outcomes including a higher rate of inpatient mortality, AKI, and HF compared with the patients without AF. Readmission rates at 30, 90, and 180 days were similar between the 2 groups.

Abstract Introduction: Scurvy, caused by vitamin C deficiency, is traditionally associated with fatigue, bleeding, and skin changes. However, its atypical presentations, particularly in elderly patients, can complicate diagnosis and management. This case report highlights an unusual presentation of scurvy in a 72-year-old female, emphasizing the significance of identifying concurrent nutritional deficiencies. Case Presentation: A 72-year-old female presented to the emergency department with altered mental status and a rash. Her medical history included hypertension and hyperlipidemia. Initial laboratory tests revealed leukocytosis, acute kidney injury (AKI), and elevated lactate levels. Imaging studies, including CT and MRI of the brain, showed chronic small vessel disease and volume loss with white matter changes. Given concerns for a central nervous system infection, the patient was initiated on broad-spectrum antibiotics and acyclovir. Despite treatment, her mental status did not improve. A lumbar puncture revealed elevated protein and glucose levels, but cultures were negative. A skin biopsy suggested mild perivascular neutrophilic inflammation, raising concerns for leukocytoclastic vasculitis; however, direct immunofluorescence results were non-specific. Rheumatological evaluation yielded elevated IgA and IgE levels, yet other findings were unremarkable. Empiric corticosteroid therapy was initiated, but the patient's condition worsened, leading to progressive thrombocytopenia. Subsequent investigations revealed severe deficiencies in vitamins C and A. These deficiencies were correlated with her clinical presentation of acute encephalopathy, thrombocytopenia, and skin rash, highlighting the interplay between nutritional status and systemic symptoms. Discussion: This case illustrates the atypical presentation of scurvy, which can manifest as cognitive decline and hematological abnormalities, as reported in the literature. Severe vitamin C deficiency can lead to cognitive impairment and isolated thrombocytopenia due to impaired collagen synthesis and vascular fragility (Pitt et al., 2013; Hale et al., 2018). Vitamin A deficiency can exacerbate cognitive issues and contribute to skin manifestations (Michaud et al., 2017). The overlap of symptoms from these deficiencies can lead to misdiagnosis, necessitating a comprehensive nutritional assessment. With the diagnosis of scurvy established, vitamin repletion was initiated, leading to gradual cognitive improvement over several days. Conclusion: Scurvy can present in complex and atypical ways, particularly in older adults. Clinicians must remain vigilant for signs of nutritional deficiencies, as timely diagnosis and intervention are crucial for improving patient outcomes. This case underscores the importance of recognizing the multifaceted nature of nutritional deficiencies in clinical practice.

Mucopolysaccharidosis type IVA (MPS IVA) is an autosomal congenital metabolic lysosomal disease caused by a deficiency of the N-acetyl-galactosamine-6-sulfate sulfatase (GALNS) gene, leading to severe skeletal dysplasia. The available therapeutics for patients with MPS IVA, enzyme replacement therapy and hematopoietic stem cell transplantation, revealed limitations in the impact of skeletal lesions. Our previous study, a significant leap forward in MPS IVA research, showed that liver-targeted adeno-associated virus (AAV) gene transfer of human GALNS (hGALNS) restored GALNS enzymatic activity in blood and multiple tissues and partially improved the aberrant accumulation of storage materials. This promising approach was further validated in our current study, where we delivered AAV8 vectors expressing hGALNS, under the control of a liver-specific or ubiquitous promoter, into MPS IVA murine disease models. The results were highly encouraging, with both AAV8 vectors leading to supraphysiological enzymatic activity in plasma and improved cytoplasmic vacuolization of chondrocytes in bone lesions of MPS IVA mice. Notably, the ubiquitous promoter constructs, a potential game-changer, resulted in significantly greater enzyme activity levels in bone and improved pathological findings of cartilage lesions in these mice than in a liver-specific one during the 12-week monitoring period, reinforcing the positive outcomes of our research in MPS IVA treatment.

BackgroundImplantable cardioverter-defibrillators last longer, and interest in reliable leads with targeted lead placement is growing. The OmniaSecure defibrillation lead is a novel, small-diameter, catheter-delivered lead designed for targeted placement, based on the established SelectSecure SureScan MRI Model 3830 lumenless pacing lead platform. ObjectiveThis trial assessed safety and efficacy of the OmniaSecure defibrillation lead. MethodsThe worldwide LEADR pivotal clinical trial enrolled patients indicated for de novo implantation of a primary or secondary prevention implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator, all of whom received the study lead. The primary efficacy end point was successful defibrillation at implantation per protocol. The primary safety end point was freedom from study lead–related major complications at 6 months. The primary efficacy and safety objectives were met if the lower bound of the 2-sided 95% credible interval was >88% and >90%, respectively. ResultsIn total, 643 patients successfully received the study lead, and 505 patients have completed 12-month follow-up. The lead was placed in the desired right ventricular location in 99.5% of patients. Defibrillation testing at implantation was completed in 119 patients, with success in 97.5%. The Kaplan-Meier estimated freedom from study lead–related major complications was 97.1% at 6 and 12 months. The trial exceeded the primary efficacy and safety objective thresholds. There were zero study lead fractures and electrical performance was stable throughout the mean follow-up of 12.7 ± 4.8 months (mean ± SD). ConclusionThe OmniaSecure lead exceeded prespecified primary end point performance goals for safety and efficacy, demonstrating high defibrillation success and a low occurrence of lead-related major complications with zero lead fractures.

Although severe acute respiratory syndrome coronavirus 2 is primarily known for its significant and potentially fatal pulmonary manifestations, case reports and literature review have linked the infection to multiple organ systems, including hematological manifestations. Scattered among these reports are cases of lymphopenia and neutropenia as well as evidence of children presenting in hypercoagulable states related to COVID-19. We present a case describing a pediatric patient who presented with leukopenia, thrombocytopenia, and severe neutropenia: a unique combination based on the current literature.