Mease Countryside Hospital

Introduction: Management of IBD is complex, commonly involving multidisciplinary care including chronic medications, surgery, and psychological support. The aim of this study is to characterize the natural history and management paradigms for IBD utilized in usual clinical practice. Methods: TARGET-IBD is a longitudinal, observational study of pediatric and adult patients with IBD managed according to local standards at academic (n=21) and community (n=14) sites in the US. In a combined retrospective/prospective design, the redacted medical record (structured and unstructured data) from consented patients, including narratives, laboratory, endoscopic, pathology, infusion records, and imaging data utilized for IBD diagnosis and treatment are abstracted into a unique centralized data core. Patient reported outcomes are assessed prospectively. Interventions for IBD, adverse events, and disease progression are longitudinally assessed. Results: Between 7/2017 and 5/2018, 667 patients were enrolled including 410 (61.5%) with Crohn's Disease (CD), 250 (37.5%) with Ulcerative Colitis (UC), and 7 (1.0%) with Indeterminate Colitis (IBDU). Median duration of disease is 10.0 yrs (0-62 range). Mean age is 45 yrs (18-91) with 16.1% older than age 65. 44.5% are male, with a racial distribution of White (85.3%), Black (8.8%), and Asian (1.3%). 1.8% are of Hispanic ethnicity. Distribution of disease involvement for those with CD was 18.7% colon, 56.7% ileocolon, and 22.4% ileum. Fistulizing disease and stricturing was noted in 24.6% and 27.1%, respectively. Upper GI tract involvement was reported in 16.8% of patients. Among those with UC, 48% had pancolitis, 41% had left sided colitis, and 9% had disease limited to proctitis. Frequent comorbid medical conditions included hypertension (20.7%), anemia (16.2%), and depression (13.8%). IBD treatment at enrollment by drug class and diagnosis includes 5-ASA (70.4% UC, 24.1% CD), Antibiotics (2.8%, 6.8%), Steroids (32.4%, 25.1%), Thiopurine (26.0%, 30.5%), Methotrexate (4.4%, 9.0%), Anti-TNF (31.6%, 50.5%), Anti-integrin (14.0%, 9.8%), and Anti-IL-12/23 (0.4%, 6.8%). Clinical characteristics between participating academic and community centers are shown in Table A. Conclusion: TARGET-IBD, a novel prospective observational cohort of patients with IBD, is evaluating treatment patterns in both academic and community settings. Ongoing recruitment and longitudinal follow up of this cohort will provide an important resource for comparative effectiveness and safety data.587 Figure 1 No Caption available.

Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD. We studied the value and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD during pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during management. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2 (D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max correlated with rCO2 max (r = −0.350) and rSO2 max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted rCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic oxygenation were feasible and improved the monitoring of therapeutic interventions for children with SCD during pain crisis.

There are only a few case reports in the literature describing the migration of metallic surgical clips into the common bile duct. Diagnosis of this postcholecystectomy complication is usually made during ERCP. We describe the identification on CT scan of a migratory surgical clip in the common bile duct in a patient with biliary colic.