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Browsing by Author "Holland, Kathleen"
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Item Microbial rRNA sequencing analysis of evaporative cooler indoor environments located in the Great Basin Desert region of the United States(Royal Society of Chemistry, 2017-02-22) Lemons, Angela R.; Hogan, Mary Beth; Gault, Ruth A.; Holland, Kathleen; Sobek, Edward; Olsen-Wilson, Kimberly A.; Park, Yeonmi; Park, Ju-Hyeong; Gu, Ja Kook; Kashon, Michael L.; Green, Brett J.; Pediatrics, School of MedicineRecent studies conducted in the Great Basin Desert region of the United States have shown that skin test reactivity to fungal and dust mite allergens are increased in children with asthma or allergy living in homes with evaporative coolers (EC). The objective of this study was to determine if the increased humidity previously reported in EC homes leads to varying microbial populations compared to homes with air conditioners (AC). Children with physician-diagnosed allergic rhinitis living in EC or AC environments were recruited into the study. Air samples were collected from the child's bedroom for genomic DNA extraction and metagenomic analysis of bacteria and fungi using the Illumina MiSeq sequencing platform. The analysis of bacterial populations revealed no major differences between EC and AC sampling environments. The fungal populations observed in EC homes differed from AC homes. The most prevalent species discovered in AC environments belonged to the genera Cryptococcus (20%) and Aspergillus (20%). In contrast, the most common fungi identified in EC homes belonged to the order Pleosporales and included Alternaria alternata (32%) and Phoma spp. (22%). The variations in fungal populations provide preliminary evidence of the microbial burden children may be exposed to within EC environments in this region.Item Proactive measurement of infliximab drug levels in children with Crohn’s disease(Hellenic Society of Gastroenterology, 2022-01) Holland, Kathleen; Bennett, William E.; Slaven, James E.; Collier, John; Waltz, Gail; Pfefferkorn, Marian; Pediatrics, School of MedicineBackground Proactively monitoring infliximab levels is an emerging area of interest in pediatric Crohn’s disease. There are only limited data on therapeutic drug monitoring for children with Crohn’s disease. The goal of our study was to determine the utility of therapeutic drug monitoring in achieving clinical remission in a cohort of pediatric Crohn’s disease patients receiving infliximab. Methods This prospective single-center study enrolled 37 patients with Crohn’s disease at the start of infliximab infusions and monitored trough levels at 6-month intervals for 18 months. Each participant was matched to a historic control for the modified pediatric Crohn’s disease activity index (mPCDAI) at baseline, age and sex. The primary outcome was an mPCDAI score of ≤7.5 at 6, 12 and 18 months. A multivariate logistic regression analysis was performed. Results Data were available for all 37 cases at 6 and 12 months and for 34 cases at 18 months. Demographics and disease characteristics were similar between groups. All 34 cases demonstrated clinical remission at 18 months (100% vs. 88%, P=0.114). Univariate and multivariate analyses did not show statistical significance. Dose intensification was seen more often in the cases at 18 months. Conclusion All of our moderate-to-severe pediatric Crohn’s disease patients who received prospective therapeutic drug monitoring of infliximab were in clinical remission at follow up, but this was not statistically significantly different from the 88% clinical remission rate of the control group.Item Varied Presentations and Comorbidities in Pediatric Autoimmune Pancreatitis(Wolters Kluwer, 2021) Suter, Blair; Patel, Feenalie; Holland, Kathleen; Brown, Brandon P.; Bhatt, Heli; Puri, Kanika; McFerron, Brian; Vanderpool, Charles; Pediatrics, School of MedicineAutoimmune pancreatitis (AIP) is a chronic inflammatory condition rarely reported in children. In 2018, to standardize the approach to AIP, INternational Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) defined AIP, outlined the clinical course, and developed diagnostic and therapeutic recommendations. We performed a retrospective review of cases at our institution from January 1, 2016, to June 1, 2019, and compared their presentations with the INSPPIRE guidelines. Our patients showed variable laboratory, radiographic, and histologic findings, highlighting the difficulty in diagnosing AIP. Histologic samples were obtained in our patients due to diagnostic uncertainty, which ultimately confirmed the diagnosis. One patient was diagnosed with autoimmune hepatitis coexistent with AIP, which has not been previously described in the pediatric population. Exocrine and endocrine complications of AIP were also noted. In all cases, symptoms improved following treatment, and decompression of the common bile duct was seen on repeat imaging. Autoimmune pancreatitis (AIP) is a chronic inflammatory condition rarely reported in children. Cases of AIP at a single academic center were reviewed from January 01, 2016, to June 01, 2019. The aim of this report is to describe differences in presentation and diagnostic considerations of pediatric AIP while illustrating comorbid conditions that can occur.