Atlantic Health System

About: Atlantic Health System is a healthcare organization based out in Morristown, New Jersey, United States. It is known for research contribution in the topics: Health care & Medicine. The organization has 277 authors who have published 299 publications receiving 6594 citations.

Neuroimmunomodulators in Neuroborreliosis and Lyme Encephalopathy.

Abstract: Background Lyme encephalopathy, characterized by nonspecific neurobehavioral symptoms including mild cognitive difficulties, may occur in patients with systemic Lyme disease and is often mistakenly attributed to central nervous system (CNS) infection. Identical symptoms occur in many inflammatory states, possibly reflecting the effect of systemic immune mediators on the CNS. Methods Multiplex immunoassays were used to measure serum and cerebrospinal fluid (CSF) cytokines in patients with or without Lyme disease to determine if there are specific markers of active CNS infection (neuroborreliosis), or systemic inflammatory mediators associated with neurobehavioral syndromes. Results CSF CXCL13 levels were elevated dramatically in confirmed neuroborreliosis (n = 8), less so in possible neuroborreliosis (n = 11) and other neuroinflammatory conditions (n = 44). Patients with Lyme (n = 63) or non-Lyme (n = 8) encephalopathy had normal CSF findings, but had elevated serum levels of interleukins 7, 17A, and 17F, thymic stromal lymphopoietin and macrophage inflammatory protein-α. Conclusions CSF CXCL13 is a sensitive and specific marker of neuroborreliosis in individuals with Borrelia-specific intrathecal antibody production. However, it does not distinguish individuals strongly suspected of having neuroborreliosis, but lacking confirmatory intrathecal antibodies, from those with other neuroinflammatory conditions. Patients with mild cognitive symptoms occurring during acute Lyme disease, and/or after appropriate treatment, have normal CSF but elevated serum levels of T-helper 17 markers and T-cell growth factors, which are also elevated in patients without Lyme disease but with similar symptoms. In the absence of CSF abnormalities, neurobehavioral symptoms appear to be associated with systemic inflammation, not CNS infection or inflammation, and are not specific to Lyme disease.

Long-Term Outcomes of Robotic-Assisted Laparoscopic Sacrocolpopexy Using Lightweight Y-Mesh.

Abstract: Objective The objective of this study was to describe anatomic and symptomatic outcomes at 5 years or longer after robotic-assisted laparoscopic sacrocolpopexy using very lightweight polypropylene Y-mesh. Methods A prospective analysis of consecutive patients who underwent surgery at a single center between 2007 and 2011 was performed. Patients consented to objective and subjective assessment at 5 years or longer postoperatively. Surgical success was defined as meeting all of the following: (1) no retreatment for pelvic organ prolapse (POP) since surgery, (2) no prolapse beyond the introitus, (3) no apical descent below -5, and (4) no prolapse symptoms reported. Secondary outcome measures included Sandvik Incontinence Severity Index, the PFDI-20, the PFIQ-7, the PISQ-12, and the SSQ-8), rates of dyspareunia, mesh complications, and subjects' need for any surgical or nonsurgical prolapse treatment since their index surgery. Results Eighty percent of the potential study group (253/316) presented for examination and subjective assessment at 5 years or longer after their index surgeries.The surgical success rate was 226 (89.3%) of 253 with no apical failures. Only 4.4% (11/253) of the group met both objective and subjective failure criteria. Sixteen patients were classified as surgical failure owing to subjective criteria alone despite having no significant objective prolapse on examination. Ten patients (4%) elected to undergo subsequent POP repair. These operations consisted of 5 native tissue anterior repairs and 5 native tissue posterior repairs. In addition, 1 patient elected to use a pessary for recurrent anterior POP. The remaining 16 patients who experienced surgical failure elected no further prolapse treatment. Conclusions Robotic-assisted laparoscopic sacrocolpopexy using very lightweight mesh provided excellent long-term results with no mesh-related complications.

Hypertension in Childhood

Abstract: 1. Leonard G. Feld, MD, PhD* 2. Howard Corey, MD† 1. *Editorial Board 2. †Director, Pediatric Nephrology, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ After completing this article, readers should be able to: 1. Describe the practical approach to confirming the diagnosis of hypertension. 2. Delineate the differential diagnosis and diagnostic approach for a child who has significant hypertension. 3. Discuss the role of the pediatrician in advising the parents and child/adolescent on the nonpharmacologic approach to treating hypertension. 4. List the primary classes of antihypertensive medications to treat hypertension in childhood. David is a 10-year-old boy who complains of frequent headaches. He generally is healthy, but he is overweight and has an anxiety disorder. There is a strong family history of hypertension. On physical examination, the seated blood pressure (BP) using a child-size cuff and an automated noninvasive blood pressure monitor is 140/85 mm Hg. Suspecting hypertension as the cause of the headache, his physician refers David to a pediatric nephrologist for additional investigation . On the initial physical examination, the seated BP reading using an adult-size cuff and a manual aneroid manometer is 135/80 mm Hg. A second reading, taken 15 minutes later, is 122/72 mm Hg. His body mass index (BMI) exceeds the 95th percentile for age. The remainder of the physical examination findings are unremarkable . Subsequently, a 24-hour ambulatory blood pressure monitor (ABPM) reveals that 35% of the daytime readings exceed the 95th percentile for age, sex, and height, confirming the diagnosis of hypertension. Echocardiography reveals mild left ventricular hypertrophy (LVH), but otherwise shows normal results, as do blood chemistries, urinalysis, plasma renin activity, catecholamine measurement, and renal ultrasonography. However, the plasma uric acid concentration is mildly elevated at 6.6 mg/dL (0.39 mmol/L) . In the 3 decades since the first Report of the Task Force on Blood Pressure Control in Children , the guidelines for pediatric hypertension have been clarified, diagnostic evaluation has been refined, and therapeutic options have been expanded. Increasing …

School Nurse Knowledge and Perceptions of Recurrent Abdominal Pain: Opportunity for Therapeutic Alliance?

Abstract: Recurrent abdominal pain of childhood affects up to 15% of school-age children, who face significant psychosocial consequences, including school absence. Because assessment of recurrent abdominal pain is frequently made at the school nurse level, a questionnaire was sent to 425 school nurses to evaluate perceptions about recurrent abdominal pain. Among the responses, 47.1% believed children were faking or seeking attention; 3.6% considered it a serious disease, 77.9% stated that affected children should see a physician, 51.5% believed they should relax, and 25.0% believed they needed medicine. Results indicated that school nurses were unclear on epidemiologic and etiologic features of recurrent abdominal pain and had negative views that may inadvertently contribute to the anxiety felt by affected children. Education of school nurses and communication from physicians may advance strategies designed to reduce the fiscal and social costs associated with this common childhood condition.

Variations in time to receiving first surgical treatment for breast cancer as a function of racial/ethnic background: a cohort study

Abstract: ObjectiveTo evaluate surgical treatment delay disparities by race/ethnic group in a group of breast cancer patients treated in the New York region.DesignCohort study.SettingTwo affiliated hospitals in the New York region.ParticipantsPatients admitted at two affiliated hospitals in the New York region for breast cancer treatment during 2007–2011.Main outcome measureTime to receiving first surgery for breast cancer, defined as the time in days between initial diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Predicted time to first surgery by race group was also analysed using a multivariate linear regression model with adjustments made for several demographic and clinical factors.ResultsTotally, 3071 patients who were first treated with surgery were identified. Racial background was classified as White, African American or Asian/other. Overall median time to surgery was 28 days: 28 days in whites, and 34 and 29 days in African Americans and Asian/others, respectively (p = 0.0...