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Article: Increased Incidence and Severity of New Graves Disease Diagnoses in Youth During the COVID-19 Pandemic.

Donner, Julia R / Has, Phinnara / Topor, Lisa Swartz

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2023 Volume 29, Issue 5, Page(s) 349–352

Abstract: Objective: Graves disease (GD), an autoimmune disease of the thyroid, is likely caused by a combination of genetic predisposition and environmental triggers. Recent data suggest that COVID-19 may be associated with the development of autoimmune disease. ...

Abstract	Objective: Graves disease (GD), an autoimmune disease of the thyroid, is likely caused by a combination of genetic predisposition and environmental triggers. Recent data suggest that COVID-19 may be associated with the development of autoimmune disease. The aim of this study was to assess the incidence and characteristics of new GD diagnoses in youth prior to and during the COVID-19 pandemic. Methods: We performed a retrospective chart review of all new GD diagnoses in patients aged 0 to 18 years diagnosed at a tertiary care pediatric hospital between January 1, 2018, and December 31, 2021. Results: Over a 4-year period, 51 patients had been diagnosed with new-onset GD. We observed an increased incidence in new-onset GD during the pandemic compared with that in the 2 prior years (P = .01). During the pandemic period, heart rates (P = .03) as well as systolic (P = .005) and diastolic (P = .01) blood pressures were higher at initial evaluation, patients more frequently reported palpitations (P = .03) and tremors (P = .04), and an increased proportion of patients required beta-blockade treatment at diagnosis (P = .002). The percentage of patients requiring thionamide treatment and thionamide doses had been similar over time. Conclusion: We identified an increase in new-onset pediatric GD diagnoses during the COVID-19 pandemic. In addition, youths had increased severity of symptoms and more frequently required beta-blockade treatment at diagnosis. Further study of the relationship between COVID-19 and autoimmune thyroid disease is needed.
MeSH term(s)	Humans ; Adolescent ; Child ; Pandemics ; Retrospective Studies ; Incidence ; COVID-19/epidemiology ; COVID-19/complications ; Graves Disease/complications ; Autoimmune Diseases/complications
Language	English
Publishing date	2023-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.1016/j.eprac.2023.01.011
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Article ; Online: Neonatal Outcomes are Similar between Patients with Resolved and Those with Persistent Oligohydramnios.

Whelan, Anna R / Has, Phinnara / Savitz, David A / Danilack, Valery A / Lewkowitz, Adam K

American journal of perinatology

2024

Abstract: Objective: Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing ... ...

Abstract	Objective: Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing perinatal outcomes in patients who are diagnosed with oligohydramnios that resolves and those who have persistent oligohydramnios. Study design: This is a secondary analysis of a National Institutes of Health-funded retrospective cohort study of singleton gestations delivered at a tertiary care hospital between 2002 and 2013 with mild hypertensive disorders and/or fetal growth restriction (FGR). Maternal characteristics, delivery, and neonatal information were abstracted by trained research nurses. Patients with a diagnosis of oligohydramnios were identified, and those with resolved versus persistent oligohydramnios at the time of delivery were compared. The primary outcome was a composite of neonatal resuscitation at delivery: administration of oxygen, bag-mask ventilation, continuous positive airway pressure, intubation, chest compression, or cardiac medication administration. Secondary outcomes included FGR, timing, and mode of delivery. Results: Of 527 women meeting study criteria, 42 had oligohydramnios that resolved prior to delivery, whereas 485 had persistent oligohydramnios. There were no significant differences in patient demographics between groups. The gestational age at diagnosis was significantly lower for patients with resolved versus persistent oligohydramnios (median: 33.0 [interquartile range, IQR: 29.1-35.9] vs. 38.0 [IQR: 36.4-39.3], Conclusion: Patients whose oligohydramnios resolved were diagnosed earlier yet had similar rates of neonatal resuscitation but higher rates of FGR than those who had persistent oligohydramnios. Key points: · When diagnosed earlier in pregnancy, oligohydramnios was more likely to resolve prenatally.. · Patients who were diagnosed with oligohydramnios earlier in pregnancy had higher rates of FGR.. · There were no differences in the rates of the composite outcome of need for neonatal resuscitation when comparing those with resolved versus those with persistent oligohydramnios. No differences in composite neonatal morbidity were noted between those with resolved versus persistent oligohydramnios..
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-2278-8948
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Article ; Online: Combination of 68Ga-FAPI-04 and Dedicated Breast PET (MAMMI PET) Outperformed Breast MRI and 18F-FDG PET/CT by Revealing Nipple and Skin Involvement of Breast Cancer.

Has Simsek, Duygu / Oflas, Melis / Yilmaz, Ravza / Tukenmez, Mustafa / Kuyumcu, Serkan

Clinical nuclear medicine

2024

Abstract: Abstract: A 41-year-old woman with newly diagnosed breast cancer had suspicious clinical findings of skin involvement on physical examination. The primary tumor had no FDG uptake in 18F-FDG PET/CT. Nipple and skin had no pathologic enhancement for ... ...

Abstract	Abstract: A 41-year-old woman with newly diagnosed breast cancer had suspicious clinical findings of skin involvement on physical examination. The primary tumor had no FDG uptake in 18F-FDG PET/CT. Nipple and skin had no pathologic enhancement for invasion in breast MRI. Because the T stage was unclear, the patient underwent 68Ga-FAPI-04 PET/CT for further evaluation. Combination of 68Ga-FAPI-04 with dedicated breast PET (MAMMI PET) showed nipple and skin involvement of breast cancer with intense FAPI uptake. Consequently, a skin-sparing mastectomy was performed. Histopathological examination confirmed invasive lobular carcinoma infiltration of the deep dermis in the nipple and skin tissue.
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	197628-x
ISSN	1536-0229 ; 0363-9762
ISSN (online)	1536-0229
ISSN	0363-9762
DOI	10.1097/RLU.0000000000005088
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Article: Prenatal Diagnosis and Findings in Ureteropelvic Junction Type Hydronephrosis.

Has, Recep / Sarac Sivrikoz, Tugba

Frontiers in pediatrics

2020 Volume 8, Page(s) 492

Abstract: The widespread use of obstetric ultrasonography has increased the detection rate of antenatal ... clinically important. Ultrasound has made differential diagnosis possible to some extent. Ureteropelvic ...

Abstract	The widespread use of obstetric ultrasonography has increased the detection rate of antenatal hydronephrosis. Although most cases of antenatal hydronephrosis are transient, one third persists and becomes clinically important. Ultrasound has made differential diagnosis possible to some extent. Ureteropelvic junction type hydronephrosis (UPJHN) is one of the most common cause of persistent fetal hydronephrosis and occurs three times more in male fetuses. It is usually sporadic and unilateral. However, when bilateral kidneys are involved and presents with severe hydronephrosis, the prognosis may be poor. Typical ultrasound findings of UPJHN is hydronephrosis without hydroureter. The size and appearance of the fetal bladder is usually normal without thickening of the bladder wall. Several grading systems are developed and increasingly being used to define the severity of prenatal hydronephrosis and provides much more information about prediction of postnatal renal prognosis. If fetal urinary tract dilation is detected; laterality, severity of hydronephrosis, echogenicity of the kidneys, presence of ureter dilation should be assessed. Bladder volume and emptying, sex of the fetus, amniotic fluid volume, and presence of associated malformations should be evaluated. Particularly the ultrasonographic signs of renal dysplasia, such as increased renal parenchymal echogenicity, thinning of the renal cortex, the presence of cortical cysts, and co-existing oligohydramnios should be noticed. Unfortunately, there is no reliable predictor of renal function in UPJHN cases. Unilateral hydronephrosis cases suggesting UPJHN are mostly followed up conservatively. However, the cases with bilateral involvement are still difficult to manage. Timing of delivery is also controversial.
Language	English
Publishing date	2020-09-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2020.00492
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Article ; Online: Advances in understanding the molecular basis of skin fragility [version 1; referees

Cristina Has

F1000Research, Vol

2 approved]

2018 Volume 7

Abstract: Skin fragility refers to a large group of conditions in which the ability of the skin to provide protection against trivial mechanical trauma is diminished, resulting in the formation of blisters, erosions, wounds, or scars. Acquired and physiological ... ...

Abstract	Skin fragility refers to a large group of conditions in which the ability of the skin to provide protection against trivial mechanical trauma is diminished, resulting in the formation of blisters, erosions, wounds, or scars. Acquired and physiological skin fragility is common; genetic disorders are rare but give insight into the molecular mechanisms ensuring skin stability. The paradigm is represented by inherited epidermolysis bullosa. This review is focused on recent advances in understanding the molecular basis of genetic skin fragility, including emerging concepts, controversies, unanswered questions, and opinions of the author. In spite of the advanced knowledge on the genetic causes of skin fragility, the molecular pathology is still expanding. Open questions in understanding the molecular basis of genetic skin fragility are the following: what are the causes of phenotypes which remain genetically unsolved, and what are the molecular modifiers which might explain phenotypic differences among individuals with similar mutations? New mutational mechanisms and new genes have recently been discovered and are briefly described here. Comprehensive next-generation sequencing-based genetic testing improved mutation detection and facilitated the identification of the genetic basis of unclear and new phenotypes. Characterization of the biochemical and cell biological consequences of the genetic variants is challenging and laborious but may represent the basis for personalized therapeutic approaches. Molecular modifiers of skin fragility have been uncovered in particular animal and genetic models but not in larger cohorts of patients. This scientific progress is the basis for revisions of the epidermolysis bullosa classification and for innovative therapeutic approaches designed for this intractable condition.
Keywords	Medicine ; R ; Science ; Q
Subject code	571
Language	English
Publishing date	2018-03-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
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Article ; Online: Psyche: The 5th 'P' and its Associated Impact on the Second Stage of Labor.

Gimovsky, Alexis C / Rasiah, Stephen S / Vergara-Lopez, Chrystal / Has, Phinnara / Ayala, Nina K / Stroud, Laura R

Rhode Island medical journal (2013)

2024 Volume 107, Issue 1, Page(s) 37–44

Abstract: Objective: Patients with depression during labor display dysregulated patterns of oxytocin release and this may impact second stage of labor. The objective of this study was to evaluate the association between maternal preconception and antenatal ... ...

Abstract	Objective: Patients with depression during labor display dysregulated patterns of oxytocin release and this may impact second stage of labor. The objective of this study was to evaluate the association between maternal preconception and antenatal depressive disorders on the duration of second stage of labor and perinatal outcomes. Study design: Secondary analysis of patients enrolled in the Behavioral and Mood in Mothers, Behavior in Infants study who reached the second stage of labor. Participants were assigned to: pre-conception only major depressive disorder (MDD), prenatal major depressive disorder, and non-depressed controls. Primary outcome was prolonged second stage of labor. Secondary outcomes included perinatal morbidities. Results: 172 patients were included. 24.4% (42/172) participants had preconception-only MDD, 42.4% (73/172) patients had prenatal MDD, and 33.1% (57/172) patients had as non-depressed controls. The adjusted pair-wise analysis between groups showed no significant difference in the duration of second stage. No statistically significant differences were noted between groups for adverse neonatal outcomes. Conclusion: Maternal depressive disorders did not impact length of second stage of labor or immediate perinatal outcomes.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; Labor Stage, Second ; Depressive Disorder, Major ; Mothers ; Retrospective Studies
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	419430-5
ISSN	2327-2228 ; 0363-7913
ISSN (online)	2327-2228
ISSN	0363-7913
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Article ; Online: Amino Acid Substitution in the Cysteine-Rich Region of the Integrin β4 Subunit Causes Late-Onset Mild Junctional Epidermolysis Bullosa without Extracutaneous Involvement.

Wang, Yao / Hotz, Alrun / Esser, Philipp R / Fischer, Judith / Has, Cristina

The Journal of investigative dermatology

2023 Volume 143, Issue 11, Page(s) 2233–2242.e3

Abstract: Integrin α6β4, encoded by ITGA6 and ITGB4, is a transmembrane component of hemidesmosomes and plays an important role in connecting keratinocytes with extracellular matrix proteins. ITGB4 or ITGA6 biallelic pathogenic variants cause junctional ... ...

Abstract	Integrin α6β4, encoded by ITGA6 and ITGB4, is a transmembrane component of hemidesmosomes and plays an important role in connecting keratinocytes with extracellular matrix proteins. ITGB4 or ITGA6 biallelic pathogenic variants cause junctional epidermolysis bullosa (JEB) with pyloric atresia, which is associated with high lethality. Patients who survive usually develop JEB of intermediate severity and urorenal manifestations. In this study, we report a very rare subtype of late-onset, nonsyndromic JEB associated with a recurrent amino acid substitution in the highly conserved cysteine-rich tandem repeats of the integrin β4 subunit. Literature review shows that among the patients diagnosed with ITGB4 mutations, only two had no extracutaneous manifestations, and only two patients with JEB with pyloric atresia carried missense mutations located in cysteine-rich tandem repeats. We analyzed the consequences of the novel ITGB4 variant c.1642G>A, p.Gly548Arg, on the clinical phenotype, the predicted protein structure, cellular phenotype, and gene expression pattern to show its pathogenicity. The results indicated that the p.Gly548Arg amino acid substitution affected the protein structure of integrin β4 subunits and disrupted the stability of hemidesmosomes and in turn impaired the adhesion of keratinocytes. RNA-sequencing results indicated similar changes in extracellular matrix structure organization and differentiation in keratinocytes completely devoid of integrin β4 and with the amino acid substitution p.Gly548Arg, which further supports the dysregulation of the function of the integrin β4 subunit caused by p.Gly548Arg. Our results provided evidence for a late-onset, mild JEB subtype without extracutaneous manifestations and extend the ITGB4-related genotype-phenotype correlations.
Language	English
Publishing date	2023-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80136-7
ISSN	1523-1747 ; 0022-202X
ISSN (online)	1523-1747
ISSN	0022-202X
DOI	10.1016/j.jid.2023.04.025
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Article: Neonatal Outcomes are Similar between Patients with Resolved and Those with Persistent Oligohydramnios

Whelan, Anna R. / Has, Phinnara / Savitz, David A. / Danilack, Valery A. / Lewkowitz, Adam K.

American Journal of Perinatology

2024

Abstract	Objective: Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing perinatal outcomes in patients who are diagnosed with oligohydramnios that resolves and those who have persistent oligohydramnios. Study Design: This is a secondary analysis of a National Institutes of Health–funded retrospective cohort study of singleton gestations delivered at a tertiary care hospital between 2002 and 2013 with mild hypertensive disorders and/or fetal growth restriction (FGR). Maternal characteristics, delivery, and neonatal information were abstracted by trained research nurses. Patients with a diagnosis of oligohydramnios were identified, and those with resolved versus persistent oligohydramnios at the time of delivery were compared. The primary outcome was a composite of neonatal resuscitation at delivery: administration of oxygen, bag–mask ventilation, continuous positive airway pressure, intubation, chest compression, or cardiac medication administration. Secondary outcomes included FGR, timing, and mode of delivery. Results: Of 527 women meeting study criteria, 42 had oligohydramnios that resolved prior to delivery, whereas 485 had persistent oligohydramnios. There were no significant differences in patient demographics between groups. The gestational age at diagnosis was significantly lower for patients with resolved versus persistent oligohydramnios (median: 33.0 [interquartile range, IQR: 29.1–35.9] vs. 38.0 [IQR: 36.4–39.3], p < 0.001). There was not a substantial difference in rate of neonatal resuscitation (41 vs. 32%, p = 0.31). Patients with resolved oligohydramnios were more likely to have developed FGR than those with persistent oligohydramnios (55 vs. 36%, p < 0.02). There were no significant differences for gestational age at delivery, birth weight, or neonatal intensive care unit admission. Conclusion: Patients whose oligohydramnios resolved were diagnosed earlier yet had similar rates of neonatal resuscitation but higher rates of FGR than those who had persistent oligohydramnios. Key Points: When diagnosed earlier in pregnancy, oligohydramnios was more likely to resolve prenatally. Patients who were diagnosed with oligohydramnios earlier in pregnancy had higher rates of FGR. There were no differences in the rates of the composite outcome of need for neonatal resuscitation when comparing those with resolved versus those with persistent oligohydramnios. No differences in composite neonatal morbidity were noted between those with resolved versus persistent oligohydramnios.
Keywords	fetal growth restriction ; neonatal resuscitation ; oligohydramnios
Language	English
Publishing date	2024-02-29
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-2278-8948
Database	Thieme publisher's database

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Article: Ustekinumab for anti-tumor necrosis factor refractory pediatric ulcerative colitis: a promising approach towards endoscopic healing.

Rehman, Rahiya / Riaz, Muhammad Safwan / Esharif, Dyadin / Has, Phinnara / Herzlinger, Michael / Shapiro, Jason / Subedi, Shova

Intestinal research

2024

Abstract: ... biochemical remission but also has promising role in inducing endoscopic healing end point in patients ...

Abstract	Background/aims: To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center. Methods: A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing. Results: Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg. Conclusions: Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.
Language	English
Publishing date	2024-02-06
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3018469-1
ISSN	2288-1956 ; 1598-9100
ISSN (online)	2288-1956
ISSN	1598-9100
DOI	10.5217/ir.2023.00091
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Article ; Online: Intertwin membrane cord insertion in dichorionic twin pregnancy: The description and comparison with other umbilical cord insertion types.

Can, Sultan / Has, Recep / Turkyilmaz, Gurcan / Aktoz, Fatih / Yuksel, Atil

Journal of clinical ultrasound : JCU

2022 Volume 50, Issue 7, Page(s) 958–963

Abstract: Purpose: Multiple pregnancy is associated with high perinatal mortality and morbidity. Abnormal cord insertions more common in twin pregnancies compared to singleton pregnancies and velamentous cord insertion is related with poor pregnancy outcomes. ... ...

Abstract	Purpose: Multiple pregnancy is associated with high perinatal mortality and morbidity. Abnormal cord insertions more common in twin pregnancies compared to singleton pregnancies and velamentous cord insertion is related with poor pregnancy outcomes. There is no definition of velamentous cord insertion into the intertwine membrane between two fetuses in the literature. Methods: In our single-center cross-sectional study, monochorionic-diamniotic and dichorionic-diamniotic twins who were admitted to our clinic between 18 + 0 and 23 + 6 weeks of pregnancy were enrolled in this study. We evaluated fetal, placental, and umbilical cord abnormalities in addition to fetal growth restrictions and weight discordance by ultrasonography. Results: Although abnormal cord insertion frequency was significantly higher in monochorionic twins (p = 0.003), intertwin membrane cord insertion could only occur in dichorionic twins. In cases with cord insertion anomaly; FGR and weight discordance was observed more frequently (p < 0.001 and p = 0.003, respectively). Weight discordance, the presence of abnormal cord insertion and abnormal UAD were found as statistically significant predictors of FGR (p < 0.001, p = 0.021, and p < 0.001, respectively). Conclusion: Intertwin membrane insertion is a novel umbilical cord insertion abnormality. The presence of abnormal umbilical cord insertion is a risk factor for poor pregnancy outcomes in twin pregnancies.
MeSH term(s)	Cross-Sectional Studies ; Female ; Humans ; Placenta/diagnostic imaging ; Pregnancy ; Pregnancy, Twin ; Twins, Monozygotic ; Ultrasonography, Prenatal ; Umbilical Cord/diagnostic imaging
Language	English
Publishing date	2022-06-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	189393-2
ISSN	1097-0096 ; 0091-2751
ISSN (online)	1097-0096
ISSN	0091-2751
DOI	10.1002/jcu.23246
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