Background

Parotitis presents in many forms, and the symptoms vary from modest to debilitating. It may
present a diagnostic challenge because of its extensive etiologies: bacterial, pure viral,
autoimmune or a combination of these. Before the development of the mumps vaccine, parotitis
caused by the mumps virus was extremely common, particularly in school-aged children.
However, in recent years, the influenza (type A most commonly) virus has emerged as another
viral etiology associated with parotitis. Given this emerging clinical knowledge, healthcare
workers should start considering influenza as a cause of parotitis, especially during flu seasons.
We present a case of a pediatric patient with a recent positive influenza test who returned to the
Emergency Room with swollen bilateral parotid glands. The patient was diagnosed with parotitis
clinically and it was associated with the influenza virus.

Case presentation

A three-year-old boy with prior medical history of hypoparathyroidism presented to the ER with
swollen bilateral facial edema a day after presenting shortness of breath, runny nose, fever and
cough consistent with influenza. Patient vaccination status was up-to-date, except for the annual
influenza one. Physical examination revealed a well developed and nourished child with nasal
secretions and bilateral facial swelling. He had clear lungs, normal breath sounds and no
respiratory distress. Pertinent labs revealed leukocytosis (12.65), increased CRP (1.8) and
increased amylase levels (241), suggesting inflammation of the parotid glands. Patient underwent
CT of facial bones with IV contrast, which revealed bilateral parotid glands swelling. Given his
upper respiratory symptoms, the patient was diagnosed with bilateral parotitis secondary to
influenza virus infection. He was treated with supportive care, acetaminophen and catch-up
influenza vaccine.

Discussion

It can be challenging to determine whether the temporal association between influenza and rare
complications indicates that the virus is causally associated with the syndrome. However,
physicians should consider the possibility of influenza infection when a patient presents with
parotitis, especially if a temporal relation exists. Patients may benefit because widespread
epidemics of influenza occur in the United States each year and such a public health response
would generally be unnecessary if a case of parotitis were found to be due to influenza rather
than mumps, the most common cause of parotitis.

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients​

**Scoring is only possible in the semifinals hall**

**Abstract:**



Posterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Scoping Review

Stroke is a leading cause of disability in the United States and the general population worldwide. Currently there are no successful treatments to restore normal function to stroke patients once brain damage has occurred. Our laboratory has pioneered antibody therapy directed at the neurite inhibitory protein Nogo-A to promote neuroplasticity and improve post-stroke recovery. Recent work from our laboratory has showed that Nogo-A blocks nerve growth factor (NGF)-dependent TrkA phosphorylation and activates a ceramide-dependent pathway, which negatively influences neuronal survival and neurite outgrowth. These findings suggest that the upregulation of Nogo-A following ischemic injury may interfere with the intrinsic neurotrophin-dependent plasticity that mediates recovery. Our central hypothesis is treatments that circumvent or block Nogo-A inhibition of TrkA to stimulate TrkA-mediated neurotrophin signaling pathways will enhance neuroplasticity and improve recovery following ischemic stroke. We conducted a pilot study, where we examined the effect of a TrkA agonist on Nogo-A signaling and functional recovery after experimental stroke in vivo. Baseline behavioral tests including skilled forelimb reaching task and horizontal ladder walk task were conducted on 8 male Long Evans, black hooded rats. The animals were then subjected to ischemic damage in the sensorimotor cortex by permanent middle cerebral artery occlusion. We continued behavior analysis 1 week after stroke and the animals were treated either with novel selective TrkA agonist gambogic amide or vehicle. Behavior was repeated 8 weeks later to determine functional recovery. In addition, we will also inject BDA for tracing of axonal pathways. The preliminary data from the behavior tests suggests that animals treated with agonist have better functional recovery as compared to control animals. This work will provide new treatments and strategies for enhancing stroke recovery in addition to advancing the knowledge of the function of Nogo-A as a negative regulator of neurotrophin signaling following brain injury.

Removal of Nogo-A Inhibition by Neurotrophin Signaling Pathway Activation Improves Sensorimotor Function After Stroke 


Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data is derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature.

Methods: We performed a retrospective analysis of all salivary gland tumors that presented to a large community practice over a 20-year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data.

Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). 203 patients were managed conservatively without definitive diagnosis or lost to follow up. A total of 495 patients underwent surgical intervention within the community practice. 26 patients underwent surgical excision at an outside hospital. 82 patients were determined to have a benign diagnosis based on FNA or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin’s tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. 

Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors is comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.

Salivary Gland Tumors: A Twenty-Year Review from a Single Community Practice

Background
The purpose of this research is to test the clinical validity of a computerized version of the Trail Making Test (TMT) in an acute rehabilitation center for predicting concurrent inpatient disability. The TMT is a widely used neuropsychological assessment that has been shown to predict brain damage. Despite its value and efficacy in testing cognitive function, the TMT is limited to patients who have intact manual dexterity because it requires using a pen. Individuals with conditions that limit manual use (e.g. bone fracture, paralysis, burns, etc.) cannot take the test. Although there are adapted TMTs to include these populations, not many of these tests still involve visual interaction. Assessment of executive function using the Computer-Assisted TMT (CTMT) has already shown to be feasible in rehabilitation patients with intact manual dexterity. This study tested the Computer-Assisted TMT (CTMT) in rehabilitation patients who lack motor hand use.
Methods
This cross-sectional study was conducted in an acute rehabilitation hospital setting with patients (n = 37) who lack hand usability with either hand. Because patients with brain illness may have slower speech, the CTMT scores were corrected for maximal oral speech rate. Participants were tested in their hospital rooms over two sessions of the CTMT to evaluate test-retest reliability. Test-retest reliability was evaluated with Pearson correlation.
Results
50 patients were approached to be in the study, and 37 of them consented to participate. Out of the 37 participants, 33 participants were able to complete one round of testing and 17 participants were able to complete both rounds of testing. Time for CTMT completion was corrected by the maximal speech production rate (diadochokinesis or DDK). Since DDK rate has shown to be modulated by age, we also corrected people 47 years and older by a factor of 0.9316, which is based on previous research. The CMT versions had excellent test-retest reliability (r = 0.93 for CTMT-A, r = 0.83 for CTMT-B, and r =0.92 for CTMT-3).
Conclusion
The results of this study could help to determine if the CTMT can reliably predict concurrent physical disability and inform new forms of cognitive rehabilitation.


The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Introduction: 

Cavernomas are low-flow vascular lesions made up of a collection of dilated capillaries with an adventitia and endothelial lining (1). Cavernous angiomas make up around 10-15% of all vascular abnormalities of the central nervous system (CNS) (2,3). These lesions can be sporadic or familial, and they have a frequency of 0.5% and an incidence of 0.3-0.7%. Females are somewhat more likely to get these lesions than men (3,4). The optic pathway, which is made up of the optic nerve, chiasm, and optic tract, can be affected in some highly unusual scenarios (2,3,5). Of the CNS cavernous malformations, optic pathway cavernomas make up fewer than 1%.(2,6). It was Uihlein et al. who first described anterior visual pathway CM in the literature in 1958(8). Cavernous malformations of the anterior visual pathway exhibit distinctive changes on MRI, with a hypointense to isointense signal on T1-weighted images and a heterogeneous "popcorn" look on T2-weighted images with mixed bright and dark signals. Gradient-echo T2 sequences enhance this dark signal because of a "blooming effect" brought on by the deposition of haemosiderin inside and around the CM (9).
Seizures are the most prevalent sign of symptomatic CMs in general, however, the symptoms of optochiasmatic CMs can vary, and many individuals remain asymptomatic. (7) . Although less common, progressive vision loss may occur, typically accompanied or preceded by headaches, nausea, and focal impairments. (5,7). The conventional therapy is gross total resection (GTR), which has resulted in symptom relief in the vast majority of patients. (1)

Case Presentation:
This 37-year-old male, a known case of Suprasellar Cavernous Angioma, presented with complaints of right-eye blurring for the past few days with no other symptoms. An MRI brain revealed a suprasellar heterogeneous tumor of <2cm. The patient previously had suprasellar cavernous angioma surgery in 2019. Testing for visual acuity showed 6/24 in the right eye and 6/6 in the left. No other investigative findings were found. The patient has no history of diabetes, hypertension, coronary artery disease, or asthma.
Operation:
LEFT PTERIONAL CRANIOTOMY AND TOTAL EXCISION surgery was performed on the patient. Supine ETGA. The head was secured in place by a three-pin Mayfield head rest. The standard procedure for a left-sided pterional craniotomy was used. The Sylvian fissure had been split. The left optic nerve and internal carotid artery were found to have numerous dense adhesions from earlier surgery that were difficult to dislodge. The tumor had bled and increased in size. A yellowish solid component was found embedded in the chiasm, which had been pushed anteriorly and to the left, along with the Right Optic nerve. Microsurgical excision was performed with care. In order to preserve vision, minute pieces adhered to the underside of the optic apparatus had to be left inside. Dura was reinforced with a patch, and the bone flap was secured using miniplates and a screw. The wound was closed in layers. The patient was treated with antibiotics, antidiabetics, analgesics, antiepileptics, anti-inflammatories, anti-emetics, steroids, gastro protectives, and other supportive measures. Histopathological sections showed brain parenchyma with areas of hemorrhage, dilated congested blood vessels, and haemosiderin laden macrophages leading to a diagnosis of cavernous hemangioma.
Discussion:
Observation:
In this case report, we present the case of a 37-year-old male with recurrent suprasellar cavernous angioma who experienced visual loss. Suprasellar cavernous angiomas are uncommon vascular lesions that can lead to neurological symptoms, including visual disturbances. Timely diagnosis and appropriate management are crucial to prevent irreversible neurological complications.
The patient had a previous history of suprasellar cavernous angioma and had undergone surgical intervention in 2019. However, he developed visual loss, which prompted further evaluation. Magnetic resonance imaging (MRI) revealed a recurrent heterogenous mass measuring less than 2 cm in the suprasellar region. Subsequently, the patient underwent a left pterional craniotomy with the intention of completely excising the mass.
During the surgical procedure, the presence of dense adhesions from the previous surgery posed challenges in separating the adhesions around the left optic nerve and internal carotid artery. Intraoperatively, the tumor was found to have bled and increased in size. Microsurgical excision was performed with careful consideration to preserve visual function. However, due to the adherence of tumor fragments to the undersurface of the optic apparatus, complete removal was not feasible, resulting in residual tumor remaining.
Histopathological examination of the excised tissue confirmed the diagnosis of cavernous hemangioma. The surgical intervention successfully alleviated compression on the optic pathways and improved the patient's visual symptoms. Postoperatively, the patient received a comprehensive treatment regimen, including appropriate antibiotics, antidiabetic agents if needed, analgesics, antiepileptics, anti-inflammatory medications, anti-emetics, steroids, and gastroprotective measures. Long-term follow-up is essential to monitor for tumor recurrence and evaluate visual outcomes. Suprasellar cavernous angiomas present management challenges due to their location and the associated risk of intraoperative bleeding. Surgical resection remains the mainstay of treatment, aiming for complete excision while minimizing damage to critical structures. In situations where complete resection is not attainable, partial resection can still provide clinical benefits.
Early diagnosis and prompt intervention are critical in preventing irreversible neurological complications associated with suprasellar cavernous angiomas. Long-term follow-up is necessary to monitor for tumor recurrence and assess visual outcomes. A multidisciplinary approach involving neurosurgeons, ophthalmologists, and other healthcare professionals is essential for comprehensive management.
In conclusion, our case underscores the significance of timely intervention in cases of recurrent suprasellar cavernous angiomas presenting with visual loss. Surgical resection, despite its challenges, can offer symptomatic relief and improve visual function. Further research is warranted to investigate optimal treatment strategies and long-term outcomes for these rare vascular lesions.
Lessons:
Cavernous hemangiomas of the optic pathway are extremely rare (<1%), and the involvement of the optic nerve in the optic canal is even rarer. Diagnosing cavernous malformations (CMs) of the optic pathway preoperatively is challenging and often can be misdiagnosed. The relevance of this case, therefore, is that in a patient with loss of visual acuity and visual field defects, it is extremely important for clinicians to keep cerebral cavernous malformations in their differential diagnosis. [3]
MRI is the most specific and sensitive imaging modality to diagnose CMs, the mainstay of treatment for which is radical resection. It is a challenging procedure, but usually curative and associated with favorable outcomes. [7]
Surgery for radical resection of the CM is a technically challenging procedure that has a high risk of morbidity and death. The hazards, which include pre- and/or post-operative bleeding, hormone imbalances, and transient or permanent nerve palsies are principally brought on by the complex neuroanatomy of the CS-sellar area. The literature only contains a small number of recorded cases claiming effective total eradication as evident in our case, wherein some minute pieces of the lesion had to be left behind in order to prevent vision loss.
In instances when complete removal implies excessive risks during the perioperative period, surgical reduction with cranial nerve decompression, followed by stereotactic radiosurgery, is currently regarded as the best choice. []
In all cases, the surgeon's experience, anatomical knowledge, and microsurgical skills are important factors that influence the final outcome. [7] With our case, we aim to highlight the importance of early surgical intervention in order to prevent regrowth and fatal complications.

Optic Pathway Cavernous Malformations - A Rare Cause Of Vision Loss

Background: To assess school-aged children’s wellbeing and to characterize changes in school-related needs from 2021 to 2022.
Methods: We surveyed a nationally representative sample of parents of children enrolled in grades K-12 in the 2021-2022 academic year in June 2021 and again one year later (June 2022). Parents completed the Strengths and Difficulties Questionnaire (SDQ) and reported their child’s general health and needs for school-related services. Weighted regressions examined associations among wellbeing, needs, and socio-demographic characteristics.
Results: 1,504 participants completed baseline and 1,199 completed follow up surveys. The percentage of children with deficits in total difficulties, hyperactivity, and prosocial behavior decreased from baseline to follow up, but a high percentage of children continued to have peer problems. Parents reported receiving support from their school for 45.3% of needs during the 2021-2022 school-year but 72.5% of parents continued to have at least one school-related need. Highest priority needs were academic enrichment, socialization, physical activity, tutoring, and coping with stress.
Implications for School Health Policy, Practice, and Equity: While many children with school-related needs received school support, a large percentage continue to have unmet needs and experience peer-related problems.
Conclusions: Continued investment in school-based services is necessary to support child health.

Changes in School-Age Children’s Wellbeing and School-Related Needs during the COVID-19 Pandemic

Background
Emergency department (ED) visits for preventable dental conditions are substantially increasing. 

Methods
A retrospective chart review of prospectively maintained data was used. We reviewed 275 children who presented to the ED between July 2019 and January 2021. The inclusion criteria were children under the age of 18 years with odontogenic pain, demographics, insurance status, primary diagnosis, services provided in the ED, prescriptions given, total ED length of stay, and disposition. We classified these visits as necessary and unnecessary based on the treatment given. Data were analyzed using chi-square and student t-test.

Results
Among these patients, 52% were males with ages 9.3±4.7 years and a median of 9 years old. The primary diagnoses were dental caries (27%), tooth pain (26%), tooth infections (17%), traumatic tooth fracture (11%), and others comprising cavities, gingivitis, and oral mucosal infections (19%). Most patients were under Medicaid-managed care (67%), followed by those without insurance (17%). After ED evaluation, 70% of patients received non-steroidal anti-inflammatory drugs (NSAIDs), 55% had dental referrals, 28% had OMFS referrals, and 27% received antibiotics. This cohort was subdivided into necessary versus unnecessary ED visitation––with the majority of patients having tooth pain (17% vs. 33%) and dental caries (21% vs. 31%) that required NSAIDs (35% vs. 34%) and home discharge (98% vs. 99%).

Conclusion
The cost of 1 ED visit in New York City averages from 1400$ to 1600$, so avoiding these 155 unnecessary ED visits, about 250,000$ could be saved. Dental pain is highly prevalent among children, with a substantial increase in ED visits for atraumatic dental problems. The fact is that dental conditions can be treated more effectively in a dental clinic due to the availability of definitive care and the likelihood of continuity of care than in a hospital. Multiple strategies are required to reduce this usage and relieve the healthcare system pressure. Reducing barriers like lack of insurance, sociocultural deterrents, and language barriers improves access to optimal dental care. Efforts should be made to raise dental health awareness and improve access and utilization of oral health care services. These will benefit the patient and decrease the reliance on hospital ED for non-traumatic dental issues.


An Audit of Dental Visits in the Pediatric Emergency Department of a Community Teaching Hospital

Background: Depression is a public health concern affecting the well-being and development of adolescents. Despite evidence-based guidelines promoting routine depression screening, many youths remain unidentified and untreated. Quality improvement (QI) initiatives may enhance depression screening practices. This retrospective chart review assesses a QI initiative's impact on depression screening rates among 12 to 18-year-old patients at four pediatric clinics in urban Nebraska from 2018 to 2022. The study evaluates trends in positive depression screens and the effectiveness of targeted interventions to increase adolescent depression screening. 
Methods: Electronic health record data was used to calculate adolescent depression screening rates and the percentage of positive depression screens. The screening rate equaled the total number of completed adolescent depression screens divided by the total number of well child exams for 12 through 18-year-old patients. The percentage of positive depression screens was the percentage of all adolescents who were screened and were positive on the Patient Health Questionnaire-4 (PHQ-4). The QI initiative comprised a “Lunch and Learn" session to raise provider awareness about the importance of depression screening. Additional interventions involved creating supportive materials for managing positive screenings, integrating depression screening into well-child exam rooming, and posting educational materials in the clinic's computer system for easy access by patients and providers. The impact of the initiative on depression screening rates was analyzed annually over five years. 
Results: The data revealed variations in depression screening rates and stability in the percentage of positive depression screens over the five-year study period. In 2018, the screening rate at well- child exams was 25.9%, with 8.1% of patients positive for depression. In 2019, the screening rate decreased to 21.6%, while the percentage of positive screenings increased to 13.1%. Following the initiation and continuation of the QI initiative in 2019, screening rates notably increased, reaching 37.2% with 11.7% positive patients in 2020. Screening rates further improved to 48.4% and 88.6% in 2021 and 2022, respectively, while the percentage of positive screenings remained relatively stable at 11.2% and 10.1%. 
Conclusion: The QI initiative positively impacted depression screening rates among adolescent patients at the four pediatric clinics, empowering healthcare providers to recognize and support adolescents facing depression. Continuous screening practice improvement efforts are crucial for early identification and intervention. The initiative offers a promising approach to enhance adolescent mental health care. 


Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Incidence of Venous Thromboembolism in Fracture Below the Knee with and without Chemical Thromboprophylaxis: A Meta-analysis

Depression and Anxiety - Diagnosis and Management in Primary Care:
Alternate Therapy Modalities: A Review

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, is a fatal neurodegenerative disease affecting motor neurons in the brain and spinal cord. Progressive muscle weakness, atrophy, and spasticity characterize the condition, which eventually leads to paralysis and respiratory failure. There is currently no cure for ALS, and the standard of care is supportive, with riluzole being one of the few FDA approved medications that has been shown to slightly slow disease progression along with Radicava (edaravone) and RELYVRIO (AMX0035) approved in 2022 with Qalsody (tofersen) being approved in 2023. With limited options for medications, the use of mesenchymal stem cells (MSCs) in the treatment of ALS is a new area of research in regenerative medicine. MSCs are multipotent stem cells that can differentiate into a variety of cell types, including neurons, and have immunomodulatory and anti-inflammatory properties, making them an appealing therapy for neurodegenerative diseases such as ALS. This review examines the safety and efficacy of MSC therapy for ALS in three Phase II randomized controlled trials. The trials involved administering MSCs via various routes, including intrathecal and intravenous, and assessing outcomes such as survival, disease progression, and quality of life. 


Underline digital video library

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients

Posterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Scoping Review

Removal of Nogo-A Inhibition by Neurotrophin Signaling Pathway Activation Improves Sensorimotor Function After Stroke

Salivary Gland Tumors: A Twenty-Year Review from a Single Community Practice

The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Optic Pathway Cavernous Malformations - A Rare Cause Of Vision Loss

Changes in School-Age Children’s Wellbeing and School-Related Needs during the COVID-19 Pandemic

An Audit of Dental Visits in the Pediatric Emergency Department of a Community Teaching Hospital

Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Incidence of Venous Thromboembolism in Fracture Below the Knee with and without Chemical Thromboprophylaxis: A Meta-analysis

Depression and Anxiety - Diagnosis and Management in Primary Care: Alternate Therapy Modalities: A Review

Mesenchymal Stem Cell Therapy for Amyotrophic Lateral Sclerosis: A Narrative Review

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

Underline digital video library

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients​

Posterior Cruciate Ligament Reconstruction with Suture Tape Augmentation: A Scoping Review

Removal of Nogo-A Inhibition by Neurotrophin Signaling Pathway Activation Improves Sensorimotor Function After Stroke

Salivary Gland Tumors: A Twenty-Year Review from a Single Community Practice

The Validation of a Computer-Assisted Trail Making Test in Acute Rehabilitation Inpatients with Manual Disability

Optic Pathway Cavernous Malformations - A Rare Cause Of Vision Loss

Changes in School-Age Children’s Wellbeing and School-Related Needs during the COVID-19 Pandemic

An Audit of Dental Visits in the Pediatric Emergency Department of a Community Teaching Hospital

Impact of Targeted Interventions on Depression Screening Rates among Adolescent Patients: A Retrospective Chart Review

Incidence of Venous Thromboembolism in Fracture Below the Knee with and without Chemical Thromboprophylaxis: A Meta-analysis

Depression and Anxiety - Diagnosis and Management in Primary Care: Alternate Therapy Modalities: A Review

Mesenchymal Stem Cell Therapy for Amyotrophic Lateral Sclerosis: A Narrative Review

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

Is there a link between parotitis and influenza? Physicians should consider influenza virus as an etiology for patients