Angiocentric glioma is a rare tumor that was recognized by the WHO Classification of Tumours of the Central Nervous System as a distinct clinicopathological entity in 2007. Since this initial description, the vast majority of cases of angiocentric glioma reported in the literature have involved tumors of the cerebral hemispheres. To date, only 1 case of angiocentric glioma arising from the posterior midbrain has been reported. The authors present the cases of 2 pediatric patients who were found to have brainstem angiocentric gliomas. The clinical course, radiological and pathological features, treatment, and follow-up are described. The first case is one of a 5-year-old girl who presented with double vision, headache, and nausea and was found to have a midbrain lesion with pathological features consistent with angiocentric glioma. She was treated with resection and endoscopic third ventriculostomy (ETV), followed by close observation and serial neuroimaging. The second case is one of a 6-year-old boy who presented with progressive mouth drooping and problems with balance. He was found to have a pontine lesion with pathological features consistent with angiocentric glioma. This patient was treated with ETV, followed by close observation and serial neuroimaging. This report includes 6 and 1.5 years of follow-up of the patients, respectively. While there are limited data regarding the prognosis or long-term management of patients with brainstem angiocentric gliomas, the cases described in this report suggest an indolent course for this tumor, similar to the course of angiocentric gliomas located in the cerebral hemispheres.

Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.

Objective To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. Study Design A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. Results A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3–1.6 years), no patient had a life-threatening cardiac event. Conclusion Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.

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Background Patients admitted to the pediatric intensive care unit (PICU) are frequently evaluated for bacterial infections and initiated on antibiotic regimens that include a MRSA-active agent even though invasive MRSA infections are rare in this population. The MRSA PCR nasal swab (MRSA-PCR) is a non-invasive test for MRSA colonization that has been shown within adult ICUs to have a high negative predictive value (NPV), making it a potentially valuable tool for antimicrobial stewardship. This study evaluated the performance of the MRSA-PCR in predicting invasive MRSA infection in critically ill pediatric patients. Methods A retrospective cohort study was performed in a 44-bed PICU from January 2013 to December 2018 when it was protocol for all admissions to be screened with a MRSA-PCR. Patients who had both a MRSA-PCR and cultures obtained to evaluate for invasive infection within seven days were included in the study. Invasive MRSA infection was defined by the isolation of MRSA from clinical cultures along with infectious signs and symptoms. A random sample comprising 55% of the patient population was evaluated. We calculated sensitivity, specificity, positive predictive value (PPV) and NPV of the MRSA-PCR for confirmed invasive MRSA infection. Results Of the 4,410 patients reviewed, 1,961 patients met inclusion criteria (45% female, mean age 7.4 yrs. [birth-19.9 yrs.]). MRSA-PCR was positive in 13.5% of patients. Invasive MRSA infection was identified in 25 patients (2 blood, 19 respiratory, 2 soft tissue, 1 pleural fluid, and 1 urine culture) equaling 1.2% of encounters and an incidence rate of 1.1 case per 1,000 patient days. The MRSA-PCR demonstrated a PPV of 8.7% and a NPV of 99.8% (see table). Conclusion The MRSA-PCR has a poor PPV but a very high NPV for invasive MRSA infection in critically ill pediatric patients, a result that is congruent with what has been reported in the adult literature. The high NPV of the MRSA-PCR in this vulnerable patient population makes it a potentially powerful tool for antimicrobial stewardship. Creation of protocols to guide antimicrobial selection based on MRSA-PCR results may lead to a significant reduction in unnecessary antibiotic exposure, drug level monitoring, and patient risk of renal injury or adverse reactions. Disclosures All Authors: No reported disclosures.