Medicine and Health Sciences Commons^™

Predictors Of Circuit Health In Neonatal Patients Receiving Extracorporeal Membrane Oxygenation (Ecmo), Rita Hazboun, Nada Darwish, Gianna Rotyliano Sykes, Nayef Chahin, Jie Xu, John Miller, Christos Calaritis, Leroy Thacker, Russell Moores, Karen Hendricks-Muñoz

Pediatrics Publications

To identify predictors of neonatal ECMO circuit health, a retrospective analysis of circuit functional pressure and flow parameters as well as infant clotting values were collected 48 h prior to and 24 h post circuit change. Circuit impairment was defined as need for partial or total circuit change. Statistical analysis used multivariate statistics and non-parametric Mann–Whitney U-test with possible non-normality of measurements. A total of 9764 ECMO circuit and clotting values in 21 circuits were analyzed. Circuit delta-P mean, and maximum values increased from 8.62 to 48.59 mmHg (p < 0.011) and 16.00 to 53.00 mmHg (p < 0.0128) respectively prior to need for circuit change. Maximum and mean Pump Flow Revolutions per minute (RPM) increased by 75% (p < 0.0043) and 81% (p < 0.0057), respectively. Mean plasma free hemoglobin (pfHb) increased from 26.45 to 76.00 mg/dl, (p < 0.0209). Sweep, venous pressure, and clotting parameters were unaffected. ECMO circuit delta-P, RPM, and pfHb were early predictors of circuit impairment.

Firearm Curriculum For Pediatric Residents Improves Safe Storage Counseling, Hannah Hollon Md, Darina Dinov Do, Benjamin Sandifer Md, Scott Risney Md, Heemali Kamdar Do, Christopher Ferrante Do, Leroy Thacker Phd, Michael S. Ryan Md, Mehp, Elizabeth Wolf Md, Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Objectives

Firearms are the leading cause of death among children and adolescents. Despite evidence to support physician training in firearm safety counseling, formal curricula are limited in pediatric residency programs. We sought to develop and implement a resident-led, feasible, sustainable, and impactful firearm safety curriculum for pediatric residents.

Methods

A firearm safety curriculum was developed by pediatric residents using Kern’s curriculum development framework and delivered to their peers at a single academic center from 2019 - 2020. The three-part series included workshops on basic firearm safety counseling principles, case-based practice, and advocacy training and a gun lock program in collaboration …

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Quiet A Puzzle: A Case Report Of 15 Year Old Female With Severe Anemia Due To Scurvy, Shaikha Alqahtani, Wang Zhihong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency.

She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam …

A State-Level Study Of Opioid Use Disorder Treatment Access And Neonatal Abstinence Syndrome, Elizabeth R. Wolf, Sebastian T. Tong, Roy T. Sabo, Steven H. Woolf, Kassie Abbinanti, James Pecsok, Alex H. Krist

Pediatrics Publications

Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS.

Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of …

Adherence Mechanism Analysis: The Role Of Prsa Gene In Lactobacillus Acidophilus And Other Infectious Microorganisms, Nujuma Moussa

Auctus: The Journal of Undergraduate Research and Creative Scholarship

No abstract provided.

Genomic Analysis Of Chimeric Human Cytomegalovirus Vaccine Candidates Derived From Strains Towne And Toledo, Nicolás M. Suárez, Betty Lau, George M. Kemble, Ronzo Lee, Edward S. Mocarski, Gavin W. G. Wilkinson, Stuart P. Adler, Michael A. Mcvoy, Andrew J. Davison

Pediatrics Publications

Human cytomegalovirus (HCMV) is an important opportunistic pathogen in immunocompromised patients and a major cause of congenital birth defects when acquired in utero. In the 1990s, four chimeric viruses were constructed by replacing genome segments of the high passage Towne strain with segments of the low passage Toledo strain, with the goal of obtaining live attenuated vaccine candidates that remained safe but were more immunogenic than the overly attenuated Towne vaccine. The chimeras were found to be safe when administered to HCMV-seronegative human volunteers, but to differ significantly in their ability to induce seroconversion. This suggests that chimera-specific genetic differences …

Use Of Management Pathways Or Algorithms In Children With Chronic Cough Chest Guideline And Expert Panel Report, Anne B. Chang, John J. Oppenheimer, Miles M. Weinberger, Bruce K. Rubin, Kelly Weir, Cameron C. Grant, Richard S. Irwin, Chest Expert Cough Panel

Pediatrics Publications

BACKGROUND: Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format.

METHODS: We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context …

Management Of Children With Chronic Wet Cough And Protracted Bacterial Bronchitis Chest Guideline And Expert Panel Report, Anne B. Chang, John J. Oppenheimer, Miles M. Weinberger, Bruce K. Rubin, Cameron C. Grant, Kelly Weir, Richard S. Irwin, Chest Expert Cough Panel

Pediatrics Publications

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged
METHODS: We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made.

RESULTS: Combining data from the …

Family-Centered Rounds And Medical Student Performance On The Nbme Pediatrics Subject (Shelf) Examination: A Retrospective Cohort Study, Tiffany N. Kimbrough, Victor Heh, N. Romesh Wijesooriya, Michael S. Ryan

Pediatrics Publications

Objective

To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam.

Methods

A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE).

Results

Eight hundred and sixteen participants …

Altered Protease And Antiprotease Balance During A Copd Exacerbation Contributes To Mucus Obstruction, Shashi Chillappagari, Jenni Preuss, Sebastian Licht, Christian Müller, Poornima Mahavadi, Gaurav Sarode, Claus Vogelmeier, Andreas Guenther, Lutz Narlich, Bruce K. Rubin, Markus O. Henke

Pediatrics Publications

Background

Proteases have been shown to degrade airway mucin proteins and to damage the epithelium impairing mucociliary clearance. There are increased proteases in the COPD airway but changes in protease-antiprotease balance and mucin degradation have not been investigated during the course of a COPD exacerbation. We hypothesized that increased protease levels would lead to mucin degradation in acute COPD exacerbations.

Methods

We measured neutrophil elastase (NE) and alpha 1 protease inhibitor (A1-PI) levels using immunoblotting, and conducted protease inhibitor studies, zymograms, elastin substrate assays and cigarette smoke condensate experiments to evaluate the stability of the gel-forming mucins, MUC5AC and MUC5B, …

Variability In Splanchnic Tissue Oxygenation During Preterm Red Blood Cell Transfusion Given For Symptomatic Anaemia May Reveal A Potential Mechanism Of Transfusion-Related Acute Gut Injury, Sean M. Bailey, Karen D. Hendricks-Muñoz, Pradeep V. Mally

Pediatrics Publications

Background

There is increasing evidence indicating an association between red blood cell (RBC) transfusions and necrotising enterocolitis (NEC) in preterm infants, especially late-onset NEC. This phenomenon is referred to as transfusion-related acute gut injury (TRAGI). One theory as to a pathophysiological mechanism is that transfusion may result in an ischemia-reperfusion injury to intestinal tissue. We tested the hypothesis that there is significantly greater variability during transfusion in splanchnic tissue oxygen saturation (SrSO2) than in cerebral tissue oxygen saturation (CrSO2).

Materials and methods

This was a prospective, observational study using near-infrared spectroscopy to monitor SrSO2 and CrSO2in preterm neonates undergoing RBC …

A Fatal Twist: Volvulus Of The Small Intestine In A 46-Year-Old Woman, Jared Klein, Kathryn Baxstrom, Stephen Donnelly, Patrick Feasel, Paul Koles

Pediatrics Publications

A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. Later that evening, she was found dead. Postmortem exam revealed acute hemorrhagic necrosis of a segment of jejunum secondary to volvulus. Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at …

Γ-Secretase Inhibitor Alleviates Acute Airway Inflammation Of Allergic Asthma In Mice By Downregulating Th17 Cell Differentiation, Weixi Zhang, Xueya Zhang, Anqun Sheng, Cuiye Weng, Tingting Zhu, Wei Zhao, Changchong Li

Pediatrics Publications

T helper 17 (Th17) cells play an important role in the pathogenesis of allergic asthma. Th17 cell differentiation requires Notch signaling. γ-Secretase inhibitor (GSI) blocks Notch signaling; thus, it may be considered as a potential treatment for allergic asthma. The aim of this study was to evaluate the effect of GSI on Th17 cell differentiation in a mouse model of allergic asthma. OVA was used to induce mouse asthma model in the presence and absence of GSI. GSI ameliorated the development of OVA-induced asthma, including suppressing airway inflammation responses and reducing the severity of clinical signs. GSI also significantly …

Is The Consistency More Important Than The Ingredients For Treatment? Case Report For Eosinophilic Esophagitis, Dan W. Parrish, Shashank Sharma, Santhosh Kumar

Surgery Publications

Eosinophilic Esophagitis seems to be an ever-changing disease, from patient-to-patient and from year-to-year in the same patient. Improvements in these patients’ lives have been made with the realization that elimination of dietary antigens helped with symptom relief and treatment with topical steroids assisted in eradication of esophageal eosinophils.

This case study has two very important aspects that should be emphasized. The first is the realization that it may be consistency of the steroid mixture rather than the ingredients that infer the effectiveness of the EoE treatment, and the second aspect is the willingness of the medical team to listen to …

Metabolic Effects Of Acute Thiamine Depletion Are Reversed By Rapamycin In Breast And Leukemia Cells, Shuqian Liu, Sumitra Miriyala, Mignon A. Keaton, Craig T. Jordan, Christina Wiedl, Daret K. St. Clair, Jeffrey A. Moscow

Pediatrics Publications

Thiamine-dependent enzymes (TDEs) control metabolic pathways that are frequently altered in cancer and therefore present cancer-relevant targets. We have previously shown that the recombinant enzyme thiaminase cleaves and depletes intracellular thiamine, has growth inhibitory activity against leukemia and breast cancer cell lines, and that its growth inhibitory effects were reversed in leukemia cell lines by rapamycin. Now, we first show further evidence of thiaminase therapeutic potential by demonstrating its activity against breast and leukemia xenografts, and against a primary leukemia xenograft. We therefore further explored the metabolic effects of thiaminase in combination with rapamycin in leukemia and breast cell lines. …

Comprehensive Analysis Of Human Cytomegalovirus Microrna Expression During Lytic And Quiescent Infection, Zhang-Zhou Shen, Xing Pan, Ling-Feng Miao, Han-Qing Ye, Stéphane Chavanas, Christian Davrinche, Michael Mcvoy, Min-Hua Luo

Pediatrics Publications

Background

Human cytomegalovirus (HCMV) encodes microRNAs (miRNAs) that function as post-transcriptional regulators of gene expression during lytic infection in permissive cells. Some miRNAs have been shown to suppress virus replication, which could help HCMV to establish or maintain latent infection. However, HCMV miRNA expression has not been comprehensively examined and compared using cell culture systems representing permissive (lytic) and semi-permissive vs. non-permissive (latent-like) infection.

Methods

Viral miRNAs levels and expression kinetics during HCMV infection were determined by miRNA-specific stem-loop RT-PCR. HCMV infected THP-1 (non-permissive), differentiated THP-1 (d-THP-1, semi-permissive) and human embryo lung fibroblasts (HELs, fully-permissive) were examined. The impact of …

Clinical Features And Genetic Analysis Of 20 Chinese Patients With X-Linked Hyper-Igm Syndrome, Lin-Lin Wang, Wei Zhou, Wei Zhao, Zhi-Qing Tian, Wei-Fan Wang, Xiao-Fang Wang, Tong-Xin Chen

Pediatrics Publications

X-linked hyper-IgM syndrome (XHIGM) is one type of primary immunodeficiency diseases, resulting from defects in the CD40 ligand/CD40 signaling pathways. We retrospectively analyzed the clinical and molecular features of 20 Chinese patients diagnosed and followed up in hospitals affiliated to Shanghai Jiao Tong University School of Medicine from 1999 to 2013. The median onset age of these patients was 8.5 months (range: 20 days–21 months). Half of them had positive family histories, with a shorter diagnosis lag. The most common symptoms were recurrent sinopulmonary infections (18 patients, 90%), neutropenia (14 patients, 70%), oral ulcer (13 patients, 65%), and protracted diarrhea …

Passive Immunization During Pregnancy For Congenital Cytomegalovirus Infection, Giovanni Nigro, Stuart P. Adler, Renato La Torre, Al M. Best

Pediatrics Publications

BACKGROUND

Currently, there is no effective intervention for a primary cytomegalovirus (CMV) infection during pregnancy.

METHODS

We studied pregnant women with a primary CMV infection. The therapy group comprised women whose amniotic fluid contained either CMV or CMV DNA and who were offered intravenous CMV hyperimmune globulin at a dose of 200 U per kilogram of maternal weight. A prevention group, consisting of women with a recent primary infection before 21 weeks' gestation or who declined amniocentesis, was offered monthly hyperimmune globulin (100 U per kilogram intravenously).

RESULTS

In the therapy group, 31 women received hyperimmune globulin, only 1 (3 …

Comparison Of Intermediate-Dose Methotrexate With Cranial Irradiation For The Post-Induction Treatment Of Acute Lymphocytic Leukemia In Children, Arnold I. Freeman , M.D., Vivian Weinberg, Martin L. Brecher , M.D., Barbara Jones , M.D., Arvin S. Glicksman , M.D., Lucius F. Sinks , M.D., Marise Weil , M.D., Hansjuerg Pleuss , M.D., Juliet Hananian , M.D., E. Omer Burgert , Jr., M.D., Gerald S. Gilchrist , M.D., Thomas Necheles , M.D., Michael Harris , M.D., Faith Kung , M.D., Richard B. Patterson , M.D., Harold Maurer , M.D., Brigid Leventhal , M.D., Louise Chevalier , M.D., Edwin Forman , M.D., James F. Holland , M.D.

Pediatrics Publications

Abstract

We compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other "sanctuary" areas. Patients were then treated with a standard maintenance regimen. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation.

Among patients with standard risk, hematologic relapses occurred …

Treatment Of Inborn Errors Of Urea Synthesis — Activation Of Alternative Pathways Of Waste Nitrogen Synthesis And Excretion, Mark L. Batshaw , M.D., Saul Brusilow , M.D., Lewis Waber , Ph.D., M.D., Wim Blom , Ph.D., Ann Mari Brubakk , M.D., Barbara K. Burton , M.D., Howard M. Cann , M.D., Douglas Kerr , M.D., Peter Mamunes , M.D., Reuben Matalon , M.D., David Myerberg , M.D., Irwin A. Schafer , M.D.

Pediatrics Publications

Abstract

Children with inborn errors of urea synthesis accumulate ammonium and other nitrogenous precursors of urea, leading to episodic coma and a high mortality rate. We used alternative pathways for the excretion of waste nitrogen as substitutes for the defective ureagenic pathways in 26 infants. These pathways involve synthesis and excretion of hippurate after sodium benzoate administration, and of citrulline and argininosuccinate after arginine supplementation.

The children were treated for seven to 62 months; 22 survived. The mean plasma level of ammonium (±S.E.) was 36±2 μmol per liter, and that of benzoate was 1.5±1.0 mg per deciliter. Alternative pathways accounted …

Solid Tumors In Children, Harold M. Maurer , M.D.

Pediatrics Publications

No abstract provided.