Medicine and Health Sciences Commons^™

Addition Of Levalbuterol To A Pediatric Emergency Department Automated Medication Management System Does Not Increase Its Use., Gregory P. Conners, Daniel P. Hays, Thomas Richardson, Frank L. Zwemer

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Although adding a drug to an emergency department-based automated medication management system is known to increase how frequently it is ordered, little is known about this effect when the added drug does not offer substantial benefit over a substitute drug that was already available.

AIMS: We studied the effect of adding nebulized levalbuterol to a pediatric emergency department-based automated medication management system that already included albuterol.

METHODS: All completed orders for nebulized levalbuterol or nebulized albuterol from our academic pediatric emergency department were retrospectively identified using a computerized pharmacy database. We compared ordering of these drugs for the year …

The 'Molar Tooth Sign' In Joubert Syndrome, Imaad Ur Rehman, Zablon Bett, Yousuf Husen, Ali Syed Muhammad Akhtar, Faisal Aziz Khan

Department of Radiology

The molar tooth sign is seen in very few conditions and is a very rare paediatric central nervous system congenital anomaly. Molar tooth sign is the result of cerebellar vermis hypoplasia, thick and maloriented superior cerebellar peduncles, and an abnormally deep interpeduncular fossa. In Joubert syndrome this is seen in about 85% of patients. We present a case of 13 months old baby boy with recurrent episodes of fits and hyperpnoea, regression of milestones and developmental delay. MRI examination showed the characteristic molar tooth sign with apposition of cerebellar hemispheres, batwing-shaped fourth ventricle communicating through a thin fissure with foramen …

Outcome And Haemato-Toxicity Of Two Chemotherapy Regimens For Childhood Non-Hodgkin's Lymphoma In A Kenyan Hospital, William Macharia

Paediatrics and Child Health, East Africa

Background: Effectiveness and toxicity of childhood cancer treatments have never been evaluated in Kenya since introduction of structured care in the early seventies.

Objective:To evaluate effectiveness and toxicity of two treatment protocols for Non- Hodgkin’s lymphoma (NHL).

Design: Historical cohort study using medical records.

Setting: Kenyatta National Hospital, a tertiary care and medical teaching hospital.

Subjects: Children ≤ 15 years with diagnosis of non-Hodgkin’s Lymphoma.

Main outcome measures: Primary outcomes were median survival, event free survival and toxicity.

Results: Out of 101 records, only 26 (25.7%) met inclusion criteria. Baseline characteristics were similar in the two treatment arms. …

Admission Creatine Kinase As A Prognostic Marker In Acute Myocardial Infarction, Khawar Abbas Kazmi, Saleem Perwaiz Iqbal, Ayla Bakr, Mohammad Perwaiz Iqbal

Section of Cardiology

OBJECTIVES: To investigate the prognostic significance of creatine kinase (CK) in Pakistani patients suffering from acute myocardial infarction (AMI) and to find out if CK combined with troponin T (TnT) could be a better predictor for long-term adverse cardiac event.

METHODS: One hundred and eighty six consecutive patients with AMI who were eligible for streptokinase (SK) treatment were included in this prospective cohort study. The relationship between their serum/plasma CK and TnT levels at the time of admission and clinical outcome was investigated over a mean follow up of 24.12 +/- 3.75 months.

RESULTS: Admission CK was found to be …

Brazilian Adolescents Infected By Hiv: Epidemiologic Characteristics And Adherence To Treatment, Julia K. C. Machado, Maria J. C. Sant'anna, Veronica Coates, Flavia J. Almeida, Eitan N. Berezin, Hatim A. Omar

Pediatrics Faculty Publications

Over the last 3 decades since the first AIDS cases appeared, we have witnessed great progress in therapeutic methodologies that have transformed the evolution of the disease from debilitating and fatal, into chronic and controllable. HIV-infected children are arriving at adolescence and bringing specific challenges, not only to themselves, but also to their families and caregivers. This retrospective study sets forth epidemiological and treatment characteristics of 46 HIV-infected adolescents followed in a specialized university service relating said characteristics to therapy adherence assessed through a combination of three indirect methods. Therapy adherence did not reveal any association with either epidemiologic characteristics …

Quantitative And Qualitative Findings And Implications Of An Intercultural Sensitivity Assessment Among Employees At A Large Health System, Jarret R. Patton Md, Jay Baglia Phd, Lynn M. Deitrick Rn, Phd, Anthony Nerino Ma, Eric J. Gertner Md, Mph, Judith Sabino Mph, Mary Kay Grim Bs, Debbie Salas-Lopez Md, Mph

Department of Pediatrics

Tuesday, November 10, 2009: 2:45 PM Jarret R. Patton, MD , Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA Jay Baglia, PhD , Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA Lynn M. Deitrick, RN, PhD , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Anthony Nerino, MA , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Eric J. Gertner, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PA Judith N. Sabino, MPH , Cultural Awareness, Lehigh Valley Health Network, Allentown, PA …

Sonography Of The Neonatal Brain, Traci B. Fox

Department of Radiologic Sciences Faculty Papers

Neurosonography is a critical part of the care of the sick newborn. Sonography is superior to other modalities in imaging of the brain because it can be performed at the bedside, is easily reproducible, and does not require ionizing radiation or sedation. This article refreshes the sonographer in the normal anatomy and appear- ance of the neonatal brain using sonography, as well as some of the more common pathologic conditions that may be encountered.

Parent- Versus Child-Reported Functional Health Status After The Fontan Procedure., Linda M. Lambert, L Luann Minich, Jane W. Newburger, Minmin Lu, Victoria L. Pemberton, Ellen A. Mcgrath, Andrew M. Atz, Mingfen Xu, Elizabeth Radojewski, Darlene Servedio, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: We sought to compare perceptions of functional health status between children who had undergone a Fontan procedure and their parents.

METHODS: Fontan procedure survivors 10 to 18 years of age were included in the study if the child completed the Child Health Questionnaire (CHQ) and the parent completed the parent form to assess the child's functional health status. Comparisons were made between raw domain scores for the parent- and child-completed CHQs.

RESULTS: Between March 2003 and April 2004, 1078 Fontan survivors were screened. Of the 546 eligible and consented patients, 354 were 10-18 years of age and 328 parent/child …

Chromosomal Anomalies Influence Parental Treatment Decisions In Relation To Prenatally Diagnosed Congenital Heart Disease., Sinai C. Zyblewski, Elizabeth G. Hill, Girish S. Shirali, Andrew Atz, Geoffrey Forbus, Javier Gonzalez, Anthony Hlavacek

Manuscripts, Articles, Book Chapters and Other Papers

This study aimed to identify the variables that influence parental treatment decisions after a prenatal diagnosis of congenital heart disease (CHD). The authors reviewed all cases of prenatally diagnosed structural CHD from August 1998 to December 2006 at their center. The following variables were studied as potential predictors of parental intent to treat: maternal age, race, insurance status, obstetric history, fetal gender, univentricular versus biventricular cardiac physiology, and fetal chromosomal abnormality. Uni- and multivariable logistic regression analyses were performed. In the review, 252 consecutive cases of prenatally diagnosed CHD were identified. Of these, 204 women pursued full medical treatment, whereas …

Developing A Coordinated School Health Approach To Child Obesity Prevention In Rural Appalachia: Results Of Focus Groups With Teachers, Parents, And Students, Karen E. Schetzina, William Dalton, Elizabeth F. Lowe, Nora Azzazy, Katrina Vonwerssowetz, Connie Givens, H. P. Stern

ETSU Faculty Works

INTRODUCTION:

High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region.

METHODS:

Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, …

Exercise-Induced Asthma: Critical Analysis Of The Protective Role Of Montelukast., Terrence W. Carver

Manuscripts, Articles, Book Chapters and Other Papers

Exercise-induced asthma/exercise-induced bronchospasm (EIA/EIB) is a prevalent and clinically important disease affecting young children through older adulthood. These terms are often used interchangeably and the differences are not clearly defined in the literature. The pathogenesis of EIA/EIB may be different in those with persistent asthma compared to those with exercise-induced symptoms only. The natural history of EIA is unclear and may be different for elite athletes. Leukotriene biology has helped the understanding of EIB. The type and intensity of exercise are important factors for EIB. Exercise participation is necessary for proper development and control of EIA is recommended. Symptoms of …

A Prospective, Randomized, Double-Blind, Placebo Controlled Trial To Evaluate 4% Liposomal Lidocaine Cream On Pain And Anxiety During Venipuncture In Pediatric Patients Who Present To The Ed, Jenny Boucher, Valerie Rupp Rn, Bsn, Joanna L. Bokovoy Drph, Rn, Scott Hamilton, Kimberly Hamilton Ba, Scott M. Brenner Md, Kevin Weaver Do

Department of Emergency Medicine

No abstract provided.

Venoarterial Pco2 Difference: A Marker Of Postoperative Cardiac Output In Children With Congenital Heart Disease, Muhammad Furqan, Fahad Hashmat, Munir Amanullah, Mansoor Khan, Hina K Durani, Anwarul Haque

Department of Paediatrics and Child Health

OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery.

STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007.

METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena …

Impairments In Attention In Occasionally Snoring Children: An Event-Related Potential Study., Maria E. Barnes, Elizabeth A. Huss, Krista N. Garrod, Eric Van Ray, Ehab Dayyat, David Gozal, Dennis L. Molfese

Faculty Scholarship

Objective: To determine whether minimal snoring is benign in children. Procedure: 22 rarely snoring children (mean age = 6.9 years, 11 females) and age- and sex-matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed the Conners Parent Rating Scales–Revised Long (CPRS–R:L). Results: Snorers scored significantly higher on four CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 msec post-stimulus onset predicted CPRS-R:L Attention Deficit Hyperactivity Disorder (ADHD) Index scores. Conclusions: Occasional snorers, according to parental report, do exhibit ADHD-like behaviors. Basic sensory processing is longer than …

Sexuality And Persons With Down Syndrome. A Study From Brazil, Bruna Marques Bononi, Maria José Carvalho Sant'anna, André Chao Vasconcellos De Oliveira, Tadeu Silveira Renattini, Carla Franchi Pinto, Maria Lúcia Passarelli, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

In recent years, important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This review will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females; 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In an evaluation of autonomy, 66% took showers, 78% …

One Specialty’S Collaborative Approach To Competency-Based Curriculum Development, Diane Kittredge, Constance D. Baldwin, Miriam Bar-On, R. Franklin Trimm, Patricia S. Beach

University Faculty and Staff Publications

The authors describe a seven-step consensus development process used to create the two most recent editions of the Academic Pediatric Association’s (APA’s) educational guidelines for pediatric residency. The 1996 (printed) and 2004 (online) editions of the guidelines were designed as flexible tools to help residency programs meet changing accreditation requirements by providing lists of goals and objectives and objective-based evaluation tools. The guidelines were developed in seven steps: (1) centralized national leadership combined with coordinated, disseminated authorship, (2) clear definition of targeted users and repeated assessment of their needs, (3) incorporation of up-to-date information from the literature and national experts, …

Congenital Cystic Adenomatoid Malformation: Case Report, K. C. Wafula, S. Waa

Imaging & Diagnostic Radiology, East Africa

Congenital cystic adenomatoid malformation of the lung is a rare lesion that typically manifests as severe progressive respiratory distress in the neonate secondary to expansion of the affected lung. We present a neonate in whom this condition was diagnosed and managed at the Aga Khan University Hospital. In presenting this patient, we hope to highlight the radiological aspects of this condition which, with prompt recognition and management and in the absence of pulmonary hypoplasia, foetal hydrops or other congenital anomalies, has a favourable prognosis.

Foreign Body Or Foreign From Body--Congenital Unilateral Lobar Hypoplasia Of Lung, Heeramani Lohana, Syed Rehan Ali, Shakeel Ahmed

Department of Paediatrics and Child Health

We report a rare case of congenital unilateral hypoplasia of the lung without any other anomaly at Aga Khan University Hospital. A 7-month-old male infant presented in emergency room with respiratory distress. There was no history of cough and wheeze. X-ray revealed left sided non homogenous opacity along with right sided hyperinflation. A suspicion of foreign body was made on chest X-ray but bronchoscopy was deferred in view of bilateral equal air entry and absence of wheeze. CT scan showed left upper lobe hypoplasia. Child recovered with supportive therapy and was discharged home. To the best of our knowledge unilateral …

Incomplete, Atypical Kawasaki Disease Or Evolving Systemic Juvenile Idiopathic Arthritis: A Case Report., Shakeel Shaikh, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Kawasaki disease is an acute febrile condition seen in children. However, it is also well recognized that some Patients do not fulfill the classic diagnostic criteria for the diagnosis of kawasaki disease. The incomplete form of kawasaki disease is termed as 'Incomplete KD' or 'Atypical KD'. We present a case of a 6 year old child with a history of prolonged fever, periorbital, oral and lip changes, changes in the extremities and an erythamatous, maculopapular rash. Based on the physical exam and her echocardiogram that showed right coronary artery dilatation, Intravenous immune globulin was administered in this Patient. This Patient …

Functional State Following The Fontan Procedure., Ismee A. Williams, Lynn A. Sleeper, Steven D. Colan, Minmin Lu, Elizabeth A. Stephenson, Jane W. Newburger, Welton M. Gersony, Meryl S. Cohen, James F. Cnota, Andrew M. Atz, Richard V. Williams, Renee Margossian, Andrew J. Powell, Mario P. Stylianou, Daphne T. Hsu, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improvements in outcomes after completion of the Fontan circulation, long-term functional state varies. We sought to identify pre- and postoperative characteristics associated with overall function.

METHODS AND RESULTS: We analyzed data from 476 survivors with the Fontan circulation enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. Mean age at creation of the Fontan circulation was 3.4 plus or minus 2.1 years, with a range from 0.7 to 17.5 years, and time since completion was 8.7 plus or minus 3.4 years, the range being from 1.1 to 17.3 years. We calculated a functional score for the survivors by …

Solar Water Disinfection In Household Settings:Hype Or Hope?, Zulfiqar Ahmed Bhutta

Woman and Child Health

No abstract provided.

Comparison Of Echocardiographic And Cardiac Magnetic Resonance Imaging Measurements Of Functional Single Ventricular Volumes, Mass, And Ejection Fraction (From The Pediatric Heart Network Fontan Cross-Sectional Study)., Renee Margossian, Marcy L. Schwartz, Ashwin Prakash, Lisa Wruck, Steven D. Colan, Andrew M. Atz, Timothy J. Bradley, Mark A. Fogel, Lynne M. Hurwitz, Edward Marcus, Andrew J. Powell, Beth F. Printz, Michael D. Puchalski, Jack Rychik, Girish S. Shirali, Richard Williams, Shi-Joon Yoo, Tal Geva, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement …

Clinical Profile And Outcome In A Paediatric Intensive Care Unit In Pakistan, Anwarul Haque, Surraiya Bano

Department of Paediatrics and Child Health

Paediatric critical care medicine is a relatively new subspecialty in Pakistan. The clinical profile and outcomes of children admitted in the PICU (paediatric intensive care unit) were retrospectively reviewed from January to December 2007. Mean age of the studied 314 patients was 24 months; 37% were less than one-year-old and 66% was male. Mean PRISM score was 13.2. There were almost equal distribution of medical (46%) and surgical (54%) cases. Ninety percent of patients received mechanical ventilation, while more than 50% received vasoactive drugs. The rate of nosocomial infection was 4.7%. The average length of PICU stay was 3.2 (1-49) …

Intrauterine Growth Restriction Increases Fetal Hepatic Gluconeogenic Capacity And Reduces Messenger Ribonucleic Acid Translation Initiation And Nutrient Sensing In Fetal Liver And Skeletal Muscle., Stephanie R Thorn, Timothy Regnault, Laura D Brown, Paul J Rozance, Jane Keng, Michael Roper, Randall B Wilkening, William W Hay, Jacob E Friedman

Paediatrics Publications

Expression of key metabolic genes and proteins involved in mRNA translation, energy sensing, and glucose metabolism in liver and skeletal muscle were investigated in a late-gestation fetal sheep model of placental insufficiency intrauterine growth restriction (PI-IUGR). PI-IUGR fetuses weighed 55% less; had reduced oxygen, glucose, isoleucine, insulin, and IGF-I levels; and had 40% reduction in net branched chain amino acid uptake. In PI-IUGR skeletal muscle, levels of insulin receptor were increased 80%, whereas phosphoinositide-3 kinase (p85) and protein kinase B (AKT2) were reduced by 40%. Expression of eukaryotic initiation factor-4e was reduced 45% in liver, suggesting a unique mechanism limiting …

Consanguinity Among The Risk Factors For Underweight In Children Under Five: A Study From Rural Sindh, S. F. Hasnain, S. K. Hashmi

Community Health Sciences

BACKGROUND: Malnutrition is a common problem, especially in developing countries. Of the 11 million children under 5 who die each year in the developing countries mainly from preventable causes, the death of about 54% are either directly or indirectly attributable to malnutrition. The objectives of this study were to assess the prevalence and associated factors for underweight in rural Sindh.METHODS: A cross-sectional survey was conducted in Jhangara Town, located in District Dadu, Sindh. Eight hundred children under 5 years of age were enrolled. A questionnaire was used to elicit required information and anthropometric measurements were made.RESULTS: The overall prevalence for …

Comparison Of Oral Versus Injectable Vitamin-D For The Treatment Of Nutritional Vitamin-D Deficiency Rickets, Abdul Gaffar Billoo, Ghulam Murtaza, M. Ashraf Memon, Sultan Ahmed Khaskheli, Khalid Iqbal, Masood Hussain Rao

Department of Paediatrics and Child Health

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D.

STUDY DESIGN: Case control.

PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004.

METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups …

Improving Outcome In Pediatric Intensive Care Unit In Academic Hospital In Pakistan, Anwarul Haque, Surraiya Bano

Department of Emergency Medicine

Objective:

To assess the impact on the clinical outcome of critically ill children before and after introduction of pediatric intensivist in an academic pediatric intensive care unit (PICU) inPakistan.

Methodology: :

This is aretrospective audit of children (age from one month to 14 years) admitted in the PICU during two 12-month periods in PICU of Aga Khan University Hospital (AKUH).Patients in Cohort one were managed by pediatric intensivist while in Cohort two were managed by general pediatricians.Patients were compared during the two 12-month cohort period.

Results:

During the study, in cohort one, 314 patients were admitted, mean age was 24 …

Multiple Major Artery Compression By An Idiopathic Aortic Aneurysm: An Unusual Cause Of Hypertensive Encephalopathy, Shakeel Ahmed, Syed Rehan Ali, Husen Yousuf

Department of Paediatrics and Child Health

Multiple major artery compression by an aortic aneurysm is extremely rare in the paediatric population. Most arterial aneurysms in children are secondary to infections mainly mycotic, connective tissue disorder, vasculitis, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and a few reports in children have been published. We describe an 8 year old boy who presented with hypertensive encephalopathy and later was found to have an idiopathic, symptomatic suprarenal aortic aneurysm compressing multiple major arteries of the abdomen. The child was subsequently managed on multiple antihypertensive medication and later required engraftment of the renal and …

Vitamin B12 Deficiency--A Major Cause Of Megaloblastic Anaemia In Patients Attending A Tertiary Care Hospital, Saira Perwaiz Iqbal, Ghulam Nabi Kakepoto, Saleem Perwaiz Iqbal

Department of Pathology and Laboratory Medicine

BACKGROUND: Folate and vitamin B12 deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in our patient population.

METHODS: In this retrospective cohort study, clinical records of 220 patients (101 females and 119 males with an age range of 1-80 years) who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. …

It Is More Than Just A Reproductive Healthcare Visit: Experiences From An Adolescent Medicine Clinic, Marlene B. Huff, Kimberly K. Mcclanahan, Heather A. Brown, Hatim A. Omar

Pediatrics Faculty Publications

The gynecologist may be the only physician that an adolescent depends on for primary and reproductive healthcare services. Because adolescent females often make personal healthcare decisions without the benefit of supportive parents/caregivers, it is imperative that the gynecologist understands the developmental issues encountered during this phase of life. The objective of this study is to identify cited complaints of adolescent females seeking reproductive care and, thus, provide gynecologists with needed information about the medical/mental health issues that may be encountered during routine reproductive care exams. The study group was adolescent females between the ages of 12 and 20 years old. …