Medicine and Health Sciences Commons^™

Neuromyelitis Optica In Child: Diagnostic And Therapeutic Challenges, Karolina Dembinski, Maria Gieron-Korthals, Carlos R. Martinez, Lisa Rodriguez

Pediatrics Faculty Publications

Neuromyelitis optica (NMO) is a rare syndrome of severe inflammatory demyelination of the central nervous system, causing attacks of optic neuritis and transverse myelitis. Although uncommon, attention should be given to the proper identification and management of the affected patients. We present a case of a 13-year-old girl with severe neuromyelitis optica. The patient’s initial presentation consisted of encephalopathy and optic neuritis. Approximately 2 months later, coinciding with the weaning of steroid treatment, she presented with ascending paralysis and respiratory failure. She was seropositive for NMO-IgG. Treatment included intravenous immune globulin, steroids, plasmapheresis, and rituximab and was complemented with proper …

Complex Cytogenetic Rearrangements At The Durs1 Locus In Syndromic Duane Retraction Syndrome, Hagit N. Baris, Wai-Man Chan, Caroline Andrews, Doron M. Behar, Diana J. Donovan, Cynthia C. Morton, Judith Ranells, Tuya Pal, Azra H. Ligon, Elizabeth C. Engle

Pediatrics Faculty Publications

No abstract provided.

Fmic Annual Report 2013 | English, French Medical Institute For Mothers And Children

FMIC Reports

No abstract provided.

Nutritional Status Of Orphaned And Separated Children And Adolescents Living In Community And Institutional Environments In Uasin Gishu County, Kenya, Paula Braitstein, Samuel Ayaya, Winstone M. Nyandiko, Allan Kamanda, Julius Koech, Peter Gisore, Lukoye Atwoli, Rachel C. Vreeman, Corey Duefield, David O. Ayuku

Paediatrics and Child Health, East Africa

Objective: To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya. Methods: The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions(CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores #-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in theprevious year, time living with current guardian, and …

Effectiveness Of Sequential V. Standard Triple Therapy For Treatment Of Helicobacter Pylori Infection In Children In Nairobi, Kenya, Ahmed Laving, Rose Kamenwa, Shahin Sayed, Andrew Nyerere Kimang'a, Gunturu Revathi

Paediatrics and Child Health, East Africa

Background: Once the diagnosis of Helicobacter pylori is confirmed, treatment requires at least two antibiotics and an acid inhibitor for a minimum of seven days. Unfortunately, treatment failures are being frequently reported. Treatment regimens that include sequential administration of antibiotics with acid inhibitors have been developed to try and increase the rate of eradication.

Objective: To determine the effectiveness of a novel 10-day sequential therapy compared with the standard 10-day triple therapy for treatment of H. pylori infection in children.

Methods: A double-blinded, randomised, controlled trial was conducted. Children under the age of 16 years with recurrent abdominal pain associated …

Simplified Regimens For Management Of Neonates And Young Infants With Severe Infection When Hospital Admission Is Not Possible, Antoinette Tshef, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayede, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmad Qazi

Paediatrics and Child Health, East Africa

Background: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care.

Methods: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The …

Development Of Frataxin Gene Expression Measures For The Evaluation Of Experimental Treatments In Friedreich's Ataxia., Heather L Plasterer, Eric C Deutsch, Matthew Belmonte, Elizabeth Egan, David R Lynch, James R Rusche

Department of Pediatrics Faculty Papers

BACKGROUND: Friedreich ataxia is a progressive neurodegenerative disorder caused by GAA triplet repeat expansions or point mutations in the FXN gene and, ultimately, a deficiency in the levels of functional frataxin protein. Heterozygous carriers of the expansion express approximately 50% of normal frataxin levels yet manifest no clinical symptoms, suggesting that therapeutic approaches that increase frataxin may be effective even if frataxin is raised only to carrier levels. Small molecule HDAC inhibitor compounds increase frataxin mRNA and protein levels, and have beneficial effects in animal models of FRDA.

METHODOLOGY/PRINCIPAL FINDINGS: To gather data supporting the use of frataxin as a …

Evaluation Of Vancomycin Dosing And Corresponding Drug Concentrations In Neonatal Intensive Care Unit (Nicu) Patients, Christine Lam Pharmd, Jenny Boucher Bs, Pharmd, Jd, Bcps

Department of Pharmacy

No abstract provided.

Snap-Ed New Mexico Social Marketing Project Phase Ii Report, Sally M. Davis, Glenda Canaca, Jose Canaca, Mary Hanrahan, Julia Meredith Hess, Danielle P. Parker

Reports & Documents

The SNAP-Ed New Mexico Social Marketing Project is a multiphase study that explores how the core nutrition messages developed by FNS and its collaborators are received by people of Hispanic-origin, particularly those of Mexican or Mexican-American descent. The objective of the SNAP-Ed New Mexico Social Marketing Project is to create culturally appropriate nutrition education messages in Spanish and implement a multi-level social marketing intervention to increase fruit, vegetable, whole grain, and low-fat and fat-free dairy consumption.

Treatment Of Fast Breathing In Neonates And Young Infants With Oral Amoxicillin Compared With Penicillin-Gentamicin Combination: Study Protocol For A Randomized, Open-Label Equivalence Trial, Antoinette Tshefu, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayed, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmed Qaz

Paediatrics and Child Health, East Africa

Background: The World Health Organization recommends hospitalization and injectable antibiotic treatment for young infants (0–59 days old), who present with signs of possible serious bacterial infection. Fast breathing alone is not associated with a high mortality risk for young infants and has been treated with oral antibiotics in some settings. This trial was designed to examine the safety and efficacy of oral amoxicillin for young infants with fast breathing compared with that of an injectable penicillin–gentamicin combination. The study is currently being conducted in the Democratic Republic of Congo, Kenya and Nigeria

Methods/Design: This is a randomized, open-label equivalence trial. …

Commonly Cited Incentives In The Community Implementation Of The Emergency Maternal And Newborn Care Study In Western Kenya, Peter Gisore, B. Rono, J. Nekesa-Mangeni, C. Tenge, E. Shipala, H. Mabeya, D. Odhiambo, K. Otieno, S. Bucher, C. Makokha, E. Liechty, F. Esamai

Paediatrics and Child Health, East Africa

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community.

Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project.

Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool …

Prevalence And Correlates Of Being Bullied Among In-School Adolescents In Malawi: Results From The 2009 Global School-Based Health Survey, H.W. Kubwalo, A.S. Muula, S. Siziya, S. Pasupulati, E. Rudatsikira

Community & Environmental Health Faculty Publications

Background

Physical and emotional violence against adolescents is a neglected, but growing problem globally. Violence against adolescents negatively affects the victim in terms of physical health, school attendance and performance and social adjustment. The literature on the prevalence and associated factors of bullying against adolescents is sparse in southern Africa outside South Africa. Such data are even sparser for Malawi. The current study was conducted to estimate the prevalence of self-reported bullying and its personal and social correlates.

Methods

A secondary analysis of the Malawi School-Based Student Health Survey (2009) was done. Descriptive analyses were done to describe the sample …

Scientific Rationale For Study Design Of Community-Based Simplified Antibiotic Therapy Trials In Newborns And Young Infants With Clinically Diagnosed Severe Infections Or Fast Breathing In South Asia And Sub-Saharan Africa., Anita K. M. Zaidi, Abdullah H. Baqui, Shamim Ahmad Qazi, Rajiv Bahl, Samir Saha, Adejumoke I. Ayede, Ebunoluwa A. Adejuyigbe, Cyril Engmann, Fabian Esamai, Antoinette Kitoto Tshefu, Robinson D. Wammanda, Adegoke G. Falade, Adetanwa Odebiyi, Peter Gisore, Adrien Lokangaka Longombe, William N. Ogala, Shiyam Sundar Tikmani, A. S. M. Nawshad Uddin Ahmed, Steve Wall, Neal Brandes, Daniel E. Roth, Gary L. Darmstadt

Paediatrics and Child Health, East Africa

Background: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0–59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted.

Methods: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are …

Nutritional Status Of Children Admitted For Diarrhoeal Diseases In A Referral Hospital In Western Kenya, I. Marete, J. Simba, Peter Gisore, C. Tenge, D. Bosire, A. Mwangi, F. Esamai

Paediatrics and Child Health, East Africa

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay.

Design: Prospective observational study.

Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya

Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012.

Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and …

Graduate Medical Education 2012-2013 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Optimizing Atraumatic Emergency Care In Child Sexual Abuse, Kristen A. Morris

Evidence-Based Practice Project Reports

Child sexual abuse has been identified as a common problem. According to the United States Department of Health and Human Services, in 2010 it was estimated that child victims of sexual abuse accounted for 9.2% (69,368) of the 573,794 children under the age of 12 years who were the victims of maltreatment. The emergency department (ED) is often the point of entry into the healthcare system for child sexual abuse victims, which adds to the resource burden of this department nationwide. The purpose of this evidence-based project was to develop a best-practice screening tool for medical providers to guide the …

Improved Accessibility Of Emergency Obstetrics And Newborn Care (Emonc) Services For Maternal And Newborn Health: A Community Based Project, Ali Turab, Shabina Ariff, Atif Habib, Imran Ahmed, Masawar Hussain, Akhtar Rashid, Zahid Memon, M. Imran Khan, Sajid Soofi, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur.
Method/Design: This community based cluster randomized controlled trial will …

B-Type Natriuretic Peptide (Bnp): A Potential Biomarker For Extubation Failure In Infants Following Cardiac Surgery, Jennifer Flint, Lori Erickson, Dawn Tucker, Erica Molitor-Kirsch

Posters

Background: BNP is a hormone released from the cardiac ventricles in response to increased pressure and volume overload1 and is an important biomarker in heart failure. Following congenital heart surgery, elevated BNP levels correlate with longer duration of mechanical ventilation, low cardiac output syndrome, and increased ICU length of stay2-4 Mechanical ventilation (MV) has an exaggerated impact on cardiopulmonary interactions in children with myocardial dysfunction, and extubation readiness can be difficult to determine post-operatively following congenital heart surgery.

Hypothesis: An increase in post-extubation BNP levels can predict extubation failure and the need for reintubation within 48 hours.

Methods:

Design: prospective, …

Commentary On "The Motor Learning Strategy Instrument: Interrater Reliability Within Usual And Virtual Reality Physical Therapy Interventions", Karen M. Kott, Sharon Held

Rehabilitation Sciences Faculty Publications

No abstract provided.

Pediatric Medical Traumatic Stress : The Impact On Children, Parents And Staff, Sarah Mcgarry

Theses: Doctorates and Masters

Burns are one of the most painful and traumatising injuries an individual can sustain and constitute a serious global health threat to children. Despite the magnitude of this public health problem, little research has examined the psychological burden of these injuries. This study used a mixed-methods approach to investigate the effect of paediatric medical trauma on children who have sustained a burn, their parents and the healthcare professionals caring for these patients. The paediatric medical traumatic stress model provided a theoretical framework for this study.

Firstly, this study aimed to gain an understanding of the lived experience of children who …

Achieving Meaningful Medical Student Evaluations Through A Clinical Encounter Card, Liborio Larussa Md, Kris Rooney Md

Department of Pediatrics

No abstract provided.

Prevalence Of Acute Kidney Injury Using Urine Neutrophil Gelatinase Associated Lipocalin As An Early Biomarker In Neonates With Perinatal Asphyxia, Farida Essajee

Theses & Dissertations

Introduction: Perinatal asphyxia is a major cause of neonatal morbidity and mortality. Acute kidney injury (AKI) is a common complication of perinatal asphyxia occurring in up to 61% of the neonates. Currently the diagnosis of AKI is based on serum creatinine levels and clinically by oliguria, however these are late markers of the disease. More novel biomarkers are emerging that predict the diagnosis early. Current research indicates urine NGAL as an early marker for AKI, yet there is paucity of data about its use in term neonates with perinatal asphyxia.

Objectives: This study aimed to investigate the prevalence …

A Study To Evaluate The Acceptability, Feasibility And Impact Of Packaged Interventions (“Diarrhea Pack”) For Prevention And Treatment Of Childhood Diarrhea In Rural Pakistan, Atif Habib, Sajid Soofi, Kamran Sadiq, Tariq Samejo, Musawar Hussain, Mushtaq Mirani, Asmatullah Rehmatullah, Imran Ahmed, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Diarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age. Interventions such as ORS, Zinc, water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before. This study attempts to evaluate the package of evidence based interventions in a “Diarrhea Pack” through first level health care providers at domiciliary level in community based settings. This study sought to evaluate the acceptability, feasibility and impact of …

Global Epidemiology Of Invasive Meningococcal Disease, Rabab Z. Jafri, Syed Asad Ali, Nancy E. Messonnier, Carol Tevi-Benissan, David Durrheim, Juhani Eskola, Florence Fermon, Keith P. Klugman, Mary Ramsay, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20years in World Health Organization and European Centre for Disease Prevention …

Micronutrient Fortification Of Food And Its Impact On Woman And Child Health: A Systematic Review, Jai K. Das, Rehana A. Salam, Rohail Kumar, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.
Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact …

Role Of Human Metapneumovirus, Influenza A Virus And Respiratory Syncytial Virus In Causing Who-Defined Severe Pneumonia In Children In A Developing Country, Asad Ali, Asif Raza Khowaja, Maaman Zahoor Bashir, Fatima Aziz, Sultan Mustafa, Anita Zaidi

Department of Paediatrics and Child Health

Objective: The role of respiratory viruses in causing severe, life threatening pneumonia in children in developing countries is not well established. Our study aims to determine the role of human metapneumovirus (HMPV), influenza A virus and respiratory syncytial virus (RSV) in children, aged 6 weeks to 2 years, hospitalized with WHO defined severe pneumonia (tachypnea plus any general danger sign or chest in-drawing) at a public sector hospital in Karachi, Pakistan.
Methods: This study was conducted from November 2010 to September 2011 at Abbassi Shaheed Hospital, a large public tertiary care hospital in Karachi, Pakistan. Children admitted with WHO-defined severe …

Setting Research Priorities For Preconception Care In Low- And Middle-Income Countries: Aiming To Reduce Maternal And Child Mortality And Morbidity, Sohni Dean, Igor Rudan, Fernando Althabe, Aimee Webb Girard, Christopher Howson, Ana Langer, Joy Lawn, Mary-Elizabeth Reeve, Katherine C. Teela, Mireille Toledano

Department of Paediatrics and Child Health

No abstract provided.

Trends Of Empiric Antibiotic Usage In A Secondary Care Hospital, Karachi, Pakistan, Syed Rehan Ali, Shakeel Ahmed, Heeramani Lohana

Department of Paediatrics and Child Health

Objectives: (1) To determine the indications, frequency, and types of antibiotics used in hospitalized paediatric patients at tertiary care hospital and (2) to evaluate whether the prescribed antibiotics were based on the isolation of organism and their sensitivity. Study Design: Descriptive observational hospital based study.
Results: A total of 131 patients were included over 6 months of study period, in whom antibiotics were prescribed at the time of admission. The majority were between 1 and 5 years of age. M:F ratio was 1:1. Fever was the commonest symptom (in 84% of cases) followed by gastroenteritis. Blood culture was done in …