Medical Specialties Commons^™

A Narrative Review On Treatment Strategies For Neonatal Hypoxic Ischemic Encephalopathy, Janelle M Korf, Louise D Mccullough, Viola Caretti

Faculty, Staff and Student Publications

Background and Objective

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of death and disability worldwide. Therapeutic hypothermia (TH) represents a significant achievement in the translation of scientific research to clinical application, but it is currently the only neuroprotective treatment for HIE. This review aims to revisit the use of TH for HIE and its longitudinal impact on patient outcomes to readers new to the field of HIE. We discuss how emerging therapies address the broader pathophysiology of injury progression in the neonatal brain days to years after HIE.

Methods

We included full articles and book chapters published in English on …

Ecmo Clinical Practice Committee: Empowering The Frontline Staff, Michelle Mckain, Shayna Evans, Johanna I. Orrick, Kari L. Davidson

Posters

Background: Extracorporeal Membrane Oxygenation (ECMO) is a complex artificial life support for patients with severe respiratory and cardiac failure. Children’s Mercy was an early ECMO pioneer, establishing a program in 1987. Despite CM’s successful history, wide variations existed between regional management of ECMO (Schwartz et al., 2022). Studies show that patient outcomes, resources, staff satisfaction, and financial metrics improve with implementation of an interprofessional shared governance team (Olender et al., 2019; Schwartz et al., 2022). In 2016, the ECMO Clinical Practice Committee (ECP) was created, tasked with addressing projects aimed at ECMO process improvements. Methods: ECP members include Registered Nurses …

Impact Of Feeding Volumes In The First 24 H Of Life On Neonatal Feeding Intolerance., Navin Kumar, Igbagbosanmi Oredein, Mohammed Al-Nahar, Nathalee Harris, Venkatesh Sampath

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: This study investigates whether volumes of intake in the first 24 h of life (24 HOL), in relation to birth weight (BW) and gestational age (GA), impact neonatal feeding intolerance (FI).

METHODS: This study employed a retrospective chart review of 6,650 infants born at ≥35 weeks. The volumes of each formula feed per kg BW in the first 24 HOL were assessed. FI was defined as evidenced by chart documentation of emesis, abdominal distension, abdominal x-ray, and/or switching to a sensitive formula.

RESULTS: Overall, the maximum volume of formula intake per feed was inversely correlated with GA and was …

Burnout As Chronic Disease, Benjamin Doolittle

Journal of Wellness

Burnout is endemic. The prevalence of burnout (~50%) among healthcare providers has been stable over the past 20 years. Acknowledging variability from year to year, burnout is pervasive, with no signs of abating. Despite increased awareness of mental health issues, the rise of Chief Wellness Officers, and the expansion of Employee Assistance Programs, there has not been much improvement. We are even burned out from burnout. Survey responses are low and often do not result in action. Longitudinal intervention trials are often small and of short duration. We need a new paradigm to manage physician burnout. A chronic care management …

Smad8 Is Increased In Duchenne Muscular Dystrophy And Suppresses Mir-1, Mir-133a, And Mir-133b, Meghan L Royle, Eric J Connolly, Sara Nowakowski, Jeff R Temple

Faculty, Staff and Student Publications

OBJECTIVES: Studies are beginning to document an association between sleep duration and a range of adolescent delinquent behaviors, including weapon carrying. However, little is known about whether and to what extent sleep quality - another dimension of sleep for healthy adolescent functioning - is associated with weapon carrying. We address this gap in knowledge by evaluating the role of restless sleep and sleep duration in adolescent weapon carrying.

METHODS: We analyze data from a diverse sample of 994 adolescents from Texas, USA collected in 2010. Multivariate logistic regression models estimate the association of sleep duration and restless sleep on weapon …

State Of The Art Bowel Management For Pediatric Colorectal Problems: Hirschsprung Disease., Elizaveta Bokova, Ninad Prasade, Sanjana Janumpally, John Rosen, Irene Isabel P. Lim, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with …

Sickle Cell Disease Treatment With Arginine Therapy (Start): Study Protocol For A Phase 3 Randomized Controlled Trial., Chris A Rees, David C. Brousseau, Daniel M Cohen, Anthony Villella, Carlton Dampier, Kathleen Brown, Andrew Campbell, Corrie E Chumpitazi, Gladstone Airewele, Todd Chang, Christopher Denton, Angela Ellison, Alexis Thompson, Fahd Ahmad, Nitya Bakshi, Keli D Coleman, Sara Leibovich, Deborah Leake, Dunia Hatabah, Hagar Wilkinson, Michelle Robinson, T Charles Casper, Elliott Vichinsky, Claudia R Morris

Department of Pediatrics Faculty Papers

BACKGROUND: Despite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults.

METHODS: STArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 …

Mobile Health As A Potential Tool To Treat Children In Obesity, Olivia Carey

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Pediatric obesity prevalence is estimated to be 22% in 2020 of all children in the US³
• Obesity is defined as greater or equal to the 95th percentile for age and sex⁴
• Childhood obesity leads to adulthood hypertension, hyperlipidemia, respiratory complications, and reduced quality of life⁴⁴
• The AAP released new 2023 guidelines that define the standard of care as a multi-modal, chronic-care treatment plan that prescribes healthy eating choices, an increase in physical activity, and mental health support.⁵
• Mobile health is the use of mobile phones and wireless technology in healthcare³
• A meta analysis of …

Small Molecules Targeting Insm1 For The Treatment Of High-Risk Neuroblastoma, Michael S. Lan, Chiachen Chen

School of Medicine Faculty Publications

Human neuroblastoma (NB) is the most common childhood extracranial tumor arising from the sympathetic nervous system. It is also a clinically heterogeneous disease that ranges from spontaneous regression to high-risk stage 4 disease. The cause of this disease remains elusive. However, the amplification of NMYC oncogene occurred in roughly 30% of NB patients, which strongly correlated with the advanced stage of disease subtype and the worse prognosis status. We discovered that N-Myc oncoprotein binds and activates INSM1, a zinc-finger transcription factor of neuroendocrine tumors. We also found that INSM1 modulates N-Myc stability mediated through PI3K/AKT/GSK3β signaling pathway. Therefore, INSM1 emerges …

Infectious Profiles In Pediatric Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Alexander J Sandweiss, Timothy A Erickson, Yike Jiang, Varun Kannan, Jonathan M Yarimi, Jesse M Levine, Kristen Fisher, Eyal Muscal, Gail Demmler-Harrison, Kristy O Murray, Shannon E Ronca

Faculty, Staff and Students Publications

Anti-N-methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE) is an antibody-mediated neurological disorder that may be caused by post-herpes simplex virus-1 meningoencephalitis (HSV ME) and ovarian teratomas, although most pediatric cases are idiopathic. We sought to evaluate if other infections precede NMDAR AE by conducting a single-center, retrospective, case-control study of 86 pediatric cases presenting to Texas Children's Hospital between 2006 and 2022. HSV ME (HSV-1 and HSV-2) was a significantly more common preceding infection in the experimental group compared to control patients with idiopathic intracranial hypertension, while there was no difference in remote HSV infection between the two groups. Recent Epstein-Barr …

Role Of Suction-Based Airway Clearance Devices In Pediatric Foreign Body Airway Obstruction, Rebecca Braver

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Introduction

• Foreign body airway obstruction (FBAO) represents a significant cause of morbidity and mortality in the pediatric population. Factors including pediatric anatomy, chewing and swallowing difficulties, developmental stages, habits and behaviors, and children’s toys and foods increase risk of FBAO in children.^1,2
• BLS guidelines for FBAO management in responsive children ages 1-8 call for a series of subdiaphragmatic abdominal thrusts, which increase intrathoracic pressure to force air and the foreign body out of the airway.^3,4 Abdominal thrusts have higher reports of injury compared to all other FBAO interventions, with risk of thoracic, vascular, and gastro-esophageal injury.^5-7
• Novel …

A Cryptic Microdeletion Del(12)(P11.21p11.23) Within An Unbalanced Translocation T(7;12)(Q21.13;Q23.1) Implicates New Candidate Loci For Intellectual Disability And Kallmann Syndrome, Afif Ben-Mahmoud, Shotaro Kishikawa, Vijay Gupta, Natalia T. Leach, Yiping Shen, Oana Moldovan, Himanshu Goel, Bruce Hopper, Kara Ranguin, Nicolas Gruchy, Saskia M. Maas, Yves Lacassie, Soo Hyun Kim, Woo Yang Kim, Bradley J. Quade, Cynthia C. Morton, Cheol Hee Kim, Lawrence C. Layman, Hyung Goo Kim

School of Medicine Faculty Publications

In a patient diagnosed with both Kallmann syndrome (KS) and intellectual disability (ID), who carried an apparently balanced translocation t(7;12)(q22;q24)dn, array comparative genomic hybridization (aCGH) disclosed a cryptic heterozygous 4.7 Mb deletion del(12)(p11.21p11.23), unrelated to the translocation breakpoint. This novel discovery prompted us to consider the possibility that the combination of KS and neurological disorder in this patient could be attributed to gene(s) within this specific deletion at 12p11.21-12p11.23, rather than disrupted or dysregulated genes at the translocation breakpoints. To further support this hypothesis, we expanded our study by screening five candidate genes at both breakpoints of the chromosomal translocation …

Analyzing Experiences With Context-Based Physical Activity Coaching (Cb-Pac) In Caregivers Of Children With Visual Impairments: A Pilot Study, Mary Godman, Angela Blackwell, Eric Hicks

Summer 2023 Virtual OTD Capstone Symposium

Caregivers have faced many barriers in providing equitable physical activity (PA) opportunities for their children with visual impairments (VI) (Armstrong et al., 2018; Columna et al., 2017; Sterbova & Kudlacek, 2014). This pilot study focused on two female caregivers of children with VI to understand their experiences and perceptions related to providing PA for their children along with a context-based coaching program to improve their child’s participation in PA. The study utilized a mixed methods design and concluded that support, motivation, strategies for participation, and equipment were important areas to address for caregivers to engage their children in PA.

Creciendo Y Floreciendo Dentro De Nuestro Ambiente: A Contextual Intervention With Latino Parents Who Have Children Diagnosed With Autism Spectrum Disorder (Asd), Jocelyn Urbina, Erik Pérez, Angela Labrie Blackwell

Summer 2023 Virtual OTD Capstone Symposium

According to the Center for Disease Control and Prevention (CDC) (2021), 1 in 44 children has been identified with autism-spectrum disorder (ASD). Children with ASD experience challenges in participation that is characterized by difficulties in areas of social communication, social interaction, repetitive behavior, and a range of impairing sensory interests or aversions (Pasco, 2018). These challenges can limit their participation in occupations if not addressed within time as well as put stress on the child’s parents or caregivers. Parents who have children with ASD experience higher elevated levels of parental stress and psychological distress when compared to parents who have …

Comparison Of Near-Infrared Spectroscopy-Based Cerebral Autoregulatory Indices In Extremely Low Birth Weight Infants, Howard Chao, Sebastian Acosta, Craig Rusin, Christopher Rhee

Faculty, Staff and Students Publications

BACKGROUND: Premature infants are born with immature cerebral autoregulation function and are vulnerable to pressure passive cerebral circulation and subsequent brain injury. Measurements derived from near-infrared spectroscopy (NIRS) have enabled continuous assessment of cerebral vasoreactivity. Although NIRS has enabled a growing field of research, the lack of clear standardization in the field remains problematic. A major limitation of current literature is the absence of a comparative analysis of the different methodologies.

OBJECTIVES: To determine the relationship between NIRS-derived continuous indices of cerebral autoregulation in a cohort of extremely low birth weight (ELBW) infants.

METHODS: Premature infants of birth weight 401-1000 …

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Faculty, Staff and Student Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …

Unraveling The Serotonin Saga: From Discovery To Weight Regulation And Beyond – A Comprehensive Scientific Review, Kristine Conde, Shuzheng Fang, Yong Xu

Faculty, Staff and Students Publications

The prevalence of obesity is rapidly increasing worldwide, while the development of effective obesity therapies lags behind. Although new therapeutic targets to alleviate obesity are identified every day, and drug efficacy is improving, adverse side effects and increased health risks remain serious issues facing the weight-loss industry. Serotonin, also known as 5-HT, has been extensively studied in relation to appetite reduction and weight loss. As a result, dozens of upstream and downstream neural targets of 5-HT have been identified, revealing a multitude of neural circuits involved in mediating the anorexigenic effect of 5-HT. Despite the rise and fall of several …

My Happy Baby Is Back: Zero Balancing, Craniosacral Therapy And A Baby’S Journey To Becoming Mobile, Veronica Quarry

Journal of Transformative Touch

Alison began receiving ZB and CST at 13 months of age due to gross motor delays: at that age she was only able to sit somewhat rigidly. After the first session, Alison changed` from being very unhappy and seemingly frustrated to being happy and more calm. Within one month of weekly sessions, Alison was able to be on her tummy, began to crawl, became more agile in seated play, was squatting and standing and took her first steps.

Donor-Recipient Specificity And Age-Dependency In Fecal Microbiota Therapy And Probiotic Resolution Of Gastrointestinal Symptoms, Qinglong Wu, Prapaporn Boonma, Shyam Badu, Nazli Yalcinkaya, Sik Yu So, Kevin W Garey, Kent Williams, L Eugene Arnold, Robert J Shulman, Richard Kellermayer, Tor C Savidge

Faculty, Staff and Students Publications

Fecal microbiota transplantation (FMT) has proven to be an effective treatment for recurrent Clostridioides difficile infection (rCDI) in both adult and pediatric patients. However, as microbiome development is a critical factor in children, it remains unclear whether adult fecal donors can provide age-appropriate functional restoration in pediatric patients. To address this issue, we conducted an integrated systems approach and found that concordant donor strain engraftment, along with metabolite restoration, are associated with FMT outcomes in both adult and pediatric rCDI patients. Although functional restoration after FMT is not strain-specific, specialized metabolic functions are retained in pediatric patients when adult fecal …

The Effects Of Covid-19 On Cognition In The Pediatric Population, Mia Ramirez, Hope Mccarroll, Lisa Griggs-Stapleton

Summer 2023 Virtual OTD Capstone Symposium

Coronavirus disease or COVID-19, is an infectious disease caused by the SARS-CoV-2 virus. COVID-19 can affect adults and children by causing long-term symptoms such as difficulty concentrating, anxiety, depression, long-term breathing problems, and even heart complications. Children represent about 19% of all reported COVID-19 cases since the pandemic first began. Children also can have trouble concentrating, which can impact their ability to attend school and do their daily activities that require concentration, such as dressing, showering, and social participation. Cognitive deficits due to COVID-19 can impact the pediatric population as they may have decreased occupational performance in desired occupations, such …

Program Development In Pediatric Prosthetic Training For Occupational Therapists, Paulina Alas, Monica Watford, Grace Evasco

Summer 2023 Virtual OTD Capstone Symposium

This project delves into the necessity for professional tools designed to assist occupational therapists (OTs) in readying themselves for the treatment of pediatric patients requiring upper limb prosthetics. The endeavor encompasses an examination of various diagnoses that warrant prosthetic intervention, an exploration of diverse prosthetic variants, and a comprehensive manual detailing pre-prosthetic and prosthetic functional training.

The Importance Of Occupational Therapy During The Transition From The Nicu To Home For Parents’ Confidence In Co-Occupations, Randa Sloan, Mary Jan Greer, Faith Saunders

Summer 2023 Virtual OTD Capstone Symposium

Parents often transition home from the NICU with decreased confidence in their abilities to care for their infant after having extensive specialized care (Craig et al., 2015). Boykova (2016) explained that parents experienced low self-confidence and fear of making mistakes in their infants’ care upon arriving home. The problem is the lack of support and education about resources for parents during the transition from the NICU to home. Parents lack knowledge about the vital role OT plays in improving confidence in co-occupations which will play a role in improved parental mental health. Furthermore, parents and caregivers lack knowledge on how …

An Sms Text Message-Based Type 2 Diabetes Prevention Program For Hispanic Adolescents With Obesity: Qualitative Co-Design Process, Erica Soltero, Callie Lopez, Sandra Mihail, Ayleen Hernandez, Salma M Musaad, Teresia M O'Connor, Debbe Thompson

Faculty, Staff and Students Publications

BACKGROUND: SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators.

OBJECTIVE: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Effect Of Body Mass Index Percentile On Complicated Appendicitis, Postoperative Complications And Health Service Utilization Among Pediatric Patients In The United States, Nutan Hebballi

Dissertations and Theses (Open Access)

While overweight and obesity have been extensively studied for complicated appendicitis, postoperative complications, and health service utilization, the effects of being underweight are unknown. This dissertation assesses the associations between the body mass index (BMI) spectrum with complicated appendicitis, postoperative complications, and healthcare service utilization in pediatric patients.  A retrospective review of pediatric patients who underwent appendectomy surgery (01/01/2016-12/31/2020) was conducted using the National Surgical Quality Improvement Program database. Computed age and gender-specific BMI percentiles were categorized into underweight, normal weight, overweight and obese. The 30-day postoperative complications were grouped into minor, major, and any. Healthcare service utilizations were compared …

Standard Atrial Epicardial Wire Placement Leads To Improved Atrial Signal Identification And Pacemaker Sensing, Nir Atlas, William Gibson, J Hermsen, A Harmon, J Torgeson, Lindsey Malloy-Walton, N Von Bergen

Posters

Background: Atrial arrhythmias are common after pediatric cardiac surgery and are associated with increased morbidity and mortality. Atrial epicardial wires (AEW), utilized to diagnose and treat atrial arrhythmias, are known to malfunction during post-operative care. There are no pediatric prospective studies examining ideal placement of AEW. Methods: This prospective multicenter pilot study compared atrial amplitudes, pacing sensitivities and thresholds via AEW placed at Bachmann’s Bundle (BB) and the right-sided interatrial groove (RSIG) versus the surgeon’s standard placement (control locations) in 26 patients aged less than six years old undergoing cardiac surgery. Participants received four total AEW - two at the …

Treatment Of Post-Operative Pain In Children With Severe Neurologic Impairment, Jordan Keys, Jessica L. Bettenhausen, Jessica L. Markham, Matthew Hall

Posters

Introduction The assessment of pain in children with severe neurologic impairment (SNI) can be more challenging than in neurotypical children. Objective To describe: 1) the type, number of classes, and duration of post-operative pain medications for common procedures among children with SNI and 2) the variability in pain management strategies across children's hospitals, specifically for opioid administration. Methods This retrospective cohort study, using the Pediatric Health Information System database, included children aged 0-21 years hospitalized with SNI who underwent common procedures during 2019. We defined SNI using previously described high-intensity neurologic impairment (HINI) diagnosis codes and identified six common ( …

The Incidence And Modifiable Risk Factors For Necrotizing Enterocolitis Inpreterm Infants A Retrospective Cohort Study, Kelvin Gitau, Roseline Ochieng, Mary Limbe, Caroline Kathomi, James Orwa

Paediatrics and Child Health, East Africa

Objectives: To evaluate the incidence and modifiable risk factors for Necrotizing enterocolitis (NEC) in preterm infants born at ≤32 weeks of gestation weighing <1500 grams, at a private tertiary care hospital in Kenya.

Materials and methods: This retrospective cohort study was conducted at the Aga Khan University Hospital Neonatal Intensive Care Unit (NICU). Preterm infants born at ≤ 32 weeks’ gestation and weighing <1500 grams admitted to NICU between 2009 and 2019, were recruited into the study. The primary outcome was NEC Bell Stage IIa-IIIb based on Modified Bell’s criteria. Maternal and neonatal characteristics were evaluated. The association between variables of interest and NEC was determined using logistic regression analysis and the incidence of NEC for the study period was calculated.

Results: A total of 261 charts of infants born at ≤ 32 weeks’ gestation, weighing <1500 were reviewed, and 200 charts met the inclusion criteria. Fifteen preterm infants developed the primary outcome of interest: NEC Stage ≥2a within the first 30 days of admission. The overall incidence of NEC for the study period was 7.5%. Three risk factors were identified as significantly associated with NEC on multivariate logistic regression analysis: antenatal exposure to steroids (OR = 0.056 CI = 0.003-0.964 p = 0.047), cumulative duration of exposure to invasive mechanical ventilation (OR = 2.172 CI = 1.242-3.799 p = 0.007) and cumulative duration of exposure to umbilical vein catheter (OR = 1.344 CI = 1.08-1.672 p = 0.008).

Conclusions: The overall incidence for the study period of NEC Stage ≥ II a was 7.5%. Exposure to antenatal steroids, duration of mechanical ventilation, and duration of umbilical vein catheterization were …

Hyperbilirubinemia, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Ultrastructure For The Diagnosis Of Primary Ciliary Dyskinesia In South Africa, A Resource-Limited Setting, Monica Birkhead, Samuel Otido, Theodore Mabaso, Keketso Mopeli, Dorcas Tlhapi, Charl Verwey, Ziyaad Dangor

Paediatrics and Child Health, East Africa

Introduction: International guidelines recommend a multi-faceted approach for successful diagnoses of primary ciliary dyskinesia (PCD). In the absence of a gold standard test, a combination of genetic testing/microscopic analysis of structure and function/nasal nitric oxide measurement is used. In resourcelimited settings, often none of the above tests are available, and in South Africa, only transmission electron microscopy (TEM) is available in central anatomical pathology departments. The aim of this study was to describe the clinical and ultrastructural findings of suspected PCD cases managed by pediatric pulmonologists at a tertiary-level state funded hospital in Johannesburg.

Methods: Nasal brushings were …