Medical Specialties Commons^™

Sleep Aspects And Sleep Disorders In Children And Adolescents, Sameh Morkous Md, Faan

Department of Pediatrics

No abstract provided.

Transanal-Only Swenson-Like Pull-Through For Late Diagnosed Hirschsprung Disease., Rebecca M. Rentea, Devin R. Halleran, Hira Ahmad, Elias Maloof, Richard J. Wood, Marc A. Levitt

Manuscripts, Articles, Book Chapters and Other Papers

Hirschsprung disease (HD) is an obstructive colonic process usually diagnosed in the neonatal period. A small subset of cases are diagnosed late, present with severe constipation without enterocolitis and have low rectosigmoid disease. A transanal-only pull-through is a well-described approach but in the newborn period risks a situation whereby the transition zone is higher than the sigmoid. We present our experience with the unique patient population of older HD patients in whom the transition zone was reliably reachable via a single-stage transanal approach, performed in prone position. Patients between 2 and 6 years of age with a rectal or sigmoid …

An Uncommon Adverse Effect Of A Common Drug-Dress Syndrome-Not Just Skin Deep!, Alamelu Udayappan

Graduate Medical Education Research Journal

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a rare, life-threatening hypersensitivity reaction that causes skin exfoliation, hematological abnormalities, lymphadenopathy, and extensive internal organ involvement. Characterized by a long latency period, this unusual side effect of aromatic anti-epileptic drugs, as well as many common drugs cause a mortality rate of up to 10% if left untreated. In the absence of a well-established therapy, primary and secondary prevention have a key role in the management of DRESS Syndrome. Herewith presenting a case of an adolescent girl with rashes and systemic symptoms, the cause of which, on obtaining a detailed …

Necrotizing Enterocolitis Following Gastroschisis Repair: An Update, Rachel K. Schlueter, Shahab F. Abdessalam, Stephen C. Raynor, Robert A. Cusick

Graduate Medical Education Research Journal

Purpose:

Necrotizing enterocolitis (NEC) is a known complication of gastroschisis with an incidence above the expected rate in the neonatal population. While many physicians today are aware of this association, the last publication to explore this association in detail and identify possible risk factors of NEC in gastroschisis patients was published over twenty years ago. From our large database of patients with gastroschisis managed by a single group of pediatric surgeons, we reviewed our experience and the recent literature to update what is known about gastroschisis and NEC.

Methods:

From 2001 to 2017, a gastroschisis registry was maintained. Data from …

Dr. Ahmed Abdelmoity To Receive Endowed Chair, Children's Mercy Hospital

Our Story Continues

Former Children’s Mercy CEO Rand O’Donnell, PhD, and his wife, Melva, are establishing an endowed chair position that will be awarded to Ahmed Abdelmoity, MD, FAAP, Division Director of Child Neurology, Section Chief of Epilepsy and Neurophysiology. Dr. Abdelmoity will become our 31st endowed chair at Children’s Mercy.

The Effect Of Aquatic Interventions In Combination With Early Start Physical Therapy Services On Gross Motor Development In A Male Child With Down Syndrome, Roxanne Mueller

San Marcos, Fall 2019

Introduction: Aquatic therapy has been used in various patient populations as a modality to facilitate motor control and manage tonicity.^1-3 Despite the variety of literature addressing individuals with Down syndrome (DS) and aquatic therapy, there has been little described about the effects of aquatic therapy on early gross motor development in children with DS.

Purpose: The purpose of this case study is to examine whether aquatic physical therapy interventions combined with early start physical therapy influence gross motor developmental delay in a child with DS.

Case Description: The patient is a 31-month-old boy with diagnosis of …

What Is Congenital Talipes Equinovarus?, Cornelia Lieb-Lundell

San Marcos, Fall 2019

An estimated 80% of clubfoot cases occur in low to middle-income countries. Incidence of clubfoot is estimated to be 1-1.5 per 1000 births, and male to female occurrence is 3:1. (1) Left untreated, this congenital anomaly becomes a “neglected clubfoot” and can result in lifelong hardships including limited ambulation related to gait deviations, pain, foot deformities and an inability to wear shoes. Without treatment, this health condition can lead to functional limitations with limited independence in activities of daily living and participation restrictions within the family and community related to decreased mobility. (2)

The intervention presented is the main components …

Impact Of Prevnar (Pcv13) Vaccine Recommendations In Pediatric And Immunocompetent Adults 65 Years And Older: What Are The Benefits And Risks?, James E. Watkins, Anne Marie Thibodeaux, John C. Darnell

Articles, Abstracts, and Reports

Background:

2000: PCV7 becomes the first FDA approved pneumococcal vaccine for pediatrics
2010: PCV13 recommended in pediatrics
2014: PCV13 recommended in immunocompetent adults 65+
2018: CDC looked at data since 2014 recommendation
2019: PCV13 now shared clinical decision-making

Unraveling Complexity About Childhood Obesity And Nutritional Interventions: Modeling Interactions Among Psychological Factors., Keith Feldman, Gisela M B Solymos, Maria Paula De Albuquerque, Nitesh V. Chawla

Manuscripts, Articles, Book Chapters and Other Papers

As the global prevalence of childhood obesity continues to rise, researchers and clinicians have sought to develop more effective and personalized intervention techniques. In doing so, obesity interventions have expanded beyond the traditional context of nutrition to address several facets of a child's life, including their psychological state. While the consideration of psychological features has significantly advanced the view of obesity as a holistic condition, attempts to associate such features with outcomes of treatment have been inconclusive. We posit that such uncertainty may arise from the univariate manner in which features are evaluated, focusing on a particular aspect such as …

Postpartum Endometritis And Infection Following Incomplete Or Complete Abortion: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Maternal Immunization Safety Data, C E. Rouse, L O. Eckert, F M. Muñoz, J S A. Stringer, S Kochhar, L Bartlett, M Sanicas, D J. Dudley, D M. Harper, Fyezah Jehan

Department of Paediatrics and Child Health

Abstract are not provided by the author/publisher

Memantine: Can It Be Used To Treat Children With Autism Spectrum Disorder?, Austin Brown, Katherine Liu, Pul Lee, Rachel Muhlenkamp, Manoranjan D'Souza

Pharmacy and Wellness Review

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social, behavior and communicative skills. The current therapy for ASD only targets the associated symptoms such as aggression, self-harming acts or temper tantrums but not the core symptoms of social dysfunction. The pathology of ASD is not fully understood. Interestingly, imaging studies in ASD patients have reported abnormal high levels of glutamate in certain brain regions that play an important role in social interaction and communication. Thus, it has been hypothesized that medications attenuating glutamate transmission may be used as treatment for some of the core symptoms of …

Management Of Hypertensive Emergencies In Pediatrics, Jennifer L. Bauer, Jamie L. Amero, Amanda C. Mcdavid, Ryan A. Fischer, Alison L. Huet, Karen L. Kier

Pharmacy and Wellness Review

As hypertension becomes more prevalent in the pediatric population, clinicians are more likely to encounter hypertensive emergencies in children, which require pharmacists and physicians to be educated on the therapeutic options for these emergencies. However, the strict governmental requirements on the testing of these drugs in pediatric patients have limited the amount of available evidence on which to base clinical decisions. This review will highlight the available evidence and preferred treatment options for the management of pediatric hypertensive emergencies.

Deworming Children For Soil-Transmitted Helminths In Low And Middle-Income Countries: Systematic Review And Individual Participant Data Network Meta-Analysis, Vivian Andrea Welch, Alomgir Hossain, Elizabeth Ghogomu, Alison Riddle, Simon Cousens, Michelle Gaffey, Paul Arora, Robert Black, Donald Bundy, Zulfiqar Ahmed Bhutta

Woman and Child Health

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup …

An Electronic Medical Records-Based Approach To Identify Idiosyncratic Drug-Induced Liver Injury In Children., Tracy L. Sandritter, Jennifer Goldman, Clayton J Habiger, James F. Daniel, Jennifer Lowry, Ryan T. Fischer

Manuscripts, Articles, Book Chapters and Other Papers

Drug-induced liver injury (DILI) is the leading cause of liver failure in the United States and the most common cause of drug recall. As opposed to the recognized direct toxicity of super-therapeutic acetaminophen or chemotherapeutic agents in children, limited data exists for pediatric populations on the incidence of idiosyncratic DILI (iDILI) that may develop independently of drug dose or duration of administration. To improve the detection of adverse drug reactions at our hospital, we utilized electronic medical records-based automated trigger tools to alert providers of potential iDILI. Clinical criteria concerning for iDILI were defined as serum ALT > 5x or serum …

Expanding Services Of A Pharmacist-Led Rural Mobile Health Clinic To School-Aged Children And Working Class Parents, Megan Stephan, Karen Kier, Michael Rush

Pharmacy Faculty Scholarship

No abstract provided.

Muscle Activation Patterns During Movement Attempts In Children With Acquired Spinal Cord Injury: Neurophysiological Assessment Of Residual Motor Function Below The Level Of Lesion., Darryn A Atkinson, Laura Mendez, Natalie Goodrich, Sevda C Aslan, Beatrice Ugiliweneza, Andrea L Behrman

Physical Therapy Collection

Introduction: Characterization of residual neuromotor capacity after spinal cord injury (SCI) is challenging. The current gold standard for measurement of sensorimotor function after SCI, the International Society for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam, seeks to determine isolated intentional muscle activation, however many individuals with SCI exhibit intentional movements and muscle activation patterns which are not confined to specific joint or muscle. Further, isolated muscle activation is a feature of the neuromuscular system that emerges during development, and thus may not be an appropriate measurement standard for children younger than 6.

Methods: We utilized neurophysiological assessment …

A Phase 1 Study Of Intravenous Busulfan As A Conditioning Regimen For Multiple Myeloma, Sabarinath V. Radhakrishnan, Michael Boyer, Catherine M. Sherwin, Maurizio Zangari, Guido Tricot

Pediatrics Faculty Publications

The efficacy of melphalan (MEL) 140 mg/m 2 pre-transplant conditioning versus MEL 200 mg/m 2 for the elderly is still debated. We hypothesized that single-agent intravenous busulfan (BU) would show significant anti-myeloma efficacy and be better tolerated by elderly patients. A prospective 3+3 dose escalation study enrolled symptomatic multiple myeloma (MM) patients 65 years or older with SWOG performance 0–2 for treatment with intravenous BU pre-transplant at different administration levels. The primary objective was to determine the maximum tolerated dose (MTD) of BU that could be safely given over the least number of days. All patients, except one, received maintenance …

Pediatric Acute Lymphoblastic Leukemia: A Review, Luke Geierman

Honors Projects

Acute Lymphoblastic Leukemia (ALL) is the most commonly diagnosed pediatric cancer and the most frequent cancer-induced cause of death among young people. Despite this fact, tremendous progress in treating the disease has been made in the last 50 years. This systematic literature review examines the incidence of the disease as well as the importance of risk stratification in treatment planning. The role of genetics in ALL risk stratification, specifically hypodiploidy and hyperdiploidy, is also considered. Finally, current treatment protocols, treatment failure, and the future of research and treatments are all each examined.

Management Of Retinoblastoma In Older Children (>5 Years) Using Intra-Arterial Chemotherapy: Comparison Of Outcomes To Prechemotherapy And Intravenous Chemotherapy Eras., Evan B. Selzer, R. Joel Welch, Pascal Jabbour, Ann M. Leahey, Carol L. Shields

Wills Eye Hospital Papers

Purpose: Intra-arterial chemotherapy (IAC) has emerged as an effective treatment for retinoblastoma (RB) however, little information exists regarding its use in older patients (>5 years). In the present study, we evaluate the use of IAC (2008-2018) for RB in older patients and compare the outcomes to those in the prechemotherapy (<1994) and intravenous chemotherapy (IVC) (1994-2007) eras.

Methods: A retrospective analysis of all patients older than 5 years treated with IAC for RB from 2008-2018. Comparisons were made to 26 active RB cases in older children treated in the prechemotherapy era and to 12 active RB cases treated in the IVC era.

Results: There were …

Distal Splenorenal Shunt (Dsrs) In Children With Extrahepatic Portal Hypertension, Zia Ur Rehman, Zafar Nazir

Department of Surgery Docs

Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.

Intravenous Dexamethasone Along With Caudal Block Improves Analgesic Efficacy Following Day-Case Inguinal Hernia Repair In Children: A Randomized Controlled Trial, Amjad Nadeem, Aliya Ahmed

Department of Anaesthesia

Objective: To assess the effectiveness of intravenous dexamethasone along with caudal block in improving analgesia following inguinal hernia repair in children.
Methods: The double-blind randomised controlled trial was conducted over a 6-month period from June 01, 2016 to November 30, 2016 at the Aga Khan University Hospital, Karachi, and comprised patients aged 1-5 years, scheduled for elective inguinal hernia repair. The subjects were randomised into two groups using the sealed envelope technique. Group D patients received 0.5mg/kg dexamethasone intravenous in 5ml, and group P was given placebo (5ml 0.9% saline). Assessment of postoperative pain was made through the faces, legs, …

Examining Pediatric Tourette Syndrome, Alyssa Orlando

Honors Projects

Pediatric Tourette Syndrome is a complex neurological disorder. Many people associate it with swearing, however in reality it is very rarely associated with that. This paper entails my own personal experiene with Tourette Syndrome and examines potential treatment options in the pediatric population.

Results Of A Phase 1 Multicentre Investigation Of Dexmedetomidine Bolus And Infusion In Corrective Infant Cardiac Surgery, Athena F Zuppa, Susan C Nicolson, Nicole S Wilder, Juan C Ibla, Erin A Gottlieb, Kristin M Burns, Mario Stylianou, Felicia Trachtenberg, Hua Ni, Tera H Skeen, Dean B Andropoulos

Faculty, Staff and Students Publications

BACKGROUND: Dexmedetomidine (DEX) is increasingly used intraoperatively in infants undergoing cardiac surgery. This phase 1 multicentre study sought to: (i) determine the safety of DEX for cardiac surgery with cardiopulmonary bypass; (ii) determine the pharmacokinetics (PK) of DEX; (iii) create a PK model and dosing for steady-state DEX plasma levels; and (iv) validate the PK model and dosing.

METHODS: We included 122 neonates and infants (0-180 days) with D-transposition of the great arteries, ventricular septal defect, or tetralogy of Fallot. Dose escalation was used to generate NONMEM® PK modelling, and then validation was performed to achieve low (200-300 pg ml …

Pneumothorax: What’S A Pediatric Pulmonologist To Do?, Terrence W. Carver

Manuscripts, Articles, Book Chapters and Other Papers

A pneumothorax is a collection of air in the pleural space commonly associated with respiratory symptoms. Patients may be relatively asymptomatic but may present with life-threatening distress. Confirmation of a clinically suspected pneumothorax is most often by chest x-ray when patients have been stabilized. Pneumothoraces are first categorized as primary, secondary, or iatrogenic and informs the evaluation and treatment plan. However, despite management guidelines in the literature, their applicability for pediatric patients is limited. Understanding of the historical risk factors including the acute clinical course and how radiographs, both chest X-ray and CT chest illuminate which patients are at highest …

Erratum: Correction To: Does Specialist Physician Supply Affect Pediatric Asthma Health Outcomes? (Bmc Health Services Research (2018) 18 1 (247)), Guido Filler, Tom Kovesi, Erik Bourdon, Sarah Ann Jones, Laurentiu Givelichian, Cheryl Rockman-Greenberg, Jason Gilliland, Marion Williams, Elaine Orrbine, Bruno Piedboeuf

Paediatrics Publications

In the original publication of this article [1], the institutional author's name needs to be revised from The Paediatric Chairs of Canada Mark Bernstein to The Paediatric Chairs of Canada.

Pediatric Brainstem Gliomas: An Institutional Experience, Altaf Ali Laghari, Mirza Zain Baig, Muhammad Ehsan Bari, Aneela Darbar, Naureen Mushtaq, Umme E Hani Abdullah, Daniya Aziz Khan

Section of Neurosurgery

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute.
Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis.
Results: The mean age of our cohort …

The Epidemiological Burden Of Obesity In Childhood: A Worldwide Epidemic Requiring Urgent Action, Mariachiara Di Cesare, Maroje Sorić, Pascal Bovet, J Jaime Miranda, Zulfiqar Ahmed Bhutta, Gretchen A. Stevens, Avula Laxmaiah, Andre-Pascal Kengne, James Bentham

Department of Paediatrics and Child Health

Background: In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.
Main body: Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund …

The Early "Unnatural" History Following Surgical Repair Of Ventricular Septal Defects., Sathish M. Chikkabyrappa, Justin T. Tretter, Arpan R. Doshi, Sujatha Buddhe, Puneet Bhatla, Achi Ludomirsky

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of …

Determinants Of Linear Growth Faltering Among Children With Moderate-To-Severe Diarrhea In The Global Enteric Multicenter Study, Rebecca L. Brander, Patricia B. Pavlinac, Judd L. Walson, Grace C. John-Stewart, Marcia R. Weaver, Abu S. G Faruque, Anita K. M. Zaidi, Dipika Sur, Samba O. Sow, M Jahangir Hossain

Department of Paediatrics and Child Health

Background: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
Methods: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A …

Gamna-Gandy Bodies Present As A Spleen Mass In A Patient With Hereditary Spherocytosis, Chandni Dargan, Sahibu Sultan M Habeebu, Grace S. Mitchell, Weijie Li

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.