Medical Specialties Commons^™

Low Plasma Citrulline Levels Are Associated With Acute Respiratory Distress Syndrome In Patients With Severe Sepsis, Lorraine B. Ware, Jordan A. Magarik, Nancy Wickersham, Gary Cunningham, Todd W. Rice, Brian W. Christman, Arthur P. Wheeler, Gordon R. Bernard, Marshall Summar

Pediatrics Faculty Publications

Introduction: The role of nitric oxide synthase (NOS) in the pathophysiology of acute respiratory distress syndrome (ARDS) is not well understood. Inducible NOS is upregulated during physiologic stress; however, if NOS substrate is insufficient then NOS can uncouple and switch from NO generation to production of damaging peroxynitrites. We hypothesized that NOS substrate levels are low in patients with severe sepsis and that low levels of the NOS substrate citrulline would be associated with end organ damage including ARDS in severe sepsis.

Methods: Plasma citrulline, arginine and ornithine levels and nitrate/nitrite were measured at baseline in 135 patients with severe …

Can Coronary Artery Involvement In Kawasaki Disease Be Predicted?, Sunil J. Ghelani, Neha Kwatra, Christopher F. Spurney

Pediatrics Faculty Publications

Background: Coronary artery involvement is seen in approximately 15–20% of children with Kawasaki disease. There is conflicting literature regarding the clinical and laboratory findings associated with coronary artery involvement. In this retrospective study, we attempt identification of predictive factors for coronary artery involvement at our institute and review the existing literature.

Methods and results: A review of 203 patients (65% males) with Kawasaki disease was performed, of whom 33 (16.3%) had coronary artery involvement. High erythrocyte sedimentation rate, high platelet count, low hematocrit, low albumin levels, and refractory Kawasaki disease showed significant association with coronary artery involvement. High …

A Randomized, Controlled Trial Of Catheter-Related Infectious Event Rates Using Antibiotic-Impregnated Catheters Versus Conventional Catheters In Pediatric Cardiovascular Surgery Patients, Elaine G. Cox, Chad A. Knoderer, Aimee Jennings, John W. Brown, Mark D. Rodefeld, Scott G. Walker, Mark W. Turrentine

Scholarship and Professional Work – COPHS

We conducted a randomized, controlled clinical trial to determine whether a difference in catheter-associated blood stream infection (CABSI) incidence existed between children who underwent cardiac surgery and had a central venous catheter impregnated with minocycline and rifampin versus those who had a conventional, nonimpregnated catheter after cardiac surgery. Due to a lower number of infections than expected, the study was terminated early. Among 288 evaluable patients, the rates of CABSI and line-related complications were similar between the 2 groups.

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.

Outcomes Of Extended-Infusion Piperacillin/Tazobactam In Pediatric Patients., Kristen R. Nichols, Katie Andricopulos, Ashley S. Crumby, Elaine G. Cox, Chad A. Knoderer

Scholarship and Professional Work – COPHS

Poster presented at: ID Week 2013, October 2013, San Francisco, California.

Linezolid-Associated Thrombocytopenia In Children With Renal Impairment, Chad A. Knoderer, Kristen R. Nichols, Heather L. Deyoung, Sara J. Jones, Elaine G. Cox

Scholarship and Professional Work – COPHS

Poster presented at ID Week, October 2013, San Francisco, California.

Vancomycin And Gentamicin Pharmacokinetic Alterations In An Adolescent Amputee, Kristen R. Nichols, Kari M. Edison, Michelle D. Rosenbaum, Chad A. Knoderer

Scholarship and Professional Work – COPHS

A 14-year-old male with bilateral above-the-knee amputations presented to our hospital for treatment of a skin and soft-tissue infection. We report the experience of vancomycin and gentamicin therapy in this patient. Because these medications require weight-based dosages and pharmacokinetic monitoring of serum levels, it was necessary to obtain peak and trough levels of the two drugs in order to determine the pharmacokinetic differences in this patient compared to those in an adolescent male without amputations. To our knowledge, this is the first report describing pharmacokinetic differences in an adolescent amputee.

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.

Susceptibility To Fatty Acid-Induced Β-Cell Dysfunction Is Enhanced In Prediabetic Diabetes-Prone Biobreeding Rats: A Potential Link Between Β-Cell Lipotoxicity And Islet Inflammation, Christine Tang, Anthony E. Naassan, Astrid Chamson-Reig, Khajag Koulajian, Tracy T. Goh, Frederick Yoon, Andrei I. Oprescu, Husam Ghanim, Gary F. Lewis, Paresh Dandona, Marc Y. Donath, Jan A. Ehses, Edith Arany, Adria Giacca

Paediatrics Publications

β-Cell lipotoxicity is thought to play an important role in the development of type 2 diabetes. However, no study has examined its role in type 1 diabetes, which could be clinically relevant for slow-onset type 1 diabetes. Reports of enhanced cytokine toxicity in fat-laden islets are consistent with the hypothesis that lipid and cytokine toxicity maybe synergistic. Thus, β-cell lipotoxicity could be enhanced in models of autoimmune diabetes. To determine this, we examined the effects of prolonged free fatty acids elevation on β-cell secretory function in the prediabetic diabetes-prone BioBreeding (dp-BB) rat, its diabetes-resistant BioBreeding (dr-BB) control, and normal Wistar-Furth …

Progastrin Stimulates Colonic Cell Proliferation Via Cck2r- And Β-Arrestin-Dependent Suppression Of Bmp2, Guangchun Jin, C. Benedikt Westphalen, Yoku Hayakawa, Daniel L. Worthley, Samuel Asfaha, Xiangdong Yang, Xiaowei Chen, Yiling Si, Hongshan Wang, Yagnesh Tailor, Richard A. Friedman, Timothy C. Wang

Paediatrics Publications

Background & Aims Progastrin stimulates colonic mucosal proliferation and carcinogenesis through the cholecystokinin 2 receptor (CCK2R) - partly by increasing the number of colonic progenitor cells. However, little is known about the mechanisms by which progastrin stimulates colonic cell proliferation. We investigated the role of bone morphogenetic proteins (BMPs) in progastrin induction of colonic cell proliferation via CCK2R. Methods We performed microarray analysis to compare changes in gene expression in the colonic mucosa of mice that express a human progastrin transgene, gastrin knockout mice, and C57BL/6 mice (controls); the effects of progastrin were also determined on in vitro colonic crypt …

Mice That Express Human Interleukin-8 Have Increased Mobilization Of Immature Myeloid Cells, Which Exacerbates Inflammation And Accelerates Colon Carcinogenesis, Samuel Asfaha, Alexander N. Dubeykovskiy, Hiroyuki Tomita, Xiangdong Yang, Sarah Stokes, Wataru Shibata, Richard A. Friedman, Hiroshi Ariyama, Zinaida A. Dubeykovskaya, Sureshkumar Muthupalani, Russell Ericksen, Harold Frucht, James G. Fox, Timothy C. Wang

Paediatrics Publications

Background & Aims: Interleukin (IL)-8 has an important role in initiating inflammation in humans, attracting immune cells such as neutrophils through their receptors CXCR1 and CXCR2. IL-8 has been proposed to contribute to chronic inflammation and cancer. However, mice do not have the IL-8 gene, so human cancer cell lines and xenograft studies have been used to study the role of IL-8 in colon and gastric carcinogenesis. We generated mice that carry a bacterial artificial chromosome that encompasses the entire human IL-8 gene, including its regulatory elements (IL-8Tg mice). Methods: We studied the effects of IL-8 expression in APCmin+/- mice …

Localization Of Pain-Related Brain Activation: A Meta-Analysis Of Neuroimaging Data, Emma G. Duerden, Marie Claire Albanese

Paediatrics Publications

A meta-analysis of 140 neuroimaging studies was performed using the activation-likelihood-estimate (ALE) method to explore the location and extent of activation in the brain in response to noxious stimuli in healthy volunteers. The first analysis involved the creation of a likelihood map illustrating brain activation common across studies using noxious stimuli. The left thalamus, right anterior cingulate cortex (ACC), bilateral anterior insulae, and left dorsal posterior insula had the highest likelihood of being activated. The second analysis contrasted noxious cold with noxious heat stimulation and revealed higher likelihood of activation to noxious cold in the subgenual ACC and the amygdala. …

Effects Of Age And Symptomatology On Cortical Thickness In Autism Spectrum Disorders, Krissy A.R. Doyle-Thomas, Emma G. Duerden, Margot J. Taylor, Jason P. Lerch, Latha V. Soorya, A. Ting Wang, Jin Fan, Eric Hollander, Evdokia Anagnostou

Paediatrics Publications

Several brain regions show structural and functional abnormalities in individuals with autism spectrum disorders (ASD), but the developmental trajectory of abnormalities in these structures and how they may relate to social and communicative impairments are still unclear. We assessed the effects of age on cortical thickness in individuals with ASD, between the ages of 7 and 39 years in comparison to typically developing controls. Additionally, we examined differences in cortical thickness in relation to symptomatology in the ASD group, and their association with age. Analyses were conducted using a general linear model, controlling for sex. Social and communication scores from …

Dietary Exposures And Allergy Prevention In High-Risk Infants, Edmond S. Chan, Carl Cummings, Mark Feldman, Ruth B. Grimes, Barbara Grueger, Larry B. Pancer, Anne Rowan Legg, Ellen P. Wood, Fabian P. Gorodzinsky, Nestor Cisneros, Janet Roberts, Adelle Atkinson, Zave Chad, Marie Josée Francoeur, Linda Kirste, Douglas Mack, Marie Noel Primeau, Timothy Vander Leek, Wade Watson

Paediatrics Publications

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk for developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps …

B.03 Clinical Utility Of Critical Care Eeg Monitoring In A Canadian Paediatric Centre, Saptharishi Lalgudi Ganesan

Data and Test Instruments

No abstract provided.

Children's Mercy Hospital Annual Report 2012, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Alloreactivity-Based Medical Conditions, Stanislav Vukmanovic, Margaret G. Petroff, Anne M. Stevens, Daniel Rukavina

Pediatrics Faculty Publications

No abstract provided.

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 …

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

Master of Medicine in Paediatrics and Child Health

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 of acute …

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 …

The Political Economy Of Undernutrition National Report: Pakistan, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Shandana Khan Mohmand, Andres Mejia Acosta

Epidemiology and Biostatistics Section

No abstract provided.

The Impact Of The Internet On The Sexual Health Of Adolescents: A Brief Review, Julia Springate, Hatim A. Omar

Pediatrics Faculty Publications

The object of this review is to summarize the impact of the Internet on the sexual health of adolescents. This article examines the use of websites, blogs and chat rooms as sources for sexual health information for adolescents. The influence of Internet pornography on sexual behaviors and attitudes is addressed. The use of the Internet as a place to find sexual partners is also assessed. During a time of great physical, emotional and sexual change, the Internet is playing a huge role in the decisions adolescents are making, both positive and negative.

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 …

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 …

Plac1 Expression Decreases In Chorionic Villi In Response To Labor, Yahdira M. Rodriguez-Prado, Xiaoyuan Kong, Michael E. Fant

Pediatrics Faculty Publications

PLAC1 (Placenta-Specific 1) is a recently described, trophoblast-expressed gene essential for normal placental development. The protein localizes to the microvillus membrane surface of the syncytiotrophoblast in direct proximity to the maternal compartment. Although its role has not been defined, increased circulating levels of human PLAC1 mRNA in maternal blood are associated with preeclampsia. Furthermore, PLAC1-null mice exhibit decreased viability in the peripartum period suggesting a role in pregnancy maintenance late in gestation. We examined PLAC1 gene expression in the human placenta during normal pregnancy and pregnancies associated with maternal diabetes and preeclampsia using quantitative, real time PCR (q-RT-PCR). Although …

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.

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 …

A New Millennium: A New Age Of Behavioral Disorders?, Artemis Tsitsika, Mari Janikian, Donald E. Greydanus, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

The internet has become one of the most widely accessible media and is a significant part of everyday life in adolescence, offering opportunities for social networking and communication, education and entertainment. However, over the past decade a specific behavioral pattern has been researched in respect to Internet use, leading to isolation and neglect of everyday activities, social life –even personal health in general. The phenomenon has received increasing attention from the scientific community, describing it in various terms such as “excessive”, “problematic”, “pathological”, “addictive” use among others.

European research on Internet addictive behavior have been conducted in the past years …

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

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

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 …