Medical Specialties Commons^™

Atypical Onset As Predictor Of Poor Outcome In Pediatric Systemic Lupus Erythematosus (Psle), A Taddio, E Rossetto, L Lepore, A C. Brescia, C Bracaglia, S Caminiti, E Cortis, D Rigante, A Stabile, M Montico, L Ronfani, C D. Rosé

Department of Pediatrics Faculty Papers

Poster Presentation.

Alma-Ata: Rebirth And Revision 8 - Primary Health Care: Making Alma-Ata A Reality, John Walley, Joy E. Lawn, Anne Tinker, Andres De Francisco, Mickey Chopra, Igor Rudan, Zulfiqar Ahmed Bhutta, Robert E. Black

Department of Paediatrics and Child Health

The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees …

Factor Xiii Deficiency In Children--Clinical Presentation And Outcome, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

OBJECTIVE: To determine the demographic features and clinical outcome of children with Factor XIII deficiency.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1996 to December 2006.

METHODOLOGY: Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted.

RESULTS: A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children (9/10) …

Infant Mortality In Delaware: The Need To Improve Maternal Health And Reduce Premature Births., David A. Paul. Md

Department of Pediatrics Faculty Papers

Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.

Effects Of Early Gestation Gh Administration On Placental And Fetal Development In Sheep., Casey D Wright, Ryan J Orbus, Timothy Regnault, Russell V Anthony

Paediatrics Publications

Ovine GH (oGH) is synthesized in placental tissue during maximal placental growth and development. Our objectives were to localize oGH mRNA in the placenta, and study the impact of exogenous GH on twin pregnancies during the normal window (35-55 days of gestational age; dGA) of placental expression. In situ hybridization localized oGH mRNA in uterine luminal epithelium but not in tissues of fetal origin. While maternal GH and IGF-I concentrations were increased (P

Perinatal Arterial Ischaemic Stroke: An Update With Literature Review, S. H. Ibrahim, Zafar Abdul Mueed

Department of Paediatrics and Child Health

Perinatal arterial ischaemic strokes are a major cause of morbidity in the neonatal period and leads to significant neurological morbidity. It is however under recognized as an entity and usually missed till the baby is 3-4 months of age when they first present with hemiplegia. Perinatal arterial ischaemic strokes are not reported from our country and this may be due to the fact that neurodiagnostic modalities were not available until the last few years. Even now this is not available in the smaller cities of our country. In this review we will discuss the common issues related to etiology and …

Criterion Validity Of The Wechsler Intelligence Scale For Children - Fourth Edition After Pediatric Traumatic Brain Injury, Jacobus Donders, Kelly Janke

University Faculty Publications and Creative Works

The performance of 40 children with complicated mild to severe traumatic brain injury on the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV; Wechsler, 2003) was compared with that of 40 demographically matched healthy controls. Of the four WISC-IV factor index scores, only Processing Speed yielded a statistically significant group difference (p < .001) as well as a statistically significant negative correlation with length of coma (p < .01). Logistic regression, using Processing Speed to classify individual children, yielded a sensitivity of 72.50% and a specificity of 62.50%, with false positive and false negative rates both exceeding 30%. We conclude that Processing Speed has acceptable criterion validity in the evaluation of children with complicated mild to severe traumatic brain injury but that the WISC-IV should be supplemented with other measures to assure sufficient accuracy in the diagnostic process. © 2008 Copyright © The International Neuropsychological Society 2008.

Medical Students: Abuse Of Psychoactive Substances And Sexuality Aspects, Kepler Alencar Mendes Carvalho, Maria José Carvalho Sant'anna, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

University students aged 17 to 24 years of age are prone to many risk factors.

OBJECTIVES: Identify risk factors related to exploring sexuality and characteristics of consumption of psychoactive substances in students attending medical school.

METHODS: 465 Medical students from Santa Casa of São Paulo Faculty of Medical Sciences (FCMSCSP) were prospectively and transversely evaluated during 2005. An anonymous, semi-structured, self-filling questionnaire was used. The average age of the students was 21.5 years, 43% females. 76.2% preferred alcohol, and 11.1% tobacco consumption; chloroethane (lança-perfume) consumption occurred in 22.6% and 15.3% consumption of other types of illicit drugs, with marijuana as …

Medical Supervision Of Young Female Athletes Training In Complex Coordinational Sports, Irina Schevchenko, Viktor V. Abramov, Paul T Gibson, Hatim A. Omar

Pediatrics Faculty Publications

This article proposes simple medical criteria that can be used by trainers and others for effective medical supervision of young female athletes.

METHODS: The cross-sectional, age-stratified study compared girls 10-17 years of age involved in intensive training in gymnastic floor exercises, trampoline, or badminton. Each sport and/or control group was represented by 40-45 girls. Data included medical history, morphometric variables and observation of biological development.

RESULTS: Gymnasts started training earliest (approximately 5-years-old) and trained most intensely (18-20 h/wk), followed by trampolinists and then badmintonists. Height, weight, body mass index, and % body fat were reduced in athletes, with gymnasts showing …

Functional Status, Heart Rate, And Rhythm Abnormalities In 521 Fontan Patients 6 To 18 Years Of Age., Andrew D. Blaufox, Lynn A. Sleeper, David J. Bradley, Roger E. Breitbart, Allan Hordof, Ronald J. Kanter, Elizabeth A. Stephenson, Mario Stylianou, Victoria L. Vetter, J Philip Saul, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Our objective was to determine the relationship between functional outcome and abnormalities of heart rate and rhythm after the Fontan operation.

METHODS: The National Heart, Lung, and Blood Institute Pediatric Heart Network conducted a cross-sectional analysis of patients who had undergone a Fontan procedure at the 7 network centers. Analysis was based on 521 patients with an electrocardiogram (n = 509) and/or bicycle exercise test (n = 404). The Child Health Questionnaire parent report and the oxygen consumption at the anaerobic threshold were used as markers of functional outcome.

RESULTS: Various Fontan procedures had been performed: intracardiac lateral tunnel …

Blood Utilization In Children Managed Non-Operatively For Blunt Solid Organ Injury., Scott J. Keckler, Kuojen Tsao, Susan W. Sharp, G W. Holcomb Iii, Daniel J. Ostlie, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Blood product utilization is an important issue in health care, given the frequent shortages in hospitals and the societal burden required to maintain the supply. Therefore, we retrospectively audited our blunt spleen/liver trauma experience to determine the percentage of cross-matched blood that was transfused to see whether more stringent typing criteria should be applied.

METHODS: A retrospective analysis of a recent 7-year experience with nonoperative management in patients with blunt spleen or liver injury was performed. Demographics, packed red blood cells prepared by cross-match, and transfusions were measured. Unmatched, O-type blood given in the trauma bay was excluded. Patients …

Management Of Pediatric Acute Appendicitis In The Computed Tomographic Era., Kuojen Tsao, Shawn D. St Peter, Patricia A. Valusek, Troy L. Spilde, Scott J. Keckler, Abhilash Nair, Daniel J. Ostlie, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND/PURPOSE: The treatment options for complicated appendicitis in children continue to evolve. Optimal management of complicated appendicitis relies on an accurate preoperative diagnosis. We examined the accuracy of our preoperative diagnosis including computed tomography (CT) and the influence on the management of children with perforated and nonperforated appendicitis.

METHODS: Following IRB approval, a 6-year review of all patients that underwent an appendectomy for suspected appendicitis was performed. Treatments included immediate operations and initial nonoperative management (antibiotic therapy +/- percutaneous drainage of abscess). Appendicitis was confirmed by histological examination.

RESULTS: One thousand seventy-eight patients underwent appendectomy for suspected appendicitis. Preoperative CT …

Resource Utilization And Outcomes From Percutaneous Drainage And Interval Appendectomy For Perforated Appendicitis With Abscess., Scott J. Keckler, Kuojen Tsao, Susan W. Sharp, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.

METHODS: After institutional review board …

Single Daily Dosing Ceftriaxone And Metronidazole Vs Standard Triple Antibiotic Regimen For Perforated Appendicitis In Children: A Prospective Randomized Trial., Shawn D. St Peter, Kuojen Tsao, Troy L. Spilde, G W. Holcomb Iii, Susan W. Sharp, J Patrick Murphy, Charles L. Snyder, Ronald J. Sharp, Walter S. Andrews, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Appendicitis is the most common emergency condition in children. Historically, a 3-drug regimen consisting of ampicillin, gentamicin, and clindamycin (AGC) has been used postoperatively for perforated appendicitis. A retrospective review at our institution has found single day dosing of ceftriaxone and metronidazole (CM) to be a more simple and cost-effective antibiotic strategy. Therefore, we performed a prospective, randomized trial to compare efficacy and cost-effectiveness of these 2 regimens.

METHODS: After internal review board approval (IRB no. 04 12-149), children found to have perforated appendicitis at appendectomy were randomized to either once daily dosing of CM (2 total doses per …

Clinical Profile And Outcome Of Cyanotic Congenital Heart Disease In Neonates, Khadija N Humayun, Mehnaz Atiq

Department of Paediatrics and Child Health

OBJECTIVE: To determine the clinical profile and assess the outcome of all neonates diagnosed with cyanotic congenital heart disease.

STUDY DESIGN: A case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital from January 1998 to December 2000.

PATIENTS AND METHODS: Neonates admitted with diagnosis of cyanotic congenital heart disease were evaluated for clinical diagnosis, survival and mortality.

RESULTS: Forty four neonates met the inclusion criteria. Eleven babies (25%) had Tetralogy of Fallot or its variants. Other malformations were d-transposition of great arteries, tricuspid valve anomalies (tricuspid atresia and Ebstein's anomaly), hypoplastic left heart syndrome, truncus arteriosus, total …

A Family With Acute Intermittent Porphyria, Abdul Gaffar Billoo, Saira Waqar Lone

Department of Paediatrics and Child Health

Porphyrias are inherited defects in heme metabolism that result in excessive secretion of porphyrins and porphyrin precursors. Porphyrias can be classified into acute, (neuropsychiatric), cutaneous and mixed forms. There are seven main types of porphyrias; acute intermittent porphyria and plumboporphyria are predominantly neuropsychiatric; congenital erythropoietic porphyria, porphyria cutanea tarda and erythropoietic protoporphyria have predominantly cutaneous manifestations and hereditary coproporphyria and variegate porphyria are classified as mixed as they both have neuropsychiatric and cutaneous features. They cause life-threatening attacks of neurovisceral symptoms that mimic many other acute medical and psychiatric conditions. Lack of clinical recognition often delays effective treatment, and inappropriate …

Chest Radiograph After Central Line Placement Under Fluoroscopy: Utility Or Futility?, Scott J. Keckler, Troy L. Spilde, Brian Ho, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Postoperative portable chest films are routinely performed after fluoroscopic placement of central venous catheters to evaluate positioning and to rule out significant complications (eg, pneumothorax). Emerging evidence in the literature has called this practice into question suggesting that routine postoperative chest x-ray is unnecessary. Therefore, we investigated our recent experience to examine the utility of these films, to examine the development of symptoms relative to therapeutic intervention, and to report a cost-benefit analysis.

METHODS: After obtaining institutional review board approval, all charts of patients undergoing central venous catheter placement from January 2004 to December 2005 at our institution were …

Current Significance Of Meconium Plug Syndrome., Scott J. Keckler, Shawn D. St Peter, Troy L. Spilde, Kuojen Tsao, Daniel J. Ostlie, G W. Holcomb Iii, Charles L. Snyder

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The significance of meconium plug syndrome is dependent on the underlying diagnosis. The incidence of pathologic finding, particularly Hirschsprung's disease, contributing to the presence of these plugs, has been debated. However, there are little recent data in the literature. Therefore, we reviewed our experience with meconium plugs as a cause of abdominal distension to evaluate the associated conditions and incidence of Hirschsprung's disease.

METHODS: We reviewed the records of newborns with meconium plugs found in the distal colon on contrast enema from 1994 to 2007. Demographics, radiologic findings, histologic findings, operative findings, and clinical courses were reviewed.

RESULTS: During …

Drug Resistant Infections In Poor Countries: A Major Burden On Children, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Making A Difference - Drug Resistant Infections In Poor Countries - A Major Burden On Children, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Short-Course Versus Long-Course Antibiotic Therapy For Non-Severe Community-Acquired Pneumonia In Children Aged 2 Months To 59 Months, Batool A. Haider, Muhammad Ammad Saeed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Pneumonia is the leading cause of mortality in children under five years of age. Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration. Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines.
Objectives: To evaluate the efficacy of short- course versus long-course therapy with the same antibiotic …

Retinopathy Of Prematurity: Frequency And Risk Factors In A Tertiary Care Hospital In Karachi, Pakistan, Ather M. Taqui, Reema Syed, Tanveer Anjum Chaudhry, Khabir Ahmad, Muhammad S. Salat

Section of Ophthalmology

Introduction: To determine the frequency of Retinopathy of Prematurity (ROP) in the premature infants born in a tertiary care hospital and to determine the risk factors associated with it.
Methods: This was a retrospective analysis of premature infants with birth weight < or = 1500 grams or gestational ago < or = 32 weeks, admitted to the Neonatal Intensive Care Unit of a tertiary care hospital in a three year period. The infants underwent eye examinations between their 4th and 7th week of life. Univariate and multiple logistic regression analysis were performed to determine the association between risk factors and ROP development.
Results: Sixty eight infants were included in the analysis. Out of these, 22 (32.4%) developed ROP (inclusive of all stages) and 14 (20.6%) developed threshold disease. Multiple logistic regression analysis revealed that low gestational age, sepsis and respiratory distress syndrome were independent predictors for the development of ROP.
Conclusion: The frequency of ROP in our hospital was on the …

A Program To Change The Approach To Care Of Children With Asthma In The Primary Care Setting Did Not Reduce Rates Of Hospital Admissions: Lessons Learned From A Descriptive Study, Sheniz Moonie, Robert C. Strunk, Mario Castro

Environmental & Global Health Faculty Research

Asthma is a critical global health issue. It affects people of all ages in countries throughout the world. The prevalence of asthma is increasing in most countries among young children who also represent the greatest proportion of health care utilization. Outpatient asthma-treatment programs managed by chest physicians or allergists have reduced hospitalizations, yet programs in pediatric offices have not successfully impacted hospitalizations. The Community Asthma Program (CAP) was designed to support pediatrician use of clinical guidelines in their everyday office practice. The goal was to reduce asthma hospitalizations by 15 percent from selected pediatric practices. A study was done in …

Chediak-Higashi Syndrome, Emaduddin Siddiqui, Shaheena Hanif

Department of Emergency Medicine

Chediak Higashi Syndrome is a rare inherited autosomal recessive disorder of immune system. Susceptibility to infection due to phagocyte dysfunction ranges from recurrent skin infection to over whelming fatal systemic infection. A five years old male child was admitted on 31st March 2006 with the complaints of pallor, fever & ear discharge for 6 month. He was treated by several medications but had temporary relief. The ear discharge was bilateral, foul smelling and of yellowish color. Past history was significant with episodes of abscess involving the different parts of body. Myeloid precursors shows giant, purple stained granules mainly in metamyelocytes, …

Pediatric Safety And Quality, Susan R. Lacey, Janis B. Smith, Karen Cox

Manuscripts, Articles, Book Chapters and Other Papers

Excerpt

Pediatric care is complex due to developmental and dependency issues associated with children. How these factors impact the specific processes of care is an area of science in which little is known. We are only beginning to understand the relationship between nurse staffing and adverse events in hospitalized children; effects that may be compounded by inadequate numbers of pediatric nurses. Throughout health care providing safe and high quality patient care continues to provide significant challenges. Efforts to improve the safety and quality of care are resource intensive and take continued commitment not only by those who deliver care, but …

Chronic Late-Gestation Hypoglycemia Upregulates Hepatic Pepck Associated With Increased Pgc1alpha Mrna And Phosphorylated Creb In Fetal Sheep., Paul J Rozance, Sean W Limesand, James S Barry, Laura D Brown, Stephanie R Thorn, Dan Loturco, Timothy Regnault, Jacob E Friedman, William W Hay

Paediatrics Publications

Hepatic glucose production is normally activated at birth but has been observed in response to experimental hypoglycemia in fetal sheep. The cellular basis for this process remains unknown. We determined the impact of 2 wk of fetal hypoglycemia during late gestation on enzymes responsible for hepatic gluconeogenesis, focusing on the insulin-signaling pathway, transcription factors, and coactivators that regulate gluconeogenesis. Hepatic phosphoenolpyruvate carboxykinase and glucose-6-phosphatase mRNA increased 12-fold and 7-fold, respectively, following chronic hypoglycemia with no change in hepatic glycogen. Chronic hypoglycemia decreased fetal plasma insulin with no change in glucagon but increased plasma cortisol 3.5-fold. Peroxisome proliferator-activated receptor-gamma coactivator-1alpha mRNA …

The Need For Formal Paediatric Resuscitation Training In Pakistan., Adina R., Sheikh Sajjad, Junaid Razzak

Department of Emergency Medicine

No abstract provided.

Current Application Of Thoracoscopy In Children., Kuojen Tsao, Shawn D. St Peter, Susan W. Sharp, Abhilash Nair, Walter S. Andrews, Ronald J. Sharp, Charles L. Snyder, Daniel J. Ostlie, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The safety and efficacy of thoracoscopy for thoracic lesions and conditions in children is evolving. Our experience with thoracoscopy has expanded in recent years. Therefore, we reviewed our most recent 7-year experience to examine the current applications for thoracoscopy in children.

METHODS: A retrospective review of all patients undergoing a thoracoscopic operation at Children's Mercy Hospital (Kansas City, MO) between January 1, 2000, and June 18, 2007, was performed. Data points reviewed included patient demographics, type of operation, final diagnosis, complications, and recovery.

RESULTS: During the study period, 230 children underwent 231 thoracoscopic procedures. The mean age was 9.6 …

Managing Severe Pneumonia In Children In Developing Countries - Increasing Resistance To First Line Antibiotics Means Recommendations Need Changing, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

2007 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.