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Background Management of pediatric pulmonary hypertension (PH) may require manipulation of multiple receptor sites to maximize response to medical therapy. Assessment of response typically occurs through imaging, labs, physical exam and recurrent cardiac catheterization, with anesthetic exposure to assess pulmonary artery pressures (PAP) and vascular resistance (PVR). We aimed to assess feasibility, safety and utility of remote PAP monitoring in pediatric PH patients. Methods We reviewed 4 pediatric patients with significant PH, each of whom underwent cardiac catheterization with pulmonary vasoreactivity testing and placement of a CardioMEMS remote PAP monitoring device. Results Four patients (P1-4: ages 5, 6, 8 and 10 years old) underwent CardioMEMS insertion without procedural complication. P1, P2 and P3 presented with unrepaired VSD;ASD with partial anomalous pulmonary venous return;and ASD and PDA, respectively, while P4 had prior repair of atrioventricular canal. Three patients had Down syndrome. All had elevated PAP and PVR. Mean left lower PA branch size was 7 mm. Mean PAP prior to therapy was 70 mm Hg for P1, 82 for P2, 93 for P3 and 30 for P4. All 4 patients required initiation of triple therapy for treatment of PH, with improvement or normalization of PAP by CardioMEMS, which also included surgical or catheter based intervention for 3 patients. Post-repair of P2, he was unable to be separated from cardiopulmonary bypass and was placed on ECMO. Right ventricular cardiac output improved over 2 weeks, with improvement of PAP determined through serial CardioMEMS. He was successfully decannulated, utilizing CardioMEMS in the OR. Two patients also developed COVID respiratory infections at home with CardioMEMS assessments allowing for oxygen and medication titration. Conclusion Remote PAP monitoring is feasible and appears safe in pediatric patients with adequate PA size. It allows for manipulation of medical therapy with real time knowledge of impact on PAP and can augment management during weaning of mechanical cardiac support. It may also augment decision-making in management of PH patients with developmental disabilities in whom traditional assessments may be more challenging.Copyright © 2023 American College of Cardiology Foundation
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Background: Ascending aortic thrombus is rare in children without history of trauma, hypercoagulable condition or vascular disease and carries a high mortality risk necessitating rapid identification and management. Aim(s): We aim to present the clinical course for a rare pediatric case. Method(s): We reviewed the medical record for a child with recurrent life-threatening thrombi. Result(s): A 12-year old previously healthy male presented with chest pain. ECG revealed ST segment elevation. Echocardiography revealed an ejection fraction of 25% and a mobile mass (10 x 20 mm) in the ascending aorta. COVID testing was negative. Troponin-I was elevated. He was emergently placed on cardiopulmonary bypass where a large organized thrombus was removed. The left anterior descending coronary artery was occluded. He underwent intracoronary tPA, aspiration thrombectomy and balloon angioplasty. Hypercoagulable and autoimmune work-up revealed elevated factor 8 activity, von willebrand factor (vWF) activity and thrombocytosis with increased function by viscoelastic testing (ROTEM). Myocarditis, cardiogenetics and genetic testing for thrombophilia were negative. He was discharged on heart failure therapy, triple anti-platelet therapy (aspirin, clopidogrel, dipyridamole) and apixiban. He underwent a heart transplant 5 months later. Three weeks post-transplantion, he was incidentally found to have a large left atrial thrombus. At this time, he was only on aspirin. Factor 8 activity at time of transplant and second thrombus discovery was >400%. vWF activity and platelet count were also elevated. ROTEM revealed elevated platelet and fibrinogen activity. He underwent left atrial thrombectomy and was restarted on triple antiplatelet therapy and apixiban. He has not had recurrence on this regimen for 8 months. Conclusion(s): Thrombocytosis and elevated pro-inflammatory coagulation factors may predispose to development of potentially fatal thrombi. Besides inflammation, etiology may be unknown, particularly in apparently healthy children, prompting additional research into potentially genetic conditions in these complex pathways to further elucidate patients at risk.
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Background Young people have the right to be informed and consulted about decisions affecting their lives. Youth Patient and Public Involvement (PPI) should be encouraged to ensure research is carried out ‘with' or ‘by' young people rather than ‘to', ‘about' or ‘for' them. PPI can ensure research is relevant, results are accessible and recruitment rates are improved. Young people have had limited involvement in the design, implementation and dissemination of public health research and there have been calls for a greater focus on youth PPI in research. Methods Following the WISH feasibility study that consulted young people pre and post-intervention, a Youth Advisory Group (YAG) was set up within the main trial. The WISH study is a clustered randomised controlled trial in which a peer-led, school-based, brisk walking intervention is compared to usual physical activity in adolescent females. The YAG was introduced to inform intervention delivery and provide researchers with an understanding of what would encourage/discourage participation. Schools were asked to invite pupils aged 12-14 years (participants) and 15-18 years (walk leaders). Participative methods were used to develop and review study documentation. The YAG completed a short questionnaire and recruitment rates were monitored. Results Fourteen pupils from 3 schools attended the 2019 YAG meeting. The YAG agreed the meeting was a good way of getting young people involved in research (93%) and attendees enjoyed the meeting (100%). As a result, changes were made to study documentation, incentives were purchased and recruitment materials developed. Participant recruitment was higher in schools who participated in the YAG (54%) compared to those who did not (47%). In 2021 the second YAG occurred and 1 teacher, 12 participants and 10 walk leaders from 2 schools provided feedback on the trials COVID-19 contingency plan. The girls felt their feedback was valued (100%) and it was important young people had the chance to contribute to research studies (100%). Conclusions The views of young people have been central to the development of the WISH Study and although youth PPI is not without challenges, there are many benefits for researchers, the study and the young people involved.
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BACKGROUND: At the end of 2019, a new disease was identified in Wuhan, China. A new type of corona virus was identified to be responsible for this illness, which was caused by a novel type of corona virus and affected nearly the entire planet. 2019-nCov, or Wuhan-corona virus, is the name given to this new virus by Chinese researchers. When working with the media, the World Health Organization refers to it as the COVID-19 virus to avoid confusion. COVID-19 is a brand-new product both globally and in India. People's minds have been thrown off by this. In Indian society, there are different rumors regarding the corona virus that induce panic in people's minds. In humans it causes respiratory tract infections which can be mild or lethal. Include mild infections like common cold, headache, running nose etc. In pigs and cows, it causes diarrhea. © The Electrochemical Society
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With the technology getting updated and enhanced every day, Augmented Reality (AR) are Virtual Reality (VR) are becoming popular in almost all the sectors. However, how much involvement of technology can one expect in fields such as Physiotherapy? The answer probably is a lot! From Telerehabilitation to Immersive VR Therapy and Gamification of physiotherapy, the options are endless! Technology has barely ever failed to catch attention of the young as well as adult. From a one-year-old infant to a seventy years old man, each one of us is attracted to technology. The idea that one can actually play virtual reality games as a part of rehabilitation is probably the most happening method of rehabilitation one could only think of in their dreams! © The Electrochemical Society
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COVID-19 has recently been expanded to more than 100 countries and territories worldwide, resulting in widespread alarming. COVID-19 is distributed in batches, mainly through respiratory drops and close contact. Fever, fatigue, and dry cough are the most common symptoms, but they can be severe due to fatigue, sore throat and headache. Symptoms include runny nose, runny nose, and diarrhoea in a few cases. Acute Respiratory Distress Syndrome (ARDS) can develop rapidly if the condition is severe (ARDS). The gold standard for diagnosing COVID-19 is a reversal of the polymerase chain reaction (RT-PCR) and the next generation sequence (NGS). Most cases of adult viral pneumonia were caused by influenza viruses. Corona virus disease 2019 (COVID-19) is now a dangerous global pandemic. The COVID-19 epidemic is projected to last for several months, coinciding with the influenza season. These two viral pneumonias have very different treatment, prognosis, and safety, and distinguishing between them has a big effect on the patient's outcome. CONCLUSION: Mortality ratio and number of infections reported worldwide due to this COVID 19 virus is very high as compared to SARS or MERS. Corona virus is extremely contagious and communicable which can be spread among society via aerosols, saliva droplets and close contact with infected person and surfaces. Self-isolation and quarantine are the initial and result oriented protocols which are required to be followed along with paramedical observation to avoid future transmission of this disease. This disease has become very serious issue of concern in positively tested elderly patients and become warning signals around the globe. © The Electrochemical Society
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Background: Effective cancer screening leads to a substantial increase in the detection of earlier stages of cancer, while decreasing the incidence of later stage cancer diagnoses. Timely screening programs are critical in reducing cancer-related mortality in both breast and colorectal cancer by detecting tumors at an early, curable stage. The COVID-19 pandemic resulted in the postponement or cancellation of many screening procedures, due to both patient fears of exposures within the healthcare system as well as the cancellation of some elective procedures. We sought to identify how the COVID-19 pandemic has impacted the incidence of early and late stage breast and colorectal cancer diagnoses at our institution. Methods: We examined staging for all patients presenting to UCSD at first presentation for a new diagnosis of malignancy or second opinion in 2019 and 2020. Treating clinicians determined the stage at presentation for all patients using an AJCC staging module (8 edition) in the electronic medical record (Epic). We compared stage distribution at presentation in 2019 vs 2020, both for cancers overall and for colorectal and breast cancer, because these cancers are frequently detected by screening. Results: Total numbers of new patient visits for malignancy were similar in 2019 and 2020 (1894 vs 1915 pts), and stage distribution for all cancer patients was similar (stage I 32% in 2019 vs 29% in 2020;stage IV 26% in both 2019 and 2020). For patients with breast cancer, we saw a lower number of patients presenting with stage I disease (64% in 2019 vs 51% in 2020) and a higher number presenting with stage IV (2% vs 6%). Similar findings were seen in colorectal cancer (stage I: 22% vs 16%;stage IV: 6% vs 18%). Conclusions: Since the COVID-19 pandemic, there has been an increase in incidence of late stage presentation of colorectal and breast cancer, corresponding with a decrease in early stage presentation of these cancers at our institution. Cancer screening is integral to cancer prevention and control, specifically in colorectal and breast cancers which are often detected by screening, and the disruption of screening services has had a significant impact on our patients. We plan to continue following these numbers closely, and will present data from the first half of 2021 as it becomes available.
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BACKGROUND: To suppress the transmission of coronavirus, many governments, including that of the island of Ireland, implemented a societal lockdown, which included school closures, limits on social gatherings, and time outdoors. This study aimed to evaluate changes in physical activity (PA), mental health, sleep, and social media use among adolescent girls during lockdown. METHODS: 281 female pupils (12-14 y) taking part in the ongoing Walking In Schools study on the island of Ireland self-reported PA, mental health, sleep, and social media use before (September-October 2019) and during lockdown (May-June 2020), via questionnaires. These were supplemented with open-ended structured interviews conducted with 16 girls during lockdown. RESULTS: During the period of lockdown and school closures, pupils tried new forms of PA and undertook PA with family, but there was no significant change in self-reported PA. There was a decline in health-related quality of life and motivation for exercise; however, self-efficacy for walking and happiness with appearance increased. There was no change in sleep quality or social media usage. CONCLUSIONS: Despite the many challenges that schools face as they reopen, there is a need to continue to prioritize PA and motivation for exercise to support health and well-being in adolescent girls.
Subject(s)
COVID-19 , Exercise , Mental Health , Sleep , Social Media , Adolescent , COVID-19/psychology , Communicable Disease Control , Female , Humans , Ireland , Quality of LifeABSTRACT
Since the introduction of COVID-19-related public health measures, notifications for most nationally notifiable diseases have declined when compared to previous years. Physical distancing, travel restrictions, and emphasis on hygiene are likely to have affected the number of expected notifications, with the greatest reductions observed among disease spread via person-to-person contact such as influenza, and among overseas-acquired infections such as dengue virus and measles. However, quantifying the magnitude of the effect of COVID-19 public health measures on communicable diseases in Australia will be difficult, due to confounding factors such as: changes in testing priorities in laboratories;diversion of resources to the COVID-19 response;changes in health-seeking behaviours;greater utilisation of telehealth practices;and financial impacts such as income loss and ability to afford healthcare. It is considered likely that these other factors will have also impacted notification numbers.