ABSTRACT
BACKGROUND: The COVID-19 pandemic has drastically changed healthcare systems and training around the world. The Training Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition sought to understand how COVID-19 has affected pediatric gastroenterology fellowship training. METHODS: A 21 question survey was distributed to all 77 pediatric gastroenterology fellowship program directors (PDs) in the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition program director database via email on April 7. Responses collected through April 19, 2020 were analyzed using descriptive statistics. RESULTS: Fifty-one of 77 (66%) PDs from the United States, Canada, and Mexico responded to the survey. Forty-six of 51 (90%) PDs reported that they were under a "stay-at-home" order for a median of 4 weeks at the time of the survey. Two of the 51 (4%) programs had fellows participating in outpatient telehealth before COVID-19 and 39 of 51 (76%) at the time of the survey. Fellows stopped participating in outpatient clinics in 22 of 51 (43%) programs and endoscopy in 26 of 51 (52%) programs. Changes to inpatient care included reduced fellow staffing, limiting who entered patient rooms, and rounding remotely. Fellows in 3 New York programs were deployed to adult medicine units. Didactics were moved to virtual conferences in 47 of 51 (94%) programs, and fellows used various online resources. Clinical research and, disproportionately, bench research were restricted. CONCLUSIONS: This report provides early information of the impact of COVID-19 on pediatric fellowship training. Rapid adoption of telehealth and reduced clinical and research experiences were important changes. Survey information may spur communication and innovation to help educators adapt.
Subject(s)
Coronavirus Infections/prevention & control , Education, Medical, Graduate/methods , Fellowships and Scholarships , Gastroenterology/education , Pandemics/prevention & control , Pediatrics/education , Pneumonia, Viral/prevention & control , Telemedicine/methods , Betacoronavirus , COVID-19 , Humans , North America , SARS-CoV-2 , Societies, Medical , Surveys and QuestionnairesABSTRACT
BACKGROUND & AIMS: Damage to hepatic sinusoidal endothelial cells (SECs) initiates sinusoidal obstruction syndrome (SOS), which is most commonly a consequence of myeloablative chemoirradiation or ingestion of pyrrolizidine alkaloids such as monocrotaline (Mct). This study examines whether SECs are of bone marrow origin, whether bone marrow repair can be a determinant of severity of liver injury, and whether treatment with progenitor cells is beneficial. METHODS: Mct-treated female rats received infusion of male whole bone marrow or CD133(+) cells at the peak of sinusoidal injury. The Y chromosome was identified in isolated SECs by fluorescent in situ hybridization. Bone marrow suppression was induced by irradiation of both lower extremities with shielding of the abdomen. RESULTS: SECs in uninjured liver have both hematopoietic (CD45, CD33) and endothelial (CD31) markers. After Mct-induced SOS, infusion of bone marrow-derived CD133(+) progenitor cells replaces more than one quarter of SECs. All CD133(+) cells recovered from the SEC fraction after injury are CD45(+). CD133(+)/CD45(+) progenitors also repaired central vein endothelium. Mct suppresses CD133(+)/CD45(+) progenitors in bone marrow by 50% and in the circulation by 97%. Irradiation-induced bone marrow suppression elicited SOS from a subtoxic dose of Mct, whereas infusion of bone marrow during the necrotic phase of SOS nearly eradicates histologic features of SOS. CONCLUSIONS: SECs have both hematopoietic and endothelial markers. Bone marrow-derived CD133(+)/CD45(+) progenitors replace SECs and central vein endothelial cells after injury. Toxicity to bone marrow progenitors impairs repair and contributes to the pathogenesis of SOS, whereas timely infusion of bone marrow has therapeutic benefit.
Subject(s)
Bone Marrow Transplantation/methods , Endothelial Cells/physiology , Hepatic Veno-Occlusive Disease/pathology , Hepatic Veno-Occlusive Disease/therapy , Stem Cells/physiology , Analysis of Variance , Animals , Antigens, CD/metabolism , Antigens, Differentiation, Myelomonocytic/metabolism , Biomarkers/analysis , Cells, Cultured , Disease Models, Animal , Endothelial Cells/cytology , Female , Flow Cytometry , Immunohistochemistry , Liver Regeneration/physiology , Male , Probability , Random Allocation , Rats , Rats, Sprague-Dawley , Sensitivity and Specificity , Sialic Acid Binding Ig-like Lectin 3 , Stem Cells/cytologyABSTRACT
Idiopathic fibrosing pancreatitis is a rare condition that affects children and adolescents. It can be the cause of recurrent abdominal pain and obstructive jaundice. There are 46 cases reported in the literature, including the first case reported by Comfort et al (Comfort MW, Gambill EE, Baggenstoss AH. Chronic Relapsing Pancreatitis. Gastroenterology 1946;6:239-285) in 1946. We report the case of a 3-year-old girl who presented with abdominal pain and obstructive jaundice. We performed a magnetic resonance cholangiopancreatography study as part of the workup of obstructive jaundice. We will review the literature on pediatric idiopathic fibrosing pancreatitis and highlight the use of endoscopic retrograde choledocho-pancreatography and magnetic resonance cholangiopancreatography in the investigation of this disease.
