Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 5 de 5
Filtrar
1.
Eur J Pediatr ; 182(8): 3375-3383, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37191690

RESUMO

Neonates with severe congenital heart disease undergoing surgical repair may face various complications, including failure to thrive. Feeding tube placement and fundoplication are often performed to combat poor growth in neonates. With the variety of feeding tubes available and controversy surrounding when fundoplication is appropriate, there is no current protocol to determine which intervention is necessary for this patient population. We aim to provide an evidence-based feeding algorithm for this patient population. Initial searches for relevant publications yielded 696 publications; after review of these studies and inclusion of additional studies through external searches, a total of 38 studies were included for qualitative synthesis. Many of the studies utilized did not directly compare the different feeding modalities. Of the 38 studies included, five studies were randomized control trials, three studies were literature reviews, one study was an online survey, and the remaining twenty-nine studies were observational. There is no current evidence to suggest that this specific patient population should be treated differently regarding enteral feeding. We propose an algorithm to assist optimal feeding for neonates with congenital heart disease. Conclusion: Nutrition remains a vital component of the care of neonates with congenital heart disease; determining the optimal feeding strategy for these patients can be approached like other neonates.


Assuntos
Refluxo Gastroesofágico , Cardiopatias Congênitas , Recém-Nascido , Humanos , Nutrição Enteral/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Refluxo Gastroesofágico/complicações , Intubação Gastrointestinal , Fundoplicatura/métodos , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/complicações
2.
Pediatr Res ; 94(4): 1385-1391, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36949285

RESUMO

BACKGROUND: Hospitalized children with acute kidney injury (AKI) have not been extensively studied for clinical outcomes including hospital stay, the need for mechanical ventilation, mortality rates, and healthcare utilization. We hypothesize significant financial costs and increased morbidity and mortality associated with pediatric AKI. METHODS: This is a retrospective study of pediatric patients (age ≤18 years) included in the Kids' Inpatient Database (KID) between January 1, 2016, and December 31, 2021. The results of the data analysis were utilized for comparative testing between the AKI and non-AKI cohorts. RESULTS: The study included 4842 children [with AKI (n = 2424) and without AKI (n = 2418)]. The odds of mortality (p = 0.004) and mechanical ventilation (p < 0.001) were observed to be significantly higher among those with AKI as compared to those without AKI. Additionally, the median (IQR) duration of stay in the hospital (p < 0.001) and total cost (p < 0.001) were significantly higher among those with AKI vs. those without AKI. CONCLUSIONS: AKI in children was associated with higher odds of mortality, longer duration of hospital stay, increased requirement of mechanical ventilation, and increased hospital expenditure. The scientific community can utilize this information to better understand the outcomes associated with this disease process in this patient population. IMPACT: This article has thoroughly evaluated epidemiologic data associated with pediatric acute kidney injury (AKI) in hospitalized patients This study assesses mortality, hospital expenditure, and other factors to strengthen single-center and few multi-center studies and provides novel data regarding insurance and cost associated with pediatric AKI With increased knowledge of current epidemiology and risk factors, the scientific community can better understand prevention and outcomes in hospitalized children with AKI.


Assuntos
Injúria Renal Aguda , Respiração Artificial , Criança , Humanos , Adolescente , Estudos Retrospectivos , Tempo de Internação , Fatores de Risco , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/complicações , Mortalidade Hospitalar
3.
Ultrasound Q ; 38(3): 222-223, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35001028

RESUMO

ABSTRACT: Polyorchidism, a very rare congenital anomaly, refers to the presence of more than 2 testes. It is often associated with many other pathologies including cryptorchidism, varicocele, testicular malignancy, and inguinal hernias.In this report, we describe a 40-year-old man who presented with an intermittently painful left groin, initially appearing as inguinal hernia. On ultrasound examination, a supernumerary testes and epididymis were found in the inguinal canal. The testes appeared sonographically normal with no evidence of associated pathologies. There was no evidence of an inguinal hernia containing fat or bowel.Ultrasound is essential in first-line diagnosis and classification of polyorchidism. Color Doppler ultrasound and magnetic resonance imaging can be used to clarify findings if sonographic images are inconclusive. We also review relevant literature as it pertains to classification, embryology, and treatment options. Patient treatment is based on imaging findings; if associated pathologies or malignancy is suspected, aggressive treatment such as surgical excision may be necessary. Otherwise, conservative treatment may be all that is needed.


Assuntos
Criptorquidismo , Hérnia Inguinal , Doenças Testiculares , Neoplasias Testiculares , Adulto , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Humanos , Masculino , Doenças Testiculares/diagnóstico por imagem , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnóstico por imagem , Testículo/diagnóstico por imagem , Testículo/patologia
4.
Cureus ; 13(11): e19826, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34963843

RESUMO

Background Medical students are applying to dramatically more ophthalmology residency programs than in the past, causing an increased administrative burden for programs and financial harm to students. This study considers the background of this situation and looks at how a lack of transparency surrounding potential residency match filters contributes. Furthermore, this study raises several potential solutions to this lack of transparency that may increase the functionality of the ophthalmology residency match. Objective The purpose of this study was to determine the availability and consistency of potential ophthalmology residency match filters through training program websites and the American Medical Association's (AMA) Residency & Fellowship Database (FREIDA). Methods This study was a cross-sectional observational study of ophthalmology residency program websites and AMA's FREIDA database entries. For 119 ophthalmology residency programs, five potential filters were evaluated for both availability and consistency on individual residency websites and FREIDA. These filters were: (1) whether a program required a minimum United States Medical Licensing Examination (USMLE) Step 1 score; (2) minimum number of letters of recommendation required; 3) whether a minimum USMLE Step 2 score was required; (4) if the program accepts the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) sequence in lieu of the USMLE; and (5) ability of the residency to sponsor a visa (J-1, H-1B, or F-1). Each program's website and FREIDA entry were independently evaluated by two authors to increase validity, with a third author brought in to break the tie in case of a disagreement. Results Only two ophthalmology residency programs had information about all five filters both available and consistent on their website and FREIDA. Inter-reviewer reliability was 92.5%. Conclusions Information about potential filters used in the ophthalmology residency match is neither publicly available nor consistent. This lack of transparency may contribute to the phenomenon of medical students applying to dramatically more ophthalmology residency programs. A standardized database of these filters is needed to increase transparency to applicants, which may reduce the expenses of medical students and the workload of program directors.

5.
Abdom Radiol (NY) ; 46(11): 5152-5161, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34304291

RESUMO

PURPOSE: To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance. METHODS: 110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was placed 2 cm below the liver capsule. The study included patients with NAFLD/NASH (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5), alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values were obtained. Comparison of less experienced sonographers (LES) and more experienced sonographers (MES) were evaluated through Student's t test for independent data. Pearson coefficient r of correlation among quantitative variables was calculated. RESULTS: The mean time to perform the exam was 129.7 ± 62.1 s. There was a statistically significant difference between LES and MES. The mean IQR/M for LS was 12.3 ± 5.5% m/s. Overall, in a cohort of difficult patients, 4.5% of LS values were not reliable. Fat quantification using attenuation imaging had a mean value of 0.60 ± 0.15 dB/cm/MHz (range 0.35-0.98 cm/dB/MHz) with an IQR/M of 14.7 ± 9.2%. Less reliable measurements of steatosis were obtained in 4.5% of patients. The mean shear wave dispersion slope was 12.74 ± 4.05 (m/s)/kHz (range 7.7-27.5 (m/s)/kHz) with an IQR/M of 38.7 ± 20.2% (range 3-131%). 20.9% of patients had values suggestive of compensated advanced chronic liver disease (cACLD). CONCLUSION: Multiparametric US can provide assessment of CLD in less than 3 min in most patients and identify patients at risk for cACLD.


Assuntos
Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Pacientes Ambulatoriais , Prática Privada , Ultrassonografia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...