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1.
J Pediatr Surg ; 58(5): 939-942, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36788055

RESUMO

BACKGROUND/PURPOSE: This is an article submitted on behalf of the Canadian Association of Pediatric Surgeons. We assert that Pediatric Surgeons must work to dismantle systemic racism. Pediatric Surgeons have expertise in both common and rare surgical diseases affecting patients ranging from premature neonates to adolescents. Thus, our professional obligation is to transform our health and social systems to prevent the harms of racism to our patients. METHODS: Specific to the Canadian context, we describe a brief history, the ongoing impact on individuals and communities, and the harmful effect on the surgical community and trainees. Finally, we developed a series of practical recommendations to help surgeons become actively anti-racist. RESULTS: Four primary recommendations are made: (1) Increasing and supporting anti-racism education; (2) Changing individual behaviours to combat racism; (3) Developing strategies for organizational change; and (4) Committing to diversity in leadership. CONCLUSION: As surgeons, we are actors of change, and we can take meaningful steps to combat racism in our health systems. LEVEL OF EVIDENCE: V.


Assuntos
Racismo , Cirurgiões , Adolescente , Recém-Nascido , Criança , Humanos , Canadá , Racismo/prevenção & controle , Antirracismo , Escolaridade , Doenças Raras
3.
J Pediatr Surg ; 56(2): 226-229, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33004187

RESUMO

BACKGROUND: The true prevalence of hearing loss among children with congenital diaphragmatic hernia (CDH) is unknown, with some studies reporting rates up to 60%. PURPOSE: The purpose of this study was to determine the prevalence of hearing loss among children with CDH and compare it to age-matched controls. METHODS: We used population-based datasets to compare the number of hearing loss diagnoses in children younger than 10 years-of-age born between 1992 and 2009 with CDH to date-of-birth matched controls without CDH. Factors associated with CDH disease severity were analyzed to determine their effect on the prevalence of hearing loss. A sensitivity analysis was performed to determine if selection bias of improved care over the course of the study affected hearing loss in CDH patients. The prevalences of hearing loss were compared using Fisher's exact tests and statistical significance was defined as p < 0.05. RESULTS: A total of 529 children, 38 CDH cases and their 491 date-of-birth matched controls, met the inclusion criteria. Hearing loss was found in 7 children with CDH (18.4%) compared to 26 (5.3%) controls; the risk ratio (RR) of hearing loss was 3.48 (95%CI = 1.61-7.49, p = 0.006). There was no association between CDH disease severity and hearing loss. CONCLUSIONS: CDH is associated with hearing loss compared to the general population. Our results suggest that congenital factors may contribute to hearing loss in CDH more than perinatal exposures. LEVEL OF EVIDENCE: 3.


Assuntos
Perda Auditiva , Hérnias Diafragmáticas Congênitas , Criança , Feminino , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/epidemiologia , Humanos , Razão de Chances , Parto , Gravidez , Prevalência , Estudos Retrospectivos
4.
Pediatr Surg Int ; 36(11): 1275-1280, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32939579

RESUMO

PURPOSE: The VICI-trial reported that in patients with congenital diaphragmatic hernia (CDH), mortality or bronchopulmonary dysplasia (BPD) were equivalent using conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation. The purpose of this study was to determine if the mode of ventilation at the time of CDH repair affected mortality or oxygen dependence at 28 days. METHODS: We performed a retrospective cohort study of infants born wih CDH from 1991 to 2015. A generalized linear model was applied to the data using a propensity score analysis. RESULTS: Eighty patients met the inclusion criteria; at the time of surgery 39 (48.8%) patients were on HFV and 41 (51.3%) patients were on CMV. In the HFV group, 16 (47.1%) patients remained oxygen dependent and there were 5 (12.8%) deaths at 28 days. In the CMV group, 5 (12.2%) patients remained oxygen dependent at 28 days but none had died. The base model demonstrated that the HFV group had increased rates of oxygen dependence [OR = 6.40 (2.13, 22.2), p = 0.002]. However, after propensity score analysis, we found no difference between HFV and CMV. CONCLUSION: Our study suggests that in infants with CDH, there is no significant difference between HFV and CMV in oxygen dependency or death.


Assuntos
Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Oxigênio/metabolismo , Respiração Artificial/métodos , Canadá/epidemiologia , Feminino , Seguimentos , Hérnias Diafragmáticas Congênitas/mortalidade , Ventilação de Alta Frequência/métodos , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências
5.
J Pediatr Surg ; 55(5): 793-795, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32081360

RESUMO

In 2015, the Truth and Reconciliation Commission called for health care institutions to address structural barriers that affect Indigenous families seeking health care in Canada. Pediatric care centers in Canada have failed to adequately address these, resulting in continued negative and life-threatening impacts on Indigenous children and families across Canada. Indigenous (First Nations, Metis, and Inuit) families across Canada "have an equal right to the enjoyment of the highest attainable standard of physical and mental health" according to the United Nations Declaration on the Rights of Indigenous Peoples. These rights have yet to be acknowledged or granted to Indigenous Peoples by Federal or Provincial governments in Canada. In the face of significant and long-standing disparities in health care that Indigenous children experience following surgical procedures, and in response to the Calls to Action from the Truth and Reconciliation Commission of Canada (TRC), the Canadian Association of Pediatric Surgeons (CAPS) hosted a session at their annual general meeting in the fall of 2019 entitled "Caring for Indigenous Children: A CAPS Perspective". A summary of the topics presented at the meeting are discussed in this paper.

6.
Eur J Pediatr Surg ; 30(1): 39-44, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707726

RESUMO

INTRODUCTION: The purpose of this study was to determine if congenital diaphragmatic hernia (CDH) survivors had worse long-term respiratory outcomes compared with age-matched controls, as measured by inhaled bronchodilator use, inhaled steroid use, and asthma-related physician visits. MATERIALS AND METHODS: We performed a retrospective case-control study of infants with isolated CDH from 1991 to 2013. The primary outcome measures were inhaled bronchodilator prescriptions, inhaled steroid prescriptions, and asthma-related physician visits between 0 and 5 years of age and between 5 and 10 years of age. Subgroup analysis compared the same outcomes for CDH patients grouped by: birth weight, gestational age, side of defect, defect size, liver herniation, hernia sac, and pulmonary hypertension. RESULTS: Fifty-six patients with CDH and 753 age-matched controls met the inclusion criteria for the 0 to 5 years of age analysis. Between 0 and 5 years of age, more CDH survivors were prescribed an inhaled bronchodilator (odds ratio [OR] = 2.47[1.38-4.48], p = 0.001) and inhaled steroid (OR = 2.03[1.07-3.74], p = 0.03), and had an asthma-related physician visit (OR = 1.92[1.00-3.56], p = 0.04). Thirty-eight cases and 491 controls met the inclusion criteria for the 5 to 10 years of age analysis. Between 5 and 10 years of age, CDH survivors were not more likely to be prescribed inhaled bronchodilators, inhaled steroids, or have an asthma-related physician visit. Among the CDH patients, we did not find a clinical characteristic associated with increased inhaled bronchodilator or steroid prescriptions at any age. CONCLUSION: A history of CDH is associated with higher rates of inhaled bronchodilator prescriptions, inhaled steroid prescriptions, and asthma-related physician visits from 0 to 5 years of age compared with age-matched controls. However, this difference resolves by 5 to 10 years of age.


Assuntos
Asma/complicações , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Hérnias Diafragmáticas Congênitas/complicações , Administração por Inalação , Corticosteroides/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Recém-Nascido , Visita a Consultório Médico , Estudos Retrospectivos , Fatores de Risco
7.
J Pediatr Surg ; 54(5): 899-902, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824242

RESUMO

INTRODUCTION: We aimed to determine if the presence of a hernia sac in neonates with isolated congenital diaphragmatic hernia (CDH) was associated with better clinical outcomes. METHODS: We performed a retrospective cohort study of infants with isolated CDH from 1991 to 2015. Primary outcome measures were oxygen-dependence and mortality at 28 days. Secondary measures were: inhaled nitric oxide use, vasoactive medication use, ventilator support, and recurrence rates. RESULTS: Seventy-one patients met the inclusion criteria: 14 patients (19.7%) had a hernia sac, and 57 patients (80.3%) did not. Mortality did not differ between the 2 groups [0 of 14 versus 3 of 57 (5.3%) (p = 1.000)]. Hernia sac patients had similar oxygen-dependence after 28 days [1 of 14 (7.1%) versus 14 of 57 (24.6%) (p = 0.273)]. Hernia sac children required less iNO (0.64 ±â€¯2.41 vs. 6.35 ±â€¯12.2 days, p = 0.002), vasoactive medications (2.79 ±â€¯3.07 vs. 5.36 ±â€¯5.52, p = 0.027), and time on ventilation (7.62 ±â€¯6.12 vs. 15.9 ±â€¯19.2, p = 0.010). Hernia sac children had similar recurrence rates within 2 years [0 of 14 versus 7 of 57 (12.3%) (p = 0.331)]. CONCLUSION: The presence of a hernia sac was not associated with lower rates of oxygen dependency or death at 28 days but was associated with decreased inhaled nitric oxide, vasoactive medication, and ventilator use. LEVEL OF EVIDENCE: III.


Assuntos
Hérnias Diafragmáticas Congênitas/mortalidade , Hérnias Diafragmáticas Congênitas/patologia , Oxigenoterapia , Administração por Inalação , Criança , Feminino , Sequestradores de Radicais Livres/administração & dosagem , Humanos , Lactente , Recém-Nascido , Masculino , Óxido Nítrico/administração & dosagem , Prognóstico , Recidiva , Respiração Artificial , Estudos Retrospectivos , Índice de Gravidade de Doença
8.
J Pediatr Surg ; 48(5): 1037-43, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23701779

RESUMO

INTRODUCTION: Calretinin, a calcium-binding protein, has been reported to be an important new marker in Hirschsprung's disease (HD). The aim is to study the diagnostic value of Calretinin in total colonic aganglionosis (TA), prematurity, and superficial biopsy when nerve hyperplasia may not be accessed by ACE activity. METHODS: Records of patients diagnosed with HD at our institution from 1985 to 2010 were studied and patients with TA identified. We examined tissue samples from those TA, partial colectomies for HD, biopsies for suspicion of HD, and rectal tissue from aborted fetuses. Immunohistochemical analysis of Calretinin was compared with ACE gold standard method in all cases. RESULTS: In the majority of the cases, the diagnosis was ascertained by ACE activity and Calretinin staining. However, in 9 cases, the diagnosis was possible with Calretinin staining but not with ACE: in 4 TA because of the absence of nerve hyperplasia, and in 5 cases because the biopsies were too superficial to examine the nerve hyperplasia. In addition, Calretinin was expressed in the gut as early as 22 gestational weeks. CONCLUSION: The use of Calretinin staining may be superior to ACE activity, particularly in the context of TA, superficial biopsies, and prematurity, allowing earlier diagnosis.


Assuntos
Calbindina 2/análise , Fibras Colinérgicas/química , Doença de Hirschsprung/diagnóstico , Proteínas do Tecido Nervoso/análise , Acetilcolinesterase/análise , Axônios/química , Biomarcadores , Calbindina 2/biossíntese , Fibras Colinérgicas/patologia , Colo/embriologia , Colo/inervação , Compostos de Diazônio , Secções Congeladas , Doença de Hirschsprung/embriologia , Doença de Hirschsprung/metabolismo , Doença de Hirschsprung/patologia , Humanos , Hiperplasia , Técnicas Imunoenzimáticas , Mucosa Intestinal/química , Músculo Liso/química , Plexo Mientérico/química , Proteínas do Tecido Nervoso/biossíntese , Variações Dependentes do Observador , Estudos Prospectivos , Reto/inervação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Coloração e Rotulagem/métodos , Plexo Submucoso/química
9.
Respir Res ; 5: 10, 2004 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-15357883

RESUMO

We studied the action of sodium metabisulphite on mucociliary transport in a frog palate epithelial injury model, hypothesizing that it may be useful for the study of mechanisms of airway injury. Sodium metabisulphite (MB) releases SO2 on contact with water. SO2 is a pollutant in automobile fumes and may play a role in the exacerbation of airway disease symptoms. We first investigated its effect on mucociliary clearance. MB 10(-1) M, increased mucociliary clearance time (MCT) by 254.5 +/- 57.3% of control values, (p < 0.001, n = 7). MB 10(-4) and 10(-2) M did not interfere with mucus clearance time compared to control values. In MB-treated frog palates, MCT did not return to control values after one hour (control, 97.3 +/- 6.3% vs. MB, 140.9 +/- 46.3%, p < 0.001, n = 7). Scanning EM images of epithelial tissue were morphometrically analyzed and showed a 25 +/- 12% loss of ciliated cells in MB palates compared to controls with an intact ciliary blanket. Intact cells or groups of ciliated cells were found in scanning EM micrographs of mucus from MB-treated palates. This was associated with increased matrix metalloproteinase (MMP-9) activity in epithelial tissue and mucus. We suggest that the loss of ciliated cells as a result of MMP-9 activation prevented full recovery of MCT after MB 10(-1) M. The mechanism of action may be on epithelial cell-cell or cell-matrix attachments leading to cell loss and a disruption of MCT. Further studies are warranted to determine whether this is an inflammatory mediated response or the result of a direct action on epithelial cells and what role this mechanism may play in the progression to chronic airway diseases with impaired mucociliary clearance.


Assuntos
Modelos Animais de Doenças , Pneumopatias/fisiopatologia , Metaloproteinases da Matriz/metabolismo , Depuração Mucociliar/efeitos dos fármacos , Palato/fisiopatologia , Sulfitos/administração & dosagem , Animais , Relação Dose-Resposta a Droga , Pneumopatias/induzido quimicamente , Pneumopatias/patologia , Palato/efeitos dos fármacos , Palato/patologia , Rana catesbeiana , Mucosa Respiratória/efeitos dos fármacos , Mucosa Respiratória/patologia
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