RESUMO
It is uncommon for a patient to have 2 different diagnoses contributing to neonatal cholestasis and poor growth. We present a 2-month-old female with extrahepatic biliary atresia status after Kasai procedure at 4 weeks old presenting with persistent neonatal cholestasis. The patient was admitted for intolerance of oral feeds, concern for cholangitis and Kasai failure, and nutritional optimization. She was found to have genetic testing positive for 2 rare cystic fibrosis transmembrane conductance regulator mutations and pancreatic insufficiency consistent with a possible diagnosis of cystic fibrosis-related disease. We discuss the implications and management considerations in a patient with both biliary atresia and cystic fibrosis.
RESUMO
Vitamin A deficiency (VAD) is common in developing countries but rare in resource-rich countries. In developed countries, malabsorption and behavioral issues are more common reasons for VAD. The current case is an example of a healthy child who developed ocular symptoms due to vitamin A deficiency in the setting of cultural influences and emotional stressors.
RESUMO
Hospitals are faced with reduced funding but must deliver high-quality care, and increase service capacity (MOHLTC 2013). In response, Mount Sinai Hospital (MSH) has established an organizational approach that engages clinicians and front-line caregivers. MSH's Effective and Efficient Utilization Committee (EEUC) focuses on cross-departmental collaboration to maximize resources, accessibility and quality, while minimizing cost. The challenges were tackled by team coordination guided by senior administration and project management review of evidence-based data supported by health analytics. Over a three-year period, the EEUC has helped reduce wait times, increase service accessibility, provide cost savings and enhance patient experience in several areas.
