Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27
Filtrar
1.
Pediatr Radiol ; 53(10): 2069-2078, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37341726

RESUMO

BACKGROUND: CT is the standard imaging technique to evaluate pediatric sinuses. Given the potential risks of radiation exposure in children, it is important to reduce pediatric CT dose and maintain image quality. OBJECTIVE: To study the utility of spectral shaping with tin filtration to improve dose efficiency for pediatric sinus CT exams. MATERIALS AND METHODS: A head phantom was scanned on a commercial dual-source CT using a conventional protocol (120 kV) and a proposed 100 kV with a 0.4-mm tin filter (Sn100 kV) protocol for comparison. Entrance point dose (EPD) of eye and parotid gland region was measured by an ion chamber. Sixty pediatric sinus CT exams (33 acquired with 120 kV, 27 acquired with Sn100 kV) were retrospectively collected. All patient images were objectively measured for image quality and blindly reviewed by 4 pediatric neuroradiologists for overall noise, overall diagnostic quality, and delineation of 4 critical paranasal sinus structures, using a 5-point Likert scale. RESULTS: Phantom CTDIvol from Sn100 kV is 4.35 mGy, compared to CTDIvol of 5.73 mGy from 120 kV at an identical noise level. EPD of sensitive organs decreases in Sn100 kV (e.g., right eye EPD 3.83±0.42 mGy), compared to 120 kV (5.26±0.24 mGy). Patients in the 2 protocol groups were age and weight (unpaired T test P>0.05) matched. The patient CTDIvol of Sn100 kV (4.45±0.47 mGy) is significantly lower than 120 kV (5.56±0.48 mGy, unpaired T test P<0.001). No statistically significant difference for any subjective readers' score (Wilcoxon test P>0.05) was found between the two groups, indicating proposed spectral shaping provides equivalent diagnostic image quality. CONCLUSION: Phantom and patient results demonstrate that spectral shaping can significantly reduce radiation dose for non-contrast pediatric sinus CT without compromising diagnostic quality.


Assuntos
Estanho , Tomografia Computadorizada por Raios X , Humanos , Criança , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos , Redução da Medicação , Doses de Radiação
2.
Headache ; 63(5): 611-620, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37114889

RESUMO

OBJECTIVE: We aimed to determine if T2-weighted hyperintense white matter lesions (WMLs) on brain magnetic resonance imaging (MRI) occur more frequently in pediatric patients with migraine and other primary headache disorders compared to the general pediatric population. BACKGROUND: Small foci of T2 hyperintensity in the white matter are frequently identified on brain MRI during the workup of pediatric headache. Such lesions have been reported to be more common among adults with migraine versus adults without migraine; however, this association has not been well established in the pediatric population. METHODS: We performed a retrospective cross-sectional single-center study of electronic medical records and radiologic studies, examining pediatric patients from 3 to 18 years old who underwent brain MRI between 2016 and 2021. Patients with existing intracranial disease or abnormalities were excluded. Patients with reports of headache were categorized. Imaging was reviewed to determine the number and location of WMLs. Headache-associated disability scores (Pediatric Migraine Disability Assessment) were noted, when available. RESULTS: Brain MRI of 248 patients with a diagnosis of headache (144 with migraine, 42 with non-migraine primary headache, and 62 with headache that could not be further classified) and 490 controls were reviewed. WMLs were encountered commonly among all study participants, with a prevalence of 40.5% (17/42) to 54.1% (265/490). There was no statistically significant difference comparing the number of lesions between each of the headache groups and the control group: migraine group versus control group median [interquartile range (IQR)], 0 [0-3] versus 1 [0-4], incidence rate ratio [95% confidence interval (CI)], 0.99 [0.69-1.44], p = 0.989, non-migraine headache group versus control group median [IQR], 0 [0-3] versus 1 [0-4], 0.71 [0.46-1.31], p = 0.156, headache not otherwise specified group versus control group median [IQR], 0 [0-4] versus 1 [0-4], 0.77 [0.45-1.31], p = 0.291. There was no significant correlation between headache-associated disability and the number of WMLs (0.07 [-0.30 to 0.17], rho [95% CI]). CONCLUSION: T2 hyperintense WMLs are common within the pediatric population and are not encountered more frequently in pediatric patients with migraine or other primary headache disorders. Thus, such lesions are presumably incidental and unlikely related to headache history.


Assuntos
Transtornos de Enxaqueca , Substância Branca , Adulto , Humanos , Criança , Pré-Escolar , Adolescente , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Estudos Retrospectivos , Estudos Transversais , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/patologia , Cefaleia/diagnóstico por imagem , Cefaleia/epidemiologia , Cefaleia/patologia , Imageamento por Ressonância Magnética/métodos
3.
Pediatr Blood Cancer ; 70(3): e30190, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36602034

RESUMO

The event-free survival of pediatric low-grade gliomas is poor, and patients often require multiple treatment strategies. While MEK and RAF inhibitors are efficacious in early-phase trials, not all patients respond, and many experience progression following completion of therapy. Evaluating combination therapies that may enhance efficacy or prolong disease stabilization is warranted. We report our institutional experience using concurrent trametinib and lenalidomide in the treatment of primary pediatric central and peripheral nervous system tumors. Two of four patients using this combination therapy experienced severe thromboembolic events, necessitating discontinuation of therapy. This combination requires further investigation, and we urge caution if used.


Assuntos
Piridonas , Pirimidinonas , Humanos , Criança , Lenalidomida/efeitos adversos , Piridonas/efeitos adversos , Pirimidinonas/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Proteínas Proto-Oncogênicas B-raf
4.
Pediatr Radiol ; 53(1): 78-85, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36074163

RESUMO

BACKGROUND: Cerebral sinovenous thrombosis (CSVT) has been proposed in legal settings to be an atraumatic mimic of abusive head trauma (AHT). OBJECTIVE: The objective of this study was to determine the prevalence of CSVT and subdural hemorrhage (SDH) in a large AHT population. MATERIALS AND METHODS: This retrospective cohort study measured the prevalence of CSVT and SDH on magnetic resonance venograms in 243 patients diagnosed with AHT at a single center. We also reported additional intra- and extracranial injuries, head injury severity and length of hospital stay. RESULTS: Among 243 patients diagnosed with AHT, 7% (16/243) had CSVT. SDH was present in 94% (15/16) of the CSVT cases. Cytotoxic edema and subarachnoid hemorrhage were in 88% (14/16) and 69% (11/16) of the CSVT cases, respectively. Extracranial signs of abuse were also in 100% (16/16) of the patients with CSVT. Critical to maximal head injury severity (abbreviated injury scale >=5) was in 75% (12/16) of the CSVT population vs. 33% (82/243) in the total AHT population. Length of hospital and pediatric intensive care unit stay was greater in those with CSVT (10 vs. 21.9 and 3.5 vs. 7.3 days). CONCLUSION: These findings suggest that CSVT is uncommon in AHT and is associated with additional traumatic injuries and greater injury severity.


Assuntos
Maus-Tratos Infantis , Traumatismos Craniocerebrais , Trombose , Criança , Humanos , Lactente , Estudos Retrospectivos , Prevalência , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/complicações , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/epidemiologia , Maus-Tratos Infantis/diagnóstico , Trombose/complicações
5.
Clin Perinatol ; 49(3): 573-586, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36113923

RESUMO

Fetal MRI is a safe, noninvasive examination of the fetus and placenta, a complement to ultrasonography. MRI provides detailed CNS evaluation, including depicting parenchymal architecture and posterior fossa morphology, and is key in prenatal assessment of spinal dysraphism, neck masses, and ventriculomegaly. Fetal MRI is typically performed after 22 weeks gestation, and ultrafast T1 and T2-weighted MRI sequences are the core of the exam, with advanced sequences such as diffusion weighted imaging used for specific questions. The fetal brain grows and develops rapidly, and familiarity with gestational age specific norms is essential to MRI interpretation.


Assuntos
Feto , Diagnóstico Pré-Natal , Feminino , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Imageamento por Ressonância Magnética/métodos , Gravidez , Cuidado Pré-Natal , Diagnóstico Pré-Natal/métodos
6.
Clin Perinatol ; 49(3): 623-640, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36113926

RESUMO

Congenital malformations of the spine and spinal cord are a large and diverse group of diagnoses, which are often broadly referred to as spinal dysraphisms (SDs). Derived from the Greek words dys (bad) and raphe (suture), the term dysraphism describes missteps in the process of forming a midline seam during the zipper-like fusion of the neural folds in primary neurulation. As such, the term "spinal dysraphism" is a designation that should technically be reserved for malformations resulting from aberrations in primary neurulation. In medical practice, however, it is a catch-all designation regularly used to describe any of the numerous abnormalities demonstrating incomplete midline closure of mesenchymal, osseous, and nervous tissue, occurring at any point during embryologic development. For the sake of clarity and completeness, this article will also include that breadth in the discussion of congenital abnormalities of the spine.


Assuntos
Anormalidades Múltiplas , Disrafismo Espinal , Humanos , Imageamento por Ressonância Magnética , Medula Espinal/anormalidades , Disrafismo Espinal/diagnóstico por imagem , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem
7.
Clin Perinatol ; 49(3): 715-734, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36113931

RESUMO

Macrocephaly is a common diagnosis in the pediatric population, particularly in the infantile time period. There is a wide range of causes of macrocephaly, from benign to malignant, for which imaging plays a key role in the diagnosis and clinical guidance. Our aim is to review the distinct and prevalent neuroimaging findings in the evaluation of the macrocephalic infant.


Assuntos
Megalencefalia , Criança , Humanos , Lactente , Megalencefalia/diagnóstico por imagem , Neuroimagem
8.
Childs Nerv Syst ; 38(6): 1181-1184, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35394211

RESUMO

PURPOSE: The circle of Willis is a circulatory anastomosis that supplies blood to the brain. If any of the bridging segments are hypoplastic or absent, the capacity for collateral flow in the setting of large vessel occlusion may be decreased. Outside of the neonatal period, the prevalence of a complete circle of Willis (CoW) in the pediatric population has not been well described. Our objectives include determining the prevalence of a complete CoW in children and identifying if there is an age-related "loss" of arterial segments. METHODS: Following IRB approval, angiograms of the CoW performed on a 3-T MR platform from 2016 to 2020 on patients 21 years or younger were retrospectively reviewed. Any patient with underlying arterial pathology that may affect the CoW was excluded. Patient age and gender at the time of imaging were obtained. RESULTS: In total, 592 pediatric CoW were assessed. Frequencies of completeness were calculated in two different fashions: scenario 1 where a CoW was characterized as complete even if it contained hypoplastic vessels (88.8%), and scenario 2 where it was characterized as complete after excluding hypoplastic vessels (44.0%). In both scenarios, our data showed that older age was more associated with an incomplete CoW (p < 0.0001). In addition, we found a higher percentage of males with an incomplete CoW compared with females (p < 0.0001). CONCLUSIONS: The presence of a complete CoW is greater in our pediatric population than what has been reported in adults. The prevalence of an incomplete circle of Willis also increases significantly with age.


Assuntos
Encéfalo , Círculo Arterial do Cérebro , Criança , Círculo Arterial do Cérebro/diagnóstico por imagem , Círculo Arterial do Cérebro/patologia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos
9.
Pediatr Radiol ; 52(7): 1266-1271, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35237855

RESUMO

BACKGROUND: Palpable masses of the head and neck are a common indication for imaging in the pediatric population. Midline lesions of the infrahyoid neck, particularly lesions isolated to the suprasternal notch, are not well studied. OBJECTIVE: To delineate the histopathological and imaging spectrum of masses that occur within and isolated to the suprasternal notch. MATERIALS AND METHODS: A retrospective study was performed to identify patients with an isolated lesion of the suprasternal notch that had available pathological diagnoses. Available imaging was reviewed and characterized by fellowship-trained pediatric radiologists and compared by descriptive statistics to the final pathological diagnoses. RESULTS: Eighteen masses isolated to the suprasternal notch with available pathological diagnoses were identified. Of these, congenital epithelial inclusion cysts were diagnosed in 14 patients (77.8%) with dermoid cysts comprising 11 of those (61.1%) and epidermoid cysts accounting for 3 (16.7%). The most common imaging appearance was a cystic or pseudosolid appearance without vascularity. CONCLUSIONS: Isolated resected lesions of the suprasternal notch in pediatric patients are most frequently dermoid/epidermoid cysts, with a differential diagnosis including other less common entities.


Assuntos
Cisto Dermoide , Cisto Epidérmico , Neoplasias de Cabeça e Pescoço , Criança , Cisto Dermoide/diagnóstico por imagem , Cisto Epidérmico/diagnóstico , Humanos , Pescoço , Estudos Retrospectivos
10.
AIDS Behav ; 25(5): 1366-1372, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33738698

RESUMO

INTRODUCTION: Our study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020. METHODS: Using data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19. RESULTS AND DISCUSSION: From week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes. CONCLUSIONS: The sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.


Assuntos
Fármacos Anti-HIV , COVID-19 , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Haiti/epidemiologia , Humanos , Pandemias , SARS-CoV-2
11.
Exp Clin Psychopharmacol ; 27(5): 474-481, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30628814

RESUMO

Impulsivity reflects a pattern of rapid behavioral responses to internal or external cues with little planning or consideration of consequences. Impulsive personality is purported to be a largely stable, trait-based quality, while impulsive choice has been shown to respond to interventions aimed at reducing impulsivity. We sought to evaluate the stability of impulsive personality and examine reductions in impulsivity during short-term residential substance use disorder (SUD) treatment. The temporal stability of the UPPS-P Impulsive Behavior Scale (UPPS-P) and discounting rates on a measure of impulsive choice (i.e., Monetary Choice Questionnaire-27 [MCQ-27]) were assessed over a brief 10-day period in a sample of individuals engaged in 14-day residential SUD treatment (N = 28). Although all five UPPS-P scales exhibited adequate to good test-retest reliability (rs > .78), Negative Urgency and (lack of) Premeditation decreased over time with large and moderate effects, respectively. Discounting rates on the MCQ-27 also declined (i.e., reduced impulsivity) during treatment. While impulsive personality is broadly understood to be trait-like and largely resistant to treatment effects, our results add to emerging evidence that two scales on the UPPS-P (i.e., Negative Urgency and [lack of] Premeditation) measure aspects of impulsive personality that respond to treatment. These findings have significant implications for understanding and conceptualizing impulsivity during initial SUD treatment and suggest opportunities for additional interventions targeting aspects of impulsive personality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comportamento Impulsivo , Tratamento Domiciliar , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários
12.
Am J Health Syst Pharm ; 75(17 Supplement 3): S72-S76, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30139726

RESUMO

PURPOSE: A quality of care-focused process improvement initiative undertaken by the pharmacy service at a Veterans Affairs (VA) medical center is described. SUMMARY: In September 2016, near the end of VA's 2016 fiscal year (FY), pharmacy leaders at the medical center held a strategic planning retreat to develop goals and objectives for FY 2017. The retreat was facilitated through use of principles of lean methodology, including "A3 problem solving," and resulted in development of a transformational plan of care (TPOC). After identifying process improvement projects with the highest value-adding potential, retreat participants prioritized those projects in accordance with targeted value streams encompassing 5 areas of pharmacy operations: United States Pharmacopeia chapter 800 compliance, standard work, physical space, technology, and people. Upon retreat completion, tasks were assigned to pharmacy service managers according to their respective areas of expertise. The status of each project and the projects' impact on both pharmacy and facility outcome measures were continually assessed throughout FY 2017. Continuous reevaluation of projects within each value stream allowed for accurate outcome tracking and creation of a pharmacy dashboard. In the months after implementation of the pharmacy service TPOC, improvements in a number of performance metrics were documented. CONCLUSION: Use of lean process improvement methodology and the A3 problem-solving process resulted in more efficient generation and implementation of ideas, consistent follow-up, and the ability to continuously reevaluate pharmacy service operations to ensure progress throughout the year.


Assuntos
Hospitais de Veteranos/normas , Assistência Centrada no Paciente/normas , Serviço de Farmácia Hospitalar/normas , Qualidade da Assistência à Saúde/normas , United States Department of Veterans Affairs/normas , Veteranos , Humanos , Assistência Centrada no Paciente/métodos , Serviço de Farmácia Hospitalar/métodos , Estados Unidos
13.
Hosp Pharm ; 53(4): 247-255, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30038444

RESUMO

Purpose: The purpose of this study was to utilize lean process improvement principles to enhance the health-system pharmacy administration learning experience within a postgraduate year 1 (PGY1) residency program. Summary: The Richard L. Roudebush VA Medical Center adopted the use of lean to improve customer service and workplace efficiency. The Residency Advisory Council, overseeing the 6 pharmacy residency programs, felt that training residents in a proven process improvement technique would benefit the service and assist in developing problem-solving skills. Yellow Belt training was incorporated into the residency programs in 2012, and the Yellow Belt project for the 2014-2015 residency class was the modification of the PGY1 Health-System Pharmacy Administration learning experience. Residents focused on a few key areas as part of their completion plan: educating residents and preceptors on the importance of leadership activities, establishing a list of consistent topic discussions to be held during the administration learning experience, confirming a topic list for the pharmacy practice management and leadership seminars, piloting collaborative precepting for the administration experience, revising the staff development program, and increasing resident involvement in the PGY1 interview process. Two portions of the project lacked effective and timely communication, and as a result, those areas were not fully implemented. The remainder of the items achieved 100% completion. Conclusion: Lean techniques were effectively utilized within a residency program to enhance the health-system pharmacy administration learning experience. Successful implementation of lean requires engagement of stakeholders within the health-system, timely communication, frequent reassessments, and accountability.

14.
J Biomater Sci Polym Ed ; 29(13): 1625-1642, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29862935

RESUMO

A promising component of biomaterial constructs for neural tissue engineering are electrospun fibers, which differentiate stem cells and neurons as well as direct neurite growth. However, means of protecting neurons, glia, and stem cells seeded on electrospun fibers between lab and surgical suite have yet to be developed. Here we report an effort to accomplish this using cell-encapsulating hydrogel fibers made by interfacial polyelectrolyte complexation (IPC). IPC-hydrogel fibers were created by interfacing acid-soluble chitosan (AsC) and cell-containing alginate and spinning them on bundles of aligned electrospun fibers. Primary spinal astrocytes, cortical neurons, or L929 fibroblasts were mixed into alginate hydrogels prior to IPC-fiber spinning. The viability of each cell type was assessed at 30 min, 4 h, 1 d, and 7 d after encapsulation in IPC hydrogels. Some neurons were encapsulated in IPC-hydrogel fibers made from water-soluble chitosan (WsC). Neurons were also stained with Tuj1 and assessed for neurite extension. Neuron survival in AsC-fibers was worse than astrocytes in AsC-fibers (p < 0.05) and neurons in WsC-fibers (p < 0.05). As expected, neuron and glia survival was worse than L929 fibroblasts (p < 0.05). Neurons in IPC-hydrogel fibers fabricated with WsC extended neurites robustly, while none in AsC fibers did. Neurons remaining inside IPC-hydrogel fibers extended neurites inside them, while others de-encapsulated, extending neurites on electrospun fibers, which did not fully integrate with IPC-hydrogel fibers. This study demonstrates that primary neurons and astrocytes can be encapsulated in IPC-hydrogel fibers at good percentages of survival. IPC hydrogel technology may be a useful tool for encapsulating neural and other cells on electrospun fiber scaffolds.


Assuntos
Hidrogéis/química , Nanofibras/química , Tecido Nervoso/química , Alicerces Teciduais/química , Alginatos/química , Animais , Astrócitos/citologia , Materiais Biocompatíveis/química , Linhagem Celular , Proliferação de Células , Sobrevivência Celular , Terapia Baseada em Transplante de Células e Tecidos/métodos , Quitosana/química , Fibroblastos/citologia , Humanos , Tecido Nervoso/metabolismo , Neuritos/química , Neurônios/citologia , Tamanho da Partícula , Ratos Sprague-Dawley , Propriedades de Superfície , Engenharia Tecidual/métodos
15.
Pediatr Radiol ; 48(8): 1066-1072, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29687227

RESUMO

BACKGROUND: Pulmonary interstitial glycogenosis is a form of childhood interstitial lung disease characterized by the histological finding of abundant glycogen-laden mesenchymal cells within the pulmonary interstitium. Patients present in the neonatal period with disproportionate respiratory distress. Often, pulmonary interstitial glycogenosis is accompanied by alveolar simplification complicating recognition and diagnosis. Despite the recognition of pulmonary interstitial glycogenosis as a distinct entity, only a few case reports describing imaging findings are found in the literature, with no published systematic review available. OBJECTIVE: The purpose of this review is to provide a review of CT findings of pulmonary interstitial glycogenosis with histological correlation to aid in early diagnosis and management. MATERIALS AND METHODS: A 10-year retrospective review was performed to identify pediatric patients <18 years who underwent biopsy and CT within the last 10 years at our institution. The inclusion criteria include patients who had a CT within 3 months of biopsy and pathology-proven pulmonary interstitial glycogenosis CTs that were evaluated by three radiologists using a standardized scoring system. RESULTS: Fifteen patients met inclusion criteria (9 male, 6 female). At the time of initial pre-biopsy CT, ages ranged from 2 weeks to 5 months. Pulmonary symptoms presented at birth in the majority of patients (n=13). Two patients presented in early infancy at 3 months (n=1) and 5 months (n=1). Ground glass opacities were the most common CT finding (n=14), which varied from diffuse to scattered. Cystic lucencies (n=11) were noted in the majority of patients as well. Interlobular septal thickening (n=10) and architectural distortion (n=8) were less common findings. CONCLUSION: The most common CT findings of pulmonary interstitial glycogenosis are ground glass opacities with cystic lucencies. While the imaging findings are distinct from the typical presentation of neuroendocrine hyperplasia of infancy, there is significant overlap of these findings with surfactant dysfunction mutations, entities that also present with respiratory distress in the neonatal period. Therefore, imaging findings in pulmonary interstitial glycogenosis are helpful in guiding the need for genetic testing and/or biopsy.


Assuntos
Doença de Depósito de Glicogênio/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Biópsia , Criança , Pré-Escolar , Feminino , Doença de Depósito de Glicogênio/patologia , Humanos , Lactente , Recém-Nascido , Doenças Pulmonares Intersticiais/patologia , Masculino
17.
PLoS One ; 12(7): e0180427, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28672008

RESUMO

Impairment of spiral ganglion neurons (SGNs) of the auditory nerve is a major cause for hearing loss occurring independently or in addition to sensory hair cell damage. Unfortunately, mammalian SGNs lack the potential for autonomous regeneration. Stem cell based therapy is a promising approach for auditory nerve regeneration, but proper integration of exogenous cells into the auditory circuit remains a fundamental challenge. Here, we present novel nanofibrous scaffolds designed to guide the integration of human stem cell-derived neurons in the internal auditory meatus (IAM), the foramen allowing passage of the spiral ganglion to the auditory brainstem. Human embryonic stem cells (hESC) were differentiated into neural precursor cells (NPCs) and seeded onto aligned nanofiber mats. The NPCs terminally differentiated into glutamatergic neurons with high efficiency, and neurite projections aligned with nanofibers in vitro. Scaffolds were assembled by seeding GFP-labeled NPCs on nanofibers integrated in a polymer sheath. Biocompatibility and functionality of the NPC-seeded scaffolds were evaluated in vivo in deafened guinea pigs (Cavia porcellus). To this end, we established an ouabain-based deafening procedure that depleted an average 72% of SGNs from apex to base of the cochleae and caused profound hearing loss. Further, we developed a surgical procedure to implant seeded scaffolds directly into the guinea pig IAM. No evidence of an inflammatory response was observed, but post-surgery tissue repair appeared to be facilitated by infiltrating Schwann cells. While NPC survival was found to be poor, both subjects implanted with NPC-seeded and cell-free control scaffolds showed partial recovery of electrically-evoked auditory brainstem thresholds. Thus, while future studies must address cell survival, nanofibrous scaffolds pose a promising strategy for auditory nerve regeneration.


Assuntos
Nervo Coclear/fisiologia , Células-Tronco Embrionárias/citologia , Nanofibras , Regeneração Nervosa/fisiologia , Neurônios/citologia , Engenharia Tecidual , Animais , Materiais Biocompatíveis , Tronco Encefálico/fisiologia , Diferenciação Celular , Transplante de Células , Surdez/terapia , Feminino , Proteínas de Fluorescência Verde/genética , Cobaias , Humanos , Masculino
18.
Fed Pract ; 34(7): 45-46, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30766290

RESUMO

A pharmaceutical take-back program assisted patients with disposal of unwanted and expired medications, promoted safety and environmental stewardship, and reduced the risk of diversion.

19.
J Pharm Technol ; 33(5): 189-194, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34860938

RESUMO

Background: Medication conversions occur frequently within the Veterans Health Administration. This manual process involves several pharmacists over an extended period of time. Macros can automate the process of converting a list of patients from one medication to a therapeutic alternative. Objectives: To develop a macro that would convert active rosuvastatin prescriptions to atorvastatin and to create an electronic dashboard to evaluate clinical outcomes. Methods: A conversion protocol was approved by the Pharmacy & Therapeutics Committee. A macro was developed using Microsoft Visual Basic. Outpatients with active prescriptions for rosuvastatin were reviewed and excluded if they had a documented allergy to atorvastatin or a significant drug-drug interaction. An electronic dashboard was created to compare safety and efficacy endpoints pre- and postconversion. Primary endpoints included low-density lipoprotein (LDL), creatine phosphokinase (CPK), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase. Secondary endpoints evaluated cardiovascular events, including the incidences of myocardial infarction, stroke, and stent placement. Results: The macro was used to convert 1520 patients from rosuvastatin to atorvastatin over a period of 20 hours saving $5760 in pharmacist labor. There were no significant changes in LDL, AST, ALT, or secondary endpoints (P > .05). There was a significant increase in alkaline phosphatase (P = .0035). Conclusions: A rapid mass medication conversion from rosuvastatin to atorvastatin saved time and money and resulted in no clinically significant changes in safety or efficacy endpoints. Macros and clinical dashboards can be applied to any Veterans Health Administration facility.

20.
Hisp Health Care Int ; 14(3): 141-55, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27553227

RESUMO

INTRODUCTION: Childhood obesity is a growing epidemic, and the rates are disproportionately higher in minorities. Clinical guidelines have contributed to decreased prevalence overall, but the rates in Hispanic preschoolers have increased. METHOD: This review of the literature summarizes the perceptions and beliefs of caregivers of Hispanic preschool children regarding weight status and feeding behaviors, as well as the perceived cultural barriers to guideline adherence. A search of the CINAHL, PubMed, Joanna Briggs, and Global Health databases identified studies performed between January 1, 2008, and April 1, 2016. Search terms included Hispanics, guideline adherence, gap, barriers, obesity, overweight, and attitude to obesity. RESULTS: Fifteen studies met the inclusion criteria, including some about Hispanic caregivers of preschool-aged children. Several cultural perceptions and beliefs were identified. CONCLUSION: Further study is needed to develop more culturally relevant and sensitive guidelines and to design specific and effective interventions for this population.


Assuntos
Peso Corporal , Cuidadores , Cultura , Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino , Obesidade Infantil , Adulto , Pré-Escolar , Humanos , Política Nutricional , Obesidade Infantil/etnologia , Obesidade Infantil/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...