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Pediatric transport

Jennifer L Walton, Diane K Dunn, Nhi Y Haines, Ilana Heisler, Michael T Bigham, Teresa A Volsko
BACKGROUND: The American Academy of Pediatrics Section on Transport recommends the use of portable ventilators during the transport of patients with advanced airways. We sought to identify knowledge gaps and evaluate the effectiveness of a transport ventilator competency boot camp. METHODS: Electronic health records of children requiring ventilatory support during air and ground interfacility transport from January 1 through December 31, 2015, were reviewed to determine when manual ventilation was used in lieu of a portable ventilator, and simulations were constructed from commonly occurring scenarios...
April 2018: Respiratory Care
Donna L Seger, Justin K Loden
CONTEXT: Following clonidine ingestion, naloxone is seldom administered as it is considered ineffective in reversing somnolence, bradycardia, or hypotension. However, this conclusion has been based on administration of small doses (2 mg or less) of naloxone. The somnolence is frequently treated with endotracheal intubation (ETI), a procedure with significant morbidity. OBJECTIVE: We aimed to determine if naloxone administration reversed the effects of clonidine or caused any adverse effects...
March 16, 2018: Clinical Toxicology
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
Wen Lin, Deqiang Li
Ventricular myocardial development is a well-orchestrated process involving different cardiac structures, multiple signal pathways, and myriad proteins. Dysregulation of this important developmental event can result in cardiomyopathies, such as left ventricle non-compaction, which affect the pediatric population and the adults. Human and mouse studies have shed light upon the etiology of some cardiomyopathy cases and highlighted the contribution of both genetic and environmental factors. However, the regulation of ventricular myocardial development remains incompletely understood...
March 13, 2018: Pediatric Cardiology
Virginia Neyro, Evelyne Jacqz-Aigrain, Tiphaine Adam de Beaumais
Identification of markers involved in drug disposition is crucial for drugs with a narrow therapeutic index. Individual genomic differences can affect the pharmacology of some drugs and participate to inter-individual variability in drug response. Pharmacogenetics is a useful tool in clinical practice for dosage adjustment and to limit drug toxicities. In pediatrics, physiological changes can also influence the disposition of drugs in infants, children and adolescents. The importance of ontogeny translates into different responses to the same drug in children and adults...
February 16, 2018: Thérapie
Jean-François Ghersi-Egea, Elodie Saudrais, Nathalie Strazielle
Drug bioavailability to the developing brain is a major concern in the treatment of neonates and infants as well as pregnant and breast-feeding women. Central adverse drug reactions can have dramatic consequences for brain development, leading to major neurological impairment. Factors setting the cerebral bioavailability of drugs include protein-unbound drug concentration in plasma, local cerebral blood flow, permeability across blood-brain interfaces, binding to neural cells, volume of cerebral fluid compartments, and cerebrospinal fluid secretion rate...
March 7, 2018: Pharmaceutical Research
Trishna Kantamneni, Lileth Mondok, Sumit Parikh
Movement disorders in the pediatric age group are largely of the hyperkinetic type. Metal ion accumulation in the central nervous system presents predominantly with movement disorders and over time leads to psychomotor decline. Abnormalities in monoamine and amino acidergic neurotransmitter metabolism present in individuals with a combination of abnormal movements, epilepsy, and cognitive and motor delay. Detailed clinical history, careful examination, appropriate diagnostic work-up with metabolic screening, cerebrospinal fluid neurotransmitters, and targeted genetic testing help with accurate diagnosis and appropriate treatment...
April 2018: Pediatric Clinics of North America
Alexandra Bukchin, Guillem Pascual-Pasto, Maria Cuadrado-Vilanova, Helena Castillo-Ecija, Carles Monterrubio, Nagore G Olaciregui, Monica Vila-Ubach, Laia Ordeix, Jaume Mora, Ángel M Carcaboso, Alejandro Sosnik
We report for the first time on a nano-drug delivery system based on glucosylated polymeric nanomicelles to actively target the second-generation tyrosine kinase inhibitor dasatinib to glucose-avid pediatric sarcomas by the intravenous route. After a comprehensive physicochemical characterization that confirmed the substantially lower critical micellar concentration and the higher encapsulation capacity of the glucosylated amphiphilic nanocarrier with respect to the pristine counterpart, we showed a 9-fold decrease of the half maximal inhibitory concentration of dasatinib in a rhabdomyosarcoma cell line, Rh30, in vitro...
February 28, 2018: Journal of Controlled Release: Official Journal of the Controlled Release Society
Mohamed Almuqbil, Michael J Rivkin, Masanori Takeoka, Edward Yang, Lance H Rodan
GLUT1 deficiency syndrome (GLUT1DS) is a well described neurometabolic disorder that results from impaired glucose transport into the central nervous system. GLUT1DS classically presents with infantile-onset epilepsy, progressive microcephaly, developmental delay, ataxia, dystonia, and spasticity, but a minority of patients may manifest with paroxysmal non-epileptic phenomena including hemiparesis (Wang et al., 2002). We report for the first time cerebral perfusion changes during an acute episode of hemiparesis in a 9 year old child with GLUT1DS...
February 19, 2018: European Journal of Paediatric Neurology: EJPN
Neeraj Raizada, Sunil D Khaparde, Virender Singh Salhotra, Raghuram Rao, Aakshi Kalra, Soumya Swaminathan, Ashwani Khanna, Kamal Kishore Chopra, M Hanif, Varinder Singh, K R Umadevi, Sreenivas Achuthan Nair, Sophie Huddart, C H Surya Prakash, Shalini Mall, Pooja Singh, B K Saha, Claudia M Denkinger, Catharina Boehme, Sanjay Sarin
BACKGROUND: Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care...
2018: PloS One
Panagiotis Krepis, Maria Papasotiriou, Maria N Tsolia, Alexandra Soldatou
OBJECTIVES: This study aimed to assess parental behavior in terms of child restraint systems (CRS) use under emergency conditions while driving to the hospital's outpatient settings as well as their routine child car safety (CCS) practices. METHODS: A cross-sectional survey of parents/caregivers transporting children 13 years or younger was conducted at the Emergency Treatment Center of a pediatric tertiary care center in Athens, Greece. Participants completed a questionnaire inquiring about the possession of CRS, and type and use of appropriate CRS while driving to the Emergency Treatment Center and under routine conditions...
February 28, 2018: Pediatric Emergency Care
Samantha W Gee, Philip L Holt, Michael J Stoner
INTRODUCTION: Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal. We sought to close this curriculum gap by developing a MCP training program immersing emergency medicine (EM) and critical care (CC) fellows together with TT members to manage a simulated patient...
March 2018: Air Medical Journal
Berit P Jensen, Rajneeta Saraf, Jing Ma, Sarah Berry, Cameron C Grant, Carlos A Camargo, Christiaan W Sies
BACKGROUND: Demand for measurement of 25-hydroxyvitamin D (25OHD) is growing and dried blood spot (DBS) sampling is attractive as samples are easier to collect, transport and store. METHODS: A 2D LC-MS/MS assay without derivatization was developed. DBS punches (3.2 mm) were ultrasonicated with d6 -25OHD3 in 70% methanol followed by hexane extraction, dry-down and reconstitution. The assay was validated and applied to two studies comparing whole blood adult DBS with serum samples (n = 40) and neonatal whole blood DBS with cord serum samples (n = 80)...
February 20, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
Jonathan B Wagner, Susan Abdel-Rahman, Leon Van Haandel, Andrea Gaedigk, Roger Gaedigk, Geetha Raghuveer, Ralph Kauffman, J Steven Leeder
This study investigated the impact of allelic variation in SLCO1B1, a gene encoding for the liver-specific solute carrier organic anion transporter family member 1B1 protein (SLCO1B1), on simvastatin and simvastatin acid (SVA) systemic exposure in children and adolescents. Participants (8-20 years old) with at least 1 variant SLCO1B1 c.521T>C allele (521TC, n = 15; 521CC, n = 2) and 2 wild-type alleles (521TT, n = 15) completed a single oral dose pharmacokinetic study. At equivalent doses, SVA exposure was 6...
February 22, 2018: Journal of Clinical Pharmacology
David Borrego, Erin M Lowe, Cari M Kitahara, Choonsik Lee
A PC Program for X ray Monte Carlo (PCXMC) has been used to calculate organ doses in patient dosimetry and for the exposure assessment in epidemiological studies of ra- diogenic health related risks. This study compared the dosimetry from using the built-in stylized phantoms in the PCXMC to that of a newer hybrid phantom library with improved anatomical realism. We simulated chest and abdominal x ray projections for 146 unique body size computational phantoms, 77 males and 69 females, with different combinations of height (125 - 180 cm) and weight (20 - 140 kg) using the built-in stylized phantoms in the PCXMC version 2...
February 21, 2018: Physics in Medicine and Biology
Keith Tchadwick Griffin, Matthew Mille, Choonsik Lee
The risks associated with exposure to external fields of ionizing radiation are important to quantify to provide guidance towards public and worker protection. In Publication 116 of 2010, the International Commission on Radiological Protection (ICRP) published adult male and female fluence-to-dose coefficients (henceforth referred to as dose coefficients) for external exposures to six types of idealized neutron fields. However, ICRP 116 dose coefficients are not appropriate for applications involving children due to their smaller body weight and stature...
February 21, 2018: Journal of Radiological Protection: Official Journal of the Society for Radiological Protection
Ryan J Reichert, Megan Gothard, M David Gothard, Hamilton P Schwartz, Michael T Bigham
INTRODUCTION: Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI...
February 21, 2018: Prehospital Emergency Care
E A Maden, C Altun, B Ozmen, F Basak
Aim: This in vivo study was designed to compare the antimicrobial effect of toothpastes containing fluoride, xylitol, or xylitol-probiotic on Streptococcus mutans and Lactobacillus in 13-15-year-old children. Materials and Methods: The study consisted of 60 pediatric patients who were randomly divided into three groups of 20 each. Group 1 recieved fluoride toothpaste (Colgate Max Fresh), group 2 used xylitol toothpaste (Xyliwhite), and group 3 used xylitol-probiotic toothpaste (PerioBiotic)...
February 2018: Nigerian Journal of Clinical Practice
Michael B Mwandri, Timothy C Hardcastle
BACKGROUND: Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower-middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends 'Essential Trauma Care' in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system. METHOD: Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults...
February 15, 2018: World Journal of Surgery
William M Pardridge, Ruben J Boado, Roberto Giugliani, Mathias Schmidt
BACKGROUND: Mucopolysaccharidosis type I (MPSI) is caused by mutations in the gene encoding the α-L-iduronidase (IDUA) lysosomal enzyme and the majority of MPSI patients have severe central nervous system (CNS) involvement. Enzyme replacement therapy (ERT) with recombinant IDUA does not treat the CNS, due to the lack of transport of the enzyme across the blood-brain barrier (BBB). Human IDUA has been re-engineered as an IgG-IDUA fusion protein, valanafusp alpha, where the IgG domain is a monoclonal antibody (MAb) against the human insulin receptor (HIR)...
February 13, 2018: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
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