scholarly journals 486. Characteristics Associated with SARS-CoV-2 Infection in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S344-S344
Author(s):  
F Curtis Sudbury ◽  
Amanda Williams ◽  
Michelle Kwon ◽  
Leah Musser ◽  
Patrick Gavigan ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Random Number Generator ◽  
Gastrointestinal Symptoms ◽  
Future Research ◽  
Logistic Regression Models ◽  
Asymptomatic Patients ◽  
Central Pennsylvania ◽  
Screening Questions ◽  
Time Of Presentation ◽  
Taste And Smell

Abstract Background We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children. Methods Patients < 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients < 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests. Results We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients. Conclusion Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing. Disclosures All Authors: No reported disclosures

scholarly journals DETERMINANTS OF LEISURE-TIME PHYSICAL ACTIVITY IN OLDER, RURAL CANCER SURVIVORS IN CENTRAL PENNSYLVANIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S388-S388
Author(s):  
Scherezade K Mama ◽  
Nishat Bhuiyan ◽  
Eugene Lengerich ◽  
Kathryn Schmitz
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Rural Areas ◽  
Regression Models ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Future Research ◽  
Environmental Support ◽  
Logistic Regression Models ◽  
Central Pennsylvania

Abstract This study explored social and environmental determinants of leisure-time physical activity (LTPA) in cancer survivors (CS) residing in Central Pennsylvania, a largely rural region. Rural CS completed questionnaires assessing LTPA, social support (SS) for LTPA, home and neighborhood environments for LTPA. Logistic regression models were used to assess associations with being active/inactive. Participants (n=219) were categorized as mature survivors (<75 years, 80.7%) or elderly survivors (>=75 years, 19.3%). Only 28.2% of elderly survivors reported meeting LTPA guidelines compared to 45.6% of mature survivors. Survivors reporting SS for LTPA were 10% more likely to active than those who did not have SS (OR=1.1, CI 1-1.1). Mature survivors that reported environmental support (home: OR=1.2: CI 1-1.3; neighborhood: OR=1.8, CI: 1-3.2) were more likely to be active than those without strong environmental support. Creating more supportive environments to foster LTPA in elderly survivors in rural areas is a key priority for future research.

Congenital herniation through the foramen Morgagni — clinical presentation, diagnosis and treatment in pediatric population

Open Medicine ◽  
2011 ◽  
Vol 6 (1) ◽  
pp. 131-135 ◽  
Author(s):  
Slavković Anđelka ◽  
Marjanović Zoran ◽  
Đorđević Ivona ◽  
Jovanović Zorica ◽  
Budić Ivana
Keyword(s):  
Clinical Symptoms ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Rare Condition ◽  
Associated Anomalies ◽  
Morgagni Hernia ◽  
Female Ratio ◽  
Delay In Diagnosis ◽  
Asymptomatic Patients ◽  
Operative Findings

AbstractCongenital Morgagni hernia is a rare entity, accounting for less than 1,5% of all types of congenital diaphragmatic hernias. The majority of Morgagni hernias are diagnosed late because patients can be asymptomatic or present with non-specific respiratory and gastrointestinal symptoms and signs. The medical records of all patients diagnosed with CMH and treated in our hospital were retrospectively reviewed for age at diagnosis, sex, site of hernia, clinical symptoms, associated anomalies, operative findings and treatment. Over a 20-year period, 5 cases with CMH diagnoses were hospitalized and operated. The age of diagnosis ranged from nine months to 11 years. Male to female ratio was 3:2. Associated anomalies were seen in 2 patients (40%). Most patients had transabdominal operations. There were no complications in the postoperative period. Morgagni hernia is a rare condition. The rarity is due to the nonspecific presentation of symptoms, which contributes to a delay in diagnosis. We advocate surgical repair even in asymptomatic patients, because of the risk of strangulation. There is a low rate of complications.

Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

scholarly journals Face Covered and Six Feet Apart: Behavioral Awareness Predicts Greater Adherence to Public Health Guidelines during the COVID-19 Pandemic

2021 ◽  
Vol 18 (16) ◽  
pp. 8247
Author(s):  
Alyssa Schneider ◽  
Emily B. Kroska
Keyword(s):  
Public Health ◽  
Psychological Flexibility ◽  
The United States ◽  
Future Research ◽  
Physical And Mental Health ◽  
Logistic Regression Models ◽  
Demographic Correlates ◽  
Amazon's Mechanical Turk ◽  
Predictors Of Adherence ◽  
Close Contacts

The COVID-19 pandemic has deleteriously impacted physical and mental health. Guidelines to limit the spread of COVID-19 include wearing a face covering in public, limiting close contacts, and physical distancing. In combatting this and future pandemics, it is essential to understand predictors of adherence, such as psychological flexibility. We hypothesized higher psychological flexibility would relate to greater adherence to public health guidelines. Participants (n = 265) were English-reading/speaking adults in the United States and were recruited through Amazon’s Mechanical Turk. Included in the present analyses are data from June (n = 360) and July 2020 (n = 265). Measures included the Comprehensive Assessment of ACT Processes (CompACT), which measured psychological flexibility. Outcome measures included mask-wearing and number of close contacts, which were operationalized categorically (100% mask-wearing in public, ≤10 close contacts in past week). Two logistic regression models examined psychological flexibility and distress as predictors of adherence to mask-wearing and limiting close contacts, while controlling for demographic correlates. Results indicated that greater behavioral awareness predicted greater odds of mask-wearing and limiting close contacts. Psychological flexibility, and behavioral awareness specifically, should be investigated in future research as targets for intervention amidst global disasters.

Comparison of Frenotomy Techniques for the Treatment of Ankyloglossia in Children: A Systematic Review

2020 ◽  
Vol 163 (3) ◽  
pp. 428-443
Author(s):  
Usman Khan ◽  
Jake MacPherson ◽  
Michael Bezuhly ◽  
Paul Hong
Keyword(s):  
Rating Scale ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Numeric Rating Scale ◽  
Assessment Tools ◽  
Future Research ◽  
Randomized Controlled ◽  
Comprehensive Search ◽  
High Level ◽  
Numeric Rating

Objective To compare the effectiveness of conventional (CF), laser (LF), and Z-plasty (ZF) frenotomies for the treatment of ankyloglossia in the pediatric population. Data Sources A comprehensive search of PUBMED, EMBASE, and COCHRANE databases was performed. Review Methods Relevant articles were independently assessed by 2 reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Thirty-five articles assessing CF (27 articles), LF (4 articles), ZF (3 articles), and/or rhomboid plasty frenotomy (1 article) were included. A high level of outcome heterogeneity prevented pooling of data. All 7 randomized controlled trials (RCTs) were of low quality. Both CF (5 articles with 589 patients) and LF (2 articles with 78 patients) were independently shown to reduce maternal nipple pain on a visual analog or numeric rating scale. There were reports of improvement with breastfeeding outcomes as assessed on validated assessment tools for 88% (7/8) of CF articles (588 patients) and 2 LF articles (78 patients). ZF improved breastfeeding outcomes on subjective maternal reports (1 article with 18 infants) only. One RCT with a high risk of bias concluded greater speech articulation improvements with ZF compared to CF. Only minor adverse events were reported for all frenotomy techniques. Conclusions Current literature does not demonstrate a clear advantage for one frenotomy technique when managing children with ankyloglossia. Recommendations for future research are provided to overcome the methodological shortcomings in the literature. We conclude that all frenotomy techniques are safe and effective for treating symptomatic ankyloglossia.

scholarly journals Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

Hernia ◽  
2021 ◽  
Author(s):  
P. U. Oppelt ◽  
I. Askevold ◽  
R. Hörbelt ◽  
F. C. Roller ◽  
W. Padberg ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Surgical Repair ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Gastric Surgery ◽  
Hiatal Hernia Repair ◽  
Single Center ◽  
Asymptomatic Patients

Abstract Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

Safety and Tolerability of Fluconazole in Children

1999 ◽  
Vol 43 (8) ◽  
pp. 1955-1960 ◽  
Author(s):  
Vas Novelli ◽  
Helen Holzel
Keyword(s):  
Side Effects ◽  
Safety Profile ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Underlying Disease ◽  
Severe Underlying Disease ◽  
Excellent Safety Profile ◽  
Concomitant Medications

ABSTRACT The safety profile of fluconazole was assessed for 562 children (ages, 0 to 17 years) comprising 323 males and 239 females. The data are derived from 12 clinical studies of fluconazole as prophylaxis or treatment for a variety of fungal infections in predominantly immunocompromised patients. Most children received multiple doses of fluconazole in the range of 1 to 12 mg/kg of body weight; a few received single doses. Administration was mainly by oral suspension or intravenous injection. Overall, 58 (10.3%) children reported 80 treatment-related side effects. The most common side effects were associated with the gastrointestinal tract (7.7%) or skin (1.2%). Self-limiting, treatment-related side effects affecting the liver and biliary system were reported in three patients (0.5%). Overall, 18 patients (3.2%) discontinued treatment due to side effects, mainly gastrointestinal symptoms. Dose and age did not appear to influence the incidence and pattern of side effects. Treatment-related laboratory abnormalities were uncommon, the most frequent being transient elevated alanine aminotransferase (4.9%), aspartate aminotransferase (2.7%), and alkaline phosphatase (2.3%) levels. Although 98.6% of patients were taking concomitant medications, no clinical or laboratory interactions were observed. The safety profile of fluconazole was compared with those of other antifungal agents, mostly oral polyenes, by using a subset of data from five controlled studies. Side effects were reported by more patients treated with fluconazole (45 of 382; 11.8%) than by those patients treated with comparable agents (25 of 381; 6.6%); vomiting and diarrhea were the most common events in both groups. The incidence and type of treatment-related laboratory abnormalities were similar for the two groups. In conclusion, fluconazole was well tolerated by the pediatric population, many of whom were suffering from severe underlying disease and were taking a variety of concurrent medications. The safety profile of fluconazole in children mirrors the excellent safety profile seen in adults.

scholarly journals Symptoms of pediatric feeding disorders among individuals with 3q29 deletion syndrome

2020 ◽  
Author(s):  
Addam J. Wawrzonek ◽  
T. Lindsey Burrell ◽  
William Sharp ◽  
Scott E. Gillespie ◽  
Rebecca Pollak ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Failure To Thrive ◽  
Food Group ◽  
Autism Spectrum ◽  
Deletion Syndrome ◽  
Future Research ◽  
Feeding Disorders ◽  
Pediatric Feeding Disorders ◽  
Remediation Strategies ◽  
Pediatric Feeding

Objective: To evaluate symptoms of pediatric feeding disorders in a sample of individuals with 3q29 Deletion Syndrome. Previous research has found that individuals with 3q29 deletion syndrome (3q29Del) may experience elevated feeding concerns in early childhood; however, the specificity of these feeding concerns in this pediatric population is not well understood. Methods: We compared individuals with 3q29Del (n = 60) to matched controls (n = 59) using an 11-item survey that assessed commonly reported symptoms associated with pediatric feeding disorders. An exploratory analysis also examined individuals with 3q29Del with and without a comorbid autism spectrum disorder (ASD) diagnosis. Results: Caregivers of 3q29Del cases reported higher incidences of feeding concerns on all 11 items included in the survey. This included statistically significant differences in food refusal behaviors, rejection of one or more food group, and a history of failure to thrive. Parents of children with comorbid autism were more likely to report concerns regarding rejection of one or more food group compared to children with 3q29Del without autism. Conclusions: Results suggest individuals with 3q29Del experience increased symptoms of pediatric feeding disorders. Future research should include a more thorough multidisciplinary evaluation to further document the severity and identify optimal remediation strategies.

scholarly journals Esophageal Pemphigus Vulgaris: A Rare Etiology of Upper Gastrointestinal Hemorrhage

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Jennifer Rose F. Del Castillo ◽  
Muhammad Nadeem Yousaf ◽  
Fizah S. Chaudhary ◽  
Nahar Saleh ◽  
Lawrence Mills
Keyword(s):  
Early Recognition ◽  
Gastrointestinal Symptoms ◽  
Pemphigus Vulgaris ◽  
Diagnostic Endoscopy ◽  
Presenting Symptoms ◽  
Esophageal Involvement ◽  
Asymptomatic Patients ◽  
Mucosal Surfaces ◽  
Early Endoscopy ◽  
Upper Gastrointestinal

Pemphigus vulgaris (PV) is an autoimmune blistering disorder of the skin and mucosal surfaces characterized by acantholysis (loss of adhesion between epidermal cells). Esophageal involvement of PV is an underdiagnosed entity as routine diagnostic endoscopy is not recommended in asymptomatic patients. Dysphagia and odynophagia are common presenting symptoms; however, upper gastrointestinal bleeding (UGIB) associated with esophageal involvement of PV without a history of mucosal blistering is extremely uncommon. We present a case of esophageal involvement of PV associated with active UGIB that was diagnosed on endoscopic evaluation. This case illustrated the importance of early endoscopy to identify the esophageal involvement of PV especially in patients with preexisting disease who present with gastrointestinal symptoms such as dysphagia, odynophagia, and hematemesis. Early recognition of esophageal involvement of PV and initiation of corticosteroid and/or immunosuppressant therapy may improve the outcome of the disease.

Early Onset Allergic Proctitis in a Preterm Neonate—A Case Report and Review of the Literature

2018 ◽  
Vol 22 (2) ◽  
pp. 152-156
Author(s):  
Emanuela Ferretti ◽  
Sarah Pilon ◽  
Margaret Boland ◽  
Dina El Demellawy
Keyword(s):  
Milk Protein ◽  
Preterm Neonate ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Premature Neonate ◽  
Cow’S Milk ◽  
Review Of The Literature ◽  
Significant Delay ◽  
Cow's Milk ◽  
Systemic Manifestations

Cow’s milk protein allergy/intolerance (CMPA/CMPI) is a common entity in the pediatric population with a nonspecific presentation ranging from gastrointestinal symptoms to systemic manifestations. Most infants with CMPI are term, and symptoms often appear in the week following the introduction of cow’s milk-based formula. There is typically a significant delay in the onset of milk allergy in premature infants compared to full term. We report a rare case of a premature neonate who presented with symptoms of CMPA within the first 2 days of life.

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