scholarly journals Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic

2018 ◽  
Vol 5 ◽  
pp. 2333794X1876914
Author(s):  
Ramya Deepthi Billa ◽  
Susan Szpunar ◽  
Lida Zeinali ◽  
Premchand Anne
Keyword(s):  
Pediatric Patients ◽  
Pediatric Cardiology ◽  
Age Group ◽  
Shortness Of Breath ◽  
Cumulative Yield ◽  
Community Based ◽  
Cardiology Clinic ◽  
First Time ◽  
Community Teaching ◽  
Echocardiographic Findings

The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital. We retrospectively reviewed the charts of 891 patients who had a first-time echocardiogram between 2011 and 2015. Positive yield was defined as echocardiographic findings that explained the reason for the echocardiogram. The overall positive yield was 8.2%. Children between birth and 3 months of age had the highest yield (34.2%), and children between 12 and 18 years of age had the lowest yield (1%). Patients with murmurs (18.1%) had the highest yield compared with patients with other signs or symptoms. By age group and reason, the highest yields were as follows: 0 to 3 months of age, murmur (39.2%); 4 to 11 months of age, >1 symptom (50%); and 1 to 5 years of age, shortness of breath (66.7%). Based on our study, the overall yield of echocardiograms in the outpatient pediatric setting is low. Age and symptoms should be considered before ordering an echocardiogram.

scholarly journals COVID-19 test positivity: predictive value of various symptoms in a large community-based testing program in California

2021 ◽  
Author(s):  
Dave P. Miller ◽  
Scott Morrow ◽  
Robert M. Califf ◽  
Cameron Kaiser ◽  
Ritu Kapur ◽  
...  
Keyword(s):  
Predictive Value ◽  
Hospital Setting ◽  
Community Setting ◽  
Test Site ◽  
Shortness Of Breath ◽  
Rt Pcr ◽  
Community Based ◽  
Testing Program ◽  
First Time ◽  
Taste And Smell

AbstractBackgroundMuch of the early data on COVID-19 symptomatology was captured in the hospital setting. In a community setting the symptoms most predictive of SARS-CoV-2 positivity may be different. Data from the California sites of a COVID-19 community testing program are presented here.MethodsPrior to being tested, participants in the Baseline COVID-19 Testing Program completed an online screener, in which they self-reported basic demographics and the presence or absence of 10 symptoms. Both positive and negative COVID-19 RT-PCR tests were linked back to the screener data. A multivariable model of positivity was fit using generalized estimating equations, adjusting for month of testing as a fixed effect and accounting for clustering of data within each test site.ResultsAmong 547,018 first-time tests in California in 2020, positivity rates were 3.4%, 9.9%, and 19.8% for participants with no symptoms, 1 symptom, or 2 or more symptoms at the time of screening, respectively. All ten symptoms were individually associated with higher positivity rates, but only six of ten symptoms were associated with higher positivity when adjusting for other symptoms. Major symptoms with highest predictive value were recent loss of taste or smell, fever, and coughing with ORs of 3.27, 1.97, and 1.95, respectively. Shortness of breath and vomiting or diarrhea were negatively associated with positivity adjusting for other symptoms and, absent other symptoms, participants with these symptoms did not have significantly higher positivity rates than asymptomatic participants.ConclusionsRecent loss of taste and smell should be elevated to a major symptom along with fever and coughing in public health messaging and in our community approach to testing and surveillance, while mild to moderate shortness of breath should be de-emphasized as a sensitive early predictor of COVID-19 positivity.

scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

Antiticiombin III Deficiency In A Large Family with 41 Affected Members

1981 ◽  
Author(s):  
J Stibbe ◽  
S Adhin ◽  
G L Ong ◽  
R S Panday ◽  
S H Peters ◽  
...  
Keyword(s):  
Autosomal Dominant ◽  
Large Family ◽  
Clinical Information ◽  
Impedance Plethysmography ◽  
Age Group ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
At Iii ◽  
L 51 ◽  
First Time

Hereditary Antithrombin III (AT III) deficiency was found in a large Hindustani family, living partly in the Netherlands, partly in Suriname. Of 201 members investigated 35 were found to affected: AT III activity (chromogenic substrate) and AT III antigen (immuno-electrophoresis according to Laurell) were about 45 %. Analysis of this fanily clearly demonstrated the autosomal dominant inheritance of the condition. Six non-investigated members (1 living, 5 non-living) were diagnosed as being affected on the basis of affected offspring.Seventeen affected members had no signs of thrombo-embolic(TE) processes (age group 0-10 years old, n=2; 11-20, n=5; 21-30, n=4; 31-40, n=4; 41-50, n=2). Thirteen showed clinical or proven signs of TE processes (first time in age group 0-10 years old, n=0; 11-20, n=l; 21-30, n=G; 31-40, n=4; 41-50,n=l; 51-60, n=0; 61-70, n=l). No clinical information is yet available on the remaining affected members. Deep venous thrombosis (DVT) occurred in 9 patients (age group 21-30, n=5; 31-40, n=3; 61-70, n=l). Triggering factors were none 4, surgery 1, oral contraceptives and preg- nancy4. Pulmonary embolism occurred in 6 patients (2 clinical, 4 proven) and was fatal in 4; ages were 19, 21, 26, 37, 48 and 68 years old. Pregnancy was uncomplicated in 3 women (total of 4 pregnancies), one of these women was treated prophylactically with anticoagulants during pregnancy (1 pregnancy). Two women (9 pregnancies) had a thrombotic episode (1st and 3rd pregnancy respectively) and 1 woman died suddenly 7 days after her 7th childbirth. DVT occurred in 2 of 4 women who used oral contraceptive pills.In some symptomless patients (age 22, 26, 32, 33, 40 years old) impedance plethysmography (n=5), 125I-fibrinogen leg scanning (n=3), 125I-fibrinogen T½(n=3) and 51C-platelet survival (n=l) were normal

An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

2021 ◽  
Author(s):  
Michael H. French ◽  
Michael S. Kung ◽  
W. Nathan Holmes ◽  
Hossein Aziz ◽  
Evelyn S. Thomas ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Obese Children ◽  
Significant Difference ◽  
Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

2021 ◽  
pp. 000992282110382
Author(s):  
Tracey M. Thompson ◽  
Ty E. Hasselman ◽  
Yanzhi Wang ◽  
David W. Jantzen
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Pediatric Cardiology ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Improve Cost Effectiveness ◽  
Cardiology Clinic ◽  
Improve Cost

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.

The Two Row Wampum-Covenant Chain Tradition as a Guide for Indigenous-University Research Partnerships

2018 ◽  
Vol 19 (5) ◽  
pp. 339-359
Author(s):  
Richard W. Hill ◽  
Daniel Coleman
Keyword(s):  
New York ◽  
Indigenous Peoples ◽  
Community Based ◽  
Research Partnerships ◽  
Basic Principles ◽  
North Americans ◽  
The Past ◽  
Six Nations ◽  
Productive Research ◽  
First Time

This co-authored article examines the oldest known treaty between incoming Europeans and Indigenous North Americans to derive five basic principles to guide healthy, productive relationships between Indigenous community-based researchers and university-based ones. Rick Hill, Tuscarora artist and knowledge keeper from the Six Nations of the Grand River, publishes for the first time here the most complete oral history that exists today of that ancient treaty, from the early seventeenth century, known as the Two Row Wampum or the Covenant Chain agreement. Interspersed with Dr. Hill’s reflections, Daniel Coleman, a settler professor of English and Cultural Studies at McMaster University, outlines five principles for research partnerships derived from the discussions of the Two Row Research Partnership seminars that Hill and Coleman have been hosting at Deyohahá:ge: Indigenous Knowledge Centre for the past four years. Formed between the Hodinöhsö:ni’ confederacy and Dutch merchants arriving near Albany, New York in 1609, the Two Row Wampum-Covenant Chain treaty set the precedent for nation-to-nation treaties between European colonial powers and Indigenous peoples with two parallel rows representing the Hodinöhsö:ni’ canoe and the Dutch ship sailing down the shared river. Each party agreed to keep their beliefs and laws in their separate vessels, and on this basis of interdependent autonomy, they established a long-lasting friendship. This article suggests that by renewing our understanding of the Two Row Wampum-Covenant Chain treaty, Indigenous and non-Indigenous researchers alike can rebuild relationships of trust and cooperation that can decolonize Western presumptions and re-establish healthy and productive research partnerships.

scholarly journals Two Pools of ATP Detected in the Brains of Pediatric Patients with Myelin Oligodendrocyte Glycoprotein Antibody Disorders (MOGAD) by 3D 31P MR Spectroscopic Imaging (MRSI) at 7T

2022 ◽  
Author(s):  
Jimin Ren ◽  
Fang Yu ◽  
Benjamin M. Greenberg
Keyword(s):  
Human Brain ◽  
Pediatric Patients ◽  
Simultaneous Detection ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Free Radical Damage ◽  
The Central Nervous System ◽  
31P Mrsi ◽  
First Time ◽  
Radical Damage ◽  
Mr Spectroscopic Imaging

Over the past four decades, ATP, the obligatory energy molecule for keeping all cells alive and functioning, was thought to contribute only one set of 31P MR signals in the human brain. Here we report for the first time the simultaneous detection of two pools of ATP in the human brain by high-resolution 3D 31P MRSI at ultrahigh field 7T. These two ATP pools differ in cytosolic Mg2+ concentration (1:0.5 ratio), with a resonance separation of 0.5 ppm at beta-ATP, a well-established imaging marker of intracellular Mg2+ concentration. Mg2+ is a cofactor of ATPase and its deficiency is associated with immune dysfunction, free radical damage, perturbations in Ca2+ homeostasis, development of atherosclerosis and dyslipidemia, and a number of neurological disorders, such as cerebral vasospasm, stroke, migraine, Alzheimer's disease, and Parkinson's disease. Our study documents reduced Mg levels in the brain of patients with myelin oligodendrocyte glycoprotein antibody disorders (MOGAD), which is an idiopathic, inflammatory, demyelinating condition of the central nervous system (CNS) more common in pediatric patients. Low-Mg2+ ATP signals in MOGAD were detected mostly in the white matter regions, which may suggest Mg2+ deficiency in oligodendrocytes, which are primarily responsible for maintenance and generation of the axonal myelin sheath. This preliminary study demonstrates the utility of the 7T 3D 31P MSRI for revealing altered energy metabolism with reduced Mg availability at a normal ATP level. The potential correlation between [Mg2+] and disease progression over time should be assessed in larger cohorts.

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