scholarly journals Analysis of Incident DKA in the Indiana New Onset T1D Patient Population

2020 ◽  
Vol 3 ◽  
Author(s):  
Brianna Beer ◽  
Kelly Moors ◽  
Carmella Evans-Molina ◽  
Emily Sims
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Body Production ◽  
New Onset

Background/Objective: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D) resulting from ketone body production and metabolic acidosis occurring due to insulin deficiency. We sought to define the occurrence of DKA amongst pediatric patients presenting with new-onset T1D in Indiana and to determine whether patterns of DKA were affected by the COVID-19 pandemic.     Methods: This was a retrospective chart review for patients <18 years admitted to Riley Children’s Hospital with a clinical diagnosis of new onset T1D who had available chemistry values. Patients diagnosed from March 23- June 30, 2020 and over the same period in 2019 were included. DKA was classified as mild (bicarbonate 10-15 mmol/L) or severe (bicarbonate <10 mmol/L).    Results: Ninety-four patients met inclusion criteria. The total number of incident T1D cases in 2019 and 2020 were similar (48 vs. 46, respectively). Similarly, there was no significant difference in rates of DKA (21 in 2019 vs. 25 in 2020; p>0.05). Of the 94 patients, 49% met criteria for DKA; 79% of cases were classified as severe and 21% as mild. More males were diagnosed with DKA in both 2019 and 2020 (61% of DKA cases). Non-Hispanic whites comprised 75% of all new onset T1D patients and no differences in race or ethnicity were present amongst those presenting in DKA.     Conclusion: DKA was present in nearly half of all new onset pediatric T1D cases in Indiana in 2019 and 2020. There was no observed impact of the COVID-19 pandemic on T1D or DKA.      Impact and Implications: DKA is common amongst pediatric patients with new onset T1D in Indiana. Prompt recognition of symptoms is needed to prevent this life-threatening complication of T1D. 

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.

scholarly journals COVID-19 Infection with Refractory Diabetic Ketoacidosis- A case Report

2021 ◽  
Vol 7 (2) ◽  
pp. 54-56
Author(s):  
Reshmi Mishra ◽  
◽  
Jyoti Ranjan Behera ◽  
P. Ramkumar ◽  
Mukesh Kumar Jain ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Vital Organ ◽  
Increased Risk ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
New Onset

Diabetic ketoacidosis is an acute life-threatening complication of type 1 diabetes. Sometimes it is the first presentation in an undiagnosed child. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) and diabetes mellitus are very much interrelated as diabetes mellitus is associated with an increased risk of severe COVID19 at the same time, many cases of new-onset diabetes had been diagnosed. Hyperglycemia, metabolic acidosis, and ketonemia are classical presentations. It is essential to correct the acidosis and fluid correction and insulin therapy in these patients, leading to vital organ dysfunction. In refractory metabolic acidosis, renal replacement therapy may help

scholarly journals Outcomes and factors influencing care decisions in life-threatening fetal and neonatal anomalies

2020 ◽  
Author(s):  
Esther J Lee ◽  
Simone Stenekes ◽  
Michael Harlos
Keyword(s):  
Palliative Care ◽  
Chart Review ◽  
Care Service ◽  
Palliative Care Service ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
Factors Influencing ◽  
Life Threatening ◽  
Perinatal Palliative Care ◽  
The Mean

Objective: A retrospective chart review was undertaken to describe the outcomes following the diagnosis of a life-threatening fetal and neonatal anomaly. Study Design: Criteria for a life-threatening anomaly included genetic conditions, renal and pulmonary diseases, central nervous system anomalies (CNS), and cardiac defects. Information that could impact decision making was collected from provincial databases Results: 176 patients met the inclusion criteria. The majority of the diagnoses were in the genetic and CNS categories. 58% (n=103) decided to terminate the pregnancy. When a live birth occurred (n=39), the mean length of survival was 13.5 days (range 1-156 days), with one death occurring at home. Conclusions: Ethnicity and geographical factors were associated with the decision to terminate a pregnancy. The involvement of the palliative care service was associated with decreased interventions. Further research to determine the needs of families would be helpful in identifying program priorities in perinatal palliative care.

Electroencephalographic Findings in Pediatric Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis: The San Diego Experience

2020 ◽  
Author(s):  
Aliya Frederick ◽  
Jennifer H. Yang ◽  
Natalie Guido-Estrada ◽  
Jose Soria-Lopez ◽  
Shifteh Sattar
Keyword(s):  
Early Diagnosis ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Nrem Sleep ◽  
Inclusion Criteria ◽  
Antibody Testing ◽  
Early Management ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

AbstractDiagnosing anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis clinically can be challenging. There is a growing interest in identifying specific electroencephalographic features to help guide early management. A retrospective chart review was conducted of pediatric patients admitted to Rady Children's Hospital between January 1, 2010 and April 1, 2017. We included patients with the diagnosis of encephalitis who underwent continuous video electroencephalogram (VEEG) for at least 12 hours, and presented with less than 14 days of symptoms. We compared the electroencephalographic features of non-rapid eye movement (NREM) sleep between patients with antibody confirmed anti-NMDAR encephalitis and patients with encephalitis from other etiologies. We identified seven patients who met our inclusion criteria, five of whom were diagnosed with anti-NMDAR encephalitis. Four of the five patients had a significant reduction in NREM sleep, while one patient had increased NREM sleep associated with clinical catatonia and hypersomnolence. Sleep was preserved in the two cases of nonimmune mediated encephalitis. Our results suggest that a prolonged VEEG to capture sleep coupled with clinical features can aid in early diagnosis and treatment of anti-NMDAR encephalitis, often before confirmatory antibody testing is available.

Evaluating the impact of CPAP weaning procedures on total days on nasal CPAP: A retrospective chart review

2021 ◽  
pp. 1-10
Author(s):  
Z.B. Puthattayil ◽  
G.P. Moore ◽  
K. Tang ◽  
N. Huneault-Purney ◽  
S.L. Lawrence
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Retrospective Chart Review ◽  
Stability Criteria ◽  
Inclusion Criteria ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

BACKGROUND: There is no consensus on how to wean infants from Nasal Continuous Positive Airway Pressure (NCPAP). We hypothesized that ceasing NCPAP abruptly would decrease the duration required, compared with a gradual wean. METHODS: This retrospective chart review included preterm infants requiring NCPAP for over 48 hours. Cohort1 weaned NCPAP by cycling on and off, while cohort 2 ceased NCPAP abruptly. The primary outcome was total days on NCPAP. Secondary outcomes included rate of bronchopulmonary dysplasia, weight gain, duration of hospital stay, and compliance with the use of stability criteria. RESULTS: 81 infants met inclusion criteria in cohort one, and 89 in cohort two. Median days on NCPAP were 17.0 and 11.0 days, respectively, not significant. There was no significant difference in secondary outcomes. CONCLUSIONS: There was no significant association between the two NCPAP weaning protocols and the outcomes studied.

37 Identifying Vulnerable Children: Burn Pediatric Warning Scores and ICU Designation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S25-S26
Author(s):  
Andrew Greenway ◽  
Jamie Heffernan ◽  
Kevin Xuereb ◽  
Abraham Houng ◽  
Carolyn Sun
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Care Delivery ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Hospital Length Of Stay ◽  
Level Of Care ◽  
Injured Child ◽  
Number Of Patients ◽  
Significant Difference

Abstract Introduction Pediatric Early Warning Scores (PEWS) facilitate the identification of non-ICU pediatric patients at risk for deterioration. Limited studies exist to describe the utility of Burn specific PEWS (bPEWS) in the early identification of clinical vulnerability. The purpose of this retrospective chart review was to associate a bPEWS assessment value with a need for elevation to an ICU level of care for the burn-injured child. Methods A retrospective chart review of all non-mechanically ventilated (nMV) pediatric patients admitted to the burn service from July 2013 to May 2016 (n=709). Data included bPEWS scores, age, total body surface area (TBSA) burn and hospital length of stay (LOS). A pediatric level of care (PLC) designation, instituted as a model of care delivery following this study, utilizes bPEWS to categorize patients by acuity. Patients are grouped by their highest bPEWS: a) unstable (bPEWS &gt; 8; b) watchers (bPEWS 5–7); and c) stable (bPEWS &lt; 5). This study retroactively utilizes this framework. Results 709 patient charts yielded 12,642 bPEWS data points. 37 patients (0.53%) scored &gt; 8 during their hospital stay. Patient age was not statistically significant, a=2.4 years, b=3.25, and c=2.3(F=0.64, p = 0.53). More secondary diagnoses were present in the a) unstable cohort (59%) than either the b) (26. 6%) or c) (20%); (c2 = 6.3, p = 0.02 and p &lt; 0.01). There was a statistically significant difference in the number of patients in the unstable cohort versus the watcher and stable cohorts combined (c2 = 13.21, p &lt; 0.01). Patient transfer to the pediatric ICU (PICU) occurred in 10.8% of the a) unstable group and none of the watcher or the stable cohorts (b, c), (p=0.02). Pediatric critical intensivist consults occurred in 19% of the a) unstable patients but not in either the watcher or the stable patients (p &lt; 0.01). The average LOS was 18.1 days in the a) unstable group, 9.41 days in the b) watcher group, and 6.06 days for the c) stable group, (F=19.20, p &lt; 0.01). TBSA burn was larger for the unstable group (12.5%), versus 5.74% for watcher patients, and 2.5 % for stable patients, (F=9.70, p &lt; 0.01). On average, the peak bPEWS scores occurred hospital day 3.27 in the unstable group, 2.58 in the watcher group, and day 1.88 in the stable status group, (NS) (F=0.88, p = 0.42). There were no mortalities. Conclusions This retrospective review captures the infrequent experience of significant clinical deterioration in the nMV pediatric burn population reflected through the bPEWS lens. There appears to be a relationship between high bPEWS scores, burn size, presence of a secondary diagnosis, and increasing LOS. This study supports the designation of these patients to higher levels of care. This bPEWS driven paradigm presently results in adjusted nursing staffing ratios, frequency of assessment, and mandated collaborative medical practice patterns. Applicability of Research to Practice Directly Applicable.

1290-P: Gut Microbiota in New-Onset Pediatric Patients with Type 1 Diabetes: Machine Learning Algorithms to Classify Microorganisms Disease-Linked

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1290-P
Author(s):  
GIUSEPPE D’ANNUNZIO ◽  
ROBERTO BIASSONI ◽  
MARGHERITA SQUILLARIO ◽  
ELISABETTA UGOLOTTI ◽  
ANNALISA BARLA ◽  
...  
Keyword(s):  
Machine Learning ◽  
Type 1 Diabetes ◽  
Gut Microbiota ◽  
Pediatric Patients ◽  
Learning Algorithms ◽  
Machine Learning Algorithms ◽  
New Onset

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals Investigation of TAGAP gene polymorphism (rs1738074) in Turkish pediatric celiac patients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Melek Pehlivan ◽  
Tülay K. Ayna ◽  
Maşallah Baran ◽  
Mustafa Soyöz ◽  
Aslı Ö. Koçyiğit ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Disease Risk ◽  
Polymerase Chain Reaction Method ◽  
Control Group ◽  
Healthy Children ◽  
Single Nucleotide ◽  
Significant Difference ◽  
Allele Specific ◽  
And Control

Abstract Objectives There are several hypotheses on the effects of the rs1738074 T/C single nucleotide polymorphism in the TAGAP gene; however, there has been no study on Turkish pediatric patients. We aimed to investigate the association of celiac disease (CD) and type 1 diabetes mellitus (T1DM) comorbidity with the polymorphism in the TAGAP gene of Turkish pediatric patients. Methods Totally, 127 pediatric CD patients and 100 healthy children were included. We determined the polymorphism by the allele-specific polymerase chain reaction method. We used IBM SPSS Statistics version 25.0 and Arlequin 3.5.2 for the statistical analyses. The authors have no conflict of interest. Results It was determined that 72% (n=154) of only CD patients had C allele, whereas 28% (n=60) had T allele. Of the patients with celiac and T1DM, 42.5% (n=17) and 57.5% (n=23) had T and C alleles, respectively. Of the individuals in control group, 67% (n=134) had C allele, whereas 33% (n=66) had T allele. Conclusions There was no significant difference in the genotype and allele frequencies between the patient and control groups (p>0.05). There was no significant association between the disease risk and the polymorphism in our study group.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Sign in / Sign up

Export Citation Format

Share Document