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Peebles PJ, Jensen EA, Herrick HM, Wildenhain PJ, Rumpel J, Moussa A, Singh N, Abou Mehrem A, Quek BH, Wagner M, Pouppirt NR, Glass KM, Tingay DG, Hodgson KA, O’Shea JE, Sawyer T, Brei BK, Jung P, Unrau J, Kim JH, Barry J, DeMeo S, Johnston LC, Nishisaki A, Foglia EE. Endotracheal Tube Size Adjustments Within Seven Days of Neonatal Intubation. Pediatrics 2024; 153:e2023062925. [PMID: 38469643 PMCID: PMC10979295 DOI: 10.1542/peds.2023-062925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal endotracheal tube (ETT) size recommendations are based on limited evidence. We sought to determine data-driven weight-based ETT sizes for infants undergoing tracheal intubation and to compare these with Neonatal Resuscitation Program (NRP) recommendations. METHODS Retrospective multicenter cohort study from an international airway registry. We evaluated ETT size changes (downsizing to a smaller ETT during the procedure or upsizing to a larger ETT within 7 days) and risk of procedural adverse outcomes associated with first-attempt ETT size selection when stratifying the cohort into 200 g subgroups. RESULTS Of 7293 intubations assessed, the initial ETT was downsized in 5.0% of encounters and upsized within 7 days in 1.5%. ETT downsizing was most common when NRP-recommended sizes were attempted in the following weight subgroups: 1000 to 1199 g with a 3.0 mm (12.6%) and 2000 to 2199 g with a 3.5 mm (17.1%). For infants in these 2 weight subgroups, selection of ETTs 0.5 mm smaller than NRP recommendations was independently associated with lower odds of adverse outcomes compared with NRP-recommended sizes. Among infants weighing 1000 to 1199 g: any tracheal intubation associated event, 20.8% with 2.5 mm versus 21.9% with 3.0 mm (adjusted OR [aOR] 0.62, 95% confidence interval [CI] 0.41-0.94); severe oxygen desaturation, 35.2% with 2.5 mm vs 52.9% with 3.0 mm (aOR 0.53, 95% CI 0.38-0.75). Among infants weighing 2000 to 2199 g: severe oxygen desaturation, 41% with 3.0 mm versus 56% with 3.5mm (aOR 0.55, 95% CI 0.34-0.89). CONCLUSIONS For infants weighing 1000 to 1199 g and 2000 to 2199 g, the recommended ETT size was frequently downsized during the procedure, whereas 0.5 mm smaller ETT sizes were associated with fewer adverse events and were rarely upsized.
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Affiliation(s)
- Patrick J. Peebles
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erik A. Jensen
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Jennifer Rumpel
- Univeristy of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ahmed Moussa
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Neetu Singh
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | | | | | - David G. Tingay
- Neonatal Research, Murdoch Children’s Research Institute, Melbourne, Australia; Royal Children’s, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | | | | | | | | | - Philipp Jung
- University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Jennifer Unrau
- Alberta Children’s Hospital, University of Calgary, Alberta, Canada
| | - Jae H. Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Barry
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - Akira Nishisaki
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Johnson MD, Tingay DG, Perkins EJ, Sett A, Devsam B, Douglas E, Charlton JK, Wildenhain P, Rumpel J, Wagner M, Nadkarni V, Johnston L, Herrick HM, Hartman T, Glass K, Jung P, DeMeo SD, Shay R, Kim JH, Unrau J, Moussa A, Nishisaki A, Foglia EE. Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326501. [PMID: 38418208 DOI: 10.1136/archdischild-2023-326501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation. DESIGN Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS). SETTING Eighteen academic NICUs in NEAR4NEOS. PATIENTS Neonates requiring two or more attempts at intubation between October 2014 and December 2021. MAIN OUTCOME MEASURES The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice. RESULTS 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs. CONCLUSIONS Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.
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Affiliation(s)
- Mitchell David Johnson
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David Gerald Tingay
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Services, Western Health, St Albans, Victoria, Australia
| | - Bianca Devsam
- Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ellen Douglas
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julia K Charlton
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Division of Neonatology, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Paul Wildenhain
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Rumpel
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Vinay Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lindsay Johnston
- Department of Pediatrics, Yale University, New Haven, Connecticut, USA
| | - Heidi M Herrick
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tyler Hartman
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kristen Glass
- Department of Pediatrics, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Stephen D DeMeo
- Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Rebecca Shay
- Department of Pediatrics, Division of Neonatology, University of Colorado, Aurora, Colorado, USA
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Unrau
- Newborn Critical Care, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Quebec, Canada
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Godoi A, Casteleyn C, Virk F, McDade-Kumar M, Byrne MHV, Moussa A, Baptiste P, Tombs M. Construction and validation of a medical career readiness inventory. Clin Teach 2024:e13733. [PMID: 38233580 DOI: 10.1111/tct.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/09/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. APPROACH We designed an instrument consisting of a series of 5-point Likert-scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. EVALUATION Exploratory Factor Analysis revealed that 16 of the 20-items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. IMPLICATIONS The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes.
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Affiliation(s)
- Amanda Godoi
- School of Medicine, Cardiff University, Cardiff, UK
| | | | - Farazi Virk
- Airedale NHS Foundation Trust, Yorkshire, UK
| | - Mia McDade-Kumar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew H V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ahmed Moussa
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | | | - Michal Tombs
- School of Medicine, Cardiff University, Cardiff, UK
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Chiasson CO, Pépin MA, Juneau AL, Moussa A. Standardization of Resuscitation Carts and Medication Trays in a Level III Neonatal Intensive Care Unit: A Quality Improvement Initiative. Can J Hosp Pharm 2024; 77:e3463. [PMID: 38204504 PMCID: PMC10754397 DOI: 10.4212/cjhp.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/11/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Charles-Olivier Chiasson
- , PharmD, MSc, is with the Department of Pharmacy, CHU Sainte-Justine and Université de Montréal, Montréal, Québec
| | - Marie-Anne Pépin
- , PharmD, MSc, is with the Department of Pharmacy, CHU Sainte-Justine and Université de Montréal, Montréal, Québec
| | - Audrey Larone Juneau
- , RN, MSc, is with the Division of Neonatology, CHU Sainte-Justine and Université de Montréal, Montréal, Québec
| | - Ahmed Moussa
- , MD, MMEd, is with the Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, and the CHU Sainte-Justine Research Centre, Montréal, Québec
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Ettetuani B, Chahboune R, Moussa A. Adjustment of p-value expression to ontology using machine learning for genetic prediction, prioritization, interaction, and its validation in glomerular disease. Front Genet 2023; 14:1215232. [PMID: 37900183 PMCID: PMC10603191 DOI: 10.3389/fgene.2023.1215232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/28/2023] [Indexed: 10/31/2023] Open
Abstract
The results of gene expression analysis based on p-value can be extracted and sorted by their absolute statistical significance and then applied to multiple similarity scores of their gene ontology (GO) terms to promote the combination and adjustment of these scores as essential predictive tasks for understanding biological/clinical pathways. The latter allows the possibility to assess whether certain aspects of gene function may be associated with other varieties of genes, to evaluate regulation, and to link them into networks that prioritize candidate genes for classification by applying machine learning techniques. We then detect significant genetic interactions based on our algorithm to validate the results. Finally, based on specifically selected tissues according to their normalized gene expression and frequencies of occurrence from their different biological and clinical inputs, a reported classification of genes under the subject category has validated the abstract (glomerular diseases) as a case study.
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Affiliation(s)
- Boutaina Ettetuani
- Systems and Data Engineering Team, National School of Applied Sciences, Abdelmalek Essaadi University, Tétouan, Morocco
| | - Rajaa Chahboune
- Life and Health Sciences Team, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tétouan, Morocco
| | - Ahmed Moussa
- Systems and Data Engineering Team, National School of Applied Sciences, Abdelmalek Essaadi University, Tétouan, Morocco
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Gizicki E, Assaad MA, Massé É, Bélanger S, Olivier F, Moussa A. Just-In-Time Neonatal Endotracheal Intubation Simulation Training: A Randomized Controlled Trial. J Pediatr 2023; 261:113576. [PMID: 37353151 DOI: 10.1016/j.jpeds.2023.113576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/09/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To assess if simulation-based just-in-time training (JITT, short video and simulation) is superior to video training (5-minute video) in acquiring skill in neonatal endotracheal intubation (ETI). STUDY DESIGN A Canadian multicenter randomized trial recruited junior residents who performed neonatal ETI from July 2017 to June 2021. The primary outcomes were overall and first attempt ETI success rate. Secondary outcomes included number of attempts, duration of attempts, ETI-related complications, and residents' confidence level. Statistical analysis included generalized estimating equations, mixed model analysis, Mann-Whitney test, and χ² tests. RESULTS Sixty-five residents performed 139 ETI. The overall success rate was similar for both groups (67% vs 70%, P = .71). However, the first attempt success rate was higher for the simulation-based JITT group (54% vs 41%, P = .035). The mean duration of attempts was shorter (35 [SD, 9] vs 62 [SD, 9] seconds, P = .048) and the median number of attempts had a tendency to be lower for the simulation-based JITT group (1 [IQR, 1; 1] vs 1 [IQR, 1; 2], P = .02). There were more mucosal trauma events in the simulation-based JITT group (P = .02). Residents in both groups reported similar confidence level in performing ETI. CONCLUSIONS Compared with video training, simulation-based JITT for neonatal ETI did not improve overall success rate. However, simulation-based JITT improved first attempt success rate and decreased the number and the duration of ETI attempts. With its positive clinical impact, simulation-based JITT can become an educational adjunct to neonatal ETI training for residents. TRIAL REGISTRATION ClinicalTrials.gov: NCT02809924.
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Affiliation(s)
- Ewa Gizicki
- Division of Neonatology, Department of Pediatrics, Royal Columbian Hospital, New Westminster, BC, Canada
| | - Michael-Andrew Assaad
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Centre for Applied Health Sciences Education (CPASS), Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Édith Massé
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sherbooke, Sherbrooke, QC, Canada
| | - Sylvie Bélanger
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Laval, Quebec, QC, Canada
| | - François Olivier
- Division of Neonatology, Department of Pediatrics, Centre Universitaire de santé McGill, Montreal, QC, Canada
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Centre for Applied Health Sciences Education (CPASS), Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada.
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Mahfouz W, Moussa A, Serati M, Balzarro M, Rubilotta E, Gubbiotti M. Linguistic translation and validation of the Arabic version of International Female Coital Incontinence Questionnaire (IFCI-Q). Arab J Urol 2023; 22:48-53. [PMID: 38205389 PMCID: PMC10776051 DOI: 10.1080/2090598x.2023.2242162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/25/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Aim of the study was to translate the International Female Coital Incontinence Questionnaire (IFCI-Q) into Arabic (Egyptian) and validate it into among Egyptian population complaining of coital urinary incontinence (CI). Methods Original questionnaire has been translated and back-translated by an expert panel, to produce the Arabic version. A pilot study was performed to make sure the questionnaire was understandable. Sixty patients included in the study were divided into two groups: Group A comprised patients with CI, and Group B comprised females who attended the urology clinic for other complaints, without CI. Reliability of the Arabic IFCI-Q was evaluated for internal consistency using Cronbach alpha coefficient. Test-retest reliability was determined using the Weighted Cohen's k-test. Discrimination validity was evaluated by comparing scores of patients with those of healthy females not complaining of CI using Mann-Whitney test. Results 83.3% of women of both groups (mean age: 43.1 ± 10.6 yrs [Group A], 38.9 ± 8 [Group B] yrs) reported OAB symptoms, 73.3% had stress urinary incontinence and 46.7% reported mixed urinary incontinence. Regarding Group A, 10 patients had CI during penetration, 12 during orgasm and 8 had both forms of CI. The comparison of the responses between Group A and Group B demonstrated a statistically difference (p < 0.00). The content validity was assessed by a panel of expert functional urologists. The Cronbach's alpha coefficients for the total score were high (0.9-1), indicating high internal consistency. The difference between the two groups revealed an internal consistency of IFCI-Q of 0.563-0.851. The test-retest procedure revealed that the k-values of each item are very good. Conclusions The Arabic version will allow utilizing this tool in a large population of Arabic-speaking countries, with different ethnic and demographic backgrounds.
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Affiliation(s)
- Wally Mahfouz
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Mahfouz W, Eid AA, Elbadry M, Elkhiat A, Moussa A, Assem A. Transobturator Tension-Free Vaginal Flap Operation versus Synthetic Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A Prospective Randomized Study. Urol Int 2023; 107:785-791. [PMID: 37499640 DOI: 10.1159/000529808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Synthetic mid-urethral slings (MUSs) are the gold standard treatment for female stress urinary incontinence (SUI). Recently, there have been reports of serious adverse events with synthetic tapes such as urethral erosion, vaginal erosion, and mesh infection. Tension-free vaginal flap (TVF) operation has been proven to be successful as a natural alternative to synthetic slings. We propose our novel technique, the transobturator tension-free vaginal flap (TO-TVF), utilizing native vaginal tissue and being suspended via transobturator route. METHODS This prospective study was conducted on 72 female patients with SUI, presenting at Alexandria University Hospital. Patients were randomized into 2 groups, group 1: 37 patients subjected to TO-TVF and group 2: 35 patients to conventional transobturator tape (TOT). In TO-TVF, a rectangular vaginal wall flap is created. A polypropylene monofilament mesh is sutured to each edge of the vaginal flap. This is inserted like conventional outside-in TOT. Patients were subjected to PGI and UDI-6 questionnaires and urodynamic study before and 6 months postoperatively. RESULTS Both groups showed comparable and significant improvements in questionnaires. Mean operative time for TO-TVF and conventional TOT was 26.31 ± 5.2 min and 21.8 ± 3.1 min, respectively. Cure rate was 89% in group 1 and 91.4% in group 2, which was not statistically significant. No significant intraoperative complications were encountered. We had no cases of vaginal or urethral erosion in both groups. CONCLUSIONS TO-TVF is a cost-effective, feasible, safe, and effective surgical alternative to synthetic MUS. Synthetic mesh tissue anchoring properties are maintained for better adjustment of tension. However, long-term follow-up on a large cohort of patients is still needed.
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Affiliation(s)
- Wally Mahfouz
- Urology department, Alexandria University, Alexandria, Egypt
| | | | | | | | - Ahmed Moussa
- Urology department, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Urology department, Alexandria University, Alexandria, Egypt
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Abstract
OBJECTIVE The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). STUDY DESIGN This was a cross-sectional survey. RESULTS The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. CONCLUSION This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. KEY POINTS · Lack of training for laryngeal mask airway use in neonatal resuscitation.. · Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device.. · Neonatal health care professionals lack confidence and skill with the laryngeal mask airway..
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Affiliation(s)
- Beverley Robin
- Department of Pediatrics, Rush University Medical Center; Chicago, Illinois
| | - Lamia M Soghier
- Department of Neonatology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences; Washington, District of Columbia
| | | | - Ahmed Moussa
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
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Zhao K, Ziv E, Alexander E, Sotirchos V, Moussa A, Marinelli B, Erinjeri J, Sofocleous C, Harding J, Sigel C, Yarmohammadi H. Abstract No. 556 Genetic Alterations in Intrahepatic Cholangiocarcinoma and Response to Yttrium-90 Transarterial Radioembolization: A Case Series Exploring High Risk Genomics. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Haghani L, Zhan C, Yarmohammadi H, Ziv E, Cornelis F, Aguirre AG, Moussa A, Santos E, Shoushtari A, Erinjeri J. Abstract No. 134 Factors Associated with Improved Overall Survival for Patients Undergoing Embolization of Metastatic Melanoma. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Holder T, Hooper FSW, Yates D, Tse Z, Patil S, Moussa A, Batten L, Radhakrishnan V, Allison M, Hewitt C, Keding A, Forshaw G, Jayagopal V. Clinical accuracy of infrared temperature measurement devices: a comparison against non-invasive core-body temperature. Clin Med (Lond) 2023; 23:157-163. [PMID: 38614547 DOI: 10.7861/clinmed.2022-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
During the coronavirus 2019 (COVID-19) pandemic, the implementation of non-contact infrared thermometry (NCIT) became an increasingly popular method of screening body temperature. However, data on the accuracy of these devices and the standardisation of their use are limited. In the current study, the body temperature of non-febrile volunteers was measured using infrared (IR) thermography, IR tympanic thermometry and IR gun thermometry at different facial feature locations and distances and compared with SpotOn core-body temperature. Poor agreement was found between all IR devices and SpotOn measurements (intra-class correlation coefficient <0.8). Bland-Alman analysis showed the narrowest limits of agreement with the IR gun at 3 cm from the forehead (bias = 0.19°C, limits of agreement (LOA): -0.58°C to 0.97°C) and widest with the IR gun at the nose (bias = 1.40°C, LOA: -1.15°C to 3.94°C). Thus, our findings challenge the established use of IR thermometry devices within hospital settings without adequate standard operating procedures to reduce operator error.
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Affiliation(s)
- Thomas Holder
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | | | - David Yates
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | - Zion Tse
- Medical Robotics Lab, University of York, York, UK.
| | | | - Ahmed Moussa
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | - Lucy Batten
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | | | | | | | | | - Greg Forshaw
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Vijay Jayagopal
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
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Attalla A, Attalla O, Moussa A, Shafique D, Raean SB, Hegazy T. Construction robotics: review of intelligent features. Int J Intell Robot Appl 2023. [DOI: 10.1007/s41315-023-00275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Gariépy-Assal L, Janaillac M, Ethier G, Pennaforte T, Lachance C, Barrington KJ, Moussa A. A tiny baby intubation team improves endotracheal intubation success rate but decreases residents' training opportunities. J Perinatol 2023; 43:215-219. [PMID: 36309565 DOI: 10.1038/s41372-022-01546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the educational and clinical impact of a tiny baby intubation team (TBIT). STUDY DESIGN Retrospective study comparing endotracheal intubation (ETI) performed: pre-implementation of a TBIT (T1), 6 months post-implementation (T2), and 4 years post-implementation (T3). RESULTS Post-implementation (T2), first-attempt success rate in tiny babies increased (44% T1; 59% T2, p = 0.04; 56% T3, p = NS) and the proportion of ETIs performed by residents decreased (53% T1; 37% T2, p = 0.001; 45% T3, p = NS). After an educational quality improvement intervention (prioritizing non-tiny baby ETIs to residents, systematic simulation training and ETI using videolaryngoscopy), in T3 residents' overall (67% T1; 60% T2, p = NS; 79% T3, p = 0.02) and non-tiny baby ETI success rate improved (72% T1; 60% T2, p = NS; 82% T3, p = 0.02). CONCLUSION A TBIT improves success rate of ETIs in ELBW infants but decreases educational exposure of residents. Educational strategies may help maintain resident procedural competency without impacting on quality of care.
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Affiliation(s)
- L Gariépy-Assal
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - M Janaillac
- Service de néonatologie, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - G Ethier
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada
| | - T Pennaforte
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - C Lachance
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada
| | - K J Barrington
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada.,CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada
| | - A Moussa
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montreal, Montréal, QC, Canada. .,CHU Sainte-Justine Research Center, Université de Montréal, Montréal, QC, Canada. .,Centre de pédagogie appliquée aux sciences de la santé, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Zoeir A, Moussa A, Mamdouh H, Gameel T, Ragab M, Abo El-Enien M, Eissa A. Which is easier for beginners: Supine or prone position percutaneous nephrolithotomy? Assessment of the learning curve in novice urologists. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00971-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Yacoub A, Ayadi A, Ayed W, Ayari S, Chebbi S, Magroun I, Ben Afia L, Mersni M, Mechergui N, Brahim D, Ben Said H, Bahri G, Youssef I, Ladhari N, Mziou N, Grassa A, M'rad M, Khessairi N, Krir A, Chihaoui M, Mahjoub S, Bahlous A, Jridi M, Cherif Y, Derbal S, Chebbi D, Hentati O, Ben Dahmen F, Abdallah M, Hamdi I, Sahli F, Ouerdani Y, Mnekbi Y, Abaza H, Ajmi M, Guedria A, Randaline A, Ben Abid H, Gaddour N, Maatouk A, Zemni I, Gara A, Kacem M, Maatouk I, Ben Fredj M, Abroug H, Ben Nasrallah C, Dhouib W, Bouanene I, Sriha A, Mahmoudi M, Gharbi G, Khsiba A, Azouz M, Ben Mohamed A, Yakoubi M, Medhioub M, Hamzaoui L, Azouz M, Ben Attig Y, Hamdi S, Essid R, Ben Jemia E, Rezgui B, Boudaya MS, Hassine H, Dabbabi H, Fradi Y, Cherif D, Lassoued I, Yacoub H, Kchir H, Maamouri N, Khairi W, Ben Ammar H, Abaza H, Chelbi E, Merhaben S, Neffati W, Ajmi M, Tarchalla S, Boughzala S, Gazzeh M, Gara S, Labidi A, Touati H, Nefzi AM, Ben Mustpha N, Fekih M, Serghini M, Boubaker J, Zouiten L, Driss A, Meddeb N, Driss I, Walha S, Ben Said H, Bel Hadj Mabrouk E, Zaimi Y, Mensi A, Trad N, Ayadi S, Said Y, Mouelhi L, Dabbèche R, Belfkih H, Bani M, Moussa A, Souissi S, Trabelsi Werchfeni B, Chelly S, Ezzi O, Ammar A, Besbes M, Njah M, Mahjoub M, Ghali H, Neffati A, Bhiri S, Bannour R, Ayadi S, Khouya FE, Kamel A, Hariz E, Aidani S, Kefacha S, Ben Cheikh A, Said H, Dogui S, Atig A, Gara A, Ezzar S, Ben Fradj M, Bouanène I, M'kadmi H, Farhati M, Dakhli N, Nalouti K, Chanoufi MB, Abouda SH, Louati C, Zaaimi Y, Dabbeche R, Hermi A, Saadi A, Mokaddem S, Boussaffa H, Bellali M, Zaghbib S, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Ben Slama R, Gannoun N, Kacem I, Tlili G, Kahloul M, Belhadj Chabbah N, Douma F, Bouhoula M, Chouchene A, Aloui A, Maoua M, Brahem A, Kalboussi H, El Maalel O, Chatti S, Jaidane M, Naija W, Mrizek N, Sellami I, Feki A, Hrairi A, Kotti N, Baklouti S, Jmal Hammami K, Masmoudi ML, Hajjaji M, Naaroura A, Ben Amar J, Ouertani H, Ben Moussa O, Zaibi H, Aouina H, Ben Jemaa S, Gassara Z, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Kallel H, Ayari M, Chehaider A, Souli F, Abdelaali I, Ziedi H, Boughzala C, Haouari W, Chelli M, Soltani M, Trabelsi H, Sahli H, Hamdaoui R, Masmoudi Y, Halouani A, Triki A, Ben Amor A, Makni C, Eloillaf M, Riahi S, Tlili R, Jmal L, Belhaj Ammar L, Nsibi S, Jmal A, Boukhzar R, Somai M, Daoud F, Rachdi I, Ben Dhaou B, Aydi Z, Boussema F, Frikha H, Hammami R, Ben Cheikh S, Chourabi S, Bokri E, Elloumi D, Hasni N, Hamza S, Berriche O, Dalhoum M, Jamoussi H, Kallel L, Mtira A, Sghaier Z, Ghezal MA, Fitouri S, Rhimi S, Omri N, Rouiss S, Soua A, Ben Slimene D, Mjendel I, Ferchichi I, Zmerli R, Belhadj Mabrouk E, Debbeche R, Makhloufi M, Chouchane A, Sridi C, Chelly F, Gaddour A, Kacem I, Chatti S, Mrizak N, Elloumi H, Debbabi H, Ben Azouz S, Marouani R, Cheikh I, Ben Said M, Kallel M, Amdouni A, Rejaibi N, Aouadi L, Zaouche K, Khouya FE, Aidani S, Khefacha S, Jelleli N, Sakly A, Zakhama W, Binous MY, Ben Said H, Bouallegue E, Jemmali S, Abcha S, Wahab H, Hmida A, Mabrouk I, Mabrouk M, Elleuch M, Mrad M, Ben Safta N, Medhioub A, Ghanem M, Boughoula K, Ben Slimane B, Ben Abdallah H, Bouali R, Bizid S, Abdelli MN, Ben Nejma Y, Bellakhal S, Antit S, Bourguiba R, Zakhama L, Douggui MH, Bahloul E, Dhouib F, Turki H, Sabbah M, Baghdadi S, Trad D, Bellil N, Bibani N, Elloumi H, Gargouri D, Ben Said M, Hamdaoui R, Chokri R, Kacem M, Ben Rejeb M, Miladi A, Kooli J, Touati S, Trabelsi S, Klila M, Rejeb H, Kammoun H, Akrout I, Greb D, Ben Abdelghaffar H, Hassene H, Fekih L, Smadhi H, Megdiche MA, Ksouri J, Kasdalli H, Hayder A, Gattoussi M, Chérif L, Ben Saida F, Gueldich M, Ben Jemaa H, Dammak A, Frikha I, Saidani A, Ben Amar J, Aissi W, Chatti AB, Naceur I, Ben Achour T, Said F, Khanfir M, Lamloum M, Ben Ghorbel I, Houman M, Cherif T, Ben Mansour A, Daghfous H, Slim A, Ben Saad S, Tritar F, Naffeti W, Abdellatif J, Ben Fredj M, Selmi M, Kbir GH, Maatouk M, Jedidi L, Taamallah F, Ben Moussa M, Halouani L, Rejeb S, Khalffalah N, Ben Ammar J, Hedhli S, Azouz MM, Chatti S, Athimni Z, Bouhoula M, Elmaalel O, Mrizak N, Maalej M, Kammoun R, Gargouri F, Sallemi S, Haddar A, Masmoudi K, Oussaifi A, Sahli A, Bhouri M, Hmaissi R, Friha M, Cherif H, Baya C, Triki M, Yangui F, Charfi MR, Ben Hamida HY, Karoui S, Aouini F, Hajlaoui A, Jlassi H, Sabbah M, Fendri MN, Kammoun N, Fehri S, Nouagui H, Harzalli A, Snène H, Belakhal S, Ben Hassine L, Labbene I, Jouini M, Kalboussi S, Ayedi Y, Harizi C, Skhiri A, Fakhfakh R, Jelleli B, Belkahla A, Fejjeri M, Zeddini M, Mahjoub S, Nouira M, Frih N, Debiche S, Blibech H, Belhaj S, Mehiri N, Ben Salah N, Louzir B, Kooli J, Bahri R, Chaka A, Abdenneji S, Majdoub Fehri S, Hammadi J, Dorgham D, Hriz N, Kwas H, Issaoui N, Jaafoura S, Bellali H, Shimi M, Belhaj Mabrouk E, Sellami R, Ketata I, Medi W, Mahjoub M, Ben Yacoub S, Ben Chaabene A, Touil E, Ben Ayed H, Ben Miled S, El Zine E, Khouni H, Ben Kadhi S, Maatoug J, Boulma R, Rezgui R, Boudokhane M, Jomni T, Chamekh S, Aissa S, Touhiri E, Jlaiel N, Oueslati B, Maaroufi N, Aouadi S, Belkhir S, Daghfous H, Merhaben S, Dhaouadi N, Ounaes Y, Chaker K, Yaich S, Marrak M, Bibi M, Mrad Dali K, Sellami A, Nouira Y, Sellami S, Anane I, Trabelsi H, Ennaifer R, Benzarti Z, Bouchabou B, Hemdani N, Nakhli A, Cherif Y, Abdelkef M, Derbel K, Barkous B, Yahiaoui A, Sayhi A, Guezguez F, Rouatbi S, Racil H, Ksouri C, Znegui T, Maazaoui S, Touil A, Habibech S, Chaouech N, Ben Hmid O, Ismail S, Chouaieb H, Chatti M, Guediri N, Belhadj Mohamed M, Bennasrallah C, Bouzid Y, Zaouali F, Toumia M, El Khemiri N, El Khemiri A, Sfar H, Farhati S, Ben Chehida F, Yamoun R, Braham N, Hamdi Y, Ben Mansour A, Mtir M, Ayari M, Toumia M, Rouis S, Sakly H, Nakhli R, Ben Garouia H, Chebil D, Hannachi H, Merzougui L, Samet S, Hrairi A, Mnif I, Hentati O, Bouzgarrou L, Souissi D, Boujdaria R, Kadoussi R, Rejeb H, Ben Limem I, Ben Salah I, Greb D, Ben Abdelghaffar H, Smadhi H, Laatiri H, Manoubi SA, Gharbaoui M, Hmandi O, Zhioua M, Taboubi F, Hamza Y, Hannach W, Jaziri H, Gharbi R, Hammami A, Dahmani W, Ben Ameur W, Ksiaa M, Ben Slama A, Brahem A, Elleuch N, Jmaa A, Kort I, Jlass S, Benabderrahim S, Turki E, Belhaj A, Kebsi D, Ben Khelil M, Rmadi N, Gamaoun H, Alaya Youzbechi F, Brahim T, Boujnah S, Abid N, Gader N, Kalboussi S, Ben Sassi S, Loukil M, Ghrairi H, Ben Said N, Mrad O, Ferjaoui M, Hedhli L, Ben Kaab B, Berriche A, Charfi R, Mourali O, Smichi I, Bel Haj Kacem L, Ksentini M, Aloui R, Ferchichi L, Nasraoui H, Maoua M, Chérif F, Belil Y, Ayed MA, Alloulou Y, Belhadj S, Daghfous J, Mehiri N, Louzir B, Abbes A, Ghrab A, Chermiti A, Akacha A, Mejri O, Debbiche A, Yahiaoui C, Binous M, Tissaoui A, Mekni K, El Fekih C, Said MA, Chtioui S, Mestiri S, Smaoui H, Ben Hamida S, Haddar A, Mrizek N, Gares N, Zaibi A, Bouazizi N, Gallas S, Lachhab A, Belhadj M, Hadj Salem N, Garrouch A, Mezgar Z, Khrouf M, Abbassi H, Souissi D, Hamra I, Ben Mustapha N, Abessi I, Boubaker F, Bouchareb S, ElOmma Mrabet H, Touil I, Boussoffara L, Knani J, Boudawara N, Alaya W, Sfar MH, Fekih S, Snène H, Boudawara N, Gargouri I, Benzarti W, Knaz A, Abdelghani A, Aissa S, Hayouni A, Mejri I, Kacem M, Mhamdi S, Daboussi S, Aichaouia C, Moatemri Z, Chaachou A, Fsili R, Ben Ghezala H, Ben Jazia A, Brahmi N. 2022 TUNISIAN NATIONAL CONGRESS OF MEDICINE ABSTRACTS. Tunis Med 2023; 101:62-64. [PMID: 37682263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 09/09/2023]
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Benamri I, Azzouzi M, Moussa A, Radouani F. An in silico analysis of rpoB mutations to affect Chlamydia trachomatis sensitivity to rifamycin. J Genet Eng Biotechnol 2022; 20:146. [DOI: 10.1186/s43141-022-00428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Chlamydia trachomatis is an obligate intracellular gram-negative pathogen, responsible for diverse affections, mainly trachoma and sexually transmitted diseases. Antibiotics are the commonly used drugs to tackle chlamydiae infections. However, when overused or wrongly used this may lead to strains’ resistance to antibiotics, this phenomenon represents a real health problem worldwide. Numerous studies showed the association of Chlamydia trachomatis resistance with mutations in different genes; these mutations could have a deleterious or neutral impacts on the encoded proteins. The aim of this study is to perform an in silico analysis of C. trachomatis rpoB-encoded proteins using numerous bioinformatics tools and to identify the functional and structural-related effects of the mutations and consequently their impact on the bacteria sensitivity to antibiotics.
Results
The analysis revealed that the prediction of the damaging impact related to the mutations in rpoB-encoded proteins showed eight mutations: V136F, Q458K, V466A, A467T, H471N, H471Y, H471L, and I517M with big deleterious effects. Among them, six mutations, V136F, Q458K, V466A, A467T, H471N, and I517M, are located in a highly conserved regions decreasing the protein’s stability. Furthermore, the structures analysis showed that the mutations A467T, H471N, I517M, and V136F models had a high deviation compared to the wild type. Moreover, the prediction of protein-protein network indicated that rpoB wild type interacts strongly with 10 proteins of C. trachomatis, which are playing different roles at different levels.
Conclusion
As conclusion, the present study revealed that the changes observed in the encoded proteins can affect their functions and structures, in addition to their interactions with other proteins which impact the bacteria sensitivity to antibiotics. Consequently, the information revealed through this in silico analysis would be useful for deeper exploration to understand the mechanisms of C. trachomatis resistance and enable managing the infection to avoid its complications. We recommend further investigations and perform deeper experimental analysis with collaboration between bioinformaticians, physicians, biologists, pharmacists, and chemistry and biochemistry scientists.
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Fahmy A, Mahfouz W, Elbadry M, Moussa A. Single step track dilatation for percutaneous nephrolithotomy in children. Int Urol Nephrol 2022; 54:2789-2795. [PMID: 35941301 PMCID: PMC9534808 DOI: 10.1007/s11255-022-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Introduction and objectives Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL. Methods Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications’ rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups. Results A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation. Conclusions Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time.
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Affiliation(s)
- Ahmed Fahmy
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Urology Department, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
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Hughes SF, Moyes AJ, Jones K, Bell C, Duckett A, Moussa A, Shergill I. Pre- and peri-operative clinical information, physiological observations and outcome measures following flexible ureterorenoscopy (FURS), for the treatment of kidney stones. A single-centre observational clinical pilot-study in 51 patients. BMC Urol 2022; 22:104. [PMID: 35836212 PMCID: PMC9284693 DOI: 10.1186/s12894-022-01053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Kidney stone disease contributes to a significant proportion of routine urological practice and remains a common cause of worldwide morbidity. The main aim of this clinical-pilot study was to investigate the effect of flexible ureterorenoscopy (FURS) on pre- and peri-operative clinical information, physiological observations and outcome measures. METHODS Included were 51 patients (31 males, 20 females), who underwent elective FURS, for the treatment of kidney stones. Pre-operative and peri-operative clinical information, and post-operative physiological observations and outcome measures were collected using a standard case report form. Pre-operative clinical information included age, gender, BMI, previous history of stone formation and hypertension. Pre-operative stone information included the size (mm), Hounsfield units (HU), laterality and intra-renal anatomical location. Peri-operative surgical details included surgical time in minutes; Laser use; Duration and energy of laser; and post-operative stenting. The physiological outcomes measured included systolic and diastolic blood pressure (mmHg), Likert pain score, temperature, heart rate (bpm) and respiration rate (bpm). Following initial descriptive analysis, a series of Pearson's correlation coefficient tests were performed to investigate the relationship between surgical factors other variable factors. RESULTS A series of significant, positive correlations were observed between; age and surgical time (p = 0.014, r = 0.373); stone size and Hounsfield unit (p = 0.029, r = 0.406); surgical time and duration of laser (p < 0.001, r = 0.702); surgical time and BMI (p = 0.035, r = 0.322); baseline heart rate and Hounsfield unit (p = 0.026, r = - 0.414); base line heart rate and BMI (p = 0.030, r = 0.307).; heart rate at 120-min post FURS and age (p = 0.038, r = - 0.308); baseline pain score and BMI (p = 0.010, r = 0.361); baseline respiration rate and BMI (p = 0.037, r = 0.296); respiration rate at 240-min post FURS and BMI (p = 0.038, r = 0.329); respiration rate at 120 min post FURS and age (p = 0.022, r = - 0.330). Four patients developed post-operative complications (3-UTIs with urinary retention, 1-urosepsis). CONCLUSIONS We report that following FURS there is an association between various physiological, clinical and surgical parameters. Although these correlations are weak, they warrant further investigation as these may be linked with untoward complications, such as infection that can occur following FURS. This data, however, will need to be validated and reproduced in larger multi-centre studies.
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Affiliation(s)
- Stephen Fôn Hughes
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK.
| | - Alyson Jayne Moyes
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- School of Medical Sciences, Bangor University, Bangor, Wales, UK
- Department of Biological Sciences, University of Chester, Chester, UK
| | - Kevin Jones
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK
- Impact Medical, Aintree Racecourse Retail & Business Park, Liverpool, UK
| | - Christopher Bell
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK
- The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Abigail Duckett
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK
- The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Ahmed Moussa
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK
- The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Iqbal Shergill
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
- Maelor Academic Unit of Medical & Surgical Sciences (MAUMSS), Betsi Cadwaladr University Health Board (BCUHB), Wrexham Maelor Hospital, Wrexham, Wales, UK
- Impact Medical, Aintree Racecourse Retail & Business Park, Liverpool, UK
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Aly A, Moussa A, Maybody M, Youssef E, Gonzalez A, Santos E. Abstract No. 549 Intranodal lymphangiography and embolization for management of iatrogenic chylous ascites after oncological surgery. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Thibault LP, Bourque CJ, Luu TM, Huot C, Cardinal G, Carriere B, Dupont-Thibodeau A, Moussa A. Residents as Research Subjects: Balancing Resident Education and Contribution to Advancing Educational Innovations. J Grad Med Educ 2022; 14:191-200. [PMID: 35463172 PMCID: PMC9017267 DOI: 10.4300/jgme-d-21-00530.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Research in education advances knowledge and improves learning, but the literature does not define how to protect residents' rights as subjects in studies or how to limit the impact of their participation on their clinical training. OBJECTIVE We aimed to develop a consensual framework on how to include residents as participants in education research, with the dual goal of protecting their rights and promoting their contributions to research. METHODS A nominal group technique approach was used to structure 3 iterative meetings held with the pre-existing residency training program committee and 7 invited experts between September 2018 and April 2019. Thematic text analysis was conducted to prepare a final report, including recommendations. RESULTS Five themes, each with recommendations, were identified: (1) Freedom of participation: participation, non-participation, or withdrawal from a study should not interfere with teacher-learner relationship (recommendation: improve recruitment and consent forms); (2) Avoidance of over-solicitation (recommendation: limit the number of ongoing studies); (3) Management of time dedicated to participation in research (recommendations: schedule and proportion of time for study participation); (4) Emotional safety (recommendation: requirement for debriefing and confidential counseling); and (5) Educational safety: data collected during a study should not influence clinical assessment of the resident (recommendation: principal investigator should not be involved in the evaluation process of learners in clinical rotation). CONCLUSIONS Our nominal group technique approach resulted in raising 5 specific issues about freedom of participation of residents in research in medical education, over-solicitation, time dedicated to research, emotional safety, and educational safety.
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Affiliation(s)
- Louis-Philippe Thibault
- Louis-Philippe Thibault, MD, BBA, is a Student, Master's in Medical Education Program, Harvard Medical School, and a Pediatrician, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Claude Julie Bourque, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, Centre for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal, Quebec, Canada
| | - Thuy Mai Luu
- Thuy Mai Luu, MD, MSc, is an Associate Clinical Professor, Department of Pediatrics, and Clinician-Scientist, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Celine Huot
- Celine Huot, MD, MSc, is a Full Clinical Professor and Researcher, Department of Pediatrics and CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Genevieve Cardinal
- Genevieve Cardinal, LLM, is Chair of the Research Ethics Board and Manager, Research Ethics Office, CHU Sainte-Justine
| | - Benoit Carriere
- Benoit Carriere, MD, MHPE, is an Associate Professor and the Director of Medical Education, CHU Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal
| | - Amelie Dupont-Thibodeau
- Amelie Dupont-Thibodeau, MD, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Ahmed Moussa
- Ahmed Moussa, MD, MMEd, is an Associate Professor, Department of Pediatrics, a Clinician-Scientist, CHU Sainte-Justine Research Center, and Director, Center for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal
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22
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Moussa A, Kazmi A, Bokhari L, Sinclair RD. Reply to: Comment on "Bicalutamide improves minoxidil induced hypertrichosis in female pattern hair loss: a retrospective review of 35 patients". J Am Acad Dermatol 2022; 87:e31-e32. [PMID: 35304166 DOI: 10.1016/j.jaad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- A Moussa
- Sinclair Dermatology, Melbourne, Victoria, Australia.
| | - A Kazmi
- Sinclair Dermatology, Melbourne, Victoria, Australia
| | - L Bokhari
- Sinclair Dermatology, Melbourne, Victoria, Australia
| | - R D Sinclair
- Sinclair Dermatology, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
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23
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Abi‐Rafeh J, Asgari M, Troka I, Canaff L, Moussa A, Pasini D, Goltzman D. Genetic deletion of menin in mouse mesenchymal stem cells: an experimental and computational analysis. JBMR Plus 2022; 6:e10622. [PMID: 35509630 PMCID: PMC9059475 DOI: 10.1002/jbm4.10622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/17/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Loss‐of‐function mutations in the MEN1 tumor‐suppressor gene cause the multiple endocrine neoplasia type 1 syndrome. Menin, the MEN1 gene product, is expressed in many tissues, including bone, where its function remains elusive. We conditionally inactivated menin in mesenchymal stem cells (MSCs) using paired‐related homeobox 1 (Prx1)‐Cre and compared resultant skeletal phenotypes of Prx1‐Cre;Men1f/f menin‐knockout mice (KO) and wild‐type controls using in vivo and in vitro experimental approaches and mechanics simulation. Dual‐energy X‐ray absorptiometry demonstrated significantly reduced bone mineral density, and 3‐dimensional micro‐CT imaging revealed a decrease in trabecular bone volume, altered trabecular structure, and an increase in trabecular separation in KO mice at 6 and 9 months of age. Numbers of osteoblasts were unaltered, and dynamic histomorphometry demonstrated unaltered bone formation; however, osteoclast number and activity and receptor activator of NF‐κB ligand/osteoprotegerin (RANKL/OPG) mRNA profiles were increased, supporting increased osteoclastogenesis and bone resorption. In vitro, proliferative capabilities of bone marrow stem cells and differentiation of osteoblasts and mineralization were unaltered; however, osteoclast generation was increased. Gross femur geometrical alterations observed included significant reductions in length and in mid‐metaphyseal cross‐sectional area. Atomic force microscopy demonstrated significant decreases in elasticity of both cortical and trabecular bone at the nanoscale, whereas three‐point bending tests demonstrated a 30% reduction in bone stiffness; finite element analysis showed morphological changes of the femur microgeometry and a significantly diminished femur flexural rigidity. The biomechanical results demonstrated the detrimental outcome of the accelerated osteoclastic bone resorption. Our studies have a twofold implication; first, MEN1 deletion from MSCs can negatively regulate bone mass and bone biomechanics, and second, the experimental and computational biomechanical analyses employed in the present study should be applicable for improved phenotypic characterization of murine bone. Furthermore, our findings of critical menin function in bone may underpin the more severe skeletal phenotype found in hyperparathyroidism associated with loss‐of‐function of the MEN1 gene. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jad Abi‐Rafeh
- Department of Medicine McGill University and McGill University Health Centre Montreal Quebec Canada
| | - Meisam Asgari
- Department of Mechanical Engineering McGill University, 817 Sherbrooke Street West Montreal QC Canada
- Theoretical and Applied Mechanics Program School of Engineering and Applied Science, Northwestern University, 2145 Sheridan Road Evanston IL USA
| | - Ildi Troka
- Department of Medicine McGill University and McGill University Health Centre Montreal Quebec Canada
| | - Lucie Canaff
- Department of Medicine McGill University and McGill University Health Centre Montreal Quebec Canada
| | - Ahmed Moussa
- Department of Mechanical Engineering McGill University, 817 Sherbrooke Street West Montreal QC Canada
| | - Damiano Pasini
- Department of Mechanical Engineering McGill University, 817 Sherbrooke Street West Montreal QC Canada
| | - David Goltzman
- Department of Medicine McGill University and McGill University Health Centre Montreal Quebec Canada
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24
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Moussa A, Sawyer T, Puia-Dumitrescu M, Foglia EE, Ades A, Napolitano N, Glass KM, Johnston L, Jung P, Singh N, Quek BH, Barry J, Zenge J, DeMeo S, Mehrem AA, Nadkarni V, Nishisaki A. Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS. J Perinatol 2022; 42:1210-1215. [PMID: 35922664 PMCID: PMC9362392 DOI: 10.1038/s41372-022-01472-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We hypothesized that videolaryngoscope use for tracheal intubations would differ across NICUs, be associated with higher first attempt success and lower adverse events. STUDY DESIGN Data from the National Emergency Airway Registry for Neonates (01/2015 to 12/2017) included intubation with direct laryngoscope or videolaryngoscope. Primary outcome was first attempt success. Secondary outcomes were adverse tracheal intubation associated events and severe desaturation. RESULTS Of 2730 encounters (13 NICUs), 626 (23%) utilized a videolaryngoscope (3% to 64% per site). Videolaryngoscope use was associated with higher first attempt success (p < 0.001), lower adverse tracheal intubation associated events (p < 0.001), but no difference in severe desaturation. After adjustment, videolaryngoscope use was not associated with higher first attempt success (OR:1.18, p = 0.136), but was associated with lower tracheal intubation associated events (OR:0.45, p < 0.001). CONCLUSION Videolaryngoscope use is variable, not independently associated with higher first attempt success but associated with fewer tracheal intubation associated events.
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Affiliation(s)
- Ahmed Moussa
- Department of Pediatrics, Division of Neonatology, Université de Montréal, Montreal, Canada.
| | - Taylor Sawyer
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA USA
| | - Mihai Puia-Dumitrescu
- grid.34477.330000000122986657Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, WA USA
| | - Elizabeth E. Foglia
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Anne Ades
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Natalie Napolitano
- grid.239552.a0000 0001 0680 8770Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kristen M. Glass
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, Penn State College of Medicine, Hershey, PA USA
| | - Lindsay Johnston
- grid.47100.320000000419368710Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Philipp Jung
- grid.412468.d0000 0004 0646 2097Universitätsklinikum Schleswig-Holstein, Campus Luebeck, Lübeck, Germany
| | - Neetu Singh
- grid.413480.a0000 0004 0440 749XDepartment of Pediatrics, Dartmouth-Hitchcock Health System, Lebanon, NH USA
| | - Bin Huey Quek
- grid.414963.d0000 0000 8958 3388KK Women’s and Children’s Hospital, Singapore, Singapore
| | - James Barry
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | - Jeanne Zenge
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | - Stephen DeMeo
- grid.417002.00000 0004 0506 9656Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, NC USA
| | - Ayman Abou Mehrem
- grid.22072.350000 0004 1936 7697Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Vinay Nadkarni
- grid.239552.a0000 0001 0680 8770Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Akira Nishisaki
- grid.239552.a0000 0001 0680 8770Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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25
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Moussa A, Bokhari L, Sinclair RD. Systemic minoxidil as maintenance treatment in alopecia areata: a retrospective case series of 24 patients. Clin Exp Dermatol 2021; 47:753-755. [PMID: 34862632 DOI: 10.1111/ced.15051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A Moussa
- Sinclair Dermatology, East Melbourne, VIC, Australia
| | - L Bokhari
- Sinclair Dermatology, East Melbourne, VIC, Australia
| | - R D Sinclair
- Sinclair Dermatology, East Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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26
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El Hamli A, Bazza A, Moussa A, Hamal M, Zerfaoui M, Ouchrif M. Data and simulation studies on the influence of scintillation crystal dimensions on spectrometric parameters. Appl Radiat Isot 2021; 181:110053. [DOI: 10.1016/j.apradiso.2021.110053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/02/2022]
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27
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Deschênes MF, Charlin B, Phan V, Grégoire G, Riendeau T, Henri M, Fehlmann A, Moussa A. Educators and practitioners' perspectives in the development of a learning by concordance tool for medical clerkship in the context of the COVID pandemic. Can Med Educ J 2021; 12:43-54. [PMID: 35003430 PMCID: PMC8740256 DOI: 10.36834/cmej.72461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has forced medical schools to create educational material to palliate the anticipated and observed decrease in clinical experiences during clerkships. An online learning by concordance (LbC) tool was developed to overcome the limitation of students' experiences with clinical cases. However, knowledge about the instructional design of an LbC tool is scarce, especially the perspectives of collaborators involved in its design: 1- educators who wrote the vignettes' questions and 2- practitioners who constitute the reference panel by answering the LbC questions. The aim of this study was to describe the key elements that supported the pedagogical design of an LbC tool from the perspectives of educators and practitioners. METHODS A descriptive qualitative research design has been used. Online questionnaires were used, and descriptive analysis was conducted. RESULTS Six educators and 19 practitioners participated in the study. Important to the educators in designing the LbC tool were prevalent or high-stake situations, theoretical knowledge, professional situations experienced and perceived difficulties among students, and that the previous workshop promoted peer discussion and helped solidify the writing process. Important for practitioners was standards of practice and consensus among experts. However, they were uncertain of the educational value of their feedback, considering the ambiguity of the situations included in the LbC tool. CONCLUSIONS The LbC tool is a relatively new training tool in medical education. Further research is needed to refine our understanding of the design of such a tool and ensure its content validity to meet the pedagogical objectives of the clerkship.
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Affiliation(s)
- Marie-France Deschênes
- Centre d’innovation en formation infirmière (CIFI) – Center for Innovation in Nursing Education, Université de Montréal, Quebec, Canada
| | | | - Véronique Phan
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | | | - Tania Riendeau
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Margaret Henri
- Faculté de Médecine, Université de Montréal, Quebec, Canada
| | - Aurore Fehlmann
- Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Switzerland
| | - Ahmed Moussa
- Faculté de Médecine, Université de Montréal, Quebec, Canada
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28
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Badawy H, Dawood W, Soliman A, Fahmy A, Mahfouz W, Moussa A, Assem A, Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Reply to letter to the editor: Staged repair of proximal hypospadias-reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2021; 56:2124. [PMID: 34229877 DOI: 10.1016/j.jpedsurg.2021.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Waleed Dawood
- Department of Urology, University of Alexandria, Egypt
| | | | - Ahmed Fahmy
- Department of Urology, University of Alexandria, Egypt
| | - Waly Mahfouz
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, University of Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Eid
- Department of Urology, University of Alexandria, Egypt
| | - Shaymaa Elsayed
- Department of Pediatrics, Section of Endocrinology, University of Alexandria, Egypt
| | - Ahmed Gawan
- Department of Urology, University of Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Egypt
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29
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Gariépy-Assal L, Moussa A, Assaad MA. 27 ECG monitoring during NRP: A false sense of security? Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
During neonatal resuscitation, use of an electrocardiogram (ECG) provides a more reliable measurement of heart rate than auscultation or pulse oximetry. Having an ECG monitor may, however, provide a false sense of security in the unlikely scenario of a newborn with pulseless rhythms. This could delay critical resuscitative steps during neonatal resuscitation.
Objectives
The aim of this study is to evaluate whether the presence of ECG monitoring has an impact on the resuscitative steps of neonatal resuscitation providers.
Design/Methods
We conducted a prospective crossover randomized controlled trial, which took place at Sainte-Justine University Health Center in Montreal, Quebec, Canada. Residents, fellows, attending physicians, transport nurses, and respiratory therapists were recruited in teams of three. They participated in two simulation scenarios (pulseless electrical activity [PEA] with and without ECG monitoring). Teams were randomized to one of the scenarios and then crossed over. A debriefing session followed the two scenarios. All sessions were video-recorded. The primary outcome was the time to pulse check once the simulated mannequin was programmed to become pulseless. Secondary outcomes were the number of pulse checks, time to intubation, time to start of chest compressions, and time to administration of epinephrine.
Results
Preliminary results (n=5 groups, 10 scenarios) showed that the time to check the pulse once the mannequin was pulseless was longer when ECG electrodes were used (98.0 vs 55.6 sec, p = 0.07). There was a statistically significant decreased number of pulse checks with the ECG compared to without (2.4 vs 5.6, p = 0.004). Time to start of positive pressure ventilation (31.3 vs 27 sec), intubation (182.4 vs 179.2 sec), chest compressions (235.2 vs 227.6 sec), and epinephrine administration (340.8 vs 241.5 sec), were all increased in the presence ECG monitoring, but the difference between groups was not statistically significant.
Conclusion
ECG monitoring may alter the behaviour of individuals and delay recognition of a pulseless state, but preliminary data suggest that clinical endpoints are not affected.
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30
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Townend G, Moussa A, Akoush Y, Dhanjal G, O'Higgins C, Gladwin L, Taha A, Mizen K, Crank S, Philip J. 1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients.
Method
A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours.
Results
240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases.
Conclusions
The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.
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Affiliation(s)
- G Townend
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - A Moussa
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Y Akoush
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - G Dhanjal
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - C O'Higgins
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - L Gladwin
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - A Taha
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - K Mizen
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - S Crank
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - J Philip
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
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31
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Benamri I, Azzouzi M, Sanak K, Moussa A, Radouani F. An overview of genes and mutations associated with Chlamydiae species' resistance to antibiotics. Ann Clin Microbiol Antimicrob 2021; 20:59. [PMID: 34479551 PMCID: PMC8414684 DOI: 10.1186/s12941-021-00465-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Chlamydiae are intracellular bacteria that cause various severe diseases in humans and animals. The common treatment for chlamydia infections are antibiotics. However, when antibiotics are misused (overuse or self-medication), this may lead to resistance of a number of chlamydia species, causing a real public health problem worldwide. Materials and methods In the present work, a comprehensive literature search was conducted in the following databases: PubMed, Google Scholar, Cochrane Library, Science direct and Web of Science. The primary purpose is to analyse a set of data describing the genes and mutations involved in Chlamydiae resistance to antibiotic mechanisms. In addition, we proceeded to a filtration process among 704 retrieved articles, then finished by focusing on 24 studies to extract data that met our requirements. Results The present study revealed that Chlamydia trachomatis may develop resistance to macrolides via mutations in the 23S rRNA, rplD, rplV genes, to rifamycins via mutations in the rpoB gene, to fluoroquinolones via mutations in the gyrA, parC and ygeD genes, to tetracyclines via mutations in the rpoB gene, to fosfomycin via mutations in the murA gene, to MDQA via mutations in the secY gene. Whereas, Chlamydia pneumoniae may develop resistance to rifamycins via mutations in the rpoB gene, to fluoroquinolones via mutations in the gyrA gene. Furthermore, the extracted data revealed that Chlamydia psittaci may develop resistance to aminoglycosides via mutations in the 16S rRNA and rpoB genes, to macrolides via mutations in the 23S rRNA gene. Moreover, Chlamydia suis can become resistance to tetracyclines via mutations in the tet(C) gene. In addition, Chlamydia caviae may develop resistance to macrolides via variations in the 23S rRNA gene. The associated mechanisms of resistance are generally: the inhibition of bacteria’s protein synthesis, the inhibition of bacterial enzymes’ action and the inhibition of bacterial transcription process. Conclusion This literature review revealed the existence of diverse mutations associated with resistance to antibiotics using molecular tools and targeting chlamydia species’ genes. Furthermore, these mutations were shown to be associated with different mechanisms that led to resistance. In that regards, more mutations and information can be shown by a deep investigation using the whole genome sequencing. Certainly, this can help improving to handle chlamydia infections and healthcare improvement by decreasing diseases complications and medical costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-021-00465-4.
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Affiliation(s)
- Ichrak Benamri
- Chlamydiae and Mycoplasma Laboratory, Institut Pasteur du Maroc, 20360, Casablanca, Morocco.,Systems & Data Engineering Team, National School of Applied Sciences, Abdelmalek Essaadi University, Tangier, Morocco
| | - Maryame Azzouzi
- Chlamydiae and Mycoplasma Laboratory, Institut Pasteur du Maroc, 20360, Casablanca, Morocco.,Laboratory of Microbiology, Pharmacology, Biotechnology and Environment, Faculty of Sciences Aîn-Chock, Hassan II University, Casablanca, Morocco
| | - Kholoud Sanak
- Chlamydiae and Mycoplasma Laboratory, Institut Pasteur du Maroc, 20360, Casablanca, Morocco.,IRDA Team, ENSIAS Mohammed V University, Rabat, Morocco
| | - Ahmed Moussa
- Systems & Data Engineering Team, National School of Applied Sciences, Abdelmalek Essaadi University, Tangier, Morocco
| | - Fouzia Radouani
- Chlamydiae and Mycoplasma Laboratory, Institut Pasteur du Maroc, 20360, Casablanca, Morocco.
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32
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Mahfouz W, Moussa A, Elbadry M. Adjustment of tension applied in transobturator tapes in females with intrinsic sphincteric deficiency: Two centers' prospective, comparative, randomized surgical trial. Urol Ann 2021; 13:134-141. [PMID: 34194139 PMCID: PMC8210713 DOI: 10.4103/ua.ua_73_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives: Stress incontinence is the most common type of urinary incontinence in females. Recently, the gold standard treatment is mid-urethral tapes, however their efficacy is questioned in intrinsic sphincter deficiency (ISD). In our study, we try to adjust the tension applied during transobturator tapes (TOT) to evaluate its effectiveness in ISD, in order to prevent obstruction or failure and persistence of stress urinary incontinence. Materials and Methods: This study was prospectively conducted on eighty female patients having ISD, presenting at the Urology Departments in Alexandria and Minia University Hospitals. The patients were randomly assigned to two groups, with Group I including forty patients, who underwent TOT using tension-free technique, and Group II including forty patients using our new tension adjustment technique under saddle anesthesia. Patients filled the International Continence Questionnaire and Urinary Distress Inventory and did pressure flow study pre- and postoperatively. Postoperatively, the patients filled Patient Global Impression of Improvement and underwent translabial ultrasound (U/S) to estimate the distance between the tape and the urethra. Results: In Group I, 70% of the patients were cured with mean Valsalva leak point pressure (VLPP) of 51.43 ± 3.39 preoperatively, 20% were not improved, and 10% were improved with a mean VLPP of 44.5 ± 3.54 preoperatively, which increased to 86 ± 4.24 postoperatively. In Group II, 95% of the patients were cured with a mean VLPP of 50.74 cmH2O ± 6.56 preoperatively and 5% improved but not cured with a mean VLPP of 31 cmH2O preoperatively, which increased to 127 cmH2O at a bladder capacity of 400 ml. All patients in both groups underwent translabial U/S 6 months postoperatively. The distance between the mid-tape and the outer urethra measured by translabial US showed no significant difference between the two studied groups. Conclusion: Performing TOT using our tensioned proposed technique in ISD seems to be effective and with low morbidity. Intraoperative adjustment of tension using Valsalva maneuver under saddle anesthesia gives better outcomes than the conventional tension-free technique. The concept of tension-free vaginal tape should be challenged.
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Affiliation(s)
- Wally Mahfouz
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, Alexandria University, Alexandria, Egypt
| | - Mohamed Elbadry
- Urology and Nephrology Center, Minia University, Minya, Egypt
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Evans P, Shults J, Weinberg DD, Napolitano N, Ades A, Johnston L, Levit O, Brei B, Krick J, Sawyer T, Glass K, Wile M, Hollenberg J, Rumpel J, Moussa A, Verreault A, Abou Mehrem A, Howlett A, McKanna J, Nishisaki A, Foglia EE. Intubation Competence During Neonatal Fellowship Training. Pediatrics 2021; 148:peds.2020-036145. [PMID: 34172556 PMCID: PMC8290971 DOI: 10.1542/peds.2020-036145] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To characterize neonatal-perinatal medicine fellows' progression toward neonatal intubation procedural competence during fellowship training. METHODS Multi-center cohort study of neonatal intubation encounters performed by neonatal-perinatal medicine fellows between 2014 through 2018 at North American academic centers in the National Emergency Airway Registry for Neonates. Cumulative sum analysis was used to characterize progression of individual fellows' intubation competence, defined by an 80% overall success rate within 2 intubation attempts. We employed multivariable analysis to assess the independent impact of advancing quarter of fellowship training on intubation success. RESULTS There were 2297 intubation encounters performed by 92 fellows in 8 hospitals. Of these, 1766 (77%) were successful within 2 attempts. Of the 40 fellows assessed from the start of training, 18 (45%) achieved procedural competence, and 12 (30%) exceeded the deficiency threshold. Among fellows who achieved competence, the number of intubations to meet this threshold was variable, with an absolute range of 8 to 46 procedures. After adjusting for patient and practice characteristics, advancing quarter of training was independently associated with an increased odds of successful intubation (adjusted odds ratio: 1.10; 95% confidence interval 1.07-1.14). CONCLUSIONS The number of neonatal intubations required to achieve procedural competence is variable, and overall intubation competence rates are modest. Although repetition leads to skill acquisition for many trainees, some learners may require adjunctive educational strategies. An individualized approach to assess trainees' progression toward intubation competence is warranted.
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Affiliation(s)
- Peter Evans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justine Shults
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Danielle D. Weinberg
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie Napolitano
- Respiratory Care, Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lindsay Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Orly Levit
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Brianna Brei
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington,Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jeanne Krick
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Taylor Sawyer
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Kristen Glass
- Penn State Children’s Hospital and College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Michelle Wile
- Penn State Children’s Hospital and College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Janice Hollenberg
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Rumpel
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Alexandra Verreault
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Alexandra Howlett
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Julie McKanna
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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34
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Brei BK, Sawyer T, Umoren R, Gray MM, Krick J, Foglia EE, Ades A, Glass K, Kim JH, Singh N, Jung P, Johnston L, Moussa A, Napolitano N, Barry J, Zenge J, Quek B, DeMeo SD, Shults J, Unrau J, Nadkarni V, Nishisaki A. Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS. Arch Dis Child Fetal Neonatal Ed 2021; 106:392-397. [PMID: 33478956 PMCID: PMC8237190 DOI: 10.1136/archdischild-2020-319709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Describe the current practice of family presence during neonatal tracheal intubations (TIs) across neonatal intensive care units (NICUs) and examine the association with outcomes. DESIGN Retrospective analysis of TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS). SETTING Thirteen academic NICUs. PATIENTS Infants undergoing TI between October 2014 and December 2017. MAIN OUTCOME MEASURES Association of family presence with TI processes and outcomes including first attempt success (primary outcome), success within two attempts, adverse TI-associated events (TIAEs) and severe oxygen desaturation ≥20% from baseline. RESULTS Of the 2570 TIs, 242 (9.4%) had family presence, which varied by site (median 3.6%, range 0%-33%; p<0.01). Family member was more often present for older infants and those with chronic respiratory failure. Fewer TIs were performed by residents when family was present (FP 10% vs no FP 18%, p=0.041). Among TIs with family presence versus without family presence, the first attempt success rate was 55% vs 49% (p=0.062), success within two attempts was 74% vs 66% (p=0.014), adverse TIAEs were 18% vs 20% (p=0.62) and severe oxygen desaturation was 49% vs 52%, (p=0.40). In multivariate analyses, there was no independent association between family presence and intubation success, adverse TIAEs or severe oxygen desaturation. CONCLUSION Family are present in less than 10% of TIs, with variation across NICUs. Even after controlling for important patient, provider and site factors, there were no significant associations between family presence and intubation success, adverse TIAEs or severe oxygen desaturation.
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Affiliation(s)
- Brianna K Brei
- Pediatrics, Division of Neonatology, University of Nebraska Medical Center, Omaha, Nebraska, USA .,Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taylor Sawyer
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel Umoren
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Megan M Gray
- Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeanne Krick
- Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Glass
- Department of Pediatrics, Division of Neonatology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jae H Kim
- Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neetu Singh
- Neonatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philipp Jung
- Pediatrics, Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | - Lindsay Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ahmed Moussa
- Pediatrics- Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Natalie Napolitano
- Nursing and Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James Barry
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jeanne Zenge
- Pediatrics, Section of Neonatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Binhuey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Stephen D DeMeo
- Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Justine Shults
- Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Unrau
- Pediatrics, Section of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vinay Nadkarni
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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35
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Johnston L, Sawyer T, Ades A, Moussa A, Zenge J, Jung P, DeMeo S, Glass K, Singh N, Howlett A, Shults J, Barry J, Brei B, Foglia E, Nishisaki A. Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS). Neonatology 2021; 118:434-442. [PMID: 34111869 PMCID: PMC8376802 DOI: 10.1159/000516372] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. METHODS Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). RESULTS Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; p < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; p = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; p < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11-0.30) for residents and 0.80 (95% CI: 0.51-1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. CONCLUSION Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.
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Affiliation(s)
- Lindsay Johnston
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Taylor Sawyer
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Anne Ades
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Ahmed Moussa
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jeanne Zenge
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig Holstein, Luebeck, Germany
| | - Stephen DeMeo
- Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Kristen Glass
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Neetu Singh
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Justine Shults
- Department of Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James Barry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brianna Brei
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Foglia
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Akira Nishisaki
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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36
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Gray MM, Rumpel JA, Brei BK, Krick JA, Sawyer T, Glass K, DeMeo S, Barry J, Ades A, Napolitano N, Johnston L, Moussa A, Jung P, Quek BH, Mehrem AA, Zenge J, Shults J, Nadkarni V, Kim J, Singh N, Tisnic A, Foglia E, Nishisaki A. Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS. Neonatology 2021; 118:470-478. [PMID: 33946064 PMCID: PMC8376756 DOI: 10.1159/000515872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear. OBJECTIVE To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets. METHODS Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites. RESULTS Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success. CONCLUSIONS Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes.
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Affiliation(s)
- Megan M Gray
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jennifer A Rumpel
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Brianna K Brei
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Taylor Sawyer
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kristen Glass
- Penn State College of Medicine, Penn State Health, Hershey, Pennsylvania, USA
| | - Stephen DeMeo
- Division of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - James Barry
- University of Colorado School of Medicine, Department of Pediatrics, Section of Neonatology, Aurora, Colorado, USA
| | - Anne Ades
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Lindsay Johnston
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, USA
| | - Ahmed Moussa
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Phillip Jung
- Department of Pediatrics, Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Bin Huey Quek
- Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jeanne Zenge
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Justine Shults
- Children's Hospital of Philadelphia, Ambler, Pennsylvania, USA
| | - Vinay Nadkarni
- Department of Anesthesiology, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jae Kim
- Perinatal Institute, Cincinnati, Ohio, USA
| | - Neetu Singh
- Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Alicia Tisnic
- Alberta Children's Hospital, Alberta, Alberta, Canada
| | - Elizabeth Foglia
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Badawy H, Dawood W, Soliman AS, Fahmy A, Mahfouz W, Moussa A, Assem A, Aboulfotouh Eid A, Elsayed S, Gawan A, Hanno A, Youssef M. Staged repair of proximal hypospadias: Reporting outcome of staged tubularized autograft repair (STAG). J Pediatr Surg 2020; 55:2710-2716. [PMID: 32854924 DOI: 10.1016/j.jpedsurg.2020.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Proximal hypospadias (PPH) repair is a challenge. Dilemma exists whether to do it in single or staged repair. Staged repair is our adopted procedure which was recently modified by Snodgrass into staged tubularized autograft repair (STAG), in which attention was given to ventral straightening of the penis together with some other technical details. Herein, we report our experience with STAG in a cohort of primary posterior hypospadias. PATIENTS AND METHODS In the period from 2011 to 2018 we operated 43 primary posterior hypospadias. Two principal surgeons (HB, MY) and multiple assistants operate children the same way, and data are recorded in a prospectively designed data base. In all children, inner prepuce graft was utilized, when curvature is more than 30 degrees, plate transection with or without ventral corporotomies were adopted. RESULTS Forty-three children with PPH and ventral curvature more than 30 degrees underwent first stage with median age 12 months (6-132 IQR16). Penile curvature was corrected by plate transection in 27 children (62.8%), ventral corporotomies in 16 children (37.2%). Graft take was successful in 90.7%, 4 children needed revision of fibrotic graft. Second stage was completed in 37 children, success was 56.8%, 21.6% fistula, 24.3% glanular dehiscence. Overall success after third surgery to correct complications was 78.4%. In a mean follow up of 3.2 years, we had recurrence of curvature in 2 children taking success rate to 72.9%. No meatal stenosis, no diverticulum, no stricture, no urethral dehiscence was encountered. Cosmetic appearance was excellent in follow up. CONCLUSION STAG achieves proper straightening of the penis and allows for reconstruction of a good urethra, yet urethrocutaneous fistula and glanular dehiscence remain the main complications. Follow up is important to address results of ventral corporotomies. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE Level IV case series with no comparison group.
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Affiliation(s)
- Haytham Badawy
- Department of Urology, University of Alexandria, Alexandria, Egypt.
| | - Waleed Dawood
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | | | - Ahmed Fahmy
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Waly Mahfouz
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | | | - Shaymaa Elsayed
- Department of Pediatrics, University of Alexandria, Alexandria, Egypt
| | - Ahmed Gawan
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Ahmed Hanno
- Department of Urology, University of Alexandria, Alexandria, Egypt
| | - Mohammed Youssef
- Department of Urology, University of Alexandria, Alexandria, Egypt
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38
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Umoren RA, Sawyer TL, Ades A, DeMeo S, Foglia EE, Glass K, Gray MM, Barry J, Johnston L, Jung P, Kim JH, Krick J, Moussa A, Mulvey C, Nadkarni V, Napolitano N, Quek BH, Singh N, Zenge JP, Shults J, Nishisaki A. Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS. Am J Perinatol 2020; 37:1417-1424. [PMID: 31365934 DOI: 10.1055/s-0039-1693698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. STUDY DESIGN TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. RESULT In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36-2.67, p < 0.001). CONCLUSION High team stress levels during TI were more frequently reported among TIs with adverse events.
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Affiliation(s)
- Rachel A Umoren
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Taylor L Sawyer
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stephen DeMeo
- Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Glass
- Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - James Barry
- Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
| | - Lindsay Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Jae H Kim
- Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, California
| | - Jeanne Krick
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Ahmed Moussa
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Christine Mulvey
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie Napolitano
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Neetu Singh
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, New Hampshire
| | - Jeanne P Zenge
- Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sawyer T, Stavroudis TA, Ades A, Dadiz R, Dammann CEL, Halamek LP, Moussa A, Soghier L, Gupta A, Aliaga S, Umoren R, French H. Simulation in Neonatal-Perinatal Medicine Fellowship Programs. Am J Perinatol 2020; 37:1258-1263. [PMID: 31307105 DOI: 10.1055/s-0039-1693465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs. STUDY DESIGN This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowship programs. RESULTS Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs. Of responding programs, 97% used simulation, which most commonly included neonatal resuscitation (94%) and procedural skills (94%) training. The time and scope of simulation use varied significantly. The majority of fellows (51%) received ≤20 hours of simulation during training. The majority of PDs (63%) wanted fellows to receive >20 hours of simulation. Barriers to simulation included lack of faculty time, experience, funding, and curriculum. CONCLUSION While the majority of fellowship programs use simulation, the time and scope of fellow exposure to simulation experiences are limited. The creation of a standardized simulation curriculum may address identified barriers to simulation.
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Affiliation(s)
- Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Theodora A Stavroudis
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, Fetal and Neonatal Institute, University of Southern California, Los Angeles, California
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Christiane E L Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Canada
| | - Lamia Soghier
- Department of Neonatology, Children's National Health System, Washington, District of Columbia
| | - Arika Gupta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia Aliaga
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Heather French
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Hughes SF, Moyes AJ, Lamb RM, Ella-Tongwiis P, Bell C, Moussa A, Shergill I. The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients. BMC Urol 2020; 20:122. [PMID: 32795278 PMCID: PMC7427952 DOI: 10.1186/s12894-020-00693-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS. METHODS Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers. RESULTS Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h. CONCLUSIONS Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS.
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Affiliation(s)
- Stephen Fôn Hughes
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK. .,North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
| | - Alyson Jayne Moyes
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,School of Medical Sciences, Bangor University, Bangor, Wales, UK.,Department of Biological Sciences, University of Chester, Chester, UK
| | - Rebecca May Lamb
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Department of Biological Sciences, University of Chester, Chester, UK
| | - Peter Ella-Tongwiis
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Christopher Bell
- North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Ahmed Moussa
- North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Iqbal Shergill
- North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
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Moussa A, Rahman S, Xu M, Tanzer M, Pasini D. Topology optimization of 3D-printed structurally porous cage for acetabular reinforcement in total hip arthroplasty. J Mech Behav Biomed Mater 2020; 105:103705. [PMID: 32279849 DOI: 10.1016/j.jmbbm.2020.103705] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023]
Abstract
Aseptic loosening and mechanical failure of acetabular reinforcement components are among the main causes of their reduced service life. Current acetabular implants typically feature a structural solid layer that provides load bearing capacity, coated with a foam of uniform porosity to reduce stress shielding and implant loosening. This paper presents an alternative concept for a 3D printed cage that consists of a multifunctional fully porous layer with graded attributes that integrate both structural function and bone in-growth properties. The design comprises a hemispherical cup affixed to a superior flange with architecture featuring an optimally graded porosity. The methodology here presented combines an upscaling mechanics scheme of lattice materials with density-based topology optimization, and includes additive manufacturing constraints and bone ingrowth requirements in the problem formulation. The numerical results indicate a 21.4% reduction in the maximum contact stress on the bone surface, and a 26% decrease in the bone-implant interface peak micromotion, values that are indicative of enhanced bone ingrowth and implant long-term stability.
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Affiliation(s)
- Ahmed Moussa
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Shakurur Rahman
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Manman Xu
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Michael Tanzer
- Division of Orthopaedics, Department of Surgery, McGill University, Jo Miller Orthopaedic Research Laboratory, Montreal, Quebec, H3G1A4, Canada
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada.
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Lizotte MH, Barrington KJ, Sultan S, Pennaforte T, Moussa A, Lachance C, Sureau M, Zao Y, Janvier A. Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology. Pediatrics 2020; 145:peds.2019-1925. [PMID: 31988171 DOI: 10.1542/peds.2019-1925] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. METHODS Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. RESULTS Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations >9 out of 10 and were all ranked top 10 communicators. CONCLUSIONS During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication.
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Affiliation(s)
- Marie-Hélène Lizotte
- Centre de Recherche.,Department of Pediatrics, Hôpital de Rimouski, Rimouski, Canada
| | | | - Serge Sultan
- Centre de Recherche.,Departments of Pediatrics.,Psychology, and
| | - Thomas Pennaforte
- Centre de Recherche.,Education, Université de Montréal, Montréal, Canada; and
| | - Ahmed Moussa
- Centre de Recherche.,Mother-Child Simulation Center.,Division of Neonatology.,Soins Palliatifs, and.,Centre de Pédagogie Appliquée aux Sciences de la Santé, and.,Departments of Pediatrics
| | | | | | | | - Annie Janvier
- Centre de Recherche, .,Division of Neonatology.,Unités des Éthique Clinique and.,Soins Palliatifs, and.,Bureau du Partenariat Patients-Familles-Soignants, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada.,Bureau de L'éthique Clinique.,Departments of Pediatrics
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Viel-Thériault I, Martin B, Thompson-Desormeaux F, Blackburn J, Moussa A, Autmizguine J. Vancomycin drug monitoring in infants with CoNS sepsis-target attainment, microbiological response and nephrotoxicity. J Perinatol 2020; 40:97-104. [PMID: 31576000 DOI: 10.1038/s41372-019-0519-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To characterize residual vancomycin concentrations (Cmin) and assess the relationships between Cmin, the risk of nephrotoxicity and persistent CoNS sepsis. METHODS In this 5-year retrospective study among infants treated with vancomycin, the primary outcome was the proportion of those with a steady state Cmin between 10 and 20 mg/L. The secondary outcomes were nephrotoxicity and persistent CoNS sepsis. RESULTS Of 120 infants included, the median first steady state Cmin was 12.4 mg/L and 77 (64%) had a Cmin between 10 and 20 mg/L. Six percent developed nephrotoxicity. This risk was not associated with Cmin. Of the 30 infants with CoNS sepsis, 17 (57%) had persistent bacteremia, and this risk did not correlate significantly with Cmin, CoNS minimal inhibitory concentration (MIC) for vancomycin, or Cmin/MIC. CONCLUSIONS The majority of infants achieved targeted levels of vancomycin, but persistent bacteremia was common. We did not identify a Cmin threshold associated with nephrotoxicity, nor with microbiological clearance.
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Affiliation(s)
| | - Brigitte Martin
- Department of Pharmacy, CHU Sainte-Justine, Montreal, QC, Canada
| | | | - Julie Blackburn
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Ahmed Moussa
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Julie Autmizguine
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada.,Clinical Pharmacology Unit, Université de Montréal, Montreal, QC, Canada
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Shoukry S, Elmissiry M, Abulfotooh A, Moussa A, Mahfouz W, Dawood W, Abdel-Karim A, Hassouna M. A prototype non-invasive urodynamic test to estimate voiding reserve in normal adult males. Arab J Urol 2019; 17:251-256. [PMID: 31723441 PMCID: PMC6830265 DOI: 10.1080/2090598x.2019.1649892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/23/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To propose a prototype non-invasive test to estimate voiding reserve in normal adult men; identifying its feasibility, limitations, and initial results. Subjects and methods: In all, 30 adult healthy male volunteers aged <40 years were included in the study. Initial free uroflowmetry was done with post-void residual urine volume (PVR) assessment using ultrasonography. The men were later asked to void into a uroflowmeter through a condom catheter attached to the glans penis and connected to an outflow tube with specific vertical heights (10, 20, 30, 40, 50 and 60 cm) on different days. The mean maximum urinary flow rate (Qmax) and PVR at each height were compared with the Qmax and PVR at the initial free uroflowmetry. The maximum height at which the Qmax and PVR remained normal was considered the normal voiding reserve for that age group. Results: All the men completed the study without any complications. At zero level, the mean Qmax was 27.6 mL/s, which then dropped gradually to reach 17.8 mL/s at 60 cm, where still 83% of the men had a normal Qmax. The PVR was nil at zero level and started to exceed the normal range at 50 and 60 cm height (58 and 65.7 mL, respectively). So, the maximum height resistance at which the men could have a normal Qmax and normal PVR was 40 cm. Conclusions: The use of the tube height-resistance test to assess voiding reserve is feasible, non-invasive and has no complications. A 40-cm height resistance can be considered a reference level that a young adult male should be tested against to estimate his voiding reserve. Abbreviations: NPV: negative predictive value; PdetQmax: maximum detrusor pressure at maximum urinary flow; PPV: positive predictive value; PVR: post-void residual urine volume; ROC: receiver operating characteristic
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Affiliation(s)
- Shafik Shoukry
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Mostafa Elmissiry
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Ahmed Abulfotooh
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Ahmed Moussa
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Waleed Dawood
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Aly Abdel-Karim
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
| | - Mohamed Hassouna
- Section of Voiding Dysfunction and Urodynamics, Department of Urology, Alexandria University, Alexandria, Egypt
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Sawyer T, Foglia EE, Ades A, Moussa A, Napolitano N, Glass K, Johnston L, Jung P, Singh N, Quek BH, Barry J, Zenge J, DeMeo SD, Brei B, Krick J, Kim JH, Nadkarni V, Nishisaki A. Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104:F461-F466. [PMID: 30796059 DOI: 10.1136/archdischild-2018-316336] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/07/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU). DESIGN Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates. SETTING Ten academic NICUs. PATIENTS Neonates intubated in the NICU at each of the sites between October 2014 and March 2017. MAIN OUTCOME MEASURES Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation. RESULTS Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47-0.53). CONCLUSIONS Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.
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MESH Headings
- Airway Management/methods
- Clinical Competence
- Emergencies/epidemiology
- Female
- Humans
- Hypoxia/etiology
- Hypoxia/prevention & control
- Incidence
- Infant, Newborn
- Infant, Premature
- Intensive Care Units, Neonatal/standards
- Intensive Care Units, Neonatal/statistics & numerical data
- Intubation, Intratracheal/adverse effects
- Intubation, Intratracheal/methods
- Intubation, Intratracheal/standards
- Intubation, Intratracheal/statistics & numerical data
- Male
- Outcome Assessment, Health Care
- Practice Patterns, Physicians'/standards
- Quality Improvement/standards
- Registries
- Retrospective Studies
- United States/epidemiology
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Affiliation(s)
- Taylor Sawyer
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Ades
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ahmed Moussa
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Sainte-Justine, Canada
| | - Natalie Napolitano
- Nursing and Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Glass
- Department of Pediatrics, Penn State - Hershey, Hershey, Pennsylvania, USA
| | | | - Philipp Jung
- University Hospital Schleswig-Holstein, Department of Pediatrics, Luebeck, Germany
| | - Neetu Singh
- Department of Pediatrics, Dartmouth-Hitchcock Health System, Lebanon, New Hampshire, USA
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - James Barry
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Jeanne Zenge
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Stephen D DeMeo
- Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Brianna Brei
- Department of Pediatrics, University of Washington, Seattle, USA
| | - Jeanne Krick
- Department of Pediatrics, University of Washington, Seattle, USA
| | - Jae H Kim
- Department of Pediatrics, University of California San Diego Medical Center, San Diego, California, USA
| | - Vinay Nadkarni
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Abdel-Karim A, Elmissiry M, Moussa A, Mahfouz W, Abulfotooh A, Dawood W, Elsalmy S. Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience. Int Urogynecol J 2019; 31:1357-1362. [PMID: 31256224 DOI: 10.1007/s00192-019-04002-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. METHODS A retrospective analysis of our records over the last 10 years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. RESULTS Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25 min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2 days. After a mean follow-up of 6.3 ± 3.1 years, all patients had undergone successful repair, except for one patient with complex VVF. CONCLUSIONS Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.
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Affiliation(s)
- Aly Abdel-Karim
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
| | - Mostafa Elmissiry
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt. .,Section of Voiding Dysfunction and Female Urology, Urology Department, Alexandria University, Azarita, Alexandria, 21113, Egypt.
| | - Ahmed Moussa
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
| | - Ahmed Abulfotooh
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
| | - Waleed Dawood
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
| | - Salah Elsalmy
- Section of Female Urology and Laparoscopy, Urology Department, Alexandria University, Alexandria, Egypt
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Ferrand A, Roy SK, Faure C, Moussa A, Aspirot A. Postoperative noninvasive ventilation and complications in esophageal atresia-tracheoesophageal fistula. J Pediatr Surg 2019; 54:945-948. [PMID: 30814037 DOI: 10.1016/j.jpedsurg.2019.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia-tracheoesophageal fistula (EA-TEF) patients. METHODS A single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05). RESULTS We reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036). CONCLUSIONS These data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amaryllis Ferrand
- Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Shreyas K Roy
- Pediatric Surgery, Centre Hospitalier Universitaire, Sainte-Justine, Canada
| | - Christophe Faure
- Esophageal Atresia Clinic, Department of Pediatric Gastroenterology, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Ahmed Moussa
- Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Ann Aspirot
- Pediatric Surgery, Centre Hospitalier Universitaire, Sainte-Justine, Canada; Esophageal Atresia Clinic, Department of Pediatric Gastroenterology, Centre Hospitalier Universitaire, Sainte Justine, Canada.
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Frikha M, Auperin A, Tao Y, Elloumi F, Toumi N, Blanchard P, Lang P, Sun S, Racadot S, Thariat J, Alfonsi M, Tuchais C, Cornely A, Moussa A, Guigay J, Daoud J, Bourhis J. A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02). Ann Oncol 2019; 29:731-736. [PMID: 29236943 DOI: 10.1093/annonc/mdx770] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Concomitant chemotherapy (CT)-radiotherapy (RT) is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established. Methods Patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin-RT or concomitant cisplatin-RT alone. The TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 day 1; cisplatin 75 mg/m2 day 1; 5FU 750 mg/m2/day days 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly. Results A total of 83 patients were included in the study. Demographics and tumour characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received three cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3-year PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm [hazard ratio (HR) = 0.44; 95% confidence interval (CI): 0.20-0.97, P = 0.042]. Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, P = 0.05). Conclusion In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.
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Affiliation(s)
- M Frikha
- Medical Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - A Auperin
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - Y Tao
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - F Elloumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - N Toumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - P Lang
- Radiation Oncology Department, Pitié Salpetrière, Paris, France
| | - S Sun
- Radiation Oncology Department, Centre Hospitalier Montbeliard, Montbeliard, France
| | - S Racadot
- Radiation Oncology Department, Centre L. Bérard, Lyon, France
| | - J Thariat
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - M Alfonsi
- Radiation Oncology Department, Clinique St Catherine, Avignon, France
| | - C Tuchais
- Radiation Oncology Department, Centre C. Papin, Angers, France
| | - A Cornely
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - A Moussa
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - J Guigay
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - J Daoud
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia.
| | - J Bourhis
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France; Radiation Oncology Department, CHUV, Lausanne, Switzerland.
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Badawy H, Soliman A, Moussa A, Youssef M, Fahmy A, Dawood W, Elmesiry M, Assem A, Elsayed S, Abulfotooh Eid A, Orabi S. Staged repair of redo and crippled hypospadias: analysis of outcomes and complications. J Pediatr Urol 2019; 15:151.e1-151.e10. [PMID: 30833176 DOI: 10.1016/j.jpurol.2019.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Residual curvature, scarred or absent urethral plate, shortage of skin, and paucity of vascularized tissues and flaps are all obstacles to overcome during repair of redo and cripple hypospadias after failed reconstruction. Limited articles address the outcome of repair of these cases using different grafts. OBJECTIVE An analysis of outcomes and complications after the repair of redo and cripple hypospadias in a cohort of children operated by a single surgeon is presented, and data are retrieved from a prospectively designed database. STUDY DESIGN Thirty-one children with a median age of 96 months (18-216, interquartile range [IQR]: 78), who underwent previous surgeries three to five times, were operated in the period from late 2011 to August 2017 in a single center by a single surgeon (first author); the first-stage repair was performed by using an inner prepuce graft in three children and oral grafts in 28 children. Penile straightening by degloving and removal of ventral scarred tissues are followed by development of glanular wings and grafting of the ventral surface. RESULTS Eleven distal penile hypospadias and 20 posterior hypospadias were operated. First-stage repair was revised in three children; 25 children, eight distal and 17 posterior hypospadias, underwent second-stage repair with a median age of 84 months (18-216, IQR: 60). The success rate after the second-stage repair was 56% (14 children), and complications were encountered in 11 children in the form of penoscrotal fistulae in four, complete dehiscence in one, and glanular dehiscence in six children. After closure of fistulae, the overall success rate increased to 72%. Although complications were more common among children with posterior hypospadias (nine children) than children with distal hypospadias (two children), no statistical significance was reached (p = .234), with no effect of age on complications (p = .233), no effect of the position of the meatus on glanular dehiscence (p = .624), and no effect of age on glanular dehiscence (p = .114). CONCLUSION Repair of redo and crippled hypospadias using staged graft repair in children could be achieved with a satisfactory overall success rate of 72%. Glanular dehiscence is the main complication; however, it is not considered by parents of children in the series, necessitating intervention. The lowest complication rate is expected among those with a position of the meatus more distal, however, not proven statistically in the series.
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Affiliation(s)
- H Badawy
- Department of Urology, University of Alexandria, Egypt.
| | - A Soliman
- Department of Urology, University of Alexandria, Egypt
| | - A Moussa
- Department of Urology, University of Alexandria, Egypt
| | - M Youssef
- Department of Urology, University of Alexandria, Egypt
| | - A Fahmy
- Department of Urology, University of Alexandria, Egypt
| | - W Dawood
- Department of Urology, University of Alexandria, Egypt
| | - M Elmesiry
- Department of Urology, University of Alexandria, Egypt
| | - A Assem
- Department of Urology, University of Alexandria, Egypt
| | - S Elsayed
- Department of Pediatrics, University of Alexandria, Egypt
| | | | - S Orabi
- Department of Urology, University of Alexandria, Egypt
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50
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Wong J, Manhas D, Campbell D, Moussa A, Sawyer T. Procedural experience of canadian neonatal-perinatal medicine fellows. J Clin Neonatol 2019. [DOI: 10.4103/jcn.jcn_110_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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