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Beshish AG, Amedi A, Harriott A, Patel S, Evans S, Scheel A, Xiang Y, Keesari R, Harding A, Davis J, Shashidharan S, Yarlagadda V, Aljiffry A. Short-Term Outcomes, Functional Status, and Risk Factors for Requiring Extracorporeal Life Support After Norwood Operation: A Single-Center Retrospective Study. ASAIO J 2024; 70:328-335. [PMID: 38557688 DOI: 10.1097/mat.0000000000002109] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Patients requiring extracorporeal life support (ECLS) post-Norwood operation constitute an extremely high-risk group. We retrospectively described short-term outcomes, functional status, and assessed risk factors for requiring ECLS post-Norwood operation between January 2010 and December 2020 in a high-volume center. During the study period, 269 patients underwent a Norwood procedure of which 65 (24%) required ECLS. Of the 65 patients, 27 (41.5%) survived to hospital discharge. Mean functional status scale (FSS) score at discharge increased from 6.0 on admission to 8.48 (p < 0.0001). This change was primary in feeding (p < 0.0001) and respiratory domains (p = 0.017). Seven survivors (26%) developed new morbidity, and two (7%) developed unfavorable functional outcomes. In the regression analysis, we showed that patients with moderate-severe univentricular dysfunction on pre-Norwood transthoracic echocardiogram (odds ratio [OR] = 6.97), modified Blalock Taussig Thomas (m-BTT) shunt as source of pulmonary blood flow (OR = 2.65), moderate-severe atrioventricular valve regurgitation on transesophageal echocardiogram (OR = 8.50), longer cardiopulmonary bypass time (OR = 1.16), longer circulatory arrest time (OR = 1.20), and delayed sternal closure (OR = 3.86), had higher odds of requiring ECLS (p < 0.05). Careful identification of these risk factors is imperative to improve the care of this high-risk cohort and improve overall outcomes.
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Affiliation(s)
- Asaad G Beshish
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Alan Amedi
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Shayli Patel
- Emory University School of Medicine, Atlanta, Georgia
| | - Sean Evans
- Emory University School of Medicine, Atlanta, Georgia
| | - Amy Scheel
- Emory University School of Medicine, Atlanta, Georgia
| | - Yijin Xiang
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rohali Keesari
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amanda Harding
- Cardiac Sonographer, Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joel Davis
- ECMO and Advanced Technologies, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Subhadra Shashidharan
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Vamsi Yarlagadda
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California
| | - Alaa Aljiffry
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Mahle WT, Keesari R, Trachtenberg F, Newburger JW, Lim H, Edelson J, Jeewa A, Lal A, Kindel SJ, Burns KM, Lang S, Bainton J, Carboni M, Villa CR, Richmond M, Henderson H, Menteer J, Pizarro C, Goldberg CS. School age and adolescent heart failure following the Norwood procedure. J Heart Lung Transplant 2024; 43:453-460. [PMID: 37866470 DOI: 10.1016/j.healun.2023.10.012] [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: 04/12/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Heart failure results in significant morbidity and mortality for young children with hypoplastic left heart syndrome (HLHS) following the Norwood procedure. The trajectory in later childhood is not well described. METHODS We studied the outcome into adolescence of participants enrolled in the Single Ventricle Reconstruction trial who underwent the Fontan procedure or survived to 6 years without having undergone Fontan procedure. The primary outcome was heart failure events, defined as heart transplant listing or death attributable to heart failure. Symptomatic heart failure for participants surviving 10 or more years was also assessed utilizing the Pediatric Quality of Life Inventory (PedsQL). RESULTS Of the 345 participants who underwent a Fontan operation or survived to 6 years without Fontan, 25 (7.2%) had a heart failure event before the age of 12 years. Among these, 21 were listed for heart transplant, and 4 died from heart failure. Nineteen participants underwent heart transplant, all of whom survived to age 12 years. Factors associated with a heart failure event included longer Norwood hospital length of stay, aortic atresia, and no Fontan operation by age 6 years. Assessment of heart failure symptoms at 12 years of age revealed that 24 (12.2%) of 196 PedsQL respondents "often" or "almost always" had difficulty walking more than one block. CONCLUSIONS Heart failure events occur in over 5% of children with palliated HLHS between preschool age and adolescence. Outcomes for children listed for transplant are excellent. However, a substantial portion of palliated HLHS children have significant symptoms of heart failure at 12 years of age.
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Affiliation(s)
- William T Mahle
- Children's Healthcare of Atlanta and Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, Georgia.
| | - Rohali Keesari
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | | | - Jane W Newburger
- Boston Children's Hospital and Department of Pediatrics Cardiology Harvard School of Medicine, Boston, Massachusetts
| | - Heang Lim
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Jonathan Edelson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ashwin Lal
- Division of Pediatric Cardiology, University of Utah Primary Children's Hospital, Salt Lake City, Utah
| | - Steven J Kindel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sean Lang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jessica Bainton
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Carboni
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Chet R Villa
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marc Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Heather Henderson
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Jondavid Menteer
- Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Christian Pizarro
- Division of Cardiothoracic Surgery, Department of Surgery, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Caren S Goldberg
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
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Abstract
BACKGROUND Multisystem inflammatory syndrome in children is a rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to assess the long-term sequelae, particularly cardiac, in a large, diverse population. METHODS We performed a retrospective cohort study of all children (aged 0-20 years, n = 304) admitted to a tertiary care centre with a diagnosis of multisystem inflammatory syndrome in children from March 1, 2020 to August 31, 2021 and had at least one follow-up visit through December 31, 2021. Data were collected at hospitalisation, 2 weeks, 6 weeks, 3 months, and 1 year after diagnosis, where applicable. Cardiovascular outcomes included left ventricular ejection fraction, presence or absence of pericardial effusion, coronary artery abnormalities, and abnormal electrocardiogram findings. RESULTS Population was median age 9 years (IQR 5-12), 62.2% male, 61.8% African American (AA), and 15.8% Hispanic. Hospitalisation findings included abnormal echocardiogram 57.2%, mean worst recorded left ventricular ejection fraction 52.4% ± 12.4%, non-trivial pericardial effusion 13.4%, coronary artery abnormalities 10.6%, and abnormal ECG 19.6%. During follow-up, abnormal echocardiogram significantly decreased to 6.0% at 2 weeks and 4.7% at 6 weeks. Mean left ventricular ejection fraction significantly increased to 65.4% ± 5.6% at 2 weeks and stabilised. Pericardial effusion significantly decreased to 3.2% at 2 weeks and stabilised. Coronary artery abnormalities significantly decreased to 2.0% and abnormal electrocardiograms significantly decreased to 6.4% at 2 weeks and stabilised. CONCLUSION Children with multisystem inflammatory syndrome in children have significant echocardiographic abnormalities during the acute presentation, but these findings typically improve within weeks. However, a small subset of patients may have persistent coronary abnormalities.
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Affiliation(s)
| | | | - Rohit Madani
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Preeti Jaggi
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matthew E Oster
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Bakshi N, Liu Z, Gillespie S, Keesari R, Leake D, Khemani K, Kumari P, Rees CA, Dampier C, Morris CR. Patient-reported outcomes in children with sickle cell disease at presentation for an acute pain episode. Blood Adv 2023; 7:5103-5107. [PMID: 36322873 PMCID: PMC10477437 DOI: 10.1182/bloodadvances.2021006794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023] Open
Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology-Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Rohali Keesari
- Pediatric Biostatistics Core, Emory University, Atlanta, GA
| | | | - Kirshma Khemani
- Division of Pediatric Hematology-Oncology-Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA
| | - Polly Kumari
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Chris A. Rees
- Children’s Healthcare of Atlanta, Atlanta, GA
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Carlton Dampier
- Division of Pediatric Hematology-Oncology-Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA
| | - Claudia R. Morris
- Children’s Healthcare of Atlanta, Atlanta, GA
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Hensley M, Goodman M, Madani R, Jaggi P, Keesari R, Zhang Q, Oster ME. Cardiac complications in children with acute COVID-19 vs multisystem inflammatory syndrome in children (MIS-C). Am Heart J 2023; 263:177-182. [PMID: 37217158 PMCID: PMC10198793 DOI: 10.1016/j.ahj.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/18/2022] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Cardiac involvement can lead to significant morbidity in children with acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C). However, the presentation and outcomes of cardiac involvement may differ among these 2 conditions. We aimed to compare the frequency and extent of cardiac involvement among children admitted with acute COVID-19 vs those with MIS-C. METHODS We conducted a cross sectional study of patients admitted to our hospital from March 2020 to August 2021 with symptomatic acute COVID-19 or MIS-C. Cardiac involvement was defined by presence of 1 or more of the following: elevated troponin, elevated brain natriuretic peptide, reduced left ventricular ejection fraction on echocardiogram, coronary dilation on echocardiogram, or abnormal electrocardiogram reading. RESULTS Among 346 acute COVID-19 patients with median age of 8.9 years and 304 MIS-C patients with median age of 9.1 years, cardiac involvement was present in 33 acute COVID-19 patients (9.5%) and 253 MIS-C patients (83.2%). The most common cardiac abnormality was abnormal electrocardiogram in acute COVID-19 patients (7.5%) and elevated troponin in MIS-C patients (67.8%). Among acute COVID-19 patients, obesity was significantly associated with cardiac involvement. Among MIS-C patients, non-Hispanic Black race/ethnicity was significantly associated with cardiac involvement. CONCLUSIONS Cardiac involvement is much more common in children with MIS-C than in those with acute COVID-19. These results reinforce our standardized practice of performing full cardiac evaluations and follow-up in all patients with MIS-C but only in acute COVID-19 patients with signs or symptoms of cardiac involvement.
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Affiliation(s)
- Matthew Hensley
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
| | | | - Rohit Madani
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Preeti Jaggi
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Qi Zhang
- Emory University School of Medicine, Atlanta, GA
| | - Matthew E Oster
- Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Mills M, John M, Tang R, Fundora MP, Keesari R, Kanter K, Maher K, Chai P. Mitral Valve Replacement in Infants and Children: Experience using a 15 mm Mechanical Valve. Ann Thorac Surg 2023:S0003-4975(23)00468-X. [PMID: 37150274 DOI: 10.1016/j.athoracsur.2023.04.035] [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: 11/09/2022] [Revised: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Reports using a 15-mm mechanical valve for mitral valve replacement in children are limited. We review our center's operative and postoperative experience with this valve. METHODS We performed a single-center retrospective chart review identifying patients having undergone 15-mm mechanical mitral valve replacements (MMVRs) between 2009 and 2022. We analyzed short and long-term outcomes using descriptive statistics. RESULTS Fifteen patients underwent 16 MMVRs with no operative deaths. The median age and weight at the time of operation was 6.2 months (IQR 4.4-13.7), and 5.16 kg (IQR 4.5-6.9), respectively. Ten implants (66%) were placed in the supra-annular position. Median post-operative duration of intubation was 1.5 days (IQR 1.0-3.75), CICU length of stay (LOS) was 6 days (IQR 3-13.5), and overall hospital LOS was 17.0 days (IQR 12-48.5). Three patients (20%) experienced major adverse events post-operatively. Four of 13 patients discharged home (31%) required readmission within 30 days for sub/supra-therapeutic INR values. There were no surgical mortalities and there were four late mortalities (27%). Six patients underwent subsequent MMVR at a median time to second MMVR of 6.8 (IQR 3.6-8.9) years. There are 6 patients with the original 15-mm MVR at a median time of 4.7 years since placement. CONCLUSIONS We present the largest single-center cohort of patients having undergone 15-mm MMVR. Our experience is distinguished by a lower rate of major adverse events than previously reported, durability of the device, and a rapid post operative recovery time. Appropriate and consistent anticoagulation is a significant challenge in this age group.
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Affiliation(s)
- Marcos Mills
- Heart Center, Children's Healthcare of Atlanta; Division of Pediatric Cardiology, Emory University School of Medicine;.
| | - Mohan John
- Heart Center, Children's Healthcare of Atlanta. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
| | - Richard Tang
- Heart Center, Children's Healthcare of Atlanta. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
| | - Michael P Fundora
- Heart Center, Children's Healthcare of Atlanta; Division of Pediatric Cardiology, Emory University School of Medicine
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine
| | - Kirk Kanter
- Heart Center, Children's Healthcare of Atlanta. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
| | - Kevin Maher
- Heart Center, Children's Healthcare of Atlanta; Division of Pediatric Cardiology, Emory University School of Medicine
| | - Paul Chai
- Heart Center, Children's Healthcare of Atlanta. Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine
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Bakshi N, Astles R, Chou E, Hurreh A, Sil S, Sinha CB, Sanders KA, Peddineni M, Gillespie SE, Keesari R, Krishnamurti L. Multimodal phenotyping and correlates of pain following hematopoietic cell transplant in children with sickle cell disease. Pediatr Blood Cancer 2023; 70:e30046. [PMID: 36322607 PMCID: PMC9820671 DOI: 10.1002/pbc.30046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is limited understanding of pain, patient-reported outcomes (PROs) of health-related quality of life (HRQoL), psychological factors, and experimental pain sensitivity before and following hematopoietic cell transplant (HCT) in children with sickle cell disease (SCD). METHODS Individuals aged 8 years and older, English speaking, and scheduled for a HCT were invited to participate in an observational study where they completed assessments of pain, PROs, psychological factors, and qualitative interviews before and around 3 months, 6 months, 1 year, and 2 years post-HCT. An optional substudy of experimental pain sensitivity before and around 6 month, 1 year, and 2 years post-HCT was also offered. RESULTS Data from eight participants (median age 13.5 years, 25% female) with sickle cell anemia (SCA) or similarly severe genotype, and successful donor-derived erythropoiesis post-HCT are reported. We found that collection of pain, PROs, psychological factors, and qualitative data were feasible in the context of HCT. We found moderate to large differences in pain and some PROs between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but only some differences were statistically significant. We found moderate to large differences in pressure pain threshold and moderate differences in cold pain threshold between baseline to 1 year and baseline to 2 year post-HCT based on effect sizes, but these differences were not statistically significant. Qualitative data indicated an improvement in pain and HRQoL post-HCT. CONCLUSION This study provides a framework for the conduct of multimodal pain assessments before and after HCT, which is feasible but faced with unique barriers.
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Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rachel Astles
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric Chou
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Asha Hurreh
- James T. Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA
| | - Soumitri Sil
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cynthia B Sinha
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kolanda Ackey Sanders
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Manasa Peddineni
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida, USA
| | - Scott E Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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Lovett ME, Daniel M, Keesari R, MacDonald J, Rodriguez V, Muszynski J, Sribnick EA, O'Brien NF, Ayad O. Catheter-associated deep vein thrombosis in children with severe traumatic brain injury: A single-center experience. Pediatr Blood Cancer 2023; 70:e30044. [PMID: 36250988 DOI: 10.1002/pbc.30044] [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: 05/18/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study was performed to describe the single-center experience of deep vein thrombosis (DVT) in children with severe traumatic brain injury (sTBI) who were mechanically ventilated with a central line, and to identify potentially modifiable risk factors. It was hypothesized that children with DVT would have a longer duration of central venous line (CVL) and a higher use of hypertonic saline (HTS) compared to those without DVT. PROCEDURE/METHODS This was a retrospective study of children (0-18 years) with sTBI, who were intubated, had a CVL, and a minimum intensive care unit (ICU) stay of 3 days. Children were analyzed by the presence or absence of DVT. HTS use was evaluated using milliliter per kilogram (ml/kg) of 3% equivalents. Univariable and multivariable logistic regression models were used to determine which factors were associated with DVT. RESULTS Seventy-seven children met inclusion criteria, 23 (29.9%) had a DVT detected in an extremity. On univariable analysis, children with DVT identified in an extremity had prolonged CVL use (14 vs. 8.5 days, p = .021) and longer duration of mechanical ventilation (15 vs. 10 days, p = .013). HTS 3% equivalent ml/kg was not different between groups. On multivariable analysis, mechanical ventilation duration was associated with DVT detection in an extremity, whereas neither CVL duration nor HTS use had an association. CONCLUSIONS There was a high incidence of extremity DVT detected in children with sTBI who received invasive mechanical ventilation and had a CVL. HTS administration was not associated with DVT detection in an extremity.
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Affiliation(s)
- Marlina E Lovett
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Megan Daniel
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer MacDonald
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Vilmarie Rodriguez
- Department of Pediatrics, Division of Hematology and Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA.,Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Eric A Sribnick
- Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Surgery, Division of Neurosurgery, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Nicole F O'Brien
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Onsy Ayad
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio, USA
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Armstrong M, Lun J, Groner JI, Thakkar RK, Fabia R, Noffsinger D, Ni A, Keesari R, Xiang H. Mobile phone virtual reality game for pediatric home burn dressing pain management: a randomized feasibility clinical trial. Pilot Feasibility Stud 2022; 8:186. [PMID: 35982492 PMCID: PMC9386208 DOI: 10.1186/s40814-022-01150-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Virtual reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital. This study addressed the potential effectiveness and feasibility of a VR game that was developed by our research team for repeated at-home burn dressing changes. METHODS A randomized clinical trial was conducted among patients recruited from the outpatient burn clinic of a large American Burn Association-verified pediatric burn center between September 2019 and June 2021. We included English-speaking burn patients aged 5-17 years old requiring daily dressing changes for at least 1 week after first outpatient dressing change. One group played an interactive VR game during dressing changes, while the other utilized standard distraction techniques available in the home for up to a week. Both child and caretaker were asked to assess perceived pain on a numerical rating scale (NRS) of 0-10. For the VR group, patients were also asked to rate various aspects of the VR game on a NRS of 0-10 and caregivers were asked questions assessing ease of use. RESULTS A total of 35 children were recruited for this study with 24 fully completing study measures. The majority of participants were male (n=19, 54.3%), White (n=29, 82.9%), and with second degree burns (n=32, 91.4%). Children and caregivers in the VR group reported less pain than the control group at the 4th dressing change. Participants in the VR group showed a clinically meaningful (≥30%) reduction in child-reported overall pain (33.3%) and caregiver-reported worst pain (31.6%) in comparison with subjects in the control group. Children's satisfaction with the VR remained at a high level across dressing changes over the 1-week period, with reported realism and engagement increasing over time. Over half of the children (54.5%) enjoyed playing the game and did not report any challenges nor any side effects. CONCLUSIONS Subjects found the VR to be a useful distraction during home dressing changes and reported no challenges/side effects. VR should be considered as a nonpharmacologic companion for pain management during at-home burn dressing changes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04548635. Registered September 14, 2020-retrospectively registered.
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Affiliation(s)
- Megan Armstrong
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jonathan Lun
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Jonathan I Groner
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Rajan K Thakkar
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Renata Fabia
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - Dana Noffsinger
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ai Ni
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Rohali Keesari
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Road, Atlanta, GA, 30322, USA
| | - Henry Xiang
- Center for Pediatric Trauma Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA.
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10
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Westphal K, Basuray RG, Keesari R, Jackson K, Reber K, Cacioppo C, Splinter A, Bode RS. Neonatal Use of Acute Care Services During the COVID-19 Pandemic. Hosp Pediatr 2022; 12:e190-e198. [PMID: 35506337 DOI: 10.1542/hpeds.2021-006397] [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: 11/24/2022]
Abstract
OBJECTIVE To describe changes in neonatal use of acute care services during the coronavirus disease 2019 (COVID-19) pandemic. We hypothesized neonatal visits would decrease and the degree of decline would vary by condition. METHODS We conducted a retrospective cohort study of neonatal visits to the urgent cares, emergency departments, inpatient units, and intensive care units at a free-standing pediatric healthcare system during the COVID-19 pandemic and a comparator period. We included visits of infants presenting for acute care within the first 30 days of life. Transfers from a referring nursery, inpatient unit, or ICU were excluded. Data collected included demographics, patient characteristics, and visit characteristics. Descriptive statistics and χ2 tests were used for analyses and to determine statistically significant differences. RESULTS We identified 4439 neonatal acute care visits, of which 2677 occurred in the prepandemic period and 1762 in the COVID-19 pandemic period, representing a 34.2% decline. Urgent cares and emergency departments experienced the greatest decline in visits for infectious conditions (49%) and the proportion of these visits also significantly decreased. Similarly, the largest clinically significant declines in hospitalizations were for infectious and respiratory diagnoses (48% and 52%, respectively) and the proportions of these hospitalizations also significantly decreased. Despite a small decline in hospitalizations for jaundice, the proportion of jaundice hospitalizations significantly increased by 5.7% (P = .02). CONCLUSIONS The COVID-19 pandemic was associated with a significant reduction in neonatal visits across a spectrum of acute care settings. The impact on use varied by diagnosis with the most notable decline in visits for infectious conditions.
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Affiliation(s)
- Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Rakhi Gupta Basuray
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Rohali Keesari
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio
| | - Kenneth Jackson
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio.,Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kristina Reber
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Carrie Cacioppo
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ansley Splinter
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ryan S Bode
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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11
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Thakkar RK, Penatzer J, Simon S, Steele L, Fabia R, Groner JI, Keesari R, Hall M. Measures of Adaptive Immune Function Predict the Risk of Nosocomial Infection in Pediatric Burn Patients. J Burn Care Res 2022; 43:1416-1425. [PMID: 35436346 PMCID: PMC9629438 DOI: 10.1093/jbcr/irac050] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thermal injury results in changes in the inflammatory and innate immune response of pediatric patients. Plasma cytokines, cellular profiles, and reduction in innate immune function following burn injury has also been correlated to adverse outcomes (e.g., mortality and infectious complications). Changes in adaptive immune function following thermal injury are not as well characterized. Our goal was to better understand if adaptive immune dysfunction occurs early after pediatric thermal injury and is a risk factor for nosocomial infections (NI). A prospective, longitudinal immune function observational study was performed at a single ABA-verified pediatric burn center. Eighty burn patients were enrolled with 20 developing a NI, defined using CDC criteria. We collected whole blood samples from pediatric burn patients within the first 72 hours from injury and between days 4-7, where applicable to analyze adaptive immune function. We compared immune function between burn patients who went on to develop NI and those that did not. Within the first 72 hours of injury, burn patients who developed NI had significantly lower absolute CD4+ lymphocyte counts and whole blood ex vivo phytohemagglutinin (PHA)-induced IFNγ and IL-10 production capacity compared to those that did not develop infection. Further analysis using receiver operating characteristic curve revealed that PHA-induced IL-10 production capacity had the highest area under the curve. Our data demonstrates early adaptive immune suppression occurs following pediatric thermal injury and PHA-induced IL-10 production capacity appears to be a predictor for the development of NI.
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Affiliation(s)
- Rajan K Thakkar
- Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Clinical and Translation Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Julia Penatzer
- Center for Clinical and Translation Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Shan Simon
- Center for Clinical and Translation Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lisa Steele
- Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Renata Fabia
- Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jonathan I Groner
- Department of Pediatric Surgery, Burn Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rohali Keesari
- Biostatistics Resource, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Mark Hall
- Center for Clinical and Translation Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Biostatistics Resource, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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12
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Coletta C, Kraft M, Keesari R, Prince B, Mikhail I, Scherzer R, Mustillo P. Timing of Allergy Skin Testing Following Food-Induced Anaphylaxis. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.374] [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: 12/01/2022]
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13
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Medeiros T, Bui V, Almekdash MH, Keesari R, Lee YR. Rate control with intravenous diltiazem, verapamil, and metoprolol in acute atrial fibrillation with rapid ventricular rate. SAGE Open Med 2021; 9:20503121211017756. [PMID: 34104435 PMCID: PMC8155749 DOI: 10.1177/20503121211017756] [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: 07/03/2020] [Accepted: 04/24/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Diltiazem is a preferred agent for rate control in atrial fibrillation due to
its quick onset, minimal side effects, and low cost. Due to its intermittent
national shortage since February 2018, the utilization of intravenous
metoprolol and verapamil has increased. This study investigated the effect
of intravenous diltiazem, metoprolol, and verapamil on rate control in
patients with atrial fibrillation with rapid ventricular rate. Methods: This study was a retrospective, single-center, cohort study conducted in
patients with acute atrial fibrillation receiving intravenous diltiazem,
metoprolol, or verapamil for rapid ventricular rate between 1 January 2012
and 31 August 2018. The primary outcome was the incidence of patients who
achieved a rate less than 100 bpm within 1 h of treatment. Secondary
outcomes included time to achieve rate control, heart rate at 30 min and 1 h
after administration, bradycardia and hypotension incidence, the requirement
of other rate control agent(s), inpatient admission, length of stay, and
mortality. Results: A total of 73 patients were included in the study. At 1 h after receiving the
initial rate control drug, there was no statistically significant difference
between diltiazem, metoprolol, and verapamil in achieving rate control.
Median time to ventricular rate control was 166 min in the diltiazem group,
297 min in the metoprolol group, and 100.5 min in the verapamil group. Conclusion: There was no difference in achieving rate control when using intravenous
diltiazem, metoprolol, or verapamil. Any of the three rate control agents
may be used for rate control. However, further studies are needed to
determine which agent is superior for rate control.
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Affiliation(s)
- Tia Medeiros
- Hendrick Medical Center, Abilene, TX, USA.,Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA
| | - Vi Bui
- Hendrick Medical Center, Abilene, TX, USA
| | - Mhd Hasan Almekdash
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rohali Keesari
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Young R Lee
- Hendrick Medical Center, Abilene, TX, USA.,Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Abilene, TX, USA
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14
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Gomez J, Shehabeldin M, Almekdash MH, Keesari R, Alderazi YJ. Angiographic And Clinical Response Of Intracranial Atherosclerotic Disease Large Vessel Occlusion Stroke Undergoing Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2020; 29:105148. [PMID: 32912534 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105148] [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: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To identify whether intracranial atherosclerotic disease large vessel occlusion strokes differ compared to embolic large vessel occlusion strokes in angiographic response to mechanical thrombectomy and clinical course. METHODS Retrospective analysis of acute ischemic stroke patients with large vessel occlusion, due to intracranial atherosclerotic disease or embolic etiology, who underwent mechanical thrombectomy in a primary stroke center from 11/2015 to 4/2018. We categorized patients into intracranial atherosclerotic disease or embolic large vessel occlusion based on the procedural findings. We compared pretreatment, procedural variables, and post-procedural outcomes. RESULTS Ninety-five patients were included, 13 with intracranial atherosclerotic disease large vessel occlusion strokes and 82 with embolic large vessel occlusion strokes. Between the two groups, there was no statistically significant difference in angiographic success (100% for intracranial atherosclerotic disease and 89% for embolic large vessel occlusion strokes); first pass success (38% for intracranial atherosclerotic disease and 34% for embolic large vessel occlusion strokes); puncture-to-first-pass time; puncture-to-recanalization time (68 minutes for intracranial atherosclerotic disease and 62 minutes for embolic large vessel occlusion strokes); number of passes; or clinical outcomes. Intracranial angioplasty was performed in 6 (46%) of intracranial atherosclerotic disease large vessel occlusion patients, and in 5 (6%) of embolic large vessel occlusion patients (p < 0.0001). CONCLUSIONS Similar angiographic success and procedural time metrics are achievable with intracranial atherosclerotic disease large vessel occlusion and embolic large vessel occlusion therapy. This occurred with more frequent intracranial angioplasty for intracranial atherosclerotic disease large vessel occlusion strokes.
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Affiliation(s)
- Juliana Gomez
- Department of Neurology. Texas Tech University Health Science Center, School of Medicine, 3601 4th Street, RM 3A105, Lubbock, TX 79430, USA.
| | - Mohamed Shehabeldin
- Department of Neurology Texas Tech University Health Science Center, School of Medicine, Lubbock, Texas, USA
| | - Mhd Hasan Almekdash
- Clinical Research Institute. Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Rohali Keesari
- Clinical Research Institute. Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Yazan J Alderazi
- Department of Neurology Texas Tech University Health Science Center, School of Medicine, Lubbock, Texas, USA; Department of Neurology University of Texas Health Sciences Center at Houston, School of Medicine, Houston, Texas, USA
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15
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Weaver PE, Smith LA, Sharma P, Keesari R, Al Mekdash H, de Riese WT. Quantitative measurements of prostate capsule and gland density and their correlation to prostate size: possible clinical implications in prostate cancer. Int Urol Nephrol 2020; 52:1829-1837. [PMID: 32506207 DOI: 10.1007/s11255-020-02527-6] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To study histo-anatomical imaging features and possible association between prostate volume, capsule thickness and glandular density within the peripheral zone (PZ) of prostates of different sizes. METHODS Patients were selected who had undergone radical prostatectomy. Specimen selection was based on two factors: first, easy reconstruction of prostate anatomy by the histological slides; and second, based on prostate size. Specimens were chosen with small (< 35 cc) and also with large size (> 80 cc). A total of 20 patients were selected. None of these patients had undergone previous treatment. Computer-based imaging for quantitative measurements of capsule thickness and glandular density within the PZ were performed. Multiple regression analysis was performed to determine the relationship between these measured parameters and the clinical characteristics of these patients. RESULTS Multiple regression analysis revealed a strong, positive association between prostate size and average capsule thickness; on the contrary, we found a negative correlation between prostate volume and average glandular density. Fibrotic thickness of the capsule was associated with gland atrophy and decreased gland density within the PZ. CONCLUSIONS The results suggest that BPH may be associated with the development of fibrosis and gland atrophy within the peripheral zone. As 80% of prostate cancer originates from the glandular epithelium within the peripheral zone, this observed phenomenon may explain the inverse relationship between BPH and incidence of prostate cancer well documented in the literature.
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Affiliation(s)
| | - Lisa A Smith
- Department of Pathology, Texas Tech University Health Sciences Center, 3601 4th Street, MS7260, Lubbock, TX, 79430-7260, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, 3601 4th Street, MS7260, Lubbock, TX, 79430-7260, USA
| | - Rohali Keesari
- Clinical Research Institute, Texas Tech University Health Sciences Center, 3601 4th Street, MS7260, Lubbock, TX, 79430-7260, USA
| | - Hasan Al Mekdash
- Clinical Research Institute, Texas Tech University Health Sciences Center, 3601 4th Street, MS7260, Lubbock, TX, 79430-7260, USA
| | - Werner T de Riese
- Department of Urology, Texas Tech University Health Sciences Center, 3601 4th Street, MS7260, Lubbock, TX, 79430-7260, USA.
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16
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Gautam B, Rogge MM, Acharya N, Keesari R, Almekdash MH. Obesogenic Toxicants in Breast Milk of Lactating Women: Investigation of a Risk Factor for Childhood Obesity. Biol Res Nurs 2020; 22:295-301. [DOI: 10.1177/1099800420909151] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Persistent organic pollutants (POPs), dispersed in all environmental compartments, are associated with increased adipogenesis and body weight. These lipophilic toxicants bioaccumulate in the human body and get transferred from mothers to their offspring via the placental circulation and breast milk. The current study was designed to compare polychlorinated biphenyl (PCB) and hexachlorobenzene (HCB) concentrations between obese and normal-weight lactating women. Methods: A cross-sectional correlation design was used to compare POP concentrations in breast milk samples of 24 obese and 21 normal-weight adult lactating women at their 2- to 8-week postpartum clinic visit. Concentrations of 12 specific PCB congeners and HCB were analyzed using high-resolution gas chromatography coupled with mass spectroscopy. Results: Of 12 targeted PCB congeners, 6 were detected in the breast milk samples of obese women compared to 3 in normal-weight lactating women. PCB presence was not significantly different between the obese and normal-weight groups. HCB was not detected in any of the breast milk samples for either group. Conclusions: This exploratory study revealed no statistically significant difference in the presence of PCBs in breast milk of obese mothers compared to that of normal-weight women. Therefore, fear of increased risk of transmission of these toxicants may not be a good reason to avoid breastfeeding. Results point to the need for a large-scale multicenter study that examines the effect of PCBs on breastfeeding, considering possible geographic variations of the examined phenomenon.
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Affiliation(s)
- Bibha Gautam
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mary M. Rogge
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Narayan Acharya
- Department of Environmental Toxicology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rohali Keesari
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Mhd Hasan Almekdash
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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