Time considerations and outcomes in pediatric tracheostomy decannulation.

OBJECTIVE: The study objective is to identify factors that impact the time to decannulation in pediatric patients ages 0 through 18 years who are tracheostomy-dependent. METHODS: This retrospective chart review from January 1, 2005 through December 31, 2020 identified pediatric tracheostomy patients at a single pediatric institution. Data extracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time with tracheostomy. RESULTS: Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with median of 24 months (IQR 12.91-45.71). In the multivariate analysis, patients with bronchopulmonary dysplasia (p = 0.021) and those with Passy-Muir® Valve at discharge (p = 0.015) were significantly associated with decannulation. In contrast, neurologic comorbidities (p = 0.06), presence of gastrostomy tube (p < 0.001), or discharged on a home ventilator (p < 0.001) were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient otolaryngology care, time to decannulation was delayed by 0.5 months (p = 0.010). For each additional outpatient otolaryngology follow-up visit, time to decannulation increased by 3.36 months (p < 0.001). CONCLUSIONS: Decannulation in pediatric tracheostomy patients is multifactorial. While timely establishment of outpatient care did correlate with quicker decannulation, factors related to medical complexity may have a greater impact on time to decannulation. Our results can help guide institutional decannulation protocols, as well as provide guidance when counseling families regarding tracheostomy expectations.

Ecological and Human Health Risk Assessment of Heavy Metals in Cultured Shrimp and Aquaculture Sludge.

Shrimp is one of the major export products in South Asian countries and also an eminent source of nutrition for humans. Hence, any negative effect of this industry may affect not only the country's economy but also human health. Therefore, in this study, we aimed to assess heavy metal contamination and associated human health risks in cultured shrimp (Penaeus monodon) and aquaculture sludge collected from three shrimp farms of the Cox's Bazar district, Bangladesh. The results showed that among the eight metals studied, Pb (17.75 ± 1.5 mg/kg) and Cu (9.43 ± 2.8 mg/kg) levels in all shrimp samples were higher than the recommended limit, whereas the concentrations of Cd (0.09 ± 0.03 mg/kg), Mn (4.83 ± 2.2 mg/kg), As (0.04 ± 0.02 mg/kg), Hg (0.02 ± 0.006 mg/kg), Zn (18.89 ± 2.9 mg/kg) and Cr (0.69 ± 0.6 mg/kg) were within the permissible level. The concentrations of Mn (1043.37 ± 59.8 mg/kg), Cr (30.38 ± 2.1 mg/kg), Zn (74.72 ± 1.13 mg/kg) and Cu (31.14 ± 1.4 mg/kg) in the sludge of all farms were higher than the recommended limit, whereas the concentrations of Pb (20.23 ± 1.9 mg/kg), Cd (0.09 ± 0.2 mg/kg), As (0.44 ± 0.34 mg/kg) and Hg (0.08 ± 0.02 mg/kg) in all sludge samples were lower than the threshold limits. However, the estimated daily intake (EDI), targeted hazard quotient (THQ) and hazard index (HI) assessed for potential human health risk implications suggested that Pb and Cr may pose non-carcinogenic health effects, although carcinogenic risks (CR) values were acceptable for consumers. However, the pollution load index (PLI) of the studied area was below 1, which indicates low deterioration of the area. Geoaccumulation index (Igeo) and contamination factor (CF) analyses revealed that study area is unpolluted and sludge is enriched with metals in the following order: Mn > Zn > Cu > Cr > Cd > Hg > Pb > As.

Telemedicine for the pediatric preoperative assessment during the COVID-19 pandemic: Evaluating patient and provider satisfaction.

The COVID-19 pandemic has presented unprecedented challenges in delivering healthcare to surgical patients. To avoid delays in patient care while still minimizing COVID-19 infection risk to patients and providers, anesthesiology preoperative clinics were presented with the opportunity to implement telemedicine to assess patients' risks prior to surgery. This study explores patient and provider satisfaction with video-based telemedicine preoperative clinic visits during the COVID-19 pandemic via a patient and provider satisfaction survey. A vast majority (>93%) of patients expressed overall satisfaction with telemedicine visits. Similarly, >85% of providers agreed with the benefits of and expressed overall satisfaction with the preoperative telemedicine visits. Overall, patient and provider study participants had positive feedback in response to anesthesia preoperative telemedicine visits. Future studies could assess the preference of telemedicine to in-person visits once the fears of COVID-19 spread have been mitigated, as well as an assessment of outcomes comparing telemedicine and in-person visits.

Do healthcare disparities play a role in pediatric testicular torsion? - Analysis of a single large pediatric center.

INTRODUCTION: Healthcare disparities have been shown to impact outcomes of various acute pediatric conditions. We sought to examine the impact of race, ethnicity and insurance status on the presentation, management and outcome of testicular torsion. MATERIALS AND METHODS: A retrospective review of a prospectively maintained testicular torsion database was performed. Patients ≤18 years of age evaluated in our pediatric institution's emergency room between April 2016-April 2020 with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR and orchiectomy rate were extracted and compared. P < 0.05 was considered statistically significant. RESULTS: A total of 206 patients were included. 114 (56.2%) were Black or African American (Black/AA), 43 were (21.2%) Hispanic/Latino, 22 (10.8%) were Caucasian, and 24 (11.8%) were designated as Other races. Ninety-eight (48.3%) patients had Medicaid, 90 (44.3%) had private insurance, and 15 (7.4%) patients were uninsured. Sixty-eight (33.0%) presented in a delayed fashion (>24 h). Compared to the Caucasian patients, Black/AA patients were 2.1 years (95% CI: 0.5, 3.8; P = 0.010) older at the time of presentation. When compared to those with Medicaid insurance, uninsured patients had 6.26 times (95% CI: 1.58, 41.88; P = 0.021) higher odds to be referred from an outside hospital for management. In those patients presenting acutely (<24 h, N = 138), there were no significant differences in the odds of orchiectomy for Black/AA or Hispanic/Latino patients when compared to Caucasian patients, however, the odds of orchiectomy in Other races (non-Caucasian, non-Black/AA, non-Hispanic/Latino) was significantly higher (OR: 10.38; 95% CI: 1.13, 246.96; P = 0.049). While the mean time in minutes from ED to OR was longer in those with Medicaid insurance (141 vs 125.4 private vs 115 uninsured, p = 0.042), this did not impact orchiectomy rate (39.8% vs 40.9% vs 46.7%, p = 0.88). CONCLUSIONS: We found no differences in the orchiectomy rates by race with the exception of a higher rate in the diverse and heterogeneous Other race (non-Caucasian, non-Black/AA, non-Hispanic/Latino) group. Those uninsured had a higher referral rate highlighting the potential existence of disparities for those uninsured and the need for further investigation.

Socioeconomic factors associated with readmission following pediatric tonsillectomy.

OBJECTIVES: We aim to analyze factors associated with readmission after tonsillectomy to understand socioeconomic factors associated with readmission. METHODS: Single institution retrospective study of pediatric patients undergoing tonsillectomy over an 8 year study period, comparing patients who required readmission for bleeding concerns or pain/dehydration to those who did not require readmission. RESULTS: Of the 14,152 tonsillectomy patients, 508 (3.6%) were readmitted with 423 (83.3%) for bleeding concerns and 85 (16.7%) for pain or dehydration. Overall readmission was more likely in age >6 years (OR: 1.61, 95% CI: 1.34-1.92, P < 0.001), while poverty level below 10% (OR: 0.79, 95% CI: 0.66-0.94, P = 0.008) and parental college education above 25% (OR: 0.79, 95% CI: 0.65-0.96, P = 0.016) were associated with lower incidence of overall readmission. For patients readmitted for bleeding concerns, age >6 years (OR 1.66, 95% CI: 1.37-2.02, P < 0.001) was associated with readmission on multivariate analysis. Within the pain/dehydration group, African American race was associated with increased readmission rates, while poverty level below 10% and parental college education above 25% were associated with decreased readmission rates. CONCLUSION: Socioeconomic factors and age play a role in readmission rates following pediatric tonsillectomy.

Epidemiology and healthcare utilization of inpatient admissions in children with pediatric intestinal pseudo-obstruction.

BACKGROUND: Pediatric intestinal pseudo-obstruction is a rare disorder affecting gastrointestinal motility leading to chronic symptoms and hospitalizations. There is limited understanding of the epidemiology and healthcare burden. METHODS: We analyzed data from Kids' Inpatient Database from 2016, which includes inpatient discharge records from US hospitals. ICD-10 codes were used to identify patients 0-18 years with pediatric intestinal pseudo-obstruction and comorbid conditions. Multivariable logistic regression and Wilcoxon rank-sum test were used. RESULTS: In 2016, there were 1671 inpatient discharges from US hospitals for patients 0-18 years of age with this diagnosis. The incidence of inpatient admission was 29/100 000 patients. After controlling for age, race, income status, and insurance, males vs females (adjusted odds ratio, aOR: 1.10; 95% CI: 0.94-1.28; P = .241) and caucasians vs other races (aOR: 1.55; 95% CI: 1.27-1.88; P < .001) were more likely to be admitted. Inpatient admissions incurred significant healthcare burden; median (inter quartile range IQR) cost of hospitalization of US$ 52 079 (US$ 23 530-120 961) and a median (IQR) length of stay of 6 days (3-14 days). Gastrostomy (32%) and ileostomy (12.6%) status appeared to incur lower healthcare burden. Parenteral nutrition, malnutrition, and central line/bloodstream infections resulted in higher healthcare burden. CONCLUSIONS: Pediatric intestinal pseudo-obstruction is a rare diagnosis with a high incidence of inpatient admissions and healthcare burden. An aggressive multidisciplinary management is crucial in reducing inpatient admissions in this cohort.

Assessment of toxic effects of the methanol extract of Citrus macroptera Montr. Fruit via biochemical and hematological evaluation in female Sprague-Dawley rats.

Citrus macroptera Montr. (C. macroptera) is locally known as Satkara. The fruit of this plant is used as appetite stimulant and in the treatment of fever. This study therefore aimed to evaluate the toxic effects of the fruit extract using some biochemical and hematological parameters in rat model. The effects of methanol extract of Citrus macroptera Montr. fruit administered at 250, 500 and 1000 mg/kg body weight were investigated on hematological and biochemical parameters in Sprague-Dawley female rats. Moreover, histopathological study was performed to observe the presence of pathological lesions in primary body organs. The extract presented no significant effect on body weight, percent water content, relative organ weight and hematological parameters in rat. Significant decrease from control group was observed in the levels of triglyceride, total cholesterol, low density lipoprotein and very low density lipoprotein; thus leading to significant decrease of cardiac risk ratio, castelli's risk index-2, atherogenic coefficient and atherogenic index of plasma at all doses. 500 mg/kg dose significantly decreased alkaline phosphatase (P<0.05), 1000 mg/kg dose significantly increased high density lipoprotein cholesterol (P<0.05) and 250 mg/kg dose significantly decreased the level of glycated hemoglobin (P<0.05) from the control group. There were no significant alterations observed with other serum biochemical parameters. Histopathological study confirmed the absence of inflammatory and necrotic features in the primary body organs. Study results indicate that methanolic fruit extract is unlikely to have significant toxicity. Moreover, these findings justified the cardio-protective, moderate hepato-protective and glucose controlling activities of the fruit extract.

Video-based human activity recognition using multilevel wavelet decomposition and stepwise linear discriminant analysis.

Video-based human activity recognition (HAR) means the analysis of motions and behaviors of human from the low level sensors. Over the last decade, automatic HAR is an exigent research area and is considered a significant concern in the field of computer vision and pattern recognition. In this paper, we have presented a robust and an accurate activity recognition system called WS-HAR that consists of wavelet transform coupled with stepwise linear discriminant analysis (SWLDA) followed by hidden Markov model (HMM). Symlet wavelet has been employed in order to extract the features from the activity frames. The most prominent features were selected by proposing a robust technique called stepwise linear discriminant analysis (SWLDA) that focuses on selecting the localized features from the activity frames and discriminating their class based on regression values (i.e., partial F-test values). Finally, we applied a well-known sequential classifier called hidden Markov model (HMM) to give the appropriate labels to the activities. In order to validate the performance of the WS-HAR, we utilized two publicly available standard datasets under two different experimental settings, n??fold cross validation scheme based on subjects; and a set of experiments was performed in order to show the effectiveness of each approach. The weighted average recognition rate for the WS-HAR was 97% across the two different datasets that is a significant improvement in classication accuracy compared to the existing well-known statistical and state-of-the-art methods.