A Prospective Observational Crossover Study Comparing Intubation by Pediatric Residents Using Video Laryngoscopy and Direct Laryngoscopy on a Pierre Robin Simulation Manikin.

INTRODUCTION: Video laryngoscopy (VL) has been proposed to increase the likelihood of successful intubation in patients with predicted difficult airways such as those with Pierre Robin sequence (PRS). Prior studies have focused on the performance of anesthesiologists, who are generally considered airway experts. Our primary aim was to investigate the success rate of intubation using VL compared with direct laryngoscopy (DL) when attempted by pediatric residents on a PRS model. METHODS: Participants were administered a 5-minute refresher video on 2 VL techniques (CMAC, conventional geometry VL, and McGrath, unconventional geometry VL) and DL. The participants were asked to intubate the AirSim PRS infant manikin. The order of VL and DL use was randomly selected. All intubations were video recorded, and the recordings were analyzed by 3 anesthesiologists blinded to the participant's identity and previous experience. RESULTS: Seventeen of 23 residents succeeded in intubating the PRS model using DL. Only 9 residents succeeded in intubating the PRS model using VL (conventional or unconventional geometry). Intubation success rate was higher when comparing DL with VL ( P = 0.04) and similar when comparing VL devices ( P = 0.69). DISCUSSION: Contrary to expectation, the intubation success rate was lower using VL than with DL among pediatric residents. This should be considered when designing residency training and in real-life resuscitation.

Predictors for hospital admission of asymptomatic to moderately symptomatic children after drowning.

Drowning is a leading cause of injury-related death worldwide, but there are limited data on the management and disposition of asymptomatic and mildly symptomatic adults and children following a drowning event. Some authors have recommended admission for all drowning victims due to the possibility of respiratory and clinical deterioration in a seemingly well patient. In order to identify predictors for admission and to establish a unified approach for management, we retrospectively collected all children ≤ 16 years old presented following a drowning event to the pediatric ED over a period of 12 years. The children were divided into two groups, those who were discharged home from the ED and those who were admitted. Seventy-one surviving and non-intubated children were asymptomatic to moderately symptomatic, and they comprised the study group. Crepitations on lung auscultation, oxygen desaturation, and respiratory distress were significantly higher in the admitted group (n = 26) compared with the discharged group (n = 45) (P < 0.05). Respiratory distress and lung crepitations were independent predictors for admission. Eventually, 30% of the hospitalized patients required oxygen therapy, but there were no cases that deteriorated and required invasive ventilation. No readmissions occurred in the group of children who were discharged from the ED.Conclusion: Children who after six hours show no respiratory distress and have normal oxygen saturation and normal auscultation can be safely discharged home. Respiratory distress and lung crepitations should both warrant the physician to consider admission of asymptomatic to moderately symptomatic children following a drowning event. An algorithm to assist patient management is proposed. What is Known: •There are few data in the literature regarding the management and disposition of asymptomatic to moderately symptomatic children after drowning. What is New: •We found that respiratory distress and lung crepitations are independent predictors for admission. An algorithm to assist patient management is proposed.

Angiosarcoma: a tissue microarray study with diagnostic implications.

BACKGROUND: Angiosarcoma (AS) is a rare soft tissue sarcoma showing endothelial differentiation as indicated by morphology and expression of CD31 (blood), D2-40 (lymphatic), factor VIII, and CD34 (both). We sought to examine the pattern of immunohistochemical markers of differentiation in AS and correlate these with outcome. DESIGN: An AS tissue microarray (n = 70 specimens) was constructed for immunohistochemical analysis of CD31, CD34, factor VIII, D2-40, and pan-cytokeratin. Samples on this array were linked to clinicopathologic and outcome data for these patients. Univariate analyses were used to explore disease-specific survival (DSS) factors. RESULTS: Nine metastatic, 23 localized, and 4 recurrent cases were included. Information about the tissue status (ie, primary or metastasis) was unavailable in 4 patients. Primary sites for the tumor included bone (n = 1), breast parenchyma (n = 11), breast skin (n = 4), heart (n = 5), skin (n = 8), soft tissue (n = 7), and unknown (n = 3). Three patients presented with multifocal disease (primary sites in these patients included breast, skin, and soft tissue). Metastatic sites included lung, bone, lymph nodes, brain, liver, and parotid. Of the 40 cases, 8 (20%) showed a pure or predominant epithelioid histology. Of the biomarkers evaluated by tissue microarray, 92% of tumors expressed at least one endothelial marker (factor VIII = 83%, CD31 = 80%, CD34 = 63%, and D2-40 = 43%) with 88% expressing 2 or more markers. Eighty-eight percent of tumors expressing D2-40 coexpressed CD31, an unusual combination in normal vessels. No endothelial marker clearly associated with disease-specific survival. Fifty percent (4/8) of epithelioid cases and 9% (3/32) of nonepithelioid cases showed keratin expression. CONCLUSIONS: Unusual patterns and loss of endothelial markers are common in AS, suggesting use of multiple markers in challenging cases and perhaps indicating important biologic characteristics.

Respiratory syncytial virus bronchiolitis among refugees and asylum seekers from war-torn countries.

BACKGROUND: Bronchiolitis is a prominent illness in children with a high burden in the developing world. Our objective was to assess bronchiolitis severity among infants and toddlers of refugees and asylum seekers who fled from developing countries with high disease burden to a developed country. STUDY DESIGN: A retrospective cohort comparative-group study of children 0-24 months of age who were admitted with a diagnosis of respiratory syncytial virus (RSV) bronchiolitis to a tertiary university-affiliated medical center during 2009-2017. The refugees and asylum seekers (study group) were mostly from war-torn African countries, and the control group was comprised of children from Israel (controls), a developed country. The primary outcome was length of stay (LOS), and the secondary outcomes were nutritional support and disease characteristics. RESULTS: A total of 185 patients were included (92 refugees and 93 controls). The mean LOS was higher for the former compared to the latter (4.7 ± 3.2 vs. 3.5 ± 2 days, respectively, p = .004). More hospitalized refugees required nutritional support compared to controls (48% vs. 24%, respectively, p = .002). No differences were found in vital signs, physical findings and symptoms, laboratory results, or complications. CONCLUSIONS: Refugees and asylum seekers from developing countries presented with a longer RSV bronchiolitis disease course and required more nutritional support compared to their Israeli counterparts. This may suggest a more severe disease.

Prolonged duration of breastfeeding does not affect lipid profile in adulthood.

BACKGROUND: The Hertfordshire study suggested that age of weaning and methods of infant feeding may influence adult serum low-density lipoprotein cholesterol (LDL-C) and mortality from ischemic heart disease in men. Although breastfeeding <1 year appeared to be protective compared with formula, prolonged breastfeeding (>1 year) was associated with increased LDL-C and mortality. This study tested the effect of breastfeeding duration on lipid profile in young adults. MATERIALS AND METHODS: Adult volunteers whose mothers could recall the age at which their child was weaned were recruited. We excluded patients with known dyslipidemia, dyslipidemia in a first-degree relative, obesity (body mass index [BMI] >30 kg/m(2)), pregnant or within 3 months of a previous pregnancy, subjects taking medications that may affect lipid profile, or subjects with a chronic medical condition. Nutritional questionnaires and number of weekly hours of exercise were recorded. Lipid profiles were obtained after a night fast. RESULTS: The three groups (no breastfeeding, breastfeeding 0-6 months, or breastfeeding >9 months) did not differ in terms of age, gender, BMI, level of education, amount of exercise, and dietary style. By stepwise background multiple regression analysis taking into account exercise, nutritional habitus, age, BMI, gender, and socioeconomic status, blood lipids were not affected by duration of breastfeeding. CONCLUSIONS: Duration of breastfeeding does not affect lipid profiles in young adults. These findings do not support negative messages on the long-term effect of prolonged lactation generated by the Hertfordshire study.

Parent-daughter discrepancies in perception of family function in bulimia nervosa.

Eating disorders have traditionally been associated with disturbed family function. Most empirical data regarding this issue, however, were gathered from eating disorders patients. Attitudes, function, and inter-personal relationships were examined within 16 families with a member suffering from bulimia nervosa (BN) and compared to 16 matched healthy families. Perception of family function was significantly more derogatory in bulimic subjects than in their parents, while in control subjects and parents, perception was largely congruent. Subjects suffering from BN perceived their families as less cohesive, adaptable, and supportive than did healthy subjects. No such difference in perception of family function was observed between parents of respective groups. This preliminary study shows that parent-daughter discrepancy in perception of family function may prove more characteristic of eating disorder families than any particular deficit. Future research should aim to replicate these findings, incorporate them into treatment paradigms, and employ them to monitor treatment outcome.

Energy expenditure in growing preterm infants receiving massage therapy.

OBJECTIVE: Massage therapy has been consistently shown to increase weight gain in preterm infants. The mechanism of this presumed improved metabolic efficiency is unknown. We conducted the following trial to test the hypothesis that massage therapy reduces energy expenditure in growing healthy preterm infants. STUDY DESIGN: A prospective, randomized, cross-over design study was conducted in 10 healthy, appropriate weights for gestational age, gavage fed preterm infants. Each infant was studied twice: after a period of either 5 days of massage therapy, or after a period of 5 days without massage therapy. Infants were randomized to 5 days of massage followed by 5 days of no massage (n = 5) or the opposite sequence (n = 5). During the massage therapy period, massage was provided daily for three 15 minute periods at the beginning of each 3 hour period every morning. Metabolic measurements were performed by indirect calorimetry, using the Deltatrac II Metabolic cart. RESULTS: Energy expenditure was significantly lower in infants after the 5 day massage therapy period (59.6 +/- 3.6 Kcal/Kg/ 24 hours) than after the period without (63.1 +/- 5.4 Kcal/Kg/ 24 hours) (p = 0.05). CONCLUSIONS: Energy expenditure is significantly lowered by 5 days of massage therapy in metabolically and thermally stable preterm infants. This decrease in energy expenditure may be in part responsible for the enhanced growth caused by massage therapy.