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INTRODUCTION: Neonatal abdominal reoperation is difficult and can be complicated by abdominal adhesions. Identifying patients who could safely undergo early reoperation would save TPN and central line days, decrease associated infection and liver injury, and NICU and hospital length of stay. We sought to determine if ultrasound (US) could accurately assess the location and severity of adhesions in neonates as an objective dynamic marker capable of informing reoperation timing. METHODS: After IRB approval, we conducted a prospective observational study including neonates undergoing abdominal operations. Patients received surgeon-performed US approximately every 2 weeks until reoperation or discharge. Adhesions were assessed in five zones: right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant (LLQ) and peri-incision (INC). RESULTS: Over a 6-month study period, 16 neonates were enrolled. Median gestational age was 34 weeks at birth and median weight 2.2 kg. 6 underwent reoperation within initial NICU admission. At time of operation US correctly identified the absence or presence and severity of adhesions in: RUQ (3/3); RLQ (6/6); LUQ (4/5); LLQ (6/6); and INC (5/5). CONCLUSION: US can identify location and severity of post-operative adhesions in neonates, potentially identifying patients who can safely undergo reoperation earlier than predetermined wait periods. LEVEL OF EVIDENCE: IV.
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Cavidad Abdominal , Catéteres Venosos Centrales , Recién Nacido , Humanos , Lactante , Reoperación , Segunda Cirugía , UltrasonografíaRESUMEN
Youth gang involvement is a serious public health challenge as adolescents involved in gangs are more likely than others to engage in violence and aggression. To better understand gang involvement, we examined the role of protective (empathy and parental support) and risk (peer deviance and lack of safety at school) factors, as well as their interactions, in predicting adolescent gang affiliation. The study involved a sample of 26,232 students (53.4% females; mean age = 14.62, SD = 1.69) participating in the California Healthy Kids Survey (CHKS), a survey investigating a wide range of youth health and risk behaviors administered in all California schools every 2 years. Using hierarchical linear modeling (HLM), findings indicated that high levels of empathy and parental support were associated with a lower likelihood of affiliating with a gang. Associating with deviant peers and perceiving the school as unsafe were positively correlated with gang membership. At the school level, lack of safety and type of school (special education, vocational, or alternative school vs. comprehensive schools) were associated with greater probability of gang membership. Empathy mitigated the association between deviant peers and gang membership.
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Conducta del Adolescente/psicología , Empatía/fisiología , Relaciones Padres-Hijo , Grupo Paritario , Seguridad/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos , Adolescente , California , Femenino , Humanos , Masculino , Factores Protectores , Factores de Riesgo , Apoyo SocialRESUMEN
Human type I interferons (IFNs) include IFN-ß and 12 subtypes of IFN-α. During viral infection, infiltrating memory CD4(+) T cells are exposed to IFNs, but their impact on memory T-cell function is poorly understood. To address this, we pretreated PBMCs with different IFNs for 16 h before stimulation with Staphylococcus aureus enterotoxin B and measured cytokine expression by flow cytometry. IFN-α8 and -α10 most potently enhanced expression of IFN-γ, IL-2, and IL-4. Potency among the subtypes differed most at doses between 10 and 100 U/mL. While enhancement of IL-2 and IL-4 correlated with the time of preincubation with type I IFN, IFN-γ production was enhanced best when IFN-α was added immediately preceding or simultaneously with T-cell stimulation. Comparison of T-cell responses to multiple doses of Staphylococcus aureus enterotoxin B and to peptide libraries from RSV or CMV demonstrated that IFN-α best enhanced cytokine expression when CD4(+) T cells were suboptimally stimulated. We conclude that type I IFNs enhance Th1 and Th2 function with dose dependency and subtype specificity, and best when T-cell stimulation is suboptimal. While type I IFNs may beneficially enhance CD4(+) T-cell memory responses to vaccines or viral pathogens, they may also enhance the function of resident Th2 cells and exacerbate allergic inflammation.
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Interferón-alfa/inmunología , Células TH1/inmunología , Células Th2/inmunología , Proteínas Bacterianas/química , Proteínas Bacterianas/inmunología , Proteínas Bacterianas/farmacología , Citomegalovirus/química , Citomegalovirus/inmunología , Enterotoxinas/química , Enterotoxinas/inmunología , Enterotoxinas/farmacología , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/inmunología , Humanos , Memoria Inmunológica/efectos de los fármacos , Memoria Inmunológica/inmunología , Interferón gamma/inmunología , Interleucina-2/inmunología , Interleucina-4/inmunología , Masculino , Péptidos/química , Péptidos/inmunología , Péptidos/farmacología , Virus Sincitiales Respiratorios/química , Virus Sincitiales Respiratorios/inmunología , Staphylococcus aureus/química , Staphylococcus aureus/inmunología , Células TH1/citología , Células Th2/citología , Proteínas Virales/química , Proteínas Virales/inmunología , Proteínas Virales/farmacologíaRESUMEN
Introduction: Epigastric hernia repair is a common procedure performed on pediatric patients. These hernias have been demonstrated to be readily identified by ultrasound. This manuscript describes and assesses a novel technique in which ultrasound is used to identify and repair the hernias in a minimally invasive manner. Methods: A retrospective chart review evaluates all the ultrasound-guided epigastric hernia repairs done with prolene suture at one institution over 20 months. Operative details and postoperative complications were compared to patients who underwent traditional open epigastric hernia repair at the same institution during the same time frame. Results: Thirty-two pediatric patients underwent epigastric hernia repair between May 2021 and December 2022. Thirteen (41%) underwent the ultrasound-guided technique with prolene suture and using only a meniscus needle and no incision. Nineteen (59%) underwent standard open repair. There were no recurrences or postoperative complications in either group. The average operative time for the ultrasound hernia repair was 24.4 minutes, which was shorter than the average operative time of 33.6 minutes for the open repair (P = .08). In 3 ultrasound cases (23%), an additional epigastric hernia that had not been clinically apparent was identified and simultaneously repaired. Conclusions: Ultrasound-guided epigastria hernia repair is a feasible alternative to traditional open repair. It has a comparable safety and efficacy profile, has a short operative time, and has the advantages of being minimally invasive and having the ability to identify and repair concurrent epigastric hernias.
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Hernia Ventral , Laparoscopía , Humanos , Niño , Herniorrafia/métodos , Estudios Retrospectivos , Polipropilenos , Laparoscopía/métodos , Hernia Ventral/cirugía , Complicaciones Posoperatorias/etiología , Mallas Quirúrgicas/efectos adversos , Ultrasonografía Intervencional/efectos adversosRESUMEN
BACKGROUND: In 2013, 25.5 million people in the United States self-identified as having limited English proficiency (LEP). LEP in adults has been associated with longer hospital stays, increased adverse events, increased emergency room visits, and decreased understanding of medications prescribed. This study aims to define the relationship between LEP and outcomes in a pediatric oncologic population. METHODS: We performed a matched case-control study utilizing data from our institutional cancer database (children = 18, 2012-2021). LEP families were matched by disease and stage with English proficient (EP) families. Descriptive, univariate, and bivariate analysis were performed. RESULTS: Twenty-four LEP children were identified and matched with 77 EP children. LEP children represented 11 languages, with the most common being Spanish (42%). Statistical regression demonstrated a clinically significant trend for LEP children to have an increased mean number of unexpected hospital admissions (p = 0.04), increased number of clinic cancellations (n = 0.003), and increased emergency department visits (p = 0.05). LEP children were more likely to have Medicaid than commercial insurance (p < 0.001). There was no difference in 2-year event free or overall survival. CONCLUSION: In our study cohort, LEP families are at risk for more negative treatment experiences than EP families. Further studies are needed to delineate specific causes and interventions. TYPE OF STUDY: Retrospective comparative cohort study. LEVEL OF EVIDENCE: Level III.
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Dominio Limitado del Inglés , Neoplasias , Niño , Adulto , Humanos , Estados Unidos/epidemiología , Estudios de Cohortes , Estudios Retrospectivos , Barreras de Comunicación , Estudios de Casos y Controles , Neoplasias/terapiaRESUMEN
BACKGROUND: Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes. METHODS: A retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used. RESULTS: Twenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1-9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75). CONCLUSIONS: Using MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population. LEVEL OF EVIDENCE: Level III.
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Malformaciones Anorrectales , Incontinencia Fecal , Imagen por Resonancia Magnética , Humanos , Estudios Retrospectivos , Masculino , Femenino , Imagen por Resonancia Magnética/métodos , Malformaciones Anorrectales/cirugía , Incontinencia Fecal/etiología , Lactante , Preescolar , Resultado del Tratamiento , Laparoscopía/métodos , Estudios de Seguimiento , Estreñimiento/etiología , Canal Anal/anomalías , Canal Anal/cirugía , Niño , Cirugía Asistida por Computador/métodos , Recto/cirugía , Recto/anomalías , Complicaciones Posoperatorias/etiología , Enema/métodos , Ano Imperforado/cirugía , Ano Imperforado/diagnóstico por imagen , Laxativos/uso terapéutico , Laxativos/administración & dosificaciónRESUMEN
BACKGROUND: Pediatric spontaneous pneumomediastinum is known to have a benign course. Despite this, there is no consensus or standardization for the workup and management. There are often a variety of imaging studies performed for patients with similar presentations. METHODS: This is a retrospective chart review evaluating the presentation, workup, and management of all pediatric patients with a primary diagnosis of spontaneous pneumomediastinum over a 5-year period at a children's hospital. RESULTS: Of the 62 patients, the initial workup consisted of either a chest x-ray (CXR) only (n = 31, 50%), a chest computed tomography scan only (n = 11, 18%) or both (n = 14, 23%); additionally, some patients came with 'other' imaging only (n = 3, 5%) or no imaging (n = 3, 5%). Twenty-seven patients (44%) underwent an additional CXR and 19 (31%) underwent an esophagram. All esophagrams were negative for an esophageal leak. A presenting symptom of pain was associated with a hospital stay of less than 24 h (p = 0.008) while shortness of breath (p = 0.0005) and emesis (p = 0.0006) were associated with a hospital stay of greater than 24 h. Associated diagnoses of respiratory infections (p = 0.02) and gastrointestinal issues (p = 0.006), such as hyperemesis, were associated with inpatient admission. CONCLUSION: Pediatric patients with spontaneous pneumomediastinum benefit from evaluation, management, and treatment based on their presenting symptoms. There is an opportunity to decrease unnecessary radiation exposure in this patient population with fewer CXRs and avoidance of esophagrams, neither of which alter management. LEVEL OF EVIDENCE: Level III.
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Enfisema Mediastínico , Humanos , Niño , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Estudios Retrospectivos , Radiografía , Tomografía Computarizada por Rayos X , DisneaRESUMEN
Objective: During the COVID-19 pandemic, our group implemented preoperative video visits (VVs) to limit physical contact. The aim of this study was to determine caregivers' and providers' perceptions of this practice and to determine feasibility for continuation. Methods: All patients who had only a preoperative VV prior to an elective surgery were identified from March-October 2020. Caregivers, surgeons, and clinic staff were surveyed about their experiences. Results: Thirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit. Of the 31 caregiver surveys completed, the majority strongly agreed that the VV was more convenient (87%, n=27). Eighty-one percent (n=25) strongly agreed or agreed that the VV saved them money. Ninety-four percent (n=29) strongly agreed or agreed that they would choose the VV option again. Caregivers saved an average travel distance of 60.3 miles one way (range 6.1-480). Of the 13/17 providers who responded, 77% (n=10) expressed that the practice should continue. Conclusions: Virtual health became a necessity during the pandemic, and caregivers were overwhelmingly satisfied. Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.
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Background: Using ultrasound guidance has been demonstrated as a feasible alternative method for gastrostomy tube placement in the pediatric population. The aim of this study is to evaluate short- and long-term postoperative complications after ultrasound-guided gastrostomy tube placement (USGTP) and to compare them with complications after laparoscopic gastrostomy tube placement (LGTP). Methods: A retrospective chart review evaluated patients who underwent USGTP (n = 41) and LGTP (n = 120) at the same institution. Comparisons were made between the two groups in the context of demographics as well as 30-day and 6-month postoperative complications. A phone survey (n = 26) further identified USGTP complications potentially not captured in the electronic medical records. Results: There were no significant differences in age, gender, and indication for procedure between the two groups. Chart review revealed that USGTP and LGTP had statistically comparable rates of emergency department (ED) visits for postoperative complications. Among USGTP patients, 8% had a recorded ED visit within 30 days of the operation and 13% presented to the ED within 6 months, compared with 6% and 11%, respectively, in the LGTP group (P = .65, P = .69). The USGTP phone survey reported total complications over an average postoperative follow-up time of 34.6 months (range 8-87) and revealed a total ED visit rate of 35%, which is comparable with rates reported in the literature for minimally invasive feeding tube placement. Conclusion: USGTP is a safe and feasible alternative option for gastrostomy tube placement in the pediatric population and it has postoperative complication rates that are comparable with LGTP.
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Nutrición Enteral , Gastrostomía , Niño , Nutrición Enteral/métodos , Gastrostomía/efectos adversos , Gastrostomía/métodos , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Ultrasonografía Intervencional/efectos adversosRESUMEN
BACKGROUND: Cloacal anomalies occur when a fetus's rectum, vagina, and urethra fail to separate and result in 1 common channel at birth. They are commonly managed by complex reconstruction in the first year of life. This manuscript presents an alternative approach to management in patients with absent or nondilated Mullerian structures. CASE: Image-guided, combined endoscopic and laparoscopic surgery (CELS) was used to perform an anorectal pull-through at 5 months of age on a patient with persistent cloaca and no definite vaginal or uterine structures seen on MRI and endoscopy. Urogenital reconstruction is delayed until adolescence. SUMMARY AND CONCLUSION: We hypothesize that performing a minimally invasive anorectoplasty on patients with complicated anatomy and low risk for hydrocolpos could potentially result in improved urologic function and better psychosocial outcomes. Delaying vaginoplasty will enable determination of the function of remnant Mullerian structures and allow the patient to direct the augmentation approach.
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Hidrocolpos , Laparoscopía , Adolescente , Animales , Cloaca/anomalías , Cloaca/cirugía , Femenino , Procedimientos Quirúrgicos Ginecológicos , Humanos , Hidrocolpos/cirugía , Recién Nacido , Recto/cirugía , Uretra , Vagina/anomalías , Vagina/cirugíaRESUMEN
An autoamputated ovary (AO) is an extremely rare circumstance with a few reports in the literature. We present a case of a 3-month-old girl with a history of vague abdominal symptoms as well as a known ovarian mass, which was initially suspected to be benign and regressing. On laparoscopy for pain and obstructive symptoms, she was found to have an AO. The pathology was consistent with necrotic and torsed ovarian tissue with superimposed infection and possibly a cystic non-malignant teratoma. AOs are thought to originate from a torsion and are typically diagnosed incidentally. This is an interesting case of an AO causing a partial small bowel obstruction.
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Obstrucción Intestinal , Laparoscopía , Neoplasias Ováricas , Teratoma , Femenino , Humanos , Lactante , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/cirugía , Teratoma/diagnóstico , Teratoma/diagnóstico por imagen , Anomalía Torsional/cirugíaRESUMEN
Although links between mental health and intimate partner violence (IPV) have been discussed extensively in the scholarly literature, little empirical data exist about these phenomena in Botswana. This study addressed this gap by examining the nature, extent, and risk factors associated with symptoms of major depressive disorders (MDD) using cross-sectional data collected in 2009-2010 in northwestern Botswana. A random sample of 469 women participated in semistructured interviews about their lives, health, and experiences with violence. Thirty-one percent of respondents were found to meet the symptom criteria for MDD. Factors associated with MDD included emotional or physical violence by an intimate partner and being in a relationship in which both partners consumed alcohol. One in five women reported a recent experience of emotional violence, while 37% of respondents reported recent physical IPV. Women who have experienced emotional or physical IPV in the last 12 months have 89% and 82% greater odds, respectively, of having symptoms of MDD (p < .05) than women who have not recently experienced either form of violence. Women in relationships in which both partners consumed alcohol had more than twice the odds of MDD compared with women in relationships where neither partner or only one partner drank. Given the significant association of violence, alcohol, and MDD, screening for all three conditions should be part of routine care in health care settings in Botswana. Interventions to reduce IPV and alcohol consumption may help alleviate the burden of MDD in women in this setting.
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Trastorno Depresivo Mayor , Violencia de Pareja , Botswana/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Factores de Riesgo , Parejas SexualesRESUMEN
PURPOSE: The aim of this study was to assess the percent decrease in fetal hemoglobin (HbF) after transfusion of adult-derived donor packed red blood cell (pRBC) units in extremely low gestational age newborns (ELGANs). METHODS: Control percent fetal hemoglobin (%HbF) levels were measured in newborn cord blood or peripheral blood samples in non-transfused patients prior to elective surgery. ELGANs were followed prospectively and %HbF was measured on residual post-test complete blood count (CBC) specimens. ELGAN %HbF values were compared to the control population and transfusions were recorded. RESULTS: Initial mean %HbF in ELGANs (n=16) was 92.2±1.3% (range 90.2-95.1%), which is similar to the control group (n=25). Mean levels dropped to 61.1±11.1% (range 34.2-73.2%) after a single pRBC transfusion (n=9) and to a mean of 35.6±6.3% after an additional transfusion (n=5). %HbF levels trended upwards if no additional transfusions were given, but levels still remained lower than expected for gestational age through discharge (n=85 samples). CONCLUSIONS: Percent fetal hemoglobin concentrations in ELGANs decrease precipitously after transfusion with adult donor pRBCs. Further studies are needed to evaluate the benefit of maintaining higher fetal hemoglobin concentrations in these patients and whether administration of HbF rather than adult donor pRBCs would improve patient outcomes.
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Transfusión Sanguínea , Hemoglobina Fetal , Adulto , Transfusión de Eritrocitos , Sangre Fetal , Hemoglobina Fetal/análisis , Edad Gestacional , Humanos , Recién NacidoRESUMEN
Although research assessing the role of self-efficacy in health behaviors in sub-Saharan Africa remains limited, recent research in Botswana suggests that travel time, frequency of visits, and sexual violence influence women's health-seeking. This study used cross-sectional data from 479 women collected in 2012 in Botswana to test the psychometric properties of the Generalized Self-Efficacy Scale (GSE) in Setswana, the local language, as a measure of self-efficacy. Findings confirm the GSE's validity as a unidimensional measure of self-efficacy in this population. Regression analyses suggest that each additional point increase on the Setswana GSE reduces by one third the odds that a woman would forego a clinic visit. Frequency of clinic visits and experiences of sexual violence were also significant predictors. Interventions that enhance self-efficacy may contribute to Botswana's health promotion efforts but will be limited if they fail to address sexual violence and how it is viewed in this setting.
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Aceptación de la Atención de Salud/psicología , Autoeficacia , Adulto , Botswana , Estudios Transversales , Femenino , Humanos , Pruebas PsicológicasRESUMEN
INTRODUCTION: Brenner Tumors are rare adenofibromas that are most commonly benign and discovered in post-menopausal women. PRESENTATION OF CASE: This is a case report of a 57-year-old female with three months of progressively worsening abdominal pain due to a large abdominal mass discovered on CT scan. Surgical removal of the mass revealed a giant mucinous tumor of the ovary with an associated Brenner tumor that was discovered incidentally. DISCUSSION: Although the Brenner tumor was accurately identified in the intraoperative frozen section evaluation, the mucinous tumor was underdiagnosed by frozen section as benign when permanent section revealed borderline mucinous cystadenoma. This finding did not change the treatment course for this particular patient as she had expressed personal preference for total abdominal hysterectomy. However, underdiagnosis of frozen sections of ovarian tumors is not rare. It is unclear whether an associated Brenner tumor increases malignancy potential. CONCLUSION: Further investigation is required to determine whether associated Brenner tumors found during frozen section are more highly associated with malignancy and could therefore change intraoperative and overall decision making.
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Factors characterizing intimate partner violence (IPV) against women vary according to setting and must be understood in localized environments if effective interventions are to be identified. This 2009-2010 exploratory study in Maun, Botswana, used semistructured interviews to elicit information from 469 women about their experiences with IPV. Characteristics found to be important included suicide attempts, childhood exposure to familial violence, access to and control over certain tangible assets, number of children, household location and monthly income, controlling behavior by a partner, and alcohol consumption. Controlling behavior by a partner was the single greatest predictor of physical or psychological IPV.
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Relaciones Interpersonales , Violencia de Pareja/psicología , Adolescente , Adulto , Anciano , Botswana , Estudios Transversales , Femenino , Humanos , Entrevistas como Asunto/métodos , Violencia de Pareja/estadística & datos numéricos , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
Despite evidence suggesting a strong association between women's experience of violence and their health-seeking behaviors, limited research has been conducted to date that explores factors associated with these behaviors in Botswana. A prospective, cross-sectional study involving semi-structured interviews with 479 women took place in Maun, Botswana, in 2012. Twenty-five percent of those interviewed reported not having visited a medical clinic at least once despite wishing to do so. Sequential binary-logistic regressions identified three factors associated with women's health services utilization: travel time, frequency of clinic visits, and experience of recent sexual intimate partner violence (IPV). Women who had experienced recent sexual IPV had over two and a half times the odds of having foregone medical care compared with women with no recent sexual IPV experience. Interventions that identify and encourage victims of sexual violence to seek timely screening and treatment may reduce overall disease burden in this population.