Factors Influencing Visits to the Pediatric Emergency Department.

Introduction Overcrowding in emergency departments (EDs) is still a national and international issue. Among the variables contributing to this crisis are an increase in patient numbers and the severity of sickness. One significant issue that has not yet been addressed and is burdening healthcare facilities is the use of EDs by parents of children who have mild illnesses. Developing successful interventions requires an understanding of the factors that lead to nonurgent visits to pediatric EDs (PEDs). Our objective was to assess the variables that could influence parental visits to PEDs. Methodology In the Eastern Region of Saudi Arabia, between September and November 2023, a descriptive cross-sectional survey was conducted among parents who had previously visited a PED. The survey had 21 questions. Along with parental viewpoints and healthcare utilization, parents' evaluations of their child's emergency state were investigated. In addition to gathering and evaluating demographic data, the survey evaluated respondents' impressions of the severity of a disease or injury. Results A total of 776 participants were included in the study. The mean parental age was 32.1 ± 12.7 years, and approximately 32.1% of the participants' children were between the ages of 1 and 5. Nearly half of the children, 44.7%, visited the ED during the evening shift. The most common reasons for presenting were fever (50.5%) and upper respiratory tract symptoms (37.1%). Among these visits, parents perceived 48.5% as nonurgent and 30.2% as urgent. The majority of respondents (54.9%) had received advice before going to the ED. In most cases (47.9%), this was from a relative or a healthcare provider (16.7%). Conclusion This analysis identified some of the reasons parents bring their children to the ED for mild illnesses. The results emphasized the varied nature of the problem. Understanding the reasons for parental ED visits may help us better design targeted interventions to decrease unnecessary visits and lessen the burden on healthcare systems.

Optimal revascularization of segmental pancreatic transplant.

Vascular anastomotic thrombosis is one of the most frequent complications after segmental transplantation of the pancreas (STP). We propose a new type of vascular anastomosis to reduce the rate of vascular thrombosis following STP. For this purpose we used double arterial-double venous anastomosis (DADVA). Four different types of vascular anastomosis used for STP were studied and compared. The rate of vascular anastomotic thrombosis was evaluated in correlation with the type of vascular anastomosis used. Traditional vascular anastomosis (TVA) was complicated by vascular thrombosis in 51.9% of cases. DADVA reduced rate of vascular thrombosis to 2.6% (P < 0.01).

Blood flow in the pancreatic segment before and after transplantation.

BACKGROUND: Blood flow in the pancreas before and after transplantation has not been studied sufficiently. Blood flow in the pancreatic transplant as a function of type vascular anastomosis used has not been explored. AIM: The objective of our study was to study blood flow in the intact pancreas prior to harvesting and at different time periods after transplantation. Two different types of vascular anastomosis were used for segmental transplantation of the pancreas. Blood flow in the transplanted pancreas was compared in this two experimental groups. METHODS: Study was conducted on 61 mongrel dogs. Autotransplantation of a pancreatic segment was performed to the left iliac vessels. There were two randomized experimental groups. In the first group (26 animals) traditional vascular anastomosis was used to revascularize pancreatic graft. Proximal end of splenic artery was anastomosed to iliac artery in "end to side" manner. Portal end of splenic vein was anastomosed to iliac vein in "end to side" manner as well. Splenic ends of splenic artery and vein were ligated. In the second group (35 animals) double arterial double venous anastomosis was used. For this purpose, after completing traditional vascular anastomosis, second arterial anastomosis was created distal to the first one between distal end of splenic artery and iliac artery in "end to side" fashion. Second venous anastomosis was performed distal to the first one between splenic end of splenic vein and iliac vein in "end to side" fashion. Blood flow in the pancreatic segment was measured using direct blood flow measurement method and electromagnetic flowmetry. After transplantation of pancreatic segment, blood flow was measured in the pancreatic graft 3 min, 1 h, 1 and 6 months following transplantation. RESULTS: Blood flow in the pancreas before harvesting was 0.69 +/- 0.01 ml/min/g. Blood flow in the pancreatic transplant in traditional vascular anastomosis group was higher than blood flow in the normal pancreas (1.13 +/- 0.05 ml/min/g after one month and 1.00 +/- 0.05 ml/min/g after six months (p < 0.01)). Blood flow in the double arterial double venous anastomosis group was not statistically significantly different from blood flow in the normal pancreas at 1 and 6 months after transplantation (0.70 +/- 0.02 and 0.67 +/- 0.02 ml/min/g accordingly). CONCLUSION: Double arterial double venous anastomosis provided more physiological blood flow to the graft, than traditional vascular anastomosis.

Serum levels of interleukin 1 and tumor necrosis factor alpha correlate with peritoneal adhesion grades in humans after major abdominal surgery.

Peritoneal adhesions are a leading cause of potential morbidity and mortality. We undertook this prospective study to determine the clinical relevance of interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF-alpha) levels as biological markers for peritoneal adhesion formation in humans. Fifteen patients who had previous colectomies and were undergoing re-exploration for an elective vascular procedure were studied. Blood samples were collected from each patient preoperatively and 30 minutes after the abdominal incision was made. Serum levels of IL-1 and TNF-alpha were determined using enzyme-linked immunosorbent assay kits. Adhesions were graded using an adhesion scale of 0 (none), 1 (mild), 2 (moderate), and 3 (extensive, dense). Preoperative levels of IL-1 and TNF-alpha did not differ significantly among all patients (IL-1 level was 60 +/- 14 pg/mL, and TNF-alpha level was 45 +/- 11 pg/mL; mean +/- standard deviation). Significant correlation was observed between grades of adhesions and early intraoperative levels of IL-1 [101 +/- 36 pg/mL for grade 1 (n = 8) vs 298 +/- 73 pg/mL for grade 3 (n = 6); P < 0.01] and TNF-alpha (88 +/- 23 pg/mL for grade 1 vs 261 +/- 88 mL for grade 3; P < 0.02). We conclude that early elevations of IL-1 and TNF-alpha are reliable biological markers for postoperative adhesions in humans. Studies utilizing cytokines antibodies to these markers may further elucidate the efficacy of this method for prevention of peritoneal adhesions.

Effect of triiodothyronine augmentation on rat lung surfactant phospholipids during sepsis.

Surfactant functional effectiveness is dependent on phospholipid compositional integrity; sepsis decreases this through an undefined mechanism. Sepsis-induced hypothyroidism is commensurate and may be related. This study examines the effect of 3,3',5-triiodo-L-thyronine (T3) supplementation on surfactant composition and function during sepsis. Male Sprague-Dawley rats underwent sham laparotomy (Sham) or cecal ligation and puncture (CLP) with or without T3 supplementation [CLP/T3 (3 ng/h)]. After 6, 12, or 24 h, surfactant was obtained by lavage. Function was assessed by a pulsating bubble surfactometer and in vivo compliance studies. Sepsis produced a decrease in surfactant phosphatidylglycerol and phosphatidic acid, with an increase in lesser surface-active lipids phosphatidylserine and phosphatidylinositol. Phosphatidylcholine content was not significantly changed. Sepsis caused an alteration in the fatty acid composition and an increase in saturation in most phospholipids. Hormonal replacement attenuated these changes. Lung compliance and surfactant adsorption were reduced by sepsis and maintained by T3 treatment. Thyroid hormone may have an active role in lung functional preservation through maintenance of surfactant homeostasis during sepsis.

Effects of interleukin-6 and its neutralizing antibodies on peritoneal adhesion formation and wound healing.

This study investigates the effects of preoperative IV administration of IL-6 and anti IL-6 on peritoneal adhesion formation and wound healing. Thirty-six male Sprague-Dawley rats (350-400 mg) were divided into three groups: control (group 1); IL-6 (group 2); and anti IL-6 (group 3). Under sterile conditions, all rats underwent a midline laparotomy. Ten cm2 of cecal serosa was abraded, the cecum further irritated with 0.1 ml of 70 per cent alcohol, and the incision closed in layers. At 3 weeks, peritoneal adhesions were graded using a score of 0 (none) to 3 (extensive, dense). Skin samples from incisional sites were examined tensiometrically (true stress and true strain), biochemically (collagen content), and histologically. Adhesion formation score was significantly increased in IL-6 group (2.78 +/- 0.44, Mean +/- SD) and decreased in anti IL-6 group (1.40 +/- 0.52) compared to control (2.00 +/- 0.50). (P < 0.03 by Kruskal Wallis test). There was no significant difference in true stress, true strain, and collagen content between the two treatment groups and controls at the 0.05 level by ANOVA. Histological analysis showed higher number of inflammatory cells and fibroblasts in IL-6 treated groups. We conclude that IL-6 plays a major role in peritoneal adhesion formation. Selective immunosuppression, using IL-6 neutralizing antibodies preoperatively, leads to a reduction of such adhesion formation without a significant effect on wound healing.

Triiodothyronine (T3) supplementation maintains surfactant biochemical integrity during sepsis.

Surfactant functional effectiveness is dependent on phospholipid compositional integrity: sepsis decreases this through an undefined mechanism. Sepsis-induced hypothyroidism is commensurate and may be related. This study examines the effect of triiodothyronine (T3) supplementation on surfactant function, metabolism, and composition during sepsis. Male Sprague-Dawley rats (n = 75) underwent sham laparotomy or cecal ligation and puncture (CLP) with or without T3 supplementation (CLP/T3; 3 ng/hr). Twenty-four hours later, surfactant was obtained by lavage. Total phospholipids were determined by chromatography. Choline phosphate cytidyltransferase (CT) activity was determined by the formation of cytidine diphosphate (CDP)-choline. In vivo lung compliance was determined by lung inflation; surfactant hysteresis plots were determined on a pulsating bubble surfactometer. Lung compliance and surfactant hysteresis plots were significantly affected by sepsis; T3 modulated this (dynamic compliance: sham = 0.66 +/- 0.02, CLP = 0.47 +/- 0.06, CLP/T3 = 0.56 +/- 0.02 mm Hg/mL; p < 0.05). Sepsis produced a decrease in phosphatidylglycerol, and phosphatidic acid, with an increase in lesser surface active lipids phosphatidylserine and phosphatidylinositol. Hormonal replacement prevented these alterations. Lung CT activity was increased by sepsis independent of T3 treatment. Thyroid hormone may have an active role in lung functional preservation during sepsis caused by maintenance of surfactant biophysical and compositional homeostasis.