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2.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
4.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289170

RESUMO

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.


Assuntos
Anestesia/métodos , Diencéfalo/patologia , Doenças Hipotalâmicas/patologia , Doenças da Hipófise/patologia , Anestésicos/administração & dosagem , Biópsia , Criança , Insuficiência de Crescimento/etiologia , Humanos , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças Hipotalâmicas/metabolismo , Unidades de Terapia Intensiva Pediátrica/normas , Cuidados Intraoperatórios , Masculino , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Cuidados Pré-Operatórios , Prognóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/métodos
5.
Indian J Gastroenterol ; 38(3): 263-267, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31254168

RESUMO

To ascertain the knowledge, awareness, and practices pertaining to celiac disease (CD) among the Indian pediatricians. A survey link containing a questionnaire was shared through electronic mail using a pediatric database. The survey was kept active for 6 months; all responses received at the end of the survey were analyzed. Two hundred and seventy one pediatricians out of more than 10,000 chose to respond to the survey. Most pediatricians agreed that more patients with CD are being diagnosed than earlier. The reasons for higher detection of CD were perceived to be higher index of clinical suspicion by pediatricians (86.7%) followed by increased awareness among parents (45.8%). Most pediatricians opined that clinical manifestations which prompted to a diagnosis of CD were failure to thrive (96.2%) and chronic diarrhea (81.4%). Knowledge about atypical manifestations of celiac disease was low.  Though knowledge about the common association of CD with type 1 diabetes (62.1%) and autoimmune hepatitis (55.8%) was there, awareness about its association with other uncommon conditions was lacking. Though 68% of the pediatricians were of the opinion that the confirmation of diagnosis by a mucosal biopsy is necessary, 26.5% of respondents believed that only a positive serology was sufficient for a diagnosis. A trial of gluten-free diet (GFD) was thought to be a logical step if serology was positive by 31.3% of respondents. While 87.7% of pediatricians advocated lifelong adherence to GFD, 12.3% felt that GFD could be discontinued in the future. This web-based survey revealed that though pediatricians are seeing increasing number of celiac disease patients, there is a need to increase awareness regarding the disease, its associated conditions, the need for mucosal biopsy to confirm the diagnosis and the necessity of lifelong adherence to GFD.


Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/terapia , Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Pediatras , Biópsia , Doença Celíaca/complicações , Diabetes Mellitus Tipo 1/complicações , Diarreia/etiologia , Dieta Livre de Glúten , Insuficiência de Crescimento/etiologia , Hepatite Autoimune/complicações , Humanos , Índia , Padrões de Prática Médica , Testes Sorológicos , Inquéritos e Questionários
6.
BMC Med Genet ; 20(1): 98, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164167

RESUMO

BACKGROUND: X-linked Adrenal Hypoplasia Congenita (AHC) is a rare cause of primary adrenal insufficiency due to mutations in the NR0B1 gene, causing a loss of function of the nuclear receptor protein DAX-1. Adrenal insufficiency usually appears in the first 2 months of life, but can sometimes emerge during childhood. Hypogonadotropic Hypogonadism is often associated later in life and patients may develop azoospermia. We describe an unusual onset of AHC started with isolated hypoaldosteronism as first and only sign of the disease. CASE PRESENTATION: A 18-days-old newborn presented with failure to thrive and feeding difficulties. Blood tests showed severe hyponatremia, hyperkalemia and hypochloremia. Renin was found over the measurable range and aldosterone was low whereas cortisol level was normal with a slightly increased ACTH. In the suspicion of Primary Hypoaldosteronism, correction of plasmatic electrolytes and replacement therapy with Fludrocortisone were promptly started. The subsequent evidence of low plasmatic and urinary cortisol and increased ACTH required the start of Hydrocortisone replacement therapy and it defined a clinical picture of adrenal insufficiency. Genetic analysis demonstrated a novel mutation in the DAX-1 gene leading to the diagnosis of AHC. CONCLUSIONS: AHC onset may involve the aldosterone production itself, miming an isolated defect of aldosterone synthesis. NR0B1/DAX-1 mutations should be considered in male infants presenting with isolated hypoaldosteronism as first sign of adrenal insufficiency.


Assuntos
Receptor Nuclear Órfão DAX-1/genética , Hipoadrenocorticismo Familiar/genética , Hipoaldosteronismo/genética , Mutação , Insuficiência Adrenal/etiologia , Insuficiência Adrenal/genética , Insuficiência de Crescimento/etiologia , Insuficiência de Crescimento/genética , Humanos , Hipoadrenocorticismo Familiar/complicações , Hipoaldosteronismo/etiologia , Recém-Nascido , Masculino
7.
BMJ Case Rep ; 12(5)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31118173

RESUMO

This article presents the case of a 3-month-old male child, who while on bolus jejunostomy tube feeds, developed recurrent episodes of hypoglycaemia. This infant had presented with failure to thrive with moderate gastroesophageal reflux necessitating a feeding jejunostomy. The infant was started on bolus feeds through the jejunostomy tube but developed recurrent episodes of hypoglycaemia. On evaluation, these episodes were hyperinsulinaemic and the baby was subsequently diagnosed with a late dumping syndrome. On changing the feeds to a continuous infusion and by eliminating added sugar from the feeds, the glucose fluctuations resolved. Dumping syndrome is a well-known complication in adults undergoing gastric surgeries. In the paediatric age group, dumping syndrome has been reported rarely, most commonly as a complication of Nissen fundoplication.


Assuntos
Síndrome de Esvaziamento Rápido/diagnóstico , Insuficiência de Crescimento/terapia , Jejunostomia/efeitos adversos , Síndrome de Esvaziamento Rápido/complicações , Nutrição Enteral/efeitos adversos , Nutrição Enteral/instrumentação , Insuficiência de Crescimento/etiologia , Humanos , Hipoglicemia/etiologia , Lactente , Masculino
11.
World J Surg ; 43(7): 1802-1808, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30843099

RESUMO

INTRODUCTION: Unplanned readmission is a common event after liver resection, and it is a burden for both patients and healthcare policy makers. This study evaluates the incidence of and reasons for unplanned readmission after liver resection, in order to identify possible preventable causes. METHODS: In this single-center cohort study, data from patients who underwent liver resection for both malignant and benign indications from 2001 to 2016 at our institute were collected from a database with prospective data. Readmissions were analyzed for their reasons and risk factors. Patients with general complaints with no specific complications were categorized as failure to thrive. RESULTS: In 406 patients, the readmission rate was 11.6%. Most patients were readmitted because of failure to thrive (35%), deep and superficial surgical site infection (28%), or cardiopulmonary complications (15%). A multivariate analysis revealed that unplanned readmission was associated with the occurrence of complications during index admission-with an odds ratio of 4.69 (CI 2.41-9.12, p < 0.001). CONCLUSION: Readmission occurs in more than 1 in 10 patients after liver resection, and it is associated with a complicated course during index admission. One-third of readmissions occur because of failure to thrive and might be preventable. Future research in strategies to reduce readmission rates should focus on both the prevention of complications during index admission and programs at the interface between primary and secondary care.


Assuntos
Insuficiência de Crescimento/etiologia , Hepatectomia/efeitos adversos , Readmissão do Paciente , Infecção da Ferida Cirúrgica/etiologia , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Cardiopatias/etiologia , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco
13.
Nutr Clin Pract ; 34(4): 581-588, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30644589

RESUMO

OBJECTIVES AND STUDY: Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinical characteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deficiencies (MDs) in children with FTT. METHODS: This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rd percentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previously known chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below -2 and height-for-age z-scores were above -2, and chronic malnutrition was defined if height-for-age z-scores were below -2. RESULTS: The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratory evaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic findings, and biopsy results led to a specific diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT were inadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections (6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deficiencies were the most common MD. CONCLUSION: We showed that the most common cause of FTT is "purely nutrition" FFT because of inadequate caloric intake, and extensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluation and anthropometry to evaluate a child with FTT.


Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Gastroenteropatias/diagnóstico , Micronutrientes/deficiência , Criança , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Diagnóstico Diferencial , Insuficiência de Crescimento/etiologia , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Estudos Retrospectivos
15.
J Pediatr ; 205: 91-97, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30340934

RESUMO

OBJECTIVE: To determine whether a sustained neonatal systemic inflammatory response was associated with poor postnatal growth among infants born very preterm during the first year of life. STUDY DESIGN: We studied prospectively 192 infants born preterm (birth weight ≤1.5 kg and gestational age ≤31 weeks). Weight, length, and head circumference were measured at birth, term, 4, and 12 months of corrected age. Serial C-reactive protein and procalcitonin were measured at 1, 3, 7, 14, and 28 days of age and averaged for each infant. A sustained neonatal systemic inflammatory response was defined as an average C-reactive protein level greater than the median for the group. Analysis was undertaken with linear mixed models. RESULTS: Decreases in mean z scores for weight, length, and head circumference were associated with the presence of a sustained neonatal systemic inflammatory response from birth to 12 months of corrected age (ß [95% CI] = -0.282 [-0.306 to -0.258]; -1.899 [-2.028,-1.769]; -0.806 [-0.910, to -0.701], P < .001, respectively) in main effect models. This association remained significant after including interaction terms for bronchopulmonary dysplasia, neonatal sepsis, and necrotizing enterocolitis (ß [95% CI] = -0.393 [-0.520 to -0.265]; -2.128 [-2.754, -1.503]; -1.102 [-1.604, -0.600]; P < .001; respectively) in interaction models. CONCLUSIONS: A sustained neonatal systemic inflammatory response was associated with poor postnatal growth, particularly poor linear growth. Serial C-reactive protein and procalcitonin may be useful markers for identifying infants at risk for postnatal growth failure.


Assuntos
Lactente Extremamente Prematuro/crescimento & desenvolvimento , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Biomarcadores/sangue , Peso ao Nascer , Índice de Massa Corporal , Displasia Broncopulmonar/epidemiologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Enterocolite Necrosante/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Sepse Neonatal/epidemiologia , Prevalência , Pró-Calcitonina/sangue , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
16.
Laryngoscope ; 129(10): 2414-2419, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30474230

RESUMO

OBJECTIVES: For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS: We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS: We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.


Assuntos
Insuficiência de Crescimento/história , Obesidade Pediátrica/história , Apneia Obstrutiva do Sono/história , Adenoidectomia/história , Peso Corporal , Criança , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , História do Século XX , História do Século XXI , Humanos , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Prevalência , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Tonsilectomia/história , Estados Unidos/epidemiologia
17.
Pediatr Transplant ; 23(1): e13321, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30417493

RESUMO

BACKGROUND: Prior to transplantation, effects of advanced CKD contribute to malnutrition and impaired growth. After transplant, children are expected to thrive, however, in a subset of transplant recipients this does not occur. Factors associated with post-transplant FTT are poorly understood. OBJECTIVE: A retrospective cohort study was conducted to determine factors associated with FTT and association of FTT with infections and hospitalizations. METHODS: Records of 119 children transplanted between 2005 and 2016 were reviewed. FTT was defined by ≥2 of the following post-transplant criteria: (a) low BMI or deceleration in BMI z-score, (b) poor growth velocity, and (c) chronic hypoalbuminemia at 1 or 3 years post-transplant. Association of FTT with deceased donor transplant, de novo DSA, intolerance to MMF, anemia, vitamin D deficiency, and CIC was investigated by logistic regression. Poisson regression was used to identify outcomes associated with FTT. RESULTS: Low pre-transplant BMI and post-transplant CIC dependence were independently associated with FTT after transplant. Odds of FTT at 1 year post-transplant decreased by 0.5 for each 1 unit increase in pre-transplant BMI z-score. Requirement for CIC conferred 3.8 and 7.8 higher odds of FTT at 1 and 3 years. Patients with FTT had 2.7 and 2.6 times infections and hospitalizations during the first year, and 4.2 and 4.3 times infections and hospitalizations over 3 years post-transplant. CONCLUSIONS: Children with low BMI prior to transplant and those requiring CIC after transplant are at increased risk for post-transplant FTT. FTT is associated with adverse outcomes, evidenced by increased infections and hospitalizations.


Assuntos
Insuficiência de Crescimento/epidemiologia , Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Insuficiência de Crescimento/diagnóstico , Insuficiência de Crescimento/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
Pediatr Ann ; 47(11): e465-e469, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30423190

RESUMO

Traditionally, nutritional risk has been defined by growth failure, with clinical intervention indicated when a child falls below the third to fifth percentile on growth charts. Although the velocity of linear growth and weight gain during the first years are unparalleled at any other time of life, this period is also unique for other reasons. Nutrition not only supports increased bone length, muscle mass, and tissue growth, but also continued development of several highly metabolic organs such as the gastrointestinal tract, the immune system, the cardiorespiratory system, the kidneys, and the central nervous system. Just as growth depends on consistent nutrients, so too does organ development, especially the brain. The undernourished child may exhibit compromised optimal development and future cognitive performance, irrespective of weight status. It is often challenging in early childhood to ensure that a child is receiving high-quality nutrition. Primary care clinicians are positioned to identify the child with potential nutritional risk and design an appropriate intervention that promotes optimal development. [Pediatr Ann. 2018;47(11):e465-e469.].


Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/diagnóstico , Insuficiência de Crescimento/diagnóstico , Atenção Primária à Saúde/métodos , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Insuficiência de Crescimento/etiologia , Gráficos de Crescimento , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Necessidades Nutricionais , Estado Nutricional , Medição de Risco/métodos
19.
J Med Case Rep ; 12(1): 324, 2018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30352615

RESUMO

BACKGROUND: Congenital cardiac defects are not rare among neonates. Prompt assessment for life-threatening anomalies is essential for rapid management decisions and positive outcomes. Extracardiac anomalies can occur in congenital heart defects, and their presence increases morbidity and mortality in these neonates. CASE PRESENTATION: We report a case of a 31- month-old infant black girl in Tanzania who presented with an on-and-off history of difficulty in breathing, easy fatigability, facial and lower-limb swelling, recurrent respiratory tract infections, and failure to thrive. CONCLUSIONS: Management of patients with heterotaxy syndrome is complex and largely depends on specific anatomy of both cardiac and noncardiac lesions. Cardiac and noncardiac management must be tailored to individual anatomy, including prophylaxis against encapsulated organisms for asplenic patients.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Insuficiência de Crescimento/fisiopatologia , Síndrome de Heterotaxia/complicações , Síndrome de Heterotaxia/diagnóstico , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/fisiopatologia , Pré-Escolar , Insuficiência de Crescimento/etiologia , Fadiga , Feminino , Síndrome de Heterotaxia/genética , Síndrome de Heterotaxia/fisiopatologia , Humanos , Isomerismo , Encaminhamento e Consulta , Tomografia Computadorizada por Raios X
20.
Ugeskr Laeger ; 180(39)2018 Sep 24.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30274573

RESUMO

We present a case report of a ten-month-old boy, who was referred due to deviating growth and recurrent respiratory tract infections. Computed tomography of the thorax showed two large, cystic components in the mediastinum. He underwent surgical removal of the cysts. Pathological examination confirmed the diagnosis lymphatic malformation. This case illustrates that intrathoracic tumors such as lymphatic malformations, although rare, should be considered in children with deviating growth curves and respiratory problems. Rather than continuous symptomatic treatment children with symptoms early in life should be prompted in further investigations.


Assuntos
Transtornos do Crescimento/etiologia , Anormalidades Linfáticas , Cisto Mediastínico , Insuficiência de Crescimento/etiologia , Humanos , Lactente , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/cirurgia , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/cirurgia , Radiografia , Infecções Respiratórias/etiologia , Tomografia Computadorizada por Raios X
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