Neonatal and Pediatric Organ Donation: Ethical Perspectives and Implications for Policy

The lifesaving processes of organ donation and transplantation in neonatology and pediatrics carry important ethical considerations. The medical community must balance the principles of autonomy, nonmaleficence, beneficence, and justice to ensure the best interest of the potential donor and to provide equitable benefit to society. Accordingly, the US Organ Procurement and Transplantation Network (OPTN) has established procedures for the ethical allocation of organs depending on several donor-specific and recipient-specific factors. To maximize the availability of transplantable organs and opportunities for dying patients and families to donate, the US government has mandated that hospitals refer potential donors in a timely manner. Expedient investigation and diagnosis of brain death where applicable are also crucial, especially in neonates. Empowering trained individuals from organ procurement organizations to discuss organ donation with families has also increased rates of consent. Other efforts to increase organ supply include recovery from donors who die by circulatory criteria (DCDD) in addition to donation after brain death (DBD), and from neonates born with immediately lethal conditions such as anencephaly. Ethical considerations in DCDD compared to DBD include a potential conflict of interest between the dying patient and others who may benefit from the organs, and the precision of the declaration of death of the donor. Most clinicians and ethicists believe in the appropriateness of the Dead Donor Rule, which states that vital organs should only be recovered from people who have died. The medical community can maximize the interests of organ donors and recipients by observing the Dead Donor Rule and acknowledging the ethical considerations in organ donation

Persistent elevation of fetal hemoglobin following chemotherapy in sickle cell disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92111/1/24106_ftp.pd

Prior History of Learning Disabilities in Reye's Syndrome Survivors

Twenty-six children, ages nine-18, who had recovered from Reye's syndrome were tested for possible memory deficits. In reviewing school histories, an unexpected finding was the disproportionately high number of students who were Learning Disabled before contracting Reye's syndrome. Seven of the children had been receiving special education services for being Learning Disabled and another two were viewed by their schools as being hyperactive. This is 10 times the expected incident rate. This group of Learning Disabled students did not score significantly worse on any measure than did the other children who had Reye's syndrome.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68975/2/10.1177_002221948501800607.pd

Sociocultural and institutional factors influencing antenatal care utilization amongst Mumbai's slum population: a critical literature synthesis

Introduction: Low-income women living in Mumbai’s slums exhibit poor antenatal care utilization and, as a result, experience a disproportionate burden of maternal mortality and morbidity. Identifying the diverse range of underlying factors associated with this population’s antenatal care seeking behavior is a vital step in developing effective antenatal care policies and programs. Background: In spite of India’s provision of free and subsidized antenatal care programming, women living in Mumbai’s slums overwhelmingly exhibit unsafe antenatal care seeking behavior. The existing public antenatal care policies and programs are insufficient to address their antenatal care utilization rates. Method: A critical literature synthesis utilizing two databases and one search engine identified peer-reviewed papers examining the factors associated with antenatal care utilization and non-utilization amongst low-income women living in Mumbai slum communities. The search utilized 10 Boolean terms and restricted inclusion to articles published since 2013. Results: The search identified 12 relevant articles and included both quantitative and qualitative studies of care seeking for pregnancy, childbirth, abortion, and family planning. Studies identified a number of factors influencing women’s decisions to seek antenatal care services, including sociodemographic factors, gender and social relations, knowledge, preferences, and beliefs, and the availability, accessibility, acceptability, and quality of care provision. Discussion: An examination of the recent literature revealed significant gaps in the literature, including measurements of between-group differences and women’s real access to components of antenatal care. Additionally, the various sociocultural and institutional factors appear to intersect and exacerbate women’s non-utilization of antenatal care services, with issues such as slum legality and weak public health governance complicating women’s access to quality antenatal care services. Conclusion: Given the complex nature of Mumbai’s slum policies and public health care systems, slum-dwelling women’s urgent need for quality antenatal care demands an effective and comprehensive public health strategy. Recommendations include adopting a more context-appropriate conceptualization of antenatal care, improving the demand for and supply of skilled antenatal care services through NGO-led community mobilization and the redistribution of key antenatal care services to more effective and acceptable providers, and addressing gaps in the existing antenatal health research

Screening of high risk infants for metabolic disease in a metropolitan hospital

Screening of symptomatic infants for metabolic diseases is described which led to an improved detection rate because of better awareness and case selection, as well as the use of a test for urinary organic acids.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147121/1/jimd0081.pd

Transfusional Iron Overload in Sickle Cell Anemia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72471/1/j.1749-6632.1989.tb24225.x.pd

Osteoclast-Like Giant Cell Carcinoma of the Distal Ureter

Extraskeletal osteoclast-like giant cell (OGC) tumors are uncommon and have mainly been found in the breast and pancreas. OGC neoplasms of the urinary tract are extremely rare. Most cases found in the renal pelvis and bladder are associated with either an in situ urothelial malignancy or a conventional high-grade urothelial carcinoma. These malignancies tend to be associated with a poor prognosis and disease course. To our knowledge, no cases of OGC tumors of the distal ureter only have been published. Here, we present the case of a 76-year-old man who underwent hand-assisted laparoscopic nephroureterectomy because of painless gross hematuria with right flank pain. Pathologic examination showed OGC carcinoma of the right distal ureter. No local tumor recurrence or distant metastasis was found at the 5-month follow-up

Designing and Evaluation of Skin Extract Agar for Isolation of Microflora from Raw Buffalo Hide

Abstract Present study was aimed to design nutrient medium most suitable for isolation and enumeration of microbial flora associated with raw buffalo hide. Skin extract agar (SEA) was designed and standardized on the basis of its chemical analysis. SEA and nutrient medium supplemented with skin extract was inoculated with buffalo hide wash. Total viable count as well as diversity of microbial colonies were enumerated on SEA as well as on nutrient agar and standard plate count agar both supplemented with skin extract (1% v/v). Bacterial strains forming diverse types of colonies on the media tested were identified on the basis of their 16S rRNA  gene sequences. The SEA was found to yield higher number of bacteria and to support growth of Acinetobacter, Exiguobacterium and Stenotrophomonas which otherwise difficult to selectively isolate from buffalo hide using nutrient agar and standard plate count agar. Diversity of microbial colonies formed on SEA was significantly higher than that observed on nutrient agar or standard plate count agar. Feasibility of utilizing SEA as a microbiological medium for isolation and identification of microflora from raw buffalo hide was successfully demonstrated. Use of skin extract medium can maximize recovery of taxonomically distinct bacteria from raw buffalo hide. This basic study, with proper manipulations could lead to development of product for enumeration and isolation of bacteria from buffalo hides especially cattle pathogens related to skin diseases

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Objective To determine the prevalence of and risk factors for extrathoracic upper-airway obstruction after pediatric cardiac surgery. Study design A retrospective chart review was performed on 213 patients younger than 18 years of age who recovered from cardiac surgery in our multidisciplinary intensive care unit in 2012. Clinically significant upper-airway obstruction was defined as postextubation stridor with at least one of the following: receiving more than 2 corticosteroid doses, receiving helium-oxygen therapy, or reintubation. Multivariate logistic regression analysis was performed to determine independent risk factors for this complication. Results Thirty-five patients (16%) with extrathoracic upper-airway obstruction were identified. On bivariate analysis, patients with upper-airway obstruction had greater surgical complexity, greater vasoactive medication requirements, and longer postoperative durations of endotracheal intubation. They also were more difficult to calm while on mechanical ventilation, as indicated by greater infusion doses of narcotics and greater likelihood to receive dexmedetomidine or vecuronium. On multivariable analysis, adjunctive use of dexmedetomedine or vecuronium (OR 3.4, 95% CI 1.4-8) remained independently associated with upper-airway obstruction. Conclusion Extrathoracic upper-airway obstruction is relatively common after pediatric cardiac surgery, especially in children who are difficult to calm during endotracheal intubation. Postoperative upper-airway obstruction could be an important outcome measure in future studies of sedation practices in this patient population