41 research outputs found
Management of Pediatric Appendicitis During the COVID-19 Pandemic: A Nationwide Multicenter Cohort Study
BACKGROUND: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes.
METHODS: A multicenter retrospective study was performed including 19 children\u27s hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital\u27s city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed.
RESULTS: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p \u3c 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p \u3c 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01-1.012), African American race (OR=2.4, 95% CI: 1.3-4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4-21.6).
CONCLUSION: Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management
Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes
<p>Abstract</p> <p>Background</p> <p>Yoga has been shown to be a simple and economical therapeutic modality that may be considered as a beneficial adjuvant for type 2 diabetes mellitus. This study investigated the impact of Hatha yoga and conventional physical training (PT) exercise regimens on biochemical, oxidative stress indicators and oxidant status in patients with type 2 diabetes.</p> <p>Methods</p> <p>This prospective randomized study consisted of 77 type 2 diabetic patients in the Hatha yoga exercise group that were matched with a similar number of type 2 diabetic patients in the conventional PT exercise and control groups. Biochemical parameters such as fasting blood glucose (FBG), serum total cholesterol (TC), triglycerides, low-density lipoprotein (LDL), very low-density lipoproteins (VLDL) and high-density lipoprotein (HDL) were determined at baseline and at two consecutive three monthly intervals. The oxidative stress indicators (malondialdehyde – MDA, protein oxidation – POX, phospholipase A2 – PLA2 activity) and oxidative status [superoxide dismutase (SOD) and catalase activities] were measured.</p> <p>Results</p> <p>The concentrations of FBG in the Hatha yoga and conventional PT exercise groups after six months decreased by 29.48% and 27.43% respectively (P < 0.0001) and there was a significant reduction in serum TC in both groups (P < 0.0001). The concentrations of VLDL in the managed groups after six months differed significantly from baseline values (P = 0.036). Lipid peroxidation as indicated by MDA significantly decreased by 19.9% and 18.1% in the Hatha yoga and conventional PT exercise groups respectively (P < 0.0001); whilst the activity of SOD significantly increased by 24.08% and 20.18% respectively (P = 0.031). There was no significant difference in the baseline and 6 months activities of PLA2 and catalase after six months although the latter increased by 13.68% and 13.19% in the Hatha yoga and conventional PT exercise groups respectively (P = 0.144).</p> <p>Conclusion</p> <p>The study demonstrate the efficacy of Hatha yoga exercise on fasting blood glucose, lipid profile, oxidative stress markers and antioxidant status in patients with type 2 diabetes and suggest that Hatha yoga exercise and conventional PT exercise may have therapeutic preventative and protective effects on diabetes mellitus by decreasing oxidative stress and improving antioxidant status.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12608000217303</p
The Relation Between Identity Status And Romantic Attachment Style In Middle And Late Adolescence
This study examined the linkages between identity formation and romantic attachment in an ethnically diverse sample of high school (n = 1 8 9) and college students (n = 3 2 4). Individuals in the foreclosed identity status group had significantly lower relationship avoidance scores than the diffused identity status group, and the foreclosed group had significantly lower relationship anxiety scores than both the achieved identity and moratorium groups. Identity status and romantic attachment style were significantly related among the college sample, but not among the high school sample. Some ethnic differences in attachment style were noted. Developmental implications are discussed. © 2005 The Association for Professionals in Services for Adolescents
3D printed model aiding in minimally invasive thoracoabdominal ganglioneuroblastoma resection: A case report
The creation of 3D models of tumors and their surrounding structures is becoming a useful tool for preoperative and intraoperative surgical planning. This case details the presentation and oncologic course of a 2.5-year old female patient with a thoracoabdominal ganglioneuroblastoma. Upon initial diagnosis, her tumor was encasing the aorta and abutting the left renal vein and was not a candidate for resection. She underwent alternative therapy for several years that was not standard of care before returning to our institution. A 3D model of the tumor was created based on pre-operative computerized tomography (CT) images, and the physical model demonstrated clear planes and lack of invasion into surrounding structures, making surgical resection an option. The 3D model was then utilized as a guide intraoperatively for the laparoscopic operation during difficult portions of the case. The tumor was successfully removed in entirety, and the patient was discharged following an uneventful post-operative course. The use of 3D printing in a pediatric abdominal oncologic case is novel, and could be a beneficial tool in future cases to complement a minimally invasive surgical approach
Low Abdominal NIRS Values and Elevated Plasma Intestinal Fatty Acid-Binding Protein in a Premature Piglet Model of Necrotizing Enterocolitis
<div><p>To identify early markers of necrotizing enterocolitis (NEC), we hypothesized that continuous abdominal near-infrared spectroscopy (A-NIRS) measurement of splanchnic tissue oxygen saturation and intermittent plasma intestinal fatty-acid binding protein (<i>p</i>I-FABP) measured every 6 hours can detect NEC prior to onset of clinical symptoms. Premature piglets received parenteral nutrition for 48-hours after delivery, followed by enteral feeds every three hours until death or euthanasia at 96-hours. Continuous A-NIRS, systemic oxygen saturation (SpO<sub>2</sub>), and heart rate were measured while monitoring for clinical signs of NEC. Blood samples obtained at 6-hour intervals were used to determine <i>p</i>I-FABP levels by ELISA. Piglets were classified as fulminant-NEC (f-NEC), non-fulminant-NEC (nf-NEC) and No-NEC according to severity of clinical and histologic features. Of 38 piglets, 37% (n=14) developed nf-NEC, 18% (n=7) developed f-NEC and 45% (n=17) had No-NEC. There were significant differences in baseline heart rate (p=0.008), SpO<sub>2</sub> (p<0.001) and A-NIRS (p<0.001) among the three groups. A-NIRS values of NEC piglets remained lower throughout the study with mean for f-NEC of 69±3.8%, 71.9±4.04% for nf-NEC, and 78.4±1.8% for No-NEC piglets (p<0.001). A-NIRS <75% predicted NEC with 97% sensitivity and 97% specificity. NEC piglets demonstrated greater variability from baseline in A-NIRS than healthy piglets (10.1% vs. 6.3%; p=0.04). Mean pI-FABP levels were higher in animals that developed NEC compared to No-NEC piglets (0.66 vs. 0.09 ng/mL;p<0.001). In f-NEC piglets, pI-FABP increased precipitously after feeds (0.04 to 1.87 ng/mL;p<0.001). <i>p</i>I-FABP levels increased in parallel with disease progression and a value >0.25ng/mL identified animals with NEC (68% sensitivity and 90% specificity). NIRS is a real-time, non-invasive tool that can serve as a diagnostic modality for NEC. In premature piglets, low A-NIRS in the early neonatal period and increased variability during initial feeds are highly predictive of NEC, which is then confirmed by rising plasma I-FABP levels. These modalities may help identify neonates with NEC prior to clinical manifestations of disease.</p></div
Proximal Jejunum Intestinal Fatty Acid Binding Protein (I-FABP) immunohistochemical staining.
<p>Immunohistochemistry fluorescent staining for I-FABP in proximal jejunum specimens. In these images I-FABP is represented in green. In the No-NEC piglets there is robust expression of I-FABP and in the NEC piglets the mucosa has been significantly denuded and I-FABP signal degraded.</p
Mean I-FABP Densitometry by NEC Score.
<p>Mean I-FABP densitometry readings demonstrating an inverse correlation between the Histologic NEC score and I-FABP protein expression in proximal jejunum tissue samples by western blot.</p
Intestinal Fatty Acid Binding Protein (I-FABP) in Plasma.
<p>Plasma I-FABP values stratified by NEC severity groups demonstrating a precipitous rise in the f-NEC group shortly after the initiation of feeds and a more gradual rise in the nf-NEC group that paralleled clinical disease progression. The No-NEC piglets never had an appreciable rise in their serum I-FABP.</p
Continuous Heart Rate Measurements.
<p>Heart rate data stratified by NEC severity groups demonstrating an overall increasing trend in heart rates throughout the study period and that f-NEC and nf-NEC piglets were significantly more tachycardic during the first 24 hours of life than No-NEC piglets. <i>‡ = p<0</i>.<i>05</i>, <i>compared to Non-Fulminant NEC; * = p<0</i>.<i>05</i>, <i>compared to No-NEC</i>.</p