Inter-Observer Agreement Among Medical Professionals in Critical Care of Neonates and Children

ABSTRACT Inter-observer agreement is essential to medical staff members and has a major effect on communication. The goal of the study was to examine the way medical professionals evaluate the potential severity of Almost Adverse Events (AAEs) that were observed in two intensive care units (ICUs). One hundred and fourteen AAEs were observed and recorded in both units by engineering students. Each AAE was rated independently by five senior medical staff members from each ICU, chosen by the unit manager, on a three-point severity level scale. Statistical analysis (K statistic and Cohen's Kappa) yielded relatively low levels of agreement among raters in both ICUs (< 0.3), but significantly greater agreement was found among nurses than among physicians in both ICUs. Low levels of agreement are attributed to the nature of work and characteristics of each ICU. Recommendations for improving agreements including forming shared mental models are specified

Inter-Observer Agreement Among Medical Professionals in Critical Care of Neonates and Children

Inter-observer agreement is essential to medical staff members and has a major effect on communication. The goal of the study was to examine the way medical professionals evaluate the potential severity of Almost Adverse Events (AAEs) that were observed in two intensive care units (ICUs). One hundred and fourteen AAEs were observed and recorded in both units by engineering students. Each AAE was rated independently by five senior medical staff members from each ICU, chosen by the unit manager, on a three- point severity level scale. Statistical analysis (K statistic and Cohen's Kappa) yielded relatively low levels of agreement among raters in both ICUs (< 0.3), but significantly greater agreement was found among nurses than among physicians in both ICUs. Low levels of agreement are attributed to the nature of work and characteristics of each ICU. Recommendations for improving agreements including forming shared mental models are specified

muscle transposition

Recto-vaginal/urethral fistula: repair with gracili

Peritoneal carcinomatosis from colorectal cancer in the pediatric population: Cytoreductive surgery and HIPEC. A systematic review

Colorectal cancer (CRC) is a rare condition in the pediatric population, but it is usually associated with worse prognosis compared to the adult population. Surgical resection is the gold standard and most effective treatment for CRC. Cytoreductive surgery (CRS) and Heated Intra-Peritoneal Chemotherapy (HIPEC) is a feasible option in resectable primary tumour with carcinomatosis and non-evidence of extra-abdominal disease. Although it is very uncommon in children when performed, CRS-HIPEC is based on the description by Sugarbaker et al. and the two most common administrated drugs are Cisplatin and Mitomycin-C. We present a review of the cases found in the literature of peritoneal carcinomatosis from CRC treated with CRS and HIPEC in children. A systematic search was performed in the major databases up to February 2020. We included all the reviews and studies reporting clinical data on pediatric patients with peritoneal colorectal carcinomatosis. Nine cases were extracted from the literature. Patient age was between 11 and 16 years old. All patients underwent neoadjuvant chemotherapy. All patients were treated with HIPEC and the majority of them received a complete cytoreduction (CC-0). At follow-up, three patients were found free from disease with an average time of follow up of 74 weeks (40–100). In 33% of cases, recurrence was described. No postoperative death within 30 days from surgery was observed. CRS and HIPEC can be a feasible option for CRC peritoneal carcinomatosis in children. Because CRC is unusual among the pediatric population, multi-institutional studies should be done to achieve larger cohorts and a more reliable analysis

Intestine and brain TLR-4 modulation following N-acetyl-cysteine treatment in NEC rodent model

Abstract Necrotizing enterocolitis (NEC) brain injury is mediated through Toll-like receptor 4 (TLR4) on the intestinal epithelium and brain microglia. Our aim was to determine whether postnatal and/or prenatal NAC can modify NEC associated intestinal and brain TLR4 expression and brain glutathione levels in a rat model of NEC. Newborn Sprague–Dawley rats were randomized into three groups: Control (n = 33); NEC (n = 32)—hypoxia and formula feeding; and NEC-NAC (n = 34)—received NAC (300 mg/kg IP) in addition to NEC conditions. Two additional groups included pups of dams treated once daily with NAC (300 mg/kg IV) for the last 3 days of pregnancy: NAC-NEC (n = 33) or NAC-NEC-NAC (n = 36) with additional postnatal NAC. Pups were sacrificed on the fifth day, and ileum and brains harvested for TLR-4 and glutathione protein levels. Brain and ileum TLR-4 protein levels were significantly increased in NEC offspring as compared to control (brain 2.5 ± 0.6 vs. 0.88 ± 0.12 U and ileum 0.24 ± 0.04 vs. 0.09 ± 0.01, p < 0.05). When NAC was administered only to dams (NAC-NEC) a significant decrease in TLR-4 levels was demonstrated in both offspring brain (1.53 ± 0.41 vs. 2.5 ± 0.6 U, p < 0.05) and ileum (0.12 ± 0.03 vs. 0.24 ± 0.04 U, p < 0.05) as compared to NEC. The same pattern was demonstrated when NAC was administered only or postnatally. The decrease in brain and ileum glutathione levels observed in NEC offspring was reversed with all NAC treatment groups. NAC reverses the increase in ileum and brain TLR-4 levels and the decrease in brain and ileum glutathione levels associated with NEC in a rat model, and thus may protect from NEC associated brain injury

Large clear cell sarcoma of the kidney mistaken as Wilms' tumor

Clear cell sarcoma of the kidney (CCSK) is a rare tumor. It has a wide histologic spectrum and often mimics other pediatric renal tumors, resulting in considerable diagnostic difficulty. We report the case of a two-year-old who presented with a large (14 cm) abdominal mass. Prior to neoadjuvant chemotherapy, a biopsy was performed, which revealed Wilms' tumor. The final pathology diagnosis at the time of resection revealed CCSK

Calcified gallstone in a 3 year-old boy: a case report

Abstract Background Gallstones are relatively rare in children. At-risk populations include patients suffering from hemolysis syndromes. Regardless of etiology, these patients usually will present with postprandial abdominal pain, and ultrasonography is the mainstay of diagnosis. However, some gallstones are radiopaque and can be visualized on plain abdominal radiography. Case presentation We present the uncommon but classic plain x-ray finding of a calcified gallstone in a 3 year-old Hispanic boy. He was treated with elective laparoscopic cholecystectomy. Conclusions Cholelithiasis is rare in children, and calcified stones that will appear on plain abdominal x-rays are even rarer. If symptomatic, cholecystectomy by a pediatric surgeon is the treatment of choice. We discuss some of the recent developments in treatment of this condition in this patient population.</p

Fetal Renal Duplicated Collecting System at 14–16 Weeks of Gestation

(1) Background: To examine the incidence of the prenatal diagnosis of the renal double-collecting system (rDCS) and describe its clinical outcome and associated genetic abnormalities. (2) Methods: This retrospective study included women who attended the obstetric clinic for early fetal anatomic sonography with findings of a renal DCS. Diagnosis was conducted by an expert sonographer using defined criteria. (3) Results: In total, 29,268 women underwent early ultrasound anatomical screening at 14–16 weeks, and 383 cases of rDCS were diagnosed (prevalence: 1:76). Associated abnormalities were diagnosed in eleven pregnancies; four had chromosomal aberrations. No chromosomal abnormalities were reported in isolated cases. Ectopic uretrocele and dysplastic kidney were diagnosed in 6 (1.5%) and 5 (1.3%) fetuses, respectively. One girl was diagnosed with vesicoureteral reflux and recurrent UTIs, and two boys were diagnosed with undescended testis. The recurrence rate of rDCS was 8% in subsequent pregnancies. (4) Conclusions: In light of its benign nature, we speculate that isolated rDCS may be considered a benign anatomic variant, but a repeat examination in the third trimester is recommended to assess hydronephrosis

ALCOHOL USE AMONG TRAUMA VICTIMS ADMITTED TO A LEVEL I TRAUMA CENTER IN ISRAEL.

מטרה: לקבוע את שיעור מקרי הטראומה שנגרמו כתוצאה משימוש באלכוהול ולבחון את מאפייניהם. שיטה: ניתוח נתונים על 854 מטופלים מתוך 5,529 מטופלים שהופיעו ברישום הטראומה הישראלי בשנים 2001-.2003 מן הממצאים: אצל 170 מהפונים נמצאה רמה גבוהה של אלכוהול בדם. בקרב אלה היה שיעור תאונות הדרכים גבוה מזה שבקרב הנפגעים ללא האלכוהול (35% לעומת 24%) וכך גם לגבי דקירות (29% לעומת 7%). חומרת הפגיעות בקרב קבוצת ה"אלכוהול" הייתה רבה יותר ושיעורי הלא-יהודים, הצעירים, והגברים בקבוצה זו היו גבוהים מהשיעורים אצל שאר הנבדקים. רוב הפגיעות המיוחסות לאלכוהול התרחשו בסופי שבוע ובשעות הערב-לילה