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Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).
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Surgeons always look for ways to reduce the size and number of ports in laparoscopy, where in today's era, we have single-incision laparoscopic surgery (SILS). While doing so, principal 'adequate exposure' should not be compromised. For upper gastrointestinal laparoscopic surgeries, we have adopted a novel technique for retraction of the left lobe of liver, which is described here. Device can be made both single sling and double sling, with help of an infant feeding tube and any routinely used suture material. Placement of device does not require any incision, special energy source, or instrument. It can help in SILS. Detailed technique is described in the text. Operative times did not change significantly. Exposure was excellent. No special instruments or energy devices are required; thus, it is cost-effective. Reducing one port for liver retraction gives better cosmetic results. No liver injury due to the device was noticed in any of the cases. This technique is simpler and cheaper and also gives reasonable cosmetic results compared to other techniques described in the literature.
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INTRODUCTION: Surgical resection with curative intent is till the mainstay of treatment for resectable esophageal cancer. Minimal invasive oesophagectomy has the potential to lower morbidity and mortality. In all likelihood, thoracoscopic oesophagectomy in semiprone position gives all the benefits of prone position and can be converted to thoracotomy without change in patient position if needed. The aim of this study is to analyze the feasibility of thoracoscopic oesophagectomy in semiprone position. MATERIALS AND METHODS: This is a retrospective analysis of the data of thoracoscopic oesophgeactomy in semiprone position at Kaizen Hospital, a tertiary care center for gastroenterology during the period of December 2011 to December 2012. All surgeries were performed under general anesthesia with a single-lumen endotracheal tube. Esophageal mobilization was done by thoracoscopic approach in a semiprone position and an end-to-end hand-sewn cervical anastomosis was done. Abdominal part was performed by laparoscopic method in 3 patients and by laparotomy in rest of the patients. RESULTS: Total of 12 patients were included in this study. There was 1 conversion to thoracotomy and 1 surgical mortality. Mean operating time for the thoracoscopic part was 103 minutes, mean estimated blood loss for the thoracoscopic part was 110 mL, mean maximum end-tidal CO2 38.5 mm Hg, mean lymph nodes retrieved 14, and all patients had R0 resection. The median intensive care unit stay was 1 day and hospital stay was 8 days. CONCLUSIONS: Thoracoscopic part of thoracolaparoscopic oesophagectomy in semiprone position is a feasible option. It gives all advantages of prone position and thoracotomy is possible without change in patient position. However, further large-scale studies are required.
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Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Posicionamiento del Paciente , Complicaciones Posoperatorias/epidemiología , Toracoscopía/métodos , Abdomen , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundario , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/secundario , Carcinoma de Células Escamosas de Esófago , Femenino , Humanos , Incidencia , India/epidemiología , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , CuelloRESUMEN
This study aimed to review the use of two methods of propofol infusion: a metred burette system where propofol is diluted in Lactated Ringer using the rule of six [ 1 ] or an infusion pump: Medrad Continuum Magnetic resonance (MR) compatible Infusion System (Medrad Inc. Indianola, PA) and to determine the difference, if any, between the total amount of drug delivered, the impact on vital signs, sedation status and discharge time of the patients. With Institutional Review Board (IRB) approval, 140 children aged 0 to 18 years, American Society of Anesthesiologists (ASA) physical status I or II requiring sedation for elective outpatient brain Magnetic Resonance Imaging (MRI) examination were included in the study. A total of 70 patients in each group were studied. The (Mean ± S.D.) total amount of propofol infused was significantly less in the infusion pump group (12.47 ± 7.67 mg/kg) than the metred burette system (15.84 ± 16.13 mg/kg, p = 0.003). There were also significant mean differences in awakening times (26.63 ± 16.35 vs. 37.06 ± 20.98 min, p = 0.006), and discharge times (53.46 ± 21.12 vs. 67.89 ± 26.84 min, p = 0.008) in the infusion pump group versus the buretrol infusion group. This study demonstrates that both infusion techniques preserve haemodynamic stability and are associated with minimal complications. The use of an infusion pump, which consistently maintains accurate dosing, reduces the amount of propofol judged adequate by the anaesthesiologist to achieve sedation in MRI. This leads to a more consistently faster emergence and early discharge after sedation in children undergoing MRI studies.
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Sedación Profunda/métodos , Bombas de Infusión , Imagen por Resonancia Magnética , Propofol/uso terapéutico , Automatización/métodos , Distribución de Chi-Cuadrado , Niño , Preescolar , Tos , Sedación Profunda/estadística & datos numéricos , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Lactante , Masculino , Movimiento , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
Dihydrorhodamine 123 (RhH2) has been used to detect 'reactive nitrogen species', including peroxynitrite and its radical decomposition products, peroxynitrite probably oxidizing RhH2 to rhodamine (Rh) via radical products rather than directly. In this study, the radical intermediate (RhH(.)) was generated by pulse radiolysis, and shown to react with oxygen with a rate constant k approximately 7 x 10(8) M(-1) s(-1). This fast reaction was exploited in experiments observing Rh being formed slowly (k approximately 4-7 x 10(5) M(-1) s(-1)) from oxidation of RhH2 by nitrogen dioxide in a rate-limiting step, >1000-fold slower than the corresponding oxidation by carbonate radicals. The time-dependent uptake of RhH2 into mammalian cells was measured, with average intracellular levels reaching only approximately 10 microM with the protocol used. The combination of low loading and relatively low reactivity of oxidants towards RhH2 compared to competing cellular nucleophiles suggests rather a small fraction of peroxynitrite-derived radicals (mainly CO3(.-)) may be scavenged intracellularly by RhH2.
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Fibroblastos/metabolismo , Dióxido de Nitrógeno/metabolismo , Ácido Peroxinitroso/metabolismo , Rodaminas/metabolismo , Animales , Línea Celular , Cricetinae , Radicales Libres/metabolismo , Cinética , Oxígeno/metabolismoRESUMEN
BACKGROUND: Intubation without the use of muscle relaxants in children is frequently done before IV access is secured. In this randomized controlled trial, we compared intubating conditions and airway response to intubation (coughing and/or movement) after sevoflurane induction in children at 2 and 3 min after the administration of intranasal remifentanil (4 mcg/kg) or saline. METHODS: One hundred eighty-eight children, 1-7-yr old, were studied. Nasal remifentanil (4 mcg/kg) or saline was administered 1 min after an 8% sevoflurane N2O induction. The sevoflurane concentration was then reduced to 5% in oxygen, and ventilation assisted/controlled. An anesthesiologist blinded to treatment assignment used a validated score to evaluate the conditions for laryngoscopy and response to intubation. Blood samples for determination of remifentanil blood concentrations were collected from 17 children at baseline, 2, 3, 4, and 10 min after nasal administration of remifentanil. RESULTS: Good or excellent intubating conditions were achieved at 2 min (after the remifentanil bolus) in 68.2% and at 3 min in 91.7% of the children who received intranasal remifentanil versus 37% and 23% in children who received placebo (P<0.01). The mean remifentanil plasma concentrations (+/-sd) at 2, 3, 4, and 10 min were 1.0 (0.60), 1.47 (0.52), 1.70 (0.46), and 1.16 (0.36) ng/mL, respectively. Peak plasma concentration was observed at 3.47 min. There were no complications associated with the use of nasal remifentanil. CONCLUSIONS: Nasal administration of remifentanil produces good-to-excellent intubating conditions in 2-3 min after sevoflurane induction of anesthesia.
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Adyuvantes Anestésicos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anestésicos por Inhalación , Anestésicos Intravenosos , Intubación Gastrointestinal , Éteres Metílicos , Piperidinas/administración & dosificación , Adyuvantes Anestésicos/farmacocinética , Administración Intranasal , Analgésicos Opioides/farmacocinética , Niño , Preescolar , Método Doble Ciego , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Lactante , Laringoscopía , Masculino , Piperidinas/farmacocinética , Remifentanilo , SevofluranoRESUMEN
2',7'-Dichlorodihydrofluorescein (DCFH2) is one of the most widely used probes for detecting intracellular oxidative stress, but requires a catalyst to be oxidized by hydrogen peroxide or superoxide and reacts nonspecifically with oxidizing radicals. Thiyl radicals are produced when many radicals are "repaired" by thiols, but are oxidizing agents and thus potentially capable of oxidizing DCFH2. The aim of this study was to investigate the reactivity of thiol-derived radicals toward DCFH2 and its oxidized, fluorescent form 2',7'-dichlorofluorescein (DCF). Thiyl radicals derived from oxidation of glutathione (GSH) or cysteine (CysSH) oxidized DCFH2 with rate constants at pH 7.4 of approximately 4 or approximately 2x10(7) M(-1) s(-1), respectively. Both the rates of oxidation and the yields of DCF were pH-dependent. Glutathione-derived radicals interacted with DCF, resulting in the formation of DCFH* absorbing at 390 nm and loss of fluorescence; in contrast, cysteine-derived radicals did not cause any depletion of DCF fluorescence. We postulate that the observed apparent difference in reactivity between GS* and CysS* toward DCF is related to the formation of carbon-centered, reducing radicals from base-catalyzed isomerization of GS*. DCF formation from interaction of DCFH2 with GS* was inhibited by oxygen in a concentration-dependent manner over the physiological range. These data indicate that in applying DCFH2 to measure oxidizing radicals in biological systems, we have to consider not only the initial competition between thiols and DCFH2 for the oxidizing radicals, but also subsequent reactions of thiol-derived radicals, together with variables--including pH and oxygen concentration--which control thiyl radical chemistry.
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Fluoresceínas/química , Colorantes Fluorescentes/química , Hidrazinas/química , Hidrazinas/metabolismo , Piridinas/química , Piridinas/metabolismo , Compuestos de Sulfhidrilo/química , Compuestos de Sulfhidrilo/farmacología , Depuradores de Radicales Libres/química , Depuradores de Radicales Libres/farmacología , Isoenzimas/química , Isoenzimas/metabolismo , Modelos Químicos , Sondas Moleculares , Oxidación-Reducción , Estrés Oxidativo , Radiólisis de Impulso , Especificidad por SustratoRESUMEN
BACKGROUND: Faculty perceptions of medical student knowledge are often based on case presentations, but their assessment of student performance can vary significantly based on content, presentation skill, and interpersonal characteristics. PURPOSE: To determine if a brief faculty development intervention could significantly decrease (>or= 20%) faculty members' variability in rating student case presentations in the ambulatory setting. METHODS: During the 1998-99 academic year, we videotaped 10 third-year medical students during one well-child presentation. Seven general pediatric faculty rated the videotapes using a validated scoring instrument measuring content: History of Present Illness (HPI), Past Medical History, and Physical Exam (PE); and communication skill: Precision of Language, Fluency, and Economy. Baseline ratings were from June to September 1999 and then repeated in October to November 2000 following a workshop where faculty reflected on the rating process and decreasing rating variance. The change in mean faculty ratings of the student's overall performance and for each item and the change in the mean difference in standard deviation before and after the workshop were analyzed. RESULTS: Internal consistency of the scoring instrument using Cronbach's alpha was 0.88. The mean faculty rating for overall presentation performance and the PE did not significantly change after the workshop, whereas for all other items it did. The mean standard deviation of faculty ratings decreased significantly for the overall performance and all other items except HPI. CONCLUSION: Despite using a validated scoring instrument to rate student case presentations significant variability exists among faculty, with rating inflation likely. A brief faculty development intervention using "reflection-on-action" was associated with more congruent ratings in the short term.
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Evaluación Educacional/normas , Docentes Médicos , Variaciones Dependientes del Observador , Estudiantes de Medicina , Pensamiento , District of Columbia , Humanos , Grabación de Cinta de VideoRESUMEN
OBJECTIVE: Racial/ethnic disparities in health care delivery have been well described, but little is known about such disparities for children who seek emergency care. The objective of this study was to test the hypothesis that severity-adjusted emergency department pediatric admission rates are associated with race/ethnicity. METHODS: Secondary analyses were conducted of an established database of 16 emergency departments that participated in a national study to validate the Pediatric Risk of Admission II score, which is used to measure severity of illness. Patients were randomly selected by the coordinating center from daily emergency department visit logs. Crude and severity-adjusted admission rates were compared among the 3 most common races/ethnicities: white, black, and Hispanic. Adjusted admission rates were calculated by using the standardized admission ratio, which was calculated by dividing the observed admissions by the predicted admissions, when predicted was calculated from the Pediatric Risk of Admission II score. RESULTS: After exclusion of 3 sites that recorded race/ethnicity in <10% of patients, there were 13 sites with 8952 patients in the 3 major race/ethnicity groups. Black and Hispanic patients were similar to each other and different from white patients; therefore, these 2 groups were combined for analyses. Both crude (8.2% vs 5.3%) and severity-adjusted (standardized admission ratio: 1.71 vs 1.1) admission rates were higher in white than in nonwhite patients. Standardized admission ratios were close to 1.0 in both race/ethnicity groups in the higher quintiles of illness severity. In contrast, white patients were admitted at 1.5 to 2 times the expected rate in the lowest 2 quintiles of severity. CONCLUSIONS: There are differences in both crude and adjusted admission rates between white and black/Hispanic patients. The results are more consistent with high rates of discretionary admissions for white patients with low illness severity than with underadmitting severely ill black or Hispanic patients.
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Etnicidad , Hospitalización/tendencias , Grupos Raciales , Índice de Severidad de la Enfermedad , Adolescente , Población Negra , Niño , Preescolar , Atención a la Salud , Servicios Médicos de Urgencia/tendencias , Femenino , Hispánicos o Latinos , Humanos , Lactante , Recién Nacido , Masculino , Pediatría/tendencias , Población BlancaRESUMEN
A novel bioreductive prodrug of 6-thioguanine, 2-amino-6-[2-(4-nitrophenyl)prop-2-ylsulfanyl]-9H-purine, containing a gem-dimethyl thioether linkage, was synthesised and compared with its unsubstituted analogue. In A549 whole cell experiments hypoxia selective release of 6-thioguanine was observed with the substituted prodrug only.
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Hipoxia de la Célula , Profármacos/química , Purinas/química , Línea Celular , Humanos , Espectroscopía de Resonancia Magnética , Espectrometría de MasasRESUMEN
OBJECTIVE: To define the natural history and outcomes of children infected with hepatitis C virus (HCV) at birth or in early childhood. STUDY DESIGN: This retrospective, prospective study identified 60 HCV-infected children through a transfusion look-back program (group 1) and by referrals (group 2). Perinatal/transfusion history, clinical course, and laboratory studies were correlated with findings from 42 liver biopsy specimens. RESULTS: Mean age at infection was 7.1 months, and duration of infection 13.4 years. The sources of infection were blood transfusion (68%), perinatal transmission (13%), and both (7%). Most patients were asymptomatic; three referral patients had advanced liver disease at presentation. Mean alanine aminotransferase level was normal in 25%, 1 to 3 times normal in 62%, and greater than 3 times normal in 13%. Liver biopsy specimens showed minimal to mild inflammation in 71%, absent or minimal fibrosis in 88%, and bridging fibrosis in 12%. Age at infection and serum gamma-glutamyltranspeptidase correlated with fibrosis; serum alanine aminotransferase correlated with inflammation unless complicated by comorbidity. Repeat biopsies within 1 to 4 years in four patients showed no significant progression in three and cirrhosis in one. Two patients died after liver transplantation. CONCLUSIONS: Children with chronic HCV infection are generally asymptomatic. By 13 years after infection, 12% of patients had significant fibrosis. Patients enrolled by referral had more severe liver disease than those identified through the look-back program, demonstrating the importance of selection bias in assessing the long-term outcome of HCV infection.
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Hepatitis C Crónica/patología , Hepatitis C Crónica/fisiopatología , Cirrosis Hepática/patología , Biopsia con Aguja , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Anticuerpos contra la Hepatitis C/análisis , Humanos , Lactante , Cirrosis Hepática/virología , Modelos Logísticos , Masculino , Probabilidad , Pronóstico , Estudios Prospectivos , ARN Viral/análisis , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Factores de Tiempo , Reacción a la TransfusiónRESUMEN
OBJECTIVE: We evaluated overutilization or underutilization of inpatient resources to measure the emergency department (ED) decision-making process and its association with the following care factors: annual pediatric volume, presence or absence of a pediatric emergency medicine specialist; and presence or absence of ED residents. STUDY DESIGN: Block random selection, using the three care factors, of 16 hospitals with pediatric intensive care units. The Pediatric Risk of Admission (PRISA II) Score was used to measure illness severity. Decision-making was evaluated for admissions (Admission Index: observed minus predicted admissions) and returns (Return Index: observed minus predicted 72-hour returns). The Combined Index was a weighted average of the Admission and Return Indexes. RESULTS: There were 11,664 patients enrolled. Residents but not volume or pediatric emergency medicine specialists were associated with the decision-making performance indexes in multivariable analysis (no residents versus residents: Admission Index: 2.5 of 1000 patients versus 34.8 of 1000, P = .082; Return Index: -3.0 of 1000 versus 33.6 of 1000, P = .039; Combined Index: 1.9 of 1000 versus 35.5 of 1000, P = .024. CONCLUSIONS: There is significant variability in ED decision-making for children. Residents but not volume or presence of a pediatric emergency medicine specialist are associated with increased differences in admission decisions. The process by which these differences occur was not investigated.
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Toma de Decisiones , Servicio de Urgencia en Hospital/estadística & datos numéricos , Admisión del Paciente , Alta del Paciente , American Hospital Association , Análisis de Varianza , Ocupación de Camas , Niño , Preescolar , Bases de Datos Factuales , Medicina de Emergencia , Femenino , Recursos en Salud/estadística & datos numéricos , Humanos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Internado y Residencia , Masculino , Proyectos de Investigación , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis y Desempeño de Tareas , Estados Unidos/epidemiología , Recursos HumanosRESUMEN
Nitrothienylprop-2-yl ether formation on the 3'-phenolic position of combretastatin A-4 (1) abolishes the cytotoxicity and tubulin polymerization-inhibitory effects of the drug. 5-Nitrothiophene derivatives of 1 were synthesized following model kinetic studies with analogous coumarin derivatives, and of these, compound 13 represents a promising new lead in bioreductively targeted cytotoxic anticancer therapies. In this compound, optimized gem-dimethyl alpha-carbon substitution enhances both the aerobic metabolic stability and the efficiency of hypoxia-mediated drug release. Only the gem-substituted derivative 13 released 1 under anoxia in either in vitro whole-cell experiments or supersomal suspensions. The rate of release of 1 from the radical anions of these prodrugs is enhanced by greater methyl substitution on the alpha-carbon. Cellular and supersomal studies showed that this alpha-substitution pattern controls the useful range of oxygen concentrations over which 1 can be effectively released by the prodrug.
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Antineoplásicos Fitogénicos/síntesis química , Antineoplásicos Fitogénicos/metabolismo , Profármacos/síntesis química , Profármacos/metabolismo , Estilbenos/química , Estilbenos/metabolismo , Tiofenos/síntesis química , Animales , Antineoplásicos Fitogénicos/química , Relación Dosis-Respuesta a Droga , Humanos , Hígado/efectos de los fármacos , Hígado/metabolismo , Ratones , Nitrocompuestos/química , Profármacos/química , Tiofenos/química , Factores de Tiempo , Tubulina (Proteína)/efectos de los fármacos , Tubulina (Proteína)/metabolismo , Células Tumorales CultivadasRESUMEN
BACKGROUND: The classic position for subclavian venipuncture is the Trendelenberg position, with the head turned away and placement of a shoulder roll (SR). The purpose of this study was to determine whether this position results in the largest cross-sectional area (CSA) of the subclavian vein (SV). METHODS: Adult volunteers underwent ultrasound imaging of the right SV in supine and Trendelenberg positioning in the following four head and shoulder positions: head neutral with the chin midline (NL), head turned away (TA), head neutral with an SR, and head TA with an SR (TA/SR). The mean CSA of the SV in each position was calculated. Statistical significance was determined using Student's t, Wilcoxon signed rank, and Bonferroni test. RESULTS: Eighteen adults participated in the study. Trendelenberg positioning significantly increased the CSA of the SV in all positions except NL compared to supine positioning (P < .03). An SR significantly decreased SV CSA in all positions. The largest SV CSA was obtained in the TA/Trendelenberg position (1.41 +/- .06 cm(2)). The classic positioning for subclavian cannulation, TA/SR/Trendelenberg, resulted in a significantly smaller CSA than TA/Trendelenberg position (1.27 +/- .06 cm(2), 15% reduction, P < .01). CONCLUSIONS: The classic recommended maneuvers of turning the head and placing an SR significantly reduce the CSA of the SV. Positioning patients in Trendelenberg with the head turned away without an SR optimizes SV size. Positioning patients in this manner may serve to reduce the morbidity associated with percutaneous access of the SV.
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Cateterismo Venoso Central/métodos , Postura , Vena Subclavia/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Valores de Referencia , UltrasonografíaRESUMEN
Abstracts presented at anesthesiology subspeciality and component society meetings are chosen by peer review. We assessed this process by examining selection criteria and determining interrater concordance. For the societies studied, the level of reviewer agreement ranged from poor to moderate, i.e., slightly better than by chance alone. We hypothesize that having clearer evaluation criteria, scoring systems with interval scales, and assessment based on quality can strengthen the peer review process.
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Anestesiología/métodos , Revisión por Pares/métodos , Sociedades Médicas , Análisis de Varianza , HumanosRESUMEN
OBJECTIVE: The excitatory amino acids (EAA); glutamate and aspartate are released into the cerebrospinal fluids (CSF) of asphyxiated newborns. The objectives of this study were: (a) to examine the relation of the concentration of EAA in the CSF with the degree of brain injury, (b) To determine the time of the release of these EAA into the CSF, and (c) to detect the effect of magnesium sulfate (MgSO(4)) on their levels. DESIGNS AND METHODS. A randomized controlled trial was conducted on 47 full term asphyxiated newborns. Twenty three infants received an intravenous 10% solution of MgSO(4) at a dose of 250 mg/kg within the first 24h of life while the other 24 newborns received isotonic saline (0.9%) of an equal volume. Levels of glutamate and aspartate were measured before and 72 h after giving the trial solution. Results. In the study population (n=47) both glutamate and aspartate were significantly elevated in infants with higher grades of HIE compared to those with lower grades (P=0.013 and 0.031, respectively). Compared to baseline level, glutamate decreased significantly over time in placebo group (-8.28+/-14.26, P=0.025) and in MgSO(4) group (-14.39+/-18.72, P=0.005). Glutamate concentration did not differ between groups when measured at baseline (29.26+/-16.31 vs. 31.27+/-22.62, P=0.82) and at 72 h (19.28+/-15.63 vs. 19.6+/-16.54, P=0.87). The change in aspartate concentration over time was not significant in placebo group (-0.45+/-1.96, P=0.34) or in MgSO(4) group (-0.7+/-3.19, P=0.37). Aspartate did not differ between groups when measured at baseline (3.52+/-2.4 vs. 3.92+/-2.59, P=0.49) or at 72 h (2.79+/-1.24 vs. 3.05+/-2.48, P=0.92). Conclusions. The EAA; glutamate and aspartate are released in the CSF of asphyxiated newborns immediately after birth and declined by 72 h. Their initial concentrations correlated with the severity of HIE. Postnatal administration of MgSO(4) did not alter the levels of these 2 EAA.
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Anticonvulsivantes/administración & dosificación , Ácido Aspártico/líquido cefalorraquídeo , Asfixia Neonatal/tratamiento farmacológico , Ácido Glutámico/líquido cefalorraquídeo , Sulfato de Magnesio/administración & dosificación , Asfixia Neonatal/líquido cefalorraquídeo , Femenino , Humanos , Hipoxia Encefálica/líquido cefalorraquídeo , Hipoxia Encefálica/tratamiento farmacológico , Recién Nacido , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Neonatal mortality and morbidity are sex biased in low birth weight infants. The "Y chromosome effect" has been suggested to be responsible for these maturational differences. OBJECTIVE: To examine the association of sex and neonatal outcomes. DESIGN AND METHODS: A retrospective observational study. Data on all low birth weight infants who survived for >48 hrs were analyzed. Neonatal outcomes were compared between male and female infants. A regression model was used to detect the influence of sex on outcomes after controlling for confounders. Analysis was repeated after stratification of infants into three groups: group A (<1000 g), group B (1000-1499 g), and group C (1500-2499 g). RESULTS: A total of 833 infants were included in this study; 419 female infants and 414 male infants. Male infants had an increased rate of overall intraventricular hemorrhage (IVH) (12.2% vs. 7.2%, p = .02) and IVH grades 3-4 (4.8% vs. 2.3%, p = .04). In addition, male infants had higher bilirubin levels (10.19 +/- 3.1 mg/dL vs. 9.32 +/- 2.94 mg/dL, p = .001). In a regression model, male sex continued to have significant influence on IVH, IVH grades 3-4, death, and bilirubin. In group A, male infants had a significantly increased prevalence of death (regression coefficient, 1.82 +/- 0.65; p = .005) that could not be explained by the increased prevalence of IVH (p = .18) in regression analysis. In group B, male sex was significantly associated with a higher bilirubin level (regression coefficient, 0.94 + 0.3; p = .002). In bivariate analyses, IVH and IVH grades 3-4 were significantly higher in male compared with female infants (19.8% vs. 3.9%, p < .0001) and (8.5% vs. 0.97%, p = .02), respectively, but these differences lost significance in multiple-regression analysis. In group C, male sex positively influenced the prevalence of IVH (regression coefficient, 1.7 +/- 0.57; p = .003). Bilirubin measured higher in male infants (11.38 +/- 2.87 mg/dL vs. 10.19 +/- 3.22 mg/dL, p = .0004), but the difference lost significance in regression analysis (regression coefficient, 0.21 +/- 0.31; p = .5). CONCLUSIONS: Bilirubin, IVH, and death were significantly higher in male infants. In subgroup analysis, significance was retained in group A (<1000 g). Whether a single biological factor is responsible for these differences or perhaps a multi-causal process involving a complex interaction of physiologic, environmental, and pathologic responses needs to be further addressed in future research.
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Ventrículos Cerebrales , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Hemorragias Intracraneales/epidemiología , Susceptibilidad a Enfermedades/epidemiología , District of Columbia/epidemiología , Femenino , Humanos , Recién Nacido , Hemorragias Intracraneales/mortalidad , Masculino , Análisis Multivariante , Prevalencia , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVE: A total of 20% of sudden infant death syndrome (SIDS) cases in the 1990s occurred in child care settings. This is much higher than the 8% expected from Census Bureau data. Factors that were associated with child care SIDS included older age; white race; older, more educated mothers; and unaccustomed prone position. Since these findings, much emphasis has been placed on promoting a safe sleep environment in child care. The objectives of this study were to determine the proportion of SIDS occurring in child care in 2001 and to assess risk factors for SIDS in child care. METHODS: We conducted a retrospective review of all SIDS deaths that occurred in 2001 in 13 US states. Information regarding demographics, SIDS risk factors, and child care arrangements were collected and analyzed. Deaths that occurred in child care were compared with deaths that occurred during parental care. RESULTS: Of 480 deaths, 79 (16.5%) occurred in child care settings. Of these child care deaths, 36.7% occurred in family child care homes, 17.7% occurred in child care centers, 21.3% occurred in relative care, and 17.7% occurred with a nanny/babysitter at home. Infants in child care were more likely to be older and to die between the hours of 8 am and 4 pm and less likely to be exposed to secondhand smoke. There was no difference in usual, found, or placed sleep position between child care and home deaths. Approximately one half of the infants who died of SIDS in both settings were found prone, and 20% of deaths in both settings were among infants who were unaccustomed to prone sleep. CONCLUSIONS: The proportion of SIDS deaths in child care has declined slightly but still remains high at 16.5%. Infants in child care are no more likely to be placed or found prone and no more likely to be on an unsafe sleep surface. Educational efforts with child care providers have been effective and should be expanded to unregulated child care providers. In addition, there may be other, yet-unidentified factors in child care that place infants in those settings at higher risk for SIDS.
Asunto(s)
Cuidadores , Guarderías Infantiles , Muerte Súbita del Lactante/epidemiología , Adolescente , Adulto , Lechos , Cuidadores/educación , Recolección de Datos , Femenino , Educación en Salud , Humanos , Lactante , Persona de Mediana Edad , Prevalencia , Posición Prona , Factores de Riesgo , Muerte Súbita del Lactante/etiología , Muerte Súbita del Lactante/prevención & control , Estados Unidos/epidemiologíaRESUMEN
We tested the efficacy and safety of glutamine (0.6 gm/kg/day) and creatine (5 gm/day) in 50 ambulant boys with Duchenne muscular dystrophy in a 6-month, double-blind, placebo-controlled clinical trial. Drug efficacy was tested by measuring muscle strength manually (34 muscle groups) and quantitatively (10 muscle groups). Timed functional tests, functional parameters, and pulmonary function tests were secondary outcome measures. Although there was no statistically significant effect of either therapy based on manual and quantitative measurements of muscle strength, a disease-modifying effect of creatine in older Duchenne muscular dystrophy and creatine and glutamine in younger Duchenne muscular dystrophy cannot be excluded. Creatine and glutamine were well tolerated.
Asunto(s)
Creatina/uso terapéutico , Glutamina/uso terapéutico , Músculo Esquelético/efectos de los fármacos , Distrofia Muscular de Duchenne/tratamiento farmacológico , Niño , Preescolar , Humanos , Masculino , Pruebas de Función RespiratoriaRESUMEN
BACKGROUND: Bloodstream infection (BSI) is a significant cause of morbidity and death encountered in the NICU. The rates of BSIs vary significantly in NICUs across the nation. However, no attempt has been made to correlate this variation with specific infection-control practices and policies. We experienced a significant increase in BSIs in the NICU at the George Washington University Hospital and were seeking additional precautionary measures to reduce BSI rates. Our objective was to review policies and practices associated with lower infection rates nationally and to test their reproducibility in our unit. DESIGN AND METHODS: Data on BSI rates in 16 NICUs were reviewed. The BSI rate at Connecticut Children's Medical Center (CCMC) was the lowest among those reviewed. A team from George Washington University Hospital conducted a site visit to CCMC to examine their practices. Differences in the aseptic precautions used for intravenous line management were noted at CCMC, where a closed medication system is used. This system was applied at George Washington University Hospital starting January 1, 2001. Infection rates among low birth weight infants (<2500 g) at George Washington University Hospital in the period from January 1998 to December 2000 (group 1) were compared with those in the period from January 2001 to December 2003 (group 2). Comparisons between the 2 cohorts were made with Fisher's exact test, the Kruskal-Wallis test, and Student's t test. Multivariate analysis was used to control for differences in birth weight, gestational age, central line days, and ventilator days. Analyses were repeated for the subgroup of very low birth weight infants (<1500 g). RESULTS: A total of 536 inborn low birth weight infants were included in this retrospective study (group 1, N = 169 infants; group 2, N = 367). The incidence of sepsis decreased significantly from group 1 to group 2 (25.4% and 2.2%, respectively). The reduction of sepsis observed in association with the new practice was statistically significant after controlling for birth weight, central line days, and ventilator days in a multiple regression model (regression coefficient: 0.95 +/- 0.29). The odds ratio of reduction in sepsis after implementation of the new practice was 2.6 (95% confidence interval: 1.5-4.5). The central line-related BSI rate decreased from 15.17 infections per 1000 line days to 2.1 infections per 1000 line days. The study included 233 very low birth weight infants, ie, 90 in group 1 and 143 in group 2. The rate of BSIs decreased significantly from group 1 to group 2 (46.7% and 5.6%, respectively). The decrease in sepsis rate remained significant in a multiple regression model (regression coefficient: 1.42 +/- 0.35). The odds ratio of decreased sepsis in relation to the new policy application among the very low birth weight infants was 4.15 (95% confidence interval: 2.1-8.3). CONCLUSION: Applying the closed medication system was associated with reduced BSI rates in our unit. This protocol was easily reproducible in our environment and showed immediate results. Serious attempts to share data can potentially optimize outcomes and standardize policies and practices among NICUs.