New Orleans, LA, United States
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Mohammad S.,Northwestern University | Di Lorenzo C.,Nationwide Childrens Hospital | Youssef N.N.,Digestive Healthcare Center | Miranda A.,Medical College of Wisconsin | And 3 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2014

Objectives: Irritable bowel syndrome is a multisymptom construct, with abdominal pain (AP) acting as the driving symptom of patient-reported severity. The Food and Drug Administration considers a >30% decrease in AP as satisfactory improvement, but this has not been validated in children. We investigated the correspondence of 2 measures for AP assessment, ≥30% improvement in AP and global assessment of improvement. METHODS: Secondary analysis of data from 72 children who completed a randomized clinical trial for abdominal pain-associated functional gastrointestinal disorders. Children completed daily assessment of AP intensity, functional disability inventory (FDI), question regarding paine's interference with activities, and 2 global assessment questions. We measured the extent to which ≥30% improvement of AP and global assessment questions correlated with each other and with disability. RESULTS: The global questions correlated with each other (r=0.74; P<0.0001) and with a ≥30% improvement in AP (P<0.01). Global outcomes were satisfaction with treatment was inversely related to the childe's report of interference with activities (P<0.01) and symptom relief was positively associated with ≥30% improvement in FDI scores (P<0.009). A 30% change in FDI scores was associated with global questions of symptom relief (P=0.009) but not with satisfaction with treatment (P=0.07). The association of AP improvement with interference with activities (P=0.14) or change in FDI scores (P=0.27) did not reach significance. CONCLUSIONS: Currently used global assessments are significantly associated with decreased pain intensity, decreased interference with daily activities, and a ≥30% change in FDI scores, whereas recommended 30% improvement in pain intensity is not as comprehensive. © 2013 by European Society for Pediatric Gastroenterology,Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.


Eagle S.,Childrens Hospital of New Orleans | Creel A.,Childrens Hospital of New Orleans | Alexandrov A.,University of Alabama at Birmingham
Journal of Palliative Medicine | Year: 2012

Background: Children admitted to pediatric intensive care units (PICUs) face potentially life limiting conditions. The toll on heath care professionals caring for these children is significant and often overlooked. There is a potential need for increased staff support, and facilitated peer support sessions could be an effective management tool, but few studies specifically evaluate this multidisciplinary population. The purpose of this pilot study is to evaluate the current rates of grief and burnout among health care professionals in our PICU, and explore facilitated support sessions as a method of reducing grief perceptions and burnout among providers. Methods: A convenience sample of approximately 50 interdisciplinary professionals was invited to participate. The Copenhagen Burnout Inventory (CBI) and Hogan Grief Reaction Checklist (HGRC) were administered before and after two interactive, facilitated peer support sessions in a pretest/posttest design. Results: The results of pretest/posttest CBI and HGRC instruments did not indicate statistically significant changes. It is notable that the instruments indicated low levels of grief and burnout among participants pre-/post-implementation. Conclusions: While facilitated peer support did not reduce grief and burnout scores among our PICU interdisciplinary staff, many factors could have affected results, including small sample size, potentially different participants across sessions, timing of sessions, and the timing of administration of posttest instruments. Additionally, even though not statistically significant, the area of personal growth showed a trend toward improvement, indicating an area for further research. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


Strong M.J.,Tulane University | Xu G.,University of California at San Diego | Morici L.,Tulane University | Splinter Bon-Durant S.,University of Wisconsin - Madison | And 6 more authors.
PLoS Pathogens | Year: 2014

The high level of accuracy and sensitivity of next generation sequencing for quantifying genetic material across organismal boundaries gives it tremendous potential for pathogen discovery and diagnosis in human disease. Despite this promise, substantial bacterial contamination is routinely found in existing human-derived RNA-seq datasets that likely arises from environmental sources. This raises the need for stringent sequencing and analysis protocols for studies investigating sequence-based microbial signatures in clinical samples. © 2014 Strong et al.


Chalew S.A.,Louisiana State University Health Sciences Center | McCarter R.J.,Childrens National Medical Center | Ory-Ascani J.,Childrens Hospital of New Orleans | Hempe J.M.,Childrens Hospital of New Orleans
Diabetes Care | Year: 2010

OBJECTIVE - We hypothesized that labile A1C (LA1C) is directly correlated with stable A1C (SA1C) and between-patient differences in SA1C, which are independent of mean blood glucose (MBG). RESEARCH DESIGN AND METHODS - We measured SA1C, LA1C, MBG, and a single clinic capillary glucose (CCG) from 152 pediatric patients with type 1 diabetes. Patients were grouped as high, moderate, or low glycators by hemoglobin glycation index (HGI). RESULTS - LA1C and SA1C were correlated with CCG and MBG. LA1C was not correlated with SA1C (r = 0.06, P = 0.453). LA1C level was significantly associated with glycator group status (P < 0.0019) and CCG (P < 0.0001). Adjusted LA1C levels were highest in the low-HGI patients and lowest in the high-HGI group. CONCLUSIONS - A conventional model of SA1C being directly correlated with LA1C concentration was not confirmed. Between-patient differences in SA1C at the same MBG may be due to complex intracellular factors influencing formation of SA1C from LA1C. © 2010 by the American Diabetes Association.


McGoey R.R.,Louisiana State University Health Sciences Center | McGoey R.R.,Childrens Hospital of New Orleans | Marble M.,Louisiana State University Health Sciences Center | Marble M.,Childrens Hospital of New Orleans
Journal of Pediatrics | Year: 2011

A neonate with elevated tetradecenoylcarnitine (C14:1) on the newborn screen was evaluated for possible very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) and found to be a carrier. However, his symptom-free mother was subsequently diagnosed with VLCADD. This documents maternal VLCADD causing a positive newborn screening result in an offspring. Copyright © 2011 Mosby Inc. All rights reserved.


Rossi J.L.,Louisiana State University Health Sciences Center | Rossi J.L.,Childrens Hospital of New Orleans | Todd T.,Louisiana State University Health Sciences Center | Bazan N.G.,Louisiana State University Health Sciences Center | Belayev L.,Louisiana State University Health Sciences Center
Journal of Neurotrauma | Year: 2013

Traumatic brain injury (TBI) in children less than 8 years of age leads to decline in intelligence and executive functioning. Neurological outcomes after TBI correlate to development of cerebral edema, which affect survival rates after TBI. It has been shown that myosin light-chain kinase (MLCK) increases cerebral edema and that pretreatment with an MLCK inhibitor (ML-7) reduces cerebral edema. The aim of this study was to determine whether inhibition of MLCK after TBI in postnatal day 24 (PND-24) mice would prevent breakdown of the blood-brain barrier (BBB) and development of cerebral edema and improve neurological outcome. We used a closed head injury model of TBI. ML-7 or saline treatment was administered at 4 h and every 24 h until sacrifice or 5 days after TBI. Mice were sacrificed at 24 h, 48 h, and 72 h and 7 days after impact. Mice treated with ML-7 after TBI had decreased levels of MLCK-expressing cells (20.7±4.8 vs. 149.3±40.6), less albumin extravasation (28.3±11.2 vs. 116.2±60.7 mm2) into surrounding parenchymal tissue, less Evans Blue extravasation (339±314 vs. 4017±560 ng/g), and showed a significant difference in wet/dry weight ratio (1.9±0.07 vs. 2.2±0.05 g), compared to saline-treated groups. Treatment with ML-7 also resulted in preserved neurological function measured by the wire hang test (57 vs. 21 sec) and two-object novel recognition test (old vs. new, 10.5 touches). We concluded that inhibition of MLCK reduces cerebral edema and preserves neurological function in PND-24 mice. © Mary Ann Liebert, Inc. 2013.


McIntire J.B.,Louisiana State University Health Sciences Center | Simon L.,Childrens Hospital of New Orleans
International Journal of Pediatric Otorhinolaryngology Extra | Year: 2012

Supraglottic cysts are rare laryngeal lesions that can cause stridor, dysphagia, and fatal airway occlusion in infancy. Treatment is usually surgical with favorable prognosis. In this report, we present a case of a premature infant with supraglottic cyst in an unusual location that was successfully treated with endoscopic marsupialization. © 2012 Elsevier Ireland Ltd. All rights reserved.


We wanted to identify practice patterns and perceived barriers among pediatric nephrologists regarding STI screening and reproductive health counseling in adolescent renal transplant recipients. We created an online Likert-scaled survey. Response rate was 54%. The majority (83%) believed STI risk in their patients was similar to or higher than healthy teens. Interestingly, while 67% felt moderately or very confident in asking about sexual activity and counseling about safer sex, only 43% routinely or always inquired about sexual activity, and only 42% routinely or always counseled about safer sex. Fifty-four percent routinely or always discussed contraceptive options and implications of unintentional pregnancy. Fifty-one percent routinely or always referred patients to a gynecologist or adolescent provider for contraception prescription. The most common counseling mechanism was informal discussions in clinic (87%). Ten percent had no mechanism in place. Major barriers included time limitations, adolescents' fear regarding confidentiality, and lack of professional training. This is the first report of perceptions and practice patterns of pediatric nephrologists regarding STI screening and reproductive health counseling. Providers seem to recognize the importance of counseling; however, translation into practice remains low. Professional training in this area and increased encounter time could improve counseling delivery and thereby reduce risk in this population. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


Pritchard C.,Childrens Hospital of New Orleans | Ellis Jr. G.S.,Childrens Hospital of New Orleans
American Orthoptic Journal | Year: 2013

Background and Purpose: Retrospective studies have shown that as many as 15% of patients with pseudostrabismus go on to develop true strabismus. This prospective study was conducted to examine the effi cacy of utilizing a modifi ed cover test technique to help identify patients with pseudostrabismus that are likely to progress to true strabismus. Patients and Methods: Fifty- three subjects were included in the study. All were evaluated using prolonged occlusion during cover testing ("occlusive" cover test). The results of this test were analyzed for its ability to predict the development of true strabismus during a mean follow-up period of 11 months. Results: The occlusive cover test was of value in detecting which subjects would later develop esotropia. Conclusion: The occlusive cover test should be incorporated into the evaluation of patients suspected of having pseudostrabismus to identify which patients are most at risk of presenting later with true strabismus. © 2013 Board of Regents of the University of Wisconsin System.


Gioe O.,Childrens Hospital of New Orleans | Chalew S.A.,Childrens Hospital of New Orleans
Endocrine Practice | Year: 2014

Objective: The mean blood glucose (MBG) level obtained from self-monitored capillary glucose (SMCG) data is a readily available metric of glycemic control for patients and their physicians. However, whether there is agreement between SMCG MBG levels and MBG levels obtained from 24-hour intensive glucose sampling is unclear. Therefore, we analyzed the relationship between MBG levels derived from SMCG data and glucose data derived from continuous glucose monitoring (CGM).Methods: SMCG and CGM were concurrently performed in 104 patients with diabetes and prediabetes over 3 to 6 days. MBG data obtained from SMCG and CGM were compared by standard correlation and Bland-Altman analyses.Results: SMCG and CGM MBG data from the longest duration of sampling were highly correlated (r = 0.965; P<.001). Single-day MBG estimates from both sources were also highly correlated, with r values ranging from 0.833 to 0.927. A SMCG MBG level of 166.1 ± 55 mg/dL (derived from 14.1 ± 4.6 samples) tended to slightly underestimate the concurrent CGM MBG level of 171.1 ± 56.4 mg/dL (derived from 1,063 ± 283 samples). The SMCG MBG was within 30 mg/dL of the CGM MBG in 94.6%of patients and within 15 mg/dL in 67%of patients. The difference between the estimates tended to increase with increasing SD of the MBG obtained from CGM (r = 0.38; P<.0001).Conclusion: MBG estimated from SMCG is a reasonable estimate of a patient's CGM MBG over the same period of time and with caveats could be used as a practical guide for long-term glycemic control that can be considered in tandem with the patient's hemoglobin A 1c in endocrine practice. © 2014 AACE.

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