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Salam M.T.,University of Southern California | Salam M.T.,Kern Medical Center | Avoundjian T.,Center for Health Care Evaluation | Knight W.M.,Acute Communicable Disease Control Program | Gilliland F.D.,University of Southern California
PLoS ONE | Year: 2015

Background: Asthma and rhinitis are common childhood health conditions. Being an understudied and rapidly growing population in the US, Hispanic children have a varying risk for these conditions that may result from sociocultural (including acculturative factors), exposure and genetic diversities. Hispanic populations have varying contributions from European, Amerindian and African ancestries. While previous literature separately reported associations between genetic ancestry and acculturation factors with asthma, whether Amerindian ancestry and acculturative factors have independent associations with development of early-life asthma and rhinitis in Hispanic children remains unknown. We hypothesized that genetic ancestry is an important determinant of early-life asthma and rhinitis occurrence in Hispanic children independent of sociodemographic, acculturation and environmental factors. Methods: Subjects were Hispanic children (5-7 years) who participated in the southern California Children's Health Study. Data from birth certificates and questionnaire provided information on acculturation, sociodemographic and environmental factors. Genetic ancestries (Amerindian, European, African and Asian) were estimated based on 233 ancestry informative markers. Asthma was defined by parental report of doctor-diagnosed asthma. Rhinitis was defined by parental report of a history of chronic sneezing or runny or blocked nose without a cold or flu. Sample sizes were 1,719 and 1,788 for investigating the role of genetic ancestry on asthma and rhinitis, respectively. Results: Children had major contributions from Amerindian and European ancestries. After accounting for potential confounders, per 25% increase in Amerindian ancestry was associated with 17.6% (95% confidence interval [CI]: 0.74-0.99) and 13.6% (95% CI: 0.79-0.98) lower odds of asthma and rhinitis, respectively. Acculturation was not associated with either outcome. Conclusions: Earlier work documented that Hispanic children with significant contribution from African ancestry are at increased asthma risk; however, in Hispanic children who have little contribution from African ancestry, Amerindian ancestry was independently associated with lower odds for development of early-childhood asthma and rhinitis.

Pakula A.M.,The Surgical Center | Phillips W.,Kern Medical Center | Skinner R.A.,The Surgical Center
World Journal of Emergency Surgery | Year: 2011

Background: Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear 1. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively.Case Presentation: A 51 year old male presented as a tier one trauma code due to an automobile versus bicycle collision. His examination and radiographic work-up revealed fractures and a subluxation at the third and fourth thoracic spine levels resulting in paraplegia. He also sustained bilateral hemothoraces secondary to multiple rib fractures. Drainage of the left hemothorax led to the diagnosis of a traumatic chylothorax. The thoracic spine fractures were addressed with surgical stabilization and the chylothorax was successfully treated with drainage and dietary manipulation.Conclusions: This unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention. © 2011 Pakula et al; licensee BioMed Central Ltd.

Khurana J.,Kern Medical Center
Journal of intensive care medicine | Year: 2013

Splenic artery aneurysm (SAA) is the most common (60%) of all visceral artery aneurysms. The majority of these cases are asymptomatic, but the presentation of their rupture can vary from abdominal/chest pain to cardiovascular collapse (Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy-a systematic review. Int J Surg. 2008;6(3):261-265.). Although rare, the mortality associated with the rupture is as high as 25% (De Vries JE, Schattenkerk ME, Malt RA. Complications of splenic artery aneurysm other than intraperitoneal rupture. Surgery. 1982;91(2):200-204; Caillouette JC, Merchant EB: Ruptured splenic artery aneurysm in pregnancy. Twelfth reported case with maternal and fetal survival. Am J Obstet Gynecol 1993;168(6 Pt 1):1810-1811) and increases to 75% among pregnant women with a concomitant fetal mortality of 95% (O'Grady JP, Day EJ, Toole AL, et al. Splenic artery aneurysm rupture in pregnancy. A review and case report. Obstet Gynecol. 1977; 50(5):627-630). Because of such high maternal and fetal mortality prompt management of SAAs is of utmost importance. We are presenting a case of a 35-year-old woman with a missed ruptured SAA who after an emergent cesarean section went into profound shock and was unable to be resuscitated. This case illustrates the importance of considering the diagnosis of SAA rupture in hemodynamically unstable peripartum females.

Spinello I.M.,University of California at Los Angeles | Spinello I.M.,Kern Medical Center
Journal of Intensive Care Medicine | Year: 2015

In the United States, each year 1% to 2% of deaths are brain deaths. Considerable variation in the practice of determining brain death still remains, despite the publication of practice parameters in 1995 and an evidence-based guideline update in 2010. This review is intended to give bedside clinicians an overview of definition, the causes and pitfalls of misdiagnosing brain death, and a focus on the specifics of the brain death determination process. © SAGE Publications.

Spinello I.M.,Kern Medical Center
Journal of Intensive Care Medicine | Year: 2011

Proper critical care training and management rests on 3 pillars-evidence-based patient care, proficient procedural skills, and compassionate end-of-life (EOL) management. The purpose of this manuscript is to provide a practical guide to EOL management for all bedside practitioners. The manuscript outlines not all but some fundamentally important ethical concepts and provides helpful rules and steps on end-of-life management based on my own personal experience and practice. Moreover, nowhere in the rigorous training of critical care or hospitalist physicians do we teach the procedure for removal of life-sustaining measures. Like any other procedure in medicine, it requires preparation, implementation and conclusion, as well as supervision and repetition to become proficient. Therefore, at the conclusion of this paper, an attempt is made to correct this lack of training by providing such outline and a guide. © SAGE Publications 2011.

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