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Abdel-Wareth L.,Pathology and Laboratory Medicine Institute | Haq A.,Pathology and Laboratory Medicine Institute | Turner A.,Pathology and Laboratory Medicine Institute | Salem A.,Pathology and Laboratory Medicine Institute | And 6 more authors.
Nutrients | Year: 2013

This study compared two methods of assaying the 25-hydroxylated metabolites of cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). A fully automated electrochemiluminescence assay from Roche Diagnostics and an HPLC based method from Chromsystems were used to measure vitamin D levels in surplus sera from 96 individuals, where the majority has the D2 form of the vitamin. Deming regression, concordance rate, correlation and Altman Bland agreement were performed. Seventy two subjects (75%) had a D2 concentration >10 nmol/L while the remaining twenty four subjects had vitamin D2 concentration of less than 10 nmol/L by HPLC. Overall, the Roche Diagnostics method showed a negative bias of -2.59 ± 4.11 nmol/L on the e602 as compared to the HPLC with a concordance rate of 84%. The concordance rate was 91% in samples with D2 of less than 10 nmol/L and 82% in those with D2 concentration >10 nmol/L. The overall correlation had an r value of 0.77. The r value was higher in samples with D2 levels of less than 10 nmol/L, r = 0.96, as compared to those with D2 values of greater than 10 nmol/L, r = 0.74. The observed bias had little impact on clinical decision and therefore is clinically acceptable. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Gonzalez-Estrada A.,Cleveland Clinic | Cuervo-Pardo L.,Medicine Institute | Ghosh B.,Cleveland Clinic | Smith M.,Medicine Institute | And 4 more authors.
Allergy and Asthma Proceedings | Year: 2015

Background: Asthma affects <300 million people globally, including 25 million in the United States. Patients with asthma frequently use the Internet as a source of information. YouTube is one of the three most popular Web sites. Objective: To determine the educational quality of YouTube videos for asthma. Methods: We performed a YouTube search by using the keyword "asthma." The 200 most frequently viewed relevant videos were included in the study. Asthma videos were analyzed for characteristics, source, and content. Source was further classified as asthma health care provider, other health care provider, patient, pharmaceutical company, and professional society and/or media. A scoring system was created to evaluate quality (<10 to 30 points). Negative points were assigned for misleading information. Results: Two hundred videos were analyzed, with a median of 18,073.5 views, 31.5 likes, and 2 dislikes, which spanned a median of 172 seconds. More video presenters were male (60.5%). The most common type of video source was other health care providers (34.5%). The most common video content was alternative treatments (38.0%), including live-fish ingestion; reflexology; acupressure and/or acupuncture; Ayurveda; yoga; raw food, vegan, gluten-free diets; marijuana; Buteyko breathing; and salt therapy. Scores for videos supplied by asthma health care providers were statistically significantly different from other sources (p < 0.001) and had the highest average score (9.91). Conclusion: YouTube videos of asthma were frequently viewed but were a poor source of accurate health care information. Videos by asthma health care providers were rated highest in quality. The allergy/immunology community has a clear opportunity to enhance the value of educational material on YouTube. © 2015, OceanSide Publications, Inc., U.S.A.

Volsko T.A.,Akron Children's Hospital | Fedor K.,Pediatric Institute | Amadei J.,Cleveland Clinic | Chatburn R.L.,Cleveland Clinic
Respiratory Care | Year: 2011

Background: Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. OBJECTIVE: To describe the relationship between the pressure generated at the airway opening and flow through a nasal cannula using a simulated infant model. We hypothesized that positive pressure generated by a standard cannula at flows > 2 L/min would be minimal and clinically unimportant. Methods: Nares were simulated with holes drilled in a plastic fixture. A nares template for CPAP prongs served as a sizing template for the holes. Small, medium, and large nares fixtures were constructed and connected to a lung simulator that simulated spontaneous breathing. Respiratory muscle pressure was simulated by setting a waveform and adjusting the amplitude to deliver a range of tidal volumes (V T) from 3 mL to 12 mL. Lung compliance and resistance were set at 0.5 mL/cm H 2O and 125 cm H 2O/L/s, respectively. Nasal cannulas were inserted in the model nares. We assured that the prong occlusion of the nares did not exceed 50%. Cannula flow was adjusted from 2-6 L/min in 1-L/min increments. Data were averaged over 20 breaths. Mean airway pressure and percent change in V T were recorded. Results: The greatest effect on V T (mean SD 0.16 ± 0.10 mL) and pressure change (mean ± SD 0.7 ± 0.5 cm H 2O) occurred with the premature cannula. The least effect on pressure (mean ± SD 0.3 ± 0.22 cm H 2O) and V T change (mean ± SD 0.01 ± 0.02 mL) occurred with the infant cannula. Conclusions: Clinically important pressures were not generated by high flows with a standard nasal cannula. The differences in spontaneous V T across all flows were negligible. © 2011 Daedalus Enterprises.

Balasubramaniam S.,Pediatric Institute | Salomons G.S.,VU University Amsterdam | Blom H.J.,VU University Amsterdam
Journal of Pediatric Neurology | Year: 2013

Methylenetetrahydrofolate reductase (MTHFR) is a key regulatory enzyme in the remethylation of homocysteine to methionine. S-adenosylmethionine, formed from methionine and adenosine triphosphate, is the methyl donor in crucial reactions for brain development and function. MTHFR deficiency is the most prevalent inborn error of folate metabolism and is characterized by hyperhomocysteinemia and hypomethioninemia. A broad clinical spectrum includes psychomotor retardation, microcephaly, seizures, central respiratory failure and death. Premature atherosclerosis, arterial and venous thrombosis or psychiatric manifestations occur in the late onset forms. We report a female neonate with severe MTHFR deficiency presenting with neonatal encephalopathy, congenital microcephaly, seizures, central hypoventilation with gross cerebral atrophy, hypomyelination and pontine hypoplasia on magnetic resonance imaging of brain. She succumbed at 10 wk of age despite treatment with oral S-adenosylmethionine, betaine, folinic acid, riboflavin and hydroxycobalamin. © 2013 - IOS Press and the authors. All rights reserved.

Wyllie R.,Pediatric Institute | Wyllie R.,Cleveland Clinic | Hyams J.,Connecticut Childrens Medical Center | Hyams J.,University of Connecticut
Pediatric Gastrointestinal and Liver Disease | Year: 2011

Pediatric Gastrointestinal and Liver Disease, by Drs. Robert Wyllie and Jeffrey S. Hyams provides the comprehensive reference you need to treat GI diseases in children. Review the latest developments in the field and get up-to-date clinical information on hot topics like polyps, capsule endoscopy, and pancreatic treatments. With expert guidance from an expanded international author base and online access to 475 board-review-style questions, this latest edition is a must-have for every practicing gastroenterologist. Confirm each diagnosis by consulting a section, organized by symptoms, that presents the full range of differential diagnoses and treatment options for each specific condition. Recognize disease processes at a glance with detailed diagrams that accurately illustrate complex concepts. Stay current with advances in the field by reviewing new chapters on Polyps and Polyposis Syndromes, Capsule Endoscopy and Small Bowel Enteroscopy, Small Bowel Transplantation, IBD, Short Gut Syndrome, Steatosis and Non-Alcoholic Fatty Liver Disease, and Pancreatic and Islet Cell Transplants. Gain fresh global perspectives from an expanded list of expert international contributors. Sharpen your visual recognition by accessing a color-plate section that displays additional endoscopy images. Prepare for certification or recertification with 475 online board review-style questions, answers, and rationales. Search the complete text online and download all illustrations at www.expertconsult.com. © 2011 Elsevier Inc. All rights reserved.

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