Pediatric Institute

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Pediatric Institute

United States
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Wyllie R.,Pediatric Institute | Wyllie R.,Cleveland Clinic | Hyams J.,Connecticut Children’s 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 © 2011 Elsevier Inc. All rights reserved.

Al Abri S.S.,Royal Hospital | Al Kaabi N.,pediatric institute | Al Rabiah F.A.M.,King Faisal Specialist Hospital And Research Center | Al Salman J.,Arabian Gulf University | And 16 more authors.
Journal of Epidemiology and Global Health | Year: 2012

Facing the availability of the new generation of quadrivalent meningococcal conjugate vaccines (Menveo®, Menactra® and others pending for license) and their recent implementation in Saudi Arabia, experts from 11 countries of the Middle East region met at a " Meningococcal Leadership Forum" (MLF), which took place in May 2010 in Dubai. The participants of the conference discussed the importance of introducing the concept of conjugate vaccines - especially for children and adolescents - and elaborated a consensus recommendation to support healthcare professionals and decision makers with their expertise. In experts' opinion, conjugate vaccines are the best choice for the prevention of meningococcal disease caused by serogroups A, C, W-135 and Y. As quadrivalent meningococcal conjugate vaccines are registered and available in the Middle East region, they should replace plain polysaccharide vaccines and be integrated in pediatric and adolescent vaccination schedules, including infant vaccination concomitantly with basic EPI vaccines when licensed. © 2012 Ministry of Health, Saudi Arabia.

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.

Abdel-Wareth L.,Pathology and Laboratory Medicine Institute | Haq A.,Pathology and Laboratory Medicine Institute | Turner A.,Pathology and Laboratory Medicine Institute | Khan S.,Military Hospital | And 7 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.

Mandelia C.,Pediatric Institute | Collyer E.,Cleveland Clinic | Mansoor S.,Pediatric Institute | Lopez R.,Cleveland Clinic | And 4 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

Objectives: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic and affects approximately 10% of children in the US. The presence of hepatic fibrosis may be the most important factor in determining the prognosis of NAFLD. Noninvasive methods to identify the presence of fibrosis in children with NAFLD are greatly needed. Hepatocyte apoptosis activates hepatic stellate cells and plays a central role in fibrosis progression in NAFLD. The aim of the present study was to evaluate the use of plasma cytokeratin-18 (CK18) fragment levels, a marker of hepatocyte apoptosis, as a noninvasive biomarker in detecting liver fibrosis in pediatric NAFLD. Methods: Consecutive children with biopsy-proven NAFLD were included and blood samples and anthropometric measurements were collected at the time of the biopsy. NAFLD activity score was calculated (0-8) and fibrosis stage was scored (0-4). We measured plasma CK18 levels using the M30-Apoptosense enzyme-linked immunosorbent assay kit. Results: A total of 201 subjects were enrolled in the study. The mean age was 10.7±2.5 years, and 37%were boys. Sixty-eight percent of the patients had any fibrosis, with 56% having F1, 6% having F2, and 6 % having F3. CK18 levels were found to be significantly higher in subjects with any fibrosis compared with those without fibrosis (304.6±124.8 vs 210.4±70.9, P<0.001). CK18 level revealed good accuracy for prediction of any fibrosis (F1-F3) with AUROC of 0.75. Multivariate logistic regression was performed to assess whether CK18 in combination with another clinical factor could improve accuracy of prediction of fibrosis. Together, CK18 with waist circumference percentile generated an area under the receiver operating characteristics curve of 0.842 for prediction of any fibrosis. Conclusions: CK18 is a promising noninvasive biomarker for fibrosis in NAFLD in children. A fibrosis prediction model that includes CK18 and waist circumference percentile should be validated in other populations. Copyright © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

PubMed | Pediatric Institute
Type: | Journal: JIMD reports | Year: 2013

We aim to present our experience with infantile Pompe disease with focus on the impact of availability of treatment on awareness, diagnosis, and management of such patients.Case - review study of patients diagnosed with infantile Pompe disease and literature search.We identified five cases of infantile Pompe disease. The first was diagnosed by muscle biopsy; all others were diagnosed by enzyme assay on peripheral blood lymphocytes or dried blood spot. There was no determination of the CRIM status on these patients. Two have died at a much later age than the reported median age of death for untreated cases. One died very early at 2 months of age with severe cardiomyopathy and had received only one dose of enzyme replacement therapy (ERT). The remaining two surviving patients are siblings: the younger was diagnosed by prenatal ultrasound screening and started on ERT at 24 h of age; she is the youngest treated patient in our case series.The natural history of infantile Pompe disease is changing, so are the challenges of managing these infants in the post- ERT era. Currently, increased awareness and early access to therapy provide the best outcomes and incur the least shift of burden from mortality to morbidity. Disclosure: Authors have received travel support to attend scientific symposiums by Genzyme. WF has also received consulting fees for speaking in a scientific symposium by Genzyme.

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