Clinton, MI, United States
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PubMed | Medical College of Wisconsin, St John Hospital And Medical Center and St John Providence Childrens Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

In anthracycline-induced cardiomyopathy, the onset of diastolic dysfunction occurs before systolic dysfunction. Although, conventional echocardiogram is the standard method to assess cardiac function post anthracycline therapy, Tissue Doppler Imaging (TDI) may detect early onset cardiac diastolic dysfunction among anthracycline-recipient survivors of childhood cancers. There are limited data on the use of TDI in assessing anthracycline-associated cardiotoxicity in children.To evaluate the role of Tissue Doppler Imaging (TDI) in assessing late-onset cardiotoxicity in survivors of paediatric cancers.This was a single site, observational, blinded study of 11 long-term survivors of childhood cancer who had been treated with anthracyclines and 22 age-matched controls. The study group and the control group underwent conventional echo and TDI; operators were blind to study group. Conventional echo measurements were obtained. TDI was used to assess systolic and diastolic parameters at the mid-interventricular septum and lateral and medial annuli of the mitral valve; these parameters included: systolic wave (S), early diastolic wave (E), late diastolic wave (A), Isovolemic Contraction Time (ICT), Isovolemic Relaxation Time (IRT) and Ejection Time (ET). Myocardial Performance Index (MPI) was also calculated.Conventional echo measurements were similar in both groups. Using TDI, cases had a lower mean E velocity (9.7 1.7 cm/s vs. 11.4 1.3 cm/s, p=0.004) and a lower E/A (1.8 0.5 vs. 2.2 0.4, p=0.022) at the mid-interventricular septum than controls. The mean E septum velocity in chemotherapy-recipients who also received chest radiotherapy was 8.50.5 cm/s in comparison to 10.21.7 cm/s in those that did not receive chest radiotherapy but this not achieve statistical significance. We did not find any additional associations between TDI parameters and patients gender, age of diagnosis, length of follow-up and dose of anthracycline.In long-term survivors of childhood cancer who received anthracyclines, diastolic dysfunction can be detected earlier by using TDI before overt systolic dysfunction. Further large-scale multicenter studies are needed.


Dharmaraj R.,St John Providence Childrens Hospital | Hagglund K.,St John Providence Childrens Hospital | Lyons H.,Wayne State University
BMC Research Notes | Year: 2015

Background: Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. Our aim was to estimate the incidence of EoE among children who were diagnosed with CD over a 42-month period. Methods: The study included patients diagnosed with CD based on endoscopy and histopathological findings between January 2010 and June 2013. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE. The patients' presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, treatments, and follow-ups were analysed. Results: Fifty-six patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Four of these patients presented with abdominal pain and diarrhea, two presented with failure to thrive, and three presented with food allergies. Endoscopic and histopathological changes typical of EoE were observed in all six patients. During follow-up, two patients showed significant improvement with the gluten-free diet and a proton-pump inhibitor (PPI). Two patients improved with the elimination diet and two patients were treated with topical corticosteroid therapy. Endoscopic appearance was normal in all children on follow-up endoscopy after treatment. Biopsy samples also showed resolution of the histologic features of EoE in all of the children. Conclusion: The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistence of EoE should be considered. © 2015 Dharmaraj et al.


Kapoor R.,St John Providence Childrens Hospital | Paul P.,Vardhman Mahavir Medical College and Safdarjang Hospital | Anne P.,Wayne State University
Journal of Clinical and Diagnostic Research | Year: 2016

Ebstein’s anomaly is a rare congenital heart disorder and has a varied clinical course, with detection as late as the seventh decade. We hereby describe an 11-year-old child in whom Ebstein’s anomaly was diagnosed. The most common presentation in early second decade is due to an arrhythmia; however, the present case report is about a patient who presented with acute congestive heart failure due to decompensation from an acute upper respiratory tract infection, which is a rather uncommon presentation. ©2016, Journal of Clinical and Diagnostic Research. All Rights Reserved.


PubMed | Wayne State University and St John Providence Childrens Hospital
Type: | Journal: BMC research notes | Year: 2015

Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. Our aim was to estimate the incidence of EoE among children who were diagnosed with CD over a 42-month period.The study included patients diagnosed with CD based on endoscopy and histopathological findings between January 2010 and June 2013. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE. The patients presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, treatments, and follow-ups were analysed.Fifty-six patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Four of these patients presented with abdominal pain and diarrhea, two presented with failure to thrive, and three presented with food allergies. Endoscopic and histopathological changes typical of EoE were observed in all six patients. During follow-up, two patients showed significant improvement with the gluten-free diet and a proton-pump inhibitor (PPI). Two patients improved with the elimination diet and two patients were treated with topical corticosteroid therapy. Endoscopic appearance was normal in all children on follow-up endoscopy after treatment. Biopsy samples also showed resolution of the histologic features of EoE in all of the children.The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistence of EoE should be considered.


PubMed | Vardhman Mahavir Medical College and Safdarjang Hospital New Delhi, St John Providence Childrens Hospital and Wayne State University
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Ebsteins anomaly is a rare congenital heart disorder and has a varied clinical course, with detection as late as the seventh decade. We hereby describe an 11-year-old child in whom Ebsteins anomaly was diagnosed. The most common presentation in early second decade is due to an arrhythmia; however, the present case report is about a patient who presented with acute congestive heart failure due to decompensation from an acute upper respiratory tract infection, which is a rather uncommon presentation.


PubMed | Wayne State University and St John Providence Childrens Hospital
Type: | Journal: BMC research notes | Year: 2015

Studies have suggested that inflammatory bowel diseases (IBD) follow a seasonal pattern with regard to their onset and exacerbations. The aim of this study is to determine if there is any seasonal pattern to the onset and exacerbation of IBD in the pediatric population and if the birth of children diagnosed with IBD follows a seasonal pattern.Patients between the ages of 1 and 21 years and with a diagnosis of IBD established between July 1992 and July 2012 were included. Their onset and exacerbations of IBD (year and season) were recorded. The birth dates of the patients were aggregated to determine whether a seasonal birth pattern existed amongst them.A total of 170 children were included in this study; 34% of patients had their onset in the fall and 19% of them had their onset in the summer. The total number of documented exacerbations was 358 and the median number of exacerbations was two, with a range of 1-11. IBD exacerbations were generally uniformly distributed throughout the year. We did not observe any specific season where children with IBD tended to be born.Our data suggests that the onset of symptoms of IBD tends to have a seasonal trend with the highest incidence in the fall. However, we did not observe any association between seasonality and exacerbations in the pediatric population. Moreover, there was no specific season in which children with IBD tended to be born in greater numbers.


PubMed | Childrens Hospital of Pittsburgh of UPMC, St John Hospital and Medical Center and St John Providence Childrens Hospital
Type: Journal Article | Journal: Clinical pediatrics | Year: 2015

It is unknown how the conflicting recommendations of the American Academy of Pediatrics and the US Preventive Services Task Force on pediatric hyperlipidemia affect screening.(a) Identify clinical predictors for screening for hyperlipidemia, (b) assess the adherence to the 2008 American Academy of Pediatrics guidelines, and (c) determine the efficacy of reminder cards in increasing the adherence to the aforementioned guidelines.Retrospective chart review in the resident, attending, and adolescent medicine clinics during a 3-month period. Reminder cards on each patient chart outlining guidelines for lipid screening for the same clinics were inserted and prospectively assessed for adherence during the following 3 months.Older age and higher body mass index increased likelihood (odds ratio = 1.2 and 12.7, respectively) for lipid screening. Reminder cards improved adherence in the resident clinic only (2 P = .016).Age and body mass index were the most significant predictors for lipid screening. Reminder cards modestly improved adherence among resident physicians.


Nagiub M.,St John Providence Childrens Hospital | Allarakhia I.,St John Providence Childrens Hospital
American Journal of Case Reports | Year: 2013

Moyamoya disease (MMD) is a progressive cerebrovascular occlusive disease of the bilateral internal carotid arteries that leads to a compensatory abnormal vascular network at the base of the brain. Its average annual incidence 0.54 per 100,000 population but it is the most common pediatric cerebrovascular disease in East Asia. The reported incidence in USA is approximately 0.086 per 100,000 patients. Case Report: We present a case of Moyamoya disease that was to detected in a 7-year-old female who presented with transient altered mental status. Conclusions: Moyamoya disease can be diagnosed if history, physical exam and brain imaging is highly suspicious. Conventional angiography remains the gold standard for diagnosis and aids in surgical planning for patients with suspected Moyamoya disease. © Am J Case Rep.


PubMed | St John Providence Childrens Hospital
Type: | Journal: The American journal of case reports | Year: 2013

Moyamoya disease (MMD) is a progressive cerebrovascular occlusive disease of the bilateral internal carotid arteries that leads to a compensatory abnormal vascular network at the base of the brain. Its average annual incidence 0.54 per 100,000 population but it is the most common pediatric cerebrovascular disease in East Asia. The reported incidence in USA is approximately 0.086 per 100,000 patients.We present a case of Moyamoya disease that was to detected in a 7-year-old female who presented with transient altered mental status.Moyamoya disease can be diagnosed if history, physical exam and brain imaging is highly suspicious. Conventional angiography remains the gold standard for diagnosis and aids in surgical planning for patients with suspected Moyamoya disease.


Montano G.T.,Childrens Hospital of Pittsburgh | Witherell R.,St John Hospital and Medical Center | Mar A.,St John Hospital and Medical Center | Szpunar S.M.,St John Providence Childrens Hospital | Anne P.,Childrens Hospital of Pittsburgh
Clinical Pediatrics | Year: 2015

Introduction. It is unknown how the conflicting recommendations of the American Academy of Pediatrics and the US Preventive Services Task Force on pediatric hyperlipidemia affect screening. Objectives. (a) Identify clinical predictors for screening for hyperlipidemia, (b) assess the adherence to the 2008 American Academy of Pediatrics guidelines, and (c) determine the efficacy of reminder cards in increasing the adherence to the aforementioned guidelines. Methods. Retrospective chart review in the resident, attending, and adolescent medicine clinics during a 3-month period. Reminder cards on each patient chart outlining guidelines for lipid screening for the same clinics were inserted and prospectively assessed for adherence during the following 3 months. Results. Older age and higher body mass index increased likelihood (odds ratio = 1.2 and 12.7, respectively) for lipid screening. Reminder cards improved adherence in the resident clinic only (?2 P =.016). Conclusions. Age and body mass index were the most significant predictors for lipid screening. Reminder cards modestly improved adherence among resident physicians. © The Author(s) 2014.

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