scholarly journals Trapianti da donatore a cuore fermo: il caso del paziente pediatrico

2009 ◽  
Vol 58 (4) ◽  
Author(s):  
Maria Luisa Di Pietro ◽  
Paola Parente ◽  
Ciro D’Alò
Keyword(s):  
Organ Transplantation ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
International Literature ◽  
Pediatric Age ◽  
Starting Point ◽  
Heart Beating ◽  
The One ◽  
End Stage ◽  
Parental Opposition

In presenza di grave insufficienza d’organo, il trapianto è la sola e unica soluzione per salvare la vita del paziente. Si stima che, attualmente, in Italia oltre 9.000 persone siano in lista d’attesa per un trapianto di organo: anche se vi è stato un incremento del numero di donazioni negli ultimi decenni, il gap tra donatori e pazienti in attesa è in continua crescita. Secondo la maggior parte delle società di trapiantologia, i donatori a cuore non battente (NHBD) possono essere una fonte di reperimento degli organi. Quanto la donazione da NHBD può ampliare il pool dei donatori? Quali sono i rischi legati al prelievo di organi da NHBD non solo per il donatore ma anche per il ricevente? Nel tentativo di chiarire almeno alcuni di tali interrogativi abbiamo condotto un’analisi della letteratura scientifica internazionale. Per valutare, poi, la possibilità di ampliamento del pool di donatori con l’introduzione di un protocollo da NHBD nella popolazione pediatrica del Policlinico “A. Gemelli” in Roma, abbiamo condotto uno studio retrospettivo sui pazienti pediatrici deceduti nel corso del triennio 2004-2007. I risultati sembrano indicare la possibilità di raddoppiare il potenziale pool di donatori; questi dati richiedono poi una valutazione attenta, innanzitutto alla luce delle percentuali di opposizione alla donazione che nell’età pediatrica sono ancora più significative che nell’adulto. I risultati ottenuti sono solo il punto di partenza per un’analisi più approfondita sui problemi relativi ai trapianti e alla donazione di organi. ---------- In case of end stage organ failure, organ transplantation is the one and only solution to save patient’s life. Currently, in Italy, more than 9.000 people are awaiting for an organ transplantation; even though the number of organ donation has been increasing during last decades, gap between organ demand and transplantation is still wide. According to ideas of most society of transplantation, non heart beating donors (NHBD) could be a solution to the shortage of organs. How much NHBD could widen donors pool? Which ones and how many risks involve NHBD, even for donors or transplantation recipients? Trying to answer these questions, we led an analysis on NHBD data in international literature. To evaluate the potential of NHBD to expand the pool of donors in pediatric population of “Policlinico Gemelli” in Rome, we studied all deceased pediatric patients in the years 2004-2007. Results showed that the potential pool of donors could be twice as much, but these data should esteem about parental opposition, in particular in pediatric age. These data represent only a starting point for a deeper analysis of transplantation and donation related problems.

scholarly journals Novel Predictive Markers on Computed Tomography for Predicting Early Epidural Hematoma Growth in Pediatric Patients

2021 ◽  
Author(s):  
Avery A. Kopacz ◽  
Hunter Miears ◽  
Reagan A. Collins ◽  
Laszlo Nagy
Keyword(s):  
Epidural Hematoma ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Middle Meningeal Artery ◽  
Hematoma Expansion ◽  
Percent Change ◽  
Life Saving ◽  
Starting Point ◽  
Hematoma Growth ◽  
Imaging Signs

Abstract Objective Epidural hematoma (EDH), most often caused by rupture of the middle meningeal artery secondary to head trauma with fracture of the temporal bone, is a potentially fatal condition that can lead to elevated intracranial pressure, herniation, and death within hours following the inciting traumatic incident, unless surgical evacuation is accomplished. Several markers have been found to be associated with hematoma expansion in intracerebral hemorrhage (ICH) patients, including: the CT Blend Sign, Swirl Sign, and Black Hole Sign. This study aims to examine these markers, along with intradural air close to or in the region of an EDH and/or close to a significant fracture, fractures involving the skull base, and complicated (i.e., comminuted or displaced) fractures for possible associations to EDH growth in the pediatric population. Predicting hematoma growth is a crucial part of patient management, as surgery can be a life-saving intervention. Methods Scans from all pediatric patients with EDH from 2012 to 2019 across two separate health systems were examined and measurements were taken to determine whether these additional factors are of predictive value. Specifications such as length, transverse, and height measurements were taken from CT images. Statistical Analysis The average percent change in the hematoma measurements was used to determine which predictive factors were associated with a “noteworthy increase,” namely, an increase of greater than 25%. Additionally, the average percent change in hematoma size was evaluated for patients whose original imaging showed either all three CT signs or intradural air in all three specified locations. Results Most of the proposed markers were associated with EDH growth in this cohort. The established CT signs were also supported. This is notable, as most of the research on these signs has been in adult populations rather than pediatric. Conclusions Adding these novel imaging signs could aid in the decision to operate on versus observe PEDH patients, thereby preventing unnecessary procedures or preserving brain function quickly when surgery is indicated. This study serves as a starting point for several other investigations into the validity of the proposed markers as well as a reevaluation of the current signs in the pediatric population.

Prevalence of Unique Pediatric Pathologies Encountered by Paramedic Students Across Age Groups

2016 ◽  
Vol 31 (4) ◽  
pp. 386-391 ◽  
Author(s):  
Eric V. Ernest ◽  
Tom B. Brazelton ◽  
Elliot D. Carhart ◽  
Jonathan R. Studnek ◽  
Patricia L. Tritt ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Saint Paul ◽  
Age Groups ◽  
Age Group ◽  
Pediatric Age ◽  
Provider Education ◽  
Publication Type ◽  
One Year

AbstractIntroductionTraditionally, Emergency Medical Services (EMS) educators have divided the pediatric population into age groups to assist in targeting their clinical and didactic curriculum. Currently, the accrediting body for paramedic training programs requires student exposure to pediatric patients based entirely on age without specifying exposure to specific pathologies within each age stratification. Identifying which pathologies are most common within the different pediatric age groups would allow educators to design curriculum targeting the most prevalent pathologies in each age group and incorporating the physiologic and psychological developmental milestones commonly seen at that age.HypothesisIt was hypothesized that there are unique clusterings of pathologies, represented by paramedic student primary impressions, that are found in different age groups which can be used to target provider education.MethodsThis is a retrospective review of prospectively collected data documented by paramedic students in the Fisdap (Field Internship Student Data Acquisition Project; Saint Paul, Minnesota USA) database over a one-year period. For the purposes of this study, pediatric patients were defined arbitrarily as those between the ages of 0-16 years. All paramedic student primary impressions recorded in Fisdap for patients aged 0-16 years were abstracted. Primary impression by age was calculated and graphed. The frequency of primary impression was then assessed for significance of trend by age with an alpha ≤.05 considered significant.ResultsThe following primary impressions showed clinically and statistically significant variability in prevalence among different pediatric age groups: respiratory distress, medical-other, abdominal pain, seizure, overdose/poisoning, behavioral, and cardiac. In patients less than 13 years old, respiratory and other-medical were the most common two primary impressions and both decreased with age. In patients 5-16 years old, the prevalence of abdominal pain and behavioral/psych increased. Bimodal distributions for overdose were seen with one spike in the toddler and another in the adolescent population. Seizures were most common in the age group associated with febrile seizure. Sepsis was seen most often in the youngest patients and its prevalence decreased with age.ConclusionThere are statistically significant variations in the frequency of paramedic student primary impressions as a function of age in the pediatric population. Emphasizing paramedic student exposure to the most common pathologies encountered in each age group, in the context of the psychological and physiological milestones of each age, may improve paramedic student pediatric practice.ErnestEV, BrazeltonTB, CarhartED, StudnekJR, TrittPL, PhilipGA, BurnettAM. Prevalence of unique pediatric pathologies encountered by paramedic students across age groups. Prehosp Disaster Med. 2016; 31(4):386–391.

scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

scholarly journals Preparedness for transplantation during COVID-19 outbreak: how to manage?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Valdi ◽  
G Varadi ◽  
A Panzera ◽  
M Parpinel ◽  
R Peressutti
Keyword(s):  
Organ Transplantation ◽  
Task Force ◽  
Emergency Situation ◽  
Donor Pool ◽  
Surge Capacity ◽  
Emergency Procedures ◽  
Life Saving ◽  
Critical Patients ◽  
End Stage ◽  
Assessment Procedures

Abstract Problem When WHO declared COVID-19 “international”, it was important not to damage some critical patients who need emergency procedures like organ transplantation, due to end stage organ disease. In 2003 SARS outbreak demonstrated the vulnerability of organ transplantation services o network. Descritption If transplantation is required as a life-saving procedure, it can be conducted with appropriate risk infection assessment. It is crucial during these emergencies to assess donor pool, as it is expected to decrease. A crucial point is to organize and evaluate the surge capacity, in terms of understaffing and lack of supplies, especially in ICU. The research methods were literature review using Pub Med, CDC, ECDC, WHO, TTS, searching as key words “SARS-CoV-2”, “COVID-19”, “transplantation”, “preparedness”. The analysis has been conducted between Feb 26th 2020 and March 5th 2020. Results As happened during SARS breakout in 2003, it is essential to establish a task force for crisis, currently updated and skilled for this particular management. Preparedness should regard especially the adoption of donor safety assessment procedures, ICU capability, the availability of covid-19 test for all the donors, and the adoption of specific post-transplant care. It is essential in this case establish preparedness in several points: education and training of the staff, practice drills, inspection of supplies, evaluation of surge capacity, relocation of patients. Lessons SARS-CoV-2 imposed in public health to establish new protocols and guidelines, which should be regularly updated to be useful in other epidemics outbreaks or other emergency situation. These protocols should focus on donor pool and ICU capability in order to carry on transplantation activities. Key messages This outbreak has tested the resilience of the whole system by day-by-day updating for transplantation teams and preparedness of the staff involved in transplantation management. During outbreak, seems to be useful a task force for crisis in order to support organ transplantation services.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals Practices of sustainability and the enactment of their natures/cultures: Ecosystem services, rights of nature, and geoengineering

2021 ◽  
pp. 053901842199894
Author(s):  
Frank Adloff ◽  
Iris Hilbrich
Keyword(s):  
Ecosystem Services ◽  
Latin American ◽  
Social Systems ◽  
The Earth ◽  
Starting Point ◽  
Knowledge Cultures ◽  
Rights Of Nature ◽  
Value Of Nature ◽  
The One ◽  
And Control

Possible trajectories of sustainability are based on different concepts of nature. The article starts out from three trajectories of sustainability (modernization, transformation and control) and reconstructs one characteristic practice for each path with its specific conceptions of nature. The notion that nature provides human societies with relevant ecosystem services is typical of the path of modernization. Nature is reified and monetarized here, with regard to its utility for human societies. Practices of transformation, in contrast, emphasize the intrinsic ethical value of nature. This becomes particularly apparent in discourses on the rights of nature, whose starting point can be found in Latin American indigenous discourses, among others. Control practices such as geoengineering are based on earth-systemic conceptions of nature, in which no distinction is made between natural and social systems. The aim is to control the earth system as a whole in order for human societies to remain viable. Practices of sustainability thus show different ontological understandings of nature (dualistic or monistic) on the one hand and (implicit) ethics and sacralizations (anthropocentric or biocentric) on the other. The three reconstructed natures/cultures have different ontological and ethical affinities and conflict with each other. They are linked to very different knowledge cultures and life-worlds, which answer very differently to the question of what is of value in a society and in nature and how these values ought to be protected.

scholarly journals Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 393
Author(s):  
Alessandra Romandini ◽  
Arianna Pani ◽  
Paolo Andrea Schenardi ◽  
Giulia Angela Carla Pattarino ◽  
Costantino De Giacomo ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Pediatric Population ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Pediatric Age ◽  
Carbapenem Resistant ◽  
Pediatric Infections ◽  
Surgical Treatments ◽  
Developing System ◽  
Near Future

Antibiotic resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produce 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) is also fueled by the lack of pediatric-specific data and trials. The ever-evolving nature of this age group also poses another issue: the partly age-dependent changes of a developing system of cytochromes determine a rather diverse population in terms of biochemical characteristics and pharmacokinetics profiles, hard to easily codify in an age- or weight-dependent dosage. The pediatric population is also penalized by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the pediatric age are MRSA, VRSA, ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and the alarming colistin resistance. Urgent actions need to be taken in order to step back from a now likely post-antibiotic era, where simple infections might cause infant death once again.

Ontology and Perception

2004 ◽  
Vol 5 (1) ◽  
pp. 43-58
Author(s):  
Jeffrey S. Galko ◽  
Keyword(s):  
Common Sense ◽  
The Other ◽  
Cognitive Capacity ◽  
Complex Environment ◽  
Starting Point ◽  
Ontological Question ◽  
The One ◽  
Bodies Of Water ◽  
The Relationship

The ontological question of what there is, from the perspective of common sense, is intricately bound to what can be perceived. The above observation, when combined with the fact that nouns within language can be divided between nouns that admit counting, such as ‘pen’ or ‘human’, and those that do not, such as ‘water’ or ‘gold’, provides the starting point for the following investigation into the foundations of our linguistic and conceptual phenomena. The purpose of this paper is to claim that such phenomena are facilitated by, on the one hand, an intricate cognitive capacity, and on the other by the complex environment within which we live. We are, in a sense, cognitively equipped to perceive discrete instances of matter such as bodies of water. This equipment is related to, but also differs from, that devoted to the perception of objects such as this computer. Behind this difference in cognitive equipment underlies a rich ontology, the beginnings of which lies in the distinction between matter and objects. The following paper is an attempt to make explicit the relationship between matter and objects and also provide a window to our cognition of such entities.

Hepatoadrenal syndrome in pediatric patients with end-stage liver disease*

2012 ◽  
Vol 13 (3) ◽  
pp. e145-e149 ◽  
Author(s):  
Gabriel J. Hauser ◽  
Hannah M. Brotzman ◽  
Stuart S. Kaufman
Keyword(s):  
Liver Disease ◽  
Pediatric Patients ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Pi-Chang Lee ◽  
Betau Hwang ◽  
Wen-Jue Soong ◽  
C. C. Laura Meng
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Cor Pulmonale ◽  
Arousal Index ◽  
Obstructive Sleep ◽  
Hemodynamic Characteristics ◽  
Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

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