1
|
Bhardwaj P, Valladares D, Gutman CK, Lucas JK, Kelly MN. Acute Visual Disturbances and Ataxia Secondary to Attempted COVID-19 Prophylaxis With Ivermectin in a Nine-Year-Old. Cureus 2023; 15:e35944. [PMID: 37038566 PMCID: PMC10082620 DOI: 10.7759/cureus.35944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/12/2023] Open
Abstract
Ivermectin is an antiparasitic agent listed as an essential medication by the World Health Organization. Ivermectin utilization has increased due to the popular, though inaccurate, perception of its use in COVID-19 management. Poison Control Central calls regarding ivermectin toxicity have increased 245% since pre-pandemic baselines. This case study illustrates the clinical presentation of ivermectin toxicity in a nine-year-old child with acute vision changes and ataxia. The child was given 60 mg (1 mg/kg) of veterinary-grade ivermectin by a parent, 10 times the clinically recommended dose of 0.1 mg/kg, as prophylaxis after household exposure to COVID-19. Ten hours later, the child developed new-onset blurry vision, a perception of red dots in the peripheral vision, dizziness, and balance issues. Physical examination was notable for pulsating pupils, ataxia, and dysmetria. Symptoms resolved completely after 10 hours. Ivermectin ingestion is an important diagnostic consideration in children presenting with similar symptoms. We hope our case aids in the identification of ivermectin toxicity and hastens necessary supportive measures.
Collapse
Affiliation(s)
- Pranshu Bhardwaj
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA
| | - Daniel Valladares
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA
| | - Colleen K Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Judith K Lucas
- Department of Pediatrics, Division of Emergency Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Maria N Kelly
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA
| |
Collapse
|
2
|
Shanefield SC, Kelly MN, Posa M. Wearable Technology Leads to Initial Workup of Graves' Disease in an Adolescent Female. J Adolesc Health 2022; 71:370-372. [PMID: 35660129 DOI: 10.1016/j.jadohealth.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Graves' disease is the most common form of hyperthyroidism in the pediatric population. While the most prevalent symptoms seen in children with Graves' disease include goiter and excessive sweating (Minamitani et al., 2017), diagnosis is frequently delayed due to presentation with non-specific symptoms (Léger et al., 2018). This case report is of a 12-year-old female who presented to her pediatrician with a one month history of episodes of tachycardia both with physical exertion and at rest. Notably, these episodes were discovered on her electronic smartwatch by its heart rate monitoring feature. Further pertinent positives elicited in the patient's review of systems included increasing anxiety, diaphoresis, intermittent hand tremors, and recent weight loss. These findings led to further workup that included thyroid studies, culminating in a diagnosis of Graves' disease. Indeed, this patient's smartwatch aided in her initial presentation to her physician and allowed for prompt workup and diagnosis. There exist limited studies to date on the use of smartwatches to detect cardiac-related conditions in children, which may be due to the absence of Food and Drug Administration approval for certain cardiac-related smartwatch features in this patient population.
Collapse
Affiliation(s)
| | - Maria N Kelly
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Molly Posa
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
3
|
Fitzgerald M, Carswell KN, Howell DM, Kelly MN. Osteogenesis Imperfecta-Like Syndrome. J Pediatr Health Care 2022; 36:376-380. [PMID: 35279353 DOI: 10.1016/j.pedhc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Melissa Fitzgerald
- Department of General Pediatrics, University of Florida, Gainesville, FL.
| | | | - Diane M Howell
- Department of General Pediatrics, University of Florida, Gainesville, FL
| | - Maria N Kelly
- Department of General Pediatrics, University of Florida, Gainesville, FL
| |
Collapse
|
4
|
Affiliation(s)
- Lindsay A Thompson
- Department of Pediatrics, University of Florida College of Medicine, Gainesville.,Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
| | - Maria N Kelly
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| |
Collapse
|
5
|
Martin SB, Lucas JK, Posa M, Howell DM, Kelly MN. Talon Noir in a Young Baseball Player: A Case Report. J Pediatr Health Care 2021; 35:235-238. [PMID: 33309391 DOI: 10.1016/j.pedhc.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
When evaluating pediatric patients with hyperpigmented lesions on the plantar aspect of the feet, the differential diagnosis should include talon noir, acral melanoma, and verruca with thrombosis. Talon noir are asymptomatic brown-black pigmented macules formed by intraepidermal hemorrhages of the feet caused by shear-force injury. Spontaneous resolution of talon noir typically occurs within 2-3 weeks. Clinicians should ensure that their patients who participate in sports have appropriately fitting shoes, which may prevent these lesions from occurring. This case report highlights a unique case of talon noir occurring in a young baseball player with an atypical distribution of plantar macules.
Collapse
|
6
|
|
7
|
Genuardi FJ, Kelly MN, Rosenberg EI, Black EW, Dawson K. Teaching Students How to Improve Safety and Quality in Two Children's Hospitals: Building a Pediatric Clerkship Patient Safety and Quality Experience. Acad Pediatr 2019; 19:712-715. [PMID: 31028949 DOI: 10.1016/j.acap.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
Abstract
This report describes a novel method to enhance medical student understanding of systems-based practice and patient safety through experiential learning, assessing the perceived value of student-identified patient safety and systems vulnerabilities, and their proposed interventions at academic children's hospitals.
Collapse
Affiliation(s)
- Frank J Genuardi
- Department of Pediatrics (FJ Genuardi), University of Florida College of Medicine-Jacksonville.
| | - Maria N Kelly
- Division of General Academic Pediatrics (MN Kelly), Department of Pediatrics (EW Black)
| | - Eric I Rosenberg
- Division of General Internal Medicine, Department of Medicine (EI Rosenberg), University of Florida College of Medicine, Gainesville
| | - Erik W Black
- Division of General Academic Pediatrics (MN Kelly), Department of Pediatrics (EW Black)
| | - Kara Dawson
- School of Teaching and Learning (K Dawson), University of Florida College of Education, Gainesville
| |
Collapse
|
8
|
Reasor JE, Rajderkar DA, Jolley CD, Joshi-Guske P, Kelly MN. A Rare Cause of Recurrent Abdominal Pain in a 5-Year-Old. J Pediatr Health Care 2019; 33:478-484. [PMID: 30660429 DOI: 10.1016/j.pedhc.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022]
|
9
|
Posa M, Nestor K, Coleman R, Rajderkar D, Kelly MN. An 11-Month-Old Male With Acute-Onset Left-Sided Facial Paralysis. Clin Pediatr (Phila) 2019; 58:594-598. [PMID: 30897949 DOI: 10.1177/0009922819837354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Molly Posa
- 1 University of Florida, Gainesville, FL, USA
| | | | | | | | | |
Collapse
|
10
|
McPhie A, Merkel K, Lossius M, Giordano BP, Kelly MN. Newborn Infant With Epidermolysis Bullosa and Ankyloglossia. J Pediatr Health Care 2016; 30:390-5. [PMID: 26833212 DOI: 10.1016/j.pedhc.2015.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
|
11
|
Tsukayama E, Otero J, Carswell K, McPhie A, Kelly MN. A Bony Mass in 2-Year-Old Boy. Pediatr Ann 2015; 44:315-7. [PMID: 26312589 DOI: 10.3928/00904481-20150812-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Frohlich DM, Caldwell KJ, Rohrs H, Kelly MN. A 17-year-old female with secondary amenorrhea, galactorrhea, and headaches. J Pediatr Health Care 2015; 29:205-11. [PMID: 25547318 DOI: 10.1016/j.pedhc.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 10/29/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
|
13
|
Kelly MN, Tuli SY, Tuli SS, Stern MA, Giordano BP. Brothers with Smith-Lemli-Opitz syndrome. J Pediatr Health Care 2015; 29:97-103. [PMID: 24954735 DOI: 10.1016/j.pedhc.2014.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/10/2014] [Accepted: 04/24/2014] [Indexed: 12/13/2022]
Abstract
Abnormal cholesterol metabolism is the cause of SLOS, with low cholesterol levels and elevated levels of cholesterol precursors thought to contribute to the clinical findings in this syndrome. Management of SLOS involves early intervention with appropriate therapies for identified disabilities, genetic counseling for families, nutritional consultations, educational interventions, and behavioral management. Although no randomized dietary studies have been conducted, cholesterol supplementation continues to be a common recommendation for persons with SLOS, because it may result in clinical improvement and has few adverse effects (Nowaczyk, 2013). Even with early detection and treatment (e.g., sibling B in this case report), persons with SLOS often have significant behavioral issues and cognitive and developmental delays that require a team approach by parents, educators, specialists, and primary care providers.
Collapse
|
14
|
Dedlow ER, Siddiqi S, Fillipps DJ, Kelly MN, Nackashi JA, Tuli SY. Symptomatic atlantoaxial instability in an adolescent with trisomy 21 (Down's syndrome). Clin Pediatr (Phila) 2013; 52:633-8. [PMID: 23564301 DOI: 10.1177/0009922813482178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atlantoaxial instability (AAI) occurs in 15% of children with Trisomy 21. Health supervision guidelines were revised by the American Academy of Pediatrics in 2011 to reflect advances in care for children with special health care needs (CSHCN). Previous guidelines recommended cervical spine radiological screenings in preschool years to evaluate for atlantoaxial instability. For patients with negative screening, re-screening was recommended if they wished to compete in the Special Olympics, or became symptomatic. We present the case of an adolescent who developed a symptomatic atlantoaxial dislocation despite previous negative radiological screening at the age three (under the 2001 guidelines). This case report highlights the revisions in the 2011 guidelines for health supervision and anticipatory guidance. It underlines the need for a high index of suspicion if symptoms develop. It also addresses the need for a medical home for CSHCN, with health care providers who know the child's baseline health status.
Collapse
Affiliation(s)
- E Rosellen Dedlow
- Department of Pediatrics, Division of General Pediatrics, University of Florida, Gainesville, FL 32608, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Kelly MN, Tuli SS, Usher S, Tuli SY. A 6-year-old with acute-onset generalized lymphadenopathy. J Pediatr Health Care 2012; 26:465-70. [PMID: 22901313 DOI: 10.1016/j.pedhc.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 06/28/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Maria N Kelly
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | | | | | | |
Collapse
|
16
|
Kelly MN, Khuddus N, Motamarry S, Tuli S. Microcephaly, lymphedema, chorioretinal dysplasia (MLCRD) syndrome. J Pediatr Health Care 2012; 26:306-11. [PMID: 22726716 DOI: 10.1016/j.pedhc.2011.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Maria N Kelly
- Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610, USA.
| | | | | | | |
Collapse
|
17
|
|
18
|
Otero J, Dragstedt AN, Tuli SY, Kelly MN. Double teeth or twinning in primary dentition. Clin Pediatr (Phila) 2012; 51:91-2. [PMID: 21224252 DOI: 10.1177/0009922810392777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
19
|
Tuli SY, Thompson LA, Saliba H, Black EW, Ryan KA, Kelly MN, Novak M, Mellott J, Tuli SS. Pediatric residents' learning styles and temperaments and their relationships to standardized test scores. J Grad Med Educ 2011. [PMID: 23205211 PMCID: PMC3244328 DOI: 10.4300/jgme-d-10-00147.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that 5 affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores. METHODS This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores. RESULTS The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P = .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores. CONCLUSIONS The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.
Collapse
|
20
|
McGowan C, Tuli SS, Kelly MN, Tuli SY. Girl with a cat eye. Clin Pediatr (Phila) 2011; 50:1076-7. [PMID: 21525082 DOI: 10.1177/0009922811407184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Kelly MN, Feldman AS, Wright J, Tuli S. Four-month-old infant with macrocephaly and prominent scalp veins. Clin Pediatr (Phila) 2011; 50:772-6. [PMID: 20926842 DOI: 10.1177/0009922810378741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
Paradise Black NM, Kelly MN, Black EW, Sessums CD, Dipietro MK, Novak MA. Family-centered rounds and medical student education: a qualitative examination of students' perceptions. Hosp Pediatr 2011; 1:24-29. [PMID: 24510926 DOI: 10.1542/hpeds.2011-0004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Although current literature supports the benefits of family-centered rounds on medical education, few studies have explored students' perceptions of family-centered rounds. PURPOSE The aim of this study was to provide a better and broader understanding of the effect of family-centered rounds on medical student education. METHODS During the inpatient portion of the third-year pediatric clerkship at a southeastern United States 4-year medical school, students were exposed to family-centered and conference room work rounds and completed a post-hoc reflective open-ended questionnaire. The study was conducted from July to December 2007 and the inpatient experience was at one of two large academic medical centers. Using a constant comparative approach, the qualitative content of 45 of the 63 potential students' responses was analyzed. RESULTS Family-centered rounds served as an opportunity for medical students to build their practice-based knowledge through direct and simultaneous interaction with the medical team, patients, and families. Family member communication, medical team communication, and increased exposure to patients allowed for unique learning opportunities such as augmentation of communication skills, practice with use of lay terms, legitimate peripheral participation, and humanizing cognitive understanding of diseases. Areas of concern noted by the students included space limitations, length of rounds, potential anxiety provoked in the patient, and faculty and resident comfort with teaching certain topics. CONCLUSIONS Our qualitative analysis of medical student perceptions on family-centered rounds suggests that pediatric medical student education may benefit by improving knowledge and practice with communication and humanizing disease processes. However, perceived barriers, such as concerns about space or instructor comfort with teaching certain topics, existed. Further studies are warranted to gain a better understanding of the educational impact of conducting this type of rounds.
Collapse
|
23
|
Abstract
Yeast-hypha differentiation is believed to be necessary for the normal progression of Candida albicans infections. The emergence and extension of a germ tube from a parental yeast cell are accompanied by dynamic changes in vacuole size and morphology. Although vacuolar function is required during this process, it is unclear if it is vacuolar expansion or some other vacuolar function that is important. We previously described a C. albicans vps11Delta mutant which lacked a recognizable vacuole compartment and with defects in multiple vacuolar functions. These include sensitivities to stress, reduced proteolytic activities, and severe defects in filamentation. Herein we utilize a partially functional VPS11 allele (vps11hr) to help define which vacuolar functions are required for differentiation and which influence interaction with macrophages. Mutant strains harboring this allele are not osmotically or temperature sensitive and have normal levels of secreted aspartyl protease and carboxypeptidase Y activity but have a fragmented vacuole morphology. Moreover, this mutant is defective in filamentation, suggesting that the major role the vacuole plays in yeast-hypha differentiation may relate directly to its morphology. The results of this study support the hypothesis that vacuole expansion is required during germ tube emergence. Both vps11 mutants were severely attenuated in their ability to kill a macrophage cell line. The viability of the vps11delta mutant was significantly reduced during macrophage interaction compared to that in the control strains, while the vps11hr mutant was unaffected. This implies some vacuolar functions are required for Candida survival within the macrophage, while additional vacuolar functions are required to inflict injury on the macrophage.
Collapse
Affiliation(s)
- G E Palmer
- Department of MIP, Louisianna State University Health Sciences Center School of Dentistry, 1100 Florida Ave., Box F8-130, New Orleans, Louisianna 70119, USA.
| | | | | |
Collapse
|
24
|
Abstract
Anxiety disorders are a common group of disorders that must be recognized more frequently by pediatricians. Outcomes can be very successful with prompt recognition and early treatment. For this reason, it is important that pediatricians recognize their central role in integrating sociological, psychological, and biological approaches to treatment. Pediatricians are vital for initial assessment, interventions, management of psychotherapeutic and pharmacotherapeutic treatments, and referral to psychiatrists and psychologists when necessary. An improved understanding of anxiety disorders by pediatricians will lead to improved diagnosis and improved quality of life for many undiagnosed pediatric patients suffering from anxiety.
Collapse
Affiliation(s)
- Maria N Kelly
- University of Florida Department of Pediatrics, Gainesville, FL 32610, USA
| |
Collapse
|