1
|
Ferreira J, Safa N, Botelho F, Petroze R, Wissanji H, Poenaru D, Puligandla P, Shaw K, Trudeau M, Guadagno E, Laberge JM, Emil S. The Impact of Educational Materials on Parental Anxiety and Productivity: A Clinical Trial in Pediatric Appendicitis. J Pediatr Surg 2024; 59:804-809. [PMID: 38402133 DOI: 10.1016/j.jpedsurg.2024.01.022] [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: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES There is limited literature on how acute appendicitis, the most common acute children's surgical illness, affects the family. We conducted a prospective study to assess the impact of educational materials on parents' anxiety and productivity during the child's illness. METHODS A quasi-experimental clinical trial was conducted among parents of children undergoing laparoscopic appendectomy. In Phase I, parents received the standard explanations at diagnosis and throughout the postoperative period. In Phase II, parents also received a comprehensive educational brochure on pediatric appendicitis at diagnosis. The primary outcome, parental preoperative anxiety, was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The secondary outcome, parental productivity, was evaluated through a post-recovery online questionnaire based on the Productivity and Disease Questionnaire (PRODISQ). Baseline characteristics and outcomes were compared between the two cohorts using t-tests, Mann-Whitney, chi-square, or Fischer's exact test as appropriate. RESULTS Phases I and II included 67 and 66 families, respectively. Patient demographics and disease severity were similar between both groups. Of the 53 parents (80.3%) in Phase II who answered the postoperative questionnaire, most recommended the booklet (96.2%), as it decreased their stress (78.0%) and enhanced their understanding of appendicitis (94.1%). However, the two groups showed similar preoperative anxiety levels and postoperative productivity loss. CONCLUSIONS Educational materials increased satisfaction with surgical care but did not mitigate the high parental preoperative anxiety levels and postoperative productivity loss. Additional research is required to elucidate interventions that may improve these important patient and family-centered outcomes. TYPE OF STUDY Non-Randomized Clinical Trial. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Julia Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Nadia Safa
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Robin Petroze
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Hussein Wissanji
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Pramod Puligandla
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Kenneth Shaw
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maeve Trudeau
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jean-Martin Laberge
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
| |
Collapse
|
2
|
Shah NR, Weadock WJ, Williams KM, Moreci R, Stoll T, Joshi A, Petroze R, Newman EA. Use of modern three-dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors. Pediatr Blood Cancer 2024; 71:e30933. [PMID: 38430473 DOI: 10.1002/pbc.30933] [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: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In complex pediatric surgical oncology, surgical planning is contingent upon data gathered from preoperative imaging. Three-dimensional (3D) modeling and printing has been shown to be beneficial for adult presurgical planning, though pediatric literature is less robust. The study reviews our institutional experience with the use of 3D image segmentation and printed models in approaching resection of extracranial solid tumors in children. METHODS This is a single institutional series from 2021 to 2023. Models were based on computed tomography and magnetic resonance imaging studies, optimized for 3D imaging. The feasibility and creation of the models is reviewed, including specific techniques, software, and printing materials from our institution. Clinical implications for surgical planning are also described, along with detailed preoperative and intraoperative images. RESULTS 3D modeling and printing was performed for four pediatric patients diagnosed with extracranial solid tumors. Diagnoses included Ewing sarcoma, hepatoblastoma, synovial sarcoma, and osteosarcoma. No intraoperative complications or discrepancies with the preoperative 3D-printed model were noted. No evidence of local recurrence was identified in any patient thus far. CONCLUSION Our institutional series demonstrates a wide spectrum of clinical application for 3D modeling and printing technology within pediatric surgical oncology. This technology may aid in surgical planning for both resection and reconstruction, can be applied to a diverse breadth of diagnoses, and may potentially augment patient and/or family education about their condition.
Collapse
Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William J Weadock
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Keyonna M Williams
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tammy Stoll
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aparna Joshi
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robin Petroze
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Wald L, Yergin C, Petroze R, Larson S, Islam S. The unnecessary workups and admissions of adolescents and young adults with spontaneous pneumomediastinum. Sci Rep 2024; 14:4501. [PMID: 38402248 PMCID: PMC10894201 DOI: 10.1038/s41598-024-55134-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare condition in children and young adults that raises concern for esophageal perforation or extension of an air leak, resulting in admissions with multiple interventions performed. To assess our outcomes, and to evaluate our resource utilization, we reviewed our experience with SPM. We conducted a retrospective review of SPM cases in patients aged 5-25 years old occurring between 2011 and 2021 at a single academic tertiary care center. Clinical, demographic, and outcome variables were collected and analyzed, and cohorts were compared using Fischer's Exact Test and Welch's T Test. 166 SPM cases were identified-all of which were Emergency Department (ED) presentations. 84% of the cases were admitted. 70% had Computerized Tomography (CT) scans, with no defined criteria for imaging. Comparison of floor admissions with discharges from the ED showed no significant difference in presenting symptoms, demographics, or outcomes between the two groups. Recurrence was noted in 4 patients with a range of 5.9 months-4.9 years from the initial episode. In the largest SPM study in the pediatric and young adult population, we noted no significant difference in management or outcomes in admitted or ED discharge patients nor those with CT imaging. Our results suggest that a large number of SPM can be managed safely with discharge from the ED.
Collapse
Affiliation(s)
- Lindsay Wald
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA.
| | - Celeste Yergin
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Robin Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Shawn Larson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| |
Collapse
|
4
|
Rosenberg A, Jayaram A, Still M, Hauser B, Dworkin M, Faktor K, Petroze R. Global Surgery Opportunities for General Surgery Residents: Are We Making Progress? J Surg Res 2022; 279:436-441. [PMID: 35841812 PMCID: PMC9750801 DOI: 10.1016/j.jss.2022.06.043] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Global surgery efforts have significantly expanded in the last decade. While an increasing number of general surgery residents are incorporating global surgery experiences and research into their training, few resources are available for residency applicants to evaluate opportunities at programs to which they are applying. MATERIALS AND METHODS A 17-question survey of all general surgery residency program directors (PDs) was conducted by the Global Surgery Student Alliance through emails to the Association of Program Directors in Surgery listserv. PDs indicated if they wished to remain anonymous or include program information in an upcoming online database. RESULTS Two hundred fifty eight general surgery PDs were emailed the survey and 45 (17%) responses were recorded. Twenty eight (62%) programs offered formal global surgery experiences for residents, including clinical rotations, research, and advocacy opportunities. Thirty one (69%) programs were developing a global health center. Forty two (93%) respondents indicated that global surgery education was an important aspect of surgical training. Barriers to global surgery participation included a lack of funding, time constraints, low faculty participation, and minimal institutional interest. CONCLUSIONS While most respondents felt that global surgery was important, less than two-thirds offered formal experiences. Despite the significant increase in public awareness and participation in global surgery, these numbers remain low. While this study is limited by a 17% response rate, it demonstrates that more efforts are needed to bolster training, research, and advocacy opportunities for surgical trainees and promote a global perspective on healthcare.
Collapse
Affiliation(s)
- Ashley Rosenberg
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia; Global Surgery Student Alliance, Cambridge Massachusetts.
| | - Anusha Jayaram
- Tufts University School of Medicine, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Megan Still
- Global Surgery Student Alliance, Cambridge Massachusetts; Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
| | - Blake Hauser
- Harvard Medical School, Boston, Massachusetts; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Myles Dworkin
- Department of Orthopedic Surgery, Brown University, Providence, Rhode Island; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Kara Faktor
- Department of Surgery, University of California San Francisco, San Francisco, California; Global Surgery Student Alliance, Cambridge Massachusetts
| | - Robin Petroze
- Division of Pediatric Surgery, University of Florida College of Medicine, Gainesville, Florida
| |
Collapse
|
5
|
Sousa J, Hawkins R, Shenoy A, Petroze R, Mustafa M, Taylor J, Larson S, Islam S. Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature. J Pediatr Surg 2022; 57:1494-1498. [PMID: 34756582 DOI: 10.1016/j.jpedsurg.2021.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/14/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Enterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. METHODS A retrospective review was performed of all pediatric appendectomies between 1997 and 2019. Patients with diagnosed with Enterobius were included for analysis. Patient demographics, operative findings, and pathologic reports were queried. Data were entered into an encrypted database and subsequently analyzed. A comprehensive review of the literature was also conducted. RESULTS Thirty-eight cases of Enterobius-associated appendicitis were identified out of 3541 (1.07%). Grossly normal appendices at operation were seen in 27% of patients. Inflammatory infiltrate was noted on histopathology in 78.3%, and Enterobius was considered to be the cause of that inflammation in 68.4%. The comprehensive literature review revealed 19 articles (1.87% incidence) that noted 35% of patients with appendiceal Enterobius had appendicitis on either histopathology or gross evaluation. CONCLUSION The high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Our comprehensive review revealed a higher proportion of Enterobius appendicitis. Treatment with antihelminthic therapy is recommended. LEVEL OF EVIDENCE (LOE) Level IV(4)-case series and comprehensive review.
Collapse
Affiliation(s)
- John Sousa
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Russell Hawkins
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Archana Shenoy
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robin Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Moiz Mustafa
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Janice Taylor
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Shawn Larson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL 32610, USA.
| |
Collapse
|
6
|
McNee MA, DeUgarte DA, Gerstle JT, Butler MW, Petroze R, Holterman AX, Velcek F, Cleary M, Krishnaswami S, Fitzgerald TN. The first six years of the APSA Travel Fellowship Program: Impact and lessons learned. J Pediatr Surg 2021; 56:862-867. [PMID: 32713712 DOI: 10.1016/j.jpedsurg.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The American Pediatric Surgical Association (APSA) travel fellowship was established in 2013 to allow pediatric surgeons from low- and middle-income countries to attend the APSA annual meeting. Travel fellows also participated in various clinical and didactic learning experiences during their stay in North America. METHODS Previous travel fellows completed a survey regarding their motivations for participation in the program, its impact on their practice in their home countries, and suggestions for improvement of the fellowship. RESULTS Eleven surgeons participated in the travel fellowship and attended the annual APSA meetings in 2013-2018. The response rate for survey completion was 100%. Fellows originated from 9 countries and 3 continents and most fellows worked in government practice (n=8, 73%). Nine fellows (82%) spent >3 weeks participating in additional learning activities such as courses and clinical observerships. The most common reasons for participation were networking (n=11, 100%), learning different ways of providing care (n=10, 90.9%), new procedural techniques (n=9, 81.8%), exposure to a different medical culture (n=10, 90.9%), and engaging in research (n=8, 72.7%). Most of the fellows participated in a structured course: colorectal (n= 6, 55%), laparoscopy (n=2, 18%), oncology (n=2, 18%), leadership skills (n=1, 9%), and safety and quality initiatives (n=1, 9%). Many fellows participated in focused clinical mentorships: general pediatric surgery (n=9, 82%), oncology (n=5, 45%), colorectal (n=3, 27%), neonatal care (n=2, 18%) and laparoscopy (n=2, 18%). Upon return to their countries, fellows reported that they were able to improve a system within their hospital (n=7, 63%), expand their research efforts (n=6, 54%), or implement a quality improvement initiative (n=6, 54%). CONCLUSIONS The APSA travel fellowship is a valuable resource for pediatric surgeons in low- and middle-income countries. After completion of these travel fellowships, the majority of these fellows have implemented important changes in their hospital's health systems, including research and quality initiatives, to improve pediatric surgical care in their home countries. LEVEL OF EVIDENCE This is not a clinical study. Therefore, the table that lists levels of evidence for "treatment study", "prognosis study", "study of diagnostic test" and "cost effectiveness study" does not apply to this paper.
Collapse
Affiliation(s)
- Madeline A McNee
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Daniel A DeUgarte
- Department of Surgery, University California Los Angeles, Los Angeles, CA
| | - J Ted Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marilyn W Butler
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Robin Petroze
- Department of Surgery, University of Florida, Gainesville, FL
| | - Ai-Xuan Holterman
- Departments of Pediatrics and Surgery, University of Illinois, Chicago, IL
| | - Francisca Velcek
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY
| | - Muriel Cleary
- Department of Surgery, University Massachusetts Memorial Health Care, Worcester, MA
| | | | | |
Collapse
|
7
|
St-Louis E, Petroze R, Baird R, Razek T, Poenaru D, Calland JF, Byiringiro JC, Ntaganda E. Calibration and validation of the pediatric resuscitation and trauma outcome model among injured children in Rwanda. J Pediatr Surg 2020; 55:2510-2516. [PMID: 32151404 PMCID: PMC10767723 DOI: 10.1016/j.jpedsurg.2020.01.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Trauma is a leading cause of mortality in low- and middle-income countries. The Pediatric Resuscitation and Trauma Outcomes (PRESTO) model uses six low-tech variables available at point of care in resource-limited environments to predict in-hospital mortality of injured children. This model was never calibrated and validated in a low-income country. We aimed to calibrate the model's coefficients and compare its performance against the Revised Trauma Score (RTS) and Kampala Trauma Score (KTS) using data from a low-income country. STUDY DESIGN Data from 2011 to 2015 in the prospectively-maintained Rwanda Injury Registry were reviewed after ethical approval was obtained. Patients were included for analysis if they were referred or admitted for traumatic injury, were younger than 15 years and if hospital outcomes were recorded. The variables in the PRESTO model include age, hypotension, heart rate, neurological status, oxygen saturation and airway intervention. The outcome of interest was in-hospital death. After calibration, Receiver-Operating-Characteristic curves were constructed to compare the area-under-curve (AUC) of PRESTO, RTS, and KTS with imputation of missing data. Comparisons of the relative AUC's were performed using Delong's test after bootstrapping in the full cohort and in a subset of patients <5 years-old. RESULTS There were 113 in-hospital deaths out of 1695 included patients (6.7%). The AUC for the PRESTO model was 0.90 (95% CI [0.82-0.91]), higher than for RTS (0.77, 95% CI [0.80-0.97], p < 0.01) but not statistically different from KTS (0.89, 95% CI [0.72-0.82], p = 0.856). In the under-five cohort, the PRESTO model AUC was 0.84 (95% CI [0.75-0.92]), significantly higher than RTS (0.73 95% CI [0.64-0.81], p < 0.01) and KTS (0.58, 95% CI [0.50-0.66], p < 0.01). CONCLUSION PRESTO appears to be the superior benchmarking tool for pediatric patients in a low- and middle-income country context. The PRESTO score outperforms the KTS in children <5 years of age. Further validation of the PRESTO model is needed from other low- and middle-income settings. LEVEL OF EVIDENCE Level III: case-control (prognostic) study.
Collapse
Affiliation(s)
- Etienne St-Louis
- Centre for Global Surgery, McGill University Health Centre; Division of Pediatric General and Thoracic Surgery, Montreal, Children's Hospital.
| | - Robin Petroze
- Division of Pediatric Surgery, University of Florida
| | - Robert Baird
- Division of Pediatric General Surgery, British Columbia Children's Hospital
| | - Tarek Razek
- Centre for Global Surgery, McGill University Health Centre
| | - Dan Poenaru
- Centre for Global Surgery, McGill University Health Centre; Division of Pediatric General and Thoracic Surgery, Montreal, Children's Hospital
| | - J Forest Calland
- Global Surgery Initiative, Department of Surgery, University of Virginia School of Medicine
| | | | - Edmond Ntaganda
- Pediatric General Surgery Unit, Centre Hospitalier Universitaire de Kigali
| |
Collapse
|
8
|
Abstract
Background: Lack of ganglion cells on adequate suction rectal biopsy is the gold standard for diagnosis of neonatal Hirschsprung disease (HD), and the presence of ganglion cells precludes such a diagnosis. Case report: A 10-day old male neonate presented with clinical symptoms concerning for HD. However, suction rectal biopsies demonstrated submucosal ganglion cells on the distal suction rectal biopsies (2 cm from anal verge) and not on the proximal (3 cm from anal verge), with similar findings on repeat biopsies. Clinical suspicion remained high, and diagnostic laparoscopy with intraoperative biopsies confirmed aganglionosis with a sigmoid transition. A pull through resection confirmed the diagnosis of distal rectal skip segment HD (SSHD) with a ∼6 cm length of circumferential aganglionosis extending into the proximal sigmoid. Conclusions: Discordant results on suction rectal biopsies should raise the possibility of SSHD. Awareness of the entity can facilitate timely definitive management in neonatal period.
Collapse
Affiliation(s)
- Archana Shenoy
- University of Florida College of Medicine , Gainesville , USA
| | | | - Kevin Neil Johnson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine , Gainesville , USA
| | - Robin Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine , Gainesville , USA
| |
Collapse
|
9
|
Redko C, Bessong P, Burt D, Luna M, Maling S, Moore C, Ntirenganya F, Martin AN, Petroze R, den Hartog J, Ballard A, Dillingham R. Exploring the Significance of Bidirectional Learning for Global Health Education. Ann Glob Health 2018; 82:955-963. [PMID: 28314497 DOI: 10.1016/j.aogh.2016.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cristina Redko
- Center for Global Health, Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH.
| | - Pascal Bessong
- HIV/AIDS and Global Health Research Program, Professor of Microbiology, University of Venda, Thohoyandou, South Africa
| | - David Burt
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Max Luna
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Samuel Maling
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christopher Moore
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Allison N Martin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Robin Petroze
- Department of Surgery, McGill University, Montreal, Quebec
| | - Julia den Hartog
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - April Ballard
- Center for Global Health, University of Virginia, Charlottesville, VA
| | - Rebecca Dillingham
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
10
|
Baird R, Pandya K, Lal DR, Calkins CM, Oldham KT, Tsai A, Naik-Mathuria B, St-Louis E, Luc MK, LaRusso K, Petroze R, Lofberg KM, Biller CK, Villalona GA, Gourlay DM, Klein M, DeUgarte D, Cleary M, Berdan EA, Siddiqui S, Lo A, Langer M, Duffy D, Blair G, Beres A, Laberge JM, Berdan EA, Radulescu A, Holterman A, Hoover JD, Fitzgerald T, Ganey M, Krishnaswami S, Ozgediz D. Regarding global pediatric surgery training opportunities. J Pediatr Surg 2018; 53:1256-1258. [PMID: 29605263 DOI: 10.1016/j.jpedsurg.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, 4480 Oak, British Columbia, Vancouver V6H3V4, Canada.
| | - Kartik Pandya
- Tuft's University, Maine Medical Center, Portland, ME
| | - Dave R Lal
- Division of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | | | | | | | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Etienne St-Louis
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Malemo Kalisya Luc
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University; HEAL Africa Hospital, Goma, D.R., Congo
| | - Kathryn LaRusso
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Robin Petroze
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | | | | | - Gustavo A Villalona
- SSM Heath Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO
| | | | - Michael Klein
- Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Daniel DeUgarte
- Division of Pediatric Surgery, UCLA and Harbor-UCLA, Los Angeles, CA
| | - Muriel Cleary
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | | | - Sabina Siddiqui
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Andrea Lo
- University of Calgary, Calgary, Alberta, Canada
| | | | - Damain Duffy
- Office of Pediatric Surgical Evaluation and Innovation, BC Children's Hospital, Vancouver, BC, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Alana Beres
- Division of Pediatric Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Jean-Martin Laberge
- Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | | | | | | | | | | | - Michael Ganey
- Loma Linda University School of Medicine, Tenwek Hospital, Bomet, Kenya
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Doruk Ozgediz
- Yale Institute for Global Health, Yale University, New Haven, CT
| |
Collapse
|
11
|
Yousef Y, Youssef F, Homsy M, Dinh T, Stagg H, Petroze R, Baird R, Larberge JM, Poenaru D, Puligandla P, Shaw K, Emil S. Appropriate use of total parenteral nutrition in children with perforated appendicitis. J Pediatr Surg 2018. [PMID: 29525273 DOI: 10.1016/j.jpedsurg.2018.02.030] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Total parenteral nutrition (TPN) is often used in children with perforated appendicitis, despite the absence of clear indications. We assessed the validity of specific clinical indications for initiation of TPN in this patient cohort. METHODS Data were gathered prospectively on duration of nil per os (NPO) status and TPN use in a cohort of children treated under a perforated appendicitis protocol during a 19-month period. TPN was started in the immediate postoperative period in patients who had generalized peritonitis and severe intestinal dilatation at operation, or later per the discretion of the attending surgeon. At discharge, TPN was considered to have been used appropriately, according to consensus guidelines, if the patient was NPO≥7days or received TPN≥5days. RESULTS During the study period, TPN was initiated in 31 (25.4%) of 122 patients operated for perforated appendicitis. Sixteen (51.6%) received TPN per operative finding indications and 15 (48.4%) for prolonged ileus. The operative indications demonstrated 47% sensitivity, 86% specificity, a positive predictive value (PPV) of 35%, and a negative predictive value (NPV) of 91%, when adherence to TPN consensus guidelines was considered the gold standard. CONCLUSION Patients without severe intestinal dilatation and generalized peritonitis at operation should not be placed on TPN in the immediate postoperative period. Refinement of selection criteria is necessary to further decrease inappropriate TPN use in children with perforated appendicitis. TYPE OF STUDY Diagnostic Test. LEVEL OF STUDY II.
Collapse
Affiliation(s)
- Yasmine Yousef
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fouad Youssef
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Homsy
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Trish Dinh
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hayden Stagg
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robin Petroze
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Martin Larberge
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pramod Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth Shaw
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
12
|
Hartman S, Petroze R, McGahren E. Two Cases of Abdominal Pain after Trauma. Pediatr Rev 2016; 37:e16-8. [PMID: 27037109 DOI: 10.1542/pir.2015-0101] [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: 11/24/2022]
Affiliation(s)
- Stephanie Hartman
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Robin Petroze
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Eugene McGahren
- Department of Surgery, University of Virginia, Charlottesville, VA
| |
Collapse
|
13
|
Ramesh A, Fezeu F, Fidele B, Ngulde SI, Moosa S, Krebs E, Gress D, Calland JF, Petroze R, Young JS, Nkusi AE, Muneza S. Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda. Cureus 2014. [DOI: 10.7759/cureus.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
14
|
|
15
|
Boyd-Kimball D, Castegna A, Sultana R, Poon HF, Petroze R, Lynn BC, Klein JB, Butterfield DA. Proteomic identification of proteins oxidized by Aβ(1–42) in synaptosomes: Implications for Alzheimer's disease. Brain Res 2005; 1044:206-15. [PMID: 15885219 DOI: 10.1016/j.brainres.2005.02.086] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 02/23/2005] [Accepted: 02/24/2005] [Indexed: 12/12/2022]
Abstract
Protein oxidation has been implicated in Alzheimer's disease (AD) and can lead to loss of protein function, abnormal protein turnover, interference with cell cycle, imbalance of cellular redox potential, and eventually cell death. Recent proteomics work in our laboratory has identified specifically oxidized proteins in AD brain such as: creatine kinase BB, glutamine synthase, ubiquitin carboxy-terminal hydrolase L-1, dihydropyrimidase-related protein 2, alpha-enolase, and heat shock cognate 71, indicating that a number of cellular mechanisms are affected including energy metabolism, excitotoxicity and/or synaptic plasticity, protein turnover, and neuronal communication. Synapse loss is known to be an early pathological event in AD, and incubation of synaptosomes with amyloid beta peptide 1-42 (Abeta 1-42) leads to the formation of protein carbonyls. In order to test the involvement of Abeta(1-42) in the oxidation of proteins in AD brain, we utilized two-dimensional gel electrophoresis, immunochemical detection of protein carbonyls, and mass spectrometry to identify proteins from synaptosomes isolated from Mongolian gerbils. Abeta(1-42) treatment leads to oxidatively modified proteins, consistent with the notion that Abeta(1-42)-induced oxidative stress plays an important role in neurodegeneration in AD brain. In this study, we identified beta-actin, glial fibrillary acidic protein, and dihydropyrimidinase-related protein-2 as significantly oxidized in synaptosomes treated with Abeta(1-42). Additionally, H+-transporting two-sector ATPase, syntaxin binding protein 1, glutamate dehydrogenase, gamma-actin, and elongation factor Tu were identified as increasingly carbonylated. These results are discussed with respect to their potential involvement in the pathogenesis of AD.
Collapse
Affiliation(s)
- Debra Boyd-Kimball
- Department of Chemistry, Center for Membrane Sciences, University of Kentucky, Lexington, KY 40506-0055, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Drake J, Petroze R, Castegna A, Ding Q, Keller JN, Markesbery WR, Lovell MA, Butterfield DA. 4-Hydroxynonenal oxidatively modifies histones: implications for Alzheimer's disease. Neurosci Lett 2004; 356:155-8. [PMID: 15036618 DOI: 10.1016/j.neulet.2003.11.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Revised: 11/03/2003] [Accepted: 11/06/2003] [Indexed: 11/18/2022]
Abstract
There is increasing evidence of DNA oxidation and altered DNA repair mechanisms in Alzheimer's disease (AD) brain. Histones, which interact with DNA, conceivably could provide a protective shield for DNA against oxidative stress. However, because of their abundant lysine residues, histones may be a target for 4-hydroxynonenal (HNE) modification. In this study, we have shown that HNE binds to histones and that this binding affects the conformation of the histone, measured by electron paramagnetic resonance in conjunction with a protein-specific spin label. The covalent modification to the histone by HNE affects the ability of the histone to bind DNA. Interestingly, acetylated histones appear to be more susceptible to HNE modifications than control histones. Conceivably, altered DNA-histone interactions, subsequent to oxidative modification of histones by the lipid peroxidation product HNE, may contribute to the vulnerability of DNA to oxidation in AD brain.
Collapse
Affiliation(s)
- Jennifer Drake
- Department of Chemistry, University of Kentucky, Lexington, KY 40506, USA
| | | | | | | | | | | | | | | |
Collapse
|