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Sharma S, Agha B, Delgado C, Walson K, Woods C, Gonzalez MD, Jerris R, Sysyn G, Beiter J, Kamidani S, Rostad CA. Croup Associated With SARS-CoV-2: Pediatric Laryngotracheitis During the Omicron Surge. J Pediatric Infect Dis Soc 2022; 11:371-374. [PMID: 35512450 PMCID: PMC9426860 DOI: 10.1093/jpids/piac032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 12/05/2022]
Abstract
In this retrospective analysis, we describe weekly croup and corresponding viral prevalence patterns in a pediatric quaternary care system in metropolitan Atlanta. We characterize a series of 24 patients with croup associated with SARS-CoV-2 infection and show that this clinical presentation increased substantially in frequency during the period of high Omicron vs Delta transmission.
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Affiliation(s)
- Sujit Sharma
- Corresponding Author: Sujit Sharma, MD, Division of Emergency Medicine, Children's Healthcare of Atlanta at Scottish Rite, 1001 Johnson Ferry Road, Atlanta, GA 30342, USA. E-mail:
| | - Beesan Agha
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Carlos Delgado
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Karen Walson
- Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Atlanta, Georgia, USA
| | - Charles Woods
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - Mark D Gonzalez
- Children’s Healthcare of Atlanta, Division of Pathology, Atlanta, Georgia, USA
| | - Robert Jerris
- Children’s Healthcare of Atlanta, Division of Pathology, Atlanta, Georgia, USA
| | - Gregory Sysyn
- Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Atlanta, Georgia, USA
| | - James Beiter
- Pediatric Emergency Medicine Associates (PEMA), LLC, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Division of Emergency Medicine, Atlanta, Georgia, USA
| | - Satoshi Kamidani
- Children’s Healthcare of Atlanta, Division of Infectious Disease, Atlanta, Georgia, USA,Department of Pediatrics, Division of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Children’s Healthcare of Atlanta, Division of Infectious Disease, Atlanta, Georgia, USA,Department of Pediatrics, Division of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
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2
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Bush HI, LaGasse AB, Collier EH, Gettis MA, Walson K. Effect of Live Versus Recorded Music on Children Receiving Mechanical Ventilation and Sedation. Am J Crit Care 2021; 30:343-349. [PMID: 34467386 DOI: 10.4037/ajcc2021646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Music is often used as a nonpharmacological pain management strategy, but little evidence is available about its role in pediatric critical care patients. OBJECTIVE To determine the effect of a live music intervention versus a recorded music intervention on heart rate, blood pressure, and respiratory rate in pediatric critical care patients receiving mechanical ventilation and sedation. METHODS An exploratory randomized controlled trial was performed in a pediatric intensive care unit. Participants were randomly allocated to receive a live music intervention with standard care or a recorded music intervention with standard care. Each intervention was delivered by a board-certified music therapist for 15 minutes. Heart rate, respiratory rate, and blood pressure were measured at baseline and at 15-minute intervals for 60 minutes after the intervention. RESULTS A total of 33 patients aged 0 to 2 years completed the study: 17 were assigned to the live music group and 16 to the recorded music group. In the live music group, a significant reduction in heart rate was observed immediately after the intervention and was sustained at 60 minutes after the intervention. Although the live music group also exhibited a downward trend in blood pressure, those differences were not significant. CONCLUSIONS The results of this study indicate that live music interventions may be more effective than recorded music interventions in reducing pain and anxiety in pediatric critical care patients. The advantage of live music may be due to the adaptability of the music delivery by a trained music therapist.
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Affiliation(s)
- Hannah Ivey Bush
- Hannah Ivey Bush is an assistant professor of music therapy, West Virginia University, Morgantown
| | - A Blythe LaGasse
- A. Blythe LaGasse is a professor of music therapy, Colorado State University, Fort Collins
| | - Elizabeth Herr Collier
- Elizabeth Herr Collier is clinical lead music therapist, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Margaret A Gettis
- Margaret A. Gettis is a nurse scientist, Children's Healthcare of Atlanta
| | - Karen Walson
- Karen Walson is medical director of the Scottish Rite pediatric intensive care unit, Children's Healthcare of Atlanta, Atlanta, Georgia
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Vera CN, Linam WM, Gadde JA, Wolf DS, Walson K, Montoya JG, Rostad CA. Congenital Toxoplasmosis Presenting as Eosinophilic Encephalomyelitis With Spinal Cord Hemorrhage. Pediatrics 2020; 145:peds.2019-1425. [PMID: 31941759 DOI: 10.1542/peds.2019-1425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
A 4-week-old male neonate with a history of intermittent hypothermia in the newborn nursery presented with an acute onset of bilateral lower extremity paralysis and areflexia. Extensive workup demonstrated eosinophilic encephalomyelitis and multifocal hemorrhages of the brain and spinal cord. Funduscopic examination revealed bilateral chorioretinitis with macular scarring. The laboratory values were notable for peripheral eosinophilia and cerebrospinal fluid eosinophilic pleocytosis (28 white blood cells/µL, 28% eosinophils), markedly elevated protein (1214 mg/dL), and hypoglycorrhachia (20 mg/dL). Toxoplasma gondii immunoglobulin M (IgM) test result was positive. Reference testing obtained at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory confirmed the diagnosis of congenital toxoplasmosis in the infant with a positive immunoglobulin G (IgG) dye test result, immunoglobulin A enzyme-linked immunosorbent assay, and IgM immunosorbent agglutination assay. The diagnosis of an infection acquired during gestation in the mother was established by a positive maternal IgG dye test result, IgM enzyme-linked immunosorbent assay, immunoglobulin A, immunoglobulin E, and low IgG avidity. At 6-month follow-up, the infant had marginal improvement in his retinal lesions and residual paraplegia with hyperreflexia and clonus of the lower extremities. A repeat MRI demonstrated interval development of encephalomalacia with suspected cortical laminar necrosis and spinal cord atrophy in the areas of previous hemorrhage. Clinicians should be aware of this severe spectrum of congenital toxoplasmosis disease and should remain vigilant for subtler signs that may prompt earlier testing, diagnosis, and treatment.
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Affiliation(s)
- Casey N Vera
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - W Matthew Linam
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Judith A Gadde
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - David S Wolf
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Karen Walson
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jose G Montoya
- Toxoplasma Serology Laboratory, Palo Alto Medical Foundation, Palo Alto, California; and.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Christina A Rostad
- Children's Healthcare of Atlanta, Atlanta, Georgia; .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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4
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Reisner A, Chern JJ, Walson K, Tillman N, Petrillo-Albarano T, Sribnick EA, Blackwell LS, Suskin ZD, Kuan CY, Vats A. Introduction of severe traumatic brain injury care protocol is associated with reduction in mortality for pediatric patients: a case study of Children's Healthcare of Atlanta's neurotrauma program. J Neurosurg Pediatr 2018; 22:165-172. [PMID: 29799350 DOI: 10.3171/2018.2.peds17562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/06/2022]
Abstract
OBJECTIVE Evidence shows mixed efficacy of applying guidelines for the treatment of traumatic brain injury (TBI) in children. A multidisciplinary team at a children's health system standardized intensive care unit-based TBI care using guidelines and best practices. The authors sought to investigate the impact of guideline implementation on outcomes. METHODS A multidisciplinary group developed a TBI care protocol based on published TBI treatment guidelines and consensus, which was implemented in March 2011. The authors retrospectively compared preimplementation outcomes (May 2009 to March 2011) and postimplementation outcomes (April 2011 to March 2014) among patients < 18 years of age admitted with severe TBI (Glasgow Coma Scale score ≤ 8) and potential survivability who underwent intracranial pressure (ICP) monitoring. Measures included mortality, hospital length of stay (LOS), ventilator LOS, critical ICP elevation time (percentage or total time that ICP was > 40 mm Hg), and survivor functionality at discharge (measured by the WeeFIM score). Data were analyzed using Student t-tests. RESULTS A total of 71 and 121 patients were included pre- and postimplementation, respectively. Mortality (32% vs 19%; p < 0.001) and length of critical ICP elevation (> 20 mm Hg; 26.3% vs 15%; p = 0.001) decreased after protocol implementation. WeeFIM discharge scores were not statistically different (57.6 vs 58.9; p = 0.9). Hospital LOS (median 19.6 days; p = 0.68) and ventilator LOS (median 10 days; p = 0.24) were unchanged. CONCLUSIONS A multidisciplinary effort to develop, disseminate, and implement an evidence-based TBI treatment protocol at a children's hospital was associated with improved outcomes, including survival and reduced time of ICP elevation. This type of ICP-based protocol can serve as a guide for other institutions looking to reduce practice disparity in the treatment of severe TBI.
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Affiliation(s)
- Andrew Reisner
- Departments of1Pediatrics and.,3Children's Healthcare of Atlanta, Georgia
| | - Joshua J Chern
- Departments of1Pediatrics and.,3Children's Healthcare of Atlanta, Georgia
| | | | | | | | - Eric A Sribnick
- 4Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Laura S Blackwell
- Departments of1Pediatrics and.,3Children's Healthcare of Atlanta, Georgia
| | - Zaev D Suskin
- 5Georgetown University School of Medicine, Washington, DC; and
| | - Chia-Yi Kuan
- 6Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
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5
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Kapralov A, Vlasova II, Feng W, Maeda A, Walson K, Tyurin VA, Huang Z, Aneja RK, Carcillo J, Bayır H, Kagan VE. Peroxidase activity of hemoglobin-haptoglobin complexes: covalent aggregation and oxidative stress in plasma and macrophages. J Biol Chem 2009; 284:30395-407. [PMID: 19740759 PMCID: PMC2781594 DOI: 10.1074/jbc.m109.045567] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [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: 07/16/2009] [Revised: 09/04/2009] [Indexed: 12/31/2022] Open
Abstract
As a hemoprotein, hemoglobin (Hb) can, in the presence of H(2)O(2), act as a peroxidase. In red blood cells, this activity is regulated by the reducing environment. For stroma-free Hb this regulation is lost, and the potential for Hb to become a peroxidase is high and further increased by inflammatory cells generating superoxide. The latter can be converted into H(2)O(2) and feed Hb peroxidase activity. Haptoglobins (Hp) bind with extracellular Hb and reportedly weaken Hb peroxidase activity. Here we demonstrate that: (i) Hb peroxidase activity is retained upon binding with Hp; (ii) in the presence of H(2)O(2), Hb-Hp peroxidase complexes undergo covalent cross-linking; (iii) peroxidase activity of Hb-Hp complexes and aggregates consumes reductants such as ascorbate and nitric oxide; (iv) cross-linked Hb-Hp aggregates are taken up by macrophages at rates exceeding those for noncovalently cross-linked Hb-Hp complexes; (v) the engulfed Hb-Hp aggregates activate superoxide production and induce intracellular oxidative stress (deplete endogenous glutathione and stimulate lipid peroxidation); (vi) Hb-Hp aggregates cause cytotoxicity to macrophages; and (vii) Hb-Hp aggregates are present in septic plasma. Overall, our data suggest that under conditions of severe inflammation and oxidative stress, peroxidase activity of Hb-Hp covalent aggregates may cause macrophage dysfunction and microvascular vasoconstriction, which are commonly seen in severe sepsis and hemolytic diseases.
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Affiliation(s)
- Alexandr Kapralov
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
| | - Irina I. Vlasova
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
- the
Research Institute of Physico-Chemical Medicine, Moscow 119992, Russia
| | - Weihong Feng
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
| | - Akihiro Maeda
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
| | - Karen Walson
- From the
Center for Free Radical and Antioxidant Health
- Critical Care Medicine, and
- the
Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15219 and
| | - Vladimir A. Tyurin
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
| | - Zhentai Huang
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
| | | | | | - Hülya Bayır
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
- Critical Care Medicine, and
- the
Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15219 and
| | - Valerian E. Kagan
- From the
Center for Free Radical and Antioxidant Health
- the Departments of
Environmental and Occupational Health and
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