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Soma G, Simmons MA, Canarie MF, Karnik R, Steele J, Tiyyagura G, Asnes J. A 13-Year-Old With Fever and Chest Pain. Pediatrics 2021; 148:peds.2021-050960. [PMID: 34344802 DOI: 10.1542/peds.2021-050960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Michael F Canarie
- Critical Care, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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Lucien MAB, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, Cerpa M, Joseph GA, Maki G, Zervos MJ, Dely P, Boncy J, Sati H, Rio AD, Ramon-Pardo P. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. Int J Infect Dis 2021; 104:250-254. [PMID: 33434666 PMCID: PMC7796801 DOI: 10.1016/j.ijid.2020.12.087] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.
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Affiliation(s)
- Mentor Ali Ber Lucien
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.
| | - Michael F Canarie
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul E Kilgore
- Eugene Applebaum School of Pharmacy, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | - Gerard A Joseph
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Gina Maki
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Marcus J Zervos
- The Global Health Initiative, Henry Ford Health System, Detroit, Michigan, USA
| | - Patrick Dely
- Direction d'Épidémiologie, de Laboratoire et de Recherches, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Hatim Sati
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Ana Del Rio
- Pan American Health Organization, AMR Special Program, Washington DC, USA
| | - Pilar Ramon-Pardo
- Pan American Health Organization, AMR Special Program, Washington DC, USA
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Abstract
OBJECTIVES Shock refractory to fluid and catecholamine therapy has significant morbidity and mortality in children. The use of methylene blue to treat refractory shock in children is not well described. We aim to collect and summarize the literature and define physicians' practice patterns regarding the use of methylene blue to treat shock in children. DESIGN We conducted a systematic search of MEDLINE, Embase, PubMed, Web of Science, Cochrane for studies involving the use of methylene blue for catecholamine-refractory shock from database inception to 2019. Collected studies were analyzed qualitatively. To describe practice patterns of methylene blue use, we electronically distributed a survey to U.S.-based pediatric critical care physicians. We assessed physician knowledge and experience with methylene blue. Survey responses were quantitatively and qualitatively evaluated. SETTING Pediatric critical and cardiac care units. PATIENTS OR SUBJECTS Patients less than or equal to 25 years old with refractory shock treated with methylene blue. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One-thousand two-hundred ninety-three abstracts met search criteria, 139 articles underwent full-text review, and 24 studies were included. Studies investigated refractory shock induced by a variety of etiologies and found that methylene blue was generally safe and increased mean arterial blood pressure. There is overall lack of studies, low number of study patients, and low quality of studies identified. Our survey had a 22.5% response rate, representing 125 institutions. Similar proportions of physicians reported using (40%) or never even considering (43%) methylene blue for shock. The most common reasons for not using methylene blue were unfamiliarity with this drug, its proper dosing, and lack of evidentiary support. CONCLUSIONS Methylene blue appears safe and may benefit children with refractory shock. There is a stark divide in familiarity and practice patterns regarding its use among physicians. Studies to formally assess safety and efficacy of methylene blue in treating pediatric shock are warranted.
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Affiliation(s)
| | - Rachel Johnson
- Department of Pediatrics, Yale University, New Haven, CT
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT
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Abstract
Infection with Corynebacterium diphtheriae persists in Haiti. Twenty-six children with clinically severe respiratory diphtheria presented to a hospital in northern Haiti during a 3-year period beginning in early 2015. The mortality rate was 50%. Partial or absent vaccinations as well as delayed and limited care contributed to mortality. This cohort offer insights into the multiple challenges involved in preventing and caring for children with diphtheria in resource-limited settings.
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Affiliation(s)
| | | | | | | | | | - Michael F Canarie
- Department of Pediatric, Yale University School of Medicine, New Haven, CT, USA
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Vermette D, Hu P, Canarie MF, Funaro M, Glover J, Pierce RW. Tight junction structure, function, and assessment in the critically ill: a systematic review. Intensive Care Med Exp 2018; 6:37. [PMID: 30259344 PMCID: PMC6158145 DOI: 10.1186/s40635-018-0203-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Epithelial and endothelial barrier integrity, essential for homeostasis, is maintained by cellular boarder structures known as tight junctions (TJs). In critical illness, TJs may become disrupted, resulting in barrier dysfunction manifesting as capillary leak, pulmonary edema, gut bacterial translocation, and multiple organ failure. We aim to provide a clinically focused overview of TJ structure and function and systematically review and analyze all studies assessing markers of endothelial and epithelial TJ breakdown correlated with clinical outcomes in critically ill humans. METHODS We systematically searched MEDLINE, EMBASE, and PubMed. Additional articles were identified by targeted searches. We included studies that looked at the relationship between biomarkers of endothelial or epithelial TJ structure or function and critical illness. Results were qualitatively analyzed due to sample size and heterogeneity. RESULTS A total of 5297 abstracts met search criteria, of which 150 articles met requirements for full text review. Of these, 30 studies met inclusion criteria. Fifteen of the 30 reports investigated proteins of endothelial tight junctions and 15 investigated epithelial TJ markers, exclusively in the gastrointestinal epithelium. No studies investigated TJ-derived proteins in primary cardiac or pulmonary pathology. CONCLUSIONS TJ integrity is essential for homeostasis. We identified multiple studies that indicate TJs are disrupted by critical illness. These studies highlight the significance of barrier disruption across many critical disease states and correlate TJ-associated markers to clinically relevant outcomes. Further study on the role of multiple tissue-specific claudins, particularly in the setting of respiratory or cardiac failure, may lead to diagnostic and therapeutic advances. SYSTEMATIC REVIEW REGISTRATION This systematic review is registered in the PROSPERO database: CRD42017074546 .
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Affiliation(s)
- David Vermette
- Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
| | - Pamela Hu
- Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
| | - Michael F Canarie
- Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
| | - Melissa Funaro
- Cushing/Whitney Medical Library, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
| | - Janis Glover
- Cushing/Whitney Medical Library, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
| | - Richard W Pierce
- Department of Pediatrics, Yale University, 333 Cedar Street, PO Box 208064, New Haven, CT 06520 USA
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Canarie MF, Shenoi AN. Teaching the Principles of Pediatric Critical Care to Non-Intensivists in Resource Limited Settings: Challenges and Opportunities. Front Pediatr 2018; 6:44. [PMID: 29552547 PMCID: PMC5840157 DOI: 10.3389/fped.2018.00044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/14/2018] [Indexed: 01/17/2023] Open
Affiliation(s)
- Michael F Canarie
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Asha N Shenoi
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
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Perez MT, Vázquez M, Canarie MF, Toribio J, León-Wyss J. Clinical Progress in the Management of Tetralogy of Fallot in the Dominican Republic: A Case Series. World J Pediatr Congenit Heart Surg 2017; 8:584-589. [PMID: 28901230 DOI: 10.1177/2150135117727257] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Definitive surgical interventions for Dominican children with congenital heart disease, like those of other low- and middle-income countries, have been historically limited. METHODS We undertook review of a case series focusing on the surgical correction of complex forms of tetralogy of Fallot at a single center, CEDIMAT Centro Cardiovascular, in the Dominican Republic, over a 30-month period. RESULTS According to our criteria, 43 cases were determined to be complex tetralogy of Fallot repairs from the two-year period. Besides tetralogy of Fallot, the cohort had an additional 55 anatomic anomalies that had to be addressed at the time of surgery. Median age at the time of surgery was notably 30 months, and an average of 42 months elapsed from the time of diagnosis to the time of surgery for this group. Only 33% of the cases reviewed had no hypercyanotic crises before repair. Median time to extubation for this group of patients was one day, with a three-day median length of stay in the intensive care setting. CONCLUSIONS Our study importantly captures the present experience of a surgical congenital heart program that has recently transitioned from a traditional "mission model" to a now self-sustaining local practice. Both the number and the complexity of the lesions corrected in this caseload represent an advance from the level of care previously provided to children in the Dominican Republic.
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Affiliation(s)
- María T Perez
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA
| | - Marietta Vázquez
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA.,2 Yale University School of Medicine, New Haven, CT, USA
| | - Michael F Canarie
- 1 Department of Pediatrics, Yale New Haven Hospital, New Haven, CT, USA.,2 Yale University School of Medicine, New Haven, CT, USA
| | - Janet Toribio
- 3 Department of Pediatric Cardiology, CEDIMAT Centro Cardiovascular, Santo Domingo, Republica Dominicana
| | - Juan León-Wyss
- 3 Department of Pediatric Cardiology, CEDIMAT Centro Cardiovascular, Santo Domingo, Republica Dominicana
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Nyirasafari R, Corden MH, Karambizi AC, Kabayiza JC, Makuza JD, Wong R, Canarie MF. Predictors of mortality in a paediatric intensive care unit in Kigali, Rwanda. Paediatr Int Child Health 2017; 37:109-115. [PMID: 27922344 DOI: 10.1080/20469047.2016.1250031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 01/09/2023]
Abstract
BACKGROUND The enormous burden of critical illness in resource-limited settings has led to a growing interest in paediatric critical care in these regions. However, published data on the practice of critical care and patient outcomes in these settings are scant. OBJECTIVE This study sought to identify risk factors associated with mortality in the newly established Paediatric Intensive Care Unit (PICU) at Kigali University Teaching Hospital (KUTH) in Rwanda and test the predictive ability of a newly devised mortality risk score, the modified PRISM (MP) score. METHODS All admissions to the PICU at KUTH from October 2012 to October 2014 were included. Demographic and physiological data on each patient were gathered and each was assigned a MP score. This prospective cross-sectional study examined the association between the characteristics and physiological status of these patients and mortality. Using logistic regression, factors associated with mortality in the PICU were analysed. RESULTS A total of 213 children were admitted to the PICU during the study period. Three patients were excluded because of missing data. Of this total, 59% were male, 25% were neonates and nearly 60% were moderately to severely malnourished. The overall mortality rate was 50%. On bivariate analysis, factors associated with increased mortality were male sex, use of vasoactive medications, a MP score ≥ 5, a discharge diagnosis of septic shock, and malnutrition on admission. On multivariate analysis, only the use of vasoactive drugs [odds ratio (OR) 12.24, 95% confidence interval (CI) 4.4-35.4, p < 0.001] and MP score ≥ 5 (OR 16.1, CI 6.3-40.8, p < 0.001) were associated with mortality. CONCLUSION The observed mortality rate was in the range reported in other resource-limited settings. The initial attempt to create and implement a risk of mortality tool for this setting determined a score that could identify those patients at higher risk of mortality. In PICUs in resource-limited settings, the gathering of data and use of severity of illness tools could improve care in a number of ways.
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Affiliation(s)
- Rosine Nyirasafari
- a Department of Pediatrics and Child Health , Ministry of Health, Rwamagana Provincial Hospital , Rwamagana , Rwanda
| | - Mark H Corden
- b Division of Hospital Medicine , Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | | | - Jean Claude Kabayiza
- d School of Medicine and Pharmacy, College of Medicine and Health Sciences , University of Rwanda , Butare , Rwanda
| | - Jean Damascene Makuza
- e STIs Care and Treatment Senior Office, HIV and STIs Division, Rwanda Biomedical Centre , Kigali , Rwanda
| | - Rex Wong
- f Yale University Global Health Leadership Institute , New Haven , CT , USA
| | - Michael F Canarie
- g Department of Pediatrics, Division of Critical Care , Yale University School of Medicine , New Haven , CT , USA
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Carroll CL, Faustino EVS, Pinto MG, Sala KA, Canarie MF, Li S, Giuliano JS, The Northeast Pediatric Critical Care Research Consortium. A regional cohort study of the treatment of critically ill children with bronchiolitis. J Asthma 2016; 53:1006-11. [PMID: 27177013 DOI: 10.1080/02770903.2016.1180697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the treatment practices in critically ill children with RSV bronchiolitis across four regional PICUs in the northeastern United States, and to determine the factors associated with increased ICU length of stay in this population. METHODS We conducted a retrospective cohort study of children who were admitted with RSV bronchiolitis between July 2009 and July 2011 to the PICUs of Connecticut Children's Medical Center, Yale-New Haven Children's Hospital, Maria Fareri Children's Hospital, and Baystate Children's Hospital. Data were collected regarding clinical characteristics and intensive care course among these hospitals. RESULTS During the study period, 323 children were admitted to one of the four ICUs with RSV bronchiolitis. Despite similar mortality risk scores among ICUs, there was considerable variation in the use of therapies, particularly intubation and mechanical ventilation, in which there was greater than a 3.5-fold increased risk of intubation between sites with the highest and lowest frequency of intubation (odds ratio: 3.8; 95% confidence interval: 2.2-6.4). Albuterol was the most commonly used respiratory treatment, followed by chest physiotherapy, high-flow nasal cannula, and hypertonic saline. Longer stays in the ICU were associated with more frequent use of therapies, specifically invasive mechanical ventilation, inhaled corticosteroids, intrapulmonary percussive ventilation, and chest physiotherapy. CONCLUSIONS Even within a close geographic region, there is significant variation in the treatment provided to critically ill children with RSV bronchiolitis. None of these treatments were associated with shorter durations of hospitalization in this population and some, such as mechanical ventilation, were associated with longer ICU lengths of stay.
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Affiliation(s)
| | | | - Matthew G Pinto
- c Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY , USA
| | - Kathleen A Sala
- a Connecticut Children's Medical Center , Hartford , CT , USA
| | | | - Simon Li
- c Maria Fareri Children's Hospital at Westchester Medical Center , Valhalla , NY , USA
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Canarie MF, Bogue CW, Banasiak KJ, Weinzimer SA, Tamborlane WV. Decompensated hyperglycemic hyperosmolarity without significant ketoacidosis in the adolescent and young adult population. J Pediatr Endocrinol Metab 2007; 20:1115-24. [PMID: 18051930 DOI: 10.1515/jpem.2007.20.10.1115] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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] [Indexed: 12/11/2022]
Abstract
AIM To identify patients aged 10-30 years with probable hyperglycemic hyperosmolar syndrome (HHS), to describe demographic and clinical profiles, and to attempt to assess risk factors for poor outcomes. STUDY DESIGN Retrospective cohort study (medical records review). SETTING A 944-bed tertiary care teaching and research hospital and a 425-bed affiliated facility. PATIENTS 10-30 year-old patients with a primary or secondary discharge diagnosis of HHS or diabetic ketoacidosis (DKA). Patients with a serum glucose >600 mg/dl in the absence of significant ketoacidosis (possible HHS) were profiled. Further stratification based on measured or calculated serum osmolarity >320 mOsm/kg (probable HHS) was undertaken. INTERVENTIONS Patients received treatment for hyperglycemic crises, consisting primarily of fluids, electrolyte replacement and insulin. MEASUREMENTS AND MAIN RESULTS Of the 629 admissions, 10 with a diagnosis of HHS and 33 with a diagnosis of DKA met the initial study criteria for HHS. 60% were African Americans and 89% were new-onset diabetics. From this group, 20 admissions had serum osmolarity > or =320 mOsm/kg. Fisher's exact test and Pearson coefficients were used to examine associations between risk factor and poor outcomes and correlations between admission data and length of hospital stay, respectively. Serious complications occurred in four patients (including two deaths, 10% mortality) and were limited to those with unreversed shock over the first 24 hours of admission and who received <40 ml/kg of intravenous fluids over the first 6 hours of treatment. CONCLUSIONS HHS was underdiagnosed in this population and occurred disproportionately in African Americans. Serious complications occurred exclusively in those with unreversed shock and inadequate fluid resuscitation.
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Affiliation(s)
- Michael F Canarie
- Section of Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
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