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Ambati SR, Kaslovsky R, Evans MT, Edge W. Vocal Cord Dysfunction During the COVID-19 Pandemic. Respir Care 2023; 68:520-523. [PMID: 36810361 PMCID: PMC10173119 DOI: 10.4187/respcare.10408] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Vocal cord dysfunction is an upper-airway disorder characterized by exaggerated and transient glottic constriction causing respiratory and laryngeal symptoms. Common presentation is with inspiratory stridor often in the context of emotional stress and anxiety. Other symptoms include wheezing (which may be on inspiration), frequent cough, choking sensation, or throat and chest tightness. This is seen commonly in teenagers, particularly in adolescent females. The COVID-19 pandemic has been a trigger for anxiety and stress with an increase in psychosomatic illness. Our objective was to find out if the incidence of vocal cord dysfunction increased during COVID-19 pandemic. METHODS We performed a retrospective chart review of all the subjects with a new diagnosis of vocal cord dysfunction who were seen at the out-patient pulmonary practice at our children's hospital between January 2019-December 2020. RESULTS The incidence of vocal cord dysfunction in 2019 was found to be 5.2%, (41/786 subjects seen) compared to 10.3% (47/457 subjects seen) in 2020, which is a nearly 100% increase in incidence (P < .001). CONCLUSIONS It is important to recognize that vocal cord dysfunction has increased during the COVID-19 pandemic. In particular, physicians treating pediatric patients, as well as respiratory therapists, should be aware of this diagnosis. It is imperative to avoid unnecessary intubations and treatments with bronchodilators and corticosteroids as opposed to behavioral and speech training to learn effective voluntary control over the muscles of inspiration and the vocal cords.
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Affiliation(s)
- Shashikanth R Ambati
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical College, Albany, New York.
| | - Robert Kaslovsky
- Division of Pediatric Pulmonology, Department of Pediatrics, Albany Medical College, Albany, New York
| | - Mary T Evans
- Division of Pediatric Pulmonology, Department of Pediatrics, Albany Medical College, Albany, New York
| | - Walter Edge
- Division of Pediatric Pulmonology, Department of Pediatrics, Albany Medical College, Albany, New York
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Ambati SR, Barry S, Matthew AA, Edwards M. Transvaginal Migration of Ventriculoperitoneal Shunts in Children: Review of Literature. Asian J Neurosurg 2022; 17:399-406. [PMID: 36398177 PMCID: PMC9665996 DOI: 10.1055/s-0042-1757218] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ventriculo-peritoneal shunt placement is the most commonly performed procedure for the treatment of hydrocephalus. The complication of migration of the distal ventriculo-peritoneal shunt is one of the many complications that occur after ventriculo-peritoneal shunt placement. The migration of the ventriculo-peritoneal shunt through the vagina is infrequently reported in children. The aim of this review is to help all the providers caring for children with ventriculo-peritoneal shunts to identify issues early when encountered with this complication and thus limit morbidity and mortality. We reviewed all cases of migration of ventriculo-peritoneal shunt through the vagina in children less than 18 years of age that were published in the literature using PubMed, Google Scholar, Web of Science, and Cochrane Library. A total of 11 articles met the eligibility criteria and were included in this review among the 93 articles obtained with title and abstract screening. Previous non-shunt-related abdominal operations and shunt revisions are consistent risk factors in all cases. We did not recognize specific approaches to catheter placement or management that could have prevented this complication. Ventriculitis necessitating shunt removal and therapies requiring additional procedures and prolonged hospitalization are the major consequences identified. Awareness of this unusual complication is very important among health care providers such as emergency care health providers who are likely to be the first to encounter these children on initial presentation.
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Affiliation(s)
- Shashikanth R Ambati
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States,Address for correspondence Shashikanth Ambati, MBBS Pediatric Critical Care, Albany Medical Center43 New Scotland Ave, A422, Albany, NY 12208United States
| | - Suzanne Barry
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States
| | - Adamo A Matthew
- Department of Pediatric Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Mary Edwards
- Department of Pediatric Surgery, Albany Medical Center, Albany, New York, United States
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Ambati SR, Tamuz M, DeVoe B, Rotjan A, Lesser M, Gangadharan S. Improving Resuscitation Timing: Random Assignment of Interprofessional Team Leaders in Simulated Resuscitation. Pediatr Emerg Care 2022; 38:e978-e982. [PMID: 35100786 DOI: 10.1097/pec.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to assess whether preassigning a team leader influences resuscitation timing using simulation and to examine relationship between response timeliness and designated leader's profession, whether physician or nurse. METHODS This is a prospective study of intervention (leader assigned) and control (no assigned leader) teams of residents and nurses participating in a simulated scenario. The primary outcome was time to bag-valve-mask (BVM) ventilation. A secondary outcome measure compared difference in time to BVM between physician- and nurse-led teams. RESULTS We assessed 25 teams, leader assigned (n = 14) or control (n = 11), composed of 92 clinicians. Leaders emerged in most of the controls (10 of 11). The median time to BVM in the leader-assigned group was 41.5 seconds (interquartile range, 34-49 seconds) compared with 53 seconds (interquartile range, 27-85 seconds) for controls (P = 0.13). In the leader-assigned group, 85% (12 of 14) of teams initiated BVM in less than 1 minute compared with only 54% teams (6 of 11) in controls (P = 0.18). Among the leader-assigned teams, we randomly assigned residents to lead 8 teams and nurses to lead 6 teams. All the nurse-led teams (6 of 6) initiated BVM in less than 1 minute compared with fewer physician-led teams (6 of 8) and only approximately half of controls (6 of 11, P = 0.19). CONCLUSIONS The leader-assigned teams and controls did not differ in resuscitation timeliness. Among leader-assigned teams, the differences in time to BVM between physician- and nurse-led teams were not statistically significant. However, all 6 nurse-led teams demonstrated timely resuscitation, suggesting a direction for future research on the feasibility of bedside nurses taking the lead during resuscitation, pending code team arrival.
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Affiliation(s)
- Shashikanth R Ambati
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany
| | | | - Barbara DeVoe
- Patient Safety Institute, Center for Learning and Innovation
| | | | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New Hyde Park
| | - Sandeep Gangadharan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York City, NY
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Mathias MD, Ortiz MV, Magnan H, Ambati SR, Slotkin EK, Chou AJ, Walsh MF, Offit K, Moskowitz C, Kentsis A, Wexler LH. A case report of concurrent embryonal rhabdomyosarcoma and diffuse large B-cell lymphoma in an adult without identifiable cancer predisposition. Biomark Res 2017; 5:7. [PMID: 28194276 PMCID: PMC5299656 DOI: 10.1186/s40364-017-0086-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma. Rhabdomyosarcoma, the most common soft tissue sarcoma of childhood. makes up less than 1% of solid malignancies in adults with around 400 new cases each year in the United States. They have not previously been reported concurrently. Case presentation A 37 year old woman presented with painful enlarging leg mass. Biopsy of the mass was consistent with embryonal rhabdomyosarcoma. Staging imaging revealed a PET avid anterior mediastinal lymph node. Excisional biopsy of this mass was consistent with diffuse large B-cell lymphoma. Hybridization capture-based next-generation DNA sequencing did not reveal shared somatic tumor mutations. Germline analysis did not show identifiable aberrations of TP53 or other heritable cancer susceptibility genes. She was treated with a personalized chemotherapy regimen combining features of R-CHOP and Children’s Oncology Group ARST 0331. Conclusions This case illustrates a unique clinical entity successfully treated with a personalized chemotherapeutic regimen.
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Affiliation(s)
- M D Mathias
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - M V Ortiz
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - H Magnan
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - S R Ambati
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - E K Slotkin
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - A J Chou
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - M F Walsh
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - K Offit
- Department of Medicine, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - C Moskowitz
- Department of Leukemia, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - A Kentsis
- Department of Pediatrics, New York, NY USA.,Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - L H Wexler
- Department of Pediatrics, New York, NY USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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Abstract
OBJECTIVE To determine the efficacy of nested polymerase chain reaction (PCR) in detecting Salmonella typhi gene sequences in blood and urine specimens and to determine the cut-off titer of Widal test using PCR as gold standard test for diagnosis of typhoid fever. METHODS Study included 71 children between the ages of 8 months and 14 years; 52 of them were suspected cases of typhoid fever, 11 were febrile non-typhoid controls and 8 were apparently healthy children. Nested PCR in Blood and Urine, Blood culture, Widal test and Urine culture were done and their results analyzed. RESULTS Among suspected typhoid cases, PCR in blood and urine had positivity of 82.7% each. Blood culture, Widal test (at cut off titer TO and/or TH > 1:160) and urine culture had positivity of 26.9%, 50% and 3.8% respectively. In one case, urine PCR was positive and blood PCR was negative. Similarly, in another case, PCR in blood was positive however urine tested negative. Considering PCR as gold standard, the antibody cut off titer was evaluated. A cut-off titer of TO > 1:80 and/or TH > 1:160 had sensitivity and specificity of 72.7% and 84.2%, while the respective figures were 50% and 89.5% when the cut-off titer was TO and/or TH > 1:160. CONCLUSION The sensitivity, specificity, positive and negative predictive values, likelihood ratios were same for PCR based detection of S. typhi in blood and urine samples. Nested PCR had higher efficacy in detecting typhoid fever than Widal test, blood and urine cultures. A cut off titer of TO > 1:80 and/or TH > 1:160 was found to have better diagnostic value in this region.
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Affiliation(s)
- S R Ambati
- Miami Childrens Hospital, Miami, FL, USA.
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Kumar A, Ambati SR. Images in neonatal medicine. Greenish liver visible through abdomen in neonatal cholestasis. Arch Dis Child Fetal Neonatal Ed 2006; 91:F408. [PMID: 17056839 PMCID: PMC2672752 DOI: 10.1136/adc.2005.075754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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