bluuebunny/crossref_metadata_2025 huggingface dataset:
P099 Molecular identification of dermatophyte species from Eastern Assam, Northeast India
Authors: Boro Sumita , Bagchi Anindita , Nath Reema
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Dermatophyte infections occur worldwide both in developing as well as developed countries. However, species of dermatophytes may vary based on geographical region. Studies on dermatophytes from northeast India are rare. This study was done to know the various species of dermatophytes that are commonly associated with infection in this part of the country.

Methods

This study was done from 2020-2021. A total of 49 consecutive isolates of dermatophytes isolated from clinically suspected cases attending Assam Medical College and Hospital, a tertiary care hospital were subjected to molecular identification by using PCR and sequencing of the ITS region of the ribosomal RNA gene as well as using MALDI-TOF (VITEK MS). Samples from active margin of lesions from skin, nail, and hair were collected and primary identification was done by culture and microscopy as well as conventional phenotypic tests. Culture was done in Sabouraud Dextrose agar, Sabouraud Dextrose agar with chloramphenicol and cycloheximide, and dermatophyte test medium which was followed by genotypic confirmation by PCR of the ITS region and sequencing of PCR amplicons using already published protocols.

Results

The species isolated were T. rubrum (36.7%), T. interdigitale (32.6%), T. mentagrophytes complex (14.2%), T. tonsurans (8%), M. gypseum (6%), T. violaceum (2%). The cases were clinically found to be T. corporis (44.89%), T. manuum (12.24%), T. pedis (12.24%), T. cruris (10.20%), T. faciei (8.16%), T. capitis (8.16%), and T. unguium (4.08%).

Conclusion

T. rubrum, T. interdigitale, T. mentagrophytes, and T. tonsurans complex were the predominant species isolated.
P103 Role of biofilm production in recalcitrant tinea
Authors: Gangar Seema , Das Shukla , Gourav Vishal , Bhattacharya S.N. , Pandhi Deepika , Singh N.P.
Published: September 2022

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objective

To determine the role of biofilm production in dermatophytic isolates from tinea infections of recalcitrant skin lesions of study patients.

Methods

An observational study conducted in UCMS and GTB Hospital Delhi, in forty clinically diagnosed and mycologically confirmed cases of recalcitrant tinea infection of glabrous skin to analyze the role of biofilm production in dermatophytes.

After taking written informed consent from the study population sample collection (skin scraping) was done.

The scraping was then mounted in 10% potassium hydroxide (KOH) for direct microscopic examination followed by culture on Sabouraud Dextrose Agar (SDA) media with antibiotics (Chloramphenicol, Gentamicin, Cycloheximide).

The fungal growth was then subjected to LPCB mount (Lactophenol cotton blue).

The isolates were allowed to form in-vitro biofilms on polystyrene microtiter plates.

Quantification of biofilm biomass was done using crystal violet staining and measuring the optical density (OD) at 570 nm and classified as non-adherent/non-producer, weak moderate, and strong biofilm producers.

Results

Tinea corporis and cruris were the most common clinical types of dermatophytosis.

T. mentegrophytes-complex was the most common dermatophyte isolated from the clinical specimens.

Majority (86.84%) of isolates formed strong (OD >4 ODc) biofilms.

Conclusion

There has been an increase in the incidents of chronic and recalcitrant dermatophytosis of skin.

The predominance of T. mentegrophytes-complex as observed in our study highlights the importance of the pathogen in causation of current and chronic and recalcitrant dermatophytosis in India.

High rate of in-vitro strong biofilm formation by the isolates indicates that these organisms might be forming biofilms in-vivo leading to chronicity and poor response to therapy.
Importance of tenosynovitis in preventing the progression through rheumatoid arthritis continuum
Authors: Izumiyama Tomomasa , Miyazawa Masaaki
Published: September 2022

Rheumatoid arthritis (RA) has long been characterized by synovitis and bone erosions typically developing symmetrically in small joints. However, recent advances in imaging modalities have indicated frequent association of tenosynovitis with RA, and some consider tenosynovitis to be not just a complication but a major trait of RA. Furthermore, as there are cases with tenosynovitis preceding the clinical detection of inflammatory arthritis in predisposed individuals, tenosynovitis may constitute an important biomarker in defining the pre-RA phase of disease development. Tenosynovitis itself must be treated as it causes functional impairment and physical as well as socioeconomic burden, and its treatment may result in effective prevention of RA development at a pre-arthritic stage. Thus, further efforts need to be taken in detecting and treating tenosynovitis in the pre-RA stage, which can be facilitated by ultrasonography and magnetic resonance imaging.
Eastern Orthodox Eschatology
Authors: Louth Andrew
Published: September 2022

There is nothing bleakly agnostic about Orthodox beliefs concerning the afterlife, nor is it the case that awareness of an eschatological dimension is absent. Rather, these beliefs are nourished by the rich liturgical life in which the Orthodox participate, which feeds on the hopes and longings of the scriptures and, in the case of the last things particularly, on the experiences and perceptions of the saints, especially as found in hagiographical writings. At the center of all this—the liturgical experience, the scriptures as understood by the Orthodox, and the transfigured lives and experience of the saints—stands the resurrection of Christ, the ultimate fount of all Christian hope. This article examines the eschatology of the Eastern Orthodox Church and discusses Eucharist as eschatology, universal eschatology, and individual eschatology. It also considers four issues in eschatology: the notion of eternal damnation and the nature of judgment, the question of purgatory, the nature of the resurrection body, and the question of universal salvation.
Enhancing Breast Milk Production with Domperidone in Mothers of Preterm Neonates: A Randomized Controlled Trial (Empower Trial)
Authors: Asztalos E , Campbell-Yeo M , DaSilva O , Kiss A , Knoppert D , Ito S
Published: September 2022

BACKGROUND: Using mother’s own expressed breast milk (EBM) has a positive impact in reducing serious neonatal morbidities and improving neurodevelopmental outcomes for very preterm infants. Mothers often struggle to maintain a supply of EBM during prolonged hospitalization. In small studies, domperidone, a potent dopamine D2 receptor antagonist that stimulates the release of prolactin, has been shown to enhance EBM production.

OBJECTIVES: The primary objective was to determine whether administration of domperidone, within the first 21 days after delivery, would lead to a higher proportion of mothers having a 50% increase in the volume of EBM at the end of 14 days of treatment. The secondary objectives were to determine if a 28 day compared to a 14 day treatment yielded a higher proportion of mothers with a 50% increase in EBM volumes; and 2) to determine if a later initiation of domperidone differed in obtaining a 50% increase in EBM volume.

DESIGN/METHODS: EMPOWER was a multicenter, double masked, randomized controlled phase-II trial. Eligible mothers were randomized to one of two treatment arms: group A: domperidone 10 mg orally three times daily for 28 days; group B: identical placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days.

RESULTS: A total of 90 mothers were randomized equally into the 2 arms; 82 were included in the analysis of the primary outcome. Baseline characteristics were similar between the two groups of mothers. There was a significant difference in the proportion of mothers who achieved a 50% increase in EBM volume at the end of the first 14 days of the study treatment: 77.8% in group A vs. 57.8% in group B [OR 0.39, 95% CI 0.16, 0.98, p=0.04] However, there was no difference in the proportion of mothers who achieved a 50% increase in EBM volume on day 28: 68.9% in group A vs. 66.7% in group B [OR .90, 95% CI 0.37, 2.19].

CONCLUSION: Introducing a galactogogue may be helpful in aiding mothers of preterm infants who present with an insufficient supply of EBM within the first 21 to 35 days after birth.
Awareness of Sentinel Injuries Among Canadian Paediatricians: A Cpsp One-Time Survey
Authors: Barrett R , Hanes L , Ornstein A
Published: September 2022

BACKGROUND: A sentinel injury is a visible or detectable minor injury in a pre-cruising infant that is poorly explained and therefore suspicious for physical abuse. Examples include bruises and intra-oral bleeding, which may be “warning injuries” for possible abuse. Timely recognition and management of a sentinel injury can potentially alter a pattern of escalating child abuse, but studies have demonstrated that in up to a third of cases, physicians miss early signs of abuse.

OBJECTIVES: Our purpose was to assess paediatrician awareness of sentinel injuries in pre-cruising children as precursors to more serious physical abuse.

DESIGN/METHODS: A Canadian Paediatric Surveillance Program (CPSP) one-time survey of Canadian paediatricians was conducted in March of 2015 to evaluate awareness of sentinel injuries and their significance. Respondents were provided with clinical vignettes describing infants with sentinel injuries and were asked questions about their differential diagnosis and management plan. Respondents were then classified as either “aware” or “not aware” based on their responses, and a multivariable logistic regression analysis was used to identify variables most strongly correlated with awareness.

RESULTS: The survey achieved a response rate of 23.4%. Of the 582 respondents, 65% were aware that bruises and intra-oral injuries in pre-cruising children are red flags for possible physical abuse. Respondents were more likely to be aware of bruises as sentinel injuries (91.9%) than they were of intra-oral injuries (67.2%). Paediatric subspecialists were significantly less likely than general paediatricians to be aware of sentinel injuries as red flags for later serious abuse (adjusted OR=0.57, 95% CI 0.37–0.88, p=0.01). Other important trends included higher awareness with more recent completion of residency, and also with additional training in the area of child abuse and neglect.

CONCLUSION: Over one-third of Canadian paediatricians are unaware that unexplained bruising and intra-oral bleeding in a pre-cruising child should prompt assessment for possible abuse. Further physician education is warranted to ensure that paediatricians understand the importance of sentinel injuries and the indications for initiating investigations to detect occult injuries of child abuse. Future directions include the development of physician training opportunities in the area of identifying and managing sentinel injuries, as well as extending the study population to include family physicians who provide primary care to children.
Midpoint Results of National Surveillance of Childhood Tuberculosis
Authors: Giroux R , Jamal A , Kitai I , Consunji-Araneta R , Baikie M , Morris SK
Published: September 2022

BACKGROUND: There is little detailed epidemiologic and clinical data about tuberculosis (TB) disease in children in Canada.

OBJECTIVES: To characterize the epidemiologic, clinical, and treatment data for all cases of TB in children under age 15 in Canada through the Canadian Pediatric Surveillance Program’s (CPSP) Childhood Tuberculosis Study. The initial results of the 3 year study presented here includes cases from September 2013 to October 2015.

DESIGN/METHODS: TB cases were identified through a monthly form sent by the CPSP to approximately 2500 active pediatricians, pediatric subspecialists, and select non-pediatricians who manage childhood TB. For cases meeting inclusion criteria, a detailed questionnaire was sent to collect clinical, epidemiological, and treatment data, followed by 6-month follow-up surveys until 6 months after treatment completion.

RESULTS: Of 164 unique incident cases reported, 84 met inclusion criteria and returned a detailed questionnaire. Selected demographic data is shown here:

Intrathoracic TB was reported in 78/84 (93%) of cases including 66 with pulmonary disease. One or more positive cultures were obtained in 32/68 (47%) of cases attempting pulmonary culture using sputum (n=17), bron-choalveolar lavage (n=2), and/or gastric aspirates (n=16). Of these, 4/9 (44%) were positive in children 12 months or younger, 8/23 (35%) between ages 1-4, 5/14 (36%) between ages 5-9, and 15/22 (68%) in children 10+ years. In two culture-negative cases, a positive AFB was found in the sputum. Extrathoracic TB was reported in 30% (n=25), with rates in children 10+ years being significantly higher than expected given the current literature. One case was MDR-TB.

CONCLUSION: Detailed clinical, epidemiological, and treatment data has been obtained for many cases of childhood TB in Canada through the CPSP Childhood Tuberculosis Study. This study will provide the most complete picture of childhood TB in Canada and will serve to refine practice in monitoring, detecting, and treating this infection.
Severe Bradycardia Following Initiation of Low-Dose Olanzapine in A Patient with Anorexia Nervosa
Authors: Mijovic H , Grant C , Couturier J
Published: September 2022

BACKGROUND: Low-dose Olanzapine has been used clinically for over a decade in anorexia nervosa (AN) patients failing standard treatment in order to decrease anxiety and facilitate weight gain. While Olanzapine has been generally well tolerated, large scale data regarding safety and side-effects in AN patients is lacking.

OBJECTIVES: To examine possible association between severe bradycar-dia and Olanzapine use in AN patients.

DESIGN/METHODS: Case study and literature review.

RESULTS: We present a case of severe bradycardia (HR 18) following initiation of low-dose Olanzapine in a 16 year old female admitted to our inpatient ward with AN and bradycardia during sleep.To our best knowl-edgeno other case studies of severe bradycardia in AN patients treated with Olanzapine have been published to date.We relate our case to findings from available literature that examines potential association between bradycardia and Olanzapine. We point to challenges with obtaining larger scale data on Olanzapine safety and side-effects in AN patients.

CONCLUSION: There areinherent cardiac risks associated with treatment of AN patients. Existing literature in patients with diagnosis other than AN suggests there may be inter-individual differences in pharmacoki-netics of Olanzapine and that bradycardia may be a possible adverse effect of Olanzapine even at a low dose. Caution should be used in initiating Olanzapine in AN patients with baseline bradycardia.
Family History-Taking in Paediatrics: It’s Much More Than Just A Checklist
Authors: Tessier L , Brehaut J , Potter B , Chakraborty P , Carroll J , Wilson B
Published: September 2022

BACKGROUND: Family history (FH) is a risk factor for many conditions in pediatric practice; interest has increased in supporting systematic FH taking in this area by identifying core conditions for enquiry and developing point of care tools. There is little published about current practice to inform implementing such changes.

OBJECTIVES: To inform future FH taking interventions by identifying pediatricians' perceptions, attitudes, beliefs, and current practices.

DESIGN/METHODS: The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community and hospital-based pediatricians Analysis was by the constant comparison method, using a thematic approach. This study was funded by the Canadian Institutes of Health Research.

RESULTS: The data revealed FH taking to be a firmly embedded, but complex aspect of pediatric practice. Participants described FH as part of regular, holistic care, extending to social and interpersonal, as well as clinical purposes; in addition to disease risk assessment, FH information helped clarify diagnosis, and select medication; tailor the overall patient management based on family circumstances; and provide psychosocial support for parents. It was also used as a method to build a relationship with parents/carers. FH and social history information were inextricably linked and often appeared to be the same concept in participants’ minds. Participating pediatricians generally expressed confidence in their FH skills and reported tailoring their approach according to experience, after initial training early in their career. While acknowledging some challenges in ensuring accuracy, they were attuned to nuances in their interactions with parents and children which would affect whether, and what, they were told about illness in the family. Most were not concerned about formal evidence, and would not change their practice except for “good reason”.

CONCLUSION: The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Recommendations for systematic enquiry about specific conditions cannot be seen as a simple additional activity to current practice. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians’ attitudes, perspectives, and practices. Further studies should explore and seek to confirm and expand our observations.
Developmental Delay? Graduating Medical Students’ Knowledge of Child Development
Authors: MacPherson P , Bischoff M , North CR , Tough S , Andrews D
Published: September 2022

BACKGROUND: Knowledge of child development is fundamental to medical practice. Previous studies have demonstrated gaps in knowledge and training among trainees and practicing physicians. We conducted a longitudinal study of medical students’ knowledge of child development. Previously, we reported that students’ knowledge of developmental milestones was poor at baseline, did not improve after preclinical teaching and improved marginally after pediatrics clerkship. Here, we report the report the data on graduating medical students.

OBJECTIVES: The present study aimed to describe graduating medical students’ knowledge of developmental milestones in comparison to their baseline knowledge. A secondary aim was to compare graduating students' knowledge to that of the general population.

DESIGN/METHODS: We assessed medical students' knowledge of developmental milestones using a previously published 17-item questionnaire. Milestones were categorized as motor or non-motor. Students were surveyed at the start of medical school in Year 1 and prior to graduation in Year 4. Changes in students' scores were assessed using paired t-tests. Graduating medical students were compared to a published general population sample using t-tests.

RESULTS: 56 students completed the survey in both Years 1 and 4 (33% of entering class). Overall, students’ percentage of correct answers increased from 24% at baseline to 32% at graduation (p<0.001). Knowledge of motor milestones did not change significantly between Years 1 and 4. Knowledge of non-motor milestones improved significantly between Years 1 and 4 (p<0.001). 85 medical students completed the questionnaire in Year 4 (50% of entering class). Compared to a sample of the general population (n=1198), graduating medical students answered 1.0 more questions correctly out of 17 (p<0.001). Students’ knowledge of non-motor milestones was greater than that of the general population (p<0.001). Knowledge of motor milestones did not differ significantly.

CONCLUSION: Medical students' knowledge of developmental milestones improved only modestly over the course of their undergraduate medical education. At graduation, their knowledge of developmental milestones was marginally better than that of the general population. This level of knowledge is likely insufficient for generalist practice. At the undergraduate level, curricular improvements including innovative teaching strategies and greater student engagement are likely necessary to remediate this knowledge gap. Pediatricians supervising medical students and residents should not assume that trainees have an adequate knowledge of normal child development and may wish to highlight the developmental achievements of typically developing children as part of their clinical teaching.
Screening for Risk of Developmental Delay in a primary care setting using the Nippising District Developmental Screen
Authors: Zabih W , Parkin P , Borkhoff C , Heuvel M Van den , Korosheygi C , Maguire J , Birken C , Cairney J ,   TARGet Kids!
Published: September 2022

BACKGROUND: Early growth and development in the first five years of life is strongly associated with health outcomes. The Nipissing District Developmental Screen (NDDS) is a free parent-reported screening tool recommended by the Canadian Pediatric Society as one of the tools for developmental screening in children

OBJECTIVES: To determine the prevalence of a positive screen for risk of developmental delay in a cohort of healthy children at 18-months and 5 years. To identify risk factors (child, socio-demo-graphic and home environment) associated with a positive screen for risk of developmental delay.

DESIGN/METHODS: A cross-sectional study of healthy Canadian children attending 18-months and 5 year well-child visits between June 2008 and February 2015 was conducted through the TARGet Kids! practice-based research network. Multivariable logistic regression was used to identify risk factors associated with a positive screen for developmental delay. Risk factors of development delay identified from literature were:, male sex, low birth weight, low income, low maternal education, maternal unemployment, non-industrialized immigrant status, single parent family, only child and older maternal age.

RESULTS: 1086 children (53% male) at 18 months and 575 children (51% male) at 5 years were included in the final analysis. At 18 months, 341 (31.4%) of children (95% CI, 28.7% - 34.3%) and at 5 years 166 (28.9%) (95% CI, 25.2% -32.8%) were screen positive base on 1+ flag NDDS. At 18 months, children with a low birthweight (OR=1.66; 95% CI 1.22-2.28), with a mother with low education (OR=1.75; 95% CI 1.07-2.85), and those from non-industrialized immigrant families (OR=1.85; 95% CI 1.37-2.49) were associated with an increased odds of a positive screen for developmental delay based on the 1+ NDDS flag. A female child (OR=0.74; 95% CI 0.57-0.96) and an only child (OR=0.76; 95% CI 0.57-0.99) were associated with a decreased odds of a positive screen for developmental delay. At 5 years, factors associated with a positive screen for developmental delay based on the 1+ NDDS flag were: low maternal education (OR 2.24; 95% CI 1.14-4.39) (children had 2.24 times greater odds of a positive screen for developmental delay) and older maternal age (OR 1.05; 95% CI 1.00-1.09) (every 1-year increase in maternal age, children had 1.05 times greater odds of a positive screen for developmental delay). A female child was associated with a decreased odds of a positive screen for developmental delay (OR=0.66; 95% CI 0.46-0.96) based on the 1+ NDDS flag.

CONCLUSION: In a population of healthy urban children the NDDS identified 30% at both 18 month and 5 years at risk for developmental delay. Risk factors for developmental delay were associated with a positive NDDS screen.
Incident Reporting as A Quality Improvement Tool in Paediatric Resuscitations
Authors: Ratnapalan S , Kelly I , Fearey L
Published: September 2022

BACKGROUND: A code is called through locating for any child under 16 years of age who requires resuscitation in our hospital and a team of physicians, nurses and resuscitation officers attend these resuscitations. All clinicians involved in the resuscitation are sent a standardised questionnaire by the resuscitation office to identify issues during that resuscitation which may not be captured elsewhere. This feedback system was established to create a mechanism for anonymous feedback from all members of resuscitation teams.

OBJECTIVES: The objective of this study was to identify the teams' perception of issues in clinical care and remedial actions that were implemented by the institution to address these gaps.

DESIGN/METHODS: A retrospective review of all voluntary anonymous survey responses that were generated at our institution from January to December 2013 was conducted after Research Ethics Board review and approval. A narrative analysis was conducted by the Resuscitation Officersand a Paediatric Emergency Consultant to identify themes and categories.

RESULTS: There were 56 medical and 49 trauma resuscitations occurred in 2013 of which all traumas (49) and 48 (86%) of medical resuscitations were in the emergency department There were fully or partially completed surveys available for 97 resuscitations that occurred in the emergency department during the study period. Major themes with positive comments included; the team lead from the emergency department and clear role identification during the resuscitations. Identified themes with concerns included providers’ knowledge gaps, process delays due to equipment issues and system issues. Knowledge gaps regarding drowning management, protocols for cardiopulmonary resuscitations, and lack of clarity regarding policies and procedures when a child is certified dead after resuscitation were identified. Equipment delays for paediatric resuscitation were due to absent batteries in laryngoscope, suction failure, lack of small cuffed endotracheal tubes in ED, inability to find oxygen saturation connectors, and lack of enteral syringes in resuscitation areas. The system issues that were identified included inadequate space in the resuscitation room, in-adequate number of lead aprons when there were more than one trauma case, specimen transport delays and delays in accessing paediatric sub-speciality services.

CONCLUSION: Issues with resuscitations can be identified through anonymous feedback even when robust systems and processes are in place to ensure appropriate personnel and equipment are readily available at paediatric resuscitations. Our study identified provider, process and system issues in paediatric resuscitations which helped to identify strategies to improve service delivery.
Rotavirus Genotypes Circulating in Ontario, Canada, Before and After the Implementation of the Immunization Program, 2010-2013
Authors: Isabel S , Higgins RR , Peci A , Deeks S L. , Gubbay JB
Published: September 2022

BACKGROUND: Rotavirus A is a common cause of acute gastroenteritis in young children and a significant cause of death worldwide. Rotavirus shows an impressive genetic diversity and its epidemiological surveillance is typically conducted with a binary genotyping system using two major outer capsid antigenic protein genes: G (VP7 gene) and P (VP4 gene). Ontario introduced a publicly funded vaccination program for two and four month old infants for rotavirus in August 2011, using Rotarix® (GlaxoSmithKline), a live monovalent oral vaccine which contains an attenuated G1P[8] strain. Rotavirus vaccination has diminished the magnitude of rotavirus seasons in many countries but it is unclear if it will contribute to selective pressure and increase the prevalence of other genotypes.

OBJECTIVES: Our aim was to describe circulating rotavirus genotypes before and after the implementation of Ontario’s immunization program. We monitored the potential change in relative proportions and emergence of rotavirus genotypes in Ontario after vaccination-program implementation.

DESIGN/METHODS: Rotavirus detection was conducted at a public health laboratory using electronic microscopy, immunochromatographic testing, and/or laboratory developed multiplex rRT-PCR. A convenience sample of rotavirus positive stool specimens collected in children and adults in Ontario from September 2010 to June 2013 were genotyped using heminested genotyping multiplex PCR. We also searched Pubmed in November 2015 for articles published on rotavirus G10 since 2008.

RESULTS: Of the 332 stool specimens collected, we found a decrease in the number of rotavirus positive specimens available for genotyping in the 23 month period post-vaccination (128 specimens) compared to the 11 month period pre-vaccination (204 specimens) in Ontario. We also found an increase in the proportion of genotype G10 in the post-vaccination period (37/128 = 29%) compared to the pre-vaccination period (11/204 = 5%). These G10 specimens originated from different regions of Ontario. Our literature review estimated that only approximately two hundred G10-positive human stool samples were reported from 14 different countries worldwide since 2008.

CONCLUSION: Our study showed a decrease in the number of rotavi-rus positive convenience samples after vaccination-program implementation. We also found an unexpected increase of the proportion of rotavirus G10 after the introduction of the immunization program. Genotype G10 is uncommon in human and vaccine effectiveness for this genotype is unclear.Ongoing monitoring of rotavirus prevalence and circulating genotypes is important to study the long-term effect of vaccination and evaluate if this increase in proportion of genotype G10 is representative or persists in Ontario, or is present in other Canadian provinces or countries.
Feeding Difficulties and Gastrointestinal Tract Morphology and Innervation in ‘Charge’ Syndrome
Authors: Hudson A , Macdonald M , Cloney K , Steele S , Berman J , Blake K , Stoyek M , Croll R , Smith F
Published: September 2022

BACKGROUND: CHARGE syndrome has been linked to mutations in the CHD7 gene and results in a number of physiological and structural abnormalities. The estimated incidence in the Atlantic Provinces is 1 in 8500 births. Challenges include eating problems, which have a profound impact throughout a child’s life and can lead to complications and even death.

OBJECTIVES: To investigate feeding difficulties and model the morphology and innervation of the gastrointestinal tract in CHARGE syndrome.

DESIGN/METHODS: Three research studies (two clinical, one basic science) were conducted to assess feeding difficulties in CHARGE syndrome. The first study conducted a qualitative analysis of parent interviews to understand packing and problematic feeding behaviors. The second study investigated general eating and GI motility problems by having parents complete a series of feeding questionnaires. The third study modeled CHARGE syndrome in zebrafish by using a morpholino to knock down the expression of CHD7.

RESULTS: Study 1: Twenty parents completed a phone interview, describing their child/adult’s (2-32 years) adverse feeding behaviors. Parents reported food packing most commonly with bread and pasta (33%), and reported that food was held in cheeks for hours after a meal had ended (35%). Packing was reported to prolong mealtimes for over an hour (30%). Parents were worried about choking during eating (30%).Study 2: Sixty-nine parents of children (age 1-18 years) completed the questionnaires. Those who were tube fed had significantly more gastrointestinal symptoms (stomach pain, nausea, etc.) and worse feeding difficulties than those who were orally fed. The CHARGE characteristics of choanal atre-sia/stenosis and cranial nerve IX/X dysfunction were associated with significantly more gastrointestinal symptoms. Parents identified constipation as a major challenge. Study 3: Immunohistochemistry demonstrated changes in the enteric innervation of the gastrointestinal tract in the CHARGE syndrome zebrafish models. There was decreased branching of the gastrointestinal nerve network surrounding the stomach. Use of fluorescent microbeads demonstrated reduced motility and delayed passage of the microbeads through the gastrointestinal tract.

CONCLUSION: These three studies provided a comprehensive analysis of feeding and gastrointestinal difficulties, from mouth to anus, in CHARGE syndrome. They provide a deeper understanding of adverse feeding behaviors, feeding difficulties, and the abnormal morphology of the gastrointestinal system. The information from this study can be useful for general pediatricians and feeding therapy teams who are involved in the care of these individuals starting in infancy. The team-based approach of conducting multiple research projects investigating a common issue may be useful in other genetic disorders.
Investigating the Need for Routine Hip Ultrasound to Detect Developmental Dysplasia of the Hips In Babies Born with Breech Presentation
Authors: D'Alessandro M , Dow K
Published: September 2022

BACKGROUND: Breech presentation at birth increases the risk for developmental dysplasia of the hips (DDH). However, international consensus with regards to screening guidelines for infants at increased risk of DDH is lacking. Kingston General Hospital (KGH), a Canadian tertiary care center, currently employs a DDH ultrasound screening protocol at 6 weeks of age for all infants born with breech presentation.

OBJECTIVES: To investigate the utility of routine ultrasound scanning in detecting DDH in patients born breech with a negative physical exam of the hips.

DESIGN/METHODS: A retrospective chart review was conducted in which electronic medical records at KGH were reviewed to identify infants born breech who received routine hip ultrasound screening for DDH between 2010 and 2015. Physical exam findings of the hips, ultrasound reports, and subsequent treatment modalities were extracted as well as gestational age, birth weight, and gender.

RESULTS: 319 infants born with breech presentation who underwent routine hip ultrasound regardless of physical exam status were identified (192 (60.2%) female; 127 (39.8%) male). 27 (8.5%) had a negative physical exam but a positive finding on ultrasound. The gender distribution of this subset was significantly different than that of the total group (p CONCLUSION: For infants born with breech presentation with a negative physical exam of the hips, consideration could be given to direct routine ultrasound screening for DDH at females only.
Infectious Episodes in Paediatric Patients with Moderate-To-Severe Chronic Benign Neutropenia and Normal Bone Marrow Evaluation
Authors: Bernard-Genest J , Beaulieu-Genest L , Michon B
Published: September 2022

BACKGROUND: Chronic benign neutropenia, often referred as primary autoimmune neutropenia, is the most frequent cause of chronic neutrope-nia in children. Despite being a common and long known entity, evidence supporting its benign infectious course is scarce. More data would help guiding parents and clinicians in regard to patient evolution.

OBJECTIVES: The aim of this study was to describe infectious episodes in children with moderate to severe autoimmune neutropenia supported by a normal bone marrow study. Secondary objectives were to determine the mean duration of the neutropenia and whether the severity of the neutro-penia was correlated to the development of severe infections.

DESIGN/METHODS: We retrospectively reviewed medical records of patients with chronic neutropenia followed by a pediatric hematologist at our tertiary pediatric center, between November 1995 and December 2013. We only included patients with chronic benign neutropenia supported by a normal bone marrow. We excluded patients with immune deficiencies, genetic syndromes and metabolic diseases. Simple and multiple logistic regression were used to determine the association between the presence of severe infections and the absolute neutrophil count (ANC). We classified the severity of infection according to the medical literature.

RESULTS: 84 medical records were retrospectively reviewed. 21 patients were excluded from the study based on exclusion criteria. We were able to collect complete data for 37 patients. The median age at diagnosis and at resolution was respectively 9 months (2mo-13yr) and 37 months (9mo-16y). The median duration of the neutropenia was 17 months (3mo-5y). During the neutropenic period, more than 112 mild infections were observed. 11 patients (29.7%) developed 13 moderate infections. 7 patients (18.9%) underwent 8 severe infections but no bacteremia was reported. ANC was not significantly different between patients who exhibited severe infections and those who did not (mean ANC=663±322×106/L vs 601±326×106/L; p=0.67). Recurrent infections occurred in 9 patients (24.3%).

CONCLUSION: To our knowledge, our study is the largest on benign chronic neutropenia in children with normal bone evaluation. Severe infections have infrequently been reported in the literature for children with chronic benign neutropenia. Yet, almost 20% of our cohort exhibited at least one severe infection, although no bacteremia occurred. Interestingly, no association was found between the severity of the neu-tropenia and the presence of severe infection. We believe that these findings will help guiding the evaluation and management in this commonly occurring affection.
Development and Implementation of a Novel On-Call Structure for Paediatric Residents
Authors: Cawthorn T , Ruhl M , Dhalla M , Lam S , Hall S
Published: September 2022

BACKGROUND: At the Alberta Children’s Hospital, residents provide 24-hour coverage of inpatient units through several shifts: a day team, an evening team, an overnight team, and a weekend team. The evening shift was designed to limit consecutive hours worked by the night team, allowing provision of five consecutive nights of coverage. Recently, residents and Hospitalist Pediatricians expressed a desire to optimize the continuity of care provided by our call system. Cross-covering residents working the evening shift felt that they were at higher risk of committing an error during these times. Furthermore, there were external pressures to reduce consecutive resident work hours to less than 15 hours.

OBJECTIVES: To design and implement a novel call system for pediatric residents at the Alberta Children’s Hospital.

DESIGN/METHODS: A committee was established to identify areas for improvement. Based on stakeholder input, a novel system was created that centered on a 12 hour construct (0800-2000) with a primary “day team” and “night team” for each weekday. A key feature of the system ensured that weekday coverage was provided by “on-service” residents (residents on a CTU rotation) and that weekend coverage was provided by “off-service” residents (on other rotations). The first iteration of the new call system was implemented in April of 2015.

RESULTS: A total of 19 residents completed a 6 month follow-up survey in November of 2015;89% of polled residents felt the new system was superior to the previous system. The majority of residents (84%) felt that patient care was improved during the weekdays, with the remaining residents indicating that weekday care was unchanged. Weekend care was felt to be unchanged under the new system by the majority of residents (74%). There were differing opinions on the impact of the new system on resident fatigue level (38% improved, 22% unchanged, 12% worsened, 27% unsure). Surveys indicated that the new system was associated with a lower perceived risk of committing a medical error across all shifts.

CONCLUSION: We were able to successfully implement a novel call system which dose not rely on either an evening “covering” shift, or 24 hour shifts. The new call system was very well received by all stakeholders and was associated with improved resident perception of patient care during the week, and decreased perceived risk of medical error across all shifts. The new system was also associated with a trend toward reduced resident fatigue overall.
Developing a Consultation Model for Neonatal Neurocritical Care: A 2-Year Experience
Authors: Mohammad K , Goswami I , Buchhalter J , Bello-Espinosa L
Published: September 2022

BACKGROUND: Developing brain has unique pattern of injury and responds to injury differently. Management of neonatal seizures, perinatal asphyxia as well as ischemic-hemorrhagic preterm brain injury requires specific skill sets of neonatology, neurology, neurophysiology and neuroradiology. The impact of neurological conditions extends beyond neonatal intensive care unit stay warranting continuity of care in order to improve outcomes.

OBJECTIVES: Establishing a special interest group to run within the existing intensive care facility based on separate subspeciality model of neurocritical care in adults and study the impact of the change on short term outcome of neurological conditions in neonates.

DESIGN/METHODS: A multidisciplinary team was formulated including faculties from Neonatology, Pediatric Neurology, Diagnostic Imaging and Neonatal Follow up to form a neonatal neurocritical care (NNCC) core team. Roles to each team members was defined and oncall schedule for round the clock coverage developed. Hypoxic Ischemic Encephalopathy (HIE) was targeted first by standardized policies and procedures to be followed after admission, introduction of continuous video EEG monitoring and series of training sessions for nurses and fellows on bedside application of diagnostic tools. The core team was involved in care of the infant from admission to discharge with a well defined follow up plan and had 24 hour remote access to EEG recorded in any of the 2 Level 3 NICU involved.

RESULTS: On comparing management and outcomes prior to and following the start of NNCC we found that the use of anti-epileptic drugs (AED) reduced from 60 to 46%, the use of maintenance dose was halved. Considerable reduction in death or MRI documented brain injury was noted.

CONCLUSION: Consultation model of NNCC resulted in improved communication and collaboration between disciplines, better HIE care pathway and short term outcomes, creation of database that will allow assessment of long term outcome. The group is currently targeting Intra-Ventricular hemorrhage and post-hemorrhagic hydrocephalus management. In future the team will focus on real time multimodal brain monitoring.
The Cost of the Gluten-Free Diet: Household Food Expenditures in Families With a Child or Adolescent With Celiac Disease
Authors: Alzaben A , Mager D , Turner J , Marcon M , Anders S
Published: September 2022

BACKGROUND: Celiac disease (CD) is a digestive disease that is caused by an immune reaction to the protein gluten. The gluten free diet (GFD) is the only treatment for CD. In 2012, the sale of GF processed foods reached up to $460million in Canada; an increase in 25% since 2008. Despite being the fastest growing food intolerance category in Canada, GFD consumers face challenges from various voluntary GF-labelling schemes and limited retail and food-service product options.

OBJECTIVES: To estimate GF-food expenditure patterns for affected families with children or adolescents with CD to identify the cost burden of following a GFD and compared against non-GFD Canadian families.

DESIGN/METHODS: A pilot study was conducted in families with a child with biopsy proven CD following the GFD (n=15; 10±3 years) and attending a GI/CD clinic. Family Socio-demographics (age of parents, number of children/number of members following GFD in households) and the receipts of food purchases over a one-month period were obtained from parents/caregivers. The cost of GFD was analyzed as “actual food costs on related receipts” and determined as total GFD cost (per household/per child with CD) basis. The result of this study was compared against average incomes and food expenditures of Canadian households as reported by Statistic Canada in 2013.

RESULTS: The mean age of the parents of child with CD was (44±5 years) and the mean number of children in households was 2.0±0.6. The average duration of following GFD was 4±2 years (age at diagnosis 6±2 years). The median income for Canadian family and for family with children with CD was C$ 84,000/year and C$ 100,000/year, respectively. The average food expenditure was C$ 842/month for the average Canadian household with children vs C$ 1105±393/month for comparable Canadian households affected by CD. The amount of money spent on GF packaged foods was C$ 145±100/month. The average food expenditure of GF food and gluten containing food was C$112±72/child/month (+GF) and C$ 29±14/house-hold member/month (-GF), respectively.

CONCLUSION: Total food expenditures in families with a child/adolescent with CD are higher than the Canadian averages. This has implications on economic access and adherence to GFD in children/adolescents with CD. CD and proper dietary adherence to GFD guidelines poses significant economic burdens on affected families. These results and unanswered questions of economic access, affordability and quality of life hold several Canadian policy implications.
Prioritizing diversity? The allocation of US federal R&D funding
Authors: Graddy-Reed Alexandra , Lanahan Lauren
Published: September 2022

We examine the distribution of federal research and development funding across the academy early in the researcher’s pipeline. We use a unique program, the US National Science Foundation’s Graduate Research Fellowship Program (GRFP), to document diversity and disparity in allocation and assess the relative impact of federal funding across four different academic divisions that include engineering, life sciences, math and physical sciences, and social sciences and psychology. After controlling for disciplinary differences in research practices, we find that the impact of federal funding yields similar rates and impact of research. However, we document disparity in how federal funding is allocated across the country to institutions and individuals. Together, these findings prompt a discussion around the trade-offs of funders focusing on national priorities or broadening participation. We conclude with recommendations for the GRFP.