bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slow pseudo sinus rhythm and atrial tachycardia of right superior venous pulmonary origin
Authors: Verbeet Thierry , Nguyen Thomas , Almorad Alexandre , Jottrand Maurice , Wauters Thierry , Castro José 
Published: October 2021

ABSTRACT
Paroxysmal atrial tachycardia usually presents as a sudden acceleration of the atrial rate combined with modifications of the P wave morphology. A 22-year-old patient presented with very fast and very slow atrial ectopic activity. He complained of repetitive episodes of fast tachycardia, some accompanied with dizziness.
When the ectopic discharge was slow, no clear-cut difference between the sinus rate and the ectopic rate was seen and thus the atrial rhythm appeared quite regular. The ectopic focus was situated deep inside the right upper pulmonary vein (RSPV).
After RSPV isolation a persistent sinus rhythm was established and since then the patient has been asymptomatic for 3 years.
Thus, subtle changes in the P wave morphology without a significant change in the heart rate in patients presenting with palpitations can give a clue to the diagnosis of the tachycardia and the localization of the ectopic focus.
Mallory–Weiss syndrome complicated by severe aspiration pneumonitis in an infant
Authors: Ebara Yukako , Shimizu Akihiko , Nomura Shigeru , Nishi Akira , Yamada Yoshiyuki 
Published: October 2021

ABSTRACT
A 1-month-old girl presented with hematemesis and dyspnea. A large amount of blood was aspirated through a nasogastric tube, and chest computed tomography showed bilateral centrilobular opacified lesions, which suggested aspiration pneumonitis due to upper gastrointestinal bleeding. Her respiratory condition exacerbated, and we initiated nitric oxide (NO) therapy. Bleeding stopped with conservative treatment. She was weaned off mechanical ventilation and extubated on Day 6 after admission. Afterward, upper gastrointestinal endoscopy showed a longitudinal linear scar indicative of Mallory–Weiss syndrome (MWS). MWS is rarely reported in early infancy since many of the risk factors are absent in infants. Patients with aspiration pneumonitis usually recover respiratory function within 24 h and severe respiratory failure is rare in aspiration pneumonitis. There are no pediatric case reports describing MWS with severe aspiration pneumonitis. Although MWS is a rare cause of neonatal hematemesis, patients can become severely ill and require multidisciplinary treatment.
Massive hematemesis and melena stool: A case report of unusual manifestation of Cow’s milk protein intolerance
Authors: Doya Leen Jamel , Aljanati Omar , Mansour Hanin Ahmed , Naamah Maria , Ibrahim Alexander Ali , Yousef Nizar , Salloum Rabab , Ibrahim Ali 
Published: October 2021

ABSTRACTCow’s milk protein intolerance (CMPI) is a common condition that causes gastrointestinal bleeding in the first year of life. It is the most common cause of chronic blood loss and anemia; however, severe massive hematemesis is an uncommon condition. Herein, we present a case of severe massive hematemesis with melena stool in a six-month-old boy with cow’s milk protein intolerance. In this case, we described management used in poor developing countries.
A case of humidifier lung with a difficult differential diagnosis from COVID-19
Authors: Ono Mariko , Nagatomo Yoko , Kinoshita Hayato , Takeda Yukihisa , Nakamura Hiroyuki , Aoshiba Kazutetsu 
Published: October 2021

ABSTRACT
Acute respiratory illnesses that presented with diffuse ground-glass opacities (GGOs) on chest computed tomography (CT) scan suggest the diagnosis of coronavirus disease 2019 (COVID-19). However, many other diseases show similar CT findings, which often offer a difficult differential diagnosis. Here, we report a case of humidifier lung, a rare phenotype of hypersensitivity pneumonitis (HP), which mimicked COVID-19. A 71-year-old man was admitted because of dyspnea and diffuse GGOs found on chest CT scan. Although COVID-19 was initially suspected, his symptoms rapidly improved by the next day. A medical interview revealed that he had started using an ultrasonic humidifier 1 month ago. A high-resolution CT (HRCT) scan showed ill-defined centrilobular nodules and mosaic attenuation, which are typical of HP but atypical of COVID-19. The inhalation challenge test confirmed the diagnosis of humidifier lung. History-taking of humidifier use and a precise HRCT interpretation are helpful to differentiate it from COVID-19.
Concomitant acute pulmonary embolism, myocardial infarction and ischemic stroke due to paradoxical embolism from a patent foramen ovale: a case report
Authors: Takemoto Kiyoshi , Nakamura Michitaka , Atagi Kazuaki 
Published: October 2021

ABSTRACT
A patent foramen ovale (PFO) is a cause of paradoxical embolism. Although most patients with a PFO are asymptomatic, various clinical manifestations may be associated with PFO. The most important is a cryptogenic stroke. Concomitant acute pulmonary embolism (APE), acute myocardial infarction (AMI) and acute ischemic stroke (AIS) due to paradoxical embolism from a PFO are extremely rare. We describe a 77-year-old woman with a past medical history of hypertension who was transferred due to a sudden onset of dyspnea followed by cardiopulmonary arrest. Based on the patient’s medical history, transthoracic and transesophageal echocardiography, coronary angiography, and a whole-body contrasted computed tomography, we diagnosed concomitant APE, AMI and AIS caused by a paradoxical embolism from a PFO. Appropriate knowledge of the pathophysiology of this rare critical illness is important for prompt diagnosis and treatment.
Concurrent cholecystoduodenal fistula and primary aortoenteric fistula
Authors: Zad Mohammadali , Do Cuong N , Teo Andrew , Dixon Eliza , Welch Christine , Karamatic Rozemary 
Published: October 2021

ABSTRACT
Bilioenteric fistulae are a rare complication and can pose a diagnostic challenge owing to non-specific symptomology. When occurring with an aortoenteric fistula, it represents a rare and potentially life-threatening disease state. We present the case of a 77-year-old gentleman initially treated as presumed ascending cholangitis. This was complicated by upper gastrointestinal bleeding secondary to an aortoenteric fistula and cholecystoduodenal fistula.
Heart failure with reduced ejection fraction due topolycythemia vera
Authors: Zaman Muhammad Omer , Kim Kevin , Yousafzai Osman K , Umer Muhammad , Jones Riley G , Shah Roshan , Kim Bernard 
Published: October 2021

ABSTRACT
Polycythemia vera is a rare hematological disorder that can cause heart failure with reduced ejection fraction from chronic micro-vascular ischemia. Appropriately recognizing the underlying cause of cardiomyopathy is essential to decrease morbidity and mortality. Patients can present with elevated troponin level and have patent epicardial coronary arteries on coronary angiogram, hence presenting a diagnostic challenge for health care professionals. Furthermore, the presentation can mimic myocarditis.
Herein, we report a case of a 61-year-old female who presented with heart failure due to microvascular thrombotic complication associated with polycythemia vera. Laboratory investigation and coronary angiogram were inconclusive. A high degree of clinical suspicion and utilizing non-invasive techniques, such as cardiac imaging, can describe myocardial pathology and aid with the diagnosis.
4 Educational Impact of Targeted Neonatal Echocardiography (TNE) on Neonatal-Perinatal Medicine (NPM) Subspecialty Residents
Authors: Friedmann Isabel , McNamara Patrick , Bhattacharya Soume , Cheng Anita 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Targeted Neonatal Echocardiography (TNE) is a real-time cardiac imaging modality used by neonatologists who have completed a minimum of one-year training in cardiovascular physiology and imaging methodology, to optimize management of neonatal cardiorespiratory compromise. TNE is provided as a clinical service, to aid in diagnosis, treatment, and monitoring of neonatal cardiovascular illness. Potential impacts of TNE on trainee education are unknown.

Objectives
This study aimed to describe trainees’ perspectives on existing neonatal hemodynamics education and perceived impacts of TNE on their education.

Design/Methods
This was a mixed quantitative and qualitative study that surveyed NPM subspecialty residents in Canada and the United States of America (USA), at centres both with and without TNE. Survey questions sought to explore current perspectives on cardiac and hemodynamics curriculum in training programs.

Results
92 residents responded to the survey, of whom 24 (26%) were enrolled in a program with an active TNE service, 64 (70%) were training at a non-TNE centre, and 4 (4%) were unsure. Trainees at TNE centres were more satisfied with their overall hemodynamics training (91% vs. 69%, p=0.040; Table 1). 25% of all trainees felt they do not have sufficient hemodynamics training to prepare them for independent practice. On analysis of curriculum content, cardiac development, myocardial functioning in prematurity, and cardiac mechanics emerged as areas of knowledge gaps among all residents (Table 2). TNE centre trainees reported that bedside TNE teaching offers immediate insights into how patients respond to management decisions, while didactic TNE teaching allows for learning at a slower pace, with appropriate knowledge consolidation. Only 9% of respondents at TNE sites reported a formal process of hemodynamics review between clinical and TNE teams. 90% of respondents believed that a TNE service would positively impact their hemodynamics education by improvement in knowledge of cardiovascular physiology and management decisions.

Conclusion
Most trainees believed that TNE may be a valuable educational tool, with current perceived satisfaction with overall hemodynamics training higher among residents training at TNE centres. 25% of all trainees felt unprepared for transitioning to independent practice. Hence, thoughtful curriculum design for real-time and consolidation learning, with specific emphasis on content gaps, as well as working toward a formal process of hemodynamics review, should be considered.
8 Food Insecurity during COVID-19 in a Canadian Academic Pediatric Hospital
Authors: Van Den Heuvel Meta , Fuller Anne E , Zaffar Nusrat , Li Xuedi , Beck Carolyn , Birken Catherine 
Published: October 2021

Abstract

Primary Subject area
Social Paediatrics

Background
There are concerns of increased food insecurity rates during the COVID-19 pandemic, but there is no evidence to date about families with children with an acute or chronic illness. Parents with a child admitted to the hospital may also experience hospital-based food insecurity, defined as the inability of caregivers to afford adequate food during their child’s hospitalization.

Objectives
We aimed to measure the prevalence of household and hospital-based food insecurity in an academic pediatric hospital setting during the COVD-19 pandemic. We also explored the effects of food insecurity on parental distress and overall caregivers’ experiences obtaining food during their hospital stay.

Design/Methods
This was a cross-sectional study from April to October 2020. Household food insecurity was measured using the 18-item U.S. Household Food Security Survey Module. Three adapted questions about hospital-based food insecurity were added. Parental distress was measured with the validated Distress Thermometer for Parents: “0” indicates “no distress” and “10” indicates “extreme distress”. Descriptive statistics were used to assess the proportions of food insecurity. Linear regression models were used to explore the relationship between food insecurity and parental distress adjusted for potential confounders. To explore caregivers’ experiences we included one open-ended question in our survey, asking: “Do you have any other feedback regarding your food situation during your child’s hospital admission?”. Recurrent themes were identified using qualitative analysis.

Results
851 families were reached by telephone and 775 (91.0%) provided consent to participate. 435 (56.1%) completed at least one questionnaire [Figure 1 Study Flow Diagram]. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.0%) food insecurity. Both adult (B= 0.21 [95% CI 0.07-0.36]), child (B= 0.38 [95% CI 0.10-0.66]) and hospital-based (B= 0.56 [95% CI 0.30-0.83]) food insecurity were significantly associated with parental distress independent of covariates [Table]. In the qualitative analysis, the financial burden and emotional and practical barriers obtaining food in the hospital were identified as important themes. Parents also commented that they “need to eat to be able to take part in the care of their child during hospitalization”.

Conclusion
Both household and hospital-based food insecurity were highly prevalent in caregivers and significantly associated with parental distress, independent of covariates. High parental distress is known to be associated with a child’s maladjustment to illness and adherence with medical treatment. Hospitals need to strongly consider reducing barriers for parents to obtain food for themselves during their child’s admission in order to reduce parental distress.
11 Exploring the Impact of COVID-19 on Families of Children with Developmental Disabilities: A Community-Based Formative Study
Authors: Filler Tali , Kaur Pardeep , Mohamed Usamah , Minhas Ripudaman , Suleman Shazeen 
Published: October 2021

Abstract

Primary Subject area
Developmental Paediatrics

Background
The COVID-19 pandemic has impacted every facet of society but has been particularly disastrous for families of children with developmental disabilities (DD) living on the margins. The unprecedented repercussions of COVID-19, including quarantine, social distancing, and service restrictions, continue to disproportionately impact these families. This is a pattern observed in previous humanitarian crises, where there has been a lack of response for children with DD. There is an urgent need to understand the experiences of families of children with DD in order to develop a community-driven model of service provision.

Objectives
This study aims to identify the experienced impact of COVID-19 on families of children with DD who have significant needs and social barriers.

Design/Methods
This was a community-based participatory study using a formative research framework in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with caregivers and care providers of children with DD. Data were recorded, transcribed, and coded using deductive and inductive coding methods by three independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency, and soundness) guidelines for qualitative research. Perceived parental stress and social support were explored using the Perceived Stress Scale (PSS-10) and Multidimensional Scale of Perceived Social Support (MSPSS).

Results
A total of 25 IDIs were conducted. Of the 15 caregivers interviewed, five were new to Canada. Results suggested both newcomer and non-newcomer families of children with DD are in crisis, reporting high stress and low social support, with increased difficulties navigating and accessing therapies and programs, including those offered virtually. Participants reported behavioural regressions and increased anxiety among their children with DD, as well as caregiver mental health challenges. Providers reported having to change their service delivery model in accordance with public health recommendations, but caregivers said that they were not included in these decisions.

Conclusion
Families of children with DD face extraordinary barriers to care, which may be further compounded by the COVID-19 pandemic. Our study demonstrates the value of community-informed design, particularly in the setting of the COVID-19 pandemic. To deliver truly patient-centred services during the pandemic, there is an urgent need for responsive programming that is built with patients, for patients.
14 Diaphragmatic Electrical Activity in Preterm Infants on Non-Invasive High Frequency Oscillatory Ventilation (DEAP-NHFO Study)
Authors: Wong Jonathan , Sasivimon Soonsawad , Omar Rawan Abu , Dunn Michael , Ng Eugene , Beck Jennifer 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Continuous Positive Airway Pressure (CPAP) is a common form of non-invasive respiratory support for preterm infants. Non-invasive high frequency ventilation (NHFOV) is a relatively new method of non-invasive respiratory support. NHFOV is being increasingly utilized in clinical practice in an attempt to prevent intubation and minimize ventilator-induced lung injury in preterm infants. Preliminary studies suggest superiority of NHFOV over CPAP, but little is known about its mechanism of action and its effect on respiratory control in the newborn. We hypothesize that NHFOV reduces respiratory drive and improves ventilation, resulting in decreased patient diaphragm energy expenditure, which can be assessed by measuring the electrical activity of the diaphragm (Edi).

Objectives
The objective of this study is to compare the effects of non-invasive respiratory support delivered by nasal CPAP versus NHFOV on respiratory pattern, as assessed by the Edi in very low birth weight (VLBW) preterm infants.

Design/Methods
In a prospective, randomized, crossover study, 20 preterm infants with birth weights ≤1500 g requiring CPAP were randomized to either NHFOV or CPAP for 105 min, followed by crossover to the other method for the same duration. Edi was continuously measured by a feeding catheter with miniaturized sensors embedded in its wall (Maquet, Solna). The general sequence was 15 minutes for acclimation to the mode, 75 minutes for a feed to be completed, followed by 15 minutes for breath-by-breath analyses of neural breathing pattern. Primary outcome was difference in the peak Edi between CPAP and NHFOV. Secondary outcomes included difference in other measures of respiratory drive: neural respiratory rate, neural inspiratory time, diaphragm energy expenditure, transcutaneous pCO2, number of apnea episodes on the Edi, and episodes of clinically significant apnea.

Results
No significant differences in Edi timing, Edi min, Edi peak, apnea, or CO2 were observed between the two modes of respiratory support.

Conclusion
In this cohort of VLBW preterm infants, neural respiratory pattern was not significantly different between NHFOV and CPAP. With this baseline information in stable preterm infants, it would now be important to assess whether these results hold true in infants with more severe lung disease, where NHFOV is often used as escalating support from CPAP.
29 Caregiver-Reported Delay in Presentation to Pediatric Emergency Departments for Fear of Contracting COVID-19: A multinational cross-sectional study
Authors: Davis Adrienne , Sunderji Alia , Marneni Shashidhar , Seiler Michelle , Hall Jeanine , Cotanda Cristina Parra , Klein Eileen , Brown Julie , Gelernter Renana , Griffiths Mark , Hoeffe Julia , Gualco Gianluca , Mater Ahmed , Manzano Sergio , Thompson Graham , Ahmed Sara , Ali Samina , Goldman Ran 
Published: October 2021

Abstract

Primary Subject area
Public Health and Preventive Medicine

Background
Visits to pediatric emergency departments have decreased up to 75% during the pandemic, with corresponding increases in high acuity visits, inpatient admissions, and intensive care unit admissions compared to historical cohorts.

Objectives
To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Secondary objectives were to: a) evaluate potential predictors of delay; b) describe the proportion of children whose symptoms worsened during time to presentation.

Design/Methods
A multicentre cross-sectional survey study of caregivers accompanying their children aged 0-19 years old to 16 pediatric EDs in 6 countries, from May-June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concerns about the child or caregiver having COVID-19 at the time of ED visit.

Results
Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child’s symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12), were independently associated with a COVID-19-related delayed presentation in multivariate regression analysis.

Conclusion
Almost one in five caregivers reported delaying ED presentation for their ill or injured child, specifically due to fear of contracting COVID-19 while in hospital. Mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work were at highest risk for delay.