bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycobacterium Avium Complex Infection as a Rare Cause of Cerebral Mass Lesion and IRIS in a Patient with AIDS: Case Report and Review of the Literature
Authors: Lane-Donovan Courtney , Bainbridge Emma , Szumowski John , Kerkhoff Andrew D , Peluso Michael J 
Published: October 2021

Abstract
A patient with advanced HIV/AIDS presented with a brain abscess. While brain biopsy culture and pathology were unrevealing, universal broad-range PCR (uPCR) demonstrated Mycobacterium avium complex (MAC). We review the clinicopathologic characteristics of MAC brain abscesses and highlight the effectiveness of uPCR as a diagnostic tool in partially-treated infections.
19 Anxiolysis for laceration repair in children: A survey of pediatric emergency providers in Canada
Authors: Kumar Kriti , Ali Samina , Sabhaney Vikram , Trottier Evelyne D , Drendel Amy , Shah Amit , Bhatt Maala , Poonai Naveen 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Laceration repair accounts for half of procedures performed in pediatric emergency departments. Although commonly used, topical anesthetics do little to alleviate emotional distress, particularly in young children. Intranasal midazolam is frequently used but is not consistently effective. Intranasal dexmedetomidine (IND) is a new and potentially effective anxiolytic but clinical uptake is limited by a lack of pediatric data.

Objectives
Our objective was to understand pediatric emergency providers’ willingness, preferences, and perceived barriers surrounding anxiolysis for laceration repair in children, to inform the design of a future clinical trial of IND.

Design/Methods
This was an online survey of Canadian pediatric emergency providers listed in the Pediatric Emergency Research Canada database. The survey was developed according to published guidelines and featured a vignette of a 3-year-old distressed child requiring laceration repair. It was hosted on the Research Electronic Data Capture platform in English and French, and was disseminated from September to December 2020. The primary outcome was the proportion of respondents that would provide anxiolysis. Secondary outcomes included perceived barriers to IND use. Data were reported using summary statistics.

Results
The response rate was 155/225 (68.9%), of which 98/141 (70%) were Royal College accredited pediatric emergency physicians. For 129/147 (88%) of respondents, 80-100% of their patients were children. 123/146 (84%) had &gt; 6 years independent practice experience and 126/146 (86%) performed &gt; 4 laceration repairs per month. 127/148 (86%) believed that &gt; 25% of children experienced distress significant enough to require physical restraint during laceration repair. 116/148 (78%) indicated they would provide anxiolysis, mainly as intranasal benzodiazepines, such as midazolam (100/109, 92%). 95/148 (64%) indicated that they would consider IND if evidence suggested it was effective. Common perceived barriers included inadequate personal (114/145, 79%) and nursing (109/145, 75%) experience with IND, and lack of formulary access to IND (60/145, 41%).

Conclusion
Most pediatric emergency providers believe that laceration repair in a young child is distressing and would provide anxiolysis. Most providers would consider IND if there was evidence of benefit, suggesting that favourable findings from a clinical trial would have good clinical uptake.
20 Adolescent and caregiver perspectives on living with a limb fracture: A qualitative study
Authors: Bharadia Manisha , Golden-Plotnik Stevi , van Manen Michael , Sivakumar Mithra , Drendel Amy , Poonai Naveen , Moir Mackenzie , Ali Samina 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families.

Objectives
Our study objectives were to understand: 1) how adolescents (12-17 years) describe the functional impact of fractures on their lives; 2) how adolescents’ reports of their experiences compare to those of their caregivers; and 3) the impact of the fracture on the family unit.

Design/Methods
We conducted individual, semi-structured interviews from June 2019 to November 2020 with adolescents and their caregivers, 7-14 days following their initial visit to a pediatric emergency department. We utilized qualitative content analysis methodology. Recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. A secondary coder reviewed 40% of the transcripts, and the coding team met regularly to discuss the coding framework and key themes. The interview script was modified in an iterative process, to reflect emerging themes.

Results
We completed a total of 29 interviews. The most commonly affected functions were: a) showering and hygiene (which required the most caregiver support); b) sleep variability (due to pain and cast-related discomfort); and c) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Adolescents valued independence and often chose to take more time to complete a task to preserve this, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration as a result of day-to-day impacts imposed by the injury. Generally, caregivers’ perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included what we described as ‘sibling burden’ or conflicts that arose when a sibling had to take on extra chores/tasks.

Conclusion
These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures. Key messages include: 1) expect pain and impaired sleep, especially in the first few days; 2) allow extra time to complete tasks independently, especially for grooming and hygiene; 3) consider family impact, especially sibling burden; 4) prepare for changes in activities and social dynamics; and 5) frustration is normal, for both adolescents and caregivers. Future work can focus on developing a novel, family-informed tool to assess functional outcomes following injury.
28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study
Authors: Burke Karina , Vujcic Branka , Hamilton Jonathan , Mace Charlotte , Teefy John , Poonai Naveen 
Published: October 2021

Abstract

Primary Subject area
Emergency Medicine - Paediatric

Background
There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies.

Objectives
Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers.

Design/Methods
We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia.

Results
All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &lt; 0 .001) was a significant negative predictor.

Conclusion
The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.
38 Clinical features and echocardiographic parameters of relative adrenal insufficiency (RAI) among preterm infants: A five-year review
Authors: Grewal Gurpreet , Ting Joseph , Lam Carol , Yadav Krishan , Kuan Mimi 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Infants born at low gestational age (GA) often present with a septic shock-like picture in the neonatal intensive care unit (NICU). Some of these premature infants are noticed to exhibit inadequate cortisol levels at such a time of stress, an entity termed ‘relative adrenal insufficiency’ (RAI), which is postulated to compromise the compensatory mechanisms and further circulatory collapse.

Objectives
To review the clinical features and echocardiographic parameters of RAI in preterm infants, and their correlation with adrenocorticotropic hormone (ACTH) stimulation tests in a quaternary NICU over 5 years.

Design/Methods
This is a single centre retrospective study. Infants born at &lt; 32 weeks GA between January 2015 to June 2019, admitted to the British Columbia Women’s Hospital NICU (Vancouver, British Columbia), were reviewed. Infants who presented with a shock-like picture with a cortisol level at this time of stress of &lt; 250 nmol/L were included. Infants who have received corticosteroid prior to cortisol collection were excluded.

Results
There were 798 infants &lt; 32 weeks admitted to the BCWH NICU over a 5 year period, of which 284 had a spot cortisol drawn. We identified 45 eligible infants in our study (5.6% of NICU admissions). Their median (IQR) for GA, birth weight, cortisol level, and age of onset of RAI were 25 weeks (24, 26), 690 g (590, 815), 83 (58, 127), and 13 days of life (8, 24), respectively. Among these infants, 73% developed significant hypotension or respiratory failure (Table 1). 13 infants (28.9%) had echocardiogram performed at the time of cardiopulmonary deterioration, and all had normal left ventricular (LV) fractioning shortening (median [IQR]: 42% [38-49%]) and LV output (median [IQR]: 242 mL/kg/min [155-330 mL/kg/min]). Only 19 infants (42.2%) received hydrocortisone, with a median [range] treatment duration of 2 days [1–8]. Lower cortisol level was associated with lower GA at the presentation of RAI (p=0.049), but not predictive of adverse clinical and laboratory outcomes (Table 2). ACTH stimulation tests were performed in 20 (44.5%) infants and 3 (15%) were found to be abnormal, and results were not correlated with clinical features.

Conclusion
In our cohort, we identified 5% of NICU admission with RAI, based on the cut-off of cortisol &lt; 250 nmol/L at the time of shock-like presentation. Lower cortisol level was associated with lower GA at the presentation of RAI. Further prospective study with a well-defined protocol is needed to understand the use of cortisol and its clinical implications.
46 Impact of early versus late medical treatment of a hemodynamically significant patent ductus arteriosus on time to reach full feeds in preterm neonates
Authors: Yadav Krishan , Ting Joseph , Castaldo Michael , Grewal Gurpreet , Kuan Mimi 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Prolonged exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants has been associated with an increase in neonatal morbidities.

Objectives
To examine the effect of timing of medical treatment (within first 7 days of life versus after 7 days of life) for a hsPDA on the duration to achieve full feeds in infants born at &lt;30 weeks of gestation.

Design/Methods
This was a retrospective cohort study in a quaternary neonatal intensive care unit (NICU) with a targeted neonatal echocardiography service. Infants admitted between July 2015 – June 2019 who received medical treatment for an hsPDA were included and grouped based on those who received first medical therapy within 7 days of life (early treatment) and after 7 days of life (late treatment). An hsPDA was defined using both clinical (worsening ventilation, pulmonary hemorrhage/edema, or hypotension requiring inotrope or hydrocortisone) and echocardiographic findings (LA/Ao ratio &gt;1.4; LVO &gt;350 mL/kg/min, PDA &gt;1.4 mm, IVRT &lt; 35 ms). Duration to reach full feeds was calculated based on number of days to reach a total enteral feed ≥ 120 mL/kg/day with no parenteral source of nutrition.

Results
Forty-six infants met the inclusion criteria. Of the 46 infants, 24 were identified as receiving early treatment and 22 received late treatment. Infants in the early treatment group had lower median birth weight than the late treatment group (802 g vs. 1016 g, p=0.022). All other clinical characteristics were not significantly different. No significant difference was found in the use of indomethacin, ibuprofen, or acetaminophen as the initial medical treatment (Table 1). The late treatment group had elevated left ventricular output (median: 286 vs. 369 mL/kg/min, p=0.013) and tricuspid annular plane systolic excursion (median: 6 vs. 8 mm, p=0.002) (Table 2). Infants in the early treatment group reached full feeds earlier than those in the late treatment group (19 vs. 30 days, p=0.042) (Table 1).

Conclusion
Early medical treatment of hsPDA was associated with shorter duration to reach full feeds in our cohort of preterm infants. Further larger scale study is needed to understand the association between the timing of medical therapy and prolonged exposure of splanchnic circulation to hemodynamically significant ductus.
50 Poractant alfa versus bovine lipid extract surfactant for respiratory distress syndrome in preterm infants: A prospective comparative effectiveness cohort study
Authors: Lemyre Brigitte , Lacaze-Masmonteil Thierry , Shah Prakesh , Bodani Jaya , Doucette Stefanie , Dunn Michael , Louis Deepak , Monterrosa Luis , Mukerji Amit , Schmolzer Georg , Singh Balpreet , Wong Jonathan , Ye Xiang Y , Offringa Martin 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
There is a paucity of comparative effectiveness data for bovine lipid extract surfactant (BLES) and poractant alfa (Curosurf).

Objectives
To compare duration of respiratory support and short-term outcomes in very preterm infants treated with bovine lipid extract surfactant and poractant alfa.

Design/Methods
We performed a prospective, multicentre, comparative effectiveness study. Thirteen Canadian level III neonatal intensive care units (NICUs) provided bovine lipid extract surfactant to infants born &lt;32 weeks’ gestational age (GA) for a set period of time in the year 2019 (3 to 9 months), then changed to poractant alfa for the remainder of the year. The primary outcome was total duration of respiratory support (invasive and non-invasive). We utilized the Canadian Neonatal Network database for all study data.

Results
A total of 968 eligible infants (530 infants &lt; 28 weeks’ GA and 438 infants 280-316weeks’ GA) were included, of which 494 received bovine lipid extract surfactant and 474 received poractant alfa. In unadjusted analysis, no difference was observed in total duration of any respiratory support (median 38 vs. 40.5 days). After adjusting for baseline characteristics and accounting for cluster effects, infants treated with poractant alfa spent a median of 4.16 fewer days on respiratory support (95% CI 0.05, 8.28 days). This reduction was observed in the subgroup of infants 280-316 weeks’ GA, but not in those &lt; 28 weeks’ GA, and was explained by their shorter time on non-invasive respiratory support. No differences were observed in the need to re-dose surfactant, hospital mortality, bronchopulmonary dysplasia, or length of stay in NICU.

Conclusion
Administration of poractant alfa was associated with shorter median duration of respiratory support compared to bovine lipid extract surfactant in preterm neonates &lt; 32 weeks’ GA.
53 Health Outcomes of Siblings of Children with Chronic Health Conditions: A Systematic Review and Meta-Analysis
Authors: Martinez Benjamin , Pechlivanoglou Petros , Meng Dorisa , Traubici Benjamin , Mahood Quenby , Korczak Daphne , Colasanto Marlena , Mahant Sanjay , Orkin Julia , Cohen Eyal 
Published: October 2021

Abstract

Primary Subject area
Mental Health

Background
Chronic childhood health conditions are known to have an impact on the well-being of family members. Parental caregivers face well-defined adverse health outcomes, though less is known about the health impacts on siblings.

Objectives
To assess clinical health outcomes in siblings of children with chronic health condition(s) compared to siblings of healthy children or normative data.

Design/Methods
We searched Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL through June 4, 2020. We included English-language studies that: (1) reported clinically diagnosable mental or physical health outcomes of siblings of children (0-18 years old) diagnosed with any childhood chronic health condition; (2) included a comparison group; and (3) used an experimental or observational study design. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Results
We included 28 studies of the 9053 screened, comprising 10 cohort studies and 18 cross-sectional studies. Studies from 11 different countries reported most commonly on siblings of children with disabilities (12 studies), cancer (8 studies), or psychiatric disorders (4 studies). Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference 0.49; 95% CI 0.33-0.65; P &lt; .001 [5 studies]) (Fig. 1), whereas anxiety scores did not differ significantly (standardized mean difference 0.24; 95% CI -0.03-0.52; P = .08 [6 studies]) (Fig. 2). Studies that reported on prevalence of psychiatric diagnoses, rather than rating scale scores, had mixed results, either indicating increased risk (3 studies) or no increased risk (4 studies) among exposed siblings. We did not meta-analyze effects for mortality (3 studies) or physical health outcomes (dental caries [1 study], traumatic brain injury [1 study], sexually transmitted infection [1 study], overweightness/obesity [1 study]) given the limited number of studies and between-study heterogeneity. Included studies were rated as high quality (12 studies) or of moderate quality (16 studies).

Conclusion
Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.
60 Impact of sequential implementation of a standardized feeding protocol and donor breastmilk on necrotizing enterocolitis among preterm infants born &lt;31 weeks gestation
Authors: Ng Laura Li Ching , Beltempo Marc , Patel Sharina , Paquette Katryn , Filion-Ouellet Emilie , Plourde Hugues , Besner Marie-Eve 
Published: October 2021

Abstract

Primary Subject area
Neonatal-Perinatal Medicine

Background
Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity and mortality among preterm infants born &lt;31 weeks. Nutritional interventions such as a standardized feeding protocol (SFP) and donor breastmilk (DBM) are recommended to reduce NEC.

Objectives
Our objective was to assess the impact of implementing a feeding protocol and pasteurized donor breastmilk protocol on NEC among preterm infants born &lt; 31 weeks GA.

Design/Methods
Retrospective cohort study including 682 infants born &lt; 31 weeks, who survived ≥ 14 days and were admitted to two tertiary NICUs from 2009-2018. Data was obtained from the local Canadian Neonatal Network database. Infants were classified into epochs, based on the timing of interventions: Epoch 1, baseline (2009-2012); Epoch 2, SFP (2013-2015); Epoch 3, SFP + DBM (2016-2018). The primary outcome was NEC stage ≥ 2. Multivariable logistic regression models were used to assess associations between epochs and outcomes and were adjusted for confounders.

Results
Among 682 infants, 46 (7%) had NEC and 74 (11%) had mortality/NEC. Rates of NEC decreased with each epoch: 10% (25/246) Epoch 1 (baseline); 5% (8/163) Epoch 2 (SFP); and 5% (13/273) Epoch 3 (SFP+DBM), (p&lt;0.01) (Table1). SFP alone was associated with significantly lower odds of NEC compared to baseline (Epoch 2 vs 1, AOR 0.42, 95% CI 0.17-0.93) (Table 2). Implementation of DBM was not associated with lower odds of NEC compared to SFP alone (Epoch 3 vs 2, AOR 0.94, 95% CI 0.38-2.42) (Table2). Number of NPO days prior to the initiation of enteric feeds after birth decreased in Epoch 3 (Epoch 1&2: 2 days versus Epoch 3: 1 day; p&lt;0.01). Exclusive human breastmilk feeds during the first 3 weeks increased from 62% in Epoch 2 to 82% in Epoch 3 (p&lt;0.01). A significant decrease in number of total parenteral nutrition and central venous line (CVL) days was observed from Epoch 1 to 3 (25 to 15 days and 26 to 15 days respectively; p&lt;0.01) (Table 1), this was reflected in the decrease in late onset sepsis (Epoch 3 vs 1, AOR 0.55, 95% CI 0.35-0.86).

Conclusion
Implementation of SFP was associated with a significant decrease in NEC among infants born &lt; 31 weeks. Combining the SFP and DBM did not further decrease NEC, but was associated with shorter NPO days, higher exclusive human breastmilk exposure, and significant decrease in number of central venous line (CVL) days.