bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foreign Body Ingestion and Aspiration in the Pediatric Population: Analysis of 315 Cases
Authors: Truong Anh Q. , Funamura Jamie L. , Senders Craig W. 
Published: August 2013

Objectives:1) Determine the patient characteristics, presentation, location, and rates of associated injury in pediatric foreign body ingestion and aspiration. 2) Analyze the types of intervention and rates of postoperative complications.Methods:Retrospective analysis of all patients under the age of 18 who were evaluated for foreign body (FB) ingestion and aspiration at a tertiary care center between January 1, 2003, and December 31, 2012.Results:We identified 315 patients. 61% were male and 39% female, with an average age of 3.9 years (SD 3.9). 55.6% of FBs were found to in the esophagus, 22.2% in the airway, and 22% in the oropharynx or GI tract. The most common signs and symptoms at presentation were emesis (30.9%), choking/gagging (27.4%), coughing (24.0%), drooling (23.4%), and dysphagia (23.4%) with an esophageal FB and increased work of breathing (50.0%), cough (48.6%), choking/gagging (44.3%), wheezing (40.0%), and stridor (20.0%) with an airway FB. The most common FBs were coins (88.6%) and nuts/seeds (42.9%) in the esophagus and airway, respectively. Patients with a proximal esophageal FB were younger than patients with a distal esophageal FB (2.53 vs. 8.29 years). There was a 44% rate of superficial mucosal injury in the esophageal FB group. Rigid bronchoscopy and esophagoscopy were the most common methods of FB retrieval. There were no pneumothoraces and pneumomediastinum noted postoperatively.Conclusions:Aerodigestive FB ingestion and aspiration represent common problems in children. History, physical exam, and imaging are all key aspects of timely diagnosis, with rigid endoscopy as the mainstay of management.
Increased Resource Burden of Methicillin‐Resistant Staphyloccoccus aureus Orbital Cellulitis in the Pediatric Population
Authors: Smith Aaron M. , Nesemeier Ryan , Cash Elizabeth , Woods Charles , Chandran Swapna K. 
Published: August 2013

Objectives:Due to the colonization of the nares, the epidemic of community acquired Methicillin‐Resistant Staphyloccoccus aureus (MRSA) poses a risk of MRSA head and neck infections. Orbital cellulitis is one such infection that commonly follows sinusitis. This infection occurs posterior to the orbital septum, posing risk to nearby structures. The purpose of this study is to stratify the differences in epidemiology and resource use between MRSA orbital cellulitis and traditional non‐MRSA orbital cellulitis.Methods:We queried the 2009 Kid Inpatient Database, identifying all cases with a primary diagnosis of International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) code 376.01, orbital cellulitis. We then extracted these cases with a secondary diagnosis of ICD‐9‐CM code 041.12, MRSA, and compared the two groups using Statistical Analysis Software.Results:In 2009, the total number of cases for orbital cellulitis was 2502 with 133 having a secondary diagnosis of MRSA (5.3%). The median age for the MRSA group was older (8yo vs 5yo), with 15‐19yo 3.14 times more likely to have MRSA (RR 3.14, 95%CI 2.17‐4.56). Facial cellulitis was the most common comorbidity for the MRSA group (14%). The MRSA group was more likely to undergo orbitotomy (RR 2.39, 95%CI 1.56‐3.66), accruing higher median total charges ($12595 vs $10131).Conclusions:Although MRSA can colonize the nares, MRSA orbital cellulitis more commonly occurs with facial cellulitis. This infection increases with increasing age. Orbital infection with MRSA poses a higher resource burden, requiring more frequent invasive measures.
Innovation in Newborn Hearing Screening in Peru: Applying Design Thinking to Improve Health Policy
Authors: Czechowicz Josephine A. , Messner Anna H. , Janka David P. , Chaparro Juan C. , Rubio Javier A. , Calderon Gina Q. , Alarcon Jorge 
Published: August 2013

Objectives:1) Apply Design Thinking methodology to create an innovative national program for newborn hearing screening (NHS) in Peru. 2) Collaborate with Peruvian Ministry of Health to optimize implementation of a newly mandated national NHS program. 3) Provide a model for expanding NHS throughout the developing world.Methods:Descriptive study with focus groups and guided interviews. Design Thinking is a human‐centered approach to interdisciplinary problem solving that tackles complex problems with many stakeholders. Insight is gained through immersion, observation, and engagement. Study dates: June‐December 2012. Condition studied: Permanent congenital hearing loss. Subjects: Stakeholders involved in NHS. Policy‐makers: officials, politicians, academic physicians. Providers: audiologists, pediatricians, otolaryngologists, health workers. Recipients: neonates, mothers, hearing‐impaired children and families. Field sites included community clinics, tertiary care hospitals, ministry of health offices, schools for the deaf, audiology offices, and patient homes.Results:Interviewed 105 individual stakeholders at 14 sites. Data were captured in logbooks, photography, and video. Data obtained from this work were applied in the following ways: creation of a needs assessment tool for use in Peruvian hospitals to facilitate implementation of NHS; inclusion of NHS data in Peru's national electronic medical record; development of educational resources, both online and classroom‐based for providers of NHS.Conclusions:This work represents the first application of Design Thinking to innovate in health policy at a national level. Through publication of these methods, the authors hope to empower providers throughout the developing world to broaden access to NHS.
Hearing Loss and Depression in Brazilians
Authors: Schlindwein‐Zanini Rachel , Zanini Fabio D. 
Published: August 2013

Objectives:Hearing loss (HL) may be related to psychopathological aspects of the individual. The Sistema Único de Saúde‐SUS (health public system of Brazil) treats patients with HL by employing multidisciplinary teams. Our goal was to verify the level/seriousness of depressive symptoms on Brazilian patients with HL that are candidates for a prosthesis and to obtain other data such as age, schooling, and work.Methods:Transversal study in a Brazilian public hospital in 2012. To verify the seriousness of depressive symptoms (dependent variables) on a sample of 105 subjects with HL (independent variable), paired on both sexes, over 18 years old, using psychological interview and Beck Depression Inventory (BDI). The study was approved by the Universidade Federal de Santa Catarina Committee on the Ethics of Research on Human Beings.Conclusions:Most patients complained of bilateral HL. Observing the study about the severity of the depressive symptoms, it was found that the 59% had completed primary school, were working (68 adults), and presented depressive signs, in which 47% of the individuals showed minimal symptoms, 18% mild, 6% moderate, and 1% presented serious symptoms. Depression has psychological consequences on a person with HL and interferes with quality of life, family and work dynamics, and indicates a need for psychological intervention.
Pediatric Dysphonia: A Cross‐sectional Survey of Subspecialty Care Clinics
Authors: Johnson Christopher M. , Anderson Danielle , Brigger Matthew T. 
Published: August 2013

Objectives:1) Determine the prevalence of caretaker reported dysphonia in children undergoing medical evaluation. 2) Determine whether subspecialty pediatric clinics are associated with variable patterns of pediatric dysphonia compared to primary care.Methods:Cross‐sectional survey recording demographic data, caretaker perception of their child's voice, and the validated pediatric voice related quality of life (PVRQOL) instrument administered to caregivers of children undergoing evaluation in primary care and subspecialty clinics. Survey responses and PVRQOL scores were stratified by clinic type and compared to general pediatrics using Fisher's exact test for categorical data and the Wilcoxon Mann Whitney test for interval data.Results:A total of 406 complete surveys were analyzed. The mean PVRQOL score for all children was 90.6 (95%CI:88.7, 92.4). Compared to general pediatrics, PVRQOL scores were lower in developmental pediatrics (P =. 0004), genetics (P =. 0240), and otolaryngology (P =. 0332) clinics. Children in developmental pediatrics also were more likely to have a prior speech evaluation (P <. 001) and speech therapy (P =. 001). Otolaryngology patients were more likely to have undergone speech evaluation (P =. 030). Of note, no difference was found comparing PVRQOL scores in general pediatrics to gastroenterology (P =. 2086) or pulmonology (P =. 6633).Conclusions:Children undergoing evaluation in developmental pediatrics, genetics, and otolaryngology have lower PVRQOL scores than children evaluated in primary care. No other significant differences between subspecialty clinics were identified. These data reinforce that all practitioners caring for children should seek to identify voice disorders and highlight the importance of subspecialists who treat developmentally challenged children to exert particular vigilance.
Robotic‐Assisted Lingual Tonsillectomy in the Pediatric Population
Authors: Leonardis Rachel , Duvvuri Umamaheswar , Mehta Deepak 
Published: August 2013

Objectives:Assess the feasibility and outcomes of robotic‐assisted lingual tonsillectomy (RALT) in the pediatric population.Methods:Retrospective medical chart review performed using a tertiary care children's hospital database identified 16 pediatric patients who underwent RALT from March 2011 through December 2012. Demographic data, comorbidities, robot docking time, operative time, surgical blood loss, and postoperative course, including complications in the immediate and longer‐term postoperative period, were collected and analyzed.Results:All patients successfully underwent RALT using the daVinci Surgical Robot (Intuitive Surgical, Sunnyvale, CA). Endotracheal intubation was used in all cases and did not interfere with visualization of the oropharynx. Optimal retraction allowed visualization of pertinent structures and maximized transoral access. A significant learning curve from the first 5 surgical cases to subsequent cases with respect to robot docking time and surgical blood loss was observed (9 versus 3 minutes and 7.4 versus 3.2 ml respectively, P <. 05). Operative time, estimated blood loss, and postoperative complication profile are within the expected and acceptable limitations for performing lingual tonsillectomy in the pediatric population.Conclusions:Technologic advances have allowed miniaturization of robotic instrumentation and have expanded the scope of surgical options for the pediatric airway. RALT is well‐tolerated and can be performed in the pediatric population with excellent success. It should be considered a feasible option for implementation at an institution‐based level.
Image Processing by Using the Wavelet Transform (PTI‐CDWT) to Diagnose Laryngopharyngeal Reflux Disease (LPRD)
Authors: Niwa Hideo , Horihata Satoshi , Makiyama Yasuhide 
Published: August 2013

Objectives:Develop Narrow Band Image (NBI) to diagnose LPRD by using a perfect translation invariance complex discrete wavelet transform (PTI‐CDWT).Methods:20 patients underwent NBI and Frequency scale for symptoms of GERD (FSSG). We performed image processing for pictures after NBI examination by using the application software of PTI‐CDWT that was developed at Toyohashi University of Technology in Japan. We looked into a correlation between PTI‐CDWT and NBI pictures.Results:Images detected by PTI‐CDWT were distinguished from linear wavelet transform to round wavelet transform. Patients with high score in FSSG tended to show round wavelet transform. On the other hand, patients with low score represented linear wavelet transform. PTI‐CDWT emphasized modulated nasopharyngeal epithelial cells with LPRD patients.Conclusions:LPRD is a common disease in the world. However, it does not have a definite diagnosis. Last year our group reported an applicability of NBI to diagnose LPRD. We showed one feature of nasopharyngeal mucosa pattern of NBI as mackerel cloud pattern. Wavelet transform are applied for signal and image processing of medical field. As image processing requiring a detail edge and directional components is important to estimate the images, one feature detection method of a discrete wavelet transform is to decompose the signal and image into each frequency component using low and high‐pass filters. PTI‐CDWT can detect more directions at various scales than previous wavelet transform. PTI‐CDWT could be applied as a useful diagnostic tool for LPRD.
Surgery for Reflux‐Induced Airway Disease: A Systematic Review
Authors: Sload Ryan L. , Brigger Matthew T. 
Published: August 2013

Objectives:1) Evaluate the current evidence regarding the efficacy and safety of anti‐reflux surgery for the treatment of severe gastroesophageal reflux related airway disease in children. 2) Provide evidence based recommendations regarding indications and outcomes of anti‐reflux surgery for airway disease in children.Methods:An a priori protocol was defined to identify all articles addressing anti‐reflux surgery for the treatment of reflux related airway disease in children where details regarding the diagnosis, treatment, and outcomes were clearly presented. The search was inclusive of all references available through January 2013 and included electronic databases to identify candidate articles as well as a comprehensive series of crosschecks. The two authors independently determined which references met inclusion criteria, extracted data, and assigned levels of evidence. Data were pooled using a random effects model due to significant study heterogeneity.Results:Thirteen articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I2 = 77%; P <. 001). However, each article uniformly presented cases suggesting that anti‐reflux surgery is efficacious and safe in treating children with severe reflux related respiratory disease. The pooled success rate for complete or partial resolution of symptoms after anti‐reflux surgery was 0.899 (95% confidence interval [CI]: 0.866, 0.932). The pooled success rate for complete symptom resolution after surgery was 0.697 (95%CI: 0.591, 0.803).Conclusions:The current literature suggests that anti‐reflux surgery is an effective and safe treatment for severe reflux related airway disease. However, the level of evidence lacks strength, and further investigation is warranted.
Trends in Hospitalizations for Pediatric Peritonsillar Abscess: 2003‐2009
Authors: Smith Aaron M. , Rife Eileen , Cash Elizabeth , Peyton Nathaniel , Woods Charles , Chandran Swapna K. 
Published: August 2013

Objectives:Peritonsillar abscesses (PTA) are the most common deep neck space infections. Although many of these infections are treated in the emergency department, these infections can become quite serious, compromising the airway or developing into Lemierre's Syndrome, requiring hospitalization. We embarked on this study to determine current hospitalized costs, length of stay (LOS), and demographic stratification of peritonsillar abscess.Methods:This study used the Kid Inpatient Database for 2003, 2006, and 2009. We queried this for International Classification of Disease, ninth revision, clinical modification (ICD‐9‐CM) code 475.00, representing PTA. We obtained stratified data for this diagnosis. Hospital resource use was compared between teaching, non‐teaching, and pediatric facilities using Statistical Analysis Software. Census data were used to calculate incidences.Results:The number of hospitalizations and incidence increased (3608 to 4502, 3.7 to 4.5/100000population). Hospitalizations increased with increasing age (for 15‐19 yo vs other ages RR 2.18, 95%CI 2.14‐2.22). Percent of cases receiving surgical drainage decreased (41% to 34%). Median LOS remained constant at 2 days. Patients had longer LOS at pediatric hospitals (2.3d vs 2.14d vs 2.02d, P < 0.001) accruing more charges ($14763 vs $10587 vs $9120, P < 0.001). Pediatric and teaching hospitals performed more drainage than nonteaching (39.4% and 40.4% vs 36.1%, P < 0.001).Conclusions:Incidence of pediatric hospitalizations for PTA increased from 2003‐2009. These infections were more common among adolescents. Surgical management decreased. Overall cost per case increased, while LOS remained constant. The national emergence of community‐acquired MRSA during this time period may be related to the increase in incidence.
Tumors of the Pediatric Maxillo‐facial Skeleton: A 20‐Year Clinical Study
Authors: Perry Katherine , Tkaczuk Andrew , Caccamese John , Ord Robert , Pereira Kevin 
Published: August 2013

Objectives:Review the clinical presentation, radiologic features, management, and outcomes of jaw tumors diagnosed in children treated in a tertiary care academic center.Methods:Retrospective review of children age 16 and under who presented to the University of Maryland Medical Center between 1992 and 2012 and were diagnosed with a jaw tumor. Charts were reviewed for symptoms, physical exam, radiological findings, pathology, intervention, and outcomes.Results:The charts of 76 patients evaluated for a jaw mass were reviewed, and 22 were diagnosed with a jaw tumor. The two most common pathologies were ameloblastoma (27%) and ossifying fibroma (18%). Two tumors were malignant, both rhabdomyosarcomas. One‐third of patients presented asymptomatically with lesions found on surveillance panorex, while the remaining two‐thirds presented with evidence of a mass or swelling. All but one infant with a suspected lymphangioma underwent biopsy and surgical excision. Twenty‐seven percent of patients underwent more than one procedure, including secondary reconstruction, prior to a satisfactory outcome.Conclusions:Pediatric jaw tumors are rare lesions most commonly presenting with a swelling or mass in the location. One‐third of patients are asymptomatic with a lesion identified on imaging. A majority of jaw tumors are benign but require surgical intervention for excision of disease. Multiple procedures, including reconstruction, may be required for certain lesions prior to cure.
Upper Airway Obstruction in Children: Prevalence, Diagnosis, Repercussions, and Comorbidities
Authors: Di Francesco Renata C. , Gamero Mauro , Paulucci Bruno , Bento Ricardo F. , Brentani Alexandra V. , Escobar Ana M. , Grisi Sandra 
Published: August 2013

Objectives:Investigate the prevalence, diagnosis, and repercussions of upper airway obstruction in children under 5 years‐old and their impact in public health.Methods:A cross‐sectional study was conducted with 197 children under 5, randomly selected from a population of 1500, from November 2011 to December 2012. Parents answered to anamnesis about respiratory problems, upper airway infections, perinatal history, and feeding habits. They answered validated questionnaires about sleep disordered breathing and allergies. All subjects underwent a physical examination, and those who complained of respiratory problems also had nasal fiberendoscopy.Results:197 subjects (2.33 ± 1.09 y.o.), 107 boys. Prevalence of mouth breathing was 19.2%, nasal obstruction 18.2%, snoring 22.8%, rhinorrhea and sneezing 36.5%, and sleep disordered breathing (SDB) 7.1%. Diagnosis: adenoid enlargement (A) 8.6%, tonsil enlargement (T) 0.5%, tonsil and adenoid enlargement (T&A) 10.7%, rhinitis 21.9%, allergic rhinitis 7.6% (totalizing 49.6%). Fifty‐five point seven percent of children were exclusively breast fed for at least 6 months, and no correlation was found with nasal obstruction. Sleep disordered breathing symptoms were found in 7.1 % and were associated only with T&A (64.2%). Children with upper airway obstruction were prone to upper airway infections and visits to the emergency room.Conclusions:Upper airway obstruction is prevalent in about 20% of children. Breast feeding was not correlated to mouth breathing. Rhinitis is a common diagnosis. T&A is associated with SDB and infections, consuming high resources. Doctors must investigate and refer young children with upper airway problems to treatment in order to minimize large consumption of health resources.
The Importance of Informed Consent and Its Role in the Outcome of Surgical Liability Cases
Authors: Mady Leila J. , Choudhry Amad , Svider Peter F. , Choudhry Asad , Setzen Michael , Baredes Soly , Eloy Jean A. 
Published: August 2013

Objectives:Previous analyses have noted perceived deficits in informed consent (IC) in many otolaryngology malpractice lawsuits. However, no comprehensive analysis of IC in malpractice litigation across surgical specialties exists. Our objectives were to 1) examine IC in litigation across surgical specialties and 2) characterize factors in determining legal responsibility.Methods:Using the Westlaw Database, 694 jury verdicts and settlement reports since 2010 involving defendants practicing general surgery, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, and urology were examined for outcome, awards, procedure types, and alleged IC deficits.Results:Of 694 cases, 67.0% of decisions favored physicians. 25.4% resulted in damages awarded and 7.6% in out‐of‐court settlements. Although perceived IC deficits did not increase the likelihood of jury awards, a high number of cases (25.1%) identified IC as a factor. Plastic surgery (48.7%), ophthalmology (41.2%), and otolaryngology (33.3%) litigations were among the highest to identify IC deficits. Many cases in plastic surgery and ophthalmology with alleged deficits in IC involved elective procedures. In contrast, otolaryngology had a lower proportion of elective procedures in cases with alleged deficits in IC.Conclusions:Although perceived deficits in IC do not necessarily increase the likelihood of a negative outcome, it may play an important role in the initiation of malpractice litigation across surgical specialties. While otolaryngology had a relatively high rate of litigation involving IC deficits, it had a lower proportion of elective procedures in comparison to other surgical specialties in this analysis, suggesting elective interventions influence legal responsibility in a specialty‐specific manner.
Aspergillus Fumigatus Extract Suppressed mRNA Expression of the BAFF and IP‐10 in Epithelial Cells
Authors: Bhushan Bharat , Norton James E. , Gupta Dave , Sha Quen , Schroeder James W. , Schleimer Robert P. 
Published: August 2013

Objectives:Inhalation of spores from the Aspergillus fumigatus may cause local inflammation. The mucosal surface of the respiratory tract provides host defense mechanism. It is unclear why airway exposure to fungal pathogens leads to Th2 response. We report inhibition of Th1 biased epithelial inflammation by an Aspergillus extract (AE).Methods:Beas2B cells were cultured in a 37°C incubator in media with 5%FBS. Cells were treated with AE for 1h and were then stimulated with the TLR3 activator dsRNA for 6h. RNA was isolated and was reverse transcribed to cDNA. Real‐time polymerase chain reaction (PCR) analysis was performed in the presence of specific primers and fluorescently labeled probes. The estimation of cytokines including BAFF and IP‐10 was conducted using commercially available kits.Results:We conducted experiments assessing the ability of AE to modulate dsRNA induced expression of Th1 biased chemokines and cytokines by epithelial cells. Expressed genes analyzed included IP‐10, BAFF, IFIT‐1, and a few other Th‐1 biased chemokines. We observed that AE suppressed dsRNA induced expression of mRNA for BAFF and IP‐10 in Beas2b cells when compared with control (p<0.001). BAFF and IP‐10 protein expression was also significantly suppressed (P < 0.05). Furthermore we found no alteration of BAFF and IP‐10 mRNA expression in Beas2b cells when treated only with the diluent (without AE) and stimulated with dsRNA for 6 hours. We observed increased dsRNA induced IL‐8 mRNA expression in cells treated with AE.Conclusions:We found that AE strongly inhibits Th1 biased responses in epithelium as evident by decreased expression of Th1 biased cytokines.