Utilizing Near-Infrared Spectroscopy (NIRS) to Identify Pediatric Trauma Patients Needing Lifesaving Interventions (LSIs): A Retrospective Study.

Objectives: The aim of this study was to investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs).

Methods: Retrospective chart review of children age 0 to 18 years who activated the trauma team response between January 1, 2015 and August 14, 2017, at a large, urban pediatric emergency department. The lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) were abstracted from the chart.

Multiple Cranial Tuberculomas Without Meningitis in Two Infants With Miliary Tuberculosis.

Magnetic resonance imaging may detect central nervous system involvement even when cerebrospinal fluid is normal and tests to detect Mycobacterium tuberculosis are negative. We describe 2 cases of miliary tuberculosis in young children with clinically unexpected central nervous system involvement. Magnetic resonance imaging of the brain should be considered part of the initial diagnostic workup for miliary tuberculosis in very young children.

Invasive Bacterial Infections in Infants Younger Than 60 Days With Skin and Soft Tissue Infections.

Objective: The objective of this study was to describe the frequency of invasive bacterial infections (IBIs) in young infants with skin and soft tissue infections (SSTIs) and the impact of IBI evaluation on disposition, length of stay (LOS), and cost.

Methods: This retrospective (2009-2014) cohort study used data from 35 children's hospitals in the Pediatric Health Information System. We included infants younger than 60 days who presented to an emergency department (ED) with SSTI.

Acute Upper Extremity Edema in a 10-Year-Old Girl as Presenting Symptom of a Rare Cancer.

Acute onset upper extremity edema can pose a diagnostic challenge for the emergency physician, with conditions ranging from mild local allergic reactions to deep venous thrombosis to underlying life threatening conditions. We discuss a case of a 10-year-old female with upper extremity edema and the diagnostic considerations, which ultimately led to uncovering a malignant etiology. This case represents a rare presentation of her underlying diagnosis, anaplastic large cell lymphoma.

Shared Medical Appointments for Adolescent Breast Reduction.

Adolescents with macromastia face serious physical, emotional, and social burdens because of their large breast size. Studies have shown that reduction mammoplasty results in improvement in physical symptoms and quality of life for these patients. Shared medical appointments (SMAs), defined as individual patient-physician encounters that occur in a group setting, have been successfully applied to clinics for adult patients seeking breast reduction for this condition.

An Update on the Appropriate Role for Hyperbaric Oxygen: Indications and Evidence.

Background: Among advanced therapeutic interventions for wounds, hyperbaric oxygen therapy (HBOT) has the unique ability to ameliorate tissue hypoxia, reduce pathologic inflammation, and mitigate ischemia reperfusion injury. Most of the conditions for which it is utilized have few successful alternative treatments, and the morbidity and mortality associated with treatment failure are significant. Data on the efficacy and effectiveness of HBOT were reviewed, comparative effectiveness research of HBOT was explained, and a new paradigm for the appropriate use of HBOT was described.

Essentials of PEM Fellowship Part 2: The Profession in Entrustable Professional Activities.

This article is the second in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article describes the development of PEM entrustable professional activities (EPAs) and the relationship of these EPAs with existing taxonomies of assessment and learning within PEM fellowship. It summarizes the field in concepts that can be taught and assessed, packaging the PEM subspecialty into EPAs.

Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, But Will They Use It?

Objective: Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience.

Recommendations for the evaluation and management of observation services: a consensus white paper: the Society of Cardiovascular Patient Care.

Observation Services (OS) was founded by emergency physicians in an attempt to manage "boarding" issues faced by emergency departments throughout the United States. As a result, OS have proven to be an effective strategy in reducing costs and decreasing lengths of stay while improving patient outcomes. When OS are appropriately leveraged for maximum efficiency, patients presenting to emergency departments with common disease processes can be effectively treated in a timely manner.

Transurethral use of a nephroscope significantly AIDS in the surgical management of an intrauterine device eroding into the bladder.

Background: Intravesical migration of an intrauterine device (IUD) is a rare occurrence. The IUD becomes the nidus for calcification. Three approaches to remove the device include the use of open cystolithotomy, transurethral grasping forceps, or minimally invasive laparoscopy.

Ligands for FKBP12 increase Ca2+ influx and protein synthesis to improve skeletal muscle function.

Rapamycin at high doses (2-10 mg/kg body weight) inhibits mammalian target of rapamycin complex 1 (mTORC1) and protein synthesis in mice. In contrast, low doses of rapamycin (10 μg/kg) increase mTORC1 activity and protein synthesis in skeletal muscle. Similar changes are found with SLF (synthetic ligand for FKBP12, which does not inhibit mTORC1) and in mice with a skeletal muscle-specific FKBP12 deficiency.

Candida speciation, antifungal treatment and adverse events in pediatric invasive candidiasis: results from 441 infections in a prospective, multi-national study.

A multi-national prospective study of pediatric patients with invasive candidiasis between August 2007 and September 2012 was performed and included 441 infections. Variation in infecting Candida species and antifungals used was noted between US and non-US sites. Antifungal-associated adverse events were most common with polyene use.

Facelift in a patient with benign symmetric lipomatosis and HIV facial lipoatrophy: a case report.

Benign symmetric lipomatosis (BSL) is a rare condition characterized by deposition of unencapsulated adipose tissue at typical sites on the body. Although the pathogenesis is not clearly defined, the disease has been associated with male gender, alcoholism, Mediterranean descent, and highly active antiretroviral therapy. A case study is presented of a facelift performed on a human immunodeficiency virus-positive patient on a highly active antiretroviral therapy with facial lipoatrophy in the anterior cheek region in combination with BSL characterized by excess fat deposits in multiple areas including the posterior cheeks and neck.

Detection of acute postoperative mediastinitis in mice using (99m)Tc-liposomes.

Rationale And Objectives: To evaluate the usefulness of size-modified (99m)Tc-labeled liposomes for the detection of acute postoperative mediastinitis in a mouse model.

Methods: Fourteen mice underwent low-neck collar incision and had sterile abscesses induced in mediastinum with turpentine. Ten of these animals were injected intravenously with anionic liposomes of 516 +/- 20 nm containing poly(ethylene)glycol labeled with (99m)Tc; the remaining four mice were injected with (67)Ga citrate and used as positive controls.