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Hospital charges and length of stay associated with septicemia among children hospitalized for leukemia treatment in the United States
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Veerajalandhar Allareddy, Sankeerth Rampa, Veerasathpurush Allareddy |
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Author Affiliations: Department of Pediatric Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, University Hospitals, Case Medical Center, USA (Allareddy V); Nance College of Business Administration, Cleveland State University, Ohio, USA (Rampa S); Department of Developmental Biology, Harvard School of Dental Medicine, USA (Allareddy V)
Corresponding Author: Veerasathpurush Allareddy, Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA (Tel: 216-571-1009; Email: VA15@hsdm.harvard.edu)
doi: 10.1007/s12519-012-0361-5
Background: This study examines hospital charges and length of stay (LOS) associated with septicemia during hospitalization for leukemia treatment among children aged ¡Ü18 years.
Methods: Nationwide Inpatient Sample (year 2008) was used. All hospitalizations (regardless of their discharge status following hospitalization) among children aged ¡Ü18 years with a primary diagnosis of leukemia were selected. Leukemia was identified using ICD-9-CM codes in the primary diagnosis field. The presence of septicemia during hospitalization was identified using ICD-9-CM codes in the secondary diagnosis field. Multivariable linear regression analyses were made to examine the effect of septicemia on hospitalization charges and LOS.
Results: Totally 6220 hospitalizations were attributed to leukemia treatment. Among these, 787 had septicemia. The mean hospitalization charge for those with septicemia was $279 137 and for those without septicemia was $113 530. The average LOS for those with septicemia was 33.18 days while the LOS for those without septicemia was 13.79 days. Septicemia was associated with increased hospitalization charges and a prolonged duration of stay in hospital after adjustments for confounders (P<0.0001).
Conclusions: Septicemia is associated with adverse outcomes among children hospitalized for leukemia treatment.
Key words: health outcomes; leukemia; pediatric oncology; septicemia
World J Pediatr 2012;8(3):222-228 |
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[Abstract] [Full Text] [PDF]
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Diffusion-weighted MRI of abscess formations in children and young adults
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Henning Neubauer, Isabel Platzer, Verena Rabea Mueller, Thomas Meyer, Johannes Liese, Herbert Koestler, Dietbert Hahn, Meinrad Beer |
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Author Affiliations: Institute of Radiology, Department of Pediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany (Neubauer H, Platzer I, Beer M); Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany (Mueller V, Liese J); Pediatric Surgery Unit, Department of Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany (Meyer T); Institute of Radiology, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany (Koestler H, Hahn D)
Corresponding Author: Henning Neubauer, MD, MBA, Institute of Radiology, Department of Pediatric Radiology, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany (Tel: 0049-931-201-34715; Fax: 0049-931-201-34857; Email: neubauer@roentgen.uni-wuerzburg.de)
doi: 10.1007/s12519-012-0362-4
Background: Diffusion-weighted MRI (DWI) is helpful for detection of brain abscess and pelvic abscess in adults. In the present study, we evaluated the diagnostic performance of DWI in children and young adults with abdominal and soft tissue abscess formations.
Methods: Seventeen patients (11 females, aged 13 ¡À 6 years) with suspected abdominal or soft-tissue abscess underwent routine MRI including free-breathing DWI and contrast-enhanced T1w imaging. Seventeen random age-matched patients with non-purulent abdominal fluid collections served as controls. Mean apparent diffusion coefficent (ADC) was measured for abscess, muscle, liver, spleen and kidney tissue as well as for cerebrospinal fluid, urine and free abdominal fluid.
Results: All fluid collections were identified on diffusion-weighted images. Thirteen of 14 confirmed abscess formations showed an ADC < 1.0 ¡Á 10-3 mm2/s with a mean value of 0.80 ¡À 0.38 mm2/s. One tuberculous soft-tissue abscess had a higher ADC of 1.85 ¡Á 10-3 mm2/s. Ring enhancement on T1w imaging was seen in three non-purulent fluid collections. There were no false-positive findings in the control group.
Conclusions: Diffusion-weighted MRI is highly sensitive for abscess and may add specificity to contrast-enhanced T1w imaging of ring-enhancing fluid collections. DWI with free-breathing rapid image acquisition and without the need of intravenous contrast application constitutes a particularly useful choice in pediatric imaging.
Key words: abscess; contrast medium; diffusion-weighted imaging; magnetic resonance imaging; pediatric
World J Pediatr 2012;8(3):229-234 |
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[Abstract] [Full Text] [PDF]
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Pediatric malignancies in Kano, Northern Nigeria
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Ochicha Ochicha, Aisha Kuliya Gwarzo, Dalhatu Gwarzo |
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Author Affiliations: Department of Pathology (Ochicha O) and Department of Hematology (Gwarzo AK, Gwarzo D), Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
Corresponding Author: Ochicha Ochicha, Pathology Department, Aminu Kano Teaching Hospital, PMB 3452 Kano, Nigeria (Email: ochicha@gmail.com)
doi: 10.1007/s12519-012-0363-3
Background: With effective immunization control of several devastating childhood infections in the developing world, non-infectious diseases such as malignancies have become increasingly important causes of pediatric morbidity and mortality. Therefore this 10-year retrospective study was undertaken to evaluate and document the pattern of childhood cancers in our locality.
Methods: We reviewed 438 childhood (¡Ü15 years) malignancies diagnosed at the histopathology and hematology laboratories of our teaching hospital in a 10-year period (2001-2010).
Results: The 438 malignancies comprised 10.9% of all cancers. The maligancies frequently seen in early childhood (0-4 years) accounted for 46.1% and in late childhood (5-9 years) for 34.7%. Retinoblastoma (30.6%), Burkitt lymphoma (19.9%) and acute leukemia (16.9%) were the most common pediatric cancers. Unlike in most other parts of the world, acute myeloid leukemia was slightly more prevalent than acute lymphoblastic leukemia.
Conclusions: Although there were notable differences, our findings were in broad agreement with those of most other sub-Saharan African series, but differed markedly from those in the Western world and other high income countries. Further studies are required to identify the environmental factors for the high prevalence of non-familial retinoblastoma and possibly acute myeloid leukemia.
Key words: acute leukemia; Nigeria; pediatric cancer; retinoblastoma
World J Pediatr 2012;8(3):235-239 |
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[Abstract] [Full Text] [PDF]
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Findings in children severely infected with a novel influenza A virus of swine origin: pulmonary imaging
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Wei Xu, Chun-Feng Liu, Ying Zhao, Jiu-Jun Li, Li-Jie Wang, Guang-Fu Wen, Zhe Liu |
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Author Affiliations: Department of Pediatrics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China (Xu W, Liu CF, Zhao Y, Li JJ, Wang LJ, Wen GF, Liu Z)
Corresponding Author: Chun-Feng Liu, MD, Department of Pediatrics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning, China (Tel: +8602423692117; Fax: +8602483955509; Email: xuw@sj-hospital.org)
doi: 10.1007/s12519-012-0364-2
Background: This article reviews the chest radiography of children with severe infection caused by a novel influenza A (H1N1) virus of swine origin (S-OIV). We analyzed the role of their pulmonary images in predicting the severity and diagnosis of the disease.
Methods: Among 97 patients with confirmed novel H1N1 infection, 42 patients treated with mechanical ventilation formed group 1, and the remaining 55 patients constituted group 2. The initial and subsequent radiograhic findings in groups 1 and 2 were compared with respect to the pattern, distribution, and extent of the abnormality.
Results: In group 1, 24 patients presented with three or more lung zone diseases, whereas only 5 patients in group 2 demonstrated these findings (P<0.001). A pneumomediastinum or pneumothorax was observed in 24/42 patients in group 1 and in 18/55 patients in group 2 (P=0.019). Twelve patients in group 1 and 5 in group 2 developed a ground-glass opacity cyst with a honeycomb appearance (P=0.007).
Conclusions: The most common radiographic and computed tomography findings in children who were severely infected with S-OIV included unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. Children with bilateral involvement or with greater opacity on the chest radiographs were more likely to worsen and require the mechanical ventilation.
Key words: chest radiography; children; H1N1; infectious diseases; pneumonia
World J Pediatr 2012;8(3):240-246 |
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[Abstract] [Full Text] [PDF]
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Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department
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Yashwant Kumar Rao, Tanu Midha, Pankaj Kumar, Virendra Nath Tripathi, Om Prakash Rai |
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Author Affiliations: Department of Pediatrics, GSVM Medical College, Kanpur, India (Rao YK, Kumar P, Tripathi VN); Department of Community Medicine, GSVM Medical College, Kanpur, India (Midha T); Department of Pulmonary Medicine, GSVM Medical College, Kanpur, India (Rai OP)
Corresponding Author: Yashwant Kumar Rao, L-20, GSVM Medical College, Kanpur-208002, India (Email: ykraoneo@yahoo.co.in)
doi: 10.1007/s12519-012-0365-1
Background: In developing countries, facilities for measuring arterial oxygen saturation are not available in most settings, which make it difficult for health providers to detect hypoxemia in children with acute respiratory tract infection (ARI). Most health providers rely on symptoms and signs to identify hypoxemia and start oxygen therapy. Therefore, this study was conducted to determine the clinical predictors of hypoxemia in children with ARI.
Methods: It was a cross-sectional study carried out at the Pediatric Emergency Department of GSVM Medical College, Kanpur, India in children in the age group between 2 months and 5 years, presenting with ARI. All children with ARI attending the pediatric emergency department from April 2007 to September 2008 were included in the study. Clinical signs and symptoms including fever, cough, nasal flaring, inability to feed/drink, cyanosis, chest wall retraction, wheezing, grunting, tachypnea and crepitations were noted and oxygen saturation (SpO2) was measured. Hypoxemia was defined as SpO2 <90%.
Results: Of the 261 children included in the study, 62 (23.8%) had hypoxemia. Chest wall retraction (sensitivity=90%), crepitations (sensitivity=87%), nasal flaring (sensitivity=84%), tachypnea (sensitivity=81%) and inability to feed (sensitivity=81%) were observed to be the most sensitive indicators of hypoxemia while the best predictors were cyanosis [positive predictive value (PPV)=88%] and nasal flaring (PPV=53%).
Conclusions: Chest wall retraction was found to be the most sensitive indicator, and cyanosis was the most specific indicator for hypoxemia. Of all the clinical signs and symptoms of hypoxemia, none had all the attributes of being a good predictor. A new hypoxemia score has been designed using a combination of clinical signs and symptoms to predict the need for supplemental oxygen therapy.
Key words: acute respiratory tract infections; hypoxemia; hypoxemia score; pulse oximetry
World J Pediatr 2012;8(3):247-251 |
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[Abstract] [Full Text] [PDF]
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Renal manifestations of HIV infected highly active antiretroviral therapy naive children in India
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Ira Shah, Shradha Gupta, Dhaval M Shah, Harshal Dhabe, Mamatha Lala |
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Author Affiliations: Department of Pediatric HIV, B.J. Wadia Hospital for Children, Mumbai, India (Shah I, Gupta S, Shah DM, Dhabe H, Lala M)
Corresponding Author: Ira Shah, 240 D. Walkeshwar Road, Malabar Hill, Mumbai 400006, India (Tel: 91-22-32905610; Email: irashah@pediatriconcall.com)
doi: 10.1007/s12519-012-0366-0
Background: There are several studies on renal manifestations in human immunodeficiency virus (HIV) infected children from American and African regions, but similar studies from India are lacking. A cross-sectional study was carried out in 28 HIV infected antiretroviral therapy (ART) naïve children coming to the pediatric HIV clinic.
Methods: Demographic data of the children, clinical presentations including blood pressure, detailed laboratory investigations (serum creatinine, glomerular filtration rate), urine analysis (urine morphology, urine albumin, pus cells, and red blood cells), and CD4 counts were collected.
Results: Of the 28 children, 15 (53.6%) had renal manifestations with a male to female ratio of 1:1.5. The most common renal manifestation in our study was abnormal glomerular filtration rate (GFR) in 11 (44.0%) of 25 children. This was followed by pus cells in urine in 6 (21.4%) of the 28 children while 3 (10.7%) of them had proteinuria. The mean age of children with renal manifestations was 5.04¡À2.75 years as compared to those without renal manifestations who had a mean age of 7.38¡À2.95 years (P=0.0390). CDC class and sex were not associated with renal manifestations.
Conclusions: Our study suggests that reduced GFR is the common renal manifestation, particularly in younger children. Other renal manifestations are related to proteinuria. The lack of correlation of CDC classification with renal manifestations mandates screening of children with HIV for renal disease. A more detailed study of renal manifestations in HIV-infected children is needed.
Key words: children; human immunodeficiency virus; renal manifestations
World J Pediatr 2012;8(3):252-255 |
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[Abstract] [Full Text] [PDF]
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Incidence of pediatric metachronous contralateral inguinal hernia in children aged ¡Ý1 year
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Jin-Hu Wang, Wei Zhang, Jin-Fa Tou, Shou-Jiang Huang, Wei-Guang Liu, Qi-Xing Xiong, Zheng-Yan Zhao |
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Author Affiliations: Children's Hospital, Zhejiang University School of Medicine (Wang JH, Zhang W, Tou JF, Huang SJ, Liu WG, Xiong QX, Zhao ZY)
Corresponding Author: Zheng-Yan Zhao, MD, Children's Hospital, Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China (Tel: 86-571-87061007 ext 12435; Fax: 86-571-87078641; Email: Zhaozy@zju.edu.cn)
doi:10.1007/s12519-012-0367-z
Background: The management of the contralateral asymptomatic side when a child with initial unilateral inguinal hernia undergoes herniorrhaphy continues to be controversial. Age less than 6 months at initial herniorrhaphy is considered as a high risk factor of the occurrence of metachronous contralateral inguinal hernia (MCIH). We performed herniorraphy for patients ¡Ý1 year with initial unilateral hernia at one-day-set outpatient-surgery department without any intervention of contralateral groin. In this study, we reviewed the characteristics of development of MCIH in this condition and discuss the management strategies of MCIH.
Methods: The subjects of this study were children who were treated at our outpatient-surgery department from January 2006 to December 2006. A total of 2129 patients with initial unilateral hernia and aged ¡Ý1 year underwent an ipsilateral herniorhhaphy only. Patients were followed up for the development of MCIH to 60 months. The Chi-square test was used for intergroup comparison, a level of P<0.05 was considered as statistically significant.
Results: Among these children 1341 (63.0%) were obtained 60 months follow-up data, 1146 (85.5%) were boys and 195 (14.5%) were girls. MCIH developed in 70 (5.2%) patients, 61 were boys and 9 were girls. In 570 patients aged 12-23 months, 43 developed MCIH (7.5%); in 564 patients aged 24-59 months, 21 developed MCIH (3.7%); and in 207 patients ¡Ý60 months, 6 patients developed MCIH (2.9%), the difference between these groups was highly significant (P=0.004). In male patients, 30 right-sided MCIHs occurred after 423 initial left-sided herniorrhaphies (7.1%) and 31 left-sided MCIHs occurred after 723 initial right-sided herniorrhaphies (4.3%), difference between these two groups was significant (P=0.041). Seventy-seven percent of the MCIHs occurred within 1 year, 94% occurred within 2 years after initial herniorraphy.
Conclusions: As the overall incidence of MCIH in patients aged ¡Ý1 year was 5.2%, routine contralateral groin exploration is not suggested. Transinguinal laparoscopy could be considered as an alternative of conventional "wait and see" policy, especially in patients less than 2 years or left-sided initial unilateral inguinal hernia. If "wait and see" policy is adopted, patients should be closely followed up for 2 years.
Key words: contralateral patent processus vaginalis; inguinal hernia; transinguinal laparoscopy
World J Pediatr 2012;8(3):256-259 |
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[Abstract] [Full Text] [PDF]
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