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  • ISSN: 2373-9312
    Volume 3, Issue 3
    Case Report
    Lily B. Glater-Welt* and Aaron Kessel
    Abstract This report describes a 13 year-old female with a history of asthma who presented in acute respiratory failure with profound hypercarbia secondary to status asthmaticus. On admission to our PICU, her neurologic exam was consistent with brain death. Her respiratory symptoms were treated with bronchodilating agents including terbutaline, magnesium, aminophylline and epinephrine infusions, as well as inhaled sevoflurane. Upon resolution of the severe hypercarbia, her neurologic status improved. She was ultimately extubated on day six of admission and discharged to an inpatient rehabilitation facility approximately one week later. At one year follow up the patient was back to school and had made a full recovery with no detectable neurologic deficits. Clinical and neuroradiographic changes consistent with brain death may be associated with high PaCO2 levels and amenable to treatments directed against the bronchospasm and respiratory failure. Only after the hypercarbia has resolved can the patient’s neurologic outcome be accurately prognosticated.
    Susan DeWolf1, Gehres Paschal2 and Ramona Sunderwirth2*
    Abstract We present the case of a two-year-old girl with the chief complaint of fever and a limp who, after seven emergency room visits over 10 days, was ultimately diagnosed with ruptured appendicitis. This case serves an important reminder about the challenge of diagnosing appendicitis in children and reviews the common features of pediatric appendicitis, many of which are uncharacteristic for adult presentations. Key points of discussion raised by this case include the importance of the availability of ultrasounds in pediatric emergency rooms and the critical value of repeat examinations in the diagnosis of appendicitis.
    Lisa Kenigsberg1, Yelena Kogelman2 and Leslie Lam1*
    Abstract Thyrotoxic periodic paralysis is a rare complication of hyperthyroidism, characterized by severe hypokalemia and episodes of skeletal muscle paralysis. Although it is commonly described in adult East Asian men, TPP has been reported in individuals of all ages and ethnic backgrounds. We describe the case of a young adult Hispanic male who presented to a Pediatric Emergency Department with paralysis and was diagnosed with TPP. We will review TPP, focusing on the clinical presentation, pathophysiology and treatment.
    Research Article
    Ahmed Moussa1*, Rashmi Raghavan2 and Susan G. Albersheim3
    Background: An objective of Neonatal-Perinatal Medicine (NPM) training is learning skills for antenatal consultation at the threshold of viability (<26 weeks’ gestation) (ACTV). However, there is no suggested educational curriculum.
    Objectives: To evaluate: 1) antenatal consultation at the threshold of viability (ACTV) training in Canada; 2) parental needs and expectations, and physician considerations for ACTV.
    Study Design: Mixed methods study. Qualitative methods informed by grounded theory traditions. Data collection included: a survey of Canadian Neonatal-Perinatal Medicine (NPM) Program Directors; a questionnaire for physicians in the Neonatal Intensive Care Unit (NICU) at British Columbia Women’s Hospital; and transcripts of focus groups (NICU physicians and parents of extremely premature babies).
    Results: Training in ACTV is insufficient, focusing on medical information rather than communication. One-third of Canadian NPM programs have formal training, employing: role modeling, direct observation and supervisor feedback. ACTV may be urgent (Labour and Delivery Room); semi-urgent (Antepartum Wards); or non-urgent (Outpatient); each with different goals. Consultations consisting of preparation, interaction and decision-making phases are best provided in two or more sessions, tailored to parents’ self-identified needs. The discussion respects parents’ religious and cultural background, appreciates their emotional turmoil and provides them with support.
    Conclusion: ACTV training, particularly in communication skills, is inadequate across Canada. This proposed framework could serve as a basis for building an educational curriculum for ACTV.
    Raul Calzada-Leon1*, Maria de la Luz Ruiz Reyes1, Nelly Altamirano Bustamante1, Lissette Arguinzoniz Valenzuela1, Hortencia Montecinos1, LA Alejandro Valderrama1 and MC Luisa Diaz Garcia2
    Aims: To define children, parents, and grandparents ideas about children overweight and obesity.
    Method: A questionnaire applied to 1380 median-low, low and very low income families living in Mexico City, selected in a consecutive way, during the assistance to primary care units, according to inclusion criteria: Parents acceptance, at least one child with overweight or obesity and at least one child with normal weight, father and mother living in every day coexistence, four grandparents alive, daily or at least 5 days/week contact with grandparents, regular assistance to school, normal reading comprehension, and one or both parents working outside of home. We use Cochran-Mantel-Haenszel association test.
    Results: The mother and grandmother’s opinion defines nutrition practices and optimal health state. Children define healthy food as the one recommended by the mother or the grandmother (100%), elaborated at home (100%), regardless of lipid and sugar amount (98%), any food with supplement and/or vitamins (97%), and Mexican style (crunchy, condiments, chili) is preferred in 95%. Adult member defines healthy food as elaborated at home (100%), regardless of lipid and/or sugar content (92%), natural food including industrialized fruit juices and sugar added flakes (98%) and those industrialized food added with minerals and vitamins (100%). Overweight was considered the best state of nutrition, and an overweight child is considered taller, stronger, leader, healthy and smart than a normal weight child. Child obesity is considered as a normal (even desirable) and transitory state. All of these observations showed a statistically significant association
    Conclusions: Social and cultural factors such as overprotection and forced feeding by grandparents and parents, false traditional beliefs about health and nutrition in grandparents, and little knowledge about nutrition in parents and caregivers are present in Mexican families.
    A high percentage consider overweight as a desirable condition during childhood, and few identify overweight or obesity as a chronic disease or related to non-communicable diseases.
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