International journal of pediatric otorhinolaryngology
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Int. J. Pediatr. Otorhinolaryngol. · Mar 2016
Clinical outcomes in a high nursing ratio ward setting for children with obstructive sleep apnea at high risk after adenotonsillectomy.
In 2012 clinical management of children having adenotonsillectomy (AT) for suspected obstructive sleep apnea (OSA) at our tertiary centre changed based on previous research: children with severe obstructive sleep apnea (OSA) at increased risk of post-operative respiratory adverse events (AE) identified using home overnight oximetry or polysomnography (PSG) were managed post-operatively in a high nurse/patient ratio unit in the ward (high acuity unit, HAU) rather than in the intensive care unit (ICU) as previously. ⋯ In a cohort of children with known moderate-severe OSA, post-operative AE after AT were all managed in the HAU. Post-operative care in HAU provides safe and effective care for high-risk children post-AT, minimizing admissions to ICU.
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Int. J. Pediatr. Otorhinolaryngol. · Jan 2016
The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative.
Given the low frequency of adverse events after tracheostomy, individual institutions struggle to collect outcome data to generate effective quality improvement protocols. The Global Tracheostomy Collaborative (GTC) is a multi-institutional, multi-disciplinary organization that utilizes a prospective database to collect data on patients undergoing tracheostomy. We describe our institution's preliminary experience with this collaborative. It was hypothesized that entry into the database would be non-burdensome and could be easily and accurately initiated by skilled specialists at the time of tracheostomy placement and completed at time of patient discharge. ⋯ The Global Tracheostomy Collaborative is a multi-institutional, multi-disciplinary collaborative that collects data on patients undergoing tracheostomy. Our experience proves proof of concept of entering demographics and outcome data into the GTC database in a manner that was both accurate and not burdensome to those participating in data entry. In our tertiary care, pediatric academic medical center, tracheostomy continues to be a safe procedure with no major tracheostomy-related morbidities occurring in this patient population involvement with the GTC has shown opportunities for improvement in communication and coordination with other tracheostomy-related disciplines.
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Int. J. Pediatr. Otorhinolaryngol. · Jan 2016
Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis.
The relationship between vitamin D and allergic diseases such as asthma and atopic dermatitis is shown in several studies. But there is a lack of knowledge about vitamin D status in children with allergic rhinitis (AR). We aimed to investigate serum vitamin D levels of children with AR or nonallergic rhinitis (NAR), to compare with normal subjects and to evaluate the relationship between vitamin D and the severity of AR. ⋯ The mean serum 25OHD3 levels of the children both with AR and NAR were lower than control group. No association between 25OHD3 levels and allergen sensitivities was found in our study. We did not find any relationship between 25OHD3 levels and the severity and duration of allergic rhinitis.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2015
Investigation of pepsin in tears of children with laryngopharyngeal reflux disease.
Numerous investigations postulated that laryngopharyngeal reflux (LPR) is implicated in the pathogenesis of various upper airway inflammatory diseases as sinusitis or dacryostenosis. The presence of pepsin in tears might be confirmed the presuntive hypothesis of the arrival in the nasolacrimal ducts and precorneal tears film through the laryngopharyngeal reflux of either gastric acid or stomach secretions (pepsin) with inflammatory potentialities. The aim of this preliminary study was to identify the presence or absence of pepsin in the tears collected from children with a high suspicion of LPR who underwent 24-h pH (MII-pH) monitoring to confirm the disease. ⋯ 20% of the children with diagnosed LPR showed pepsin in the tears. Our specific investigation might provide information regarding sinusitis or dacryostenosis.
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Int. J. Pediatr. Otorhinolaryngol. · Dec 2015
Metabolic alterations in adolescents with obstructive sleep apnea.
Obesity is one of the leading health concerns in developed and in developing countries. The risk of obstructive sleep apnea (OSA) is greatly increased by obesity. Obesity is known to be associated with the Metabolic Syndrome and cardiovascular disease in adults. This same association in children is not well defined. Understanding the relationship of obesity, OSA, and metabolic alterations in children would improve understanding of the risks of cardiovascular disease into adulthood. ⋯ OSA severity is associated with increased fasting insulin, blood glucose and HOMA-IR even after controlling for the age, and BMI z score in adolescents.