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1. Faculty Development in Proficiency and Application of Point-Of-Care Ultrasound

Author

Sameer Prakash DO, Grace Kibuule MD, Nooraldin Merza MD, Deborah Trammell, Michelle Balducci, Muhammad Nazim MD, Ariel Santos MD, and Izi Obokhare MD

Abstract

Introduction: Point-of-care ultrasound (POCUS) continues to be integrated into medical school and residency curriculums with objectives to increase proficiency and utilization in practice. Implementation of a targeted curriculum with faculty can increase proficiency of ultrasound. Methods: We created a POCUS pilot program at a small academic center to assess faculty members’ knowledges and perception about ultrasound in surgical settings. We conducted an observational cross-sectional study to test the hypothesis and hypothesized members would have increased confidence in their proficiency. Participants attended a 2-hour session with expert faculty. Our session consisted of a pre-test assessment survey, one-hour of didactic lecture, hands-on workshop with an ultrasound simulation machine and live standardized patient, and a post-test assessment survey. Faculty were given the option to return for further self-directed learning with ultrasound simulation machine after the pilot program if desired. Results: There was a statistically significant difference in pre- and post-survey questions that addressed comfort using ultrasound in clinical setting and critical care setting, comfort in using ultrasound at bedside rounds, comfort teaching medical student and residents, comfort performing FAST (Focused Abdominal Sonogram for Trauma) exam and comfort in doing basic bedside echocardiography. Faculty indicated time, availability of ultrasound equipment to faculty and house staff, and cost of equipment as important barriers to utilization of ultrasound in the clinical setting. Discussion: Our pilot POCUS course showed improved confidence in ultrasound skills among faculty members. It is important to address barriers such as limited availability of equipment and adequate time preparation for future POCUS curriculums.

Published
2022

3. Endothelial Injury and Glycocalyx Degradation in Critically Ill Coronavirus Disease 2019 Patients: Implications for Microvascular Platelet Aggregation

Author

Douglas D. Fraser, MD, PhD, Eric K. Patterson, PhD, Marat Slessarev, MD, MSc, Sean E. Gill, PhD, Claudio Martin, MD, MSc, Mark Daley, PhD, Michael R. Miller, PhD, Maitray A. Patel, BSc, Claudia C. dos Santos, MD, MSc, Karen J. Bosma, MD, David B. O’Gorman, PhD, Gediminas Cepinskas, DVM, PhD, on behalf of the Lawson COVID19 Study Team, Robert Arntfield, Ian Ball, Gordon Barkwell, Tracey Bentall, Karen Bosma, Saoirse Cameron, Eileen Campbell, David Carter, Carolina Gillio-Meina, Robert Hegele, Natalya Odoardi, Ram Singh, Kelly Summers, and Sue Tereschyn

Subjects
medicine.medical_specialty, Gastroenterology, Virus, Nitric oxide, Endothelial activation, Glycocalyx, chemistry.chemical_compound, coronavirus disease 2019, Von Willebrand factor, Internal medicine, Hyaluronic acid, medicine, Original Clinical Report, thrombosis, biology, business.industry, RC86-88.9, Mortality rate, Medical emergencies. Critical care. Intensive care. First aid, glycocalyx degradation, General Medicine, endothelial injury, medicine.disease, Thrombosis, chemistry, biology.protein, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, platelet adhesion, business
Abstract

Supplemental Digital Content is available in the text., Objectives: Coronavirus disease 2019 is caused by the novel severe acute respiratory syndrome coronavirus 2 virus. Patients admitted to the ICU suffer from microvascular thrombosis, which may contribute to mortality. Our aim was to profile plasma thrombotic factors and endothelial injury markers in critically ill coronavirus disease 2019 ICU patients to help understand their thrombotic mechanisms. Design: Daily blood coagulation and thrombotic factor profiling with immunoassays and in vitro experiments on human pulmonary microvascular endothelial cells. Setting: Tertiary care ICU and academic laboratory. Subjects: All patients admitted to the ICU suspected of being infected with severe acute respiratory syndrome coronavirus 2, using standardized hospital screening methodologies, had daily blood samples collected until testing was confirmed coronavirus disease 2019 negative on either ICU day 3 or ICU day 7 if the patient was coronavirus disease 2019 positive. Interventions: None. Measurement and Main Results: Age- and sex-matched healthy control subjects and ICU patients that were either coronavirus disease 2019 positive or coronavirus disease 2019 negative were enrolled. Cohorts were well balanced with the exception that coronavirus disease 2019 positive patients were more likely than coronavirus disease 2019 negative patients to suffer bilateral pneumonia. Mortality rate for coronavirus disease 2019 positive ICU patients was 40%. Compared with healthy control subjects, coronavirus disease 2019 positive patients had higher plasma von Willebrand factor (p < 0.001) and glycocalyx-degradation products (chondroitin sulfate and syndecan-1; p < 0.01). When compared with coronavirus disease 2019 negative patients, coronavirus disease 2019 positive patients had persistently higher soluble P-selectin, hyaluronic acid, and syndecan-1 (p < 0.05), particularly on ICU day 3 and thereafter. Thrombosis profiling on ICU days 1–3 predicted coronavirus disease 2019 status with 85% accuracy and patient mortality with 86% accuracy. Surface hyaluronic acid removal from human pulmonary microvascular endothelial cells with hyaluronidase treatment resulted in depressed nitric oxide, an instigating mechanism for platelet adhesion to the microvascular endothelium. Conclusions: Thrombosis profiling identified endothelial activation and glycocalyx degradation in coronavirus disease 2019 positive patients. Our data suggest that medications to protect and/or restore the endothelial glycocalyx, as well as platelet inhibitors, should be considered for further study.

Published
2020

4. KIDSTALENTUM: OUTDOOR TRAINING PROGRAM TO IMPROVE EMOTIONAL INTELLIGENCE IN ADOLESCENTS IN MANCHESTER UNITED SOCCER SCHOOLS, LISBON

Author

Mário Fortes Santos PHD, María Jesús Carrasco-Santos PHD, Maria da Glória Salazar D' Eça Costa Franco PHD, José Luis Minguete Chinchilla PHD, Miguel Reinoso-Caparrós PHD Reinoso-Caparrós PHD, Sara Bahia PHD, Natalie Santos MD, and Maria João Pereira Beja PHD

Abstract

This paper intends to evaluate the Outdoor Training methodology, widely used by consultants working for the emotional and social skills of entrepreneurs, in order to verify if it is also valid for working with adolescents, specifically, for developing their emotional intelligence skills. With this in mind, we chose an experimental study involving two groups of 30 adolescents, one as an experimental group and the other as a control group. They were students of the Manchester United Soccer Schools, Lisbon, Portugal. For the assessment of emotional intelligence, we used the Bar-On Emotional Quotient Inventory: Youth Version. The data obtained point to the evidence of improvements in the emotional skills of adaptability, interpersonal relationships, positive mood, and stress management.

Published
2017

5. The effect of galsulfase enzyme replacement therapy on the growth of patients with mucopolysaccharidosis VI (Maroteaux-Lamy syndrome)

Author

Harmatz P1, Hendriksz CJ2, Lampe C3, McGill JJ4, Parini R5, Leão Teles E6, Valayannopoulos V7, Cole TJ8, Matousek R9, Graham S9, Guffon N10, Quartel A9, he MPS VI Study Group co investigators were Yasmina Amraoui, Children's Hospital, Md, University of Mainz, Germany, Laila, Arash, Children's Hospital, University of Mainz, Germany, Javier Arroyo, Md, Hospital San Pedro de Alcantara, Hospital de día de Pediatría, Caceres, Spain, Ana, Cecliaíazevedo, Serviço de Genética Médica/HCPA, Md, Department of Genetics/UFRGS, Porto Alegre, Brazil, Barone, RITA MARIA ELISA, Department of Pediatrics, Md, University of Catania, Catania, Italy, Michael Beck, Md, D. N. Bennett Jones, Md, Consultant General Renal Physician, Whitehaven, Philippe Bernard, Md, Centre Hospitalier d'Arras, Arras, France, Thierry Billette de Villemeur, Hôpital Trousseau, Paris, France, Raquel, Boy, Hospital Universitário Pedro Ernesto, Md, Rio de Janeiro, Brazil, Susan, Conrad, Research Center Oakland, Oakland, Ca, Usa, Eduardo Coopman, Md, Hospital del Cobre D. e. Salvador, Calama, Chile, Agata Fiumara, Md, Department of Pediatrics, University of Catania, Catania, Italy, William, Frischman, The Townsville Hospital, Md, Townsville, Australia, Roberto, Giugliani, Phd, Md, Serviço de Genética Médica/HCPA, Department of Genetics/UFRGS, Porto Alegre, Brazil, Elio Gizzi, Md, Children's Hospital Research Center Oakland, Oakland, Usa, Ca, Paul, Harmatz, John J. Hopwood, Department of Genetic Medicine, Women'S, Children's Hospital Adelaide, North Adelaide, Australia, Simon Jones, Md, Royal Manchester Children's Hospital, Manchester, Paige Kaplan, Children's Hospital of Philadelphia, Philadelphia, Pa, Laura Keppen, Md, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, Sd, David Ketteridge, Department of Genetic Medicine, Prof Rudolf Korinthenberg, Universitätsklinikum Freiburg, Zentrum für Kinderheilkunde und Jugendmedizin, Klinik II Neuropädiatrie und Muskelerkrankungen, Freiburg, Germany, Michel, Kretz, Hôpital Civil de Colmar, Md, Le Parc Centre de la Mère et de l'Enfant, Colmar, Elisa Leão Teles, Md, Unidade de Doenças Metabólicas, Departamento Pediatria, Hospital de Sao João, Porto, Portugal, Claudia Lee, Mph, Shuan Pei Lin, MacKay Memorial Hospital, Md, Department of Genetics, Taipei, Taiwan, Lionel Lubitz, Md, Royal Children's Hospital, Melbourne, Ana Maria Martins, Md, Unifesp, Instituto de Oncologia Pediátrica, Graacc/unifesp, Departamento de Pediatria, São Paulo, Brazil, Clara Sá Miranda, M., Unidade de Biologia do Lisossoma e. Peroxisoma, Md, Instituto de Biologia Molecular e. Celular, Porto, Stephanie Oates, RN Department of Genetic Medicine, Anne O'Meara, Md, Our Lady's Hospital for Sick Children, Dublin, Ireland, Ans van der Ploeg, Md, Erasmus MC University Medical Center, Rotterdam, The, Netherlands, Isabel Cristina Neves de Souza, Md, Universidade Federal do Pará, Centro de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Belém, Ray Pais, Md, Pediatric Hematology/Oncology, East Tennessee Children's Hospital, Knoxville, Tn, Gregory Pastores, Md, Phd, NYU Medical Center, Rusk Institute, New York, Usa, Ny, Lorenzo, Pavone, Barbara Plecko, U. n. i. v. Klinik fur Kinder und Jugendheilkunde, Graz, Austria, Silvio, Pozzi, Ospedale Vito Fazzi, Md, UO Pediatria, Lecce, Uwe Preiss, Md, Universitaetsklinik und Poliklinik fuer Kinder, Halle, Emerson Santana Santos, Md, Fundação Universidade de Ciências da Saúde de Alagoas Governador, Departamento de Pediatria, Maceió, Brazil, Maurizio, Scarpa, Department of Pediatrics, University of Padova, Padova, Italy, Schwartz, Ida Vanessa D., David, Sillence, Westmead, Australia, Luiz Carlos Santana da Silva, Phd, Universidade Federal do Pará, Centro de Ciências Biológicas, Hospital Universitário João de Barros Barreto, Belém, Brazil, Julie, Simon, Children's Hospital, Rn, Prof Giovanni Sorge, Department of Pediatrics, Robert Steiner, Departments of Pediatrics, Molecular, Medical, Genetics, Oregon Health Science University, Portland, Usa, Or, Valadares, Eugênia R., Hospital das Clínicas, Faculdade de Medicina da Universidade Federal de Minas Gerais UFMG, Avenida Professor Alfredo Balena, Belo Horizonte Minas Gerais, Bonito Victor, Md, Lewis Waber, Md, Phd, Pediatric Genetics, Metabolism, University of Texas Southwest Medical Center, Dallas, Usa, Tx, John, Waterson, Whitley, Chester B., University of Minnesota Medical School, Minneapolis, Usa, Mn, Edmond Wraith, J., Royal Manchester Children's Hospital, Md, and Manchester, U. k.

Subjects
0301 basic medicine, Arylsulfatase B, Male, Lysosomal storage disorder, N-Acetylgalactosamine-4-Sulfatase, Endocrinology, Diabetes and Metabolism, Mucopolysaccharidosis, Growth, Biochemistry, Gastroenterology, chemistry.chemical_compound, Endocrinology, Child, Mucopolysaccharidosis VI, Age Factors, Enzyme replacement therapy, Recombinant Proteins, Diabetes and Metabolism, Galsulfase, Height, Maroteaux-Lamy syndrome, Molecular Biology, Genetics, Child, Preschool, Female, medicine.symptom, medicine.medical_specialty, Adolescent, Urinary system, Short stature, 03 medical and health sciences, Internal medicine, medicine, Humans, Enzyme Replacement Therapy, Creatinine, business.industry, Infant, Newborn, Infant, medicine.disease, Body Height, Maroteaux–Lamy syndrome, 030104 developmental biology, chemistry, Immunology, business, Follow-Up Studies
Abstract

Mucopolysaccharidosis (MPS) VI is an autosomal recessive lysosomal storage disorder arising from deficient activity of N-acetylgalactosamine-4-sulfatase (arylsulfatase B) and subsequent intracellular accumulation of the glycosaminoglycans (GAGs) dermatan sulfate and chondroitin-4-sulfate. Manifestations are multi-systemic and include skeletal abnormalities such as dysostosis multiplex and short stature. Reference height-for-age growth charts for treatment-naive MPS VI patients have been published for both the slowly and rapidly progressing populations. Categorization of disease progression for these charts was based on urinary GAG (uGAG) level; high (>200μg/mg creatinine) levels identified subjects as rapidly progressing. Height data for 141 patients who began galsulfase treatment by the age of 18years were collected and stratified by baseline uGAG level and age at ERT initiation in 3-year increments. The reference MPS VI growth charts were used to calculate change in Z-score from pre-treatment baseline to last follow-up. Among patients with high baseline uGAG levels, galsulfase ERT was associated with an increase in Z-score for those beginning treatment at 0-3, >3-6, >6-9, >9-12, and >12-15years of age (p

Published
2017

6. Successful treatment of catatonic syndrome in bipolar I disorder adding aripiprazole to ECT: A case report

Author

Hidalgo, MD, Diego, Parellada, MD, PhD, Eduard, Martín-Santos, MD, PhD, Rocío, and Benabarre, MD, PhD, Antonio

Subjects
Bipolar disorder, Second generation antipsychotics, Aripiprazole, Catatonia, ECT
Abstract

Background and Objectives: Catatonic syndrome is a condition presenting in multiple ways, sharing many of them with the neuroleptic malignant syndrome and other diseases. This diagnostic challenge is the main cause of keep treating catatonic syndromes without neuroleptics. Methods: Review of the literature and a case report. Results: We present the case of a 19 years old bipolar I patient with a severe catatonic syndrome, with a torpid clinical evolution, partial response to benzodiazepines and ECT, which successfully resolved with intramuscular aripiprazole. We found through a systematic review (PubMed 2005-2010) that there are few but significant case reports of catatonic syndromes treated with new second generation antipsychotics for different reasons with good outcomes as ours. The pharmacological profile of aripiprazole and the low incidence of NMS reported make it a suitable option in treating this syndrome. Conclusions: We think that this case report could contribute to add more evidence for aripiprazole to be considered a good third-line option in the treatment of catatonic syndrome. However, this would require randomized controlled trials to confirm its effectiveness and safety.

Published
2012

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