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Discussion Bupropion is an antidepressant that inhibits dopamine and less substantially noradrenaline reuptake in neurons. Though Erythema Multiforme is a common skin manifestation associated with infections, malignancy, certain antibiotics and autoimmune conditions, only 0. We report a case of Erythema Multiforme with onset within hours of bupropion overdose.

Purpose of study Residents are constantly faced with pain management and end of life care discussions during their training. We wanted to assess the comfort level and if more education is necessary in pain management and end of life care discussions. Methods used Residents from all specialties in either a community or university-based program completed an anonymous 10 questions survey online.

Summary of results Our survey was taken by residents anonymously. While on the other hand, residents felt more comfortable regarding end of life care discussions. Conclusions Residents need more education on pain management and end of life care discussions to make them feel adequate and better prepared. However, no study has validated the subdomain structure of the SNOT This study aims to validate the existence of underlying symptom subdomains of the SNOT using confirmatory factor analysis CFA and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.

A CFA was performed to develop a validated measurement model for the underlying SNOT subdomains along with various tests of validity and goodness of fit. Summary of results EFA demonstrated four distinct factors reflecting: Purpose of study The use of ultrasound US is increasingly being used as a reliable technique for the evaluation of pneumothorax.

A computerised tomography CT-scan is currently the gold standard to diagnosing a pneumothorax; however, obtaining a CT-scan takes time and exposes patients to radiation. We hypothesised that the use of E-FAST is a valid modality to investigate the need for thoracotomy tube placement in patients with traumatic pneumothorax. Methods used We reviewed retrospectively patients who received thoracic ultrasound to evaluate for pneumothoraces.

The University of Arizona Department of Emergency Medicine QPath database was utilised to retrospectively review ultrasound studies performed to evaluate pneumothoraces. We accessed patient electronic medical record via the EPIC medical record to obitan demographic informaiton and hospital course i. Data was summarised using descriptive statistics to determine any difference in the thoracic ultrasound findings in trauma patient versus other modalities like x-rays and CT scans. Summary of results We looked at a total of subject, 84 males and 24 females with the average age of 68 years.

We demonstrated the need for thoracostomy tube placement in patients who were diagnosed with a traumatic pneumothorax was comparable among subjects receiving the E-FAST ultrasound or a CT-scan. Purpose of study Exposure to UV radiation leads to acute inflammatory responses and apoptosis in the skin but also long-term damages. These reactions can result in sunburn to the skin as well as an increased risk of skin cancer.

A herbal plant, RZ, has been traditionally used to treat various inflammatory conditions such as canker sores and cervical ectropion, indicating that RZ possesses anti-inflammatory and antioxidant properties. The cells were then treated with various concentrations of RZ extract: Positive and negative controls did not receive drug treatment. The results were analysed with a two-way ANOVA to evaluate the statistical significance of RZ treated cells compared to negative and positive control cells.

Summary of results Treatment using the acetone extract of RZ at the concentration of 0. The increase in cell viability was dose-dependent and ranged from 8. Additionally, UV radiation caused significant cytotoxicity to cells with a Conclusions The acetone extract of RZ promoted epidermal cell proliferation.

In addition, it showed strong and significant protection against UV radiation-induced cell death. We hope to further test these effects in wound healing and in vivo mice models. Purpose of study Recent studies have indicated that a majority of pathologists provide treatment suggestions during their evaluation of melanocytic skin lesions.

This national study was designed to examine any variation present in treatment recommendations provided by pathologists in their interpretation of these melanocytic skin lesions. Methods used melanocytic skin biopsies were acquired and grouped into 5 sets of 48 cases each. A reference diagnosis and associated treatment recommendation was developed for each biospy by consensus conference between three expert dermatopathologists.

Pathologists reported their diagnoses and treatment recommendations into an online histology form, in addition to completing a baseline survey containing demographic questions and perceptions of their own treatment suggestion patterns. Summary of results Pathologists had the highest accuracy in treatment recommendations for wholly benign nevi and invasive melanoma, with Their accuracy was significantly less for severely dysplastic nevi, with Age, gender, and academic affiliation were found to have no significant impact on accuracy of treatment recommendations.

Conclusions There is significant variability present in treatment recommendations provided by pathologists for melanocytic skin lesions. The least variability was noted in lesions with available American Joint Committee on Cancer guidelines benign lesions and invasive melanomas , potentially indicating benefits of further standardisation of diagnoses and treatment criteria, as well as those of more robust continuing medical education CME programs.

Purpose of study To evaluate the relationship between therapeutic hypothermia TH , pattern of injury on MRI, and neurodevelopmental outcome at 1—2 years in a prospective cohort of term infants with neonatal encephalopathy NE. Motor outcome was also classified as abnormal in children with a functional motor deficit in whom Bayley testing was not performed. Propensity score nearest neighbour matching accounting for covariates that comprise eligibility for TH was used to estimate the average treatment effect of TH stratified by pattern of injury.

Stratified by pattern of injury, TH was independently associated with decreased probability of an abnormal motor outcome N: Conclusions TH is associated with improved motor and cognitive outcomes in term infants with NE stratified by pattern of injury, suggesting that TH mediates improved outcomes by reducing the severity of injury and potentially reducing injury beyond the resolution of conventional MRI. We have compelling data supporting the efficacy and safety of an human neural stem cell hNSC -based intervention that salvages injured brain parenchyma leading to improved histologic and behavioural outcomes.

Prior studies demonstrate that hNSCs used in a rodent model of HII can alter their fate to help reconstitute all damaged brain components as well as recruit host neural and non-neural repair elements. However, none of these studies evaluated hNSCs under hypothermic conditions, so it remains uncertain whether HT antagonises or complements hNSC function. Proliferation and scratch assay migration patterns were documented with direct microscopy and quantified using Image J analysis.

Summary of results There was a gross reduction in the number of surviving hypothermic vs normothermic hNSCs. The doubling time for normothermic cells was 5. IF and Western blot data for hypothermic cells demonstrated a significant decrease in proliferating cell nuclear antigen PCNA which is a marker of cell division. Conclusions Proliferation, migration, and protein production are all significantly impaired in hNSCs subjected to hypothermia. This may adversely affect their ultimate function of neuronal differentiation and support of host repair mechanisms, but whether this has a negative impact on outcomes remains to be tested in both in vitro and in vivo animal models of hypoxic brain injury.

CDH can lower diastolic gut perfusion pressures and limit systemic oxygenated blood flow directly contributing to gastrointestinal hypoperfusion and ischemia, ultimately increasing the risk for NEC. Near Infrared Spectroscopy NIRS can be utilised to non-invasively assess regional oxygen saturations rSO 2 in the splanchnic and cerebral vascular beds of neonates.

The objective of this study is to determine whether premature infants with PGE-dependent CHD receiving enteral feedings have impaired intestinal oxygenation compared to control infants. Average values were calculated for the periods immediately preceding, during, and after each feeding. There was also a significant difference in baseline cerebral rSO 2 between the two groups The lower cerebral and splanchnic rSO 2 in CHD infants persisted during both the feeding and post feeding time periods.

Conclusions These preliminary results demonstrate an overall significantly lower cerebral and splanchnic rSO 2 in premature infants with PGE-dependent CHD compared to control infants. This data raises concerns regarding impaired oxygenation not only in the splanchnic vascular bed with the predisposition to develop NEC, but also for prolonged lower cerebral oxygenation in this population. Patients that were transferred out from their care facility were excluded.

Summary of results There were identified cases of neonatal HIE in After matching for severity of disease, cases were identified, of which, More investigation is needed in order to understand the cause for the difference in length of stay at the two different types of facilities. Weighted variables were provided and applied in the analysis for national estimates.

Bivariate tests were conducted to compare characteristics between survived and died independent t-test and Chi-square test. The number of newborns who received CPR increased each year between to , with a slightly decrease in Further evaluation of these trends are needed to improve target interventions and optimise the outcomes of these populations. Purpose of study To evaluate the correlation between oxygen saturation index OSI and oxygenation index OI in neonates with respiratory distress.

Methods used Retrospective data collected from arterial blood gases and noninvasive saturation monitoring over the first three days of NICU admissionin neonates with respiratory distress. Summary of results In , paired measurements were collected from 46 neonates, median of 6 samples per patient. Samples were correlated, and also stratified by gestational age, and source of PaO 2 and SpO 2 measurements See table 1 In both term and preterm infants, the PaO 2 correlated more strongly with post-ductal saturation. Conclusions In neonates with respiratory distress, OSI strongly correlated with OI, suggesting that noninvasive monitoring can be used to assess severity of clinical illness.

Purpose of study We assessed the influence of obstetric anaesthetic technique using general GA vs regional RA on the need for neonatal resuscitation and short-term outcomes in larger preterm infants who required resuscitation in the delivery room DR at our institution. Data from for infants who were delivered after maternal GA was compared with data from infants who were delivered after RA. Summary of results Out of large preterm infants who received DR respiratory support, were delivered after RA while 88 were delivered after GA.

There was a significant increase in chest compression rates in the GA group vs RA group 6. A limited amount of CSF flow research has been conducted in neonates, and no studies have used the most current MR technology. However, image interpretation is complicated. Methods used We performed our studies on clinical 3T MR scanners. The images were then analysed by selecting four regions of interest ROI for comparison of image contrast.

Voxels were drawn over the brainstem parenchyma , fourth ventricle tagged static CSF , and lateral ventricle untagged static CSF. The measurements in these ROIs were used to compare voxel intensities. Purpose of study The mechanisms that lead to reduced muscle mass in the IUGR fetus may include lower concentrations of insulin, a myogenic growth factor. In normally growing fetal sheep in vivo and in cultured myoblasts harvested from IUGR fetal sheep in vitro , exposure to increased insulin concentrations stimulates myoblast proliferation.

We hypothesised that raising insulin concentrations by direct fetal infusion would increase myoblast proliferation in IUGR fetal sheep. Dextrose was infused to maintain euglycemia in the INS group. There was not a decline in oxygen or pH in the INS group; therefore, other factors in the IUGR fetus, such as decreased glucose, increased catecholamines and reduced amino acids might impair myoblast proliferation during hyperinsulinemia. Purpose of study IUGR infants are born with reduced skeletal muscle mass, in part due to smaller myofiber area.

In our sheep model of placental insufficiency, IUGR fetal muscle has lower branched chain amino acid BCAA uptake and protein accretion rates compared to control CON , without increased protein breakdown rates. IUGR muscle also has net release of alanine, suggesting an active glucose-alanine cycle where alanine is produced from carbons derived from pyruvate via glucose and nitrogens from BCAA.

We aimed to identify mechanisms that cause alanine release by IUGR skeletal muscle. Summary of results Expression of the glycolytic enzymes PFK and PK was similar between groups, supporting normal rates of pyruvate production from glucose. However, expression of BCKD, the enzyme that decarboxylates keto-acids, was maintained. BCAAs that enter the myofiber likely undergo transamination to support alanine production, as opposed to protein accretion. Keto-acids appear to undergo normal catabolism, leading to accumulation of TCA cycle intemediates and their breakdown products. The glucose-alanine cycle may be a survival mechanism to transport carbon and nitrogen from muscle to liver for gluconeogenesis and nitrogen disposal.

Purpose of study Pravastatin is currently being studied clinically for prevention of preeclampsia. Low expression of heme oxygenase-1 HO-1 due to polymorphisms in the human HO-1 promoter region may cause impaired placental development resulting in intrauterine growth restriction IUGR , preeclampsia, and recurrent miscarriages. We have also found that statins can induce HO-1 expression. Therefore, our aim was to evaluate the effect of pravastatin on pregnancy outcome and placental development in HOdeficient mice.

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Summary of results At E Histologically, placentas of pravastatin-treated mice had less apoptosis, more glycogen-laden cells, and larger vessel diameters in the spongiotrophoblast layer, reflecting improved placental development. Conclusions Pravastatin induces liver and placental HO activity and appears to improve pregnancy outcome and placental development in HOdeficient mice. We conclude that pravastatin has potential for use in the treatment of not only preeclampsia, but also of IUGR due to its effects on placental development.

We speculate that among women at risk, those with low HO-1 expression may specifically benefit from pravastatin. Purpose of study Human intrauterine growth restriction IUGR is associated with changes in placental nutrient transport, including down-regulation of amino acid transport, believed to directly contribute to restricted fetal growth and its short- and long-term morbidity. Conclusions Maternal nutrient restriction in the baboon results in upregulation of placental FATP in late pregnancy. These findings suggest an adaptive response to maintain delivery of fatty acids for brain growth during the final third of gestation when maximal fat accretion normally takes place.

Purpose of study Fetal outcomes after uteroplacental insufficiency UPI include growth restriction and sex-divergent increase in neonatal and adult-onset disease. We previously showed, in a rat model, that UPI results in fetal growth restriction and development of sex-divergent neonatal and adult onset disease.

Methods used UPI was induced by bilateral uterine artery ligation at embryonic day 19 in pregnant Sprague Dawley rats. Male and female fetal rat serum and corresponding placenta were surgically collected at term embryonic day Purpose of study Idiopathic Pulmonary Fibrosis IPF is a progressive, incurable fibrotic disease that is restricted to the lung. We have identified a gain-of-function variant in the promoter of the lung gel-forming mucin gene MUC5B that is the strongest risk factor for developing IPF. Samples were balanced by age and gender. Immunohistochemical validation of these results is currently being conducted.

Conclusions Our results confirm the previous studies that have demonstrated that IPF is associated with increased expression of ER stress genes. Purpose of study We previously found that obese severe asthmatics using statins had worse lung function, despite having improved symptom scores.

We wondered whether the negative association with statin use was due to statins or the underlying statin indication, i. We hypothesised that atherosclerosis in the form of CAD is associated with more asthma exacerbations, worse lung function, and worse symptom control in obese severe asthmatics, independent of statin use. Methods used We conducted a retrospective cross-sectional study in our University academic severe asthma clinic U. The without-CAD group had hyperlipidemia as their statin indication. The primary endpoint was the association between CAD and asthma outcomes.

Univariate analyses using hierarchical linear and logistic regressions models were used for modelling fitting, as well as t-test where appropriate. Summary of results Among statin-users, having CAD was associated with a higher rate of acute mild exacerbations 1. In a subset of severe asthmatics, CRP was measured as an inflammatory marker, and patients not taking statins had higher CRP than statin-users 2. Conclusions In our obese severe asthmatic population, the presence of co-morbid CAD itself had a significantly higher rate of mild exacerbations, markedly worse lung functions, and required significantly more oral corticosteroid bursts, independent of statin use, even after accounting for potential confounders i.

This study highlights a new conceptual model in obese severe asthmatics linking asthma disease severity with CAD. The relationship between severe asthma, obesity, atherosclerosis, and systemic inflammation deserve further study. Purpose of study Tacrolimus is a renal-toxic immunosuppressant historically monitored via enzyme based immunoassay.

After , some laboratories implemented mass spectrometry LC-MS to monitor tacrolimus. Given the potential variability between LC-MS and immunoassay, we sought to compare rates of acute kidney injury AKI for lung transplant recipients by method of monitoring. Subjects were categorised by the tacrolimus assay used in their home laboratory. Baseline renal function was defined as the median creatinine between hospital discharge and transition to home monitoring generally six weeks.

Summary of results Among the 82 subjects in the LC-MS group and in the immunoassay group, there were no differences in gender, age, baseline renal function, or race. Conclusions When using existing cut-points to monitor and titrate tacrolimus dosing, monitoring with LC-MS is associated with higher risk of AKI compared to immunoassay. While LC-MS reflects a more accurate measure of tacrolimus blood levels, established cut-points for tacrolimus dosing may need to be lowered to account for the increased risk of AKI. Time to first Kidney injury. Dashed line represents monitoring of tacrolimus with LC-MS and solid line represents monitoring of tacrolimus with immunoassay.

Baseline creatinine is defined as median creatinine over the first six weeks after hospital discharge. Introduction Clostridium species are anaerobic, gram-positive rods capable of forming endospores. Older people are at greater risk of developing invasive infections, and the majority of reported cases of clostridium empyema have been attributed to iatrogenic trauma, invasive procedures or aspiration, although spontaneous Pleuropulmonary disease related to Clostridial species have been described in the medical literature.

Case report year-old male recently diagnosed with GI mantle B-cell lymphoma complicated with bowel perforation requiring exploratory laparotomy and small bowel resection with incidental finding of bilateral pleural effusions on imaging. CT abdomen revealed unresolved bilateral pleural effusions, septations and loculations. The pleural fluid obtained from a left thoracentesis with pigtail catheter placement was exudative and grew Clostridium perfringens. He was not a thoracic surgical candidate due to neutropenia and poor performance status.

A righ pigtail catheter was placed and the pleural fluid had no organisms, however he had been on antibiotics for 7 days. A week later, saline and t-PA were instilled into the chest tubes to improve the drainage. Repeated imaging showed improvement of the bilateral effusions and the patient was discharged home after the chest tubes were discontinued successfully.

Whether this was from direct spread across the diaphragm or from hematogenous dissemination is not clear. In an immunocompromised patient, the infection may have had more to do with intestinal damage than from any immunosuppressive effect. Also, we emphasise on the recommendations that patients with spontaneous clostridial infections be screened for cancer as supported by other reviews. The primary mechanism of injury is hepatocyte necrosis, secondary to formation of the toxic metabolite NAPQI.

Interestingly, acute respiratory failure has been observed in the setting of APAP toxicity. However, the mechanisms underlying APAP induced pulmonary toxicity are unknown. The aim of this study is to use a murine model of APAP induced hepatotoxicity to study the underlying mechanisms that link hepatic failure to pulmonary inflammation.

Lung injury was determined by measuring total cell count differentials and protein content in BALF. Pulmonary NF-kB signalling was assessed by western blot for phosphorylated p Consistent with injuries occurring first in the liver, pulmonary toxicity was noted at later time points. We noted degradation of Nf-kB inhibitory proteins IkB-beta and IkB-alpha, as well as increased phosphorylated p65, indicating pulmonary Nf-kB activation. At later time points, the presence of phosphorylated p65 and elevated levels of inflammatory cytokines in pulmonary tissue may indicate that NF-kB activation is an underlying cause of pulmonary inflammation due to APAP induced hepatotoxicity.

Future studies of the NF-kB signalling pathway may reveal potential therapeutic targets to prevent pulmonary injury associated with hepatic failure. Case report Sarcoidosis is a disease of unknown origin that is most commonly associated with non-caseating granulomas. While these granulomas can be found in a wide variety of organ systems there is a strong tendency for these granulomas to occur within the lungs.

Sarcoidosis my initially present with cough, shortness of breath, wheezing, dyspnea on exertion as well as chest pain. Moreover these patients may also manifest extra-pulmonary symptoms including skin, and ocular involvement. However the prevalence of pleural effusion in sarcoidosis is an uncommon finding. A chest x-ray was performed and showed a new large right-sided pleural effusion, never seen on previous radiological studies. The pt subsequently underwent diagnostic and therapeutic thoracentesis which drained 1.

He reported immediate symptomatic improvement after the procedure. Post-thoracentesis CXR showed resolution of the pleural effusion. Chest x-ray and serology studies suggested an exudative effusion with a lymphocyte predominant cell count. Gram stain was negative and cultures showed no growth. He returned to his primary care physician 2 months post thoracentesis stating that his symptoms have gradually returned.

At that time a repeat chest x-ray confirmed the right sided pleural effusion had gradually re-accumulated. Three months later, after completion of his steroid course he was symptom free and was back to his previous state of health. A repeat chest x-ray confirmed that no pleural effusion was present at that time.

He has remained symptom-free for more than 6 months after completion of the prednisone therapy. Purpose of study Nephrotic syndrome NS is a common paediatric kidney disorder. Despite our CP, some children relapse during induction therapy. We hypothesised that these children early relapsers have a worse subsequent clinical course than those who do not relapse during induction.

All were initiated on our CP and followed for up to 2 years median days. Outcomes included time to first relapse after the start of induction, use of steroid-sparing agents SSA , and clinical course as reflected by number of relapses. The R group was significantly younger 3. Conclusions NS children that relapse during induction are younger, have more frequent relapses, and are more likely to require a SSA than their relapse-free counterparts. Relapse during induction may serve as an indicator for unfavourable longer-term relapsing outcomes.

In our cohort, these associations occurred despite a standardised induction pathway which controls for early relapses due to underdosing. Results will help guide alternative treatment recommendations for early relapsers in future CP iterations. Purpose of study Okanogan County is the a large, rural county in Washington. In Okanogan, the rate of teenage pregnancy is more than twice the rest of Washington, with 56 births per adolescent girls. To address the difference in teenage pregnancy, Learning by Phone LBP is a program utilise a series of web-based quizzes to create an interactive learning environment based on subjects of contraceptive use, accessing the healthcare system, and sexually transmitted infections.

Interviews with county agencies were held to find a community partner, as well as further information about Okanogan. A literature review was performed to find effective measures of reaching and educating adolescents. The findings were shared with the community partner, who showed interest in a texting program. Following this review, short quizzes were written into a internet platform. Questions were written with subjects such as obtaining independent insurance, confidentiality for adolescents, types of contraceptive use, and sexually transmitted infections.

Summary of results The community partner evaluated the literature review and selected LBP as the best option. The module is planned and written into 8 short quizzes and integrated into a web platform. Conclusions The research behind educational texting shows a moderate efficacy in increasing contraceptive use and decreasing teenage pregnancy. When LBP is implemented, we hope to see a similar effect and decrease in the rate of pregnancy in Okanogan County. It is a promising program due to feasibility, easy access, and affordability.

In the future, LBP could be improved by finding a better platform, so that it can rely on texting, rather than the internet. This could increase access for adolescents, as well as increase the number of participants.

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LBP has great potential in its ability to reach out to teenagers give them the information they need to be safe. There were no associated symptoms of syncope, shortness of breath, diaphoresis, or palpitations. He had no recent history of fever, rash, respiratory, or gastrointestinal symptoms. His past medical history was negative for previous episodes of chest pain.

He denied use of medications, tobacco, alcohol, or illicit drug use. His initially electrocardiogram showed ST segment elevation in the inferior leads. His troponin was elevated at 0. Sublingual nitroglycerin and aspirin were given with resolution of pain. Patient had a normal complete blood count, chemistry panel, lipid panel, coagulation panel, hypercoagulability panel, toxicology screen, and viral panel.

Trended cardiac enzymes measured a troponin peak of Initial echocardiogram showed normal function, repeat echo raised concern for possible coronary artery variant. A cardiac MRI showed delayed enhancement in the left ventricular inferior basal wall, extending to the septum, with focal dyskinesis and mild global hypokinesis with an area of microvascular occlusion with no reflow in region of MRI delayed enhancement. Subsequent CT coronary showed a likely right-dominant system with distal right coronary and majority of circumflex being very small. Patient was discharged on a calcium channel blocker and aspirin.

Posthospitalization there was no recurrence of chest pain, repeat MRI at 5 weeks showed persistent sequelae of infarction in unchanged distribution. Cases have shown caffeine induced vasoconstriction of coronary arteries. This case suggests that in the setting of low dose of caffeine in a otherwise healthy adolescent with chest pain to consider evaluation for cardiac abnormalities. Purpose of study Sleep related breathing disorders SRBD , such as obstructive sleep apnea, are commonly found in the paediatric population.

Facial shape has been associated with these disorders in both children and adults. Historically, craniofacial measurements were done with metric tape or lateral and frontal two-dimensional imaging. However, limitations exist for accurately recording three-dimensional 3D geometry using these methods. Stereophotogrammetry, a recent advancement in imaging, has made obtaining 3D images much more practical and removes the need for post-capture photo alteration.

The objective of this study was to use stereophotogrammetry to explore whether a correlation exists between the 3D facial morphometric parameters of children aged 2—17 years, and their reported sleep disturbances as measured by the validated Paediatric Sleep Questionnaire PSQ.

We hypothesised children with a more convex profile and longer, narrower facial shape will be at higher risk. Methods used This was a cross-sectional observational study. Stereophotogrammetric images were acquired using the 3dMD face system.

After images were taken, participants completed the PSQ to assess sleep. Patient images were analysed and 3D coordinates were derived from the identified soft tissue landmarks. Linear and angular measurements between landmarks were calculated; this included computing a mid-face projection and width to height ratio. A stepwise multiple logistic regression analysis was performed to look for any significant association between the facial measurements and PSQ.

Age, sex, and ethnicity of participants were also analysed. Summary of results Out of patients recruited, The median age of participants was 7, with Further analysis is still occurring for the 3D images. Conclusions Data analysis is currently ongoing and findings will be presented. By exploring craniofacial shape as a potential marker of sleep disturbances at a young age, this study could influence clinical approach to this patient population. Future studies will include assessment longitudinally on how facial shape changes after treatment for sleep disorders and vice versa.

Purpose of study High flow oxygen HFO has been used more commonly as supportive treatment of paediatric patients with bronchiolitis. Methods used We performed a literature based review through PubMed and Google Scholar databases using key terms such as: Summary of results Out of the 23 articles found, 4 satisfied our inclusion criteria see table 1 below. Many articles were excluded because they lacked controls or patients were admitted directly to the PICU.

The studies were limited in controlling for severity of disease or using retrospective controls. Also, the protocols for using HFNC were variable among different studies. Conclusions Our review revealed conflicting results in regards to usefulness of HFNC in decreasing hospital stay, intubation and PICU admission rates in children less than 2 years of age with bronchiolitis who are admitted to the paediatric ward. Larger prospective controlled studies with standardised HFO protocols are needed to confirm efficacy of HFNC in treatment of paediatric patients with bronchiolitis. Studies comparing the effects of high flow oxygen vs.

Case report We share the case of an obese 12 year-old boy who presented as a toddler with bilateral leg-bowing, and was later diagnosed with vitamin D deficiency rickets. In a metabolic state characterised by being overweight, it is peculiar to develop a condition defined by a nutritional deficit, as seen in rickets. A lack of vitamin D could potentially be the common factor, as the presence of excess adipose tissue in obesity has been proposed to contribute to vitamin D deficiency, while the poor mineralization of bones in nutritional rickets is known to be a result of that depleted state.

Our case asks if this bridge between obesity and rickets could actually exist, and if so, could this open the door to a greater conversation.

Initially, he was diagnosed with a viral syndrome and discharged home. Several hours later, the patient developed projectile emesis and returned to the ED. An abdominal radiograph showed findings suspicious for a diaphragmatic hernia. CT scan revealed gastric outlet obstruction from a portion of stomach located intrathoracically through a left diaphragmatic hernia. He was taken emergently to the operating room where he was discovered to have a left paraesophageal congenital diaphragmatic hernia with gastric volvulus.

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The patient underwent a laparoscopic reduction with primary closure and Nissen fundoplication. He experienced complete resolution of symptoms and tolerated a soft mechanical diet while receiving care in the paediatric intensive care unit. The patient was discharged home on post-operative day four and was found to be clinically improved at his first outpatient follow-up visit with no further emesis or feeding intolerance. Most cases of congenital diaphragmatic hernias CDH are diagnosed in the antenatal or neonatal period, however an estimated 5—30 percent of CDH cases are considered late-onset presenting after 30 days of age and are discovered incidentally on chest x-ray.

However, it can occasionally present acutely as a surgical emergency if there is a concurrent gastric volvulus or perforation. This patient had no medical problems through infancy but never re-established paediatric care after moving from another state at age 11 months. Aside from several brief episodes of emesis, he was reportedly asymptomatic until one day prior to his presentation when he presented with symptoms of an acute gastric volvulus.

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