Objective
Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims ...to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies.
Methods
A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available.
Results
A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher‐evidence items such as randomized‐controlled trials, guidelines, and systematic reviews. A 34‐statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus.
Conclusions
Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures.
Level of Evidence
5 Laryngoscope, 134:1437–1444, 2024
This article presents a clinical consensus statement aimed at providing a diagnosis and management framework for pediatric inferior turbinate hypertrophy (PedTH), a frequently overlooked cause of nasal breathing difficulties in children. The statement was developed by a panel of 20 contributors from 5 different European and North American countries using the modified Delphi method and is based on shared clinical experience and analysis of the strongest evidence currently available. The statement emphasizes the importance of considering PedTH as a nasal obstructive disease and recommends less invasive treatment options.
Shock refractory to fluid and catecholamine therapy has significant morbidity and mortality in children. The use of methylene blue to treat refractory shock in children is not well described. We aim ...to collect and summarize the literature and define physicians' practice patterns regarding the use of methylene blue to treat shock in children.
We conducted a systematic search of MEDLINE, Embase, PubMed, Web of Science, Cochrane for studies involving the use of methylene blue for catecholamine-refractory shock from database inception to 2019. Collected studies were analyzed qualitatively. To describe practice patterns of methylene blue use, we electronically distributed a survey to U.S.-based pediatric critical care physicians. We assessed physician knowledge and experience with methylene blue. Survey responses were quantitatively and qualitatively evaluated.
Pediatric critical and cardiac care units.
Patients less than or equal to 25 years old with refractory shock treated with methylene blue.
None.
One-thousand two-hundred ninety-three abstracts met search criteria, 139 articles underwent full-text review, and 24 studies were included. Studies investigated refractory shock induced by a variety of etiologies and found that methylene blue was generally safe and increased mean arterial blood pressure. There is overall lack of studies, low number of study patients, and low quality of studies identified. Our survey had a 22.5% response rate, representing 125 institutions. Similar proportions of physicians reported using (40%) or never even considering (43%) methylene blue for shock. The most common reasons for not using methylene blue were unfamiliarity with this drug, its proper dosing, and lack of evidentiary support.
Methylene blue appears safe and may benefit children with refractory shock. There is a stark divide in familiarity and practice patterns regarding its use among physicians. Studies to formally assess safety and efficacy of methylene blue in treating pediatric shock are warranted.
•This time series study (July 2019 to March 2022) was undertaken to address changes in Gram-negative bacilli (GNB) incidence and antibiotic consumption in intensive care units.•Antibiotics against ...multidrug GNB signficantly increased, while other anti-GNB agents decreased.•These variations showed a significant correlation with the increase in overall GNB and in the amount of resistance mechanisms.•Health authorities must be prepared to respond rapidly and in a timely manner to resource demands in the face of possible future pandemics.
There was a reported increase in the antimicrobial consumption in hospitals during the COVID-19 pandemic, accompanied by an increase in infections due to multidrug-resistant (MDR) bacteria.
This retrospective time series study from intensive care units in Buenos Aires examined changes in antibiotic consumption (defined daily doses/1000 patients/day), the incidence of Gram-negative bacilli (GNB) and the mechanism of resistance. Antibiotics were categorised into group 1 (agents against MDR GNB) and group 2 (agents against non-MDR infections). Bacteriological samples included respiratory samples and blood cultures. Periods were divided into pre-pandemic (July 2019 to March 2020) and pandemic (April 2020 to March 2022). Correlation coefficients (r) were analysed and the Mann-Whitney test was performed to compare both periods.
During the study period, GNB incidence, group 1 antibiotic consumption and resistance mechanisms increased, whereas antibiotics decreased in group 2. A significant positive correlation was seen between the consumption of antibiotics in group 1 and the incidence of GNB (r = 0.63; P < 0.001) and resistance (r = 0.52; P = 0.002). Significant differences were found between pre-pandemic and pandemic periods regarding the medians of group 1 consumption (520 408–570 vs. 753 495–851 DDD/1000 patients/day; P = 0.029), incidence of GNB (12 10–13 vs. 43 25–52.5 cases/month; P < 0.001) and resistance mechanisms (5 4–8 vs. 17 10–25 cases/month; P < 0.001), extended-spectrum beta lactamases (2 1–2 vs. 6 3–8 cases/month; P < 0.001) and metallo-beta-lactamases (0 0–0 vs. 6 1.75–8.5 cases/month; P < 0.001).
During the COVID-19 pandemic, the rise in GNB incidence and the amount of resistance mechanisms significantly correlated with the increase in consumption of agents against MDR strains.
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La desigualdad en Colombia ha sido ampliamente documentada desde distintas ópticas, pero poco se sabe sobre las desigualdades en el contexto urbano-rural. Este trabajo estudia la desigualdad ...urbano-rural en el mercado laboral mediante el uso de una descomposición Blinder-Oaxaca para los ingresos laborales y una caracterización de los mercados laborales rurales y urbanos. Encontramos que cerca del 60 % de la brecha en ingresos laborales se explica por factores observados de los trabajadores como el nivel educativo y edad; el restante 40 % se debe a características no observadas, como preferencias de los empleadores, habilidad de los trabajadores, etc. Identificamos tres condiciones del mercado laboral rural que explican y promueven la brecha en ingresos laborales urbano-rural: i) baja participación laboral femenina y altas tasas de desempleo en comparación con sus contrapartes urbanas; ii) informalidad laboral significativamente más alta que en las zonas urbanas; y iii) mayor incidencia del trabajo infantil.
Canangucha is a palm from the Colombian Amazon of great industry interest, due to its expansion and ecosystem and food services it offers to communities. The objective of this work was to evaluate ...the morphometric, physical, and chemical characteristics, as well as the yield of the canangucha fruit in both EI and EII ecotypes, this characterization can become the starting point for the development of the value chain of the fruit. For the fruits and seeds, the longitudinal diameter (LD), equatorial diameter (ED), mass (g), and color (L*, a*, b*) were determined. The pulp was characterized based on pH, °Brix, moisture content, aw, color, crude protein, total lipids, crude fiber, carbohydrates, minerals, total phenols (TP), antioxidant capacity (ABTS and DPPH methods), α-carotene, β- carotene and α-tocopherol. The fruit mass is comprised 61-65% seed, 15 17% pulp and 19-21% pericarp. The morphometric variables of the fruit and seed of ecotypes I and II showed a significant difference (P<0.05). The color of the fruit presented significant changes based on its ripeness, and the luminosity fluctuated between 26.8%-53.7%; while the pulp presented a yellow-orange hue with a variation in the color plane (a*, b*), being between (11.3, 5.1) and (23.4, 43.5). The EI ecotype pulp presented better quality attributes: total lipids (34.2%), crude fiber (22.2%), crude protein (6.8%), pH: 3.6-4.4, °Brix: 15-16, TP: 1467.3±146.5 mg GAE 100g-1, DPPH: 2.5±0.1 mg TE g-1, ABTS: 3.0±0.2 mg TE g-1, β carotene: 68.2±9.6 mg 100g-1, and 11927.7 µg RAE. It was concluded that canangucha has an important nutritional value and compounds with physiological activity, which identifies it with great potential to be used in the food and pharmaceutical industries.
Purpose
To describe changes in hemodynamic variables, sedation, and pain score after discontinuation of prolonged infusions of dexmedetomidine in a pediatric population of critically ill cardiac ...patients.
Methods
Retrospective case series of patients who received continuous infusions of dexmedetomidine for longer than 3 days in a pediatric cardiac intensive care unit from 2008 to 2010.
Results
Sixty-two patients, age 5.2 months (range 0.3 months–17 years) and weight 5.1 kg (range 2.2–84 kg), were included. Thirty-nine patients (63%) were younger than 1 year of age. Median duration of dexmedetomidine infusion was 5.8 days (range 4–26 days) and median infusion dose was 0.71 μg/kg/h (range 0.2–2.1 μg/kg/h). Median weaning time and dose at discontinuation were 43 h (range 0–189 h) and 0.2 μg/kg/h (range 0.1–1.3 μg/kg/h). Tachycardia, transient hypertension and agitation were observed in 27, 35 and 27% of patients. Episodes of tachycardia were more frequent in children older than 1 year of age (61 vs. 8%,
p
< 0.001), patients who received dexmedetomidine for 4 days when compared to those who received 5 days or longer (48 vs. 17%,
p
= 0.011), and patients whose infusion was discontinued abruptly (42 vs. 14%,
p
= 0.045). Tachyarrhythmias were seen in nine patients (15%) after discontinuation of the dexmedetomidine infusion. Adequate sedation and analgesia scores at the moment of infusion discontinuation were seen in 90 and 88% of patients, respectively.
Conclusions
Our study suggests that tachycardia, transient hypertension, and agitation are frequently observed in pediatric cardiac intensive care unit patients after discontinuing prolonged dexmedetomidine infusions.
Temperate forest understorey vegetation poses an excellent study system to investigate whether increases in resource availability lead to an increase in plant species richness. Most sunlight is ...absorbed by the species-poor tree canopy, making the much more species-rich understorey species inhabit a severely resource-limited habitat. Additionally, the heterogeneity of light availability, resulting from management-moderated tree composition and age structure, may contribute to species coexistence. One would therefore expect that the diversity in the herb layer correlates positively with either the overall light availability, or the light heterogeneity, depending on whether resource availability or heterogeneity are more important drivers of diversity. To test this idea, we assessed variability of light conditions in 75 forest plots across three ecoregions with four different methods. We correlated these data with vegetation relev#233;s and found light availability to be strongly positively correlated with understorey plant species richness, as well as with understorey cover. Light variability (assessed with two approaches) within plots was positively correlated with transmittance, but did not improve the relationship further, suggesting that the main driver of species richness in this system is the overall resource availability. Two of the three beech-dominated regions exhibited near-identical effects of light transmittance, while the third, featuring pine alongside beech and thus with the longest gradient of transmittance and lowest species richness, displayed a weaker light response. While site conditions are certainly responsible for the trees selected by foresters, for the resulting forest structure, and for the differences in plant species pools, our results suggest that light transmittance is a strong mediating factor of understorey plant species richness.
La situación generada por el COVID-19 ha puesto de manifiesto que, en educación infantil, el modelo asistencial se ha quedado atrás frente al educativo. Con esta investigación se ha analizado, en la ...situación excepcional de confinamiento, tanto la manera de afrontar esta situación de cierre de las aulas desde los centros educativos como las respuestas proporcionadas por las familias, teniendo en cuenta la titularidad de los centros, el ciclo impartido (primer ciclo, segundo ciclo o ambos), el año de nacimiento de los menores o el número de hijos en los hogares. Para ello, se han elaborado ad hoc dos cuestionarios contestados durante los meses de abril y mayo por 1235 docentes de esta etapa de todas las Comunidades y Ciudades Autónomas de España y por 1266 familias de menores que cursan educación infantil. Los datos recogidos se han analizado mediante un examen exploratorio de las respuestas y el cálculo de los principales porcentajes asociados a las variables consideradas para, posteriormente, realizar un análisis inferencial de la información disponible, empleando la prueba H de Kruskal-Wallis para analizar los datos procedentes de las escalas Likert y la prueba Chi-cuadrado para el estudio de las variables categóricas. Los resultados muestran que existen diferencias estadísticamente significativas en el envío de tareas en función del ciclo y de la titularidad del centro, siendo los centros privados los que menos actividades han enviado. Asimismo, casi la mitad de las familias encuestadas señala que necesitan recibir más indicaciones, siendo aquellas cuyos hijos asisten a escuelas públicas las que más lo demandan. Es por esto por lo que se puede concluir que las máximas establecidas en la legislación vigente no se han cumplido en todos los casos.
La investigación presenta un enfoque basado en analítica de datos y mecanismos de aprendizaje automático integrado a una de las plataformas digitales de aprendizaje más usadas en el mundo (open EDX) ...como aporte al mejoramiento de los procesos de aprendizaje en estudiantes de educación media de municipios de Colombia. Metodológicamente con base en Creswell y Plano Clark (2007) y Clements et al. (2017), se construyó un sistema que posibilita la recomendación de contenidos educativos adecuados a las características individuales de estudiantes teniendo en cuenta las limitaciones en el uso y apropiación social de las tecnologías en las instituciones educativas, se realizaron entrevistas con docentes y grupos focales con estudiantes de grados 10 y 11 de media vocacional; como resultado se generó una propuesta de arquitectura funcional que permite la generación de recomendaciones iniciales de contenidos administrados según el desempeño de los estudiantes y las características propias del territorio. Palabras claves: Sistema de recomendación, plataforma de aprendizaje, modelo de datos, aprendizaje automático, educación. The research presents an approach based on data analytics and automatic learning mechanisms integrated into one of the most widely used digital learning platforms in the world (open EDX) as a contribution to the improvement of learning processes in middle school students in municipalities of Colombia. Methodologically, according to Creswell y Plano Clark (2007), and Clements et al. (2017) a system was created to recommend educational contents adapted to the individual characteristics of students considering the limitations in the use of technologies in educational institutions; we developed interviews with teachers and focus groups with students of 10 and 11 grade; as a result, a functional architecture proposal was generated that allows the generation of initial recommendations of contents managed according to the students' performance and the characteristics of the territory. Keywords: Recommendation system, learning platform, data model, machine learning, education.
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