Mari Charisse Trinidad

Perinatal Oxygen in the Developing Lung

Lung diseases, such as bronchopulmonary dysplasia (BPD), wheezing, and asthma, remain significant causes of morbidity and mortality in the pediatric population, particularly in the setting of premature birth. Pulmonary outcomes in these infants are highly influenced by perinatal exposures including prenatal inflammation, postnatal intensive care unit interventions, and environmental agents. Here, there is strong evidence that perinatal supplemental oxygen administration has significant effects on pulmonary development and health. This is of particular importance in the preterm lung, where premature exposure to room air represents a hyperoxic insult that may cause harm to a lung primed to develop in a hypoxic environment. Preterm infants are also subject to increased episodes of hypoxia, which may also result in pulmonary damage and disease. Here, we summarize the current understanding of the effects of oxygen on the developing lung and how low vs. high oxygen may predispose to pulmonary disease that may extend even into adulthood. Better understanding of the underlying mechanisms will help lead to improved care and outcomes in this vulnerable population.

Incidental Gynecologic Findings on Computed Tomography Scans Done in the Emergency Department

INTRODUCTION: Computed tomography (CT) scans are frequently used for diagnostic imaging in the emergency department. Although incidental findings are common, no study has specifically examined the prevalence of incidental gynecological findings on CT scans done in a general female emergency department (ED) population. We sought to determine the prevalence of incidental gynecological findings found on CT scans done in the ED. METHODS: This was a retrospective chart review of 730 consecutively sampled women aged 18 years and older (range 18–92 years) who received a CT scan of the abdomen and pelvis in the ED in 2012. Patients with a primary gynecological diagnosis were excluded. Computed tomography reports were reviewed and any gynecological findings noted on the scan that were not related to the chief complaint were considered “incidental gynecological findings.” Subsequent imaging studies, operative dictations, and histopathology reports for these women were then reviewed. RESULTS: Incidental gynecological findings were identified in 110 (15.1%) of the 730 women who had CT scans done in the ED. The most common incidental gynecological finding was an ovarian cyst found in 58 patients (52.7%), the majority (88%) of which was less 5 cm. The second most common finding was uterine fibroids found in 28 patients (25.4%). Among patients with incidental gynecological findings, 19 (17.2%) had additional imaging done with pelvic ultrasonography. Only six patients (5.4%) had subsequent surgical evaluation and all had benign pathology. CONCLUSION: Incidental gynecological findings are common in women undergoing CT scans in the ED. Although many findings may not warrant follow-up, clinical correlation is still necessary.

Development of a Targeting Task Trainer for Ultrasound-Guided Needle Procedures

INTRODUCTION: Ultrasound-guided needle procedures are difficult skills to master considering the decrease in the need for invasive testing with the emergence of cell-free fetal DNA testing. Because these procedures will continue to be needed in the foreseeable future, simulation will need to take on a larger role in the training. METHODS: Three models using wooden dowels, drinking straws, and wooden balls as ultrasound targets were constructed and used in three distinct targeting tasks. Targeting tasks were devised that required participants to hit targets in the same ultrasound plane (dowel) while following a restrictive path (straw) and outside the initial ultrasound plane (ball). Completion time and targeting errors were recorded for residents (11), maternal-fetal medicine fellows (three), and maternal-fetal medicine (three) attendings. Performance was compared between those with experience in needle-guided procedures (fellows and attendings) and those without experience (residents) using a Mann–Whitney U test. RESULTS: All attendings felt the tasks would allow the practice of targeting skills and aid in training. There were no differences between the experienced and inexperienced groups on either the dowel or straw tasks. Experienced health care providers performed significantly better than inexperienced group in the ball task (P<.05). CONCLUSIONS: We describe training tasks that can aid in the training of ultrasound-guided needle procedures. Although the dowel and straw tasks did not discriminate, the ball task clearly showed benefit of prior experience. Although the ball task is likely to be helpful in training, other tasks with good discriminatory ability need to be devised.