The Journal of the Oklahoma State Medical Association最新文献

Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has essentially become habitual for most obstetricians, its theorized usefulness to help promote expeditious lung aeration after delivery by removal of amniotic fluid, meconium, mucus and blood that may otherwise be aspirated by the newborn, is currently not recommended. ONPS can cause vagal stimulation-induced bradycardia and thus hypercapnea, iatrogenic infection due to mucous membrane injury, and development of subsequent neonatal brain injury due to changes in cerebral blood flow regulation, particularly in premature infants. Multiple studies that have been performed comparing routine use of ONPS to no intervention controls indicate that newborns receiving ONPS took a longer time to achieve normal oxygen saturations, caused apneic episodes, and caused disturbances in heart rate (mainly bradycardia) compared to the control groups. Although the ONPS groups revealed no significantly different APGAR scores at 1 and 5 minutes, the ONPS groups took longer than the control group to reach an arterial oxygen saturation greater than or equal to 92% in the first minutes of life. Currently, Neonatal Resuscitation Program guidelines discourage the use of or meconium-stained amniotic fluid and in the absence of obvious obstruction. Furthermore, this manuscript highlights various literature sources revealing that the routine use of ONPS at the time of delivery can cause more harm than good, if any good at all.

Hydrops fetalis is a rare manifestation of severe congestive heart failure in a fetus, resulting in pathological fluid accumulation in fetal soft tissues and/or serous cavities. Non-compaction of the ventricular myocardium, frequently referred to as the left ventricular non-compaction (LVNC), is a very rare congenital cardiomyopathy. For LVNC, echocardiography is the diagnostic modality of choice. Various diagnostic criteria exist based on either echocardiography or MRI. Currently, nonimmune hydrops fetalis (NIHF) comprise almost 90% of all hydrops fetalis cases. Among cardiovascular conditions that contribute to NIHF (20%), structural malformations (especially hypoplastic left heart, endocardial cushion defect) and arrhythmias are the most frequent etiological factors. We describe an extremely preterm neonate who presented with features of non-Immune hydrops fetalis (NIHF) associated with LVNC and profound refractory systemic hypotension.

Clinical question: In pediatric populations, is nasal saline irrigation as effective as intranasal corticosteroids at relieving allergic rhinitis symptoms?

Answer: No. Intranasal steroids are more effective than nasal saline alone to reduce symptoms of allergic rhinitis (AR) in children. Combination therapy further improves symptom reduction. LEVEL OF EVIDENCE FOR THE ANSWER: B SEARCH TERMS: Allergic Rhinitis, Nasal Saline, Nasal corticosteroids, children younger than age 18. DATE SEARCH WAS CONDUCTED: August and September 2014, October 2015.

Inclusion criteria: Meta-analyses, randomized controlled trials, systematic reviews, cohort studies, nasal spray, hypertonic saline solution, nasal lavage, rhinitis, intranasal administration, nasal saline, human, English language.

Exclusion criteria: Antihistamines, Adults, Articles older than 2008.

Purpose: The purpose of this study was to assess the magnitude of prescription drug misuse among Oklahoma high school students, examine associated risk factors, and inform state-based prevention strategies.

Methods: Data from the 2013 Oklahoma Youth Risk Behavior Survey were used for this analysis and were representative of public school students in grades 9 through 12 in Oklahoma. Variables were examined using percentages and 95% confidence intervals. The chi-square test was used to test for differences in proportions. Logistic regression was used to produce adjusted odds ratios as measures of association between selected independent variables and prescription drug misuse.

Results: Nearly one in five students had ever used a prescription drug without a doctor's prescription. While there was no statistically significant difference of prescription drug misuse by gender or grade in the bivariate analysis, after covariate adjustment, females were 1.5 times more likely than males to have misused prescription drugs and twelfth graders were 1.7 times more likely than ninth graders to have misused prescription drugs.

Conclusion: Students who had ever taken prescription drugs without a doctor's prescription were significantly more likely than students who had never taken prescription drugs without a doctor's prescription to have engaged in current tobacco use, current binge drinking, current marijuana use, and lifetime drug use and have a higher prevalence of suicide risk.