Teenage Patients Research Articles

Obstetric and perinatal outcomes in teenage pregnancy: a literature review

Pregnancy during adolescence continues to be a frequent situation, mostly in developing countries. Maternal age is a key element to be taken into account when managing obstetric patients, as it is related with obstetric and perinatal outcomes. We conducted a literature review to address the obstetric results of pregnancy in teenage mothers. We reviewed articles for the last 5 years in different databases including ‘Pregnancy’, ‘Teenager’, ‘Adolescent’, ‘Complications’ and ‘Outcomes’ as key words. We obtained 2260 articles after the initial search, but only 28 met the inclusion criteria and were therefore reviewed. Most studies were excluded for not clearly specifying one of more groups of teenage patients, lacking comparison of these groups with no-teenage patients, or not addressing the obstetric outcomes of those pregnancies. The outcomes were divided into complications of pregnancy, childbirth, puerperium and neonatal complications. We found that there is an association between young maternal age and preterm birth, pre-eclampsia/eclampsia, fetal growth restriction and stillbirth, among others. For the newborn we found outcomes such as low APGAR scores and admission to intensive care were more frequent in teenage mothers. We conclude that maternal age is an important feature, as there are several obstetric and perinatal compications that are more frequent in teenage mothers than in other age groups.

Current view on treatment of attention deficit hyperactivity disorder in adolescents

Diagnosis of attention deficit hyperactivity disorder (ADHD) in adolescent patients may be problematic, because of the broad spectrum of symptoms. Population research display heritable character. The function of dopaminergic, adrenergic, and serotoninergic systems is disordered in different ways in patients, who suffer from this disease. Purpose: The aim of this article is to show the actual view on the treatment of attention deficit hyperactivity disorder in teenage patients.. Results: In the treatment of ADHD the most important thing is pedagogical therapy as well as cooperation of parents and medical crew. In some particular cases pharmacologic treatment should also be included in therapeutic process, which is described in this review. Methylphenidate is the most frequent drug used in the treatment and that is why we focused on the complex description of the substance. Conclusions: Teachers and the school responsible for teaching these children must adapt didactic methods to the severity of the disorder. It is valuable to conduct the drug in the therapy of teenagers whose parents ready to cooperate, always with psychiatric supervision. In the process of pharmacotherapy, it is crucial to include breaks, for example during vacations. Psychostimulants are highly addictive substances, which is why many researchers are uncertain about the routine prescription of methylphenidate.

Health Professionals' Views on Lifestyle Advice Delivery to Teenage and Young Adult Cancer Patients: A Qualitative Study.

Many health professionals working with teenage and young adult cancer patients (TYA-HPs) do not provide advice on physical activity, dietary intake, smoking cessation, and alcohol consumption as part of routine cancer care. The aim of this study was to understand TYA-HPs' perspectives on the provision of health behavior advice and preferences on an intervention to help develop their health promotion skills. In-depth, semistructured interviews were conducted with 26 TYA-HPs (12 nurses, 8 clinicians, and 6 allied health professionals) whose average time working with teenage and young adult (TYA) cancer patients was 8 years. Each interview followed the same semistructured guide, which was based upon constructs of the COM-B model of behavior change (capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation), transcribed verbatim, and analyzed using the Framework analysis. Overall, TYA-HPs recognized the value and importance of promoting health behaviors but felt that their capability to provide health behavior advice was limited by the availability of, and access to, good-quality evidence linking health behavior to cancer outcomes. The TYA-HPs expressed confusion over professional responsibility to provide choices. The TYA-HPs recognize health behavior promotion to be a core part of TYA cancer care but feel ill-equipped to provide such advice to patients. Mapped to constructs of the COM-B model of behavior, these findings suggest that TYA-HPs would benefit from cross-multidisciplinary team support for improved access to TYA-specific resources covering key health behaviors and skills-based training on delivering lifestyle advice.

Pediatric Patients with Sickle Cell Disease at Harbor-UCLA & Early Experience of L-Glutamine Therapy

Background.Sickle cell disease (SCD) affects millions of people worldwide, including >100,000 Americans, and is often complicated by acute crises. Complex pathophysiology makes it challenging to ameliorate SCD severity, which can be influenced by hydration and disease-modifying agents such as hydroxyurea (HU). Due to the increased metabolic demands of chronic illness, optimal nutrition and presumably antioxidant L-glutamine (Gln) may further contribute to disease control. Thus, we hypothesized that better nutrition and Gln adherence may reduce occurrences of pain crises in SCD. Methods.An IRB-approved retrospective review of pediatric patients with SCD ≥1 y of age was conducted at our institution, along with voluntary nutrition surveys. Evaluations were carried out for associations between disease severity and clinical/laboratory variables representing nutrition, growth, hematologic parameters [fetal hemoglobin (HbF), mean corpuscular volume (MCV)], and treatment compliance (with HU and/or Gln). Results.Preliminary analyses included data from 50 SCD patients (25 F/25 M), with a mean age of 9.1 ±7 y and a mean BMI of 56.4 ±32.6% (±SDEV). Sixty percent of the patients had HbSS/Sß0 (32%-HbSC and 8%-HbSß+). The average number of annual pain crises (APC, 0.97 ±1.14) requiring hospital visits or admissions per patient rose with age. HbF expectedly dropped with age. HbF levels <10% in teenage and older patients were associated with a ≥2-fold higher APC, compared to younger patients (despite similar proportions of HbSS/Sß0). Proper hydration and nutrition were reported by 69% and 43% of 35 survey participants, respectively. APC values for 3 main groups were: - 0.87 ±1.1 for well hydrated/well nourished (n=14, 3.1 ±2.3 y) - 1.4 ±2 for well hydrated/poorly nourished (n=10, 11 ±6.4 y) - 1.97 ±2 for poorly hydrated/poorly nourished (n=8, 13 ±5.4 y). There were no correlations between caloric intake and BMI. However, 20% of surveyed patients (12 ±7.8 y) had Z-scores lower than -1 SD for both height and weight. Their mean APC was significantly higher (2.5 ±2.5vs.1 ±1.3,p=0.03 byt-test). Their prealbumin levels trended lower than normal for age, and were more diminished in older patients. Nearly 60% of our patients were on HU (80% with HbSS/Sß0, age 10.8 ±7.4 y). Good HU adherence was reported by 22 patients, typically ≥90%, which was associated with higher MCVs (92 ±9.6 vs. 74 ±10 f/L,p<0.01), a trend toward higher HbF levels, and younger ages (15 vs. 9% and 9.7 ±7 vs. 14 ±7.7 y,p=NS). The majority (83%) of our patients 5 y of age or older were prescribed Gln, and 70% of the prescriptions were dispensed. Some refused Gln due to abdominal pain or taste, and a quarter of patients reported <50% Gln intake while on both HU and Gln. Thus, overall Gln compliance in 23-months was ≥70% in 12 patients. Patients were excluded while on chronic transfusion. Of 10 evaluable patients, 6 (8.8 ±2.2 y) had a significantly lower APC with Gln (mean APC decrease 0.9 to 0.2,p=0.016 by pairedt-test) coupled with a 12% rise in prealbumin (14.1 to 15.8 mg/dL;p=0.1). Conclusions.Well-nourished/hydrated patients were younger and had a milder disease phenotype, whereas more severe disease was seen in poorly nourished older patients, often with suboptimal compliance. L-Glutamine can be a clinically meaningful addition to HU and should be further studied in pediatric SCD. Disclosures No relevant conflicts of interest to declare.

Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions.

Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients. Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8). The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function. Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491-1496.

Cancer-related fatigue in teenage and young adult cancer patients: Clinicians' perspectives, practice and challenges.

Cancer-related fatigue (CRF) is a common and distressing symptom experienced by teenage and young adult cancer patients (TYAs). This study aimed to explore clinicians' perspectives, practices and challenges in supporting TYAs with CRF. Ten clinicians from a TYA multidisciplinary team (MDT) participated in semi-structured interviews which were thematically analysed. Clinicians perceived CRF as a common, but individual experience for TYAs and framed the broad impact of CRF in the context of TYAs' development. Clinicians' assessment and management of CRF for TYAs varied. Clinicians described a range of challenges affecting their practice in supporting TYAs with CRF, including limited knowledge, difficulties engaging TYAs, inadequate time in consultations and a lack of age-appropriate resources. Despite clinicians' good insight into TYAs' unique experiences of CRF, the assessment and management of CRF for TYAs are complicated by numerous challenges. The development of evidence-based interventions and guidelines, clear pathways of care, and TYA-friendly resources, measures and programmes, is vital to support clinicians, and TYAs, in managing CRF.

Treatment of young patients with pilonidal sinus disease with the original (unmodified) Limberg flap standardized for the first time.

Pilonidal sinus disease (PSD) is commonly seen in young adults but may also affect adolescents. Our goal was to present results from operated patients, with a focus on the original Limberg flap, which we standardized for the first time. This study was a retrospective review of 60 teenage patients who underwent surgery in a single pediatric surgery center over approximately 15years. Of the 60 patients, 33 (55%) were male and the mean age was 14.20±1.31 (9-17) years. After pilonidal sinus excision, primary repair and Limberg flap were performed in 45 (75%) and 15 (25%) patients respectively. There were no complications in the patients who underwent the Limberg flap technique, whereas 49% of the patients who underwent primary repair exhibited complications. The mean follow-up was 6.7±4.8years. We standardized the Limberg flap for the first time in children with measurements and consider that it meets expectations: it is not difficult to perform, it has low complication and recurrence rates, it requires an acceptable period to return to normal activities, and gives satisfactory cosmetic results. We did not identify any complications in patients treated with the Limberg flap excision and post-operative epilation. We consider that findings achieved by the treatment of original, standardized Limberg flap excision is comparable with all of the treatment methods reported in the literature related with children.

Host Adaptation Predisposes Pseudomonas aeruginosa to Type VI Secretion System-Mediated Predation by the Burkholderia cepacia Complex

Pseudomonas aeruginosa and Burkholderia cepacia complex (Bcc) species are opportunistic lung pathogens of cystic fibrosis (CF) patients. While P.aeruginosa can initiate long-term infections in younger CF patients, Bcc infections only arise in teenagers and adults. Both P.aeruginosa and Bcc use type VI secretion systems (T6SSs) to mediate interbacterial competition. Here, we show P.aeruginosa isolates from teenage and adult CF patients, but not those from young CF patients, are outcompeted by the epidemic Bcc isolate Burkholderia cenocepacia strain AU1054 in a T6SS-dependent manner. The genomes of susceptible P.aeruginosa isolates harbor T6SS-abrogating mutations, the repair of which, in some cases, rendered the isolates resistant. Moreover, seven of eight Bcc strains outcompeted P.aeruginosa strains isolated from the same patients. Our findings suggest certain mutations that arise as P.aeruginosa adapts to the CF lung abrogate T6SS activity, making P.aeruginosa and its human host susceptible to potentially fatal Bcc superinfection.

CASE SERIES: AMLODIPINE INTOXICATION

BACKGROUND: Drug poisoning is an important cause of morbidity and mortality in pediatric patients. However, amlodipine poisoning, a widely used dihydropyridine calcium chanel blocker, is not fully documented in Ecuador. Treatment consists of classic measures for shock management and specific measures for this type of intoxication. CASE REPORTS: We present two case reports, both of teenage patients admitted into the pediatric intensive care unit for suicide attempt by taking amlodipine and some other drugs. EVOLUTION: During hospital stay, they presented a different evolutionary course. In both cases vasoactive drugs were needed, dosage was modified according to clinical course. Also in both patients, calcium gluconate was administered along with other support measures described in this paper. Finally, both patients presented a good outcome and were discharged after psychological and psychiatric assessment and follow up. CONCLUSION: The low frequency of amlodipine poisoning and the lack of evidence-based knowledge, constitute it as a diagnostic and therapeutic challenge. Based on our experience, we highlight the importance of early suspicion and prioritizing the use of vasopressors over fluid resuscitation. Additionally, we recommend documenting the exact dose of intake and inquiring about consumption of other drugs to properly classify the severity of the poisoning and stablish the treatment plan. Finally, constant clinical monitoring and support of laboratory tests will guide the conduct.

Substance Use among Poisoned Teenage Patients

Substance use is a growing problem in many countries especially among teenagers. We aimed to estimate the prevalence and complications of substance use in teenagers referring to a tertiary hospital following intoxication. In a cross-sectional study between 2012 and 2013 in Loghman Hakim Hospital, Tehran, Iran, sixteen substances were checked in teenagers referring due to poisoning. They divided into two groups of young (13 to <16 yr; group 1) and old-teenagers (16 to 19 yr; group 2). History of lifetime substance use and drug use within the week prior to admission were recorded. Mean (range) age of young teenagers was 14.5±0.6 [13, 15] and 17.7±1.1 [16, 19] in old-teenagers with female predominance. Of 264 teenagers, four in group 1 and 27 in group 2 were admitted due to drug overdose. Six and 69 patients in groups 1 and 2 claimed that they had used some kind of substance in the week prior to admission. Twenty (37%) and 106 (50.5%) patients in the young and old-teenager groups were defined as drug users and rates of unreported substance use were 27.8% (15 cases) and 23.8% (50 cases) respectively. Ninety-six substance users (36.4%) had referred due to poisonings other than recreational intoxication (P<.001). Screening toxicological lab data showed significant opioid and sedative exposure in old-teenagers. It seems young adolescents hide their drug abuse more than old teenagers. Using illicit drugs screening tests may help us to provide hidden rate of abuse in teenagers.

EFFECT OF PAROXETINE IN ANXIETY DISORDER AMONG SCHOOL DROPOUT TEENAGER IN SOUTH INDIAN POPULATION

Objective: Anxiety disorders are the most common group of psychiatric illnesses in children. This study is to observe the effectiveness of Paroxetine in anxiety disorder among teenagers in South India population using Hamilton Anxiety Rating Scale (HAM-A) and to screen the possible risk for paroxetine in anxiety disorder among teenagers.&#x0D; Methods: This study is a prospective observational study that was conducted for a period of 6 mo. Of 84 teenage patients with anxiety disorder assessed using Hamilton Anxiety Rating Scale (HAM-A) were followed-up in an outpatient psychiatric ward. Study population includes both sexes, age group between 13 to 19 y, Teenage patient receiving paroxetine for anxiety disorder were included and patients unwilling to give written informed consent or assent form were excluded.&#x0D; Results: Out of 84 patients the prevalence of symptoms before the drug treatment, 65 patients were falling in very severe category, which was assessed by HAM-A scale. Then reassessed with drug Paroxetine at week 4 and week 8. There was a drastic reduction in the prevalence of symptoms in week 8 than compared to week 4. A significant reduction in body weight was also observed during the study period. Among various side effects, nausea was the prominent risk found during the study.&#x0D; Conclusion: The present study demonstrated that paroxetine is effective and well-tolerated for the treatment of various types of anxiety disorder in teenagers with few side effects.

Primary endovascular treatment for acute ischemic stroke in teenage patients: a short case series.

To analyze the safety and efficacy of primary endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients younger than 18years of age. Review of 4 patients < 18years of age with AIS, prospectively enrolled in an electronic database registry for acute ischemic stroke patients who underwent thrombectomy at tertiary centers, from January 2011 to February 2017. Clinical and imaging data were analyzed. All patients were female. Patients 1 to 4 were 14, 13, 16, and 13years old, respectively. Patients 1 and 3 had left middle cerebral artery occlusion, patient 2 basilar occlusion, and patient 4 right tandem occlusion. Mean NIHSS score was 13 (7-19) on arrival and 4 (0-5) at 24h. Patient 2 had Osler-Weber-Rendu disease and patient 4 a previously surgically repaired complete atrioventricular canal. All patients presented with clinical-radiological mismatch. CT/CTA was used in patients 1 and 4 and MRI/MRA in patients 2 and 3. Stent retriever was used in 3 patients (patients 1, 3, and 4) and direct aspiration first-pass technique in 1 (patient 2). All 4 procedures resulted in successful recanalization and 3-month functional independence. Primary EVT is reported in patients 13 to 16years of age with AIS due to large vessel occlusion and clinical-radiological mismatch. Procedures were safe and effective with prompt recanalization and good clinical outcome.

Novel coronavirus infection in children outside of Wuhan, China.

BackgroundSince December 8, 2019, an epidemic of coronavirus disease 2019 (COVID‐19) has spread rapidly, but information about children with COVID‐19 is limited.MethodsThis retrospective and the single‐center study were done at the Public Health Clinic Center of Changsha, Hunan, China. We identified all hospitalized children diagnosed with COVID‐19 between January 8, 2019 and February 19, 2020, in Changsha. Epidemiological and clinical data of these children were collected and analyzed. Outcomes were followed until February 26th, 2020.ResultsBy February 19, 2020, nine pediatric patients were identified as having 2019‐nCoV infection in Changsha. Six children had a family exposure and could provide the exact dates of close contact with someone who was confirmed to have 2019‐nCoV infection, among whom the median incubation period was 7.5 days. The initial symptoms of the nine children were mild, including fever (3/9), diarrhea (2/9), cough (1/9), and sore throat (1/9), two had no symptoms. Two of the enrolled patients showed small ground‐glass opacity of chest computed tomography scan. As of February 26, six patients had a negative RT‐PCR for 2019‐nCoV and were discharged. The median time from exposure to a negative RT‐PCR was 14 days.ConclusionsThe clinical symptoms of the new coronavirus infection in children were not typical and showed a less aggressive clinical course than teenage and adult patients. Children who have a familial clustering or have a family member with a definite diagnosis should be reported to ensure a timely diagnosis.

PD25-07 ASSESSING TRENDS IN SPERM CRYOPRESERVATION AT A TERTIARY REFERRAL CENTRE OVER 25-YEARS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-07 ASSESSING TRENDS IN SPERM CRYOPRESERVATION AT A TERTIARY REFERRAL CENTRE OVER 25-YEARS Tharu Tharakan, Miles Smith*, Thomas Stroud, Ee Teng Goh, Monica Figueiredo, Lia Joannou, Chey Dearing, Lona Vyas, Channa Jayasena, Jonathan Ramsay, and Suks Minhas Tharu TharakanTharu Tharakan More articles by this author , Miles Smith*Miles Smith* More articles by this author , Thomas StroudThomas Stroud More articles by this author , Ee Teng GohEe Teng Goh More articles by this author , Monica FigueiredoMonica Figueiredo More articles by this author , Lia JoannouLia Joannou More articles by this author , Chey DearingChey Dearing More articles by this author , Lona VyasLona Vyas More articles by this author , Channa JayasenaChanna Jayasena More articles by this author , Jonathan RamsayJonathan Ramsay More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer survival rates are improving. This has resulted in an increased focus on male survivorship programmes, including fertility preservation. Whilst the gonadotoxic effects of cancer therapy are widely recognised, there is a paucity of data regarding trends in sperm cryopreservation. In particular, there remains a lack of knowledge regarding the types of cancers for which preservation is undertaken and whether there has been an increase in the utility of services. METHODS: An analysis of all oncological sperm cryopreservation at a UK tertiary centre between 1992-2016. Primary measures concerned trends in referrals over this period; in particular, the number of patients, the malignant indication for cryopreservation and patient age. Pre-freeze semen parameters were also assessed over time and used to calculate Total Motile Count (TMC). RESULTS: 3433 oncological patients cryopreserved sperm during the 25-year period. Referrals increased from each year group to the next, with an overall rise of 112%; from 415 (1992-1996) to 878 (2012-2016). Testicular malignancies remained the most prevalent indication for sperm cryopreservation throughout, although the relative contribution of each cancer type changed over time (p<0.001). Most notable was the rise in the proportion of patients with prostate cancer, from 0.5% of patients (1992-1996) to 5.6% (2012-2016). The median age of patients freezing sperm increased over the study period (p<0.001), from 29 years (1992-1996) to 32 years (2012-2016). Overall, 5.5% of men (n=190) were aged 50 or over at the time of their cryopreservation; with 39% of these individuals (n=74) banking sperm between 2012-2016. In all, 339 teenage cancer patients (aged 13-19) cryopreserved. Whilst there was an absolute increase in the number of teenage patients seen over the 25 years, the proportion they accounted for in each year group slightly reduced; from 9.2% (1992-1996) to 8.9% (2012-2016). Median TMC values did not change significantly across the timeframe, either overall or for individual cancer types. CONCLUSIONS: This study represents the largest single-centre evaluation of oncological sperm cryopreservation. We report a number of important trends over a 25-year period; the number of patients electing to bank sperm before oncological therapy is increasing, whilst the types of cancer encountered are changing. Furthermore, there has been a rise in the number of patients cryopreserving sperm at both extremes of age. These findings are encouraging and indicate an increased awareness of fertility preservation amongst men of all ages and cancer types. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e540-e541 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tharu Tharakan More articles by this author Miles Smith* More articles by this author Thomas Stroud More articles by this author Ee Teng Goh More articles by this author Monica Figueiredo More articles by this author Lia Joannou More articles by this author Chey Dearing More articles by this author Lona Vyas More articles by this author Channa Jayasena More articles by this author Jonathan Ramsay More articles by this author Suks Minhas More articles by this author Expand All Advertisement PDF downloadLoading ...

586 Scalp Burn Injury Associated with Hair Highlight Treatment

Abstract Introduction Hair highlighting treatment has become popular at salons across the country. The ubiquity of this beauty treatment gives many people the impression that it is safe. The process of changing hair color differs between hair salons and hair stylists. We describe the cases of two teenage patients who received third degree burns from hair highlighting treatments. Differences in highlighting technique and treatment modality will be compared and contrasted. Methods As part of a quality assurance project looking at variation in scalp burn treatment and outcome, two patients were identified who experienced scalp burn injury due to hair highlighting. Patient 1 received a hot foil hair lighting application. After 5 minutes, the patient experienced tingling in the scalp and removed heat lamp and foils from hair. The first two weeks of treatment were administered by her primary care provider before the patient admitted to our burn facility, where topical collagenase was initiated. Forty two days after initial injury the patient underwent first surgery for debridement, followed by subsequent excision and grafting of scalp. Patient returned for tissue expansion nine months later. Patient 2 received a hair highlighting treatment of bleach and water. Patient 2 complained of burning and immediately her hair was washed out by the hairdresser. The patient was seen two weeks later in our clinic, and treated conservatively with mineral oil and antibacterial topical application. Patient was offered tissue expansion surgery but declined. Results Table 1. compares injury type, treatment and outcome in these two patients. Both injuries required significant time to heal, ranging between 56–70 days. Although similar injuries, mode of treatment differed at this same institution. Both patients made decisions based on school activities and fear or surgery, which prolonged time of conservative treatment. Patient 1 received psychological support and anti-anxiety medication prior to all treatments. After tissue expansion Patient 1 no longer required medication and had no sign of alopecia. Patient 2 has area of alopecia 2x2 cm. Neither patient requires further follow up, however Patient 2 could return for tissue expansion if desired. Conclusions Hair highlighting is a risk for serious scalp burn injury. Conservative treatment (often per patient preference) is associated with prolonged days to healing. Surgical intervention which includes subsequent tissue expansion, combined with psychological support and anxiety management results in good outcome. Applicability of Research to Practice Results from this analysis will be used to develop treatment protocols and staff education on scalp burn injury.

Greater knee joint laxity remains in teenagers after anatomical double-bundle anterior cruciate ligament reconstruction compared to young adults

There is paucity in studies regarding double-bundle anterior cruciate ligament reconstruction (DB-ACLR) in teenagers. The purpose of this study is to investigate clinical outcome after DB-ACLR and analyze whether any differences exist between teenagers and young adults. A retrospective study was performed between 2009 and 2017. Teenagers were defined as patients between 15 and 19years and young adults between 20 and 25years old. Isolated anterior cruciate ligament (ACL) injuries with DB-ACLR with minimum two-year follow up were included. Pre and post-operative Lysholm score, Tegner activity scale, KT-2000 arthrometer, manual pivot-shift grade, were assessed with post-operative one-leg hop test, isokinetic knee extensor strength test at 60°/sec, International Knee Documentation Committee Score (IKDC score), and re-injury rate. One-hundred and thirty-one patients, 75 patients in the teenage group (Group A) and 56 patients in the young adult group (Group B), were enrolled. Lysholm score was significantly lower in Group A (89.6 ± 21.1) compared to Group B (95.9 ± 4.6) (p = 0.04). Side to side difference in KT-2000 arthrometer (2.3 ± 2.2mm vs 1.0 ± 2.3mm, Group A vs Group B, respectively, p < 0.01) and ratio of post-operative positive pivot shift was significantly greater in Group A (30.7%) compared to Group B (7.1%) (p < 0.01). No significant difference was seen in re-injury rate (n.s.). Teenage patients have a greater tendency for residual knee joint laxity after DB-ACLR. Although teenagers and patients in the early twenties are close in age, characteristic in knee joint laxity may be different and, therefore, may require attention upon surgery and post-operative follow-up. III.

Abstract No. 729 Thoracic duct externalization

Percutaneous thoracic duct (TD) externalization has been utilized for lymphatic decompression of body edema in infants and as part of the staged TD embolization for chylothorax. The aim of this study is to demonstrate technical feasibility of percutaneous TD externalization for both diagnostic and therapeutic purposes. This is a retrospective review of 8 patients (M:F/3:5) who underwent percutaneous TD externalization. Three of 8 (37.5%) patients were infants (range, 5-7 m), 5/8 (62.5%) patients were teens (range, 9-20 y). Indications for TD externalization was non-immune hydrops with anasarca in 3 infants and chylothorax in 5 teenage patients. All 3 infants demonstrated immediate improvement of body wall edema. The chylothorax improved significantly in two of five teenage patients and the TD was embolized in a retrograde manner via the externalized duct. Three of five teenage patients initially displayed short-term worsening of their symptoms after TD externalization. Repeat MR lymphangiography demonstrated stenotic TD in one patient which was successfully dilated with subsequent improvement. The remaining 2 cases demonstrated accessory lymphatic pathways. These patients underwent TD embolization as well as targeted embolization of the accessory lymphatics. Overall, all 8 patients experienced symptomatic improvement. Patients spent an average of 9.9 days with the TD drain (range, 2 to 41 d). Average TD drainage per day was 1367 mL/day (range, 150-4456 mL/day) or 96.5 mL/kg/day. There were no major intra-procedural complications. One patient developed SIRS reaction. We have demonstrated that percutaneous TD externalization is technically safe and provides an effective way to drain TD. The ability to drain the TD can palliate neonates with non-immune hydrops. The ability to temporarily externalize the TD can be used to evaluate the short-term consequences of TD embolization. This technique could be expanded to treat patients with a variety of immune disorders and intravascular congestion such as heart failure. Additionally, it can provide an opportunity for lymphatic fluid sampling.

New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students.

Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong. Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test. Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure. Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.

Autism-Spectrum Quotient in Teenage Patients Suffering from Difficulty Getting Up Due to Excessive Morning Sleepiness

School attendance is essential for both academic and socialemotional development. However, increasing numbers of teenagers visit our sleep clinic because of school absenteeism caused by difficulty getting up or excessive morning sleepiness..

Vesicocutaneous fistula: a better way to conduct clean intermittent catheterization

Clean intermittent catheterization (CIC) is indicated for the management of voiding disability. Urethral catheterization through nature route could be problematic. Vesicocutaneous fistula (VCF) can be created as a continent urinary stoma to perform CIC. We retrospectively reviewed patients with incomplete bladder emptying who performed CIC through VCF from January 1997 to December 2017. The VCF was created similar to vesicostomy without suture the bladder mucosa to the skin. Nineteen patients including 10 boys and 9 girls underwent VCF at a mean age of 10.6 years (range 6 days to 22.4 years). The mean follow-up period was 4.2 years. The mean daily number of catheterizations was 4.4. Eight out of 10 teenage patients with VCF performed self-CIC. With regular CIC through VCF, the frequency of urinary tract infection decreased and the renal function was preserved. Complications included peristomal granulation (n=9), difficult catheter insertion (n=4) which resolved after sequential dilation in 2 weeks, and revision of VCF in one patient after spontaneous obliteration of VCF. These stoma related problems happened before fistula tract maturation which usually takes 6 months. Two patients had minor urine leak (minimal amount, once to twice a week). Three adolescents who conducted CIC through nature Vecisocutaneous fistula is a simple procedure with minimal morbidity. It provides a continent route to perform CIC. Complication of VCF is often minor and resolved under proper management.