Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

An Uncommon Meridional Globe Rupture due to Blunt Eye Trauma

Abstract: Open globe injury (OGI) is a severe form of eye trauma It is an important cause of monocular blindness worldwide Ruptures from blunt trauma are most common at the sites where the sclera is thinnest, at the insertions of the extraocular muscles, and at the limbus Most often, rupture is equatorial We present a unique case of open globe injury due to blunt ocular trauma from a thrown rock that resulted in a meridional rupture of the eye The pertinent literature is reviewed

When to perform urine cultures in respiratory syncytial virus-positive febrile older infants?

Abstract: Background Respiratory syncytial virus (RSV) infections are associated with clinically significant rate of urinary tract infections (UTIs) in young infants. Previous research investigating RSV infections and UTIs has been performed mainly in infants younger than 2 to 3 months and has not focused on the risk of UTI in infants 3 to 12 months. Objective This study aimed to assess the rate of UTIs in febrile RSV-positive older infants admitted as inpatients and identify predictors of UTI in febrile RSV-positive older infants. Methods This is a retrospective comparative study of febrile RSV-positive infants 0 to 12 months of age admitted to the inpatient pediatric unit of Lincoln Medical and Mental Health Center, Bronx, from September through April 2006 to 2012. Infants 3 to 12 months were considered the cases, and infants 0 to 3 months were the comparative group. The rate of UTIs between the 2 groups was compared. Univariate tests and multiple logistic regression were used to identify demographic/clinical factors associated with UTI in febrile RSV-positive older infants. Results A total of 414 RSV-positive febrile infants were enrolled including 297 infants 3 to 12 months of age. The rate of UTI in older infants was 6.1% compared with 6.8% in infants younger than 3 months. Positive urinalysis finding was an independent predictor of UTI (P = 0.003) in older infants. All 11 boys with UTI were uncircumcised, and none of the 51 circumcised boys had UTI. Demographic (race, sex, and age) and clinical factors (temperature, white blood cell count, and absolute neutrophil count) were not associated with UTI. Conclusions Febrile older infants who are RSV positive have a clinically significant rate of UTIs. It seems prudent to examine the urine of these older infants. Positive urinalysis finding was a predictive factor of UTI. Circumcised boys are at a decreased risk of UTI, compared with uncircumcised boys.

Fungal endocarditis in a premature infant complicated by a right atrial mycetoma and inferior vena cava thrombosis.

Abstract: The incidence of fungal endocarditis in premature infants is on the rise, reported in the last decade secondary to use of central venous lines, the frequent use of broad spectrum antibiotics and neonatal surgical interventions. Central line related thrombosis is a significant risk factor for persistent fungemia and end organ complications including endocarditis. We present a fatal case of progressive thrombosis of the inferior vena cava and right atrial mycetoma in a premature infant with candidemia who underwent ileostomy for bowel perforation. Renal failure occurred secondary to inferior vena cava thrombosis and right atrial mycetoma, both of which had a potential for hemodynamic compromise and embolism.

Elbow Fractures Overview

Abstract: The most common type of fracture in the pediatric population is elbow fractures. Most commonly, individuals fall on their outstretched hand. Prompt assessment and management of elbow fractures are critical, as these fractures carry the risk of neurovascular compromise. The following are the types of elbow fractures in pediatrics: Supracondylar Fractures This type of fracture involves the distal humerus just above the elbow. It is the most common type of elbow fracture and accounts for approximately 60% of all elbow fractures. It is considered an injury of the immature skeleton and occurs in young children between 5 to 10 years of age. Based on the mechanism of injury and the displacement of the distal fragment, professionals classify these as either extension or flexion type fractures.In an extension type of fracture, which happens more than 95% cases, the elbow displaces posteriorly. The typical mechanism is falling on an outstretched hand with the elbow in full extension. An example is falling from monkey bars. Beware that a nondisplaced fracture may be subtle and may only be recognized by one of the following: Posterior fat pad sign Anterior sail sign Disruption of the anterior humeral line Radiographically, these fractures are classified into three types: Type I: minimal or no displacement Type II: displaced fracture, posterior cortex intact Type III: totally displaced fracture, anterior and posterior cortices disrupted In a flexion type fracture that happens in less than 5% of cases, the elbow is displaced anteriorly. The typical mechanism is when a direct anterior force is applied against a flexed elbow, which causes anterior displacement of the distal fragment. With the displacement of the fragment, the periosteum tears posteriorly. Since the mechanism is a direct force, flexion type fractures are often open. Type I fracture: non-displaced or minimally displaced Type II fracture: incomplete fracture; anterior cortex is intact Type III fracture: completely displaced; distal fragment migrates proximally and anteriorly One of the most serious complications is neurovascular injury following the fracture, as the brachial artery and median nerve are located close to the site of fracture and can be easily compromised. Gartland Classification Supracondylar fractures can be classified depending on the degree of displacement: Gartland Type 1 Fracture: Minimally displaced or occult fracture. The fracture is difficult to see on x-rays. The anterior humeral line still intersects the anterior half of the capitellum. The only visible sign on an x-ray will be a positive fat pad sign. Gartland Type 2 Fracture: Fracture that is displaced more posteriorly, but the posterior cortex remains intact. Gartland Type 3 Fracture: Completely displaced fracture with cortical disruption. Posteromedial displacement is more common happening in 75% of cases compared to posterolateral displacement which occurs in 25% of cases. Lateral Condyle Fractures These types of fracture are the second most common type of elbow fracture in children and account for 15% to 20% of all elbow fractures. This fracture involves the lateral condyle of the distal humerus, which is the outer bony prominence of the elbow. The peak age for the occurrence of lateral condyle fractures is four to ten years old. Most commonly, these are Salter-Harris type IV ( a fracture that transects the metaphysis, physis, and epiphysis) involving the lateral condyle.Two types of classifications are used to describe lateral condyle fractures: Milch classification Milch 1: Less common type. Fracture line traverses laterally to the trochlear groove. Elbow is stable. Milch II: More common type. Fracture passes through the trochlear groove. Elbow is unstable. Displacement Classification Type 1: Displacement less than 2 mm Type 2: more than 2 mm but less than 4 mm displacement. Fragment is close to the humerus Type 3: Wide displacement, the articular surface is disrupted. Medial Epicondyle Fractures These fractures are the third most common type of elbow fracture in children. It is an extra-articular fracture. It involves fracture of the medial epicondyle apophysis, which is located on the posteromedial aspect of the elbow. It commonly occurs in early adolescence, between the ages of nine to 14 years of age. It is more common in boys and occurs during athletic activities such as football, baseball, or gymnastics. The common mechanisms of injury are a posterior elbow dislocation and repeated valgus stress. An example is throwing a baseball repeatedly. One term for this is “little league elbow.”Common presentation is medial elbow pain, tenderness over the medial epicondyle, and valgus instability. Radial Head and Neck Fractures These fractures comprise about 1% to 5% of all pediatric elbow fractures. Most commonly these are Salter-Harris type II fractures that transect the physis and extend into the metaphysis for a short distance. This usually occurs between the ages of nine to ten years. Olecranon Fractures Olecranon fractures are uncommon in children. These are mostly associated with radial head and neck fractures.