Texas Medical Center

About: Texas Medical Center is a healthcare organization based out in Houston, Texas, United States. It is known for research contribution in the topics: Population & Cancer. The organization has 2845 authors who have published 2394 publications receiving 79426 citations.

Obesity and gastroesophageal refl ux disease and gastroesophageal refl ux symptoms in children

Abstract: Background: The association between body mass index (BMI) and gastroesophageal refl ux disease (GERD) has been extensively studied among adults but few studies have examined such association in children. Aims: 1) to determine the relationship between BMI in children and GERD, and 2) to use the National Center for Health Statistics (NCHS) values for BMI as a valid source for comparison. Methods: We identifi ed two cohorts of children aged between two and 17 years who were seen at Texas Children’s Hospital (TCH). The fi rst cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI) at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic fi ndings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal refl ux (GER) who received outpatient gastrointestinal (GI) consultation at TCH for any 9th revision of the International Statistical Classifi cation of Diseases (ICD-9) code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded. Measurements: The records for each child namely, age, gender, height, and weight were obtained

FabAV antivenin use after copperhead snakebite: clinically indicated or knee-jerk reaction?

Abstract: Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) antivenin is commonly recommended after pit viper snakebites. Because copperhead envenomations are usually self-limited, some physicians are reluctant to use this costly treatment routinely, while others follow a more liberal approach. We hypothesized that, in practice, only patients with evidence of significant (moderate or severe) copperhead envenomation [those with snakebite severity score (SSS) > 3] receive FabAV and examined a large cohort to determine the relationship between clinical findings and FabAV administration. All data from patients evaluated for copperhead snakebite at a rural tertiary referral center from 5/2002 to 10/2013 were compiled. Demographics, transfer status, antivenin use, and clinical findings were collected; SSS was calculated. The relationships among FabAV use, clinical findings, and SSS were analyzed using t-test, chi-square, and Pearson’s coefficient (p 3, indicating moderate or severe envenomation, was only very weakly correlated with antivenin use (r = 0.217; p 3 (65.8 %) did not receive antivenin while most patients who did receive antivenin (70.5 %) had SSS ≤ 3 (indicating mild envenomation). Considerable variation occurs in antivenin administration after copperhead snakebite. Use of FabAV appears poorly correlated with patients’ symptoms. This practice may expose patients to the risks of antivenin and increasing costs of medical care without improving outcomes. Guidelines used for treating other pit viper strikes, such as rattlesnake or cottonmouth snakebite may be too liberal for copperhead envenomations. Our data suggests that most patients with mild or moderate envenomation appear to do well independent of FabAV use. We suggest, for patients with copperhead snakebite, that consideration be given to withholding FabAV for those without clinical evidence of severe envenomation until prospective randomized data are available.