Diving Deep in the Ocean State: Hasbro Electives

Musings of our residents on elective rotations

Growth Attenuation Therapy in Children with Severe Physical and Cognitive Disabilities

Diving Deep in the Ocean State: Hasbro Electives / June 2, 2022

by Julia R. Donner, MD (’23)
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The goal of therapy for Ashley’s family and of those like hers is to prolong care time at home within the family and make this care more feasible to prevent transition to facilities. Lifting and transferring of children becomes more challenging the larger they grow and formation of bed sores and other side effects of being sedentary become a larger issue with increasing size. Growth attenuation could potentially prevent these effects and allow for better quality of life for these children as they age and are able to remain at home. 

HORMONES AND THE HEART

Diving Deep in the Ocean State: Hasbro Electives / January 21, 2022

Julia Donner, MD (’23)
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Prolongation of QT interval carries increased risk for sudden life threatening arrythmias, specifically torsades de pointes (TdP) and sudden cardiac death (SCD). Female gender is a risk factor for arrythmias, specifically drug related TdP, and both endogenous and exogenous sex hormones affect the QT interval. The impact of gender and gonadal steroids on cardiac rhythm and arrhythmias is recognized and is more prominent in females than in males. There is a higher propensity towards arrhythmia in females than males and rate corrected QT intervals are longer in females than males. While QTc intervals are longer in women than in men, this difference only becomes apparent after puberty suggesting that sex hormones may be responsible. In addition, progesterone, not estrogen has dominant effect on ventricular repolarization in women. Androgens are known to be protective and higher serum progesterone concentrations may be protective against drug-induced QT interval lengthening. 

IT TAKES A VILLAGE: Community Approach to Preventing Child Abuse

Diving Deep in the Ocean State: Hasbro Electives / August 26, 2021

by Greg Lopez (’24)
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If we can identify community risk factors that contribute to higher rates of child maltreatment, we do our kids a disservice if we do not actively confront those issues. Thinking upstream widens the scope of possible solutions, as any approach that seeks to reduce poverty or make communities safer becomes viable. Advocating for causes like universal healthcare, increased wages, and more affordable housing would all directly impact risk factors of child maltreatment by providing socioeconomic benefits to families and communities. These broader efforts, in conjunction with existing targeted interventions, provide a truly comprehensive approach to addressing child maltreatment and ensure that we are doing everything we can to keep kids safe.

HEART ON FIRE: Post-COVID Vaccine Myocarditis

Diving Deep in the Ocean State: Hasbro Electives / August 2, 2021

by Torie Quinn, DO (’23)
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n between the Pfizer and Moderna mRNA SARS-CoV-2 vaccines and myocarditis. Recently, Marshall et al. Pediatrics. 2021 illustrated a case series of seven healthy males aged 14-19 who, just like the patient above, presented with chest pain within four days of their second dose of the Pfizer vaccine and were found to have ST elevations, significant troponin leak, cardiac dysfunction and positive cardiac MRI findings. 

While this is fascinating and ever-evolving science, it also highlights what I believe to be one of the most crucial skills in pediatrics – the ability to sift through the literature, look parents in the eyes, and counsel them on how to keep their children safe. It requires shared decision making, anticipatory guidance, and benefit-risk discussions. Because while we as medical professionals view a 12-in-one-million chance of developing myocarditis after receipt of a vaccine that can help curtail a pandemic as a significant benefit, parents will understandably focus on the risk of their child being one of those 12.

THIS IS BANANAS!

Diving Deep in the Ocean State: Hasbro Electives / August 3, 2020

by Melissa Rodriguez, MD (’21)
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“Hypokalemia is the presence of a serum potassium concentration less than 3.5 mEq/L, but it isn’t considered life threatening until around less than 2.5 mEq/L. In pediatrics the most common cause of hypokalemia is GI losses such as diarrhea and vomiting. Other reasons include urinary losses (diuretic use, DKA), inadequate potassium intake (eating disorders), and intracellular shifts of potassium (metabolic alkalosis, beta adrenergic agonist use, hyperthyroidism).”

BREATHING EASY

Diving Deep in the Ocean State: Hasbro Electives / August 3, 2020

by Adam Kronish, MD (’22)
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“Next time I get overwhelmed by the med rec of a complex care patient and their sick plan, I’ll take a moment, take a deep breath, and remember that however frustrating it may be for me to find the Sick plan documented in EPIC, these families have an exponentially more demanding time taking care of these children to prevent them from coming into the hospital.”