Faculty Bibliography

OBJECTIVES/OBJECTIVE:We aimed to describe patient and encounter characteristics of patient portal users and nonusers and to evaluate usage of specific portal functions in a pediatric emergency department (PED). METHODS:A single-center retrospective analysis of patients up to 21 years of age at an urban, tertiary care pediatric emergency department was conducted. Portal registration status of patients was analyzed. Relations between variables and usage were evaluated using logistic regression. Portal functions were analyzed for prevalence and timing of usage with respect to the PED encounter. RESULTS:Portal users made up 48.4% of 29,881 patients. Variables associated with portal usage included multiple prior PED visits (aOR 2.19, CI: 2.04-2.35), multiple admissions (aOR 2.61, CI: 2.00-3.46), PED length of stay greater than 6 hours (aOR 1.30, CI: 1.17-1.5,) and patient Hispanic ethnicity (aOR 1.24, CI: 1.13-1.36). Non-English primary language (aOR 0.64, CI: 0.60-0.70) and patient male sex (aOR 0.90, CI: 0.84-0.96) were associated with lower likelihood of usage. About 17% of users viewed laboratory and imaging results during the PED visit, and 67% within 7 days after visit. CONCLUSIONS:Between portal users and nonusers, there are differences with respect to patient sex, ethnicity, primary language, number of prior emergency visits and admissions, and length of stay in the pediatric emergency department. Portals are not commonly accessed during visits but are commonly used to view laboratory and imaging data after the emergency visit.

PURPOSE OF REVIEW:Point-of-care ultrasound (POCUS) has various diagnostic and therapeutic applications in the pediatric acute care setting that have an impact on clinical outcomes. RECENT FINDINGS:POCUS can improve diagnostic efficiency and expedite management in pediatric patients who present to the emergency department with common complaints such as respiratory distress, abdominal pain, shock, and pain. SUMMARY:Rapid advancements in POCUS have allowed it to become a powerful tool in pediatric care. As the clinical applications of ultrasound diversify, research is needed to evaluate impacts on healthcare outcomes, delivery, and costs.

BACKGROUND:Infectious bronchitis virus (IBV) is a pathogenic chicken coronavirus. Currently, vaccination against IBV is only partially protective; therefore, better preventions and treatments are needed. Plants produce antimicrobial secondary compounds, which may be a source for novel anti-viral drugs. Non-cytotoxic, crude ethanol extracts of Rhodiola rosea roots, Nigella sativa seeds, and Sambucus nigra fruit were tested for anti-IBV activity, since these safe, widely used plant tissues contain polyphenol derivatives that inhibit other viruses. RESULTS:Dose-response cytotoxicity curves on Vero cells using trypan blue staining determined the highest non-cytotoxic concentrations of each plant extract. To screen for IBV inhibition, cells and virus were pretreated with extracts, followed by infection in the presence of extract. Viral cytopathic effect was assessed visually following an additional 24 h incubation with extract. Cells and supernatants were harvested separately and virus titers were quantified by plaque assay. Variations of this screening protocol determined the effects of a number of shortened S. nigra extract treatments. Finally, S. nigra extract-treated virions were visualized by transmission electron microscopy with negative staining.Virus titers from infected cells treated with R. rosea and N. sativa extracts were not substantially different from infected cells treated with solvent alone. However, treatment with S. nigra extracts reduced virus titers by four orders of magnitude at a multiplicity of infection (MOI) of 1 in a dose-responsive manner. Infection at a low MOI reduced viral titers by six orders of magnitude and pretreatment of virus was necessary, but not sufficient, for full virus inhibition. Electron microscopy of virions treated with S. nigra extract showed compromised envelopes and the presence of membrane vesicles, which suggested a mechanism of action. CONCLUSIONS:These results demonstrate that S. nigra extract can inhibit IBV at an early point in infection, probably by rendering the virus non-infectious. They also suggest that future studies using S. nigra extract to treat or prevent IBV or other coronaviruses are warranted.