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Wekre SL, Uleberg O, Næss LE, Haugland H. Mortality rates in Norwegian HEMS-a retrospective analysis from Central Norway. Scand J Trauma Resusc Emerg Med 2024; 32:29. [PMID: 38627817 PMCID: PMC11022357 DOI: 10.1186/s13049-024-01202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) provide rapid and specialized care to critically ill or injured patients. Norwegian HEMS in Central Norway serves an important role in pre-hospital emergency medical care. To grade the severity of patients, HEMS uses the National Advisory Committee for Aeronautics' (NACA) severity score. The objective of this study was to describe the short- and long term mortality overall and in each NACA-group for patients transported by HEMS Trondheim using linkage of HEMS and hospital data. METHODS The study used a retrospective cohort design, aligning with the STROBE recommendations. Patient data from Trondheim HEMS between 01.01.2017 and 31.12.2019 was linked to mortality data from a hospital database and analyzed. Kaplan Meier plots and cumulative mortality rates were calculated for each NACA group at day one, day 30, and one year and three years after the incident. RESULTS Trondheim HEMS responded to 2224 alarms in the included time period, with 1431 patients meeting inclusion criteria for the study. Overall mortality rates at respective time points were 10.1% at day one, 13.4% at 30 days, 18.5% at one year, and 22.3% at three years. The one-year cumulative mortality rates for each NACA group were as follows: 0% for NACA 1 and 2, 2.9% for NACA 3, 10.1% for NACA 4, 24.7% for NACA 5 and 49.5% for NACA 6. Statistical analysis with a global log-rank test indicated a significant difference in survival outcomes among the groups (p < 2⋅10- 16). CONCLUSION Among patients transported by Trondheim HEMS, we observed an incremental rise in mortality rates with increasing NACA scores. The study further suggests that a one-year follow-up may be sufficient for future investigations into HEMS outcomes.
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Affiliation(s)
- Stian Lande Wekre
- Norwegian University of Science and Technology (NTNU), Trondheim, NO-7018, Norway.
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Lars Eide Næss
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Major T, Tiet MY, Horvath R, Hensiek AE. Correlation Between the SARA and A-T NEST Clinical Severity Scores in Adults with Ataxia-Telangiectasia. Cerebellum 2024; 23:455-458. [PMID: 37036622 PMCID: PMC10951025 DOI: 10.1007/s12311-023-01528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 04/11/2023]
Abstract
Ataxia-Telangiectasia (A-T) is an autosomal recessive neurodegenerative disease associated with cerebellar ataxia and extrapyramidal features. A-T has a complex and diverse phenotype with varying rates of disease progression. The development of robust natural history studies and therapeutic trials relies on the accurate recording of phenotype using relevant and validated severity of illness indexes. We compared the commonly used Scale for the Assessment and Rating of Ataxia (SARA) and the disease-specific A-T Neurological Examination Scale Toolkit (A-T NEST), in our adult A-T cohort. We found a strong correlation between A-T NEST and the established SARA score, validating the use of A-T NEST and SARA in capturing the natural history of A-T patients.
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Affiliation(s)
- Toby Major
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0SP, UK
| | - May Yung Tiet
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 2QQ, UK
| | - Anke E Hensiek
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
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Tang JY, Chen ML, Wan M, Wei JY, Qian T, Fan YK, Yang Z, Fu J, Li J. Associations of serum gamma-linolenic acid levels with erythema severity and anxiety/depression status in patients with rosacea. An Bras Dermatol 2024; 99:189-195. [PMID: 38061964 PMCID: PMC10943310 DOI: 10.1016/j.abd.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The development of rosacea is suggested to be closely associated with lipid metabolism, inflammation, and anxiety/depression. Gamma linolenic acid (GLA) is a key factor participating in lipid metabolism, which is also confirmed to regulate the inflammatory response. However, the associations of serum GLA levels with rosacea severity and psychological status still remain unclear. OBJECTIVE AND LIMITATIONS OF THE STUDY The present study aimed to investigate the associations of gamma linolenic acid (GLA), a key factor participating in lipid metabolism and the inflammatory response, with rosacea severity and psychological status. The present study still had some limitations. First, this study is a cross-sectional study and does not provide longitudinal evidence about the relationship between GLA and rosacea; Second, the cohort in this study is also relatively small, and a larger cohort is needed in further investigation to reveal the potential role of lipid metabolism in the pathogenesis of rosacea. METHODS A total of 62 rosacea patients were consecutively recruited. Patient's Self-Assessment (PSA) scale and Clinician Erythema Assessment (CEA) as well as 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Patient Health Questionnaire (PHQ-9) were conducted to evaluate the degree of erythema severity and anxiety/depression, respectively. Serum GLA levels were determined by gas chromatography mass. RESULTS Lower levels of serum GLA in rosacea patients were observed (p<0.001), and subgroup analysis revealed that patients with higher-level GLA had lower scores of PSA, CEA, GAD-7 and PHQ-9. Moreover, Spearman correlation analysis uncovered that serum GLA levels were negatively associated with PSA, CEA, GAD-7 as well and PHQ-9 scores, respectively. Linear regression model found that serum GLA levels at baseline were a predictive factor for prognosis of clinical outcomes after 1-month conventional treatment. CONCLUSION The present study indicates that lower levels of serum GLA in rosacea patients are negatively associated with the degree of erythema and anxiety/depression status.
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Affiliation(s)
- Jin-Yi Tang
- Office of Scientific Research Administration, Division of Medical Affairs, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mei-Ling Chen
- Nuclear Medicine Department, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mei Wan
- Dermatology Department, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jin-Yu Wei
- Dermatology Department, The 920th Hospital of Joint Logistics Support Force of PLA, Kunming, China
| | - Tian Qian
- Dermatology Department, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Kun Fan
- Dermatology Department, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi Yang
- Dermatology Department, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Fu
- Urology, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Jian Li
- Dermatology Department, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Goo HW, Park SH. Complimentary Cardiac Computed Tomography Ventricular Volumetry-Derived Metrics of Severity in Patients with Ebstein Anomaly: Comparison with Echocardiography-Based Severity Indices. Pediatr Cardiol 2024; 45:24-31. [PMID: 38012401 DOI: 10.1007/s00246-023-03342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
Detailed three-dimensional cardiac segmentations using cardiac computed tomography (CT) data is technically feasible in patients with Ebstein anomaly, but its complementary role has not been evaluated. This single-center, retrospective study was aimed to evaluate the complementary role of cardiac CT ventricular volumetry in evaluating the severity of Ebstein anomaly. Preoperative cardiac CT ventricular volumetry was performed in 21 children with Ebstein anomaly. CT-based ventricular functional measures were compared between Carpentier types, and between definitive surgical repair types. The Celermajer severity index measured with echocardiography was correlated with CT-based functional parameters. Total right ventricle (RV) and functional RV (fRV) volumes, fRV fraction, fRV/left ventricle (LV) volume ratio, and end-diastolic CT severity index demonstrated statistically significant differences between Carpentier type A/B and Carpentier type C/D (p < 0.05). The Celermajer severity index measured with echocardiography showed a high positive correlation with the end-diastolic CT severity index (R = 0.720, p < 0.002). There were no statistically significant differences in both echocardiography- and CT-based functional measures between patients with biventricular repair and patients with one-and-a-half or univentricular repair (p > 0.05). Compared with echocardiography, cardiac CT ventricular volumetry can provide the severity of Ebstein anomaly objectively and may be used in select patients when echocardiographic results are inconclusive or inconsistent.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Sang Hyub Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Ribeiro de Souza ALC, Piovezani A, Ventura JC, Penido MGMG, Bresolin NL, Moreno YMF. Nutritional and clinical factors associated with acute kidney injury development in critically ill children. J Nephrol 2023; 36:2601-2611. [PMID: 37921951 DOI: 10.1007/s40620-023-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/07/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in the pediatric intensive care unit (ICU) and is associated with poorer clinical outcomes. There is scarce data to support an association between nutritional status and nutrient delivery in critically ill pediatric patients. Therefore, the present study aimed to identify the nutritional and clinical factors associated with the development of AKI during pediatric ICU stay. METHODS This prospective study included critically ill pediatric patients aged < 15 years who were admitted to the medical and surgical pediatric ICU. Clinical, laboratory, nutritional status, nutritional therapy parameters, and AKI data were recorded. Adjusted logistic regression was applied and expressed as odds ratio (OR) and 95% confidence interval (95%CI). P-value < 0.05 was considered significant. RESULTS We enrolled 108 patients with a median age of 9 months (interquartile range/IQR 2.4-62.5), and 43.5% developed AKI. Sepsis/septic shock (OR 8.00; 95% CI 2.06-32.51, p = 0.003), higher severity of illness (OR 1.89; 95% CI 1.24-2.90, p = 0.003), hypoalbuminemia (OR 4.11; 95% CI 1.61-10.46, p = 0.006), edema (OR 3.42, 95% CI 1.10-10.67, p = 0.034), fluid overload (OR 3.52, 95% CI 1.56-7.96, p = 0.003), need for mechanical ventilation (OR 3.62, 95% CI 1.45-9.04, p = 0.006) and adequate protein intake (OR 0.79, 95% CI 0.63-1.00, p = 0.048) were associated with development of AKI. CONCLUSIONS Hypoalbuminemia, need for mechanical ventilation, fluid overload, severity of illness, sepsis/septic shock, and edema were risk factors for AKI in pediatric ICU. Furthermore, adequate protein intake is associated with AKI during pediatric ICU stay, making it important to implement nutritional assessment and nutritional therapy protocols for critically ill pediatric patients.
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Affiliation(s)
| | - Alberto Piovezani
- Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil
| | - Julia Carvalho Ventura
- Federal University of Santa Catarina, Graduate Program in Nutrition, Florianópolis, Santa Catarina, Brazil
| | - Maria Goretti Moreira Guimarães Penido
- Santa Casa de Belo Horizonte Hospital - Pediatric Nephrology Unit, Nephrology Center, Belo Horizonte, Minas Gerais, Brazil.
- Federal University of Minas Gerais , Pediatric Nephrology Unit, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Yara Maria Franco Moreno
- Federal University of Santa Catarina, Graduate Program in Nutrition, Florianópolis, Santa Catarina, Brazil
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Upreti G, Thomas R, Sundaresan R, Rebekah G, Rupali P, Jasper A. Clinico-Radiological Evaluation for Longitudinal Assessment in Central Skull Base Osteomyelitis: Proposal of Novel Scoring System. Indian J Otolaryngol Head Neck Surg 2023; 75:3553-3564. [PMID: 37974699 PMCID: PMC10646027 DOI: 10.1007/s12070-023-03956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
This study aims to evaluate clinical, radiological and laboratory parameters for longitudinal assessment and prognostication in central skull base osteomyelitis (CSBO). Novel radiological score and cranial nerve assessment score (CNAS) have been proposed and analysed along with pain score (VAS), ESR, CRP, WBC count, and HbA1c for utility in disease-monitoring and predicting outcome in CSBO. CSBO cases managed in a tertiary care centre from January 2018 to November 2020, with a minimum follow-up of 6 months were included. The parameters were recorded at presentation, 3-month, 6-month postoperative follow-up, and at completion of therapy, for statistical analysis. Significant positive correlation was found amongst pain score, CNAS, radiological score, ESR, and CRP at different timelines. On longitudinal assessment, there was a statistically significant reduction in above-mentioned parameters, in the cases who recovered. Those with initial radiological score < 30, pain score ≤ 7, and CNAS < 10 showed early clinical improvement, required shorter duration of antimicrobial therapy, and exhibited higher probability of becoming disease-free at an earlier time, compared to those presenting with higher scores. We propose the use of pain score, a novel cranial nerve assessment score, and a novel radiological score for longitudinal assessment in CSBO. The trend in these parameters along with ESR and CRP are useful to monitor the disease process. The initial assessment scores can predict duration of antimicrobial therapy and probability of early recovery. WBC count and HbA1c were neither useful for disease-monitoring nor predicting outcome.
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Affiliation(s)
- Garima Upreti
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu India
- Present Address: Department of Otorhinolaryngology, All India Institute of Medical Sciences, Rajkot, Gujarat 360006 India
| | - Regi Thomas
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu India
| | - Rajan Sundaresan
- Skull Base Surgery Unit, Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu India
| | - Anitha Jasper
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu India
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Han H, Zhao Y, Lv Q, Liu J, Liang Y. Reliability and Validity of the Chinese Version of Reflux Symptom Score. J Voice 2023:S0892-1997(23)00268-0. [PMID: 37743110 DOI: 10.1016/j.jvoice.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To evaluate the reliability, validity and clinical value of the Chinese version of reflux symptom score (RSS) (RSS in Chinese). METHODS This was a prospective study that contained 42 healthy volunteers and 135 possible laryngopharyngeal reflux disease (LPRD) patients. Reflux symptom index, reflux finding score, oropharyngeal pH monitoring (Dx-pH monitoring), and RSS of each patient were performed. RSS was performed again after 1 week. Confirmed LPRD patients were treated with proton pump inhibitor (PPI) for 8 weeks. And RSS was performed again after treatment. The reliability and validity of RSS was evaluated. RESULTS The Cronbach's α coefficient of the Chinese version of RSS was 0.772, which indicated good internal reliability. The results of test-retest found all P values were less than 0.05, which supported good external reliability. The comparison of the results of RSS with oropharyngeal pH monitoring discovered a diagnostic coincidence rate of 83.70% and a positive predictive value of 84.96%, which showed good criterion validity. After 8 weeks treatment of PPI, RSS decreased significantly (pretreatment 84.79 ± 42.50,post-treatment 20.11 ± 22.82, P < 0.001), indicating good responsiveness to change of RSS. The score of quality of life impact of suspected LPRD patients was obviously higher than that of healthy volunteers (t = 7.153, P < 0.001). All patients and volunteers agreed that RSS in Chinese can evaluate their symptoms well. CONCLUSION RSS in Chinese had good internal and external reliability, good criterion validity and good responsiveness to change. The content and method of evaluation of RSS in Chinese was better and more comprehensive. RSS in Chinese could be a new instrument to evaluate LPRD in China.
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Affiliation(s)
- Honglei Han
- Otolarygology Head and Neck Surgey Department, China-Japan Friendship Hospital, Beijing city, Beijing, China.
| | - Yu Zhao
- Otolarygology Head and Neck Surgey Department, China-Japan Friendship Hospital, Beijing city, Beijing, China
| | - Qiuping Lv
- Otolarygology Head and Neck Surgey Department, China-Japan Friendship Hospital, Beijing city, Beijing, China
| | - Jianfeng Liu
- Otolarygology Head and Neck Surgey Department, China-Japan Friendship Hospital, Beijing city, Beijing, China
| | - Yan Liang
- Gastroesophageal Surgery Department, Chinese PLA Rocket Force Characteristic Medical Center, Beijing city, Beijing, China
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Jiao Y, Liu Y, Li H, Song Z, Wang S, Zhang J, Li J, Liu J, Wang P, Chen Y. Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes. BMC Pregnancy Childbirth 2023; 23:591. [PMID: 37596554 PMCID: PMC10436574 DOI: 10.1186/s12884-023-05862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND HELLP syndrome refers to a group of clinical syndromes characterized by hemolysis, elevated liver enzymes and low platelet, and the evidence on the association between proteinuria and the severity of HELLP and its maternal and neonatal outcomes is rare. METHODS 106 pregnant women were assigned to the proteinuric group (24-hUPro ≥ 0.3 g, 79 cases) and the non-proteinuric group (24-hUPro < 0.3 g, 27 cases). The proteinuric group was further divided into three subgroups: mild group (24-hUPro:0.3-2.0 g, 33 cases), moderate group (24-hUPro:2.0-5.0 g, 21 cases) and severe group (24-hUPro: ≥5.0 g, 25 cases). The general clinical data, laboratory indexes, complications and pregnancy outcome and adverse neonatal outcomes of HELLP with or without proteinuric were analyzed. RESULTS Compared with proteinuric group, the non-albuminuric group or in the three proteinuric subgroups of HELLP pregnant women's, increased proteinuria was associated with earlier onset gestations, higher incidence of abdominal pain, skin jaundice, headache, blurred vision (p < 0.05 respectively), and also the higher levels of ALT, AST, LDH, Fib, APTT, ATII, proportions of tubular urine and lower levels of ALB, PLT (p < 0.05 respectively). In the three subgroups of the proteinuric group, the ratio of fetal growth restriction, cesarean section and postpartum hemorrhage were compared, and the difference was statistically significant (p < 0.05 respectively). Compared with the proteinuric group, the non-proteinuric group had higher birth weight, birth length, and lower SGA, admission rate in NICU (p < 0.05 respectively). In the three subgroups of the proteinuric group, significant differences were identified in the adverse outcomes of newborns (p < 0.05 respectively), and the incidence of adverse outcomes in neonates tended to be higher. Significant differences were identified in birth weight, birth length, and lower SGA and NICU occupancy rate among the three subgroups (p < 0.05 respectively). CONCLUSIONS HELLP syndrome is a severe complication of pregnancy, involving multiple systems of the whole body. It has posed a great challenge to obstetricians for its acute onset, dangerous condition, rapid progress, and great harm. Thus, insights into HELLP syndrome should be gained, and early diagnosis, early treatment and timely termination of pregnancy should be conducted to reduce the incidence of maternal and fetal adverse outcomes and improve maternal and fetal prognosis.
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Affiliation(s)
- Yan Jiao
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Yan Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Hongyuan Li
- Department of neurology, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Zimeng Song
- School of medical technology, Xuzhou Medical University, Xuzhou No.209, Tong Shan Road, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Shiliang Wang
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jiao Zhang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jian Li
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jia Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Peng Wang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
| | - Yanhong Chen
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
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Wilk M, Pripp AH, Korkosz M, Haugeberg G. Exploring pain catastrophizing and its associations with low disease activity in rheumatic inflammatory disorders. Rheumatol Int 2023; 43:687-694. [PMID: 36624289 DOI: 10.1007/s00296-023-05271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland.
| | - Are H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Macieja Jakubowskiego 2, 30-688, Cracow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Issak ER, Amin MM. Timing of corticosteroids in non-severe non-hospitalized COVID-19 patients: open-label, two-center, randomized controlled study (TICS-COV19 study). Korean J Intern Med 2023; 38:207-217. [PMID: 36646988 PMCID: PMC9993104 DOI: 10.3904/kjim.2022.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19); however, their utility remains controversial in mild to moderate cases. The timing of CSs initiation during the disease course remains unaddressed. The study aims to evaluate the impact of early CSs in non-severe COVID-19. METHODS A randomized controlled, open-label study was conducted on 754 COVID-19 patients randomized into a study group (n = 377) in which patients received CSs with COVID-19 protocol and a control group (n = 377) in which patients received COVID-19 protocol only. RESULTS Both groups were comparable regarding baseline characteristics, presenting symptoms, and inflammatory markers. The composite endpoint (need for O2, need for hospitalization or 28-day mortality) was significantly (p = 0.004) lower in the CS group 42 (11.14%) versus the control group 70 (18.67%) with odds ratio 0.55 (95% confidence interval [CI], 0.36 to 0.83), absolute risk reduction 7.53% (95% CI, 2.46% to 12.59%) and number needed to treat of 13.29 (95% CI, 7.94 to 40.61). Regarding severity at day 10, only (11.1%) of the study group patients were severe versus (18.7%) of the control group patients (p < 0.001). The median time-to-return to daily activity in the CS group was 8.0 days, while in the control group, it was 22.0 days (p < 0.001). CONCLUSION In non-severe COVID-19, CS may decrease hospitalization, severity, and mortality.
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Affiliation(s)
- Emad R. Issak
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo,
Egypt
- Department of Internal Medicine, Asalam Center, Cairo,
Egypt
| | - Mariam M. Amin
- Department of Internal Medicine, Allergy and Clinical Immunology, Faculty of Medicine, Ain Shams University, Cairo,
Egypt
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Bai L, Jiang W, Cheng R, Dang Y, Min L, Zhang S. Does Early Endoscopy Affect the Clinical Outcomes of Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding? A Systematic Review and Meta-Analysis. Gut Liver 2022:gnl220291. [PMID: 36578195 DOI: 10.5009/gnl220291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022] Open
Abstract
Background/Aims In patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), the optimal timing of endoscopy is still a matter of dispute. We conducted a systematic review and meta-analysis to determine the clinical benefit of early endoscopy. Methods A literature search of the MEDLINE, Embase, and Cochrane databases was conducted to identify publications from inception to March 1, 2022. Eligible studies included observational cohort studies and randomized controlled trials that reported clinical outcomes of endoscopy in patients with ANVUGIB. ANVUGIB patients who underwent endoscopy within 24 hours of admission were considered to have had an early endoscopy. The primary outcome was the mortality rate in ANVUGIB patients who had early or nonearly endoscopy. Results The final analysis included five randomized controlled studies (RCTs) and 20 observational studies from the 1,206 identified articles. The mortality rate was not significantly reduced among patients who received endoscopy performed within 24 hours, whether in cohort studies nor in RCTs. For subgroup analysis, a higher mortality rate was found only among patients who received very early endoscopy within 12 hours (odds ratio, 1.66; p<0.001, I2=0) in cohort studies. No significant difference in mortality rates was found among patients at high risk of bleeding who received early versus nonearly endoscopy. Conclusions Early endoscopy within 24 hours does not appear to significantly reduce the mortality rates of patients with ANVUGIB. Further well-designed studies are warranted to address if very early endoscopy within 12 hours can provide a clinical benefit for patients at high risk of bleeding.
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Affiliation(s)
- Liyi Bai
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
| | - Wei Jiang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
| | - Rui Cheng
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
| | - Yan Dang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
| | - Li Min
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, National Clinical Research Center for Digestive Diseases, and Beijing Digestive Disease Center
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12
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Beniwal A, Juneja D, Singh O, Goel A, Singh A, Beniwal HK. Scoring systems in critically ill: Which one to use in cancer patients? World J Crit Care Med 2022; 11:364-374. [PMID: 36439324 PMCID: PMC9693908 DOI: 10.5492/wjccm.v11.i6.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/12/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Scoring systems have not been evaluated in oncology patients. We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, APACHE IV, Simplified Acute Physiology Score (SAPS) II, SAPS III, Mortality Probability Model (MPM) II0 and Sequential Organ Failure Assessment (SOFA) score in critically ill oncology patients.
AIM To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.
METHODS We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period. Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.
RESULTS In our study, the overall intensive care unit and hospital mortality was 43.5% and 57.8%, respectively. All of the seven tested scores underestimated mortality. The mortality as predicted by MPM II0 predicted death rate (PDR) was nearest to the actual mortality followed by that predicted by APACHE II, with a standardized mortality rate (SMR) of 1.305 and 1.547, respectively. The best calibration was shown by the APACHE III score (χ2 = 4.704, P = 0.788). On the other hand, SOFA score (χ2 = 15.966, P = 0.025) had the worst calibration, although the difference was not statistically significant. All of the seven scores had acceptable discrimination with good efficacy however, SAPS III PDR and MPM II0 PDR (AUROC = 0.762), had a better performance as compared to others. The correlation between the different scoring systems was significant (P < 0.001).
CONCLUSION All the severity scores were tested under-predicted mortality in the present study. As the difference in efficacy and performance was not statistically significant, the choice of scoring system used may depend on the ease of use and local preferences.
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Affiliation(s)
- Anisha Beniwal
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Amit Goel
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Akhilesh Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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13
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Ye YM, Koh YI, Choi JH, Kim MA, Park JW, Kim TB, Nam YH, Chang YS, Park HS. The burden of symptomatic patients with chronic spontaneous urticaria: a real-world study in Korea. Korean J Intern Med 2022; 37:1050-1060. [PMID: 36068718 PMCID: PMC9449199 DOI: 10.3904/kjim.2022.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS Chronic spontaneous urticaria (CSU) poses a considerable burden both on the quality of life (QoL) of individual patients and on healthcare systems. Real‑world data evaluating the disease burden of CSU are limited in this country. This study evaluated the disease burden and healthcare resource utilization (HRU) among symptomatic CSU patients. METHODS This multicenter, noninterventional, retrospective, and cross-sectional study assessed CSU patients symptomatic for more than 6 months despite step-wise H1-antihistamine medications. Primary outcomes included Urticaria Activity Score over 7 days (UAS7) and Chronic Urticaria QoL scale (CU-QoL). Secondary outcomes included EuroQol 5-Dimension 5-Level (EQ-5D-5L), Dermatology Life Quality Index (DLQI), association of disease activity with QoL, medications used for the past 6 months, and HRU. RESULTS Five hundred patients with CSU were enrolled. Mean disease duration was 3.7 years. Based on UAS7, 22.2% of patients were in well-controlled status and 31.2%, 28.4%, and 18.2% of them had mild, moderate, and severe disease, respectively. Mean CU-QoL and DLQI scores were 57.5 ± 29.7 and 10.2 ± 7.6, respectively, while the EQ-5D-5L utility score was 0.8 ± 0.2. H1-antihistamines were prescribed to 95% of patients, while omalizumab was prescribed to 33% of patients. Most patients (98%) had outpatient visits in the past 6 months. Negative correlations were noted between UAS7 and CU-QoL, EQ-5D-5L, EQ-5D-5L visual analog scale scores, but a positive correlation was noted with DLQI score (p < 0.001 for all). The number of outpatient department visits increased with disease activity (p = 0.001). CONCLUSION CSU affects QoL, leading to increased HRU, particularly in patients with severe disease.
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Affiliation(s)
- Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Il Koh
- Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Won Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Lee HJ, Ko BS, Ryoo SM, Han E, Suh GJ, Choi SH, Chung SP, Lim TH, Kim WY, Kwon WY, Hwang SY, Jo YH, Shin J, Shin TG, Kim K, Chung TN, Lee JH, Kim KS, Park YS, Yoon YH, Choi HS, Han KS, Kang G, Kim YJ, Cho H. Modified cardiovascular SOFA score in sepsis: development and internal and external validation. BMC Med 2022; 20:263. [PMID: 35989336 PMCID: PMC9394016 DOI: 10.1186/s12916-022-02461-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. METHODS We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. RESULTS We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%). CONCLUSIONS Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.
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Affiliation(s)
- Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Eunah Han
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - You Hwan Jo
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-Do, South Korea.
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Tejwani R, Lee HJ, Hughes TL, Hobbs KT, Aksenov LI, Scales CD, Routh JC. Predicting postoperative complications in pediatric surgery: A novel pediatric comorbidity index. J Pediatr Urol 2022; 18:291-301. [PMID: 35410802 PMCID: PMC9233007 DOI: 10.1016/j.jpurol.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/25/2022] [Accepted: 03/06/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION/BACKGROUND Comorbidity-driven surgical risk assessment is essential for informed patient counseling, risk-stratification, and outcomes-based health-services research. Existing mortality-focused comorbidity indices have had mixed success at risk-adjustment in children. OBJECTIVE To develop a new comorbidity-driven multispecialty surgical risk index predicting 30-day postoperative complications in children. STUDY DESIGN This retrospective cohort study investigated children undergoing surgical procedures across seven specialties in 2014-2015 using the MarketScan® Research databases. The risk index was derived separately for ambulatory and inpatient surgery patients using logistic regression with backward selection. The performance of the novel index in discriminating postoperative complications vis-à-vis three existing comorbidity indices was compared using bootstrapping and area under the receiver operating characteristics curves (AUC). RESULTS We identified 190,629 ambulatory and 22,633 inpatient patients. The novel index had the best performance for discriminating postoperative complications for inpatients (AUC 0.76, 95% confidence interval [CI] 0.75-0.77) relative to the Charlson Comorbidity Index (CCI, 0.56, 95% CI 0.56-0.57), Van Walraven Index (VWI, 0.60, 95% CI 0.60-0.61), and Rhee Score (RS, 0.69, 95% CI 0.68-0.70). In the ambulatory cohort, the novel index outperformed all three existing indices, though none demonstrated excellent discriminatory ability for complications (novel score 0.68, 95% CI 0.67-0.68; CCI 0.53, 95% CI 0.52-0.53; VWI 0.53, 95% CI 0.52-0.53; RS 0.50, 95% CI 0.49-0.50). DISCUSSION In both inpatient and ambulatory pediatric settings, our novel comorbidity index demonstrated better performance at predicting postoperative complications than three widely used alternatives. This index will be useful for research and may be adaptable to clinical settings to identify high-risk patients and facilitate perioperative planning. CONCLUSION We developed a novel pediatric comorbidity index with better performance at predicting postoperative complications than three widely used alternatives.
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Affiliation(s)
- Rohit Tejwani
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Taylor L Hughes
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin T Hobbs
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Leonid I Aksenov
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
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Sahin U, Reeve K, Tochtermann G, Kilanowski K, Navarini A, Imhof L, Held U, Hofbauer GFL. HautTief Multidisciplinary Educational Program for Patients with Psoriasis or Atopic Dermatitis: A Randomized Controlled Study. Dermatology 2022; 238:1050-1059. [PMID: 35533665 PMCID: PMC9677846 DOI: 10.1159/000524225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving health-related quality of life (HRQoL), disease severity, and treatment adherence through patient education is an increasingly important, yet relatively new area in dermatology. This randomized controlled trial aims to contribute to this growing area of research by exploring the effects of a 9-week educational program for patients with chronic skin diseases. Objective The aim of the study was to evaluate the effect of a multidisciplinary educational program on HRQoL and disease severity in patients with psoriasis or atopic dermatitis (AD). Methods Sixty-four patients with diagnosed psoriasis or AD were recruited from University Hospital Zurich and randomized (1:1) to the intervention or control group. To assess HRQoL, the following self-reported questionnaires were used: Dermatology Life Quality Index (DLQI), Skindex-29, EuroQol-5D (EQ-5D), RAND 36-Item Short Form Survey (SF-36), and Beck Depression Inventory (BDI) to measure depression symptoms. Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI) were used to capture disease extent. These scores were assessed at four study visits, which were performed at baseline and 3, 6, and 9 months after the start of the program. Results At month 6, an improvement of at least 25% in BDI was recorded in 15 (68.2%) of 22 patients in the intervention group and 6 (27.3%) of 22 patients in the control group (difference 40.9%, p = 0.016). 53.3% (16 of 30) of patients achieved an improvement in one subdomain of the SF-36 score (role limitations due to emotional problems) at 6-month follow-up, compared with 23.1% (6 of 26) of those not attending the educational program (difference 30.2%; p = 0.042). No significant differences in DLQI, Skindex-29, EQ-5D, PASI, and EASI between both groups at the three time points were found. Conclusion An educational program may improve HRQoL and depression status of patients with psoriasis or AD.
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Affiliation(s)
- Ugur Sahin
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Giulia Tochtermann
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Kamilla Kilanowski
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich (UZH), Zurich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
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Sabaté JM, Iglicki F. Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome. World J Gastroenterol 2022; 28:732-744. [PMID: 35317278 PMCID: PMC8891724 DOI: 10.3748/wjg.v28.i7.732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/18/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bifidobacterium longum 35624 has shown efficacy in improving irritable bowel syndrome (IBS) symptoms compared with placebo in double-blind randomized studies. However, few data are available from real-life clinical practice or from studies that used Rome IV criteria to diagnose IBS.
AIM To assess the effect of B. longum 35624 on IBS severity and quality of life in a real-life setting.
METHODS From November 2018 to January 2020, 278 patients with IBS (according to Rome IV criteria) were enrolled in a prospective, open-label, multicenter observational study by private practice gastroenterologists to received one capsule of B. longum 35624 (109 colony-forming units) per day for 30 d. Participation in the study was independently proposed to patients during spontaneous consultations. Disease severity (assessed by the IBS severity scoring system) and patient quality of life (assessed by the IBS quality of life questionnaire) were compared between the inclusion visit (baseline) and the visit at the end of 30 d of treatment. The characteristics of patients were described at baseline. Continuous variables comparisons between inclusion and end-of-treatment visits were performed using the t-test and Kruskal-Wallis test. Categorical variables comparisons were performed using the χ2 test.
RESULTS A total of 233 patients, with a mean age of 51.4 years and composed of 71.2% women, were included in the study. Of these patients, 48.1% had moderate IBS and 46.4% had severe IBS. After a 30-d treatment period with one B. longum 35624 capsule per day, a significant decrease in IBS severity was observed compared to baseline (mean ± SD, IBS severity scoring system scores: 208 ± 104 vs 303 ± 81, P < 0.001) and 57% of patients moved to lower severity categories or achieved remission. The quality of life of patients was also improved by the treatment (IBS Quality of Life questionnaire score: 68.8 ± 20.9 vs 60.2 ± 20.5; P < 0.001) and 63.8% of patients were satisfied with the treatment.
CONCLUSION Thirty days of treatment with B. longum 35624 reduces disease severity and improves the quality of life of patients with IBS, particularly those with the most severe forms of IBS.
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Affiliation(s)
- Jean-Marc Sabaté
- Department of Gastroenterology, Hôpital Avicenne, AP-HP, Sorbonne Paris Nord, Bobigny 93000, France
- INSERM U-987, Pathophysiology and Clinical Pharmacology of Pain, Ambroise Paré Hospital, Boulogne-Billancourt 92100, France
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Inoue A, Takahashi H, Ibe T, Ishii H, Kurata Y, Ishizuka Y, Hamamoto Y. Comparison of semiquantitative chest CT scoring systems to estimate severity in coronavirus disease 2019 (COVID-19) pneumonia. Eur Radiol 2022; 32:3513-3524. [PMID: 35020014 PMCID: PMC8753957 DOI: 10.1007/s00330-021-08435-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the clinical usefulness among three different semiquantitative computed tomography (CT) severity scoring systems for coronavirus disease 2019 (COVID-19) pneumonia. METHODS Two radiologists independently reviewed chest CT images in 108 patients to rate three CT scoring systems (total CT score [TSS], chest CT score [CCTS], and CT severity score [CTSS]). We made a minor modification to CTSS. Quantitative dense area ratio (QDAR: the ratio of lung involvement to lung parenchyma) was calculated using the U-net model. Clinical severity at admission was classified as severe (n = 14) or mild (n = 94). Interobserver agreement, interpretation time, and degree of correlation with clinical severity as well as QDAR were evaluated. RESULTS Interobserver agreement was excellent (intraclass correlation coefficient: 0.952-0.970, p < 0.001). Mean interpretation time was significantly longer in CTSS (48.9-80.0 s) than in TSS (25.7-41.7 s, p < 0.001) and CCTS (27.7-39.5 s, p < 0.001). Area under the curve for differentiating clinical severity at admission was 0.855-0.842 in TSS, 0.853-0.850 in CCTS, and 0.853-0.836 in CTSS. All scoring systems correlated with QDAR in the order of CCTS (ρ = 0.443-0.448), TSS (ρ = 0.435-0.437), and CTSS (ρ = 0.415-0.426). CONCLUSIONS All semiquantitative scoring systems demonstrated substantial diagnostic performance for clinical severity at admission with excellent interobserver agreement. Interpretation time was significantly shorter in TSS and CCTS than in CTSS. The correlation between the scoring system and QDAR was highest in CCTS, followed by TSS and CTSS. CCTS appeared to be the most appropriate CT scoring system for clinical practice. KEY POINTS • Three semiquantitative scoring systems demonstrate substantial accuracy (area under the curve: 0.836-0.855) for diagnosing clinical severity at admission and (area under the curve: 0.786-0.802) for risk of developing critical illness. • Total CT score (TSS) and chest CT score (CCTS) were considered to be more appropriate in terms of clinical usefulness as compared with CT severity score (CTSS), given the shorter interpretation time in TSS and CCTS, and the lowest correlation with quantitative dense area ratio in CTSS. • CCTS is assumed to distinguish subtle from mild lung involvement better than TSS by adopting a 5% threshold in scoring the degree of severity.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Ōtsu, Japan.,Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hiroaki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Tatsuya Ibe
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Hisashi Ishii
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yuhei Kurata
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yoshikazu Ishizuka
- Department of Radiology, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yoichiro Hamamoto
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
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Brandt F, Solomayer EF, Sklavounos P. Correlation between the Incontinence Severity Index (ISI) and the quality of life dimensions of the King's Health Questionnaire (KHQ) in German-speaking urinary incontinent women. J Gynecol Obstet Hum Reprod 2021; 51:102288. [PMID: 34902634 DOI: 10.1016/j.jogoh.2021.102288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Incontinence Severity Index (ISI) is a patient questionnaire to ascertain severity of urinary incontinence (UI) via two items. The aim of this study was to translate the ISI into German, to compare it with the German-language King's Health Questionnaire (KHQ), an already validated German-language questionnaire within the scope of UI to measure condition-specific quality of life (QoL), and to gain more insights into association between symptom severity and QoL in German-speaking women affected. METHODS A total of 161 urinary incontinent women completed the ISI and the KHQ. Mean scores of the KHQ domains were computed and separated into severity-groups ascertained by the ISI (slight, moderate, severe, and very severe). Differences between severity-groups were examined using Kruskal-Wallis and Mann-Whitney U test. Correlation between ISI and KHQ were computed using Spearman's correlation coefficient to investigate construct validity of the ISI as well as association between symptom severity and QoL. RESULTS Overall, mean scores of the KHQ domains increased with increasing severity level. A consistent significant increase was found in role, physical, and social limitations (p < 0.05). Furthermore, the ISI showed moderate to strong correlations with related domains (convergent validity) and weak correlations with non-related domains of the KHQ (discriminant validity). CONCLUSIONS Construct validity of the German-language ISI is acceptable. Therefore this study supports its use in German-speaking women but further studies have to be done to gain more comprehensive insights into its psychometric properties. Moreover, increasing symptom severity is associated with decreasing QoL, especially concerning role, physical, and social limitations. TRIAL REGISTRATION NUMBER DRKS00018777.
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Affiliation(s)
- Florian Brandt
- Clinic for Gynecology, Obstetrics and Reproductive Medicine at Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany; IKK Südwest, Saarbrücken, Germany.
| | - Erich-Franz Solomayer
- Clinic for Gynecology, Obstetrics and Reproductive Medicine at Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Panagiotis Sklavounos
- Clinic for Gynecology, Obstetrics and Reproductive Medicine at Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
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Hayama M, Maeda Y, Shikina T, Tatehara S, Inokuchi G, Hoag JB, Sato T, Obata S, Nakatani A, Amano Y, Hida E, Nibu KI, Inohara H. Validation of epistaxis severity score for hereditary hemorrhagic telangiectasia in Japan. Auris Nasus Larynx 2021; 49:415-420. [PMID: 34857410 DOI: 10.1016/j.anl.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to assess the health-related QoL (HR-QoL) of patients with hereditary hemorrhagic telangiectasia (HHT), with emphasis on the role/social aspects, and validate the Japanese version of the epistaxis severity score (ESS) in these patients. METHODS The Japanese version of the ESS was created through forward and reverse translation, and consultation with the original author. A validation analysis was performed by comparing ESS severity with the invasiveness of previous treatments for epistaxis and assessing the correlation between the ESS and HR-QoL. Medical history forms, ESS questionnaires, and the Medical Outcomes Study Short Form 36 (SF-36) were distributed to participants with HHT in August 2020. The relation between the ESS and summary scores of SF-36 was assessed by performing analysis of variance and Spearman's correlation. RESULTS In total, 73 participants were included in this study. The average ESS was 5.02; there were mild (32.9%), moderate (45.2%), and severe (21.9%) epistaxis groups. Patients with higher ESS received a significantly more invasive treatment (Fisher's exact test, p < 0.05). The ESS was also negatively correlated with the physical component score (PCS) (r = -0.489, p < 0.001). Comorbid liver and gastrointestinal arteriovenous malformations significantly reduced the PCS (p < 0.05). Multiple regression analysis revealed that the ESS was a significant variable (p < 0.01). The role/social component score was significantly lower in the severe ESS group than in the mild or moderate group. CONCLUSION The Japanese version of the ESS was considered valid and may be useful as an outcome measure of future HHT-associated epistaxis trials in Japan.
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Affiliation(s)
- Masaki Hayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan.
| | - Yohei Maeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | | | - Shun Tatehara
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe city, Hyogo, Japan
| | - Go Inokuchi
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe city, Hyogo, Japan
| | - Jeffrey B Hoag
- Department of Pulmonary, Allergy and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Tomoharu Sato
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | - Sho Obata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | - Ayaka Nakatani
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | - Yuta Amano
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | - Eisuke Hida
- Department of Biostatistics and Data Science, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe city, Hyogo, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita city, Osaka, Japan
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Fazeli A, Sharifi S, Behdad F, Okati S, Esmaielifar G, Jelveh N, Eshghi P, Mohammadi S. Early high-titer convalescent plasma therapy in patients with moderate and severe COVID-19. Transfus Apher Sci 2021; 61:103321. [PMID: 34836825 PMCID: PMC8612443 DOI: 10.1016/j.transci.2021.103321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/06/2021] [Accepted: 11/13/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of COVID-19 convalescent plasma (CCP) has been approved by the FDA. We assessed the outcome of patients with moderate and severe COVID-19 following convalescent plasma therapy and the association with variables such as antibody titer in CCP units and transfusion time. MATERIALS AND METHODS In this prospective cohort study, 3097 patients with moderate and severe COVID-19 (according to WHO Progression Scale) had heterogeneous demographic and clinical characteristics received plasma with an unknown titer at the transfusion time. Firstly, information about age, sex, blood group, the time interval from hospitalization to CCP transfusion, underlying disease, and antibody titer with the outcome were investigated. Then, multivariate logistic regression and area under the curve (AUC) were performed for the association between disease severity and intubation variables with transfusion time and outcome. RESULTS Patients with younger age receiving CCP in the first five days of hospitalization had lower mortality (P < 0.0001). Moreover, patients without the underlying disease had lower mortality (P < 0.001). The mortality rate also decreased in severe patients who were intubated receiving CCP for less than five days (P < 0.001). In patients with moderate severity (score less than 5) who received IgG antibody levels above 1:320 in less than five days had lower mortality (P < 0.0001). CONCLUSION Our findings suggested that COVID-19 patients with the moderate type of disease receiving CCP units with high antibody titers in the early stages of the disease experienced greater effectiveness of CCP therapy.
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Affiliation(s)
- Alieh Fazeli
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Sharifi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Fatemeh Behdad
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Shamsi Okati
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Gilda Esmaielifar
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Nooshin Jelveh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Peyman Eshghi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeed Mohammadi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Khalil MH, Sekma A, Yaakoubi H, Bel Haj Ali K, Msolli MA, Beltaief K, Grissa MH, Boubaker H, Sassi M, Chouchene H, Hassen Y, Ben Soltane H, Mezgar Z, Boukef R, Bouida W, Nouira S. 30 day predicted outcome in undifferentiated chest pain: multicenter validation of the HEART score in Tunisian population. BMC Cardiovasc Disord 2021; 21:555. [PMID: 34798811 PMCID: PMC8603499 DOI: 10.1186/s12872-021-02381-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one. OBJECTIVE To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain. METHODS Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer-Lemeshow goodness of test. RESULTS We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85-0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03). CONCLUSION HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population.
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Affiliation(s)
- Mohamed Hassene Khalil
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
| | - Adel Sekma
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Sassi
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamadi Chouchene
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Youssef Hassen
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Houda Ben Soltane
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Zied Mezgar
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Wahid Bouida
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
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23
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Fijačko N, Masterson Creber R, Gosak L, Kocbek P, Cilar L, Creber P, Štiglic G. A Review of Mortality Risk Prediction Models in Smartphone Applications. J Med Syst 2021; 45:107. [PMID: 34735603 PMCID: PMC8566656 DOI: 10.1007/s10916-021-01776-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
Healthcare professionals in healthcare systems need access to freely available, real-time, evidence-based mortality risk prediction smartphone applications to facilitate resource allocation. The objective of this study is to evaluate the quality of smartphone mobile health applications that include mortality prediction models, and corresponding information quality.
We conducted a systematic review of commercially available smartphone applications in Google Play for Android, and iTunes for iOS smartphone applications. We performed initial screening, data extraction, and rated smartphone application quality using the Mobile Application Rating Scale: user version (uMARS). The information quality of smartphone applications was evaluated using two patient vignettes, representing low and high risk of mortality, based on critical care data from the Medical Information Mart for Intensive Care (MIMIC) III database.
Out of 3051 evaluated smartphone applications, 33 met our final inclusion criteria. We identified 21 discrete mortality risk prediction models in smartphone applications. The most common mortality predicting models were Sequential Organ Failure Assessment (SOFA) (n = 15) and Acute Physiology and Clinical Health Assessment II (n = 13). The smartphone applications with the highest quality uMARS scores were Observation—NEWS 2 (4.64) for iOS smartphones, and MDCalc Medical Calculator (4.75) for Android smartphones. All SOFA-based smartphone applications provided consistent information quality with the original SOFA model for both the low and high-risk patient vignettes.
We identified freely available, high-quality mortality risk prediction smartphone applications that can be used by healthcare professionals to make evidence-based decisions in critical care environments.
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Affiliation(s)
- Nino Fijačko
- Faculty of Health Sciences, University of Maribor, Zitna 15, Maribor, Slovenia.
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, NY, USA
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Primož Kocbek
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Leona Cilar
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Peter Creber
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, UK
| | - Gregor Štiglic
- Faculty of Health Sciences and Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
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24
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Fillâtre P, Dufour MJ, Behillil S, Vatan R, Reusse P, Gabellec A, Velmans N, Montagne C, Geffroy Du Coudret S, Droumaguet E, Merour V, Enouf V, Buzelé R, Valence M, Guillotel E, Gagnière B, Baidaliuk A, Zhukova A, Tourdjman M, Thibault V, Grolhier C, Pronier C, Lescure FX, Simon-Loriere E, Costagliola D, Van Der Werf S, Tattevin P, Massart N. A new SARS-CoV-2 variant with high lethality poorly detected by RT-PCR on nasopharyngeal samples: an observational study. Clin Microbiol Infect 2021:S1198-743X(21)00565-6. [PMID: 34627988 DOI: 10.1016/j.cmi.2021.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
Objectives In early January 2021 an outbreak of nosocomial cases of coronavirus disease 2019 (COVID-19) emerged in Western France; RT-PCR tests were repeatedly negative on nasopharyngeal samples but positive on lower respiratory tract samples. Whole-genome sequencing (WGS) revealed a new variant, currently defining a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage B.1.616. In March, the WHO classified this as a ‘variant under investigation’ (VUI). We analysed the characteristics and outcomes of COVID-19 cases related to this new variant. Methods Clinical, virological, and radiological data were retrospectively collected from medical charts in the two hospitals involved. We enrolled those inpatients with: (a) positive SARS-CoV-2 RT-PCR on a respiratory sample, (b) seroconversion with anti-SARS-CoV-2 IgG/IgM, or (c) suggestive symptoms and typical features of COVID-19 on a chest CT scan. Cases were categorized as B.1.616, a variant of concern (VOC), or unknown. Results From 1st January to 24th March 2021, 114 patients fulfilled the inclusion criteria: B.1.616 (n = 39), VOC (n = 32), and unknown (n = 43). B.1.616-related cases were older than VOC-related cases (81 years, interquartile range (IQR) 73–88 versus 73 years, IQR 67–82, p < 0.05) and their first RT-PCR tests were rarely positive (6/39, 15% versus 31/32, 97%, p < 0.05). The B.1.616 variant was independently associated with severe disease (multivariable Cox model HR 4.0, 95%CI 1.5–10.9) and increased lethality (28-day mortality 18/39 (46%) for B.1.616 versus 5/32 (16%) for VOC, p = 0.006). Conclusion We report a nosocomial outbreak of COVID-19 cases related to a new variant, B.1.616, which is poorly detected by RT-PCR on nasopharyngeal samples and is associated with high lethality.
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25
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de Assis AM, Moreira AM, Carnevale FC, Lanz-Luces JR. Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience. Radiol Bras 2021; 54:219-224. [PMID: 34393287 PMCID: PMC8354184 DOI: 10.1590/0100-3984.2020.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 08/30/2023] Open
Abstract
Objective To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.
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Affiliation(s)
- André Moreira de Assis
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Airton Mota Moreira
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - José Ramón Lanz-Luces
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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26
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Srikanth JK, Kumar R, Gupta NK, Ish P, Yadav SR, Chakrabarti S, Gupta N. A Prospective Study Evaluating Sleep Quality and Disorders in Post-ARDS Patients. ACTA ACUST UNITED AC 2021; 5:267-274. [PMID: 34368616 PMCID: PMC8324182 DOI: 10.1007/s41782-021-00158-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 04/27/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
Introduction Critically ill patients are predisposed to developing sleep disorders due to multiple factors like pre-existing sleep disorders, severe acute illness, sleep-altering medical interventions, and the disturbing intensive care unit (ICU) environment. In the current study, a multi-modality approach has been attempted to capture the different aspects of sleep disturbances, including insomnia (using ISI), daytime sleepiness (using ESS), sleep quality (using PSQI), sleep architecture, and SDB (using PSG). Materials and Methods The eligible ARDS survivor patients were updated about the study's design prior to hospital discharge. At admission, data regarding demographic details, clinical history, etiology of ARDS, and PaO2/FiO2 (P/F) ratio at presentation, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores was collected. All enrolled patients were evaluated twice (early-within 7 days of admission and late-after 6 weeks of discharge) by the Richards-Campbell Sleep Questionnaire (RCSQ), Insomnia severity index (ISI), and level 1 PSG. Additionally, ESS questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were also recorded in late evaluation. Abnormal sleep was defined if one or more of the following characteristics met: ISI > 15, ESS > 10, global PSQI > 5, AHI ≥ 5 events/h. Results Thirty patients were recruited out of the total of 88 ARDS patients screened at admission. The median (IQR) PaO2/FiO2 ratio and APACHE II scores were 176 (151-191.5) and 14 (14-16), respectively. The median (IQR) duration of stay in the ICU was 10 (7.3-19.5) days. The median RCSQ score in the early and late evaluation was 42 and 69, respectively. The mean ISI score in the early evaluation was 16.67 ± 4.72, which decreased to 11.70 ± 5.03 in late evaluation (p < 0.05). ISI score > 15 (clinical insomnia) was found in 18 out of 30 subjects (60%) in early evaluation and 11 out of 30 (36%) in late evaluation. During the early evaluation, sleep efficiency was low (median 59.9% and predominantly N1 and N2) which improved in late evaluation (median 80.6%). Of the 30 patients, only 4 had AHI > 5 in early evaluation and none in late evaluation. Neither of P/F ratio, SOFA, and APACHE II scores did correlate with ICU events in the early and late evaluations. Regression analysis showed subjects with ICU stay more than 10 days, duration of IMV more than 7 days, Fentanyl more than 7 mg, duration of sedative use more than 7 days was independently associated with poor objective sleep quality (low sleep efficiency, low TST and high arousal index) during the early and late evaluations after ICU discharge compared to counterparts (p value < 0.05). Conclusion We conclude that sleep quality in ARDS survivors was poor within 7 days of ICU discharge, characterized by severe disruption of sleep architecture and sleep-disordered breathing. After 6 weeks of ICU discharge sleep quality showed significant improvement in the N3 stage and AHI, however persistent insomnia was observed even at 6 weeks. Therefore, prior identification of risk factors and early diagnosis of sleep quality disorders in post-ARDS patients is essential.
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Affiliation(s)
- Juvva Kishan Srikanth
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Rohit Kumar
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Neeraj Kumar Gupta
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Pranav Ish
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Siddharth Raj Yadav
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Shibdas Chakrabarti
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
| | - Nitesh Gupta
- Office of Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, Room Number 638, Superspeciality Block, New Delhi, 110029 India
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Affiliation(s)
- Marie-Pierre Revel
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France.
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Ergashev K, Chung JM, Lee SD. Concealed index for concealed penis in prepubertal children. Investig Clin Urol 2021; 62:217-223. [PMID: 33660450 PMCID: PMC7940854 DOI: 10.4111/icu.20200401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The concealed penis (CP) is a congenital or acquired genital anomaly that requires surgical correction. To construct an objective CP severity index, we compared the penile parameters of a CP with a normal penis (NP) and postoperative outcomes of CP patients. MATERIALS AND METHODS In this retrospective study, 391 boys under 14 years who visited our hospital between September 2017 and February 2020 were included. Among these boys, 105 patients had a CP and 286 boys had a NP without CP. The stretched penile length (SPL), penile circumference (PC), and penile length above baseline skin level (BPL) were measured using a ruler (cm), and the testicular volume was measured using an orchidometer (mL). We defined the concealed index according to SPL (CIs) as BPL/SPL and the concealed index according to circumference (CIc) as BPL/PC. A repair of the CP was performed in the CP patients. All parameters were measured before surgery and after three months. RESULTS The CP had significantly shorter SPL and BPL, and smaller CIs, and CIc than the NP. The cutoff values for the CIs and CIc were 0.68 and 0.58, respectively (sensitivity 86.7% and 86.7%; specificity 65.0% and 88.5%, respectively). After repair of the CP, all penile parameters were significantly improved. CONCLUSIONS The CIs and CIc are useful and objective parameters for checking the severity of CP, and evaluating the postoperative outcome of CP repair. We newly introduced cutoff values for the CIs (0.68) and CIc (0.58) for diagnosing and evaluating CP repair.
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Affiliation(s)
- Kobiljon Ergashev
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Urology, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Devie A, Kanagaratnam L, Perotin JM, Jolly D, Ravey JN, Djelouah M, Hoeffel C. COVID-19: A qualitative chest CT model to identify severe form of the disease. Diagn Interv Imaging 2020; 102:77-84. [PMID: 33419693 PMCID: PMC7746121 DOI: 10.1016/j.diii.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
Chest CT helps identify patients with severe COVID-19 using only three qualitative features. A qualitative model based on three qualitative variables can avoid calculating semi-quantitative total CT score. New Early Warning Score 2 is comparable to the CT score for identification of severe forms of COVID-19.
Purpose The purpose of this study was to identify clinical and chest computed tomography (CT) features associated with a severe form of coronavirus disease 2019 (COVID-19) and to propose a quick and easy to use model to identify patients at risk of a severe form. Materials and methods A total of 158 patients with biologically confirmed COVID-19 who underwent a chest CT after the onset of the symptoms were included. There were 84 men and 74 women with a mean age of 68 ± 14 (SD) years (range: 24–96 years). There were 100 non-severe and 58 severe cases. Their clinical data were recorded and the first chest CT examination was reviewed using a computerized standardized report. Univariate and multivariate analyses were performed in order to identify the risk factors associated with disease severity. Two models were built: one was based only on qualitative CT features and the other one included a semi-quantitative total CT score to replace the variable representing the extent of the disease. Areas under the ROC curves (AUC) of the two models were compared with DeLong's method. Results Central involvement of lung parenchyma (P < 0.001), area of consolidation (P < 0.008), air bronchogram sign (P < 0.001), bronchiectasis (P < 0.001), traction bronchiectasis (P < 0.011), pleural effusion (P < 0.026), large involvement of either one of the upper lobes or of the middle lobe (P < 0.001) and total CT score ≥ 15 (P < 0.001) were more often observed in the severe group than in the non-severe group. No significant differences were found between the qualitative model (large involvement of either upper lobes or middle lobe [odd ratio (OR) = 2.473], central involvement [OR = 2.760], pleural effusion [OR = 2.699]) and the semi-quantitative model (total CT score ≥ 15 [OR = 3.342], central involvement [OR = 2.344], pleural effusion [OR = 2.754]) with AUC of 0.722 (95% CI: 0.638–0.806) vs. 0.739 (95% CI: 0.656–0.823), respectively (P = 0.209). Conclusion We have developed a new qualitative chest CT-based multivariate model that provides independent risk factors associated with severe form of COVID-19.
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Affiliation(s)
- Antoine Devie
- Department of Radiology, Reims University Hospital, 51092 Reims, France.
| | - Lukshe Kanagaratnam
- Clinical Research Department, Reims University Hospital, 51092 Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, INSERM UMRS 1250, Reims University Hospital, 51092 Reims, France
| | - Damien Jolly
- Clinical Research Department, Reims University Hospital, 51092 Reims, France
| | - Jean-Noël Ravey
- Department of Radiology, Grenoble University Hospital, 38700 Grenoble, France
| | - Manel Djelouah
- Department of Radiology, Reims University Hospital, 51092 Reims, France
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
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Cui Y, Sun Z, Ma S, Liu W, Wang X, Zhang X, Wang X. Automatic Detection and Scoring of Kidney Stones on Noncontrast CT Images Using S.T.O.N.E. Nephrolithometry: Combined Deep Learning and Thresholding Methods. Mol Imaging Biol 2021; 23:436-45. [PMID: 33108801 DOI: 10.1007/s11307-020-01554-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/06/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop and validate a deep learning and thresholding-based model for automatic kidney stone detection and scoring according to S.T.O.N.E. nephrolithometry. PROCEDURES Abdominal noncontrast computed tomography (NCCT) images were retrospectively archived from February 2018 to April 2019 for three parts: a segmentation dataset (n = 167), a hydronephrosis classification dataset (n = 282), and test dataset (n = 117). The model consisted of four steps. First, the 3D U-Nets for kidney and renal sinus segmentation were developed. Second, the deep 3D dual-path networks for hydronephrosis grading were developed. Third, the thresholding methods were used to detect and segment stones in the renal sinus region. The stone size, CT attenuation, and tract length were calculated from the segmented stone region. Fourth, the stone's location was determined. The stone detection performance was estimated with sensitivity and positive predictive value (PPV). The hydronephrosis grading and stone size, tract length, number of involved calyces, and essence grading were estimated with the area under the curve (AUC) method and linear-weighted κ statistics, respectively. RESULTS The stone detection algorithm reached a sensitivity of 95.9 % (236/246) and a PPV of 98.7 % (236/239). The hydronephrosis classification algorithm achieved an AUC of 0.97. The scoring model results showed good agreement with radiologist results for the stone size, tract length, number of involved calyces, and essence grading (κ = 0.95, 95 % confidence interval [CI]: 0.92, 0.98; κ = 0.97, 95 % CI: 0.95, 1.00; κ = 0.95, 95 % CI: 0.92, 0.98; and κ = 0.97, 95 % CI: 0.94, 1.00), respectively. CONCLUSIONS The scoring model was constructed that can automatically detect and score stones in NCCT images.
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Minordi LM, Larosa L, Papa A, Cimino G, Bevere A, Brizi MG, Manfredi R. A review of Magnetic Resonance Enterography classification and quantitative evaluation of active disease in patients with Crohn's disease. Clin Imaging 2020; 69:50-62. [PMID: 32653818 DOI: 10.1016/j.clinimag.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/04/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Abstract
Crohn's disease (CD) is a chronic inflammation of the gastro-intestinal system in which episodes of clinical worsening alternate with episodes of clinical regression. Monitoring of disease is mandatory to evaluate the efficacy of therapy and it is usually performed using a combination of clinical symptoms, laboratory tests, endoscopy and radiological exams, such as MR enterography or CT enterography. MR enterography should be preferred to CT enterography because of the absence of ionizing radiation, a very high soft tissue contrast, and a lower incidence of adverse events. In 2003, Maglinte introduced a radiological classification to identify patients in different stages of disease (active inflammatory, fibrostenotic and fistulising/perforating subtypes), based on following parameters: oedema, ulcers, stenosis, mural thickening, stratified contrast enhancement, engorged vasa recta, fistulae/abscess and mesenteric inflammation. In general, medical therapy is efficient in reducing inflammation while fibrotic disease and fistulising subtypes usually require surgery. Moreover, in patients with active CD it is important to quantify disease activity in order to adequately plan therapy and to monitor drug effects, by using some MR enterography indexes such as MaRIA score, Clermont index, and others. In this review we describe how to apply Maglinte's classification in MR enterography exams and how to quantify active disease.
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Affiliation(s)
- Laura Maria Minordi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy.
| | - Luigi Larosa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Alfredo Papa
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gastroenterologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Giovanni Cimino
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Antonio Bevere
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Maria Gabriella Brizi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Largo Francesco Vito, 1, 00168 Roma, Italy
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Hon KL, Lam PH, Ng WG, Kung JS, Cheng NS, Lin ZX, Chow CM, Leung TF. Age, sex, and disease status as determinants of skin hydration and transepidermal water loss among children with and without eczema. Hong Kong Med J 2020; 26:19-26. [PMID: 32051333 DOI: 10.12809/hkmj198150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Skin hydration (SH) and transepidermal water loss (TEWL) are important skin biophysical parameters for assessment of childhood eczema. This study investigated whether age, sex, and disease status influence these parameters. METHODS Skin hydration and TEWL were measured by Delfin MoistureMeterSC and Delfin Vapometer SWL5, respectively, among children aged ≤18 years with and without eczema. Disease status was evaluated using Scoring Atopic Dermatitis (SCORAD) and Nottingham Eczema Severity Score (NESS) clinical tools. RESULTS Clinical scores and objective measurements were reviewed for 132 patients with eczema and 120 patients without eczema. In both sexes, SH was significantly higher among children aged ≤2 years with and without eczema than among children aged >2 years with and without eczema. Among children aged >2 years, SH was higher among girls with and without eczema than among boys with and without eczema. Regardless of age or sex, SH was lower among children with eczema than among children without eczema. Age-, sex-, and disease-related differences were not observed for TEWL. Skin hydration was negatively correlated with objective SCORAD (r=-0.418, P<0.001), overall SCORAD (r=-0.385, P<0.001), oedema/papulation (r=-0.243, P=0.041), lichenification (r=-0.363, P=0.002), dryness (r=-0.415, P<0.001), and intensity (r=-0.266, P=0.025). Transepidermal water loss was positively correlated with objective SCORAD (r=0.209, P=0.018), overall SCORAD (r=0.215, P=0.015), and lichenification (r=0.240, P=0.043). Skin hydration was negatively correlated with TEWL among children without eczema (r=-0.401, P<0.001), but not among children with eczema. CONCLUSION Skin hydration can be used to distinguish clinical differences in eczema based on age, sex, and disease status.
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Affiliation(s)
- K L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - P H Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - W G Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J S Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - N S Cheng
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Z X Lin
- The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C M Chow
- Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
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Pan NP, Zhou WX, Tang J, Zhou JH, Li JQ. [Analysis of influencing factors of endometrial disease of patients with breast cancer after operation]. Zhonghua Fu Chan Ke Za Zhi 2020; 54:848-853. [PMID: 31874475 DOI: 10.3760/cma.j.issn.0529-567x.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods: A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results: The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions: The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.
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Affiliation(s)
- N P Pan
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, China
| | - W X Zhou
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, China
| | - J Tang
- Department of Obstetrics and Gynecology, Yuhang District Maternal and Child Health Hospital, Hangzhou 311100, China
| | - J H Zhou
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, China
| | - J Q Li
- Department of Obstetrics and Gynecology, Women's Hospital School of Medicine Zhejiang University, Hangzhou 310006, China
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Donadio MVF, Campos NE, Vendrusculo FM, Stofella AM, Almeida ACDS, Ziegler B, Schivinski CIS, Santuzzi CH, Sarges EDSNF, Gonçalves FM, Ribeiro MÂGDO, Santana NN, de Paiva SB, de Godoy VCWP, Aquino EDS. Respiratory physical therapy techniques recommended for patients with cystic fibrosis treated in specialized centers. Braz J Phys Ther 2019; 24:532-538. [PMID: 31810864 DOI: 10.1016/j.bjpt.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 11/04/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Respiratory therapy is a part of the treatment of patients with cystic fibrosis (CF). However, there is no information about the main factors influencing the recommendation of the use of different techniques or devices by physical therapists from different specialized centers. OBJECTIVE To determine the respiratory therapy techniques recommended for the treatment of patients with CF seen in specialized treatment centers in Brazil. METHODS This is a descriptive study including a sample of Brazilian CF specialized treatment centers. Data on demographics, spirometric variables, and recommended respiratory therapy treatment techniques were collected. RESULTS Twelve specialized treatment centers with a total of 974 patients were included (13.5±11.3 years old and FEV1 (%) 75.7±27.9). The most recommended techniques were huffing (61.1% of patients), high frequency oral oscillation (HFOO) (52.0%), and positive expiratory pressure (PEP) (45.3%). Most often, recommendation was to perform treatment once (54.8% of patients) or twice (34%) a day. There was great variability in the recommendation among the different states. When data were separated by age, there was a predominance of performing conventional and manual techniques in infants and preschool children. There were no significant variations according to pulmonary function. Based on the literature, techniques based on volume, huffing, and PEP were most prevalently performed in international centers. CONCLUSION The most recommended treatment techniques for patients with CF in Brazil are huffing, HFOO, and PEP, followed by volume-based techniques. There were geographical variations in the preferred treatment techniques, as well as based on patient age, but not based on the level of pulmonary function.
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Affiliation(s)
- Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
| | - Natália Evangelista Campos
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Fernanda Maria Vendrusculo
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | | | - Bruna Ziegler
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | | | | | | | | | - Nelbe Nesi Santana
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/Fiocruz), Rio de janeiro, RJ, Brazil
| | | | | | - Evanirso da Silva Aquino
- Department of Biological Science and Health, Pontifícia Universidade Católica de Minas Gerais (PUCMG), Campus Betim, Belo Horizonte, MG, Brazil
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Mason SE, Dieffenbach PB, Englert JA, Rogers AA, Massaro AF, Fredenburgh LE, Higuera A, Pinilla-Vera M, Vilas M, San Jose Estepar R, Washko GR, Baron RM, Ash SY. Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients. Respir Res 2019; 20:218. [PMID: 31606045 PMCID: PMC6790038 DOI: 10.1186/s12931-019-1201-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis. Methods All individuals enrolled in the Registry of Critical Illness at Brigham and Women’s Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient’s CXR was assigned an opacification score of 0–4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score’s association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively. Results A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05–1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07–1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04–1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02–1.07, p < 0.001). Conclusions Higher values on a simple visual score of a patient’s CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.
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Affiliation(s)
- Stefanie E Mason
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA.
| | - Paul B Dieffenbach
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Joshua A Englert
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, 2050 Kenny Road Suite 2200, Columbus, OH, 43221, USA
| | - Angela A Rogers
- Department of Medicine, Division of Pulmonary, Critical Care Medicine, Stanford University School of Medicine, 300 Pasteur Dr A165, Stanford, CA, 94305, USA
| | - Anthony F Massaro
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Laura E Fredenburgh
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Angelica Higuera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Mayra Pinilla-Vera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Marta Vilas
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St Room 216, Boston, MA, 02215, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St Room 216, Boston, MA, 02215, USA
| | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Rebecca M Baron
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
| | - Samuel Y Ash
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA, 02115, USA
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Chung SW, Hur J, Ha YJ, Kang EH, Hyon JY, Lee HJ, Song YW, Lee YJ. Impact of sleep quality on clinical features of primary Sjögren's syndrome. Korean J Intern Med 2019; 34:1154-1164. [PMID: 29458245 PMCID: PMC6718760 DOI: 10.3904/kjim.2017.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the inf luence of poor sleep quality on clinical features of primary Sjögren's syndrome (pSS). METHODS Sleep quality was cross-sectionally assessed using the Pittsburgh Sleep Quality Index (PSQI), and demographic, clinical, and laboratory data were collected from 115 Korean patients with pSS. The patients completed questionnaires on the European League Against Rheumatism (EULAR) SS Patient Reported Index (ESSPRI), quality of life (EuroQOL five dimensions questionnaire [EQ-5D]), fatigue (fatigue severity score [FSS]), and depression (Beck Depression Inventory [BDI] II]). Symptoms and patient global assessment (PGA) were evaluated with a 100-mm visual analogue scale (VAS). The EULAR sicca score (ESS), ESSPRI, and EULAR SS Disease Activity Index (ESSDAI) were calculated at study enrollment. RESULTS Fifty-three patients (46.1%) had poor sleep quality and 32.4% of 71 patients without depression were poor sleepers. Poor sleepers had a significantly lower EQ-5D or ESSDAI and a significantly higher FSS, BDI-II, PGA, ESS, ESSPRI, or VAS scores for extra-glandular symptoms than good sleepers. Neutrophil and lymphocyte counts were significantly higher and immunoglobulin G levels tended to decrease in poor sleepers. Additionally, PSQI was negatively correlated with EQ-5D and ESSDAI and positively with ESS, FSS, BDI-II, PGA, VAS scores for their symptoms, and ESSPRI. Multivariate analysis revealed that poor sleep quality remained the independent determinants of the unsatisfactory symptom state (ESSPRI ≥ 5). CONCLUSION Our results showed that poor sleep quality could significantly affect the patient-oriented outcomes and physician-reported activity index of pSS patients through the various effects of sleep quality on the psychological or somatic symptoms and the immune system.
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Affiliation(s)
- Sang Wan Chung
- Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jaehyung Hur
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You-Jung Ha
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Jung Lee
- Department of Periodontology, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeong Wook Song
- Department of Internal Medicine, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
- WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Yun Jong Lee, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7049 Fax: +82-31-787-4051 E-mail:
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Su YD, Liang QF, Wang NL, Antoine L. [A study on the diagnostic value of tear film objective scatter index in dry eye]. Zhonghua Yan Ke Za Zhi 2017; 53:668-74. [PMID: 28926884 DOI: 10.3760/cma.j.issn.0412-4081.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the sensitivity and specificity of tear film objective scatter index to the diagnosis dry eye disease (DED). Methods: A prospective case-controlled study. Fifty-three patients with DED and 32 healthy age- and sex-matched control subjects were included from July to October 2016. All subjects underwent the examinations sequentially as follows: evaluation of ocular surface disease symptoms using the Ocular Surface Disease Index, optical quality detection, lipid layer thickness, tear film breakup time and SchirmerⅠtest. With Optical Quality Analysis SystemⅡ, the values of modulation transfer function cut off, basic objective scatter index (OSI) and total OSI were measured. To eliminate the influence of other refractive media, the tear film OSI (TF-OSI) was calculated, and the difference in TF-OSI between two groups was analyzed with the independent-samples t test. Spearman's correlation analysis was used to detect the correlation of each parameter in the DED group. With the receiver operating characteristic curve and the area under the curve (AUC), the specificity and sensitivity of TF-OSI and other parameters were described to differentiate DED from normal eyes. Results: In the dry eye group, the value of modulation transfer function cut off (32.07±11.95) was significantly lower than the normal group (39.38±9.44, t=-3.096, P=0.003) , and the mean value and dispersion of TF-OSI (0.50±0.43, 0.52±0.81) were higher than the normal group (0.21±0.16, 0.12±0.01) (t=4.300, P=0.000, t=3.546, P=0.001) . The mean value of TF-OSI had a positive correlation with lipid layer thickness (r=0.365, P=0.007) and dispersion of TF-OSI (r=0.581, P=0.000), and a negative correlation with MTF cut off (r=-0.368, P=0.007). To the diagnostic value of DED, the mean value of TF-OSI had a sensitivity of 0.736, a specificity of 0.762, and the AUC was 0.764. The dispersion of TF-OSI had a sensitivity of 0.811 and a specificity of 0.810, and the AUC was 0.900. Conclusion: In the DED group, the mean value and dispersion of TF-OSI were higher than the normal group. With its advantages, the TF-OSI may be a new method for the auxiliary diagnosis of dry eye. (Chin J Ophthalmol, 2017, 53: 668-674).
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Chen Q, Zhang L, Ge S, He W, Zeng M. Prognosis predictive value of the Oxford Acute Severity of Illness Score for sepsis: a retrospective cohort study. PeerJ 2019; 7:e7083. [PMID: 31218129 PMCID: PMC6563807 DOI: 10.7717/peerj.7083] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background The Oxford Acute Severity of Illness Score (OASIS) has shown fair prognosis predictive value in critically ill patients, but its predictive value has not been assessed in septic patients. Objective The aim of this study was to evaluate the performance of the OASIS for the assessment of mortality in septic patients, especially when compared with the Sepsis-related Organ Failure Assessment (SOFA) score. Methods A retrospective cohort study was conducted using data from a public database and septic patients were identified using the Sepsis-3 criteria. The primary outcome was hospital mortality. Data were mainly analyzed using multivariable logistic regression and receiver operating characteristic (ROC) curves. Sensitive analyses were performed in patients with an ICD-9-CM code for sepsis and ROC curves analyses were also conducted in septic patients stratified by the Simplified Acute Physiology Score (SAPS) II as subgroup analyses. Results A total of 10,305 septic patients were included. The OASIS was found to be significantly associated with hospital mortality (odds ratio 1.07 per one-point increase, 95% confidence interval [1.06–1.08]), while ROC curves analyses showed the discriminatory power of the OASIS for hospital mortality was statistically significantly lower than that of the SOFA score (area under the ROC curve: 0.652 vs 0.682, p < 0.001). Results of sensitive analyses were consistent, but the significant difference existed only when the SAPS II was higher than 50 according to results of the subgroup analyses. Conclusions The OASIS might serve as an initial predictor of clinical outcomes for septic patients, but one should be circumspect when it is applied to severer patients.
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Affiliation(s)
- Qingui Chen
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lishan Zhang
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shanhui Ge
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wanmei He
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mian Zeng
- Department of Medical Intensive Care Unit, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Umemura Y, Ogura H, Gando S, Shiraishi A, Saitoh D, Fujishima S, Mayumi T, Kushimoto S, Abe T, Shiino Y, Nakada TA, Tarui T, Hifumi T, Otomo Y, Okamoto K, Kotani J, Sakamoto Y, Sasaki J, Shiraishi SI, Takuma K, Tsuruta R, Hagiwara A, Masuno T, Takeyama N, Yamashita N, Ikeda H, Ueyama M, Yamakawa K; Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group. Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients. J Infect Chemother 2019; 25:943-9. [PMID: 31182332 DOI: 10.1016/j.jiac.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. MATERIALS AND METHODS This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. RESULTS We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. CONCLUSION This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.
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de Siqueira Corradi MB, D Ávila R, Duim E, Rodrigues CIS. Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital. Am J Surg 2019; 219:645-650. [PMID: 31130212 DOI: 10.1016/j.amjsurg.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.
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Affiliation(s)
| | - Ronaldo D Ávila
- Department of Medicine, Nephrology Division, School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
| | - Etienne Duim
- School of Public Health, Universidade de São Paulo (USP), Faculty of Health, Medicine and Life Sciences, Av. Dr Arnaldo, 715, 01246-904, São Paulo, SP, Brazil.
| | - Cibele Isaac Saad Rodrigues
- Department of Medicine, Nephrology Division and Education in Health Professions Master Program, School of Medical and Health Sciences, PUC-SP. R, Jouberte Wey, 290, Vergueiro, 18030-070, Sorocaba, SP, Brazil.
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Akavipat P, Thinkhamrop J, Thinkhamrop B, Sriraj W. ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE) II SCORE - THE CLINICAL PREDICTOR IN NEUROSURGICAL INTENSIVE CARE UNIT. Acta Clin Croat 2019; 58:50-56. [PMID: 31363325 PMCID: PMC6629196 DOI: 10.20471/acc.2019.58.01.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The APACHE II scoring system is approved for its benchmarking and mortality predictions, but there are only a few articles published to demonstrate it in neurosurgical patients. Therefore, this study was performed to acknowledge this score and its predictive performance to hospital mortality in a tertiary referral neurosurgical intensive care unit (ICU). All patients admitted to the Neurosurgical ICU from February 1 to July 31, 2011 were recruited. The parameters indicated in APACHE II score were collected. The adjusted predicted risk of death was calculated and compared with the death rate observed. Descriptive statistics including the receiver operating characteristic curve (ROC) was performed. The results showed that 276 patients were admitted during the mentioned period. The APACHE II score was 16.56 (95% CI, 15.84-17.29) and 19.08 (95% CI, 15.40-22.76) in survivors and non-survivors, while the adjusted predicted death rates were 13.39% (95% CI, 11.83-14.95) and 17.49% (95% CI, 9.81-25.17), respectively. The observed mortality was only 4.35%. The area under the ROC of APACHE II score to the hospital mortality was 0.62 (95% CI, 0.44-0.79). In conclusion, not only the APACHE II score in neurosurgical patients indicated low severity, but its performance to predict hospital mortality was also inferior. Additional studies of predicting mortality among these critical patients should be undertaken.
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Affiliation(s)
| | - Jadsada Thinkhamrop
- 1Anesthesiology Department, Prasat Neurological Institute, Bangkok, Thailand; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; 4Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bandit Thinkhamrop
- 1Anesthesiology Department, Prasat Neurological Institute, Bangkok, Thailand; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; 4Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wimonrat Sriraj
- 1Anesthesiology Department, Prasat Neurological Institute, Bangkok, Thailand; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; 4Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Lee SM, Lee MH, Chang YS. The Clinical Risk Index for Babies II for Prediction of Time-Dependent Mortality and Short-Term Morbidities in Very Low Birth Weight Infants. Neonatology 2019; 116:244-251. [PMID: 31307048 DOI: 10.1159/000500270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A simple predictive indicator of mortality and morbidities is essential to assess neonatal illness severity and plan proper management. OBJECTIVE This study aimed to test the time-dependent performance of the Clinical Risk Index for Babies (CRIB) II in predicting mortality and major short-term morbidities among very low birth weight infants (VLBWIs). METHODS This population-based prospective study from 67 Korean Neonatal Network centers performed between 2013 and 2016 included 5,296 VLBWIs with CRIB II calculation and 6,398 infants with CRIB II calculation but without the base excess (CRIB II-BE). A regression model predicting time-dependent mortality and morbidities using the CRIB II score was designed. The discriminate ability of the CRIB II and CRIB II-BE scores in predicting mortality and morbidities was explored using receiver-operating characteristic analysis. RESULTS CRIB II performed significantly better in predicting mortality than did gestational age or birth weight alone. The time-dependent performance of CRIB II was good in the first 30 days (area under the curve [AUC], 0.8435) and at 31-90 days (AUC, 0.8458). However, it was poor after 90 days (AUC, 0.6576). Specific CRIB II cutoffs were associated with severe intraventricular hemorrhage (AUC, 0.81), bronchopulmonary dysplasia (AUC, 0.77), and mortality or major morbidities (AUC, 0.80), respectively. The model using CRIB II-BE showed similar performance in predicting mortality and morbidities to that of the CRIB II model. CONCLUSION Certain CRIB II cutoffs were significantly associated with time-dependent mortality, particularly within the first 90 days after birth as well as with short-term morbidities.
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Affiliation(s)
- Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea,
| | - Myung Hee Lee
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Lehrl S, Kardos P, Matthys H, Kamin W. Validation of a Clinical Instrument for Measuring the Severity of Acute Bronchitis in Children - The BSS-ped. Open Respir Med J 2018; 12:50-66. [PMID: 30505368 PMCID: PMC6210530 DOI: 10.2174/1874306401812010050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023] Open
Abstract
Background: There are no validated standardised clinical procedures for severity measurement of acute bronchitis in children. The “BSS-ped”, a short version of the physician-rated assessment scale BSS (Bronchitis Severity Scale), can fill this gap, if it is valid. Objective: To examine the scale´s validity. Methods: Investigations were planned according to classical clinical-psychometric validity criteria including a formal competence evaluation of the scale´s authors and statistical analyses of data from 78 patients aged 1-6 and diagnosed with “acute bronchitis”. Cross-validation was provided by analysis of data from 70 children with matching age, sex and diagnosis. All children were examined three times (day 0, 3-5 and 7) using the BSS-ped in addition to other clinical and psychometric monitoring procedures. Results: The evidently high level of expertise of the scale’s authors substantiates pronounced content validity and relevance of the BSS-ped and its items. The validity criterion, i.e. to reflect the unidimensional severity of acute bronchitis and its change using the BSS-ped score, was fulfilled. There were substantial correlations with other scales measuring the current health-related quality of life, as well as satisfaction and success of treatment. Severity change prognoses for acute bronchitis under placebo and an active substance were correct. The BSS-ped was found to be a feasible instrument because it can be repeated at short intervals (minute range) without any special technical aids or extended training. Conclusion: The BSS-ped is a valid procedure for measuring the severity of acute bronchitis in children.
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Affiliation(s)
- Siegfried Lehrl
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Kardos
- Group Practice and Centre for Pneumology, Center for Respiratory, Allergy and Sleep Medicine at Red Cross Maingau Hospital, Frankfurt am Main, Germany
| | - Heinrich Matthys
- Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
| | - Wolfgang Kamin
- Clinic for Paediatrics, Evangelic Hospital Hamm, Hamm, Germany
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Bergquist M, Hästbacka J, Glaumann C, Freden F, Huss F, Lipcsey M. The time-course of the inflammatory response to major burn injury and its relation to organ failure and outcome. Burns 2018; 45:354-363. [PMID: 30274808 DOI: 10.1016/j.burns.2018.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
Burn injury causes major inflammatory activation and cytokine release, however, the temporal resolution of the acute and sub-acute inflammatory response has not yet been fully delineated. To this end, we have quantified 20 inflammatory mediators in plasma from 44 adult patients 0-21 days after burn injury and related the time course of these mediators to % total body surface area (TBSA) burned, clinical parameters, organ failure and outcome. Of the cytokines analyzed in these patients, interleukin 6 (IL-6), IL-8, IL-10 and monocyte chemoattractant protein 1 (MCP-1) correlated to the size of the injury at 24-48h after burn injury. In our study, the concentration of IL-10 had prognostic value in patients with burn injury both measured at admission and at 24-48h after injury. However, simple demographic data such as age, % burned TBSA, inhalation injury and their combination, the Baux score and modified Baux score, outperform most of the cytokines, with the exception of IL-8 and MCP-1 levels on admission, in predicting death.
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Affiliation(s)
- Maria Bergquist
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johanna Hästbacka
- Intensive Care Medicine, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christian Glaumann
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Filip Freden
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- The Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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Fortis S, O'Shea AMJ, Beck BF, Nair R, Goto M, Kaboli PJ, Perencevich EN, Reisinger HS, Sarrazin MV. An automated computerized critical illness severity scoring system derived from APACHE III: modified APACHE. J Crit Care 2018; 48:237-242. [PMID: 30243204 DOI: 10.1016/j.jcrc.2018.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the performance of an automated computerized ICU severity scoring derived from the APACHE III. MATERIALS AND METHODS Within a retrospective cohort of patients admitted to Veterans Health Administration ICUs between 2009 and 2015, we created an automated illness severity score(modified APACHE or mAPACHE), that we extracted from the electronic health records, using the same scoring as the APACHE III excluding the Glasgow Coma Scale, urine output, arterial blood gas components of APACHE III. We assessed the mAPACHE discrimination by using the area under the curve(AUC), and calibration by using the Hosmer-Lemeshow test and calculating the difference between observed and expected mortality across equal-sized risk deciles for death. RESULTS The ICU and 30-day mortality was 5.07% of 7.82%, respectively (n = 490,955 patients). The AUC of mAPACHE for ICU and 30-day mortality was 0.771 and 0.786, respectively. The Hosmer-Lemeshow test was significant for both ICU and 30-day mortality (p < .001). The absolute difference between observed and expected mortality did not exceed ±1.53% across equal-sized deciles of risk for death. The AUC for ICU mortality was >0.7 in all admission diagnosis categories except in endocrine, respiratory, and sepsis. The AUC for 30-day mortality was >0.7 in every category. CONCLUSION mAPACHE has adequate performance to predict mortality.
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Affiliation(s)
- Spyridon Fortis
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
| | - Amy M J O'Shea
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Brice F Beck
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - Rajeshwari Nair
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Michihiko Goto
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Peter J Kaboli
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Eli N Perencevich
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Heather S Reisinger
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Mary V Sarrazin
- Center for Comprehensive Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Weeda ER, Caranfa JT, Lyman GH, Kuderer NM, Nguyen E, Coleman CI, Kohn CG. External validation of three risk stratification rules in patients presenting with pulmonary embolism and cancer. Support Care Cancer 2018; 27:921-925. [PMID: 30090992 DOI: 10.1007/s00520-018-4380-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
Numerous risk stratification rules exist to predict post-pulmonary embolism (PE) mortality; however, few were designed for use in cancer patients. In the EPIPHANY registry, adapted versions of common rules (the Hestia criteria, Pulmonary Embolism Severity Index [PESI], and simplified PESI [sPESI]) displayed high sensitivity for prognosticating mortality in PE patients with cancer. These adapted rules have yet to be externally validated. Therefore, we sought to evaluate the performance of an adapted Hestia criteria, PESI, and sPESI for predicting 30-day post-PE mortality in patients with cancer. We identified consecutive, adults presenting with objectively confirmed PE and cancer to our institution (November 2010 to January 2014). The proportion of patients categorized as low or high risk by these three risk stratification rules was calculated, and each rule's accuracy for predicting 30-day all-cause mortality was determined. Of the 124 patients with PE and active cancer identified, 25 (20%) experienced mortality at 30 days. The adapted Hestia criteria categorized 23 (19%) patients as low risk, while exhibiting a sensitivity of 88% (95% confidence interval [CI] = 68-97%), a negative predictive value NPV of 87% (95% CI = 65-97%), and a specificity of 20% (95% CI = 13-30%). A total of 38 (31%) and 30 (24%) patients were low risk by the adapted PESI and sPESI, with both displaying sensitivities of 92% and NPVs > 93%. Specificities were 36% (95% CI = 27-47%) and 28% (95% CI = 20-38%) for PESI and sPESI. In our external validation, the adapted Hestia, PESI, and sPESI demonstrated high sensitivity but low specificity for 30-day PE mortality in patients with cancer. Larger, prospective trials are needed to optimize strategies for risk stratification in this population.
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Affiliation(s)
- Erin R Weeda
- Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Elaine Nguyen
- Idaho State University College of Pharmacy, Meridian, ID, USA
| | - Craig I Coleman
- University of Connecticut/Hartford Hospital Evidence-Based Practice Center, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Christine G Kohn
- University of Connecticut School of Medicine, Farmington, CT, USA. .,University of Connecticut/Hartford Hospital Evidence-Based Practice Center, 80 Seymour Street, Hartford, CT, 06102, USA.
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Izquierdo YE, Fonseca EV, Moreno LÁ, Montoya RD, Guerrero Lozano R. Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis. Pediatr Radiol 2018; 48:954-961. [PMID: 29468366 DOI: 10.1007/s00247-018-4101-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/27/2017] [Accepted: 02/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Computed tomography (CT) is useful for the diagnosis of local complications in children with acute pancreatitis but its role as a prognostic tool remains controversial. OBJECTIVE To establish the correlation between the CT Severity Index and the Revised Atlanta Classification regarding unfavorable outcomes such as severe acute pancreatitis and need for Pediatric Special Care Unit attention in children with acute pancreatitis. MATERIALS AND METHODS We conducted a retrospective and concordance cohort study in which we obtained abdominal CT scans from 30 patients ages 0 to 18 years with acute pancreatitis. Two pediatric radiologists interpreted the results using the CT Severity Index and the Revised Atlanta Classification. The kappa coefficient was determined for each scale. The association among severe acute pancreatitis, need for admission to the Pediatric Special Care Unit and CT systems were established using chi-square or Mann-Whitney U tests. The best CT Severity Index value to predict the need for admission to the Pediatric Special Care Unit was estimated through a receiver operating characteristic (ROC) curve. RESULTS Mean CT Severity Index was 5.1±2.8 (mean ± standard deviation on a scale of 0 to 10) for the severe acute pancreatitis group vs. 3.8±2.7 for the mild acute pancreatitis group (P=0.230). The CT Severity Index for the children who were not hospitalized at the Pediatric Special Care Unit was 2.2±2.2 vs. 5.6±2.4 for the group hospitalized at the Pediatric Special Care Unit (P=0.001). Only parenchymal necrosis >30% was associated with severe acute pancreatitis (P=0.021). A CT Severity Index ≥3 has a sensitivity of 89% and specificity of 72% to predict need for admission to the Pediatric Special Care Unit. None of the Revised Atlanta Classification categories was associated with severe acute pancreatitis or admission to the Pediatric Special Care Unit. CONCLUSION A CT Severity Index ≥3 in children with acute pancreatitis who require CT assessment based on clinical criteria is associated with the need for admission to the Pediatric Special Care Unit. We found that pancreatic necrosis greater than 30% is the only tomographic parameter related to severe acute pancreatitis. New studies with a greater sample size are necessary to confirm this result.
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Affiliation(s)
- Yojhan E Izquierdo
- Department of Radiology and Diagnostic Imaging, Universidad Nacional de Colombia, Carrera 30 #45-03, Building 271, Office 102, 111321, Bogotá, D.C., Colombia.
| | - Eileen V Fonseca
- Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Luz-Ángela Moreno
- Department of Radiology and Diagnostic Imaging, Universidad Nacional de Colombia, Carrera 30 #45-03, Building 271, Office 102, 111321, Bogotá, D.C., Colombia
- Department of Radiology and Diagnostic Imaging, Fundación Hospital de la Misericordia, Bogotá, D.C., Colombia
| | - Rubén D Montoya
- Department of Radiology and Diagnostic Imaging, Universidad Nacional de Colombia, Carrera 30 #45-03, Building 271, Office 102, 111321, Bogotá, D.C., Colombia
- Department of Radiology and Diagnostic Imaging, Fundación Hospital de la Misericordia, Bogotá, D.C., Colombia
| | - Rafael Guerrero Lozano
- Division of Pediatric Gastroenterology, Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
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Chiaramonte R, Di Luciano C, Chiaramonte I, Serra A, Bonfiglio M. Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis. Acta Otorrinolaringol Esp (Engl Ed) 2018; 70:25-31. [PMID: 29699694 DOI: 10.1016/j.otorri.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time. MATERIALS AND METHODS 22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing. RESULTS In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration. CONCLUSIONS A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.
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Affiliation(s)
- Rita Chiaramonte
- Department of Physical Medicine and Rehabilitation, University of Catania, 95125 Catania, Italy.
| | - Carmela Di Luciano
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
| | | | - Agostino Serra
- Departments of Otolaryngology, University of Catania, 95125 Catania, Italy
| | - Marco Bonfiglio
- Department for Health activities and Epidemiologic Observatory, Sicily Region, Italy
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Choi CW, Kim BR, Park JS, Youn SW. Both Educational Lectures and Reference Photographs Are Necessary to Improve the Accuracy and Reliability of Psoriasis Area and Severity Index (PASI) Assessment: Results from Korean Nation-Wide PASI Educational Workshop. Ann Dermatol 2018; 30:284-289. [PMID: 29853741 PMCID: PMC5929944 DOI: 10.5021/ad.2018.30.3.284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Accurate assessment of the severity of psoriasis is important in daily practice and clinical studies. However, the assessment of psoriasis area and severity index (PASI) reflects the physician's experience, and thus evaluations by physicians are inherently subjective, with intra-rater and inter-rater variability. Objective To elucidate the effectiveness of PASI educational lectures and the use of reference photographs on the improvement of accuracy and reliability in PASI assessments and to develop effective educational programs for PASI assessments. Methods We performed a before-and-after comparison study during nation-wide PASI educational workshops. The participants were asked to assess the severity components of PASI (erythema, thickness, scale, and affected area) three times: in the test administered before an educational lecture, the test immediately after the lecture, and lastly the test with the use of reference photographs. The improvement of accuracy and reliability was analyzed by comparing the results of three tests. Results Ninety-six board-certified dermatologists and residents participated and 72 participants completed all three tests. The accuracy and reliability of the assessment of severity components of PASI increased significantly after the educational lecture and the use of reference photographs. Use of reference photographs resulted in limited improvements when the recognition of three-dimensional structures was required, such as in the assessment of thickness or scale. Conclusion Our study confirmed that the combination of standardized educational training and reference photographs can improve the accuracy and reliability of PASI assessments. Understanding how to evaluate three-dimensional psoriatic lesions can help with proper assessment of the severity of psoriasis.
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Affiliation(s)
- Chong Won Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Seo Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Sakai K, Sasaki K, Furuta T, Sugiura S, Watanabe Y, Kobayashi T, Kawabe T, Morishita M, Nakanishi K, Ito K. Evaluation of the results of oral food challenges conducted in specialized and general hospitals. Asia Pac Allergy 2017; 7:234-242. [PMID: 29094022 PMCID: PMC5663752 DOI: 10.5415/apallergy.2017.7.4.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/04/2022] Open
Abstract
Background Oral food challenge (OFC) tests are conducted in both specialized institutions and general hospitals. We aimed to compare the severity of the conditions of the patients between these 2 types of institutions in order to consider the role of such institutions in society. Objective We evaluated the results of OFC tests for hen's egg, cow's milk, and wheat that were conducted in a specialized institution (Aichi Children's Health and Medical Center [ACHMC], n = 835) and in 4 general hospitals (n = 327) in Aichi prefecture, Japan. Methods The symptoms provoked were scored using the total score (TS) of the Anaphylaxis Scoring Aichi scoring system in combination with the total ingested protein dose (Pro) before the appearance of allergic symptoms. Results The total ingested dose of the challenge-positive patients in ACHMC was significantly less than that in the general hospitals (p < 0.01). The median TS of the provoked symptoms in ACHMC and the general hospitals did not differ to a statistically significant extent in the hen's egg or cow's milk challenges; however, the median TS in ACHMC was significantly lower than that in the general hospitals for the wheat challenge (p = 0.02). The median TS/Pro values in ACHMC were almost identical to the upper 25% of the TS/Pro values in the general hospitals, suggesting that the specialized institution usually managed more severe patients. Conclusion The specialized institution performed OFC tests at a lower threshold dose, but provoked similar TSs to the general hospitals. This evaluation may help in optimizing the distribution of patients to general hospitals and specialized institutions.
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Affiliation(s)
- Kazunori Sakai
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
| | - Kemal Sasaki
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
| | - Tomoko Furuta
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
| | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
| | - Yukari Watanabe
- Department of Pediatrics, Okazaki City Hospital, Okazaki 444-8553, Japan
| | - Takae Kobayashi
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai 486-8510, Japan
| | - Takashi Kawabe
- Department of Pediatrics, Kasugai Municipal Hospital, Kasugai 486-8510, Japan
| | - Masashi Morishita
- Department of Pediatrics, Tosei General Hospital, Seto 489-8642, Japan
| | - Kumiko Nakanishi
- Department of Pediatrics, Toyota Kosei Hospital, Toyota 470-0396, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Obu 474-8710, Japan
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