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Shakoei S, Seifi G, Ghanami F, Ghandi N, Hamzelou S, Nasimi M, Etesami I. Clinical and demographic characteristics associated with nail involvement in alopecia areata: A cross-sectional study of 197 patients. Health Sci Rep 2024; 7:e2020. [PMID: 38567188 PMCID: PMC10985222 DOI: 10.1002/hsr2.2020] [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: 10/19/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aims Alopecia areata (AA) is an immune-mediated nonscarring alopecia. Nail changes are a common disfiguring feature of AA with an average prevalence of 30%. We aimed to evaluate the frequency of different types of nail changes and determine demographic and clinical associations. Methods This cross-sectional study included 197 AA patients. Demographic and clinical variables including the Severity of Alopecia Tool (SALT) score, type of AA, and nail changes were evaluated. Results Among 197 AA patients with a mean age of 28.95 ± 14.45 years, 50.3% were female. Nail changes were detected in 165 patients (83.8%). The most frequent nail abnormalities were pitting (53.3%), linear line (46.7%), and distal notching (26.9%). AA patients with nail abnormalities were significantly younger than patients without nail changes (25.31 ± 14.96 vs. 32.22 ± 9.77 years; p < 0.001). Considering age groups, younger children (less than 10 years) were more likely to have nail changes than adults (97.1% vs. 76.5%; p < 0.001). The prevalence of linear line (69.6%) and distal notching (46.4%) were significantly higher in the universalis variant compared to other variants (p < 0.001). Pitting (54.5%), distal notching (43.9%), and koilonychia (12.1%) were the most common nail changes in severe forms compared to mild-to-moderate forms (p < 0.009). Conclusions Our study revealed that young patients with severe disease are prone to nail abnormalities. Pitting, distal notching, and linear line were the most common nail changes. Of note, koilonychia, leukonychia, and red spots lunula are more expected in more severe AA.
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Affiliation(s)
- Safoura Shakoei
- Department of Dermatology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Golnoosh Seifi
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
| | - Farbod Ghanami
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
| | - Narges Ghandi
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
| | - Shahin Hamzelou
- Department of Dermatology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
| | - Ifa Etesami
- Department of Dermatology, Razi Hospital, Tehran University of medical SciencesTehran University of Medical SciencesTehranIran
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Froehner Junior I, Jorge JMN, Marques CFS, Santos VLCDG, Jukemura J. CONSTIPATION SCORING SYSTEM VALIDATED FOR THE PORTUGUESE LANGUAGE (ÍNDICE DE GRAVIDADE DA CONSTIPAÇÃO INTESTINAL): IS IT RELIABLE IN ASSESSING THE SEVERITY OF INTESTINAL CHRONIC CONSTIPATION IN OUR POPULATION? Arq Bras Cir Dig 2024; 36:e1785. [PMID: 38511799 PMCID: PMC10949929 DOI: 10.1590/0102-672020230067e1785] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/08/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.
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Affiliation(s)
- Ilario Froehner Junior
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - José Marcio Neves Jorge
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | | | - José Jukemura
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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Sonkoly E, Maul JT, Megna M, Gorecki P, Crombag E, Buyze J, Savage L. Guselkumab in Patients with Scalp Psoriasis: A post hoc Analysis of the VOYAGE 2 Phase III Randomized Clinical Trial. Acta Derm Venereol 2024; 104:adv18672. [PMID: 38436429 PMCID: PMC10924269 DOI: 10.2340/actadv.v104.18672] [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: 09/11/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Scalp psoriasis affects approximately 80% of patients with psoriasis and can negatively impact their quality of life. This post hoc analysis of the VOYAGE 2 Phase III randomized clinical trial evaluated scalp response to guselkumab treatment and its association with skin response and patient-reported outcomes. The study included patients with moderate-to-severe plaque psoriasis and baseline scalp psoriasis who were initially randomized to receive guselkumab. Patients were divided into 3 groups based on their achievement of a Psoriasis Area and Severity Index 90 response at week 28: responder continuation, non-responder continuation and responder withdrawal. In all 3 groups, mean Psoriasis Area and Severity Index head and scalp-specific Investigator's Global Assessment scores improved through week 28. In the responder withdrawal group, these scores worsened after treatment withdrawal at week 28, but remained stable through week 48 in both continuation groups. Trends in Dermatology Life Quality Index and Psoriasis Symptoms and Signs Diary itch scores mirrored those of mean scalp-specific Investigator's Global Assessment scores through week 48. Within-subject correlations were 0.83 between scalp-specific Investigator's Global Assessment and Psoriasis Area and Severity Index head scores and 0.78 between scalp-specific Investigator's Global Assessment and Psoriasis Symptoms and Signs Diary itch scores. Through week 252, Psoriasis Area and Severity Index head scores remained stable in the responder continuation group, improved in the non-responder continuation group and rapidly improved by week 84 in the responder withdrawal group after retreatment.
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Affiliation(s)
- Enikö Sonkoly
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Dermatology and Venereology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | | | - Laura Savage
- Leeds Centre for Dermatology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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Singh JKA, Ling WH, Sivanesom RS, Huay CCS, Lan ACS. Age at autism spectrum disorder diagnosis and its association with child and family characteristics in a tertiary care hospital in Malaysia. Autism Res 2024; 17:637-649. [PMID: 38400514 DOI: 10.1002/aur.3106] [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: 02/23/2023] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Despite the absence of a cure, early diagnosis and intensive early intervention can improve the outcomes. However, little is known about the median age at ASD diagnosis in Malaysia or the child/family characteristics associated with early diagnosis. Therefore, this study aimed to determine the median age at ASD diagnosis among Malaysian children presenting to the country's largest public tertiary neurodevelopmental center and to investigate the possible demographic, child, and family characteristics associated with an early age at diagnosis. Data were collected between February 2017 and February 2019 from a database maintained by the child development unit of the country's largest publicly funded tertiary hospital, containing data from an ethnically diverse population. Among Malaysian children attending the clinic, the median age at ASD diagnosis was 48 months. Early autism diagnosis (<36 months of age) was associated with increased severity of social communication and interaction impairments, coexisting intellectual impairment, children from high socioeconomic status families, and children who receive joint care from their families and a maid or babysitter. The study findings highlight the socioeconomic inequalities in the country, a lack of parental awareness of early ASD signs, and the presence of cultural influences on the age at diagnosis of ASD.
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Affiliation(s)
| | - Wong Hoi Ling
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | | | - Cindy Chan Su Huay
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Audrey Chong Shuk Lan
- Clinical Research Centre, Sabah Woman & Children's Hospital, Kota Kinabalu, Sabah, Malaysia
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Romano A, Lotan M, Fabio RA. A Severity Comparison between Italian and Israeli Rett Syndrome Cohorts. Diagnostics (Basel) 2023; 13:3390. [PMID: 37958286 PMCID: PMC10648171 DOI: 10.3390/diagnostics13213390] [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: 08/18/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Rett syndrome (RTT) is a neurodevelopmental disorder marked by profound cognitive, communication, and motor impairments. Despite identified genotype/phenotype connections, the extent of clinical severity varies even among individuals sharing the same genetic mutation. Diverse sociocultural environments, such as the level of inclusivity of the scholar system, the time spent with family, and the intensity of the rehabilitative intervention provided, might influence their development diversely. This study examines the severity of RTT in people in Italy and Israel, countries with distinct contradictory approaches to caring for those with intricate disabilities, across two age groups. Data from 136 Italian and 59 Israeli girls and women with RTT were assessed and divided into two age categories: above and below 12 years. The RARS, a standardized RTT-specific clinical severity tool, was administered. Despite no differences in age and genetic characteristics, the Italian group showed better scores in the RARS motor and disease-related characteristics areas in both age groups. Moreover, the young Italian participants gathered better total RARS scores and emotional and behavioral characteristics area scores. Furthermore, the young group showed significantly less scoliosis, foot problems, and epilepsy than the older group. These findings endorse the inclusion of girls with RTT in the regular schooling system for a limited daily period, investing in high activity levels within the home and community environments, and suggest continuously providing the person with daily occasions of physical activity and socialization.
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Affiliation(s)
- Alberto Romano
- Department of Health System Management, Ariel University, Ariel 4070000, Israel
| | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel 4070000, Israel
- Israeli Rett Syndrome National Evaluation Team, Ramat Gan 5200100, Israel
| | - Rosa Angela Fabio
- Department of Economics, University of Messina, 98122 Messina, Italy
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Hwang SY, Kim IK, Jeong D, Park JE, Lee GT, Yoo J, Choi K, Shin TG, Kim K. Prognostic Performance of Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation III, and Simplified Acute Physiology Score II Scores in Patients with Suspected Infection According to Intensive Care Unit Type. J Clin Med 2023; 12:6402. [PMID: 37835046 PMCID: PMC10573563 DOI: 10.3390/jcm12196402] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
We investigated the prognostic performance of scoring systems by the intensive care unit (ICU) type. This was a retrospective observational study using data from the Marketplace for Medical Information in the Intensive Care IV database. The primary outcome was in-hospital mortality. We obtained Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) III, and Simplified Acute Physiology Score (SAPS) II scores in each ICU type. Prognostic performance was evaluated with the area under the receiver operating characteristic curve (AUROC) and was compared among ICU types. A total of 29,618 patients were analyzed, and the in-hospital mortality was 12.4%. The overall prognostic performance of APACHE III was significantly higher than those of SOFA and SAPS II (0.807, [95% confidence interval, 0.799-0.814], 0.785 [0.773-0.797], and 0.795 [0.787-0.811], respectively). The prognostic performance of SOFA, APACHE III, and SAPS II scores was significantly different between ICU types. The AUROC ranges of SOFA, APACHE III, and SAPS II were 0.723-0.826, 0.728-0.860, and 0.759-0.819, respectively. The neurosurgical and surgical ICUs had lower prognostic performance than other ICU types. The prognostic performance of scoring systems in patients with suspected infection is significantly different according to ICU type. APACHE III systems have the highest prediction performance. ICU type may be a significant factor in the prognostication.
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Affiliation(s)
- Sung-Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - In-Kyu Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Jong-Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Gun-Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Junsang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Kihwan Choi
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
| | - Tae-Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
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Basu S, Verma RN, Joshi A, Dwivedi D, Mateen MA, Bhatia JS. A prospective observational study to correlate lung ultrasound with clinical severity and prognosis score in patients with primary pulmonary pathology on invasive ventilatory support. Int J Crit Illn Inj Sci 2023; 13:151-158. [PMID: 38292395 PMCID: PMC10824203 DOI: 10.4103/ijciis.ijciis_31_23] [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: 06/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 02/01/2024] Open
Abstract
Background Lung ultrasound (LUS) is a known imaging modality employed for monitoring patients in an intensive care unit. This study evaluates, LUS in assessing disease severity and prognosis, by correlating its score with the three commonly used clinical severity scoring systems (CSSS), namely, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, and simplified acute physiology score (SAPS) II. Methods This single-center prospective observational study included 54 adult patients of primary lung disease-induced acute respiratory distress syndrome (ARDS), on invasive ventilation. The primary objective was to correlate LUS score with SOFA score. Secondary objectives were to correlate LUS score with APACHE II and SAPS II scores. LUS score was also correlated with the estimated mortality derived from the above-mentioned scores. A subgroup analysis on COVID-19-positive cases was also carried out. All scores were calculated on the initiation of mechanical ventilation, daily for 7 days or mortality, whichever was earlier. Results A significant positive correlation (P < 0.001) was found between LUS and all three severity scores, as well as their corresponding estimated mortality percentages, for all days of the study period, in both non-COVID-19 ARDS patients and in COVID-19 patients. The merit of all four scores in differentiating between the survivor and mortality group for the duration of study also showed significant (P < 0.05) to very significant (P < 0.001) results. Conclusion Point-of-care LUS in conjunction with CSSS is a reliable tool for assessing the severity and progression of primary lung disease.
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Affiliation(s)
- Sulagna Basu
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Rishiraj Narayan Verma
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Aditya Joshi
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Deepak Dwivedi
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Mohammad Abdul Mateen
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
| | - Jagdeep Singh Bhatia
- Department of Anaesthesia and Critical Care, Command Hospital (EC), Kolkata, West Bengal, India
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Seol JE, Hong SM, Ahn SW, Jang SH, Kim H. Two-dimensional planimetry for alopecia areata severity evaluation compared with severity of alopecia tool: A pilot study. Skin Res Technol 2023; 29:e13440. [PMID: 37753671 PMCID: PMC10444945 DOI: 10.1111/srt.13440] [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: 04/02/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Severity of Alopecia Tool (SALT) is widely used to assess the severity of alopecia areata (AA). However, physician-related subjectivity exists in SALT scoring (S1-5), especially with initial inspection in the clinical practice. This study investigated two-dimensional planimetric method to calculate actual surface area of AA, validating SALT scoring. MATERIALS AND METHODS SALT score was measured twice in each patient based on "initial" inspection in the clinic (SALT-I) and retrospective assessment of the "photograph" (SALT-P). Planimetric surface area was calculated by Image J program. Subgroup analysis was performed depending on the agreement between SALT-I and -P; score was described in the order of SALT-I and SALT-P. RESULTS A total of 93 subjects were enrolled. Planimetric surface area (cm2 ) of SALT-I was 2.5-74.9 (S1), 48.8-100.6 (S2), 83.6-205.4 (S3), and 282-367.9 (S4), while SALT-P was 2.5-59.2 (S1), 41.6-205.4 (S2), 48.8-183.2 (S3), and 282-367.9 (S4). In subgroup analysis, SALT-I and SALT-P agreed group showed planimetric surface area (cm2 ) as 2.5-59.2 (S1-1), 64.2-100.6 (S2-2), 168.3-183 (S3-3), and 282.6-367.9 (S4-4). Disagreed group showed the value as 54.7 (S1-2), 41.6-74.9 (S2-1), 83.6-205.4 (S2-3), and 48.8-88.6 (S3-2). CONCLUSION SALT-P was more clearly correlated with actual surface area than SALT-I. Planimetric surface area measurement could be used as a supplementary method especially in the S1 to S3, suggesting 60 cm2 , 100 cm2 , and 200 cm2 as objective cutoff values to differentiate S1, S2, and S3.
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Affiliation(s)
- Jung Eun Seol
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seong Min Hong
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Sang Woo Ahn
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Seung Hee Jang
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
| | - Hyojin Kim
- Department of DermatologyBusan Paik Hospital, Inje UniversityBusanSouth Korea
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Ballaz SJ, Fors M. Predictive Value of the Platelet Times Neutrophil-to-Lymphocyte Ratio (SII Index) for COVID-19 In-Hospital Mortality. EJIFCC 2023; 34:167-173. [PMID: 37455846 PMCID: PMC10349308] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Objective The performance of the platelet times neutrophil-to-lymphocyte ratio, namely systemic immune inflammation (SII) index, is an inflammatory index that shows controversial results as a predicting indicator of the poor outcomes of COVID-19. In this study, this indicator was analyzed in 3280 patients admitted at a COVID-19 reference hospital in Quito (Ecuador). Methods The Receiver Operating Characteristic (ROC) curve analysis was conducted on SII values upon admission to identify the most appropriate cut-off values in discriminating COVID-19 severity and in-hospital mortality. Results SII was higher in both severe patients and in those who finally died (cut-off points of 757.3 and 808.5 respectively). However, the AUC-ROC analysis (0.60-0.67) demonstrated a modest discriminating performance of SII for COVID-19 severity (61.2% sensitivity and 61.5% specificity), which sensibly improved for COVID-19 mortality (AUC-ROC: 0.73-0.83, sensitivity: 80.6% specificity; 63.6%). Conclusion SII index may well be an indicator of inflammatory conditions secondary to COVID-19 leading to a higher mortality, rather than a predictor of severe forms of the disease.
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Affiliation(s)
| | - Martha Fors
- Medical School, Universidad de las Américas-UDLA, Quito, Ecuador
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Pala E, Melikoğlu M, Karaşahin Ö, Alkan Melikoğlu M. The Frequency of Association of Nail Involvement and Psoriatic Arthritis in Psoriasis Patients. Eurasian J Med 2023; 55:158-164. [PMID: 37403914 PMCID: PMC10440947 DOI: 10.5152/eurasianjmed.2023.53] [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: 05/30/2023] [Accepted: 02/20/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE While the relationship between psoriatic arthritis and skin findings is well-known in patients with psoriasis, the relationship between psoriatic arthritis and nail involvement is less known. In this study, it was aimed to examine the frequency of association between nail involvement and psoriatic arthritis in patients with psoriasis. MATERIALS AND METHODS Our study is a retrospective observational study. It was conducted with 250 regis- tered patients who applied to the dermatology polyclinic and clinic of our university hospital. The follow-up forms of the patients were scanned retrospectively and the findings were recorded. RESULTS The average age of the 250 patients evaluated in this study was 39.62 ± 9.30, and 133 (53.2%) of them were women. The frequency of nail involvement in psoriasis patients was determined to be 36.8% (n=92) and the frequency of arthritis was determined to be 8.8% (n=22). Nail involvement was statisti- cally significantly more common in those with arthritis, and nail involvement was present in all of those with arthritis (P < .001). Nail involvement was significantly more common in those with only arthralgia (P < .001). A significantly higher average of nail psoriasis severity index was found in those with both joint and nail involvement compared to those with only nail involvement (P < .001). There was no statistically significant difference in terms of psoriasis area severity index average (P=.235). Proximal and distal interphalangeal arthralgia and sacroiliac arthralgia were found significantly more frequently in those with nail involvement than in those without nail involvement (respectively P = .007 and P < .001). There was no statistically signifi- cant relationship between nail involvement with the presence of arthritis and the clinical type (respectively P = .288 and P = .955). CONCLUSION Joint involvement and nail involvement in patients with psoriasis are closely related, and we think that nail and joint involvement in psoriasis patients should be evaluated together.
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Affiliation(s)
- Erdal Pala
- Department of Dermatology and Venerology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Melikoğlu
- Department of Dermatology and Venerology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Ömer Karaşahin
- Erzurum Regional Training and Research Hospital, Infectious Diseases Erzurum, Turkey
| | - Meltem Alkan Melikoğlu
- Department of Physical Therapy and Rehabilitation, Atatürk University, Faculty of Medicine, Erzurum, Turkey
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Leung T, Horn SD, Sharkey PD, Brooks KR, Kennerly S. The Nursing Home Severity Index and Application to Pressure Injury Risk: Measure Development and Validation Study. JMIR Aging 2023; 6:e43130. [PMID: 36757779 PMCID: PMC9951072 DOI: 10.2196/43130] [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: 10/01/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An assessment tool is needed to measure the clinical severity of nursing home residents to improve the prediction of outcomes and provide guidance in treatment planning. OBJECTIVE This study aims to describe the development of the Nursing Home Severity Index, a clinical severity measure targeted for nursing home residents with the potential to be individually tailored to different outcomes, such as pressure injury. METHODS A retrospective nonexperimental design was used to develop and validate the Nursing Home Severity Index using secondary data from 9 nursing homes participating in the 12-month preintervention period of the Turn Everyone and Move for Ulcer Prevention (TEAM-UP) pragmatic clinical trial. Expert opinion and clinical literature were used to identify indicators, which were grouped into severity dimensions. Index performance and validation to predict risk of pressure injury were accomplished using secondary data from nursing home electronic health records, Minimum Data Sets, and Risk Management Systems. Logistic regression models including a resident's Worst-Braden score with/without severity dimensions generated propensity scores. Goodness of fit for overall models was assessed using C statistic; the significance of improvement of fit after adding severity components to the model was determined using the likelihood ratio chi-square test. The significance of each component was assessed with odds ratios. Validation based on randomly selected 65% training and 35% validation data sets was used to confirm the reliability of the severity measure. Finally, the discriminating ability of models was evaluated using propensity stratification to evaluate which model best discriminated between residents with/without pressure injury. RESULTS Data from 1015 residents without pressure injuries on admission were used for the Nursing Home Severity Index-Pressure Injury and included laboratory, weights/vitals/pain, underweight, and locomotion severity dimensions. Logistic regression C statistic measuring predictive accuracy increased by 19.3% (from 0.627 to 0.748; P<.001) when adding four severity dimensions to Worst-Braden scores. Significantly higher odds of developing pressure injuries were associated with increasing dimension scores. The use of the three highest propensity deciles predicting the greatest risk of pressure injury improved predictive accuracy by detecting 21 more residents who developed pressure injury (n=58, 65.2% vs n=37, 42.0%) when both severity dimensions and Worst-Braden score were included in prediction modeling. CONCLUSIONS The clinical Nursing Home Severity Index-Pressure Injury was successfully developed and tested using the outcome of pressure injury. Overall predictive capacity was enhanced when using severity dimensions in combination with Worst-Braden scores. This index has the potential to significantly impact the quality of care decisions aimed at improving individual pressure injury prevention plans. TRIAL REGISTRATION ClinicalTrials.gov NCT02996331; http://clinicaltrials.gov/ct2/show/NCT02996331.
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Affiliation(s)
| | - Susan D Horn
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Phoebe D Sharkey
- Sellinger School of Business, Loyola University Maryland, Baltimore, MD, United States
| | - Katie R Brooks
- School of Nursing, Duke University, Durham, NC, United States
| | - Susan Kennerly
- College of Nursing, East Carolina University, Greenville, NC, United States
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12
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E Silva LGA, de Maio Carrilho CMD, Talizin TB, Cardoso LTQ, Lavado EL, Grion CMC. Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study. Acute Crit Care 2023; 38:68-75. [PMID: 36935536 PMCID: PMC10030242 DOI: 10.4266/acc.2022.01375] [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: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital. METHODS Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model. RESULTS A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality. CONCLUSIONS Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.
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Affiliation(s)
| | | | | | | | - Edson Lopes Lavado
- Departamento de Fisioterapia, Universidade Estadual de Londrina, São Paulo, Brazil
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13
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Khalil M, Abbas Q, Azhar MK, Aamir FB, Hashmi S, Ali S, Faiz T, Malik MA. Cardiac Children Hospital Early Warning ScoreVersus the Inadequate Oxygen Delivery Index for the Detection of Early Warning Signs of Deterioration. Crit Care Explor 2023; 5:e0833. [PMID: 36713629 DOI: 10.1097/CCE.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/26/2023] Open
Abstract
To assess the utility of the Cardiac Children's Hospital Early Warning Score (C-CHEWS) in the early detection of deterioration. DESIGN Single-center longitudinal pilot study. SETTING Pediatric cardiac ICU (PCICU), Aga Khan University. INTERVENTIONS C-CHEWS and Inadequate Oxygen Delivery (IDO2) Index calculation every 2 hours. PATIENTS A total of 60 children (0 d to 18 yr old). MEASUREMENTS AND MAIN RESULTS A single-center longitudinal pilot study was conducted at PCICU. All postoperative extubated patients were assessed and scored between 0 and 11, and these scores were then correlated with the IDO2 index data available from the T3 platform. Adverse events were defined as a need for cardiopulmonary resuscitation, or reintubation, and death. A total of 920 C-CHEWS and IDO2 scores were analyzed on 60 patients during the study period. There were 36 males and 24 females, and the median age of the study population was 34 months (interquartile range, 9.0-72.0 mo). Fourteen patients (23.3%) developed adverse events; these included 9 reintubations and 5 cardiopulmonary arrests, resulting in 2 deaths. The area under the curve (AUC) for C-CHEWS scores fell in an acceptable range of 0.956 (95% CI, 0.869-0.992), suggesting an optimal accuracy for identifying early warning signs of cardiopulmonary arrest. Whereas, IDO2 showed no discriminatory power to detect the adverse events with an AUC of 0.522 (95% CI, 0.389-0.652). CONCLUSIONS The C-CHEWS tool provides a standardized assessment and approach to deteriorating congenital cardiac surgery patients in recognizing early postoperative deterioration.
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14
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Amruthalingam L, Mang N, Gottfrois P, Gonzalez Jimenez A, Maul JT, Kunz M, Pouly M, Navarini AA. Objective hand eczema severity assessment with automated lesion anatomical stratification. Exp Dermatol 2023; 32:521-528. [PMID: 36627238 DOI: 10.1111/exd.14744] [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: 06/05/2022] [Revised: 12/23/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
Hand eczema (HE) is one of the most frequent dermatoses, known to be both relapsing and remitting. Regular and precise evaluation of the disease severity is key for treatment management. Current scoring systems such as the hand eczema severity index (HECSI) suffer from intra- and inter-observer variance. We propose an automated system based on deep learning models (DLM) to quantify HE lesions' surface and determine their anatomical stratification. In this retrospective study, a team of 11 experienced dermatologists annotated eczema lesions in 312 HE pictures, and a medical student created anatomical maps of 215 hands pictures based on 37 anatomical subregions. Each data set was split into training and test pictures and used to train and evaluate two DLMs, one for anatomical mapping, the other for HE lesions segmentation. On the respective test sets, the anatomy DLM achieved average precision and sensitivity of 83% (95% confidence interval [CI] 80-85) and 85% (CI 82-88), while the HE DLM achieved precision and sensitivity of 75% (CI 64-82) and 69% (CI 55-81). The intraclass correlation of the predicted HE surface with dermatologists' estimated surface was 0.94 (CI 0.90-0.96). The proposed method automatically predicts the anatomical stratification of HE lesions' surface and can serve as support to evaluate hand eczema severity, improving reliability, precision and efficiency over manual assessment. Furthermore, the anatomical DLM is not limited to HE and can be applied to any other skin disease occurring on the hands such as lentigo or psoriasis.
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Affiliation(s)
- Ludovic Amruthalingam
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Lucerne School of Computer Science and Information Technology, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Nora Mang
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Philippe Gottfrois
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zürich, Zurich, Switzerland
| | - Michael Kunz
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Marc Pouly
- Lucerne School of Computer Science and Information Technology, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Alexander A Navarini
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Dermatology, University Hospital of Basel, Basel, Switzerland
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15
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Tapper EB, Bonafede M, Fishman J, Dodge S, Miller K, Zeng N, Lewandowski D, Bogdanov A. Healthcare resource utilization and costs of care in the United States for patients with non-alcoholic steatohepatitis. J Med Econ 2023; 26:348-356. [PMID: 36866575 DOI: 10.1080/13696998.2023.2184967] [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] [Indexed: 03/04/2023]
Abstract
AIMS This retrospective, observational cohort study aimed to determine the burden of comorbidities, hospitalization, and healthcare costs among patients with non-alcoholic steatohepatitis (NASH) in the United States stratified by fibrosis-4 (FIB-4) or body mass index (BMI). METHODS Adults with NASH were identified in the Veradigm Health Insights Electronic Health Record Database and linked Komodo claims data. The index date was the earliest coded NASH diagnosis between 1 January 2016 and 31 December 2020 with valid FIB-4 and ≥6 months of database activity and continuous enrollment pre- and post-index. We excluded patients with viral hepatitis, alcohol-use disorder, or alcoholic liver disease. Patients were stratified by FIB-4: FIB-4 ≤ 0.95, 0.95 < FIB-4 ≤ 2.67, 2.67 < FIB-4 ≤ 4.12, FIB-4 > 4.12) or BMI (BMI <25, 25 ≤ BMI ≤30, BMI > 30). Multivariate analysis was used to assess the relationship of FIB-4 with costs and hospitalizations. RESULTS Among 6,743 qualifying patients, index FIB-4 was ≤0.95 for 2,345 patents, 0.95-2.67 for 3,289 patients, 2.67-4.12 for 571 patients, and >4.12 for 538 patients (mean age 55.8 years; 62.9% female). Mean age, comorbidity burden, cardiovascular disease risk, and healthcare utilization increased with increasing FIB-4. Mean ± SD annual costs increased from $16,744±$53,810 to $34,667±$67,691 between the lowest and highest FIB-4 cohorts and were higher among patients with BMI <25 ($24,568±$81,250) than BMI >30 ($21,542±$61,490). A one-unit increase in FIB-4 at index was associated with a 3.4% (95%CI: 1.7%-5.2%) increase in mean total annual cost and an 11.6% (95%CI: 8.0%-15.3%) increased likelihood of hospitalization. CONCLUSIONS A higher FIB-4 was associated with increased healthcare costs and risk of hospitalization in adults with NASH; however, even patients with FIB-4 ≤ 0.95 presented a significant burden.
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Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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16
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Blum JD, Beiriger J, Villavisanis DF, Morales C, Cho DY, Tao W, Whitaker R, Bartlett SP, Taylor JA, Goldstein JA, Swanson JW. Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome? J Craniofac Surg 2023; 34:58-64. [PMID: 35946829 PMCID: PMC9825625 DOI: 10.1097/scs.0000000000008868] [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: 03/21/2022] [Accepted: 05/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There have been few longitudinal studies assessing the effect of preoperative phenotypic severity on long-term esthetic outcomes in metopic craniosynostosis. This study evaluates the relationship between metopic severity and long-term esthetic outcomes using interfrontal angle (IFA) and CranioRate, a novel metopic synostosis severity measure. METHODS Patients with metopic craniosynostosis who underwent bifrontal orbital advancement and remodeling between 2012 and 2017 were reviewed. Preoperative computed tomography head scans were analyzed for IFA and CranioRate, a machine learning algorithm which generates quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Long-term esthetic outcomes were assessed by craniofacial surgeons using blinded 3-rater esthetic grading of clinical photos. Raters assessed Whitaker score and the presence of temporal hollowing, lateral orbital retrusion, frontal bone irregularities and/or "any visible irregularities." RESULTS Preoperative scans were performed at a mean age of 7.7±3.4 months, with average MSS of 6/10, CMD of 200/300, and IFA of 116.8±13.8 degrees. Patients underwent bifrontal orbital advancement and remodeling at mean 9.9±3.1 months. The average time from operation to esthetic assessment was 5.4±1.0 years. Pearson correlation revealed a significant negative correlation between MSS and age at computed tomography ( r =-0.451, P =0.004) and IFA ( r =-0.371, P =0.034) and between IFA and age at surgery ( r =-0.383, P =0.018). In multinomial logistic regression, preoperative MSS was the only independent predictor of visible irregularities (odds ratio=2.18, B =0.780, P =0.024) and preoperative IFA alone significantly predicted Whitaker score, with more acute IFA predicting worse Whitaker score (odds ratio=0.928, B =-0.074, P =0.928). CONCLUSIONS More severe preoperative phenotypes of metopic craniosynostosis were associated with worse esthetic dysmorphology. Objective measures of preoperative metopic severity predicted long-term esthetic outcomes.
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Affiliation(s)
- Jessica D Blum
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Justin Beiriger
- Division of Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Carrie Morales
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Daniel Y Cho
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Wenzheng Tao
- School of Computing, University of Utah, Salt Lake City, UT
| | - Ross Whitaker
- School of Computing, University of Utah, Salt Lake City, UT
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Jesse A Goldstein
- Division of Plastic Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia
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17
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Kim J, Park SH, Kim JM. Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching. JMIR Public Health Surveill 2022; 8:e35025. [PMID: 36265125 PMCID: PMC9678330 DOI: 10.2196/35025] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A vaccine against COVID-19 has been developed; however, COVID-19 transmission continues. Although there have been many studies of comorbidities that have important roles in COVID-19, some studies have reported contradictory results. OBJECTIVE This study was conducted using real-world data from COVID-19 patients in South Korea and aimed to investigate the impact of patient demographics and comorbidities on the infection rate and severity of COVID-19. METHODS Data were derived from a nationwide South Korean COVID-19 cohort study with propensity score (PS) matching. We included infected individuals who were COVID-19-positive between January 1, 2020, and May 30, 2020, and PS-matched uninfected controls. PS matching was performed to balance the baseline characteristics of each comorbidity and to adjust for potential confounders, such as age, sex, Charlson Comorbidity Index, medication, and other comorbidities, that were matched with binary variables. The outcomes were the confirmed comorbidities affecting the infection rate and severity of COVID-19. The endpoints were COVID-19 positivity and severe clinical outcomes of COVID-19 (such as tracheostomy, continuous renal replacement therapy, intensive care unit admission, ventilator use, cardiopulmonary resuscitation, and death). RESULTS The COVID-19 cohort with PS matching included 8070 individuals with positive COVID-19 test results and 8070 matched controls. The proportions of patients in the severe group were higher for individuals 60 years or older (severe clinical outcomes for those 60 years or older, 16.52%; severe clinical outcomes for those of other ages, 2.12%), those insured with Medicaid (Medicaid, 10.81%; other insurance, 5.61%), and those with disabilities (with disabilities, 18.26%; without disabilities, 5.07%). The COVID-19 infection rate was high for patients with pulmonary disease (odds ratio [OR] 1.88; 95% CI 1.70-2.03), dementia (OR 1.75; 95% CI 1.40-2.20), gastrointestinal disease (OR 1.74; 95% CI 1.62-1.88), stroke (OR 1.67; 95% CI 1.23-2.27), hepatobiliary disease (OR 1.31; 95% CI 1.19-1.44), diabetes mellitus (OR 1.28; 95% CI 1.16-1.43), and cardiovascular disease (OR 1.20; 95% CI 1.07-1.35). In contrast, it was lower for individuals with hyperlipidemia (OR 0.73; 95% CI 0.67-0.80), autoimmune disease (OR 0.73; 95% CI 0.60-0.89), and cancer (OR 0.73; 95% CI 0.62-0.86). The severity of COVID-19 was high for individuals with kidney disease (OR 5.59; 95% CI 2.48-12.63), hypertension (OR 2.92; 95% CI 1.91-4.47), dementia (OR 2.92; 95% CI 1.91-4.47), cancer (OR 1.84; 95% CI 1.15-2.94), pulmonary disease (OR 1.72; 95% CI 1.35-2.19), cardiovascular disease (OR 1.54; 95% CI 1.17-2.04), diabetes mellitus (OR 1.43; 95% CI 1.09-1.87), and psychotic disorders (OR 1.29; 95% CI 1.01-6.52). However, it was low for those with hyperlipidemia (OR 0.78; 95% CI 0.60-1.00). CONCLUSIONS Upon PS matching considering the use of statins, it was concluded that people with hyperlipidemia could have lower infection rates and disease severity of COVID-19.
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Affiliation(s)
- Jiyong Kim
- Department of Rehabilitation, Inje University Ilsanpaik Hospital, Goyang, Republic of Korea
| | - Seong Hun Park
- Statistical analysis company, HYMS, Gwangju, Republic of Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
- Department of Medical Informatics Big Data Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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18
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Defazio G, Hallett M, Berardelli A, Perlmutter JS, Berman BD, Jankovic J, Bäumer T, Comella C, Ercoli T, Ferrazzano G, Fox SH, Kim H, Moukheiber ES, Pirio Richardson S, Weissbach A, Gigante AF, Jinnah HA. Measurement Properties of Clinical Scales Rating the Severity of Blepharospasm: A Multicenter Observational Study. Mov Disord Clin Pract 2022; 9:949-955. [PMID: 36247913 PMCID: PMC9547140 DOI: 10.1002/mdc3.13530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background Several scales have been proposed to clinically evaluate the Motor Severity of Blepharospasm (BSP) but information about their measurement properties as a multicenter instrument is limited. Objective To compare the measurement properties of four clinical scales in rating the severity of BSP in a large sample of patients from multiple sites. Methods The Burke-Fahn-Marsden Scale (BFMS), the Global Dystonia Severity Rating Scale (GDRS), the Jankovic Rating Scale (JRS), and the Blepharospasm Severity Rating Scale (BSRS) were administered to 211 patients across 10 sites who were also requested to self-complete the Blepharospasm Disability Index (BDI). Measurement properties to be assessed included inter-/intra-observer agreement, item-to-total correlation, internal consistency, floor and ceiling effect, convergent/discriminant validity, and adherence to the distribution of BDI. Results The BFMS had unsatisfactory measurement properties, the GDRS had acceptable reliability but other properties could not be completely testable; the JRS had satisfactory measurement properties but the scale did not accurately reflect the distribution of disability parameter (BDI) in the sample, and the BSRS had satisfactory measurement properties and also showed the best adherence to the distribution of BDI in the assessed sample. Conclusion The comparison of the measurement properties of four rating scales to assess the motor state of the BSP in a large sample of patients from multiple sites showed that the GDRS should be used to simultaneously assess BSP and dystonia in other body parts, while the JRS (easier to use) and BSRS (better to discriminate severity) should be used to assess BSP alone.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Mark Hallett
- Human Motor Control Section, NINDS, NIHBethesdaMDUSA
| | - Alfredo Berardelli
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
- IRCCS NEUROMEDPozzilliItaly
| | - Joel S. Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational TherapyWashington University in St. LouisSt LouisMOUSA
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTXUSA
| | - Tobias Bäumer
- Institute of Systems Motor ScienceUniversity of LuebeckLuebeckGermany
| | | | - Tommaso Ercoli
- Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Gina Ferrazzano
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Susan H. Fox
- Toronto Western Hospital, Krembil Brain InstituteUniversity of TorontoTorontoONCanada
| | - Han‐Joon Kim
- Department of Neurology and Movement Disorder CentreSeoul National University HospitalSeoulSouth Korea
| | | | | | - Anne Weissbach
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTXUSA
- Institute of Systems Motor Science and Institute of NeurogeneticsUniversity of Lübeck, LübeckGermany
| | | | - Hyder A. Jinnah
- Department of Neurology and Human GeneticsEmory UniversityAtlantaGAUSA
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Tosin MHS, Stebbins GT, Goetz CG, Hagerman RJ, Hessl D, Zolecki MA, Todd PK, Leehey MA, Hall DA. Fragile X-associated tremor ataxia syndrome rating scale: Revision and content validity using a mixed method approach. Front Neurol 2022; 13:977380. [PMID: 36188408 PMCID: PMC9515309 DOI: 10.3389/fneur.2022.977380] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background The original Fragile X-associated Tremor Ataxia Syndrome Rating Scale (FXTAS-RS) contained 61 items, some requiring modifications to better meet recommendations for patient-focused rating scale development. Purpose Provide initial validation of a revised version of the FXTAS-RS for motor signs. Method We conducted a two-phase mixed-method approach. In Phase 1, revision, we implemented a Delphi technique identifying pertinent domains/subdomains and developing items through expert consensus. In Phase 2, content validation, we conducted cognitive pretesting assessing comprehensibility, comprehensiveness, and relevance of items to FXTAS motor signs. Results After five rounds of Delphi panel and two rounds of cognitive pretesting, the revised version of the FXTAS-RS was established with 18 items covering five domains and 13 subdomains of motor signs. Cognitive pretesting revealed adequate content validity for the assessment of FXTAS motor signs. Conclusion The revised FXTAS-RS has been successfully validated for content and it is now ready for large-scale field validation.
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Affiliation(s)
- Michelle H. S. Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Randi J. Hagerman
- Department of Pediatrics and the MIND Institute, University of California, Davis School of Medicine, Sacramento, CA, United States
| | - David Hessl
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | | | - Peter K. Todd
- University of Michigan, Ann Harbor, MI, United States
- Ann Arbor Veterans Administration Healthcare System, Ann Arbor, MI, United States
| | - Maureen A. Leehey
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Guney MC, Keles T, Karaduman BD, Ayhan H, Suygun H, Kahyaoglu M, Bozkurt E. Predictors and Prognostic Implications of Myocardial Injury After Transcatheter Aortic Valve Replacement. Tex Heart Inst J 2022; 49:483735. [PMID: 35838644 DOI: 10.14503/thij-20-7380] [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] [Indexed: 11/23/2022]
Abstract
Myocardial injury (MI) is not unusual after transcatheter aortic valve replacement (TAVR). To determine precipitating factors and prognostic outcomes of MI after TAVR, we retrospectively investigated relationships between MI after TAVR and aortic root dimensions, baseline patient characteristics, echocardiographic findings, and procedural features. Of 474 patients who underwent transfemoral TAVR for severe aortic stenosis in our tertiary center from June 2011 through June 2018, 188 (mean age, 77.7 ± 7.7 yr; 96 women [51%]) met the study inclusion criteria. Patients were divided into postprocedural MI (PMI) (n=74) and no-PMI (n=114) groups, in accordance with high-sensitivity troponin T levels. We found that MI risk was associated with older age (odds ratio [OR]=1.054; 95% CI, 1.013-1.098; P=0.01), transcatheter heart valve type (OR=10.207; 95% CI, 2.861-36.463; P=0.001), distances from the aortic annulus to the right coronary artery ostium (OR=0.853; 95% CI, 0.731-0.995; P=0.04) and the left main coronary artery ostium (OR=0.747; 95% CI, 0.616-0.906; P=0.003), and baseline glomerular filtration rate (OR=0.985; 95% CI, 0.970-1.000; P=0.04). Moreover, the PMI group had a longer time to hospital discharge (P=0.001) and a higher permanent pacemaker implantation rate (P=0.04) than did the no-PMI group. Our findings may enable better estimation of which patients are at higher risk of MI after TAVR and thus improve the planning and course of clinical care.
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Affiliation(s)
- Murat Can Guney
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Telat Keles
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Duran Karaduman
- Department of Cardiology, Faculty of Medicine, Atilim University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Huseyin Ayhan
- Department of Cardiology, Faculty of Medicine, Atilim University, Medicana International Ankara Hospital, Ankara, Turkey
| | - Hakan Suygun
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Muzaffer Kahyaoglu
- Department of Cardiology, Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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Trieschmann K, Chang L, Park S, Naliboff B, Joshi S, Labus JS, Sauk JS, Limketkai BN, Mayer EA. The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease. Neurogastroenterol Motil 2022; 34:e14384. [PMID: 35478469 PMCID: PMC9427691 DOI: 10.1111/nmo.14384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are chronic gastrointestinal (GI) disorders. GI symptom-specific anxiety (GSA) is the cognitive, affective, and behavioral response stemming from fear of GI symptoms. The Visceral Sensitivity Index (VSI) measures GSA and is validated in IBS and may be useful in IBD. METHODS We compared VSI scores in IBD participants to IBS participants and healthy controls (HCs). Using validated questionnaires, we assessed the VSI's correlation with anxiety, health-related quality of life (HRQOL), and IBD activity. KEY RESULTS We recruited 222 age- and sex-matched participants (74 IBD [23 Crohn's disease; 51 ulcerative colitis], 74 IBS, and 74 HCs). IBD and IBS participants had higher VSI scores compared with HCs (IBD = 26.62 ± 16.64, IBS = 38.83 ± 15.06; HCs = 3.42±5.06; all p's < 0.001). VSI scores were lower in IBD vs IBS (p < 0.001). In IBD, VSI modestly correlated with current anxiety (R = 0.35, p = 0.002) and the physical component of HRQOL (R = -0.45, p = 0.0001) but less with the mental component of HRQOL (R = -0.23, p = 0.05). CONCLUSIONS & INFERENCES Our findings suggest the VSI is a useful measure in IBD. The VSI in IBD is related to general anxiety but is measuring a different construct and is not affected by the presence of trait anxiety. IBD patients have GSA that is associated with decreased HRQOL, which can negatively affect treatment compliance and other long-term disease outcomes. Future studies are needed to further validate the VSI in IBD and to assess its correlation with disease activity.
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Affiliation(s)
- Kimberly Trieschmann
- UCLA Division of Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah Park
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Swapna Joshi
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S. Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jenny S. Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Berkeley N. Limketkai
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A. Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
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22
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Jung JM, Jung CJ, Yang HJ, Lee WJ, Won CH, Lee MW, Chang SE. Clinical implications of facial psoriasis in children and adolescents. Pediatr Dermatol 2022; 39:528-534. [PMID: 35347761 DOI: 10.1111/pde.14986] [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: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The clinical implications of facial involvement in pediatric patients with psoriasis have not been adequately studied. The objectives of this study are to evaluate the association between facial involvement and clinical features including disease severity of psoriasis in children and adolescents. METHODS The clinical features of patients aged below 20 years diagnosed with psoriasis were retrospectively evaluated and grouped based on the presence or absence of facial involvement at presentation. Demographic and clinical data were compared between groups. RESULTS Of the 175 patients, 110 patients (62.9%) had facial involvement of psoriasis at presentation. The group with facial involvement was significantly younger at disease onset (p = .032) and had a higher body mass index (BMI) (p = .043) and psoriasis area and severity index (PASI) score (p <.001). The severity of pruritus was significantly higher in the facial than in the non-facial group (p = .020). Involvement of the nose was associated with the highest disease severity as assessed by the PASI score and affected body surface area. A significantly higher number of treatment modalities were used in the facial group than in the non-facial group (p = .013). The BMI (odds ratio (OR), 1.39; 95% CI (confidence interval), 1.07-1.80) and PASI score (OR, 1.45; 95% CI, 1.03-2.03) were independent factors associated with facial involvement of psoriasis. CONCLUSIONS Facial involvement in psoriasis was associated with higher disease severity and more treatment modalities in children and adolescents.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Joo Yang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fuentes A, Earla JR, Iso T, Swan JT. Impact of Recent Acute Kidney Injury on Creatinine Clearance Estimation in Critically Ill Patients Undergoing Cardiac Surgery. Tex Heart Inst J 2022; 49:483027. [PMID: 35727922 DOI: 10.14503/thij-20-7382] [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] [Indexed: 11/23/2022]
Abstract
Acute kidney injury (AKI), often present in critically ill patients and patients with cardiac dysfunction, may alter estimates of renal function. The impact of recent AKI on the accuracy of the Cockcroft-Gault creatinine clearance equation (CG-CrCl) before cardiac surgery is unknown. This single-center, retrospective study included patients who underwent cardiac surgery from 1 January 2006 through 30 June 2012 and whose 24-hour urine creatinine clearance (24hr-CrCl) was measured in the intensive care unit before surgery. We evaluated CG-CrCl accuracy by calculating absolute differences between 24hr-CrCl and CG-CrCl estimates. Clinical impact was signified by discrepancies in United States Food and Drug Administration (FDA) renal impairment stage indicated by 24hr-CrCl versus CG-CrCl estimates. Acute kidney injury was evaluated by using Kidney Disease: Improving Global Outcomes criteria. Of 161 patients, 93 (58%) had recent AKI: stage 1, 31 (33%); stage 2, 39 (42%); and stage 3, 23 (25%). In mL/min, the CG-CrCl overestimated 24hr-CrCl (absolute difference: total, -10 ± 25; no AKI, -7 ± 26; stage 1, -8 ± 17; stage 2, -16 ± 28; and stage 3, -10 ± 26; P=0.29). Renal impairment stages assigned by CG-CrCl did not match 24hr-CrCl in 70 (43%) of the 161 patients, especially those with recent AKI: no AKI, 24/68 (35%); stage 1, 13/31 (42%); stage 2, 23/39 (59%); and stage 3, 10/23 (43%). The CG-CrCl consistently overestimated 24hr-CrCl in critically ill patients before cardiac surgery. Clinicians should use the CG-CrCl cautiously when estimating renal function and medication dosages in this population.
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Affiliation(s)
- Amaris Fuentes
- System Quality and Patient Safety, Houston Methodist, Houston, Texas
| | - Jagadeswara R Earla
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas
| | - Tomona Iso
- Department of Pharmacy, Houston Methodist, Houston, Texas.,Department of Surgery, Houston Methodist, Houston, Texas
| | - Joshua T Swan
- Department of Pharmacy, Houston Methodist, Houston, Texas.,Department of Surgery, Houston Methodist, Houston, Texas.,Center for Outcomes Research, Houston Methodist, Houston, Texas
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24
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Wang L, Pan M, Ou Q. The effects of long-term continuous positive airway pressure on apnea-hypopnea index change following short-term that withdrawal in patients with obstructive sleep apnea. Clin Respir J 2022; 16:352-360. [PMID: 35466516 PMCID: PMC9366582 DOI: 10.1111/crj.13488] [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] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022]
Abstract
The effect of long‐term continuous positive airway pressure (CPAP) treatment on apnea–hypopnea index (AHI) after CPAP withdrawal remains unclear, especially in obstructive sleep apnea (OSA) patients screened from the population. To examine that, 1241 civil servants who participated in the annual physical examination were screened for OSA between September and December 2017. Screened OSA firstly underwent 1‐week CPAP adherence assessment. Then, patients with good CPAP adherence would be freely provided CPAP to continued treatment. All OSA patients were followed for 2 years. At study end, all OSA patients underwent home sleep testing (HST) again within 1 week of CPAP withdrawal. The effect of 2‐year CPAP treatment on OSA severity was investigated by using linear regression and multinominal logistic regression. In total, 103 OSA patients were screened, including 41 cases (39.8%) in CPAP treatment group and 62 cases (60.2%) in non‐CPAP treatment group. At 2‐year follow‐up, compared with baseline, in CPAP treatment group, following CPAP withdrawal, a significant decrease in AHI was observed in patients with severe OSA (P = 0.014); in non‐CPAP treatment group, a significant increase in AHI was observed in patients with moderate OSA (P = 0.028). After adjustment for confounding factors, multivariate linear regression showed that △AHI was negatively associated with CPAP treatment (β = −4.930, 95% confidence interval [CI] [−9.361, −0.500], P = 0.030). Multinominal logistic regression showed that the AHI of patients not treated with CPAP tended to be unchanged or worsened with the AHI improvement group as a reference (OR [odds ration] [95% CI], 4.555 [1.307, 15.875], P = 0.017; 6.536 [1.171, 36.478], P = 0.032). In conclusion, active OSA screening and long‐term CPAP intervention may improve the severity of severe OSA patients following short‐term CPAP withdrawal in the general population.
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Affiliation(s)
- Longlong Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Minxia Pan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Qiong Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences; Guangdong Provincial Geriatrics Institute, Guangzhou, China
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Kumar S, Chandrachari KP, Mariswamappa K, Pillai SV, Vijayendra VH, Lale S, Hegde T. Development and Validation of a Multivariable Model to Predict Surgical Outcome in Patients with Chiari malformations. Neurol India 2022; 70:905-912. [PMID: 35864617 DOI: 10.4103/0028-3886.349662] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Surgical outcome predictive models for Chiari malformations (CM) which are applicable to all age groups and simple enough to use on outpatient basis are lacking. Objective The aim of this study was to develop and validate a preoperative index for predicting long-term outcomes in Chiari 1 (CM1) and Chiari 0 (CM0) malformations. Materials and Methods It was a single-institution, ambidirectional, cohort study from 2014 to 2019, having patients between 5 to 70 years. Outcome was assessed using Chicago Chiari outcome score (CCOS) over 2 years follow-up. Preoperative clinical and radiological factors were analyzed using Chi-square test and Mann Whitney U test, in relation to CCOS and those attaining P value ≤0.05, were used to develop model - Chiari Outcome Predictive Index (COPI). COPI was internally validated using 10-fold cross-validation and c-statistic for discrimination. Results A total of 88 patients (66 in development and 22 in validation cohort) were included in the study. Outcome was negatively associated with presence of motor, sensory or cranial nerve symptoms, poor functional status, basilar invagination, and tonsillar descent. It was positively associated with shorter duration of presenting symptom (<9 months) and syrinx diameter <6 mm. COPI predicted CCOS with 91.1% accuracy (10-fold cross-validation). It had excellent discrimination for improved outcome (c = 0.968 in development and 0.976 in validation cohort), at threshold index of -1. Conclusions COPI is simple tool that can be administered in outpatient setting. It can facilitate evidence-based preoperative counseling of patients, to help them develop reasonable expectations regarding surgical outcomes.
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Affiliation(s)
- Shishir Kumar
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Komal P Chandrachari
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Kiran Mariswamappa
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Shibu V Pillai
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Vishwas H Vijayendra
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Sathyanarayana Lale
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
| | - Thimappa Hegde
- Department of Neurosurgery, Narayana Institute of Neurosciences, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, Karnataka, India
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Leven EA, Kurdi AT, Govindarajulu U, Schiano T, Pinney S, Crismale JF. Child-Turcotte-Pugh versus MELD-XI identify distinct high-risk populations for heart transplantation following ventricular assist device placement. Clin Transplant 2022; 36:e14617. [PMID: 35191097 DOI: 10.1111/ctr.14617] [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: 10/05/2021] [Revised: 01/05/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with end-stage heart failure frequently have significant congestive hepatopathy requiring hepatology assessment prior to heart transplantation listing. An elevated Model for End-stage Liver Disease score with modification to exclude INR (MELD-XI) has been associated with increased mortality following heart transplantation (HT). This study's primary aim was to examine whether Child-Turcotte-Pugh (CTP) classification is associated with post-transplant mortality in patients bridged to transplant with left ventricular assist devices. METHODS AND RESULTS We conducted a retrospective analysis of 134 patients from our center. Age, CTP class, and MELD-XI at HT were included in the multivariate model for the primary outcome, which demonstrated a significant association between 1-year mortality and CTP class (CTP-A HR: .08, CI .01-.46, P < .01; CTP-B HR: .25, CI .05-1.2, P = .08; reference group CTP-C), and MELD-XI (HR: 1.15; CI: 1.03-1.28; P = .01), but no significant difference for age (HR: .97; CI: .93-1.01; P = .15). Only 13/33 patients with CTP improvement after assist device also had improvement in MELD-XI. CONCLUSIONS Patients with relatively low MELD-XI scores with discordantly high CTP classification may be a distinct subset for whom MELD-XI underestimates the risk of mortality after heart transplantation compared to CTP.
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Affiliation(s)
- Emily A Leven
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed T Kurdi
- Department of Medicine, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean Pinney
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - James F Crismale
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Medeiros Araujo C, de Morais NR, Sacomori C, de Sousa Dantas D. Pad test for urinary incontinence diagnosis in adults: Systematic review of diagnostic test accuracy. Neurourol Urodyn 2022; 41:696-709. [PMID: 35114027 DOI: 10.1002/nau.24878] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The pad test is an assessment tool for urinary incontinence (UI) severity classification and therapeutic response monitoring. However, the reliability and reproducibility of this test have been questioned. OBJECTIVES To summarize the evidence regarding the accuracy measures and reproducibility of different pad test protocols for assessing UI. METHODS A systematic review of the diagnostic accuracy of this tool was performed (CRD42020219392). Eligibility criteria: Studies reporting data on the accuracy measures and reproducibility of the pad test when used for detecting UI in adult men and women. DATA SOURCES MEDLINE, Science Direct, Cochrane, Web of Science, LILACS, and Pedro. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the articles, extracted the data, and evaluated the risk of bias (RoB) using the QUADAS-2 tool. RESULTS From 1048 studies, 18 studies were included. Eight of these reported accuracy data, and 12 reported reproducibility properties. A total of 1070 individuals were analyzed, whose mean age ranged from 20 to 90 years. The accuracy of the long-duration protocols was generally moderate to high (sensitivity, 60%-93%; specificity, 60%-84%). The 1-h protocols obtained higher accuracy values. The overall reproducibility was moderate to high (κ ≥ 0.66). LIMITATIONS The RoB was high and, due to different cutoff points adopted by studies, the bivariate model was not satisfied to perform a meta-analysis. DISCUSSION The 1-h pad test was more accurate but less reproducible when compared to the long-duration tests. Pad test results should be used with caution in clinical practice.
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Affiliation(s)
| | - Nívea Rosa de Morais
- Physiotherapy Department, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Cinara Sacomori
- Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
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Prudente R, Ferrari R, Mesquita C, Machado L, Franco E, Godoy I, Tanni S. Nine-Year Follow-Up of Interleukin 6 in Chronic Obstructive Pulmonary Disease - Complementary Results from Previous Studies. Int J Chron Obstruct Pulmon Dis 2021; 16:3019-3026. [PMID: 34764645 PMCID: PMC8572745 DOI: 10.2147/copd.s328266] [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: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Systemic manifestations of chronic obstructive pulmonary disease (COPD) are related to increased systemic inflammatory process; however, it is not entirely clear how much they are related and how the systemic inflammation, in particular interleukin-6 (IL-6), is associated with exacerbation and mortality risk. Objective To evaluate the role of IL-6 in COPD patients over nine years. Study Design and Methods A total of 133 COPD patients were assessed at baseline between 2004 and 2006 and reassessed after three and nine years through clinical evaluation, comorbidities, hematological blood count and IL-6 analysis. Results After nine years, 19 patients lost the follow-up and were not possible to identify the date of death of four patients; 12 refused to participate and 1 could not be involved due to recurrent exacerbations. Therefore, 33 patients were included in the reassessment after nine years of follow-up and 92 patients were included in the Cox mortality analysis with IL-6 as a time-dependent covariate. Regarding the inflammatory profile, in patients who survived after nine years, there was a significant increase in IL-6 [0.4 (0.2–0.8) vs 5.7 (3.4–11) pg/mL; p < 0.001] and reduction in lymphocyte count [2.1 (1.6–2.4) vs 1.4 (1.2–2.1)10^9/L; p < 0.01] with an increase in the neutrophil/lymphocyte ratio (2.0 ± 0.7 vs 2.7 ± 1.2; p = 0.003). The Cox mortality model did not show a statistical significance influence of IL-6 assessed during the follow-up. Conclusion There was a progressive increase in IL-6 during the follow-up, however, without influence on mortality.
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Affiliation(s)
- Robson Prudente
- Clinical Hospital of Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Renata Ferrari
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Carolina Mesquita
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Luiz Machado
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Estefânia Franco
- Clinical Hospital of Botucatu Medical School, Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Irma Godoy
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Suzana Tanni
- Department of Internal Medicine, Pneumology Area, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Tosin MHS, Stebbins GT, Comella C, Patterson CG, Hall DA. Does MDS-UPDRS Provide Greater Sensitivity to Mild Disease than UPDRS in De Novo Parkinson's Disease? Mov Disord Clin Pract 2021; 8:1092-1099. [PMID: 34631945 DOI: 10.1002/mdc3.13329] [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: 04/27/2021] [Revised: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 11/08/2022] Open
Abstract
Background The Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was designed to be more sensitive to mild motor severity than the Unified Parkinson's Disease Rating Scale (UPDRS). Objective To test whether MDS-UPDRS Part III items provide increased sensitivity to mild motor severity when compared to the same items of the UPDRS in de novo PD patients. Method Using a sample of 129 de novo PD patients assessed at one time point simultaneously with both scales, we compared the scale's scores on the 17 items measuring the same motor function. The scaling anchors for the MDS-UPDRS were Slight, Mild, Moderate and Severe, and for the UPDRS were Mild, Moderate, Severe and Marked. Using Classical Test Theory (CTT) we compared the distributions of the scaling anchors from the individual items. Using Item Response Theory (IRT), we examined the sensitivity of the scaling anchors from each scale to the latent-trait measurement of overall parkinsonian motor severity. Results There was 2193 observations of individual scaling anchors from the 17 items in both scales. The CTT approach revealed frequent floor effects with only the item assessing Gait demonstrating a significance difference in the scaling distribution between the scales (P = 0.005). The IRT analyses revealed similar levels of sensitivity to the latent trait of PD motor function. Conclusion These results do not support increased sensitivity of MDS-UPDRS over the UPDRS for assessing mild motor severity in de novo PD patients, with significant difference in the scaling only for the item assessing gait.
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Affiliation(s)
- Michelle H S Tosin
- Department of Nursing Fluminense Federal University Niteroi Brazil.,Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Glenn T Stebbins
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Cynthia Comella
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
| | - Charity G Patterson
- Department of Physical Therapy, School of Health and Rehabilitation Sciences Data Center University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Deborah A Hall
- Department of Neurological Sciences Rush University Medical Center Chicago Illinois USA
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Huang WC, Xie HJ, Fan HT, Yan MH, Hong YC. Comparison of prognosis predictive value of 4 disease severity scoring systems in patients with acute respiratory failure in intensive care unit: A STROBE report. Medicine (Baltimore) 2021; 100:e27380. [PMID: 34596157 PMCID: PMC8483864 DOI: 10.1097/md.0000000000027380] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/11/2020] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Various disease severity scoring systems were currently used in critically ill patients with acute respiratory failure, while their performances were not well investigated.The study aimed to investigate the difference in prognosis predictive value of 4 different disease severity scoring systems in patients with acute respiratory failure.With a retrospective cohort study design, adult patients admitted to intensive care unit (ICU) with acute respiratory failure were screened and relevant data were extracted from an open-access American intensive care database to calculate the following disease severity scores on ICU admission: acute physiology score (APS) III, Sequential Organ Failure Assessment score (SOFA), quick SOFA (qSOFA), and Oxford Acute Severity of Illness Score (OASIS). Hospital mortality was chosen as the primary outcome. Multivariable logistic regression analyses were performed to analyze the association of each scoring system with the outcome. Receiver operating characteristic curve analyses were conducted to evaluate the prognosis predictive performance of each scoring system.A total of 4828 patients with acute respiratory failure were enrolled with a hospital mortality rate of 16.78%. APS III (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.03), SOFA (OR 1.15, 95% CI 1.12-1.18), qSOFA (OR 1.26, 95% CI 1.11-1.42), and OASIS (OR 1.06, 95% CI 1.05-1.08) were all significantly associated with hospital mortality after adjustment for age and comorbidities. Receiver operating characteristic analyses showed that APS III had the highest area under the curve (AUC) (0.703, 95% CI 0.683-0.722), and SOFA and OASIS shared similar predictive performance (area under the curve 0.653 [95% CI 0.631-0.675] and 0.664 [95% CI 0.644-0.685], respectively), while qSOFA had the worst predictive performance for predicting hospital mortality (0.553, 95% CI 0.535-0.572).These results suggested the prognosis predictive value varied among the 4 different disease severity scores for patients admitted to ICU with acute respiratory failure.
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Affiliation(s)
- Wen-Cheng Huang
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, Fujian, People's Republic of China
| | - Hong-Jian Xie
- Department of Respiratory Medicine, Quanzhou Guangqian Hospital, Quanzhou, Fujian, People's Republic of China
| | - Hong-Tao Fan
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, Fujian, People's Republic of China
| | - Mei-Hao Yan
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, Fujian, People's Republic of China
| | - Yuan-Cheng Hong
- Department of Respiratory Medicine, The 910th Hospital of People's Liberation Army, Quanzhou, Fujian, People's Republic of China
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Maghfour J, Sivesind TE, Dellavalle RP, Dunnick C. Trends in Hidradenitis Suppurativa Disease Severity and Quality of Life Outcome Measures: Scoping Review. JMIR Dermatol 2021; 4:e27869. [PMID: 37632807 PMCID: PMC10334968 DOI: 10.2196/27869] [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: 02/10/2021] [Revised: 05/04/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although there has been an increase in the number of randomized controlled trials evaluating treatment efficacy for hidradenitis suppurativa (HS), instrument measurements of disease severity and quality of life (QoL) are varied, making the compilation of data and comparisons between studies a challenge for clinicians. OBJECTIVE We aimed to perform a systematic literature search to examine the recent trends in the use of disease severity and QoL outcome instruments in randomized controlled trials that have been conducted on patients with HS. METHODS A scoping review was conducted in February 2021. The PubMed, Embase, Web of Science, and Cochrane databases were used to identify all articles published from January 1964 to February 2021. In total, 41 articles were included in this systematic review. RESULTS The HS Clinical Response (HiSCR) score (18/41, 44%) was the most commonly used instrument for disease severity, followed by the Sartorius and Modified Sartorius scales (combined: 16/41, 39%). The Dermatology Life Quality Index (18/41, 44%) and visual analogue pain scales (12/41, 29%) were the most commonly used QoL outcome instruments in HS research. CONCLUSIONS Randomized controlled trials conducted from 2013 onward commonly used the validated HiSCR score, while older studies were more heterogeneous and less likely to use a validated scale. A few (6/18, 33%) QoL measures were validated instruments but were not specific to HS; therefore, they may not be representative of all factors that impact patients with HS. TRIAL REGISTRATION National Institute of Health Research PROSPERO CRD42020209582; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209582.
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Affiliation(s)
- Jalal Maghfour
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, United States
| | - Torunn Elise Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert Paul Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Cory Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
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Kachmar AG, Wypij D, Perry MA, Curley MAQ. Income-driven socioeconomic status and presenting illness severity in children with acute respiratory failure. Res Nurs Health 2021; 44:920-930. [PMID: 34505720 DOI: 10.1002/nur.22182] [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: 02/16/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
Children living in low socioeconomic communities are vulnerable to poor health outcomes, especially when critically ill. The purpose of this study was to investigate the association between socioeconomic status (SES) and illness severity upon pediatric intensive care unit (PICU) admission in children with acute respiratory failure. This secondary analysis of the multicenter Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial includes children, 2 weeks to 17 years old, mechanically ventilated for acute respiratory failure; specifically, subjects who had parental consent for follow-up and residential addresses that could be matched with census tracts (n = 2006). Subjects were categorized into quartiles based on income, with a median income of $54,036 for the census tracts represented in the sample. Subjects in the highest income quartile were more likely to be older, non-Hispanic White, and hospitalized for pneumonia. Subjects in the lowest income quartile were more likely to be Black, younger, and hospitalized for asthma or bronchiolitis, to have age-appropriate baseline functional status, and history of prematurity and asthma. After controlling for age group, gender, race, and primary diagnosis, there were no associations between income quartile and either Pediatric Risk of Mortality scores or pediatric acute respiratory distress syndrome. As measured, income-based SES was not associated with illness severity upon PICU admission in this cohort of patients. More robust and reliable methods for measuring SES may help to better explain the mechanisms by which socioeconomic affect critical illness.
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Affiliation(s)
- Alicia G Kachmar
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Wypij
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mallory A Perry
- Research Institute, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Research Institute, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Al Hussain SK, Kurdi A, Abutheraa N, AlDawsari A, Sneddon J, Godman B, Seaton RA. Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:1202. [PMID: 34574976 DOI: 10.3390/healthcare9091202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/27/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia). Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores’ performance in predicting mortality. Results: Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25–0.94) and 0.96 (95% CI = 0.49–1.00), and for CRB-65, 0.09 (95% CI = 0.01–0.48) and 0.93 (95% CI = 0.50–0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73–0.96) and 0.64 (95% CI = 0.45–0.79), and for CRB-65, 0.99 (95% CI = 0.95–1.00) and 0.43 (95% CI = 0.24–0.64). Conclusions: CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).
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Bergamini LL, Spineli-Silva S, Félix TM, Gil-da-Silva-Lopes VL, Vieira TP, Ribeiro EM, Xavier AC, Lustosa-Mendes E, Fontes MÍB, Monlleó IL. Craniofacial microsomia: Reflections on diagnosis and severity assessment based on a series of cases. Congenit Anom (Kyoto) 2021; 61:148-158. [PMID: 33900643 DOI: 10.1111/cga.12422] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
This study aims to discuss diagnostic criteria and severity assessment for craniofacial microsomia (CFM). A series of 61 patients with diverse CFM phenotypes had their clinical data collected by experienced dysmorphologists using a single protocol. Genetic abnormalities were searched through karyotype and chromosomal microarray analysis. Sex ratio, prenatal risk factors, and recurrence rate corroborated the literature. Despite the wide variability of clinical findings, ear disruption was universal. Eight patients were assigned as syndromic, four of whom had demonstrable genetic alterations. The majority of patients (67.2%) fulfilled four known diagnostic criteria, while 9.8% fulfilled one of them. Data strengthened disruptions of the ear and deafness as a semiotically valuable sign in CFM. Facial impairment should consider asymmetry as a mild expression of microsomia. Spinal and cardiac anomalies, microcephaly, and developmental delay were prevalent among extra craniofacial features and should be screened before planning treatment and follow up. The severity index was able to recognize the less and the most affected patients. However, it was not useful to support therapeutic decisions and prognosis in the clinical scenario due to syndromic and non-syndromic phenotypes overlapping. These issues make contemporary the debate on diagnostic methods and disease severity assessment for CFM. They also impact care and etiopathogenetic studies.
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Affiliation(s)
- Luna Lira Bergamini
- Faculty of Medicine, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
| | - Samira Spineli-Silva
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Têmis Maria Félix
- Medical Genetics Service, Clinical Hospital of Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vera L Gil-da-Silva-Lopes
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Tarsis P Vieira
- Department of Translational Medicine, Medical Genetics and Genomic Medicine, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Erlane Marques Ribeiro
- Medical Genetics Service, Children's Hospital Albert Sabin (HIAS), Fortaleza, Ceará, Brazil
| | - Ana Carolina Xavier
- Center for Research and Rehabilitation of Lip and Palate Lesions, Prefeito Luiz Gomes Center, Joinville, Santa Catarina, Brazil
| | | | | | - Isabella L Monlleó
- Faculty of Medicine, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil.,Clinical Genetics Service, University Hospital, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
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Tang JW, Li JW, Baulderstone D, Jeyaseelan D. Presenting age and features of females diagnosed with autism spectrum disorder. J Paediatr Child Health 2021; 57:1182-1189. [PMID: 33645862 DOI: 10.1111/jpc.15417] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Autism spectrum disorder (ASD) is reportedly more prevalent in males than in females. Hypotheses for this gender imbalance include differing presentations in females. The aim of this study was to identify gender-based ASD differences in age at presentation, clinical features, comorbidities and severity levels. METHODS A cross-sectional study was conducted at a Child Development Unit. Children diagnosed with ASD during a 6-month period were analysed. RESULTS A total of 195 children were analysed with a male-to-female ratio of 2.8:1. No difference was found between gender and age at diagnosis. Males were more likely to display deficits in imaginative play and use repeated or learned phrases. Females were more likely to present with proprioception and vestibular issues, fears reflecting sensory avoidance and ASD of lesser severity. CONCLUSION Our study supports the hypothesis that gender-based differences exist within ASD presenting features. These differences should be considered when assessing for ASD in females to avoid under recognition.
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Affiliation(s)
- Jonathan W Tang
- Child Development Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jason W Li
- Child Development Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - David Baulderstone
- Child Development Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Deepa Jeyaseelan
- Child Development Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Letsou GV, Baldwin ACW, Civitello AB, Cohn WE, Frazier OH. Continuous-Flow Left Ventricular Assist Device Explantation After More Than 5 Years of Circulatory Support and Ventricular Reconditioning. Tex Heart Inst J 2021; 48:466218. [PMID: 34111275 DOI: 10.14503/thij-20-7266] [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] [Indexed: 11/23/2022]
Abstract
Continuous-flow left ventricular assist devices have proved to be effective, durable, life-saving tools in patients with end-stage heart failure. However, because of the risks associated with mechanical circulatory support (including stroke, infection, gastrointestinal bleeding, and device malfunction), the optimal goal of device therapy is myocardial recovery and device removal. Ventricular reconditioning and pump explantation after continuous-flow support have been reported; however, little is known about variables that govern the pace and degree of myocardial response in patients who experience such recovery. We describe our long-term pump-weaning strategy for a 25-year-old man who had a continuous-flow device implanted and then needed more than 5 years of support from it before developing cardiac reserve sufficient to enable pump explantation. To our knowledge, this is the longest period of uninterrupted continuous-flow device support to end in successful pump deactivation and a return to medical therapy. This case highlights the importance of actively and persistently pursuing a device-weaning strategy in all patients who need left ventricular assist device therapy.
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Affiliation(s)
- George V Letsou
- Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | | | | | - William E Cohn
- Center for Cardiac Support, Texas Heart Institute, Houston, Texas
| | - O H Frazier
- Center for Cardiac Support, Texas Heart Institute, Houston, Texas
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Prince RD, Akhondi-Asl A, Mehta NM, Geva A. A Machine Learning Classifier Improves Mortality Prediction Compared With Pediatric Logistic Organ Dysfunction-2 Score: Model Development and Validation. Crit Care Explor 2021; 3:e0426. [PMID: 34036277 DOI: 10.1097/CCE.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: To determine whether machine learning algorithms can better predict PICU mortality than the Pediatric Logistic Organ Dysfunction-2 score. Design: Retrospective study. Setting: Quaternary care medical-surgical PICU. Patients: All patients admitted to the PICU from 2013 to 2019. Interventions: None. Measurements and Main Results: We investigated the performance of various machine learning algorithms using the same variables used to calculate the Pediatric Logistic Organ Dysfunction-2 score to predict PICU mortality. We used 10,194 patient records from 2013 to 2017 for training and 4,043 patient records from 2018 to 2019 as a holdout validation cohort. Mortality rate was 3.0% in the training cohort and 3.4% in the validation cohort. The best performing algorithm was a random forest model (area under the receiver operating characteristic curve, 0.867 [95% CI, 0.863–0.895]; area under the precision-recall curve, 0.327 [95% CI, 0.246–0.414]; F1, 0.396 [95% CI, 0.321–0.468]) and significantly outperformed the Pediatric Logistic Organ Dysfunction-2 score (area under the receiver operating characteristic curve, 0.761 [95% CI, 0.713–0.810]; area under the precision-recall curve (0.239 [95% CI, 0.165–0.316]; F1, 0.284 [95% CI, 0.209–0.360]), although this difference was reduced after retraining the Pediatric Logistic Organ Dysfunction-2 logistic regression model at the study institution. The random forest model also showed better calibration than the Pediatric Logistic Organ Dysfunction-2 score, and calibration of the random forest model remained superior to the retrained Pediatric Logistic Organ Dysfunction-2 model. Conclusions: A machine learning model achieved better performance than a logistic regression-based score for predicting ICU mortality. Better estimation of mortality risk can improve our ability to adjust for severity of illness in future studies, although external validation is required before this method can be widely deployed.
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Li P, Cai H, Wang Y, Wang L, He J, Dong Y. Temporal changes in the chest based on findings from imaging in severe patients with novel coronavirus pneumonia. Mol Med Rep 2021; 23:442. [PMID: 33846778 DOI: 10.3892/mmr.2021.12081] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/22/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to observe the temporal changes in the chest based on findings from imaging in severe patients with novel coronavirus pneumonia. A total of 33 severe confirmed cases (20 male patients and 13 female patients) were enrolled in the present study between January 31, 2020 and March 10, 2020. Chest imaging findings and clinical data were collected and analyzed. The median age was 65 years (age range, 25‑90 years). As of April 7, 2020, 24 patients were discharged, and 9 patients died. With regards to the clinical manifestations, 28 patients had fever, 17 patients had a cough and 15 patients had shortness of breath. Of these, 29 patients had underlying health conditions. Ground glass opacities, consolidation and interlobular septal thickening were the most common and typical chest computerized tomography (CT) scan abnormalities. A total of 6/33 (18.2%) patients had 1 affected lobe, 6/33 (18.2%) patients had 2 affected lobes, 5/33 (15.2%) patients had 3 affected lobes, 9/33 (27.3%) patients had 4 affected lobes and 7/33 (21.2%) patients had 5 affected lobes in the initial chest CT scan. The mean interval time between two consecutive CT examinations was 4.5 days (range, 3‑9 days). Most severe patients exhibited some degree of aggravation based on the CT findings in the 3 weeks from illness onset. After 3 weeks from illness onset, these severe survivors demonstrated improvements in the chest CT findings, which included complete absorption or only a few remaining fibrous stripes. Chest CT manifestations of patients infected with novel coronavirus pneumonia were diverse and varied. Severe patients had imaging features of rapid progression and slow absorption. Monitoring of chest imaging findings is vital to detect any changes in a timely manner.
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Affiliation(s)
- Ping Li
- Department of Respiratory and Critical Care Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
| | - Helun Cai
- Department of Respiratory and Critical Care Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
| | - Yong Wang
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
| | - Lisha Wang
- Department of Radiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
| | - Jiwu He
- Department of Medical Service Section, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
| | - Yan Dong
- Department of Respiratory and Critical Care Medicine, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441001, P.R. China
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Abstract
OBJECTIVE This study examined whether the severity of left ventricular systolic dysfunction is associated with depression in patients with heart failure (HF). Other factors were also studied to identify independent correlates of depression in HF. METHODS The sample consisted of 400 hospitalized patients with HF. Left ventricular ejection fraction and other medical data were obtained from medical records. Depression and other psychosocial characteristics were assessed by an interview and questionnaires. Proportional odds models were used to test the relationships of these characteristics to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) depressive disorders, and analysis of covariance was used to test relationships with continuous measures of depression in secondary models. RESULTS The models produced no evidence of an association between left ventricular ejection fraction and depression. The adjusted odds ratio (95% confidence interval) was 1.00 (0.98-1.01; p = .87) for depression diagnosis. Analysis of covariance estimates (standard errors) were -0.01 (0.02; p = .54) for the Hamilton Rating Scale for Depression and -0.01 (0.01; p = .59) for the Patient Health Questionnaire. The odds of depression were higher in African American patients and in those with high levels of anxiety or stress. Other characteristics that have been associated with depression in previous studies, including sex and age, were not consistently associated with depression in this study. CONCLUSIONS There is no relationship between the severity of left ventricular systolic dysfunction and depression in hospitalized patients with HF. In contrast, African American patients and those with a high level of anxiety or perceived stress are more likely than other patients to have a comorbid depressive disorder.
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Korematsu T, Koga H. Transient Neutropenia in Immunocompetent Infants with Respiratory Syncytial Virus Infection. Viruses 2021; 13:301. [PMID: 33671944 DOI: 10.3390/v13020301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/05/2021] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022] Open
Abstract
The incidence of neutropenia and the association between neutropenia and severity of respiratory symptoms among infants with respiratory syncytial virus (RSV) infections remain to be elucidated. This single-center, retrospective study included immunocompetent infants (<10 months old) with laboratory-confirmed RSV infection admitted to our center between January 2012 and December 2019. Incidence of neutropenia (<1.0 × 109/L) within 10 days of onset and risk factors associated with subsequent neutropenia were evaluated. Among the 292 infants with RSV infection, including 232 (79%) with mild infection, neutropenia was observed in 31 (11%), with severe neutropenia (<0.5 × 109/L) in 3 (1.0%). No neutropenic infants developed serious infection or hematological disorder. Infants without neutropenia showed age <3 months at onset in 34%, C-reactive protein level <1.0 mg/L in 27%, and nasopharyngeal microbiota composition with any of Moraxella catarrhalis, Streptococcus pneumoniae, or Haemophilus influenzae in 63%. In comparison, infants with neutropenia showed age <3 months at onset in 74% (relative risk [RR] 2.15; 95% confidence interval [CI] 1.65-2.81), C-reactive protein level <1.0 mg/L in 55% (RR 2.02; 95% CI 1.38-2.94), and microbiota including Moraxella catarrhalis, Streptococcus pneumoniae, or Haemophilus influenzae in 15% (RR 0.24; 95% CI 0.10-0.61). Multiple logistic regression analyses showed that younger age at onset and absence of that nasopharyngeal microbiota profile were associated with development of neutropenia. In conclusion, age and airway microbiota are considered as risk factors for the development of transient neutropenia among infants with RSV infection. However, the neutropenia seems not to develop serious infection or hematological disorder.
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Whiteneck GG, Ketchum JM, Almeida EJ, Goldstein R, Brown AW, Corrigan JD, Hammond FM, Weintraub AH, Tefertiller C. Developing an Index of Medical Conditions Associated with Outcomes after Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2021; 38:593-603. [PMID: 33256501 DOI: 10.1089/neu.2020.7366] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Medical conditions co-occurring with traumatic brain injury (TBI) are associated with outcomes, and comorbidity indices such as Charlson and Elixhauser are used in TBI research, but they are not TBI specific. The purpose of this research was to develop an index or indices of medical conditions, identified in acute care after moderate to severe TBI, that are associated with outcomes at rehabilitation discharge. Using the TBI Model Systems National Database, the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes of 8988 participants were converted to Healthcare Cost and Utilization Project (HCUP) diagnostic categories. Poisson regression models were built predicting Disability Rating Scale and Functional Independence Measure Cognitive and Motor subscale scores from HCUP categories after controlling for demographic and injury characteristics. Unweighted, weighted, and anchored indices based on the outcome models predicted 7.5-14.3% of the variance in the observed outcomes. When the indices were applied to a new validation sample of 1613 cases, however, only 2.6-6.6% of the observed outcomes were predicted. Therefore, no models or indices were recommended for future use, but several study findings are highlighted suggesting the importance and the potential for future research in this area.
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Affiliation(s)
| | | | - Emily J Almeida
- Research Department, Craig Hospital, Englewood, Colorado, USA
| | | | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, Ohio, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana School of Medicine, Indianapolis, Indiana, USA.,Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
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De Paulis M, Oliveira DBL, Thomazelli LM, Ferraro AA, Durigon EL, Vieira SE. The importance of viral load in the severity of acute bronchiolitis in hospitalized infants. Clinics (Sao Paulo) 2021; 76:e3192. [PMID: 34878030 PMCID: PMC8610217 DOI: 10.6061/clinics/2021/e3192] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The relationship between viral load and the clinical evolution of bronchiolitis is controversial. Therefore, we aimed to analyze viral loads in infants hospitalized for bronchiolitis. METHODS We tested for the presence of human respiratory syncytial virus (HRSV) or human rhinovirus (HRV) using quantitative molecular tests of nasopharyngeal secretions and recorded severity outcomes. RESULTS We included 70 infants [49 (70%) HRSV, 9 (13%) HRV and 12 (17%) HRSV+HRV]. There were no differences among the groups according to the outcomes analyzed individually. Clinical scores showed greater severity in the isolated HRSV infection group. A higher isolated HRSV viral load was associated with more prolonged ventilatory support, oxygen therapy, and hospitalization days, even after adjustment for the age and period of nasopharyngeal secretion collection. In the co-infection groups, there was a longer duration of oxygen therapy when the HRSV viral load was predominant. Isolated HRV infection and co-infection with a predominance of HRV were not associated with severity. CONCLUSION Higher HRSV viral load in isolated infections and the predominance of HRSV in co-infections, independent of viral load, were associated with greater severity. These results contribute to the development of therapeutic and prophylactic approaches and a greater understanding of the pathophysiology of bronchiolitis.
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Affiliation(s)
- Milena De Paulis
- Unidade de Urgencia e Emergencia Referenciada Infantil, Divisao de Pediatria, Hospital Universitario, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Unidade de Pronto Atendimento, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Danielle Bruna Leal Oliveira
- Laboratorio de Virologia Clinica e Molecular, Departamento de Microbiologia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Sao Paulo, SP, BR
| | - Luciano Matsumiya Thomazelli
- Laboratorio de Virologia Clinica e Molecular, Departamento de Microbiologia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Edison Luiz Durigon
- Laboratorio de Virologia Clinica e Molecular, Departamento de Microbiologia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Plataforma Cientifica Pasteur, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sandra E. Vieira
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Baletto AA, Acosta SG, Piasterlini F, Barrios C, Carboni Bisso I, Martinez Aquino E. [Clinical characteristics of SARS-CoV-2 disease (COVID-19) in middle-aged patients]. Medicina (B Aires) 2021; 81:401-407. [PMID: 34137700] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) meant an unprecedented global crisis, which involved the reorganization of health systems and the rationalization of available diagnostic and therapeutic resources. The objective of this observational and retrospective study was to analyze the clinical characteristics and evolution of patients admitted to general ward, intensive care unit and emergency department of a high complexity hospital in Buenos Aires city, during the first seven months of viral circulation. A total of 1005 patients with laboratory-confirmed COVID-19 were included. The median age was 45 years, and 73.7% were men. Half of the patients had at least one comorbidity. Among the laboratory findings, the median of total leukocytes was 6300 cells/mm3 and that of lymphocytes 818 cells/mm3; 82.3% of the patients presented alterations in the chest tomography, and the most frequently observed radiological pattern was ground-glass opacity (33%); 82.4% of them received empirical antibiotic therapy directed to the respiratory focus and, in addition, 18.7% were treated with dexamethasone. Regarding severity, 14.7% of the patients presented uncomplicated disease, 55.2% mild pneumonia, 20.8% moderate pneumonia, and 9.2% severe pneumonia. Likewise, 8.7% of them were transferred to intensive care. In-hospital mortality was 2.3%, and 20.5% among critically ill patients. A statistically significant association was found between mortality and age, with an age difference of 9.6 years, being greater among the deceased (p = 0.0004; 95% CI 4-14). However, there was no association between the presence of comorbidities and sex vs. mortality and severity of the disease.
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Affiliation(s)
- Ariel A Baletto
- Servicio de Clínica Médica, Sanatorio Franchin, Buenos Aires, Argentina
| | - S Gonzalo Acosta
- Servicio de Clínica Médica, Sanatorio Franchin, Buenos Aires, Argentina
| | | | - Cecilia Barrios
- Terapia Intensiva de Adultos, Sanatorio Franchin, Buenos Aires, Argentina
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Terapia Intensiva de Adultos, Hospital Ignacio Pirovano, Buenos Aires, Argentina
| | - Indalecio Carboni Bisso
- Terapia Intensiva de Adultos, Sanatorio Franchin, Buenos Aires, Argentina
- Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
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Zhang VRY, Woo ASJ, Scaduto C, Cruz MTK, Tan YY, Du H, Feng M, Siah KTH. Systematic review on the definition and predictors of severe Clostridiodes difficile infection. J Gastroenterol Hepatol 2021; 36:89-104. [PMID: 32424877 DOI: 10.1111/jgh.15102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/15/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Clostridiodes difficile infection (CDI) is one of the most common hospital-acquired infections with high mortality rates. Optimal management of CDI depends on early recognition of severity. However, currently, there is no acceptable standard of prediction. We reviewed severe CDI predictors in published literature and its definition according to clinical guidelines. We systematically reviewed studies describing clinical predictors for severe CDI in medical databases (Cochrane, EMBASE, Global Health Library, and MEDLINE/PubMed). They were independently evaluated by two reviewers. Six hundred thirty-three titles and abstracts were screened, and 31 studies were included. We excluded studies that were restricted to a specific patient population. There were 16 articles that examined mortality in CDI, as compared with 15 articles investigating non-mortality outcomes of CDI. The commonest risk factors identified were comorbidities, white blood cell count, serum albumin level, age, serum creatinine level and intensive care unit admission. Generally, the studies had small patient populations, were retrospective in nature, and mostly from Western centers. The commonest severe CDI criteria in clinical guidelines were raised white blood cell count, followed by low serum albumin and raised serum creatinine levels. There was no commonly agreed upon definition of severe CDI severity in the literature. Current clinical guidelines' definitions for severe CDI are heterogeneous. Hence, there is a need for prospective multi-center studies using standardized protocol for biospecimen investigation collection and shared data on outcomes of patients in order to devise a universally accepted definition for severe CDI.
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Affiliation(s)
- Valencia Ru Yan Zhang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aaron Shu Jeng Woo
- Gastroenterology and Hepatology Service, Sengkang General Hospital, Singapore
| | - Christina Scaduto
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria Teresa Kasunuran Cruz
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Yan Yuan Tan
- Alliance Healthcare Group, Singapore.,Babylon Health, Singapore
| | - Hao Du
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore
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Fontenele MMFT, Silva CF, Leite ÁJM, Castro ECM, Carvalho FHC, Silva AVSE. SNAPPE II: ANALYSIS OF ACCURACY AND DETERMINATION OF THE CUTOFF POINT AS A DEATH PREDICTOR IN A BRAZILIAN NEONATAL INTENSIVE CARE UNIT. Rev Paul Pediatr 2020; 38:e2019029. [PMID: 33331559 PMCID: PMC7747781 DOI: 10.1590/1984-0462/2020/38/2019029] [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] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the accuracy of the Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II) as a death predictor, to determine the cutoff point for mortality, and to analyze the association of independent variables with death. METHODS Prospective, longitudinal, hospital-based study on newborns admitted to the Neonatal Intensive Care Unit (NICU) for the first time from November 1, 2016 to April 30, 2017. Newborns with less than 12 hours of length of stay at the NICU, out-of-hospital births, major congenital malformations, and inter-hospital transfer were excluded. Variables were grouped according to hierarchical framework, related to maternal characteristics (distal level), prenatal and childbirth care (intermediate level), and birth conditions (proximal level). Descriptive analyses of SNAPPE II score ranges, Receiver Operating Characteristics Curve (ROC curve) to define the cutoff point for mortality, and bivariate analysis by the Wald test and multiple logistic regression were conducted. RESULTS After selection, the sample consisted of 247 newborns. In this study, the SNAPPE II cutoff point for mortality was 27, with sensitivity of 84.1% and specificity of 82.4%. 61% of those with a score ≥27 died. Multiple logistic regression showed an association between death and proximal-level variables: sepsis (Odds Ratio [OR] 10.68; 95% confidence interval [95%CI] 2.82-40.48; p<0.001); SNAPPE II ≥27 (OR 5.85; 95%CI 1.90-18.05; p=0.002); birth weight 750-999 g (OR 4.15; 95%CI 1.06-16.14; p=0.040); and nonuse of surfactant (OR 0.159; 95%CI 0.04-0.53; p=0.003). CONCLUSIONS Neonatal mortality was directly proportional to increase in SNAPPE II. Score≥27 increased the odds of dying by six times compared with neonates with lower scores. The proximal variables related to health conditions and neonatal care were associated with death.
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Estrada-Alvarez JM, Orozco-Hernández JP, Aristizabal-Franco LE. Validation of chronic obstructive pulmonary disease severity score (COPDSS) for primary care in a Colombian population. Biomedica 2020; 40:664-72. [PMID: 33275345 DOI: 10.7705/biomedica.5123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 11/21/2022]
Abstract
Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un importante problema de salud mundial con una alta morbimortalidad. Se requiere la medición de la gravedad de la enfermedad mediante una herramienta de fácil aplicación, bajo costo y fácil disponibilidad en áreas rurales. Objetivo. Evaluar la validez y contabilidad del puntaje de valoración de la gravedad de la EPOC (Chronic Obstructive Pulmonary Disease Severity Score, COPDSS) en una población de atención primaria en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal en una muestra de 100 pacientes con diagnóstico de EPOC según las guías GOLD. La validez concurrente se evaluó correlacionando los resultados del COPDSS con otras variables de importancia como las del cuestionario sobre la enfermedad respiratoria crónica (Chronic Respiratory Disease Questionnaire, CRQ) y el volumen espiratorio forzado en el primer segundo (Forced Expiratory Volume in one second, FEV1). Resultados. El COPDSS presentó una correlación significativa con el FEV1 (r=-0,33), con el CRQ (r=-0,57) y sus dimensiones: disnea (r=0,51), fatiga (r=0,53), función emocional (r=0,43) y control de la enfermedad (r=0,50). En el análisis factorial se determinó un solo factor con una varianza acumulada de 59,1 %. El análisis de coherencia interna mostró un alfa de Cronbach de 0,76, valor este considerado adecuado. Conclusiones. Se observó que el uso del COPDSS como cuestionario de valoración de la gravedad de pacientes con EPOC en Colombia tenía validez y confiabilidad adecuadas y que es de fácil aplicación en la atención primaria.
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Abstract
OBJECTIVES To estimate the direct medical costs associated with the management of patients with primary open-angle glaucoma and to compare the costs of patients according to the degree of severity. METHODS A longitudinal retrospective study was carried out using all patients with primary open-angle glaucoma that recorded follow-up from May 2010 to June 2013 at the Hospital Privado de Córdoba. We estimated the cost of the disease from the perspectives of the institution, with a bottom-up approach. RESULTS The three-year follow-up after treatment of 104 patients revealed that the average cost of care for a patient with primary open-angle glaucoma was US$2746 ± 1560. The first year of treatment was significantly more expensive than subsequent ones (US$1100-$810-$827). Cost was related to the degree of severity of glaucoma; patients in "Stage 0" had significantly lower costs than those in other groups (Kruskal-Wallis test, p < 0.01). This was a consequence of lower costs associated with medication and a lower percentage of patients undergoing surgery. DISCUSSION The direct medical costs of a patient with primary open-angle glaucoma vary according to the severity of their disease and the year of treatment. We found that costs increased with disease severity, but decreased over time.
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Affiliation(s)
- J P Real
- UNITEFA-CONICET, Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - M C Lafuente
- Hospital Privado Universitario Centro Médico de Córdoba, Córdoba, Argentina
| | - S D Palma
- UNITEFA-CONICET, Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - L I Tártara
- UNITEFA-CONICET, Departamento de Farmacia, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Hu X, Zeng W, Zhang Y, Zhen Z, Zheng Y, Cheng L, Wang X, Luo H, Zhang S, Wu Z, Sun Z, Li X, Cao Y, Xu M, Wang J, Chen W. CT imaging features of different clinical types of COVID-19 calculated by AI system: a Chinese multicenter study. J Thorac Dis 2020; 12:5336-5346. [PMID: 33209367 PMCID: PMC7656439 DOI: 10.21037/jtd-20-1584] [Citation(s) in RCA: 3] [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] [Indexed: 01/08/2023]
Abstract
Background The study is designed to explore the chest CT features of different clinical types of coronavirus disease 2019 (COVID-19) pneumonia based on a Chinese multicenter dataset using an artificial intelligence (AI) system. Methods A total of 164 patients confirmed COVID-19 were retrospectively enrolled from 6 hospitals. All patients were divided into the mild type (136 cases) and the severe type (28 cases) according to their clinical manifestations. The total CT severity score and quantitative CT features were calculated by AI pneumonia detection and evaluation system with correction by radiologists. The clinical and CT imaging features of different types were analyzed. Results It was observed that patients in the severe type group were older than the mild type group. Round lesions, Fan-shaped lesions, crazy-paving pattern, fibrosis, “white lung”, pleural thickening, pleural indentation, mediastinal lymphadenectasis were more common in the CT images of severe patients than in the mild ones. A higher total lung severity score and scores of each lobe were observed in the severe group, with higher scores in bilateral lower lobes of both groups. Further analysis showed that the volume and number of pneumonia lesions and consolidation lesions in overall lung were higher in the severe group, and showed a wider distribution in the lower lobes of bilateral lung in both groups. Conclusions Chest CT of patients with severe COVID-19 pneumonia showed more consolidative and progressive lesions. With the assistance of AI, CT could evaluate the clinical severity of COVID-19 pneumonia more precisely and help the early diagnosis and surveillance of the patients.
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Affiliation(s)
- Xiaofei Hu
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Wenbing Zeng
- Department of Radiology, Chongqing University Three Gorges Hospital, Wanzhou, China.,Department of Radiology, Chongqing Three Gorges Central Hospital, Chongqing Three Gorges Central Hospital, Wanzhou, China
| | - Yuhan Zhang
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Zhiming Zhen
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Yalan Zheng
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Lin Cheng
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Xianqi Wang
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Haoran Luo
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Shu Zhang
- Deepwise AI Lab, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, China
| | - Zifeng Wu
- Deepwise AI Lab, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, China
| | - Zeyu Sun
- Deepwise AI Lab, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, China
| | - Xiuli Li
- Deepwise AI Lab, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, China
| | - Yang Cao
- Department of Radiology, Dianjiang People's Hospital of Chongqing, Dianjiang, China
| | - Ming Xu
- Department of Radiology, Chongqing Tongnan County Peoples Hospital, Tongnan, China
| | - Jian Wang
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
| | - Wei Chen
- Department of Radiology, First Affiliated Hospital of the Army Medical University (Southwest Hospital), Chongqing, China
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Abstract
OBJECTIVE To assess the validity of an electronic version of the Pediatric Index of Mortality 2 score. DESIGN Retrospective observational study. SETTING Pediatric and cardiac ICUs at a quaternary medical center. PATIENTS Patients more than 60 days old admitted to the PICU or cardiac ICU between January 1, 2010, and December 31, 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After adapting the Pediatric Index of Mortality 2 score into a version applicable to retrospective electronic health record data, it was validated in a mixed-ICU cohort. A manually ascertained Pediatric Index of Mortality 2 score was directly compared with the electronically derived electronic version of the Pediatric Index of Mortality 2 score in 100 randomly selected patients with good agreement between score components with nine out of 11 components having an intraclass correlation coefficient or Cohen κ greater than or equal to 0.6. In assessing the electronic version of the Pediatric Index of Mortality 2 score in the entire cohort of 12,582 patient encounters, it had good discrimination with area under the receiver operating curve of 0.89, appropriate calibration with no significant difference between observed and expected deaths, and excellent predictive ability with a Brier score of 0.0135. CONCLUSIONS The Pediatric Index of Mortality 2 score can be adapted to utilize retrospective electronic health record data with acceptable discrimination, calibration and accuracy a large mixed-ICU cohort.
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Jiang H, Guo W, Shi Z, Jiang H, Zhang M, Wei L, Pan Y. Clinical imaging characteristics of inpatients with coronavirus disease-2019 in Heilongjiang Province, China: a retrospective study. Aging (Albany NY) 2020; 12:13860-13868. [PMID: 32688346 PMCID: PMC7425485 DOI: 10.18632/aging.103633] [Citation(s) in RCA: 8] [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: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the clinical, laboratory, and radiological characteristics of patients with coronavirus disease-2019 (COVID-19) in Heilongjiang Province. Results: Patients in the ICU group were older and their incidence of cardiovascular disease was higher than those in the non-ICU group. Lymphocyte levels were lower and neutrophil and D-dimer levels were higher in the ICU than that in the non-ICU group. Compared to the non-ICU group, the incidence of pulmonary consolidation and ground-glass opacity with consolidation was significantly higher in the ICU group, all lung lobes were more likely to be involved, with higher number of lung lobes and areas surrounding the bronchi. Of the 59 patients with COVID-19 in this group, 15 received mechanical ventilation. All intubated patients involved lung lobes, and a large number of lesions were observed in the area around the bronchial vessels. Conclusion: Significant differences were observed in clinical symptoms, laboratory tests, and computed tomography features between the ICU and non-ICU groups. Methods: A total of 59 patients with COVID-19, comprising 44 patients in the intensive care unit (ICU) and 15 in the non-ICU, were retrospectively analyzed. Characteristics of the two groups of patients were compared.
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Affiliation(s)
- Hao Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Guo
- Department of Ultrasound, Harbin The First Hospital, Harbin, China
| | - Zhongxing Shi
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huijie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mingyu Zhang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Lai Wei
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongmei Pan
- Department of Radiology, Harbin Hong'an Hospital, Harbin, China
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