Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis

AbstractIn children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.

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A new self-designed “tongue root holder” device to aid fiberoptic intubation

Clinical Oral Investigations ◽

10.1007/s00784-020-03297-2 ◽

2020 ◽

Vol 24 (12) ◽

pp. 4335-4342

Author(s):

Xiaofei Cao ◽

Junbei Wu ◽

Yin Fang ◽

Zhengnian Ding ◽

Tao Qi

Keyword(s):

Risk Factors ◽

Difficult Airway ◽

Soft Palate ◽

Elective Surgery ◽

Upper Airway ◽

Orotracheal Intubation ◽

Fiberoptic Intubation ◽

Fiberoptic Bronchoscope ◽

Airway Clearance ◽

Jaw Thrust Maneuver

Abstract Objective In this study, we aimed to assess the feasibility of fiberoptic intubation (FOI), using a new, self-designed, “tongue root holder” device, in combination with the jaw thrust maneuver. Methods Three hundred patients undergoing elective surgery requiring orotracheal intubation were enrolled. Patients presented at least one or more risk factors for difficult airway. The patients were randomly allocated at a 1:1 ratio to one of two groups: group L, FOI with tongue root holder, or group C, standard FOI. Orotracheal FOI was performed after commencement of anesthesia. The jaw thrust maneuver was applied in both groups to facilitate advancement of the fiberoptic bronchoscope. The primary endpoint was the feasibility of FOI. The secondary endpoints were number of attempts, time to intubation, and airway clearance at the soft palate and epiglottis levels. Results The FOI was achieved in all 150 patients in group L, significantly higher than that in group C (100% vs 95.3%; P = 0.015). Less attempts of intubation were made in group L (P = 0.039). Mean time to successful intubation on the first attempt was shorter in group L (P < 0.001). The mean times to view the vocal cord and carina were also shorter in group L (P = 0.011 and P < 0.001, respectively). Airway clearance was better in group L at both the soft palate and the glottis levels (P = 0.010 and P = 0.038, respectively). Conclusions This study shows that FOI is feasible with the newly introduced, self-designed, “tongue root holder” device, when combined with the jaw thrust maneuver in patients with risk factors for difficult airway. The device also provides better airway clearance, less intubation attempts, and shorter time to intubation at first attempt. Clinical relevance Fiberoptic bronchoscope has been the gold standard for routine management of difficult airway. A technique to open the airway is introduced to reduce the incidence rate of upper airway obstruction.

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Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

PLoS ONE ◽

10.1371/journal.pone.0246399 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246399

Author(s):

Do-Yang Park ◽

Ji-Su Kim ◽

Bumhee Park ◽

Hyun Jun Kim

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Goodness Of Fit ◽

Upper Airway ◽

Physical Exam ◽

Berlin Questionnaire ◽

Clinical Prediction ◽

Obstructive Sleep ◽

Tongue Position

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

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Prevalence and risk factors for bone loss in rheumatoid arthritis patients from South China: modeled by three methods

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04403-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhuoran Hu ◽

Lei Zhang ◽

Zhiming Lin ◽

Changlin Zhao ◽

Shuiming Xu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Lumbar Spine ◽

Bone Loss ◽

South China ◽

Serum Vitamin ◽

Tumor Necrosis Factor Inhibitor ◽

Healthy Controls ◽

Mineral Density ◽

Serum Vitamin D

Abstract Background To explore the prevalence of bone loss among patients with rheumatoid arthritis (RA) and healthy controls (HC) and further explored the risk factors for osteopenia and osteoporosis of RA patients. Methods A cross-sectional survey was undertaken in four hospitals in different districts in South China to reveal the prevalence of bone loss in patients. Case records, laboratory tests, and bone mineral density (BMD) results of patients were collected. Traditional multivariable logistic regression analysis and two machine learning methods, including least absolute shrinkage selection operator (LASSO) and random forest (RF) were for exploring the risk factors for osteopenia or osteoporosis in RA patients. Results Four hundred five patients with RA and 198 HC were included. RA patients had lower BMD in almost BMD measurement sites than healthy controls; the decline of lumbar spine BMD was earlier than HC. RA patients were more likely to comorbid with osteopenia and osteoporosis (p for trend < 0.001) in the lumbar spine than HC. Higher serum 25-hydroxyvitamin D3 level and using tumor necrosis factor inhibitor in the last year were protective factors; aging, lower body mass index, and increased serum uric acid might be risk factors for bone loss. Conclusions RA patients were more prone and earlier to have bone loss than HC. More attention should be paid to measuring BMD in RA patients aging with lower BMI or hyperuricemia. Besides, serum vitamin D and all three measurement sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

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A Systematic Review and Pooled Prevalence of Paediatric Delirium in Critically Ill Children

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.038 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i31-i32

Author(s):

D Semple ◽

M M Howlett ◽

J D Strawbridge ◽

C V Breatnach ◽

J C Hayden

Keyword(s):

Risk Factors ◽

Critical Care ◽

Critically Ill ◽

Observational Studies ◽

Confusion Assessment Method ◽

Assessment Method ◽

Assessment Tools ◽

Critically Ill Children ◽

Confusion Assessment ◽

Pooled Prevalence

Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73

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Dimensional analysis of the upper airway in obstructive sleep apnea syndrome patients treated with mandibular advancement device: a bi and three‐dimensional evaluation

Journal of Oral Rehabilitation ◽

10.1111/joor.13176 ◽

2021 ◽

Author(s):

Rocío Marco‐Pitarch ◽

Marina Selva‐García ◽

Andrés Plaza‐Espín ◽

Javier Puertas‐Cuesta ◽

Rubén Agustín‐Panadero ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Dimensional Analysis ◽

Sleep Apnea Syndrome ◽

Three Dimensional ◽

Upper Airway ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Apnea Syndrome

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Radio Base Stations and Electromagnetic Fields: GIS Applications and Models for Identifying Possible Risk Factors and Areas Exposed. Some Exemplifications in Rome

ISPRS International Journal of Geo-Information ◽

10.3390/ijgi10010003 ◽

2020 ◽

Vol 10 (1) ◽

pp. 3

Author(s):

Cristiano Pesaresi ◽

Davide Pavia

Keyword(s):

Risk Factors ◽

Electromagnetic Fields ◽

Digital Health ◽

Three Dimensional ◽

Health Information System ◽

Medical Geography ◽

Base Stations ◽

Buffer Zones ◽

North East ◽

Gis Applications

This paper—which is contextualized in the discussion on the methodological pluralism and the main topics of medical geography, the complexity theory in geographies of health, the remaking of medical geography and ad hoc systems of data elaboration—focuses on radio base stations (RBSs) as sources of electromagnetic fields, to provide GIS applications and simplifying-prudential models that are able to identify areas that could potentially be exposed to hazard. After highlighting some specific aspects regarding RBSs and their characteristics and summarizing the results of a number of studies concerning the possible effects of electromagnetic fields on health, we have taken an area of north-east Rome with a high population and building density as a case study, and we have provided some methodological and applicative exemplifications for different situations and types of antennas. Through specific functionalities and criteria, drawing inspiration from a precautionary principle, these exemplifications show some particular cases in order to support: possible risk factor identification, surveillance and spatial analysis; correlation analysis between potential risk factors and outbreak of diseases and symptoms; measurement campaigns in heavily exposed areas and buildings; education policies and prevention actions. From an operative viewpoint, we have: conducted some field surveys and recorded data and images with specific geotechnological and geomatics instruments; retraced the routes by geobrowsers and basemaps and harmonized and joined up the materials in a GIS environment; used different functions to define, on aero-satellite images, concentric circular buffer zones starting from each RBS, and geographically and geometrically delimited the connected areas subject to high and different exposure levels; produced digital applications and tested prime three-dimensional models, in addition to a video from a bird’s eye view perspective, able to show the buildings in the different buffer zones and which are subject to a hazard hierarchy due to exposure to an RBS. A similar GIS-based model—reproposable with methodological adjustments to other polluting sources—can make it possible to conceive a dynamic and multiscale digital system functional in terms of strategic planning, decision-making and public health promotion in a performant digital health information system.

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A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01328-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Amy S. Shah ◽

Scott Isom ◽

Dana Dabelea ◽

Ralph D’Agostino ◽

Lawrence M. Dolan ◽

...

Keyword(s):

Risk Factors ◽

Diastolic Function ◽

Healthy Controls ◽

Cross Sectional ◽

Factors Associated ◽

Youth Study ◽

Hispanic White ◽

Diabetes In Youth

Abstract Aims To compare left ventricular structure (LV) and diastolic function in young adults with youth- onset diabetes by type, determine the prevalence of abnormal diastolic function by diabetes type using published values from age similar healthy controls, and examine the risk factors associated with diastolic function. Methods In a cross sectional analysis we compared LV structure and diastolic function from two dimensional echocardiogram in participants with type 1 (T1D) and type 2 diabetes (T2D) who participated in the SEARCH for Diabetes in Youth Study. Linear models were used to examine the risk factors associated with worse diastolic function. Results Of 479 participants studied, 258 had T1D (mean age 21.2 ± 5.2 years, 60.5% non-Hispanic white, 53.9% female) and 221 had T2D (mean age 24.8 ± 4.3 years, 24.4% non-Hispanic white, 73.8% female). Median diabetes duration was 11.6 years. Participants with T2D had greater LV mass index and worse diastolic function that persisted after adjustment for differences in risk factors compared with participants with T1D (all p < 0.05). Abnormal diastolic function, quantified using healthy controls, was pronounced in both groups but greater in those with T2D than T1D (T2D: 57.7% vs T1D: 47.2%, respectively), p < 0.05. Risk factors associated with worse diastolic function included older age at diabetes diagnosis, female sex, higher BP, heart rate and HbA1c and longer diabetes duration. Conclusions LV structure and diastolic function is worse in individuals with T2D compared to T1D. However, abnormal diastolic function in seen in both groups compared to published values from age similar healthy controls.

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SAT0077 CARDIOVASCULAR RISK ASSESSMENT WITH CAROTID ULTRASONOGRAPHY IN ADDITION TO THE TRADITIONAL CARDIOVASCULAR RISK FACTORS IN RHEUMATOID ARTHRITIS PATIENTS: A CASE CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6420 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 973-973

Author(s):

R. Gonzalez Mazario ◽

J. J. Fragio-Gil ◽

P. Martinez Calabuig ◽

E. Grau García ◽

M. De la Rubia Navarro ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Disease Duration ◽

Case Control Study ◽

Case Control ◽

Healthy Controls ◽

Carotid Ultrasonography ◽

Control Study

Background:Cardiovascular disease (CV) is the most frequent cause of death in rheumatoid arthritis (RA) patients. It is well known that RA acts as an independent cardiovascular risk factor.Objectives:To assess the CV risk in RA patients using carotid ultrasonography (US) additionally to the traditional CV risk factors.Methods:A prospective transversal case control study was performed, including adult RA patients who fulfilled ACR/EULAR 2010 criteria and healthy controls matched according to CV risk factors. Population over 75 years old, patients with established CV disease and/or chronic kidney failure (from III stage) were excluded. The US evaluator was blinded to the case/control condition and evaluated the presence of plaques and the intima-media thickness. Statistical analysis was performed with R (3.6.1 version) and included a multivariate variance analysis (MANOVA) and a negative binomial regression adjusted by confounding factors (age, sex and CV risk factors).Results:A total of 200 cases and 111 healthy controls were included in the study. Demographical, clinical and US data are exposed in table 1. Not any difference was detected in terms of CV risk factors between the cases and controls. In both groups a relationship between age, BMI and high blood pressure was detected (p<0.001).Table 1.Table 2.RA basal characteristicsDisease duration (years)16,98 (11,38)Erosions (X-Ray of hands/feet)163 (81,5%)Seropositive (RF/anti-CCP)146 (73%)Extra-articular symptoms44 (22%)Intersticial difusse lung disease10 (5%)Rheumatoid nodules14 (7%)Prednisone use103 (51,5%)Median dose of Prednisone last year (mg)2,34 (2,84)sDMARDsMethotrexate104 (52%)Leflunomide29 (14,5%)Hydroxycloroquine9 (4,5%)bDMARDs89 (44,5%) TNFi41 (20,5%) Abatacept15 (7,5%) IL6i22 (11%) RTX11 (5,5%)JAKi26 (13%) Baricitinib11 (5,5%) Tofacitinib15 (7,5%)DAS 28-ESR3,1 (2,3, 3,9)SDAI7,85 (4,04, 13,41)HAQ0,88 (0,22, 1,5)RF (U/mL)51 (15, 164,25)Anti-CCP (U/mL)173 (22, 340)Patients showed higher intima-media (both right and left) thickness compared to controls (p<0.006). Moreover it was also related to the disease duration and DAS28 score (p<0.001). A higher plaque account was noted in cases(p<0.004) and it was also related to the disease duration (p<0.001).Conclusion:RA implies a higher CV risk. Traditional CV risk factors explains only partially the global risk. These findings support that RA acts as an independent cardiovascular risk factor.Disclosure of Interests:None declared

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