Early mannitol administration improves clinical outcomes of pediatric patients with brain edema

Background: Mannitol 20% is used to treat patients with decreased consciousness and as the first line of treatment to reduce intracranial pressure (ICP). However, its application in pediatric patients is still based on minimal evidence. This study was performed to determine the predictive factors of clinical outcomes in pediatric patients with brain edema in the pediatric intensive care unit (PICU).Methods: This prospective cohort study was conducted in the PICU, Sanglah Hospital Denpasar, Bali, Indonesia. The subjects were chosen by consecutive sampling from July 2016 to July 2017. The primary outcome variable was the patient’s clinical outcome. A chi-square test was used to evaluate the association between the timing of mannitol administration and the patient’s clinical outcome. Multivariate analysis was performed on all variables with p≤0.25.Results: Forty-one patients were included in the study, 65% of them were male, 65% had good nutritional status, 90% had non-traumatic brain injury, and 73% had confirmed intracranial infection. The risk of sequelae or death for patients in a coma was 1.8 times greater than that of non-comatose patients (p=0.018; CI 95% 1.119–3.047). Based on the timing of mannitol administration from the onset of decreased consciousness, the risk of sequelae or death in patients who received mannitol after 24 hours was 2.1 times higher than that in patients who received mannitol within 24 hours (p=0.006; CI 95% 1.167–3.779). Based on multivariate analysis, only two variables were associated with the patient’s clinical outcome: pediatric Glasgow coma scale (PGCS) ≤3 (p=0.03) and timing of mannitol administration >24 hours (p=0.01).Conclusion: Early administration (<24 hours) of mannitol and high PGCS are related to favorable outcomes in patients with brain edema in the PICU.

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Full outline of unresponsiveness score as a predictor of outcomes in critically ill pediatric patients

Paediatrica Indonesiana ◽

10.14238/pi60.2.2020.77-82 ◽

2020 ◽

Vol 60 (2) ◽

pp. 77-82

Author(s):

Novita Purnamasari Assa ◽

Dyah Kanya Wati ◽

Ida Bagus Subanada ◽

Soetjiningsih Soetjiningsih ◽

Made Kardana ◽

...

Keyword(s):

Multivariate Analysis ◽

Critically Ill ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Bivariate Analysis ◽

Chi Square ◽

Risk Of Death ◽

Good Ability ◽

Chi Square Test ◽

Four Score

Background Mortality predictions are very important for improving service quality in the pediatric intensive care unit (PICU). The full outline of unresponsiveness (FOUR) is a new coma scale and is considered capable of predicting mortality and outcome. Objective To assess the ability of FOUR scores to predict outcomes of critically ill patients in the PICU. Methods This prospective cohort study included children aged 1 months - 18 years who were admitted to the PICU. Subjects were assessed by FOUR, grouped into score < 9 or score >9, and followed until outcomes were obtained. Bivariate analysis to assess the risk of death was made by cross-tabulation and the strength of the association in the form of risk ratio by Chi-square test. Multivariate analysis was done by logistic regression test. Results Of 94 subjects, 47 had FOUR scores ≤9 and 47 subjects had FOUR >9. Bivariate analysis revealed that PICU patients with FOUR score ≤9 had a higher risk of death than those with FOUR score >9 (RR 12.5; 95%CI 3.1 to 49.8; P<0.0001). Multivariate analysis revealed that FOUR score, length of stay ≤7 days, and non-surgical disease significantly increased the risk of mortality in PICU patients (by 42.8 times, 8.9 times, and 5.9 times, respectively). Conclusion The FOUR scores have good ability to predict the outcomes of critically ill pediatric patients. A FOUR score ≤9 at the beginning of treatment is significantly associated with the outcome of mortality during treatment in the PICU.

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Full outline of unresponsiveness score as a predictor of outcomes in critically ill pediatric patients

Paediatrica Indonesiana ◽

10.14238/pi60.2.2020.76-81 ◽

2020 ◽

Vol 60 (2) ◽

pp. 76-81

Author(s):

Novita Purnamasari Assa ◽

Dyah Kanya Wati ◽

Ida Bagus Subanada ◽

Soetjiningsih Soetjiningsih ◽

Made Kardana ◽

...

Keyword(s):

Multivariate Analysis ◽

Critically Ill ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Bivariate Analysis ◽

Chi Square ◽

Risk Of Death ◽

Good Ability ◽

Chi Square Test ◽

Four Score

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Antibiotic Surveillance in the Pediatric Intensive Care Unit (PICU) at Sanglah Hospital Denpasar in the Year of 2015-2017

The Open Microbiology Journal ◽

10.2174/1874285801913010146 ◽

2019 ◽

Vol 13 (1) ◽

pp. 146-153

Author(s):

Dyah Kanya Wati ◽

I Wayan Gustawan ◽

Ni Nengah Dwi Fatmawati ◽

I Ketut Tunas ◽

Putu Andrie Setiawan

Keyword(s):

Intensive Care Unit ◽

Multivariate Analysis ◽

Intensive Care ◽

Length Of Stay ◽

Pediatric Intensive Care Unit ◽

Antibiotic Sensitivity ◽

Pediatric Intensive Care ◽

Antibiotic Use ◽

Chi Square ◽

Chi Square Test

Background: Antibiotic surveillance in hospital settings is mandatory for optimal antibiotic therapy for the patient. Only a small number of studies have focused on antibiotic surveillance in hospitalized newborns, infants, and children. Objectives: The goal was to evaluate antibiotic use in our Pediatric Intensive Care Unit (PICU) and evaluate it for a possible association with the length of PICU stay. Methods: A retrospective, observational, cohort study was conducted from January 2015 to April 2017, involving subjects who were hospitalized in the PICU at Sanglah Hospital. The inclusion criteria were children aged between 1-month-12-years old, who had a blood culture and antibiotic sensitivity test result in their medical record. The exclusion criteria were incomplete medical records, blood cultures showing 2 types of bacteria at the same time (gram-positive and negative), or contaminated blood results. Factors associated with mortality were analyzed using a Chi-square test, with p < 0.05 considered to be statistically significant and the Risk Ratio (RR) of the associated factors was determined by 95% CI. Results: Multivariate analysis showed that the significant predictors of PICU length of stay were the appropriate continuation of antibiotics (RR 1.19; 95% CI 1.043 to 1.373; P = 0.047). There were also significant results for antibiotic compatibility and length of stay (RR 3.6; 95% CI 0.869 to 15.428; P = 0.049). Conclusion: Appropriate continuation of antibiotics and the compatibility of continuation antibiotics were significant predictors of length of PICU stay based on multivariate analysis.

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688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

SLEEP ◽

10.1093/sleep/zsab072.686 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A269-A269

Author(s):

Vaishal Shah ◽

Nancy Foldvary-Schaefer ◽

Lu Wang ◽

Lara Jehi ◽

Cynthia Pena Obrea ◽

...

Keyword(s):

High Risk ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Pediatric Patients ◽

Control Design ◽

Supplemental Oxygen ◽

Case Control ◽

World Health ◽

Invasive Ventilation ◽

High Flow Oxygen

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (<18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2<90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2<90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

British Journal of Surgery ◽

10.1093/bjs/znab160.044 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

G Martínez Izquierdo ◽

A R Arnaiz Pérez ◽

E Escolano Fernández ◽

M Merayo Álvarez ◽

B Carrasco Aguilera ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Radical Nephrectomy ◽

Univariate Analysis ◽

Malignant Neoplasms ◽

Histopathological Analysis ◽

Chi Square ◽

Renal Sinus ◽

Chi Square Test

Abstract INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

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Clinical and Electroencephalographic Profile Of Children

Kathmandu University Medical Journal ◽

10.3126/kumj.v11i2.12484 ◽

2015 ◽

Vol 11 (2) ◽

pp. 110-116

Author(s):

N Limbu ◽

BH Paudel ◽

D Thakur

Keyword(s):

Cerebral Palsy ◽

Febrile Seizure ◽

Pediatric Patients ◽

Birth Asphyxia ◽

Seizure Disorder ◽

Chi Square ◽

Demographic Profiles ◽

Epileptiform Discharges ◽

Chi Square Test ◽

The Relationship

Background Reports on pediatric electroencephalogram of Nepalese patients are rare. Objective We aimed to study the relationship between provisional clinical and electrophysiological diagnoses of pediatric patients with documentation of demographic profiles, and type and frequency of the disorders/diseases. Methods Electroencephalographic reports of 634 children from 2006 to 2009 were analyzed at neurophysiology laboratory, department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, retrospectively. Chi-Square test was applied after detail descriptive statistics. Results Male and female were 72.2 % (n=458/634) and 27.76 % (n=176/634) respectively. Most frequent EEG abnormality was seizure disorder (n=370, 59.39%), then febrile seizure (n= 94, 15.08%) and birth asphyxia with hypoxic-induced encephalopathy (n=68, 10.91%). Electroencephalogram showed significant epileptiform discharges in seizure disorder (p=0.001, OR= 2.26, 95 % CI= 1.61 to 3.18) and in cerebral palsy (p=0.049, OR=6.88, 95 % CI=0.89 to 145.95), specifically in 6 to 12 (p=0.001, OR=2.94, 95 % CI=1.43 to 6.06) and one to five (p=0.019) years, respectively. Electroencephalogram detected significantly less epileptiform discharges (p=0.001, OR=0.25, 95 % CI= 0.15 to 0.42) in febrile seizure specifically in 1 to 5 years (p=0.003, OR=0.16, 95 % CI= 0.04 to 0.63). Conclusion Predominant Electroencephalographic abnormality was seizure disorder, followed by febrile seizure and birth asphyxia with hypoxic-induced encephalopathy respectively. Electroencephalographic abnormality was highly associated with seizure disorder and cerebral palsy but was not associated with febrile seizure. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12484 Kathmandu University Medical Journal Vol.11(2) 2013: 110-116

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Gaining a Continuous Retaining Relationship with Customers in Mobile Sector

Digital Marketing and Consumer Engagement ◽

10.4018/978-1-5225-5187-4.ch023 ◽

2017 ◽

pp. 444-459

Author(s):

Irene Samanta

Keyword(s):

Multivariate Analysis ◽

Mobile Phones ◽

Global Economy ◽

Chi Square ◽

Oligopolistic Market ◽

Oligopolistic Markets ◽

Mobile Industry ◽

Chi Square Test ◽

The Relationship ◽

New Situation

One of the main characteristics of the global economy is the creation of oligopolistic markets. The decisions of those industries are characterised by interactivity. The risk arising from the domination of the power of oligopoly is the previous stage of manipulation of the market. This situation is against the concept of competitiveness and causes an entirely new situation to the customer's disadvantage. Mobile industry which is a typical oligopolistic market in Europe leads us to examine this specific market in Greece. Therefore, the present study examines the factors that influence the relationship marketing strategy of the industry. The research was conducted using a sample of 806 users of mobile phones. The method used for the quantitative analysis is chi-square test, discriminant analysis, which is based on Multivariate Analysis of Variance (MANOVA). The study has indicated that intense competition between mobile phone firms in Greece leads to the manipulation of consumers' behaviour. Also, findings of the current research demonstrate that firms create a unified policy in order to restrain their customers' consuming behaviour to a state of inertia, the customer passively re-buys the same service provider without much thought.

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Genotype–Phenotype Correlations in Children with HHT

Journal of Clinical Medicine ◽

10.3390/jcm9092714 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2714 ◽

Cited By ~ 1

Author(s):

Alexandra Kilian ◽

Giuseppe Latino ◽

Andrew White ◽

Dewi Clark ◽

Murali Chakinala ◽

...

Keyword(s):

Pediatric Patients ◽

Autosomal Dominant ◽

Vascular Malformations ◽

Genetic Data ◽

Chi Square ◽

Chi Square Test ◽

Dominant Disease ◽

The Central Nervous System ◽

Age Range ◽

Rare Autosomal Dominant Disease

Hereditary hemorrhagic telangiectasia (HHT), a rare autosomal dominant disease mostly caused by mutations in three known genes (ENG, ACVRL1, and SMAD4), is characterized by the development of vascular malformations (VMs). Patients with HHT may present with mucocutaneous telangiectasia, as well as organ arteriovenous malformations (AVMs) of the central nervous system, lungs, and liver. Genotype–phenotype correlations have been well described in adults with HHT. We aimed to investigate genotype–phenotype correlations among pediatric HHT patients. Demographic, clinical, and genetic data were collected and analyzed in 205 children enrolled in the multicenter Brain Vascular Malformation Consortium HHT Project. A chi-square test was used to determine the association between phenotypic presentations and genotype. Among 205 patients (age range: 0–18 years; mean: 11 years), ENG mutation was associated with the presence of pulmonary AVMs (p < 0.001) and brain VM (p < 0.001). The presence of a combined phenotype—defined as both pulmonary AVMs and brain VMs—was also associated with ENG mutation. Gastrointestinal bleeding was rare (4.4%), but was associated with SMAD4 genotype (p < 0.001). We conclude that genotype–phenotype correlations among pediatric HHT patients are similar to those described among adults. Specifically, pediatric patients with ENG mutation have a greater prevalence of pulmonary AVMs, brain VMs, and a combined phenotype.

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Epidemiology and Clinical Outcomes of the M-Component Immunoglobulin Types of Multiple Myeloma in an Inner City Hispanic Population.

Blood ◽

10.1182/blood.v110.11.4736.4736 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4736-4736

Author(s):

George Nicolas Batty ◽

Jonathan Brower ◽

Adel Aziz ◽

Neelima Maddukuri ◽

James Tadros ◽

...

Keyword(s):

Multiple Myeloma ◽

African Americans ◽

Inner City ◽

Clinical Outcomes ◽

Ethnic Groups ◽

Light Chain ◽

Chi Square ◽

Chi Square Test ◽

Related Mortality ◽

New Onset

Abstract Introduction: Different types of myeloma are classified by the type of immunoglobulin. From prior analysis, we know that IgG is the commonest class of myeloma and that this type seems to be the most benign. While IgA myeloma appear to be of intermediate outcome, IgD myeloma and lambda light-chain disease are the most aggressive types. Breakdown by immunoglobulin type reveals higher prevalence of IgG myeloma among Whites, compared to Blacks. This study examines the type of immunoglobulin and clinical implication in Hispanics compared to other ethnic groups. Methods: In a single inner city institution, we retrospectively examined patients diagnosed with multiple myeloma over a 5-year period. This investigation defined Hispanic patients as those of Latin American descent. We identified the M-component immunoglobulin type from immunoelectrophoresis as reported in medical records. New onset renal failure and disease related mortality are considered as adverse clinical outcomes. Various ethnic groups were compared between the type of immunoglobulin and adverse clinical outcomes using chi-square test. Results: A total of 203 patients were examined, of which 63 (30.9%) were Hispanics, 87 (42.9%) Caucasians and 53 (26.2%) African American, (104 males, 99 females, age range 34 – 93 yrs, mean age 67.45 ± sd 10.28 yrs). IgG and IgA M-components predominated among all ethnic groups respectively Hispanics 36 (57.9%), 6 (10.5%), Caucasians 51 (59%), 18 (22.7%) and African Americans 25 (50%), 20 (37.5%). A higher proportion of light-chain cases were seen among Hispanics since 21 (31.6%) had no peak on immunoelectrophoresis compared to Caucasians 31 (18.3%) and African Americans 8 (12.5%) (chi-square test, two-tailed p=0.426). Adverse clinical outcomes of new onset renal failure developed correspondingly in 20 (31.6%) Hispanics, 31 (36.3%) Caucasians and 15 (28.6%) African Americans while disease related mortality occurred in 20 (31.6%) Hispanics, 18 (21.4%) Caucasians and 9 (18.2%) African Americans (chi-square test, two-tailed p= 0.132). However, differences were not statistically significant. Conclusion: Although Hispanics exhibited more myeloma of light chain type and worse clinical outcomes compared to other ethnic groups, our study was unable to detect a statistical disparity. Further prospective large population based studies via the new light chain immunodiagnostic assay are warranted to define the epidemiology of this disease.

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