scholarly journals Survival in critically ill pediatric surgical patients with elevated PYMS and caloric deficit

2021 ◽  
Author(s):  
Taymi Castro Morales ◽  
Alfredo Carlos Rodriguez Portelles ◽  
Alberto Ruben Piriz Assa ◽  
Arianna Maite Cespedes Romulo
Keyword(s):  
Intensive Care ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Pediatric Intensive Care ◽  
Roc Curves ◽  
Nutritional Risk ◽  
Surgical Patients ◽  
Cross Sectional ◽  
Nutritional Monitoring ◽  
Caloric Deficit

Abstract Introduction: The nutritional counseling of the critical surgical pediatric patient is complex, it requires nutritional monitoring tools to improve their survival. The Pediatric Yorkhill Malnutrition Score (PYMS) is highly valid for determining nutritional risk. In Cuba there are no comparative studies on survival and PYMS. Objective: To determine survival in pediatric surgical patients with high PYMS and caloric deficit. Methods: An observational, prospective, cross-sectional and survival study was carried out in the Pediatric Intensive Care Unit of the Octavio de la Concepción de la Pedraja Pediatric Hospital, Holguín, Cuba, in the period from January 2018 to January 2019. analyzed 21 demographic and nutritional variables. Pearson's correlation coefficient was used for the bivariate variables. Kaplan Mier survival curves and ROC curves were created to determine optimal cut-off points for mortality. Results: All patients who did not survive presented high PYMS (p = 0.001) log Rank: X2 10.5, the patients with better caloric adequacy had better survival (p = 0.513) log Rank: X2 0.428 but without statistical significance. The area under the curve to determine mortality according to the PYMS score was higher (0.891) than caloric deficit (0.468) with a sensitivity of 1 and a specificity of 0.66. Conclusions: The survival of critical surgical pediatric patients with high PYMS and caloric deficit was determined. The non-survivors of the study had an elevated PYMS. The PYMS score is a better predictor of mortality than the caloric deficit. Demonstrating its excellent utility in advising nutritional risk in pediatric intensive care.

Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis

2010 ◽  
Vol 70 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Eugenio de Miguel ◽  
Santiago Muñoz-Fernández ◽  
Concepción Castillo ◽  
Tatiana Cobo-Ibáñez ◽  
Emilio Martín-Mola
Keyword(s):  
New York ◽  
Diagnostic Accuracy ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Controlled Study ◽  
Diagnostic Classification ◽  
Hla B27 ◽  
Cross Sectional ◽  
Ultrasound Score

ObjectiveTo determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.MethodsA cross-sectional, blinded and controlled study. Standardised bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.Results113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.ConclusionsEntheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.

Muscle strength cut-points for metabolic syndrome detection among adults and the elderly from Brazil

2021 ◽  
Vol 46 (4) ◽  
pp. 379-388
Author(s):  
Tiago Rodrigues de Lima ◽  
David Alejandro González-Chica ◽  
Eleonora D’Orsi ◽  
Xuemei Sui ◽  
Diego Augusto Santos Silva
Keyword(s):  
Metabolic Syndrome ◽  
Muscle Strength ◽  
Lifestyle Modification ◽  
Handgrip Strength ◽  
Area Under The Curve ◽  
Roc Curves ◽  
The Elderly ◽  
Youden Index ◽  
Cross Sectional ◽  
Cut Points

We aimed to determine cut-points for muscle strength based on metabolic syndrome diagnosis. This cross-sectional analysis comprised data from 2 cohorts in Brazil (EpiFloripa Adult, n = 626, 44.0 ± 11.1 years; EpiFloripa Aging, n = 365, 71.6 ± 6.1 years). Metabolic syndrome was assessed by relative handgrip strength (kgf/kg). Metabolic syndrome was defined as including ≥3 of the 5 metabolic abnormalities according to the Joint Interim Statement. Optimal cut-points from Receiver Operating Characteristic (ROC) curves were determined. Adjusted logistic regression was used to test the association between metabolic syndrome and the cut-points created. The cut-point identified for muscle strength was 1.07 kgf/kg (Youden index = 0.310; area under the curve (AUC)) = 0.693, 95% CI 0.614–0.764) for men and 0.73 kgf/kg (Youden index = 0.481; AUC = 0.768, 95% confidence interval (CI) = 0.709–0.821) for women (age group 25 to < 50 years). The best cut-points for men and women aged 50+ years were 0.99 kgf/kg (Youden index = 0.312; AUC = 0.651; 95% CI = 0.583–0.714) and 0.58 kgf/kg (Youden index = 0.378; AUC = 0.743; 95% CI = 0.696–0.786), respectively. Cut-points derived from ROC analysis have good discriminatory power for metabolic syndrome among adults aged 25 to <50 years but not for adults aged 50+ years. Novelty: First-line management recommendation for metabolic syndrome is lifestyle modification, including improvement of muscle strength. Cut-points for muscle strength levels according to sex and age range based on metabolic syndrome were created. Cut-points for muscle strength can assist in the identification of adults at risk for cardiometabolic disease.

Increase in Pediatric Intensive Care Unit Hospitalizations Due to Toxic Ingestions during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Jennifer L. van Helmond ◽  
Brittany Fitts ◽  
Jigar C. Chauhan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Home Environment ◽  
Clinical Characteristics ◽  
Pediatric Intensive Care ◽  
Cross Sectional Study ◽  
Mitigation Measures ◽  
Sectional Study ◽  
Cross Sectional

AbstractThe coronavirus disease 2019 (COVID-19) pandemic and related community mitigation measures had a significant psychosocial impact. We suspected that more patients were admitted to our pediatric intensive care unit (PICU) for toxic ingestions since the start of the pandemic. We therefore investigated if PICU admissions related to toxic ingestions were higher in 2020 as a result of COVID-19 compared with previous years. We completed a cross-sectional study at a tertiary children's hospital comparing admissions to our PICU between April 2020 and October 2020, during which COVID-19 and community mitigation measures were in place, to those during the same 7-month period in the previous 3 years. Total PICU admissions, admissions for all toxic ingestions (intentional ingestions and accidental ingestions), and demographic and clinical characteristics of patients were compared. Total PICU admissions in 2020 during COVID-19 pandemic months were lower compared with the same months in the preceding 3 years (−16%, p< 0.001), however, admissions for toxic ingestions were higher during COVID-19 (+64%, p< 0.001). When separated by type, intentional (+55%, p = 0.012) and accidental ingestions (+94%, p = 0.021) were higher during COVID-19. COVID-19 with community mitigation measures has led to an increase in PICU admissions for intentional and accidental ingestions, indicating an increase in severity of toxic ingestions in children associated with the pandemic. Mental health of adolescents, and safety of infants and toddlers in their home environment, should be targeted with specific interventions in the ongoing COVID-19 pandemic.

Reduction of Adult Fingers Visualized on Pediatric Intensive Care Unit (PICU) Chest Radiographs after Radiation Technologist and PICU Staff Radiation Safety Education

2009 ◽  
Vol 60 (4) ◽  
pp. 182-184 ◽  
Author(s):  
Jennifer R. Tynan ◽  
Meghan D. Duncan ◽  
Brent E. Burbridge
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Radiation Safety ◽  
Pediatric Intensive Care ◽  
Critical Issue ◽  
Chest Radiographs ◽  
Safety Education ◽  
Cross Sectional ◽  
Medical Radiation

Purpose A recent publication from our centre revealed a disturbing finding of a significant incidence of adult fingers seen on the pediatric intensive care unit (PICU) chest radiographs. This is inappropriate occupational exposure to diagnostic radiation. We hypothesized that the incidence of adult fingers on PICU chest radiographs would decline after radiation safety educational seminars were given to the medical radiation technologists and PICU staff. Methods The present study's objectives were addressed by using a pretest-posttest design. Two cross-sectional PICU chest radiograph samples, taken before and after the administration of radiation safety education for our medical radiation technologists and PICU staff, were compared by using a χ2 test. Results There was a 61.2% and 76.9% reduction in extraneous adult fingers, directly exposed to the x-ray beam and those seen in the coned regions of the film, respectively, on PICU chest radiographs (66.7% reduction overall). This reduction was statistically significant (χ2 = 20.613, P < .001). Conclusions Limiting unnecessary occupational radiation exposure is a critical issue in radiology. There was a statistically and clinically significant association between radiation safety education and the decreased number of adult fingers seen on PICU chest radiographs. This study provides preliminary evidence in favour of the benefit of radiation safety seminars.

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery

2017 ◽  
Vol 38 (5) ◽  
pp. 551-557 ◽  
Author(s):  
Hiok Yang Chan ◽  
Jerry Yongqiang Chen ◽  
Suraya Zainul-Abidin ◽  
Hao Ying ◽  
Kevin Koo ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Effect Size ◽  
Statistical Significance ◽  
Area Under The Curve ◽  
Mean Difference ◽  
P Value ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American Orthopaedic

Background: The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient’s experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients’ demographics to the MCID. Methods: We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: “How would you rate the overall results of your treatment for your foot and ankle condition?” (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered “good” versus “fair” based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Results: Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value < .001). There were no statistical differences between demographics or preoperative AOFAS scores of patients with good versus fair satisfaction levels. At 2 years, patients who had good satisfaction had higher AOFAS scores than fair satisfaction (83.9 vs 78.1, P < .001) and higher mean change (30.2 vs 22.3, P = .015). Mean change in AOFAS score in patients with good satisfaction was 30.2 (SD = 19.8). Mean difference in good versus fair satisfaction was 7.9. Using ROC analysis, the cut-off point is 29.0, with an area under the curve (AUC) of 0.62. Effect size method derived an MCID of 8.4 with a moderate effect size of 0.5. Multiple linear regression demonstrated increasing age (β = −0.129, CI = −0.245, –0.013, P = .030) and higher preoperative AOFAS score (β = −0.874, CI = −0.644, –0.081, P < .001) to significantly decrease the amount of change in the AOFAS score. Conclusion: The MCID of AOFAS score in hallux valgus surgery was 7.9 to 30.2. The MCID can ensure clinical improvement from a patient’s perspective and also aid in interpreting results from clinical trials and other studies. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Sleep, quality of life and mood of nursing professionals of pediatric intensive care units

2016 ◽  
Vol 50 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Priscilla Caetano Guerra ◽  
Nilton Ferraro Oliveira ◽  
Maria Teresa de Sande e Lemos Ramos Ascensão Terreri ◽  
Claudio Arnaldo Len
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
Sleep Quality ◽  
Intensive Care Units ◽  
Statistical Significance ◽  
Pediatric Intensive Care ◽  
Pediatric Intensive Care Units ◽  
Sleeping Problems ◽  
Nursing Professionals

Abstract OBJECTIVE To assess sleep, quality of life and mood of nursing professionals of pediatric intensive care units. METHOD Quantitative, cross-sectional and descriptive study. Professionals grouped by morning, afternoon and evening shifts were assessed by means of the instruments: Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Generic questionnaire for the assessment of quality of life (SF-36); Beck Depression Inventory; Beck Anxiety Inventory; State-Trait Anxiety Inventory. RESULTS Sample consisted of 168 professionals, with prevalence of neutral typology (57.49%). There was no statistical significance regarding sleep, despite scores showing a poor quality of sleep and excessive daytime sleepiness for the three shifts. Quality of life did not reveal any statistical significance, but in the field "social role functioning" of the evening shift, a lower score was observed (p<0.007). There was no statistical significance regarding levels of anxiety and depression. CONCLUSION The results suggest that these professionals may present sleeping problems, but they do not have lower scores of quality of life or mood disorders. Likely explanations for these findings may include an adaptation to their work type over time and the fact that working with children is rewarding.

scholarly journals Clinical profile, etiology, management and outcome of serum sodium disturbances in children admitted in PICU

2017 ◽  
Vol 5 (6) ◽  
pp. 2546
Author(s):  
Balaji Jayakumar ◽  
Ekambaranath Sambasivam
Keyword(s):  
Intensive Care ◽  
Venous Blood ◽  
Pediatric Intensive Care ◽  
Urine Osmolality ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Glucose Levels ◽  
Sick Children ◽  
Almost All

Background: Sodium disorders are common in children who need intensive care, they occur in variety of conditions, may remain unrecognized if not suspected and monitored and result in morbidity and mortality irrespective of primary problem. The aim of the study is to know etiology, management and outcome of sodium disturbances in sick children admitted to pediatric intensive care unit to Institute of Social Pediatrics Stanley Medical College.Methods: This is a hospital based cross sectional study. Two hundred and twenty-seven children in the age group of 1month to 12 years admitted in PICU over the period of 8 months were included in the study. Venous blood sampling is obtained from each patient enrolled in the study and is sent for estimation of electrolytes, blood urea, glucose levels. Serum osmolality (calculated), urine osmolality, urine spot sodium were done in selected patients.Results: Among the 227 children studied, 85 children had sodium disturbances that included both hyponatremia (80 children) and hypernatremia (5 children) The most common cause of hyponatremia is CNS disorder 25 patients (31.25%) followed by poisoning 17.Conclusions: Hyponatremia occurs frequently and should be looked for in all sick children. It is of hypotonic- euvolemic type in almost all the acute infections except diarrhea and should be managed accordingly. They contribute significantly to the mortality and morbidity. 

scholarly journals Clinical profile and outcome of the patients admitted in PICU in tertiary hospital.

2021 ◽  
Vol 28 (04) ◽  
pp. 548-551
Author(s):  
Maria Saleem ◽  
Asim Khurshid ◽  
Amna Wajdan ◽  
Muhammad Salman Zafar
Keyword(s):  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Clinical Profile ◽  
Cross Sectional ◽  
Respiratory Disorders ◽  
The Mean ◽  
Seriously Ill Patients ◽  
Study Setting

Objectives: To analyze the clinical profile, etiologies and outcome of seriously ill patients admitted in Pediatric Intensive Care Unit (PICU). Study Design: Cross Sectional study. Setting: PICU of Nishtar Medical Hospital, Multan, Pakistan. Period: January 2018 to December 2018. Material & Methods: During the study period, a total of 150 children, aged 1 to 12 years, with better prognosis and post-surgical cases requiring intensive care were registered. Age, gender, cause for hospitalization (clinical, surgical or emergency), length of PICU stay, diagnosis and outcome were recorded for all patients. Results: During the year of the study, 83 (55.3%) children were noted to be male. The mean age was 56.9+12.5 months. Mechanical ventilation was done in 62 (41.3%) patients. Major indications for admission to the PICU were respiratory disorders (21.5%), followed by sepsis (11.4%) and meningitis (8.1%). Majority, 80 (53.3%) patients improved and were shifted to ward and later discharged while 27 (18.0%) expired. Conclusion: Most of the children admitted in the PICU were male, aged below 5 years. Most common indication for admission in the PICU were respiratory disorders followed by sepsis and meningitis.

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