scholarly journals Can we Rely on Transcutaneous Bilirbinometry during Phototherapy?

2020 ◽  
pp. 5-12
Author(s):  
Dr. Pearl Mary Varughese
Keyword(s):  
Serum Bilirubin ◽  
Late Preterm ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Neonatal Septicemia ◽  
New Born ◽  
Prolonged Hospitalization ◽  
Preterm Babies ◽  
Screening Device ◽  
Transcutaneous Bilirubinometer

Background:Neonatal jaundiceis one of the main reasons for prolonged hospitalization in newborns, and its progress and treatment depends on serum bilirubin values. Phototherapy remains the mainstay of treatment of pathological jaundice in newborn babies. Though, transcutaneous bilirubinometer has been used as a screening device for measuring bilirubin, its role during phototherapy has always been questioned. Objective: To study the correlation between Transcutaneous bilirubinometer (TcB) values with serum bilirubin levels (TSB) in infants during phototherapy in term and late preterm babies. Materials and Methods: The study was conducted in a tertiary new-born center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations, and those on phototherapy.

scholarly journals Kramer’s scale or transcutaneous bilirubinometry: the ideal choice of a pediatrician? can we trust our eyes?

2019 ◽  
Vol 6 (5) ◽  
pp. 1794 ◽  
Author(s):  
Pearl Mary Varughese
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Roc Curves ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Neonatal Septicemia ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometer ◽  
Transcutaneous Bilirubinometry

Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer’s scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it’s always best to screen for jaundice using Kramer’s scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it’s better to do serum bilirubin levels.

scholarly journals Cord serum bilirubin as a predictor of neonatal hyperbilirubinemia in healthy term and late preterm neonates

2018 ◽  
Vol 5 (5) ◽  
pp. 1815
Author(s):  
Ramanathan R. ◽  
Baby Praveena A.
Keyword(s):  
Predictive Value ◽  
Serum Bilirubin ◽  
Neonatal Period ◽  
Hospital Readmissions ◽  
Mode Of Delivery ◽  
Late Preterm ◽  
Preterm Neonates ◽  
Cord Serum ◽  
Early Neonatal Period ◽  
Preterm Babies

Background: Icterus neonatorum is the most common neonatal illness occurring in the first 7 days of life. It is the most important cause for hospital readmissions during the early neonatal period and also the cause for neonatal morbidity. In this study our main objective is, to find out that whether detecting umbilical cord blood bilirubin levels soon after birth, will help to identify the development of significant jaundice in early neonatal period which requires immediate interventionMethods: This was a prospective observational study carried out among 150 term and preterm babies. Their cord bilirubin level were estimated. Jaundice was determined by using yellowish appearance of eyes, skin and Kramer score. Statistics employed include Chi-square test and receiver operator characteristic curveResults: Study participants enrolled into the study was 150. Cord serum bilirubin was significantly associated with Kramer score and yellowish discoloration of eyes and skin and not significantly associated with sex, mode of delivery, gestational age and birth weight. When cord serum bilirubin was compared against the occurrence of clinical jaundice, sensitivity was found to be 58.33%, specificity was 96.49% positive predictive value was 84% and negative predictive value was 88%. Receiver operator characteristics curve indicated that the area below the curve was 0.842.Conclusions: Cord serum bilirubin can be used as a screening tool to identify the neonatal jaundice in both term and late preterm babies. Present study has shown increased specificity than sensitivity which warrants further exploration.

Adverse Effects of Natural Products: A Brief Pre-Systematic Review

2020 ◽  
Vol 01 ◽  
Author(s):  
Carla Pires ◽  
Ana Fernandes
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Natural Products ◽  
Adverse Events ◽  
In Vitro Study ◽  
Google Scholar ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Meta Analyses

Background: Natural products are commonly used for treating health problems. These products may be associated with adverse events, which are defined as "noxious and unintended response to a medicinal product" by the European Medicine Agency. Objectives: To identify studies describing at least one adverse event (or with potential to promote an adverse event) related to the use of natural products, as well as to describe the involved product(s) and adverse event(s). Methods: A pre-systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Keywords: "natural product(s)" and ["adverse drug reaction(s)" or "adverse effect(s)"]. Screened databases: PubMed, SciELO, DOAJ and Google Scholar. Inclusion criteria: papers describing at least one adverse event associated with the use of natural products and published between 2017 and 2019. Exclusion criteria: Repeated studies, reviews and papers written in other languages than English, Portuguese, French or Spanish. Results: 104 studies were identified (20 PubMed; 0 SciELO; 2 DOAJ; 82 Google Scholar), but only 10 were selected (4 PubMed and 6 Google Scholar): 1 in-vitro study; 2 non-clinical studies, 1 study reporting in-vitro and clinical data and 5 studies were cases reports. Globally, 997 reports of adverse drug reactions with natural products were identified, mainly non-severe cases. Conclusion: Since a limited number of studies was found, we conclude that adverse events due to natural products may be underreported, or natural products may have a good safety profile. This review contributes for assuring the safety of natural products consumers, by evaluating the knowledge/information on the potential adverse events and interactions of these products.

scholarly journals The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert J. Sanchez ◽  
Wenzhen Ge ◽  
Wenhui Wei ◽  
Manish P. Ponda ◽  
Robert S. Rosenson
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Adult Population ◽  
Baseline Period ◽  
Prior History ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Recurrent Acute Pancreatitis ◽  
History Of ◽  
Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

Applicability of the VOYAGER trial criteria: a cohort study on patients in the nationwide Danish Vascular Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Soegaard ◽  
P.B Nielsen ◽  
F Skjoeth ◽  
T.B Larsen ◽  
N Eldrup
Keyword(s):  
Myocardial Infarction ◽  
Lower Extremity ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Inclusion Criteria ◽  
Private Company ◽  
Exclusion Criteria ◽  
Dual Pathway ◽  
Event Rates ◽  
Lower Extremity Revascularization

Abstract Introduction Peripheral artery disease (PAD) carries a high risk of debilitating stroke, myocardial infarction, and death. The VOYAGER PAD trial investigates whether rivaroxaban 2.5 mg plus aspirin vs aspirin alone leads to a reduction in major adverse cardiovascular events (MACE) in patients with symptomatic PAD undergoing revascularization. However, it is unclear whether patients enrolled in VOYAGER PAD reflect those undergoing lower extremity revascularization in daily clinical practice. Purpose To describe the proportion of patients eligible for the VOYAGER PAD trial within the nationwide Danish Vascular Registry (DVR), the reasons for ineligibility, and rates of cardiovascular outcomes in VOYAGER-eligible and VOYAGER-ineligible patients. Methods We identified and characterized all patients from 2000–2016 undergoing open surgical or endovascular revascularization for symptomatic PAD in the DVR and applied the VOYAGER inclusion and exclusion criteria. We computed one-year rates per 100 person-years of VOYAGER PAD trial endpoints of MACE, myocardial infarction, ischemic stroke, major amputation, major bleeding, cardiovascular (CV) death, and all cause death. Results In the DVR, 32,911 patients underwent lower extremity revascularization for symptomatic PAD and were evaluated for eligibility. Among these, 32.2% had at least one exclusion criteria and an additional 40.6% without exclusion criteria did not fulfil inclusion criteria. The “VOYAGER-eligible” population therefore comprised 27.2% of the identified patients (Figure 1A). Main reasons for exclusion were atrial fibrillation (30.7%), poorly regulated hypertension (19.6%), PCI or ACS within 12 months before (16.0%), treatment with strong inhibitors or inducers of cytochrome P450 (9.2%), active cancer (8.8%), and severe renal failure (8.3%). Main reasons for non-inclusion were aorto-iliac procedures (79.0%), non-successful revascularization (13.1%), and age&lt;50 years (7.1%). Compared with “VOYAGER-eligible” patients, event rates were slightly lower among patients in the DVR not fulfilling inclusion criteria and markedly higher for “VOYAGER excluded” patients (Figure 1B). Conclusion In this nationwide cohort of symptomatic PAD patients undergoing lower extremity revascularization, 27.2% full filled the inclusion and exclusion criteria for dual pathway therapy in the VOYAGER PAD trial. Non-inclusion predominantly related to aorto-iliac procedures and were associated with lower event rates. Future studies are needed to clarify if these patients could also benefit from dual pathway therapy. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG, Berlin, Germany

scholarly journals Single-bone versus both-bone plating of unstable paediatric both-bone forearm fractures. A randomized controlled clinical trial

2021 ◽  
Author(s):  
Mohamed Khaled ◽  
Amr A. Fadle ◽  
Ahmed Khalil Attia ◽  
Andrew Sami ◽  
Abdelkhalek Hafez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Operative Time ◽  
Forearm Fractures ◽  
Inclusion Criteria ◽  
Fracture Union ◽  
Exclusion Criteria ◽  
Bone Fixation ◽  
Fixation Group ◽  
Significant Difference ◽  
Single Bone

Abstract Purpose This clinical trial compares the functional and radiological outcomes of single-bone fixation to both-bone fixation of unstable paediatric both-bone forearm fractures. Methods This individually randomized two-group parallel clinical trial was performed following the Consolidated Standards of Reporting Trials (CONSORT) statement at a single academic tertiary medical centre with an established paediatric orthopaedics unit. All children aged between nine and 15 years who presented to the emergency department at Assiut university with unstable diaphyseal, both-bone forearm fractures requiring surgical intervention between November 1, 2018, and February 28, 2020, were screened for eligibility against the inclusion and exclusion criteria. Inclusion criteria were diaphyseal unstable fractures defined as shaft fractures between the distal and proximal metaphyses with an angulation of > 10°, and/or malrotation of > 30°, and/or displacement > 10 mm after attempted closed reduction. Exclusion criteria included open fractures, Galeazzi fractures, Monteggia fractures, radial head fractures, and associated neurovascular injuries. Patients who met the inclusion criteria were randomized to either the single-bone fixation group (intervention) or the both-bone fixation group (control). Primary outcomes were forearm range of motion and fracture union, while secondary outcomes were forearm function (price criteria), radius re-angulation, wrist and elbow range of motion, and surgical time Results A total of 50 children were included. Out of these 50 children, 25 were randomized to either arm of the study. All children in either group received the treatment assigned by randomization. Fifty (100%) children were available for final follow-up at six months post-operatively. The mean age of single-bone and both-bone fixation groups was 11.48 ± 1.93 and 13 ± 1.75 years, respectively, with a statistically significant difference (p = 0.006). There were no statistically significant differences in gender, laterality, affection of the dominant hand, or mode of trauma between single-bone and both-bone fixation groups. All patients in both groups achieved fracture union. There mean radius re-angulation of the single-bone fixation groups was 5.36 ± 4.39 (0–20) degrees, while there was no radius re-angulation in the both-bone fixation group, with a statistically significant difference (p < 0.001). The time to union in the single-bone group was 6.28 ± 1.51 weeks, while the time to union in the both-bone fixation group was 6.64 ± 1.75 weeks, with no statistically significant difference (p = 0.44). There were no infections or refractures in either group. In the single-bone fixation group, 24 (96%) patients have regained their full forearm ROM (loss of ROM < 15°), while only one (4%) patient lost between 15 and 30° of ROM. In the both-bone fixation group, 23 (92%) patients have regained their full forearm ROM (loss of ROM < 15°), while only two (8%) patients lost between 15 and 30° of ROM. There was no statistically significant difference between groups in loss of forearm ROM (p = 0.55). All patients in both groups regained full ROM of their elbow and wrist joints. On price grading, 24 (96%) and 23 (92%) patients who underwent single bone fixation and both-bone fixation scored excellent, respectively. Only one (4%) patient in the single-bone fixation group and two (8%) patients in the both-bone fixation group scored good, with no statistically significant difference in price score between groups (p = 0.49). The majority of the patients from both groups had no pain on the numerical pain scale; 22 (88%) patients in the single-bone fixation group and 21 (84%) patients in the both-bone fixation groups, with no statistically significant difference between groups (p = 0.38). The single-bone fixation group had a significantly shorter mean operative time in comparison to both-bones plating (43.60 ± 6.21 vs. 88.60 ± 10.56 (min); p < 0.001). Conclusion Single-bone ulna open reduction and plate fixation and casting are safe and had a significantly shorter operative time than both-bone fixation. However, single-bone ORIF had a higher risk radius re-angulation, alas clinically acceptable. Both groups had equally excellent functional outcomes, forearm ROM, and union rates with no complications or refractures. Long-term studies are required.

Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Biscaglia ◽  
G Campo ◽  
K Fox ◽  
J.C Tardif ◽  
M Tendera ◽  
...  
Keyword(s):  
High Risk ◽  
Major Bleeding ◽  
Artery Bypass ◽  
Real Life ◽  
Prolonged Treatment ◽  
Funding Source ◽  
Inclusion Criteria ◽  
Private Company ◽  
Exclusion Criteria ◽  
Coronary Syndrome

Abstract Background/Introduction The PEGASUS-TIMI 54 trial showed that prolonged treatment with ticagrelor reduces the cumulative occurrence of ischemic adverse events. CLARIFY is the biggest real life registry on chronic coronary syndrome. Purpose - To evaluate the percentage of patients eligible for long-term ticagrelor therapy in the CLARIFY registry. – To compare the outcome of this subgroup of patients with those with PEGASUS exclusion criteria or without PEGASUS inclusion criteria. Methods Within the CLARIFY population, we selected post MI patients and we excluded those with missing info (post MI evaluable population). Then, we divided patients into 3 groups: excluded (meeting PEGASUS exclusion criteria, namely use of P2Y12 receptor antagonists or chronic oral anticoagulant, any stroke, coronary-artery bypass grafting in the past 5 years); eligible (meeting PEGASUS high-risk inclusion criteria, namely age≥65 years; diabetes; multivessel disease; creatinine clearance &lt;60 ml/min) and ineligible (not meeting PEGASUS high-risk inclusion criteria). We therefore compared the ischemic (CV death, MI and stroke) and bleeding (major bleeding) outcome of the 3 groups adjusting for age, sex, smoking and geographical region. Results Among the 11811 post-MI evaluable patients, 4706 (39.8%) were included in the eligible group, 5715 (48.4%) in the excluded group, and 1390 in the ineligible group (11.8%). Both the ischemic and bleeding endpoints were significantly different among the 3 groups with the excluded patients with the worst and ineligible patients with the best outcome (see table). The same trend was shown for CV death, while the occurrence of MI was not significantly different among the 3 groups. In the eligible group, the ratio between ischemic and bleeding events was 6:1, whereas between CV death and major bleeding was 3.5:1. Conclusions Around 40% of CLARIFY post-MI patients could benefit from prolonged ticagrelor therapy. In this group of patients, ischemic risk seems to be higher than the bleeding one. Ischemic & bleeding risk in the 3 groups Funding Acknowledgement Type of funding source: Private company. Main funding source(s): CLARIFY registry was funded by Servier

scholarly journals Exoskeletons for all: The interplay between exoskeletons, inclusion, gender, and intersectionality

2020 ◽  
Vol 11 (1) ◽  
pp. 217-227 ◽  
Author(s):  
Roger Andre Søraa ◽  
Eduard Fosch-Villaronga
Keyword(s):  
New Technology ◽  
Health Condition ◽  
End Users ◽  
Target Market ◽  
Inclusion Criteria ◽  
Wearable Robot ◽  
Exclusion Criteria ◽  
Intersectionality Theory ◽  
Design Choice ◽  
The One

AbstractIn this article, we investigate the relation between gender and exoskeleton development through the lens of intersectionality theory. Exoskeleton users come in a wide variety of shapes, sizes, and genders. However, it is often the case that wearable robot engineers do not develop such devices primarily on the premise that the product should fit as many end users as possible. Instead, designers tend to use the one-size-fits-all approach – a design choice that seems legitimate from the return of an investment viewpoint but that may not do as much justice to end users. Intended users of exoskeletons have a series of user criteria, including height, weight, and health condition, in the case of rehabilitation. By having rigid inclusion criteria for whom the intended user of the technology can be, the exclusion criteria will grow in parallel. The implications and deep-rootedness of gender and diversity considerations in practices and structural systems have been largely disregarded. Mechanical and robot technology were historically seen as part of a distinct male sphere, and the criteria used today to develop new technology may reflect the biases that existed in another time that should no longer be valid. To make this technology available for all, we suggest some tools to designers and manufacturers to help them think beyond their target market and be more inclusive.

scholarly journals Applicability of Moyers analysis in mixed dentition: A systematic review

2013 ◽  
Vol 18 (6) ◽  
pp. 100-105 ◽  
Author(s):  
Mariana de Aguiar Bulhões Galvão ◽  
Gladys Cristina Dominguez ◽  
Sérgio Thomaz Tormin ◽  
Alex Akamine ◽  
André Tortamano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Clinical Case ◽  
Case Reports ◽  
Mixed Dentition ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Theoretical Probability ◽  
Study Population ◽  
Mixed Dentition Analysis

INTRODUCTION: Moyers analysis is widely used for analyzing mixed dentition, however, the accuracy of its theoretical probability tables has been recently questioned. Taking into consideration the fact the mixed dentition analysis is of paramount importance to precisely determine the space needed for alignment of canines and premolars, this research aimed at objectively assessing in the literature such an important step for orthodontic diagnosis. METHODS: A computerized search involving articles published on PubMed and Lilacs between 1990 and September, 2011 was conducted in accordance with the method described in the Cochrane 5.1.0 handbook. RESULTS: The research resulted in a sample composed of 629 articles. The inclusion criteria were: Articles using the Moyers analysis with a sample greater or equal to 40 patients. Conversely, the exclusion criteria were: Dental casts of patients with syndromes or oral cleft, researches conducted with a literature review, only, or clinical case reports and researches conducted before 1990. For this systematic review, 19 articles were selected. CONCLUSION: Based on the literature available, we can conclude that the Moyers mixed dentition analysis must be carefully used, since the majority of the articles analyzed showed that the probability of 75% was not as accurate as expected, leading to the need of adapting the probability levels depending on the study population.

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