Mantoux test revisited: Variability in reading tuberculin test in pediatric population

Introduction: Mantoux test aids in the diagnosis of tuberculosis (TB), however its application and interpretation are dependent on multiple factors. Methodology: A prospective study enrolling 400 children (aged 2-12) suspected to have tuberculosis. All participants received Mantoux test with two different strengths (1 TU and 5 TU) of Purified Protein Derivative (PPD) on different forearms. The test was read by two readers after 48 ± 2 and 72 ± 2 hours. Primary outcome was difference in the size of induration when read by two readers (interobserver variability). Secondary outcomes were difference in the size of induration at different intervals, with different strengths of PPD and percentage positivity of Mantoux test in TB patients. Results: Statistically significant difference was seen in the size of induration when read by two different readers, with fair to moderate agreement when read at 48 and 72 hours (1 TU: p = 0.002, k = 0.52 and p = 0.1, k = 0.73 respectively, 5 TU: p = 0.001, k = 0.39 and p = 0.0009, k = 0.33 respectively). Tendency of under-reading occurred when size of induration was close to significant level (10-14 mm). Size of induration was similar when read at 48 or 72 hours (1 TU: p = 0.9, 5 TU: p = 1.0). Mantoux positivity rate in patients with TB was more with 5 TU as compared to 1 TU (61.2% vs. 16.3%). Conclusions: There is significant interobserver variability with a tendency to under-read around the cutoff point. The use of 5 TU PPD at 48 hours by a trained physician can aid in early and more reliable diagnosis of TB.

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Comparison of Outcomes of Pediatric Catheter Ablation by Anesthesia Strategy: A Report from the NCDR ® IMPACT Registry

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.009849 ◽

2021 ◽

Author(s):

Christopher M. Janson ◽

Maully J. Shah ◽

Kevin F. Kennedy ◽

V. Ramesh Iyer ◽

Tammy L. Sweeten ◽

...

Keyword(s):

Primary Outcome ◽

Pediatric Population ◽

Anesthesia Care ◽

Monitored Anesthesia Care ◽

Significant Difference ◽

Ablation Success ◽

Multivariable Models ◽

Vt Ablation ◽

Procedural Outcomes ◽

First Time

Background - Anesthesia strategies for pediatric ablation procedures include general anesthesia (GA) and monitored anesthesia care (MAC). The effects of anesthesia strategy on arrhythmia inducibility and procedural outcomes have not been investigated. Methods - A multicenter retrospective study was performed, utilizing data from the NCDR ® IMPACT Registry. Data from subjects 1-21 years undergoing elective first-time electrophysiology study (EPS) for evaluation of documented SVT, EAT, or PVC/VT from 4/1/16-12/31/19 were included, excluding cases with WPW, congenital heart disease, and/or cardiomyopathy. The primary outcome was a negative EPS, defined as failure to induce the clinical tachyarrhythmia. Secondary outcomes included ablation success and adverse events (AE). Results - 6621 subjects from 78 centers were evaluated: 49% male; mean age 13.3±3.8 years. GA was utilized in 5913 (89%), with MAC in 708 (11%). A negative EPS occurred in 9% of cases overall, with no difference by anesthesia strategy (9% GA vs. 10% MAC, p=0.2). In SVT and EAT, there was no significant difference in likelihood of a negative EPS by anesthesia strategy. In PVC/VT, there was a higher rate of negative EPS under GA (28% GA vs. 16% MAC, p=0.02), translating to a higher rate of non-ablation (34% GA vs. 14% MAC, p<0.001). In multivariable models, GA was associated with negative EPS in PVC/VT (OR 2.2, 95% CI 1.1-4.4, p=0.03), but not in SVT or EAT. Acute ablation success was not different between strategies (94% GA vs. 94% MAC, p=0.2). Major AE were rare, with no differences between GA and MAC. Conclusions - In this first report on pediatric ablation data in IMPACT, there were no differences between GA and MAC in SVT or EAT inducibility, acute ablation success, or major AE. GA was associated with higher rates of non-inducibility and non-ablation in PVC/VT cases. A MAC strategy should be considered for PVC/VT ablation in the pediatric population.

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8 The Adoption of Rescue Colloid During Resuscitation Decreases Fluid Administered and Returns End Organ Perfusion

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.012 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S8-S9

Author(s):

Paul Comish ◽

Manuel Castillo-Angeles ◽

Deborah Carlson ◽

Herb Phelan ◽

Brett Arnoldo ◽

...

Keyword(s):

Clinical Outcomes ◽

Urine Output ◽

Primary Outcome ◽

Organ Function ◽

Significant Difference ◽

Thermal Injuries ◽

Secondary Outcomes ◽

Total Urine ◽

A Prospective Study ◽

Injured Patients

Abstract Introduction Traditionally lactated ringers (LR) has been utilized for the resuscitation of thermally injured patients. Both the Parkland and Brooke formula’s include the addition of albumin as part of their ongoing resuscitation after the initial 24 hours. Over the last five years, the addition of albumin to current protocols has been reported to decrease fluid creep. Our institution has adopted these practices and here we present our findings during the adoption phase of rescue albumin during resuscitation. Methods A prospectively collected burn registry was queried for patients greater than 18 years, between July 2017 and December 2018, who sustained a thermal injury and required a formal resuscitation. Patients were included in the rescue albumin group if the treating team administered 25% albumin for a sustained urine output less than 0.5ml/kg over 2–3 hours. Our primary outcome was a total volume of resuscitation ml LR/%TBSA/kg. Our secondary outcomes were the change in resuscitation rate and the change in urine output three hours before and three hours after the administration of albumin normalized to %TBSA/kgs. Finally, we compared clinical outcomes of ICU days and length of stay (LOS) between the rescue albumin and no rescue albumin group. Results A total of 92 patients with thermal injuries were included: median age was 40 (IQR 31–57), 73% were male, and 30 patients received rescue albumin. The TBSA was increased in those who received rescue albumin (47% vs 38% p=0.02). Despite a higher TBSA in the albumin group the total LR given during resuscitation normalized to TBSA and KG was not significantly different (ml LR/%TBSA/kg: 3.66 vs. 4.31, p=0.149). Similarly, the total urine output (UOP) and the adjusted UOP showed no significant difference, total UOP 1,781 ml no albumin vs 1,483ml rescue albumin (p=0.149) and UOP/kg 21.7ml no albumin vs 18.9 ml rescue albumin (p=0.341). But our secondary outcomes did demonstrate there was a decrease in the LR rate by -0.06 ml/%TBSA/kg/hr (SD 0.13) and an increase in the UOP by 1.61 ml/kg/hr (SD 3.25), see Figure 1. Conclusions Rescue albumin administration decreases the amount of fluid administered during resuscitation, and increases end organ function as evidenced by increase UOP. This was observed in patients who sustained larger burns and were failing traditional increases in resuscitation LR. These findings are the basis for a modification to our current protocol and a prospective study of the clinical outcomes. Applicability of Research to Practice We believe these findings support the limited use of albumin in patients who fail a conventional LR based resuscitation.

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A Prospective Study Evaluating IOP Changes after Switching from a Therapy with Prostaglandin Eye Drops Containing Preservatives to Nonpreserved Tafluprost in Glaucoma Patients

The Scientific World JOURNAL ◽

10.1100/2012/804730 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Stefano Ranno ◽

Matteo Sacchi ◽

Cinzia Brancato ◽

Daniela Gilardi ◽

Andrea Lembo ◽

...

Keyword(s):

Primary Outcome ◽

Open Angle Glaucoma ◽

Hypotensive Effect ◽

Eye Drops ◽

Lowering Effect ◽

Significant Difference ◽

Ocular Discomfort ◽

The Mean ◽

A Prospective Study ◽

Time Point

Purpose. To compare the ocular hypotensive effect of tafluprost with prostaglandin analogues (PGAs) in glaucoma patients.Methods. 89 primary open-angle glaucoma patients treated with bimatoprost, latanoprost, or travoprost for at least 3 months complaining for ocular discomfort were switched to tafluprost. IOP was assessed at baseline and 3 months after switching the therapy by daily curve. Primary outcome was to compare the mean daily IOP of tafluprost with PGAs.Results. The mean daily IOP was16±2.1and16.6±2.0 mm Hg at baseline and after switching to tafluprost, respectively (P>0.05). When analysis was carried out between tafluprost and each previous PGAs, the comparison between latanoprost and tafluprost and travoprost and tafluprost did not show any statistically significant difference in mean daily IOP and at each time point. The comparison between bimatoprost and tafluprost showed a statistically significant difference in mean daily IOP (P<0.05) and at each time point (P<0.05).Conclusions. After 3 months of switching tafluprost showed an overall IOP lowering effect similar to others PGAs. When each PGA was compared with tafluprost, bimatoprost showed to provide a statistically significant additional IOP lowering effect.

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The Timing of Tuberculin Tests in Relation to Immunization With Live Viral Vaccines

PEDIATRICS ◽

10.1542/peds.55.3.392 ◽

1975 ◽

Vol 55 (3) ◽

pp. 392-396

Author(s):

Helen F. Brickman ◽

Pierre H. Beaudry ◽

Melvin I. Marks

Keyword(s):

Preventive Care ◽

Tuberculin Test ◽

Mantoux Test ◽

Control Group ◽

Simultaneous Administration ◽

Rubella Vaccine ◽

Viral Vaccine ◽

Significant Difference ◽

Viral Vaccines ◽

Tuberculin Tests

The validity of the recommendation that routine screening for tuberculosis precede the administration of live viral vaccines was tested in a field study. One hundred and ten children already known to be tuberculin-positive, mostly on the basis of prior vaccination with BCG, were immunized with live viral vaccine and retested with tuberculin at the same time. Reversion to a negative tine test occurred in 3% of children given measles, mumps, or rubella vaccine, and 3.6% of controls who received no vaccine but had the tuberculin test repeated at the same intercal. Very few Mantoux reactions (two of 68) reverted to negative in children given one of the three vaccines, singly or in combination; some became smaller, but there was no significant difference in the changes in the size of the Mantoux reaction between the vaccinated group and the control group, with the exception of an unexplained increase in the size of the reaction in many of those who received rubella vaccine. Screening for tuberculosis by tine or Mantoux test is not invalidated by simultaneous administration of vaccines against measles, mumps, or rubella, given singly or in combination, as part of preventive care programs.

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Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm10102054 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2054

Author(s):

Gerasimos Kopsinis ◽

Dimitrios Tsoukanas ◽

Dimitra Kopsini ◽

Theodoros Filippopoulos

Keyword(s):

Mitomycin C ◽

Primary Outcome ◽

Randomized Study ◽

Primary Outcome Measure ◽

Complication Rates ◽

Filtration Surgery ◽

Significant Difference ◽

Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

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Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock

Perfusion ◽

10.1177/02676591211033947 ◽

2021 ◽

pp. 026765912110339

Author(s):

Shek-yin Au ◽

Ka-man Fong ◽

Chun-Fung Sunny Tsang ◽

Ka-Chun Alan Chan ◽

Chi Yuen Wong ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Mechanical Circulatory Support ◽

Primary Outcome ◽

Left Ventricular ◽

Circulatory Support ◽

Queen Elizabeth Hospital ◽

Intra Aortic Balloon Pump ◽

Membrane Oxygenation ◽

Significant Difference ◽

Va Ecmo

Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

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SMILE and Wavefront-Guided LASIK Out-Compete Other Refractive Surgeries in Ameliorating the Induction of High-Order Aberrations in Anterior Corneal Surface

Journal of Ophthalmology ◽

10.1155/2016/8702162 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Min-jie Ye ◽

Cai-yuan Liu ◽

Rong-feng Liao ◽

Zheng-yu Gu ◽

Bing-ying Zhao ◽

...

Keyword(s):

Spherical Aberration ◽

Laser In Situ Keratomileusis ◽

Small Incision Lenticule Extraction ◽

Corneal Surface ◽

Small Incision ◽

Significant Difference ◽

Lenticule Extraction ◽

A Prospective Study ◽

High Order Aberrations

Purpose. To compare the change of anterior corneal higher-order aberrations (HOAs) after laser in situ keratomileusis (LASIK), wavefront-guided LASIK with iris registration (WF-LASIK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE).Methods. In a prospective study, 82 eyes underwent LASIK, 119 eyes underwent WF-LASIK, 88 eyes underwent FS-LASIK, and 170 eyes underwent SMILE surgery. HOAs were measured with Pentacam device preoperatively and 6 months after surgery. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs, spherical aberration (SA), horizontal coma, and vertical coma over 6 mm diameter central corneal zone.Results. Six months postoperatively, all procedures result in increase of anterior corneal total HOAs and SA. There were no significant differences in the induced HOAs between LASIK and FS-LASIK, while SMILE induced fewer total HOAs and SA compared with LASIK and FS-LASIK. Similarly, WF-LASIK also induced less total HOAs than LASIK and FS-LASIK, but only fewer SA than FS-LASIK (P<0.05). No significant difference could be detected in the induced total HOAs and SA between SMILE and WF-LASIK, whereas SMILE induced more horizontal coma and vertical coma compared with WF-LASIK (P<0.05).Conclusion. FS-LASIK and LASIK induced comparable anterior corneal HOAs. Compared to LASIK and FS-LASIK, both SMILE and WF-LASIK showed advantages in inducing less total HOAs. In addition, SMILE also possesses better ability to reduce the induction of SA in comparison with LASIK and FS-LASIK. However, SMILE induced more horizontal coma and vertical coma compared with WF-LASIK, indicating that the centration of SMILE procedure is probably less precise than WF-LASIK.

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Impact of Treatment on Vestibular Schwannoma–Associated Symptoms: A Prospective Study Comparing Treatment Modalities

Otolaryngology ◽

10.1177/0194599820986564 ◽

2021 ◽

pp. 019459982098656

Author(s):

Jason H. Barnes ◽

Neil S. Patel ◽

Christine M. Lohse ◽

Nicole M. Tombers ◽

Michael J. Link ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Median Number ◽

Treatment Modalities ◽

Baseline Survey ◽

Limited Attention ◽

Subjective Symptoms ◽

Prospective Survey ◽

Significant Difference ◽

Associated Symptoms ◽

A Prospective Study

Objective The degree to which various treatment modalities modify vestibular schwannoma (VS)–associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. Study Design Prospective survey. Setting Tertiary neurotology referral center. Methods Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. Results A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus ( P = .15), dizziness or imbalance ( P = 0.66), or headaches ( P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. Conclusions Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.

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PREDICTIVE VALUE OF LOW AT III LEVELS FOR THE OCCURRENCE OF IVH, IRDS AND DEATH IN PREMATURE NEONATES

10.1055/s-0038-1644268 ◽

1987 ◽

Author(s):

W van den Berg ◽

M Peters ◽

C Breederveld ◽

J W ten Cate ◽

J G Koppe

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Distress Syndrome ◽

Peripheral Vein ◽

Premature Neonates ◽

Significant Difference ◽

At Iii ◽

Diffuse Intravascular Coagulation ◽

Idiopathic Respiratory Distress Syndrome ◽

A Prospective Study

The observation of AT III deficiency in premature neonates with Idiopathic Respiratory Distress Syndrome (IRDS), suggests a positive predictive value for a poor outcome. The underlying diffuse intravascular coagulation could generate serious hemorrhagic complications like Peri/Intraventricular Hemorrhage (IVH).A prospective study was performed in consecutively born neonates to assess the predictive value of low AT III for theoccurrence of IVH, (gr. III/IV), IRDS, and death. Eighty-one neonates were included in the study during a period of 5 months. AT III levels were determined immediately after birth by a chromogenic substrate assay. Values in umbilical cord blood were identical with values in capillary or peripheral vein blood samples taken within 6 hours after birth. There was no correlation between AT III values and gestational age (r: 0.18). Twenty-four neonates with IRDS showed a mean AT III value of 0.23 U/ml (S. D. ± 0.07 U/ml) which was significantly lower than a mean AT III value of 0.35 U/ml (S. D. ± 0.1 U/ml) for neonates without IRDS (p ≺0.00005). When IVH gr. III/IV was diagnosed in neonates having IRDS (8/24) no significant difference in mean AT IIIact was observed with respect to jnean AT III levels of remaining neonates without this complication. No death occurred in neonates without IRDS. Mean AT IIIact (0.21 U/ml) in neonates with IRDS who died (9/24) was low compared with mean AT III levels of neonates with IRDS who survived (0.25 U/ml), but did not reach significance (p≻0.1). Assuming a critical value of AT III of 20% a positive predictive value of 89% for IRDS, 44% for IVH, and 56% for death was calculated. It is concluded that low AT Illact levels have a high predictive value for IRDS.

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INR Response to Low-Dose Vitamin K in Warfarin Patients

Annals of Pharmacotherapy ◽

10.1177/1060028021993239 ◽

2021 ◽

pp. 106002802199323

Author(s):

Caitlin E. Kulig ◽

A. Joshua Roberts ◽

A. Shaun Rowe ◽

Hahyoon Kim ◽

William E. Dager

Keyword(s):

Vitamin K ◽

Primary Outcome ◽

Low Dose ◽

International Normalized Ratio ◽

Mortality Rates ◽

Observational Cohort Study ◽

Significant Difference ◽

Observational Cohort ◽

Reduction Effect ◽

Retrospective Observational Cohort Study

Background Literature suggests that 2 mg of vitamin K intravenously (IV) provides a similar effect as 10 mg to reverse warfarin. Doses <5 mg haven’t been studied in depth. Objective The objective was to determine the international normalized ratio (INR) reduction effect of ultra low-dose (ULD) IV vitamin K. Methods This retrospective, observational cohort study compared IV vitamin K doses of 0.25-0.5 mg (ULD) versus 1-2 mg (standard low dose [SLD]). The primary outcome assessed ΔINR at 36 hours; secondary outcomes assessed ΔINR at 12 hours and 30-day venous thromboembolism (VTE) and mortality rates. Results Of 88 patients identified (median baseline INR [IQR], 5.1 [3.1, 7.3] vs 4.5 [2.8, 8.2], ULD vs SLD, respectively), 59 had an INR at 12 hours. The ULD had fewer 12-hour INR values <2, with no statistical difference in the ΔINR at 12 hours between the ULD and SLD cohorts (median ΔINR, 2.2 [1.1, 3.4] vs 2.2 [1.1, 6.3]; P = 0.54; median INR, 2.3 vs 1.8). A total of 41 patients had both a 12- and 36-hour INR. No significant difference in the ΔINR between the 12- and 36-hour values occurred (median ΔINR, 0.52 [0.2, 0.91] vs ΔINR, 0.46 [0.18, 0.55]; P = 0.61), suggesting no rebound or excessive reversal and no difference in 30-day rates of VTE ( P > 0.99) or death ( P = 0.38). Conclusion and Relevance ULD IV vitamin K reversed INR similarly to doses of 1-2 mg without rebound. A ULD strategy may be considered in patients requiring more cautious reversal.

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