Category: Nevin Manimala

ANZ J Surg. 2022 Aug 18. doi: 10.1111/ans.17946. Online ahead of print.

ABSTRACT

BACKGROUND: We previously conducted a systematic review to identify surgical mortality risk prediction tools suitable for adapting in the Australian context and identified the Surgical Outcome Risk Tool (SORT) as an ideal model. The primary aim was to investigate the external validity of SORT for predicting in-hospital mortality in a large Australian private health insurance dataset.

METHODS: A cohort study using a prospectively collected Australian private health insurance dataset containing over 2 million deidentified records. External validation was conducted by applying the predictive equation for SORT to the complete case analysis dataset. Model re-estimation (recalibration) was performed by logistic regression.

RESULTS: The complete case analysis dataset contained 161 277 records. In-hospital mortality was 0.2% (308/161277). The mean estimated risk given by SORT was 0.2% and the median (IQR) was 0.01% (0.003%-0.08%). Discrimination was high (c-statistic 0.96) and calibration was accurate over the range 0%-10%, beyond which mortality was over-predicted but confidence intervals included or closely approached the perfect prediction line. Re-estimation of the equation did not improve over-prediction. Model diagnostics suggested the presence of outliers or highly influential values.

CONCLUSION: The low perioperative mortality rate suggests the dataset was not representative of the overall Australian surgical population, primarily due to selection bias and classification bias. Our results suggest SORT may significantly under-predict 30-day mortality in this dataset. Given potential differences in perioperative mortality, private health insurance status and hospital setting should be considered as covariables when a locally validated national surgical mortality risk prediction model is developed.

PMID:35979735 | DOI:10.1111/ans.17946

Pediatrics. 2022 Aug 18:e2021054955. doi: 10.1542/peds.2021-054955. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Central line-associated bloodstream infections (CLABSIs), eminently preventable nosocomial infections, are a substantial source of morbidity, mortality, and increased resource utilization in pediatric care. Racial or ethnic disparities in health outcomes have been demonstrated across an array of medical specialties and practices in pediatric patients. However, it is unknown whether disparities exist in the rate of CLABSIs. Our objective was to evaluate the trends in racial and ethnic disparities of CLABSIs over the past 5 years.

METHODS: This is a retrospective cohort study using data from Pediatric Health Information System database collected from tertiary children’s hospitals in the United States. Participants included 226 802 children (<18 years) admitted to the emergency department or inpatient ward between 2016 and 2021 who required central venous catheter placement. The primary outcome was risk-adjusted rate of CLABSI, occurring during the same admission, across race and ethnicity.

RESULTS: Of the 226 802 children, 121 156 (53.4%) were White, 40 589 (17.9%) were Black, and 43 374 (19.1%) were Hispanic. CLABSI rate decreased in all racial/ethnic groups over the study period, with the rates being consistently higher in Black (relative risk [RR], 1.27; 95% confidence interval [CI], 1.17-1.37; P < .01) and Hispanic children (RR, 1.16; 95% CI, 1.08-1.26; P < .01) than in White children. There was no statistically significant evidence that gaps in CLABSI rate between racial/ethnic groups narrowed over time.

CONCLUSIONS: CLABSI rate was persistently higher among Black and Hispanic children than their White peers. These findings emphasize the need for future exploration of the causes of persistent racial and ethnic disparities in pediatric patients.

PMID:35979730 | DOI:10.1542/peds.2021-054955

Conserv Biol. 2022 Aug 18:e13984. doi: 10.1111/cobi.13984. Online ahead of print.

NO ABSTRACT

PMID:35979709 | DOI:10.1111/cobi.13984

Conserv Biol. 2022 Aug 18:e13985. doi: 10.1111/cobi.13985. Online ahead of print.

NO ABSTRACT

PMID:35979706 | DOI:10.1111/cobi.13985

Neurourol Urodyn. 2022 Aug 18. doi: 10.1002/nau.25025. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to examine associations of specific anxiety disorders, depressive symptoms, and incontinence in a representative, population-based sample of preschool children.

METHODS: All preschool children of a defined geographical area examined before school-entry were included. Parents completed a questionnaire including the Preschool Feelings Checklist (PFC), eight questions referring to nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI) and constipation, and 30 items regarding Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of separation anxiety disorder (SAD), social phobia (SOC), specific phobia (PHOB), and generalized anxiety disorder (GAD). Data of 1206 children (mean age = 5.7 years; 53.5% boys) are presented.

RESULTS: 34.6% of incontinent children had an anxiety disorder based on DSM-5 criteria and 13.3% had clinically relevant depressive symptoms (measured by the PFC). Rates of incontinence overall were 14.1% (11.9% NE, 3.1% DUI, and 1.8% FI) and 6.3% for constipation. Rates of SOC and PHOB were increased in NE (20.8% and 25.4%), DUI (39.3% and 34.5%) and FI (35.3% and 50.0%) compared to continent children (13.5% and 17.2%). Children with constipation had higher rates of SOC, PHOB, and GAD than those without. Compared to continent children (9.7%), depressive symptoms were more frequent in children with NE (26.8%), DUI (50.0%), and FI (61.9%).

CONCLUSION: Anxiety disorders and depressive symptoms are common in children with incontinence. The most specific DSM-5 disorders associated with incontinence are SOC and PHOB, which can be incapacitating and may require treatment. Due to the high rates of anxiety disorders, it is important to screen all children with incontinence, for example, with specific questionnaires.

PMID:35979705 | DOI:10.1002/nau.25025

Conserv Biol. 2022 Aug 18:e13986. doi: 10.1111/cobi.13986. Online ahead of print.

NO ABSTRACT

PMID:35979704 | DOI:10.1111/cobi.13986

Conserv Biol. 2022 Aug 18:e13987. doi: 10.1111/cobi.13987. Online ahead of print.

NO ABSTRACT

PMID:35979701 | DOI:10.1111/cobi.13987

J Card Surg. 2022 Aug 18. doi: 10.1111/jocs.16853. Online ahead of print.

ABSTRACT

INTRODUCTION: Connective tissue disorders predispose patients to earlier aortic dissections and aneurysms. However, there is limited large cohort data given its low incidence.

METHODS: The National Inpatient Sample was searched for all adults with Marfans (MFS) and Ehlers Danlos (EDS) disease between 2010 and 2017. ICD codes were used to select those with a type A aortic dissection or aneurysm.

RESULTS: There was a total of 19,567 cases, giving the estimated incidence of MFS and EDS of 18 and 22.4 per 100k people, respectively. After inclusion criteria, there were 2553 MF and 180 EDS patients. There was no statistical difference in mortality between the MFS and EDS cohorts (4.6% vs. 2.8%, p = .26). EDS patients were more likely to undergo a TEVAR procedure (2.8% vs. 1.0%, p = .03). MF patients were more likely to have a complication of acute kidney injury (p = .02). EDS patients were more likely older (50 vs. 42, p < .001) and female (47% vs. 33%, p < .001). MFS patients were more likely to have a type A aortic dissection (44% vs. 31%, p < .001). The majority (89%) of patients were treated at urban teaching hospitals. On univariable logistic regression, aortic dissection was a predictor for mortality (odds ratio 7.31, p < .001). The type of connective tissue disease was not a significant predictor.

CONCLUSIONS: National level estimates show low mortality for patients with MF or ED presenting to the hospital with aortic dissection or aneurysm. The differences in age and gender can guide surveillance for these patient populations, leading to more elective admissions and reduced hospital mortality.

PMID:35979682 | DOI:10.1111/jocs.16853

Echocardiography. 2022 Aug 17. doi: 10.1111/echo.15437. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is an inherited autosomal dominant heart disease, characterized by increased left ventricular wall thickness and abnormal loading conditions. Imaging modalities are the first choice for diagnosis and risk stratification. Although heart dimensions have been characterized widely in HCM adults from cardiac imaging, there is limited information about children affected by HCM. The aim of this study is to evaluate left ventricular function and left heart dimensions in a small population of children diagnosed with HCM.

METHODS: A total of 16 (seven male, nine female) pediatric patients with an average age of 14.0 ± 2.5 years diagnosed with HCM at Great Ormond Street Hospital for Children were included in this study. Cardiac magnetic resonance (CMR) images were used to measure left and right ventricular dimensions, and septal and left ventricular free wall thicknesses in Simpleware ScanIP. The gender groups were compared using student t-test or non-parametric Mann-Whitney U-test depending on the sample distribution.

RESULTS: Differences in heart rate, left ventricular end-diastolic volume and end-diastolic volume index, left ventricular stroke volume and stroke volume index, left ventricular end-systolic long axis length, left ventricular end-systolic long axis length index, left ventricular end-diastolic mid-cavity diameter, left ventricular end-diastolic free wall thickness, left ventricular end-diastolic free wall thickness index, right ventricular end-diastolic long axis length were statistically significant in males and females.

CONCLUSION: Left ventricular wall and intraventricular septal thickness increase affecting left ventricle cavity dimensions and there may be differences in anatomical and physiological parameters in males and females affected by HCM.

PMID:35978451 | DOI:10.1111/echo.15437

BMC Vet Res. 2022 Aug 17;18(1):317. doi: 10.1186/s12917-022-03397-z.

ABSTRACT

BACKGROUND: Bacterial corneal infections are common and potentially blinding diseases in all species. As antibiotic resistance is a growing concern, alternative treatment methods are an important focus of research. Photoactivated chromophore for keratitis-corneal crosslinking (PACK-CXL) is a promising oxygen radical-mediated alternative to antibiotic treatment. The main goal of this study was to assess the anti-bactericidal efficacy on clinical bacterial isolates of the current standard and an accelerated PACK-CXL treatment protocol delivering the same energy dose (5.4 J/cm²).

METHODS: Clinical bacterial isolates from 11 dogs, five horses, one cat and one guinea pig were cultured, brought into suspension with 0.1% riboflavin and subsequently irradiated. Irradiation was performed with a 365 nm UVA light source for 30 min at 3mW/cm² (standard protocol) or for 5 min at 18mW/cm² (accelerated protocol), respectively. After treatment, the samples were cultured and colony forming units (CFU’s) were counted and the weighted average mean of CFU’s per μl was calculated. Results were statistically compared between treated and control samples using a linear mixed effects model.

RESULTS: Both PACK-CXL protocols demonstrated a significant bactericidal effect on all tested isolates when compared to untreated controls. No efficacy difference between the two PACK-CXL protocols was observed.

CONCLUSION: The accelerated PACK-CXL protocol can be recommended for empirical use in the treatment of bacterial corneal infections in veterinary patients while awaiting culture results. This will facilitate immediate treatment, the delivery of higher fluence PACK-CXL treatment within a reasonable time, and minimize the required anesthetic time or even obviate the need for general anesthesia.

PMID:35978428 | DOI:10.1186/s12917-022-03397-z