ミトコンドリア遺伝子の欠損は肝細胞癌の増殖を促進する

博士(医学)大阪市立大

Estimation Of The Scale Matrix Of A Multivariate T-model

The classical theory of Multivariate Statistical Analysis is primarily based on the multivariate normal model. However, in the recent literature several authors have made studies as to how the conclusions will be affected if the population model departs from normality. The class of elliptical models shares some intrinsic properties of the multivariate normal model and has been getting increasing attention by the researchers in the recent literature.;In the present thesis we restrict the model to a suitable multivariate t-model which belongs to the class of elliptical models and at the same time accommodates the multivariate normal model. This model has found applications in the context of stock market problems. The main results of the thesis are outlined below.;Improved estimators of the scale matrix of the multivariate t-model have been obtained under a squared error loss function. Similar improved estimators for the characteristic roots of the scale matrix, trace of the scale matrix and also for the inverse of the scale matrix have been obtained. Some Improved estimators of the scale matrix of multivariate t-model have been obtained under the entropy loss function. Some other related new results are as follows.;An elegant expression has been obtained for the characteristic function of the multivariate t-distribution in terms of the well-known Macdonald function. Also a limit theory for the Macdonald function has been obtained. Some identities involving expectations of the sum of product matrix, based on the multivariate t-model, have been derived

Clinical profile and outcome in a paediatric intensive care unit in Pakistan

Paediatric critical care medicine is a relatively new subspecialty in Pakistan. The clinical profile and outcomes of children admitted in the PICU (paediatric intensive care unit) were retrospectively reviewed from January to December 2007. Mean age of the studied 314 patients was 24 months; 37% were less than one-year-old and 66% was male. Mean PRISM score was 13.2. There were almost equal distribution of medical (46%) and surgical (54%) cases. Ninety percent of patients received mechanical ventilation, while more than 50% received vasoactive drugs. The rate of nosocomial infection was 4.7%. The average length of PICU stay was 3.2 (1-49) days. The overall mortality rate was 14%. The results are encouraging and efforts should be made to establish more PICUs

Efficacy and safety of procedural sedation and analgesia by paediatric intensivist in paediatric oncology unit

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of Anaesthesiology guidelines. A small-dose of ketamine and intermittent doses of propofol was administered intravenously until needed. No procedure was aborted due to sedation. All patients tolerated the procedure well without any major adverse events. There were few transient respiratory adverse events which resolved with minor interventions. PSA for children undergoing oncology procedures, can safely and effectively be provided by paediatric intensivist in controlled setting by using a standardized sedation protocol outside the operating room

Improving outcome in pediatric intensive care unit in Academic Hospital in Pakistan

Objective: To assess the impact on the clinical outcome of critically ill children before and after introduction of pediatric intensivist in an academic pediatric intensive care unit (PICU) inPakistan. Methodology: : This is aretrospective audit of children (age from one month to 14 years) admitted in the PICU during two 12-month periods in PICU of Aga Khan University Hospital (AKUH).Patients in Cohort one were managed by pediatric intensivist while in Cohort two were managed by general pediatricians.Patients were compared during the two 12-month cohort period. Results: During the study, in cohort one, 314 patients were admitted, mean age was 24 months (range, one month -14 year), 37% were less than 1-year old, 66% were male, mean PRISM Score was 13.2(3- 39) while in cohort 2, 99 patients were admitted; mean age was 29 months and 60% were male. There were similar medical diagnostic categories in both cohorts. There were significant differences in two cohort for mortality (35% vs. 14%), length of stay (7.5 days vs. 3.2 days)(p314 vs. 99) Conclusion: Our data showed that implementation of full-time trained pediatric intensivist in a tertiary-care PICU of university hospital was associated with improve outcome of critically ill children

Acute cerebellitis with hydrocephalus

We report a case of an 8 years old child who presented with sudden onset of headache and vomiting. He had broad-based gait and intention tremors on admission. MRI brain revealed isointense signals on T1-weighted imaging and hyperintense signals on T2-weighted imaging. Cerebellar swelling was also identified with significant mass effect obliterating the fourth ventricle. CT head showed prominent third and lateral ventricles. He was treated with high dose corticosteroids and required an external ventricular drain (EVD) insertion. He made an uneventful recovery and suffered no neurologic deficit. The clinical and radiologic findings in this boy were consistent with cerebellitis complicated by hydrocephalus

Teaching paediatric critical care medicine to paediatric residents

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care unit is very dynamic, thrilling, enjoyable and provides a lot of learning opportunities. During the rotation, the residents were exposed to all major critical care illnesses in infants and children. We use four traditional models of learning in our Paediatric Intensive Care Unit (PICU): bedside rounds, direct patient care, didactic learning and self-study. Our curriculum enhances the resident\u27s educational and clinical experience of paediatric intensive care medicine

Use of N-acetylcysteine in children with fulminant hepatic failure caused by acute viral hepatitis

Objective: To determine the efficacy of N-acetylcysteine (NAC) in children aged \u3e 1 month to 16 years admitted with Fulminant Hepatic Failure (FHF) secondary to Acute Viral Hepatitis (AVH) in a tertiary care center of a developing country. Study Design: Analytical study. Place and Duration of Study: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011. Methodology: Medical records of children (\u3e 1 month - 16 years) with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests (mean ± SD) at baseline, 24 hours after NAC and before or at the time of discharge/death were recorded and compared via using repeated measures ANOVA (r-ANOVA). Efficacy of NAC is defined in improvement in biochemical markers, liver function test and discharge disposition (survived or died). Mortality associated risk factors were identified by using logistic regression analysis. P-value and 95% confidence interval were recorded. Results: Forty children (mean age was 80 ± 40 months) with FHF secondary to AVH received NAC. Majority were males (n=25; 63%). Vomiting (75%) and jaundice (65%) were the main presenting symptoms, one-third had hypoglycemic, while 40% had altered sensorium at the time of admission. There was significant statistical difference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC (p \u3c 0.001). Fifteen (38%) children died. Severe vomiting {Odds Ratio (OR) 0.22, 95% Confidence Interval (CI) 0.05 - 0.8}, jaundice (OR 9.3, CI 1.1 - 82.6), inotropic support (OR 20.6, CI 3.5 - 118.3) and mechanical ventilation (OR 4.3, CI 1.1 - 16.6) at the time of admission are associated with risk factors for mortality in children with FHF secondary to AVH. Conclusion: NAC used in children with FHF secondary to AVH is associated with markedly improved liver function tests and recovery. FHF with complications is high risk for mortalit