Computed Tomography With Intravenous Contrast Alone: The Role of Intra‐abdominal Fat on the Ability to Visualize the Normal Appendix in Children

Background Computed tomography ( CT ) with enteric contrast is frequently used to evaluate children with suspected appendicitis. The use of CT with intravenous ( IV ) contrast alone ( CT IV ) may be sufficient, however, particularly in patients with adequate intra‐abdominal fat ( IAF ). Objectives The authors aimed 1) to determine the ability of radiologists to visualize the normal (nondiseased) appendix with CT IV in children and to assess whether IAF adequacy affects this ability and 2) to assess the association between IAF adequacy and patient characteristics. Methods This was a retrospective 16‐center study using a preexisting database of abdominal CT scans. Children 3 to 18 years who had CT IV scan and measured weights and for whom appendectomy history was known from medical record review were included. The sample was chosen based on age to yield a sample with and without adequate IAF . Radiologists at each center reread their site's CT IV scans to assess appendix visualization and IAF adequacy. IAF was categorized as “adequate” if there was any amount of fat completely surrounding the cecum and “inadequate” if otherwise. Results A total of 280 patients were included, with mean age of 10.6 years (range = 3.1 to 17.9 years). All 280 had no history of prior appendectomy; therefore, each patient had a presumed normal appendix. A total of 102 patients (36.4%) had adequate IAF . The proportion of normal appendices visualized with CT IV was 72.9% (95% confidence interval [ CI ] = 67.2% to 78.0%); the proportions were 89% (95% CI  = 81.5% to 94.5%) and 63% (95% CI  = 56.0% to 70.6%) in those with and without adequate IAF (95% CI for difference of proportions = 16% to 36%). Greater weight and older age were strongly associated with IAF adequacy (p < 0.001), with weight appearing to be a stronger predictor, particularly in females. Although statistically associated, there was noted overlap in the weights and ages of those with and without adequate IAF . Conclusions Protocols using CT with IV contrast alone to visualize the appendix can reasonably include weight, age, or both as considerations for determining when this approach is appropriate. However, although IAF will more frequently be adequate in older, heavier patients, highly accurate prediction of IAF adequacy appears challenging solely based on age and weight. Resumen Tomografía Computarizada Únicamente con Contraste Intravenoso: El Papel de la Grasa Intrabadominal en la Capacidad para Visualizar el Apéndice Normal en los Niños Introduction La tomografía computarizada ( TC ) con contraste entérico es usada frecuentemente para evaluar a los niños con sospecha de apendicitis. El uso de la TC únicamente con contraste intravenoso ( TC IV ) puede ser suficiente, especialmente en pacientes con adecuada grasa intrabdominal ( GIA ). Objetivos 1) Determinar la capacidad de los radiólogos para visualizar el apéndice normal (sin enfermedad) con TC IV en niños, y valorar si la cantidad de GIA afecta a esta capacidad; y 2) valorar la asociación entre la idoneidad de la GIA y las características del paciente. Metodología Estudio retrospectivo de 16 hospitales que utilizó una base de datos prexistente de TC abdominales. Se incluyó a los niños entre 3 y 18 años que tenían una TC IV , una medida del peso e historia de apendectomía conocida por la revisión de la historia clínica. La muestra se eligió en base a la edad con el fin de conseguir una muestra con y sin GIA adecuada. Los radiólogos de cada centro releyeron las TC IV de sus centros para valorar la visualización del apéndice y la adecuación de la GIA . La GIA se clasificó como “adecuada” si había cualquier cantidad de grasa completamente alrededor del ciego e “inadecuada” si era de otra manera. Resultados Se incluyeron 280 pacientes, con una media de edad de 10,6 años (rango 3,1 a 17,9 años). Ninguno tenía historia previa de apendectomía; por lo tanto todos los pacientes tuvieron un apéndice presumiblemente normal. Ciento dos pacientes (36,4%) tuvieron GIA adecuada. El porcentaje de apéndices normales visualizados con TC IV fue de 72,9% ( IC 95% = 67,2% a 78,0%); la proporción fue 89% ( IC 95% = 81,5% a 94,5%), y 63% ( IC 95% = 56,0% a 70,6%) en aquéllos con y sin GIA adecuada ( IC 95% para la diferencia de proporciones = 16% a 36%). El mayor peso y la mayor edad se asociaron fuertemente con la adecuación de la GIA (p < 0,001), y el peso resultó ser el mayor factor predictivo, especialmente en mujeres. Aunque se asoció estadísticamente, se vio un solapamiento en los pesos y edades de aquéllos con y sin GIA adecuada. Conclusiones Los protocolos que usan la TC IV para visualizar el apéndice pueden razonablemente incluir el peso, la edad, o ambas como consideraciones para determinar cuándo esta aproximación es apropiada. Sin embargo, aunque la cantidad de GIA será frecuentemente más apropiada en los pacientes más mayores y de mayor peso, la predicción certera de adecuación de GIA es altamente desafiante si se basa sólo en la edad y el peso.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99695/1/acem12185.pd

Measuring Research Performance of 19th Century British Era Universities of Indian Subcontinent

Objectives: This study aims to evaluate the research productivity of universities established by the British rulers during the 19th century in un-divided Indian sub-continent. Another objective of the study is to explore the collaboration patterns and to perform impact analysis on the research produced by the studied universities. Methods: Bibliometric method was used to perform this analysis on the data retrieved from Scopus database. Research yield of studied universities in the form of bibliographic records of research publications was the sample of this study. Results: Chemistry was the most published subject area in the studied universities. Researchers in the studied universities preferred to publish most of their research in the form of journal articles. Multi-authorship is a dominant authorship pattern. Collaborative research attracted more citations than the research publications with single-authorship. Conclusion: This study is the first bibliometric study conducted to explore the research patterns and volume of British era universities of Indian sub-continent

Gastrografin Enemas for Treatment of Distal Intestinal Obstruction Syndrome in Children and Adults with Cystic Fibrosis

Background: Distal intestinal obstruction syndrome (DIOS) presents in both children and adults with cystic fibrosis (CF). When DIOS is characterized by bilious vomiting or when washout therapy with polyethylene glycol has failed, radio-opaque hypertonic enema (ROHE) is recommended as the next therapeutic option. Techniques for use of ROHE in infants with meconium ileus are described in the literature but have not been reported for children and adults with DIOS.Methods: We described the technique, volume, and results of Gastrografin enema usage for DIOS in children and adults with CF at our institution between 2006 and 2011. We reviewed the incidence of DIOS reported to the CF Foundation Patient Registry (CFFPR) between 2001 and 2011Results: The mean amount of dilute Gastrografin used was 1220ml or 31 ml/kg, (range 240 - 3500ml; 19 – 59 ml/kg). Three patients had incomplete resolution after an initial enema and underwent repeat enemas on consecutive days. The incidence of DIOS in the CFFPR increased from 223 to 498 cases in children 18 years over the ten year period studied.Conclusions: Large volume radio-opaque hypertonic enemas can resolve episodes of acute DIOS and can be repeated on subsequent days if needed, without complications. The incidence of DIOS reported to the United States CF Foundation Patient Registry has increased in both children and adults over the past decade

Gastrografin Enemas for Treatment of Distal Intestinal Obstruction Syndrome in Children and Adults with Cystic Fibrosis

Background: Distal intestinal obstruction syndrome (DIOS) presents in both children and adults with cystic fibrosis (CF). When DIOS is characterized by bilious vomiting or when washout therapy with polyethylene glycol has failed, radio-opaque hypertonic enema (ROHE) is recommended as the next therapeutic option. Techniques for use of ROHE in infants with meconium ileus are described in the literature but have not been reported for children and adults with DIOS.Methods: We described the technique, volume, and results of Gastrografin enema usage for DIOS in children and adults with CF at our institution between 2006 and 2011. We reviewed the incidence of DIOS reported to the CF Foundation Patient Registry (CFFPR) between 2001 and 2011Results: The mean amount of dilute Gastrografin used was 1220ml or 31 ml/kg, (range 240 - 3500ml; 19 – 59 ml/kg). Three patients had incomplete resolution after an initial enema and underwent repeat enemas on consecutive days. The incidence of DIOS in the CFFPR increased from 223 to 498 cases in children 18 years over the ten year period studied.Conclusions: Large volume radio-opaque hypertonic enemas can resolve episodes of acute DIOS and can be repeated on subsequent days if needed, without complications. The incidence of DIOS reported to the United States CF Foundation Patient Registry has increased in both children and adults over the past decade

Relationship between IT Self-Efficacy and Personal Knowledge and Information Management for Sustainable Lifelong Learning and Organizational Performance: A Systematic Review from 2000 to 2022

This study aims to identify the relationship between IT self-efficacy and personal knowledge and information management (PKIM) practices. It also intends to investigate trending tools and approaches being applied for PKIM for sustainable lifelong learning and organizational performance. It also reveals challenges for the development of an effective PKIM system. To meet the study&rsquo;s objectives, a systematic literature review was carried out. Fifty research papers published in peer-reviewed journals were included to conduct a comprehensive systematic review. The findings of the study revealed that a significant positive relationship exists between IT self-efficacy and personal knowledge and information management for sustainable lifelong learning and innovative organizational performance. Social media tools, the adoption of emerging technologies, and artificial intelligence were trending techniques for the successful implementation of PKIM practices in academia and the field. This research has significant theoretical, practical, social, academic, and managerial implications

Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis

Importance: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. Objective: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. Design, Setting, and Participants: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. Interventions: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. Results: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P &lt; .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). Conclusions and Relevance: Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. Trial Registration: isrctn.com Identifier: ISRCTN57819173