Comparison of the model for end-stage liver disease and disease sodium values in prognosticating short term 3-month mortality in chronic liver disease

Background: Chronic liver disease (CLD) cirrhosis of liver is one of the common non communicable disease, accounting for significant morbidity and mortality in developing countries like India. several prognostic scoring systems have evolved from the need to prioritize patients for liver transplantation model for end-stage liver disease (MELD) and its variant, which includes sodium values (MELD-Na) have been recently popularized.Methods: Prospective observational study with follow-up telephone call every month for 3 months, with ppurposive sampling done on 60 patients admitted to AIMS BG Nagara Mandya district Karnataka India. Statistical analysis included the strength of association was assessed using Pearson's correlation and the ROC curve was drawn to assess the accuracy and diagnostic utility of the two models. A p<0.05 was considered statistically significant.Results: In the present study, the mean age of patients was 49.68±9.89 years of age. The strength of association between the MELD score and MELD-Na score was found to be a very strong positive strength of association (r=0.904, p<0.05). The mean MELD score and MELD-Na score was found to be higher in non-survivors’ group (28.5 and 30.5) compared to survivors group (22.03 and 25.67) which was statistically very significant.Conclusions: MELD-Na score was higher among the patients with outcome of death compared to the MELD score among the patient. The ROC curve showed a comparable result with MELD and MELD-Na scores. There was a relation of severity of hyponatremia with the child-Pugh scores.

Clinical and laboratory profile of tuberculosis in HIV positive individuals

Background: Tuberculosis (TB), major public health problem in most of the developing countries. There is significant difference in the laboratory profile of tuberculosis in human immuno-deficiency virus (HIV) infected compared to immunocompetent host. Prompt diagnosis and treatment of tuberculosis in HIV infected will improve the morbidity and mortality associated with dual infection. Objectives of the research were: to study about the clinical profile of tuberculosis in HIV positive individuals; and also, to study about the laboratory profile of tuberculosis in HIV positive individuals.Methods: Patients with HIV positive status who fulfill the inclusion and exclusion criteria and admitted in Adichunchanagiri hospital and research center, BG Nagara Mandya district, Karnataka India, during the period of January 2020 to June 2021.Results: Fever was the most common symptom (92.8%). Most common manifestation was extrapulmonary TB (54%). TB meningitis was the most common extra pulmonary involvement seen in 28.67%. Amongst patients with pulmonary TB, 6.3% of cases were smear positive for AFB bacilli, 58% of cases had pulmonary infiltrates on chest X-ray. In all cases of extra pulmonary TB (EPTB) CD4T cell counts were &lt;200 cells/μl.Conclusions: Chest X-rays were atypical with more of lowerzone infiltrative lesions. Sputum acid-fast bacillus (AFB) is negative in most of the patients with pulmonary TB, however had sputum cartridge based nucleic acid amplification test (CBNAAT) positive status, hence sputum CBNAAT remains the gold standard investigation. Fluid analysis with ADA correlation holds good for the diagnosis of TB meningitis and tubercular pleural effusion

Associations between sleep, obesity, and asthma in urban minority children.

STUDY OBJECTIVES: Although obesity, asthma, and sleep-disordered breathing are interrelated, there is limited understanding of the independent contributions of body-mass index and pulmonary function on polysomnography in children with asthma. METHODS: We conducted a retrospective chart review on 448 7- to 18-year-old children with asthma who had undergone polysomnography testing between 1/2007-12/2011 to elucidate the association between spirometry variables, body-mass index, and polysomnography parameters, adjusting for asthma and antiallergic medications. RESULTS: Obese children had poorer sleep architecture and more severe gas exchange abnormalities compared to healthy weight children. Multivariate analysis revealed an independent association of body-mass index with sleep efficiency, with more light and less deep sleep in both obese and healthy-weight children, and with baseline oxygen saturation and oxygen nadir in obese children. In obese children, forced vital capacity was independently associated with less deep sleep (time in N3 sleep) as well as with oxygen nadir, while among healthy-weight children, forced expiratory volume directly correlated but forced vital capacity inversely correlated with deep sleep. In obese children, inhaled corticosteroid was associated with baseline oxygen saturation, and montelukast was associated with lower end-tidal carbon dioxide. In healthy-weight children, inhaled corticosteroid was associated with arousal awakening index, and montelukast was associated with light sleep. Antiallergic medications were not independently associated with polysomnography parameters. CONCLUSIONS: Pulmonary function, body-mass index, and asthma medications have independent and differing influences on sleep architecture and gas exchange polysomnography parameters in obese and healthy-weight children with asthma. Asthma medications are associated with improved gas exchange in obese children and improved sleep architecture in healthy-weight children with asthma. CITATION: Conrad LA, Nandalike K, Rani S, Rastogi D. Associations between sleep, obesity, and asthma in urban minority children. J Clin Sleep Med. 2022;18(10):2377-2385

The Feasibility and Utility of Level III Portable Sleep Studies in the Pediatric Inpatient Setting.

Study objectivesSleep-disordered breathing (SDB) may significantly impact the course of medical illness in hospitalized children. Polysomnography (PSG) is the gold standard for establishing diagnosis of SDB, but its availability is limited. The aim of this study was to explore the feasibility and utility of level III portable sleep studies in hospitalized children with SDB.MethodsA retrospective study was conducted at a tertiary hospital over the preceding 2 years in hospitalized children &lt; 18 years who had undergone a level III sleep study using the Nox T3 system. The information obtained included demographic data, comorbidities, indication for admission and sleep study, time interval between the study ordered and done, adequacy of technical data from sleep study, study diagnosis, and subsequent management interventions for SDB.ResultsA total of 51 hospitalized children had these studies; 32 were female and mean age was 4.3 years. Approximately 90% of children had significant comorbidities, including neurological and craniofacial abnormalities. The majority (80%) of studies were conducted within 24 hours of the time requested and 92.1% studies had technically adequate data for analysis. Thirty-nine (76.5%) children were identified with SDB; all but one patient underwent therapy for SDB during that same hospitalization, including supplemental oxygen (48.7%), positive airway pressure therapy (23%), surgical intervention (38.2%) or caffeine (10.2%). Twelve percent of children had more than one intervention done.ConclusionsThe level III portable sleep study is readily available, sufficient to diagnose SDB, and help to provide appropriate medical and/or surgical therapies in hospitalized children with complex medical conditions

Sleep Disordered Breathing in Children with Neuromuscular Disease.

Sleep disordered breathing (SDB) in children with neuromuscular disease (NMD) is more prevalent compared to the general population, and often manifests as sleep-related hypoventilation, sleep-related hypoxemia, obstructive sleep apnea, central sleep apnea, and/or disordered control of breathing. Other sleep problems include, sleep fragmentation, abnormal sleep architecture, and nocturnal seizures in certain neuromuscular diseases. The manifestation of sleep disordered breathing in children depends on the extent, type, and progression of neuromuscular weakness, and in some instances, may be the first sign of a neuromuscular weakness leading to diagnosis of an NMD. In-lab diagnostic polysomnography (PSG) remains the gold standard for the diagnosis of sleep disordered breathing in children, but poses several challenges, including access to many children with neuromuscular disease who are non-ambulatory. If SDB is untreated, it can result in significant morbidity and mortality. Hence, we aimed to perform a comprehensive review of the literature of SDB in children with NMD. This review includes pathophysiological changes during sleep, clinical evaluation, diagnosis, challenges in interpreting PSG data using American Academy of Sleep (AASM) diagnostic criteria, management of SDB, and suggests areas for future research

Nasal trumpet as a long-term remedy for obstructive sleep apnea syndrome in a child.

We present a case of successful long-term use of nasal trumpet for severe obstructive sleep apnea syndrome in a child with cerebral palsy and complex medical issues. Obstructive sleep apnea syndrome is frequently seen in pediatric patients with cerebral palsy due to their abnormal airway tone and pulmonary vulnerability. Identifying children with cerebral palsy who are at risk for obstructive sleep apnea syndrome is important because its treatment can improve quality of life and seizure control. Although first-line treatment for obstructive sleep apnea syndrome is adenotonsillectomy, children with cerebral palsy are more likely to have residual obstructive sleep apnea syndrome postoperatively. Other options such as positive airway pressure therapy and other upper airway surgeries may pose significant challenges and tolerance issues, as in our patient. As demonstrated in our report, the low rate of complications and ease of use make nasal trumpets a potential long-term treatment option for children with obstructive sleep apnea syndrome who fail or cannot comply with the traditional treatment options

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review.

AIM:To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. METHODS:We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children &lt; 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). RESULTS:We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (range: 12.2%-75%). FFB successfully re-expanded atelectasis or removed mucus plugs in 60.3% (range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9% (range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION:FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients

Vaping in today's pandemic: E-cigarette, or vaping, product use-associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress.

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use-associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use-associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19

Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea

Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI &gt; 25/hr, who underwent tonsillectomy and adenoidectomy (T&amp;A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 &plusmn; 5.2 vs. 8.0 &plusmn; 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 &plusmn; 27.4 vs. 44.8 &plusmn; 24.9; p &lt; 0.01), lower oxygen nadirs (70.0 &plusmn; 13.0% vs. 83.0 &plusmn; 7.0%; p &lt; 0.01), and had lower body metabolic index Z-scores (&minus;0.51 &plusmn; 2.1 vs. 0.66 &plusmn; 1.5; p &lt; 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI &gt; 40/h, younger children (&lt;2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring