Purpose
Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9–13) may benefit from better stratification. We aimed to compare neurocritical care utilization and ...functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11–13), low GCS modTBI (lmodTBI, GCS 9–10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI.
Methods
Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18 years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3 months using the Glasgow Outcome Scale–Extended Pediatric Revision (GOS-E Peds, scale 1–8, 1 = upper good recovery, 8 = death).
Results
We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%,
p
< 0.001), longer PICU stay (days, median IQR; 5.00 4.00, 9.75 vs 4.00 2.00, 5.00,
p
= 0.007), and longer hospital stay (days, median IQR: 13.00 8.00, 17.00 vs. 8.00 5.00, 12, 25,
p
= 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 1.00, 3.00), lmodTBI (3.00 IQR 2.00, 5.75), and sTBI (5.00 IQR 1.00, 6.00) (
p
< 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52),
p
= 0.018, and 1.27 (0.33),
p
< 0.001, respectively) compared with hmodTBI.
Conclusions
Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI.
This work was performed in hospitals within the PACCMAN and LARed networks.
No reprints will be ordered.
We present an analysis of the thermal response of a hot-wire electroexplosive device (EED) excited with different transient signals. First-order and second-order analytical models to calculate the ...thermal response of an EED are assessed taking as reference numerical simulations obtained using ANSYS. For the early-time response, when the time is much smaller than the thermal constant of the EED, the best approach corresponds to a first-order differential model in which the thermal capacitance is calculated with short-pulse excitations. A linear simplification to calculate the maximum temperature due to short excitations is also shown to be adequate. On the other hand, the most appropriate model for the late-time response is a second-order model. The models are used to assess the electromagnetic susceptibility of a wired EED for different electromagnetic pulsed environments. Radiated signals produced by a mesoband radiator, two types of radars, and a hyperband radiator are considered. The radar signal proved to be the most disturbing source because of its highest duty cycle and its flat spectral response around a specific frequency. Even the temperature firing threshold can be exceeded with the radiated field produced by a radar of 200 kW of output power located at a distance of 5 m.
Objetivo: Describir las características demográficas del cáncer de tiroides en la Región de Ñuble en pacientes operados en el servicio de cirugía del Hospital Clínico Herminda Martin del 2017 al ...2019. Materiales y Método: Mediante estudio descriptivo, se revisaron las historias clínicas de los pacientes operados en la Unidad de Cirugía de Adultos del hospital entre enero de 2017 y diciembre de 2019, tabulando las variables demográficas, clínicas e histopatológicas y método diagnóstico.Resultados: Se operaron 124 pacientes con afecciones tiroideas, 58 resultaron tener cáncer. Predominó el sexo femenino (50 pacientes). Se realizaron 43 tiroidectomías totales como primera cirugía y 15 disecciones cervicales. El carcinoma papilar fue el más diagnosticado (93,1%). Hubo discrepancias entre las categorías Bethesda II y IV en cuanto al diagnóstico definitivo. En mujeres el 36% de los tumores tuvo extensión extra tiroidea y el 54% tenían un diámetro mayor a 1 cm.Discusión: La prevalencia en el sexo femenino corresponde con los datos que se aportan a nivel mundial y en Chile. La discrepancia en el sistema Bethesda pudo corresponder a errores de la toma de muestra o su interpretación citológica. Los hallazgos de extensión y tamaño tumoral pueden estar en relación con el tiempo de espera para la cirugía.Conclusiones: El cáncer tiroideo es más frecuente en el sexo femenino. El carcinoma papilar fue el más diagnosticado. La asociación de tiroiditis con cáncer tiroideo fue de 98%. No se realizó ninguna cirugía conservadora.
Background
COVID-19 requires an early diagnosis to optimize management and limit transmission. SARS-CoV-2 is able to spread effectively. Infected asymptomatic individuals have been found to be ...contagious. RT-qPCR is the currently recommended laboratory method for diagnosing acute infection. However, rapid antigen detection (RAD) tests are not only fast, but require less specialized training. The possibility of using RAD tests to identify asymptomatic patients is attractive, as it could effectively contribute to minimizing the hospital spread of SARS-CoV-2. The objective of the study was to determine the performance of RAD vs. RT-qPCR for the detection of asymptomatic cases in INER health personnel.
Methods
In order to follow WHO guidelines, generalized tests, a test station for health care workers was implemented on demand. A rapid test was carried out and a second sample was taken to be processed by RT-qPCR. With the results of both tests we conducted a retrospective study. Sensitivity, specificity, positive predictive value, negative predictive value and negative likelihood ratios were calculated.
Results
A total of 1640 RAD tests were performed in health care workers (mean age was 39, 69, 47% with a self-reported comorbidity). Participants provided 1,640 valid RAD/RT-qPCR test pairs with 2% testing positive
via
RT-qPCR. 12 RAD samples were positive for SARS-CoV-2. Overall sensitivity of the PANBIO ™ COVID-19 Ag Rapid Test test was 35.2%.
Conclusions
RADs are not recommended for the detection of asymptomatic cases due to low performance.
Purpose
We aimed to investigate the association between initial dysnatremia (hyponatremia and hypernatremia) and in-hospital mortality, as well as between initial dysnatremia and functional outcomes, ...among children with traumatic brain injury (TBI).
Method
We performed a multicenter observational study among 26 pediatric intensive care units from January 2014 to August 2022. We recruited children with TBI under 18 years of age who presented to participating sites within 24 h of injury. We compared demographics and clinical characteristics between children with initial hyponatremia and eu-natremia and between those with initial hypernatremia and eu-natremia. We defined poor functional outcome as a discharge Pediatric Cerebral Performance Category (PCPC) score of moderate, severe disability, coma, and death, or an increase of at least 2 categories from baseline. We performed multivariable logistic regression for mortality and poor PCPC outcome.
Results
Among 648 children, 84 (13.0%) and 42 (6.5%) presented with hyponatremia and hypernatremia, respectively. We observed fewer 14-day ventilation-free days between those with initial hyponatremia 7.0 (interquartile range (IQR) = 0.0–11.0) and initial hypernatremia 0.0 (IQR = 0.0–10.0), compared to eu-natremia 9.0 (IQR = 4.0–12.0);
p
= 0.006 and
p
< 0.001. We observed fewer 14-day ICU-free days between those with initial hyponatremia 3.0 (IQR = 0.0–9.0) and initial hypernatremia 0.0 (IQR = 0.0–3.0), compared to eu-natremia 7.0 (IQR = 0.0–11.0);
p
= 0.006 and
p
< 0.001. After adjusting for age, severity, and sex, presenting hyponatremia was associated with in-hospital mortality adjusted odds ratio (aOR) = 2.47, 95% confidence interval (CI) = 1.31–4.66,
p
= 0.005 and poor outcome (aOR = 1.67, 95% CI = 1.01–2.76,
p
= 0.045). After adjustment, initial hypernatremia was associated with mortality (aOR = 5.91, 95% CI = 2.85–12.25,
p
< 0.001) and poor outcome (aOR = 3.00, 95% CI = 1.50–5.98,
p
= 0.002).
Conclusion
Among children with TBI, presenting dysnatremia was associated with in-hospital mortality and poor functional outcome, particularly hypernatremia. Future research should investigate longitudinal sodium measurements in pediatric TBI and their association with clinical outcomes.
The burden of traumatic brain injury (TBI) is disproportionately high in low- and middle-income countries (LMICs). This study aimed to compare clinical outcomes and healthcare utilization for ...children with moderate to severe TBIs between LMICs and non-LMICs in Asia and Latin America.
The authors performed an observational multicenter study from January 2014 to February 2023 among children with moderate to severe TBIs admitted to participating pediatric intensive care units (PICUs) in the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) and Red Colaborativa Pediátrica de Latinoamérica (LARed Network). They classified sites according to their 2019 sociodemographic index (SDI). Low, low-middle, and middle SDI sites were considered LMICs, while high-middle and high SDI sites were considered non-LMICs. The authors documented patient demographics and TBI management. Accounting for death, they recorded 14-day PICU-free and 28-day hospital-free days, with fewer free days indicating poorer outcome. The authors compared children who died and those who had poor functional outcomes (defined as Pediatric Cerebral Performance Category PCPC level of moderate disability, severe disability, or vegetative state or coma) between LMICs and non-LMICs and performed a multivariable logistic regression analysis for predicting poor functional outcomes.
In total, 771 children with TBIs were analyzed. Mortality was comparable between LMICs and non-LMICs (9.6% vs 12.9%, p = 0.146). Children with TBIs from LMICs were more likely to have a poor PCPC outcome (31.0% vs 21.3%, p = 0.004) and had fewer ICU-free days (median IQR 6 0-10 days vs 8 0-11 days, p = 0.004) and hospital-free days (median IQR 9 0-18 days vs 13 0-20 days, p = 0.007). Poor functional outcomes were associated with LMIC status (adjusted OR aOR 1.53, 95% CI 1.04-2.26), a lower Glasgow Coma Scale score (aOR 0.83, 95% CI 0.78-0.88), and the presence of multiple trauma (aOR 1.49, 95% CI 1.01-2.19). Children with TBIs in LMICs required greater resource utilization in the form of early intubation and mechanical ventilation (81.6% vs 73.2%, p = 0.006), use of hyperosmolar therapy (77.7% vs 63.6%, p < 0.001), and use of antiepileptic drugs (73.9% vs 53.1%, p < 0.001).
Within Asia and Latin America, children with TBIs in LMICs were more likely to have poor functional outcomes and required greater resource utilization. Further research should focus on investigating causal factors and developing targeted interventions to mitigate these disparities.
There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency ...departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks.
The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status.
Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites.
This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions.
Detection and quantification of Mycoplasma genitalium were evaluated in 83 patients with urethritis (group 1), 60 patients with urethral symptoms but no urethritis (group 2), and 50 asymptomatic men ...(group 3). Quantification of M. genitalium was carried out using real-time polymerase chain reaction (PCR) analysis of first-pass urine samples. The rate of detection of M. genitalium was significantly higher in group 1 than in groups 2 and 3 (P < .0001). The mean observed concentration of M. genitalium was 1.2 × 104 equivalent genomes/mL of urine (range, 50 to 8 × 104 equivalent genomes/mL). Analysis of M. genitalium load in serial urine samples collected before and after the administration of antibacterial treatment showed an association between clinical and microbiological responses, with a shift to negative PCR results in symptom-free patients. Our results illustrate the usefulness of monitoring the M. genitalium load in evaluating the susceptibility of M. genitalium to antibacterial treatment.
Pepper's ghost effect has been used since its beginnings at the second half of XIX century to generate 3D projections of virtual people in real environments. Nowadays this effect is used by ...‘holographic’ displays for the projection not only of virtual people but also of objects and even animations that can interact with real objects. Marketing and product presentations are some of the most used applications for these displays. Nevertheless, another interesting application is been explored recently: knowledge transfer for both industrial and educational purposes. Regardless the application there is a little problem with these displays: when they are used in a high-illuminated place the contents projected are lost. That is the motivation for this project, which seeks to evaluate the use of a PDLC film (that allows to control its transmittance) to minimize these problem. Action research methodology is being used as a guideline for planning and executing the actions required in the project. The results were satisfactory; achieving an improvement in the visualizations of the contents displayed using the PDLC film.
PDF
