ABSTRACT
OBJECTIVE@#The study aimed to identify risk factors associated with mortality among patients admitted for PCAP C and D.@*METHODOLOGY@#The study was a cross-sectional study involving children admitted for PCAP C and D at PCMC from January 2017 to December 2019. Univariate and multivariate analyses through binomial logistic regression were used to determine significant predictors of mortality.@*RESULTS@#A total of 472 patients were included in the study, of whom 77% had PCAP C and 23% had PCAP D. More than half in each patient group were infants; male; and of normal nutritional status. Most common comorbidities in both groups were neurologic and cardiovascular in nature. Leukocytosis, thrombocytosis, and anemia were the most common hematologic findings. Overall mortality rate among patients was 5.08%. On univariate analysis, being severely underweight (cOR 8.28 [95% CI 2.52–27.23]), with history of antibiotic use (cOR 3.01 [95% CI 1.18–7.62], neurologic comorbidities (cOR 4.04 [95% CI 1.42–11.43]), cardiac comorbidities (cOR 5.33 [95% CI 1.31–21.75]), Down syndrome (cOR 22.11 [95% CI 2.44- 200.30]), and thrombocytopenia (cOR 22.11 [95% CI 2.44-200.30]) were associated with greater odds of mortality among PCAP-D patients. On multivariate analysis, the odds of mortality were 5.02 (95% CI 1.05-23.96) for severely underweight patients, 4.51 (95% CI 1.13-17.95) in patients with neurologic disease, and 73.62 (95% CI 3.63–1491.10) in patients with Down syndrome.@*CONCLUSION@#Patients with PCAP D who have severe malnutrition, Down syndrome, cardiac and neurologic abnormalities, and thrombocytopenia should be managed more aggressively to decrease mortality in these patients.
ABSTRACT
@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The diagnosis of asthma is difficult to establish using spirometry in children below 5 years old. Tidal breathing analysis (TBA) can provide useful information about lung function in infants and young children, as it is effort-independent. </p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine if baseline and post-bronchodilator ratios of the time and volume until peak expiratory flow to the total expiratory time and volume, (tPEF/tE and V PEF/V E) can distinguish asthmatics from normal children.</p><p style="text-align: justify;"><strong>METHODS:</strong> This is a cross-sectional study wherein 146 children ages 6 months to 5 years old completed TBA before and 15 minutes after administration of 250?g of salbutamol via nebulization. Children 3 years old and below who did not cooperate were given sedation with oral diphenhydramine (1mg/kg/dose). The tPEF/tE and VPEF/VE were compared between the controls and asthmatics.</p><p style="text-align: justify;"><strong>RESULTS:</strong> In children below 2 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 29.6 ± 13.8and 22.0 ± 6.6. The area under the curve (AUC) was 0.649 attPEF/tEof 32.250, with a sensitivity and specificity of 50% and 97%. The baseline VPEF/VE of asthmatics and non-asthmatics were 32.7 ±12.4 and 26.0 ± 4.9.AUC was 0.661 at VPEF/VEof34.500, with a sensitivity and specificity of 50% and 97%.In subjects 2 to 5 years old, the baseline tPEF/tE of asthmatics and non-asthmatics were 35.3 ± 14.7 and 35.0 ± 13.1. The baseline VPEF/VE were 37.0 ± 12.3 and 36.7 ± 10.7. After salbutamol nebulization, the tPEF/tE of asthmatics and non-asthmatics in all ages were 30.9±13.7 and 27.9± 10.8. The VPEF/VE were 34.1± 11.4 and 30.9± 9.0.</p><p style="text-align: justify;"><strong>CONCLUSION</strong>: Baseline tPEF/tE and VPEF/VE can distinguish asthmatics from non-asthmatics in children below 2 years old. However, baseline tPEF/tE and VPEF/VE in children 2 to 5 years old and post-bronchodilator tPEF/tE and VPEF/VE in all ages could not distinguish asthmatics from non-asthmatics after nebulization with 250?g of salbutamol.</p>