Establishment and analysis of nomogram prediction model for early critical changes in children with febrile convulsion / 中国实用护理杂志

Objective:To establish a nomograph prediction model of early critical changes in children with febrile convulsion, and to provide guidance for the prevention and nursing of children with febrile convulsion.Methods:Convenient sampling method was adopted to select 384 children with febrile convulsion in Anhui Children ′s Hospital from January 2018 to April 2021 as the research objects. Based on pews, the children with febrile convulsion were divided into 334 cases of non risk group and 50 cases of risk group. Binary Logistic regression analysis were used to determine the independent risk factors affecting the early critical changes of children with febrile convulsion. A nomogram was drawn based on the independent risk factors. The discrimination and consistency of the model were verified by model ROC curve and Hosmer Lemeshow goodness of fit.The external validation of model prediction efficiency were verified by validation data. Results:Binary Logistic regression analysis showed that age, respiratory rhythm disorder, unconsciousness, breath rate, heart rate, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), duration of first convulsion and mean body temperature after first convulsion were influence factors for early critical changes in children with febrile convulsion ( P<0.05). The C-index of the model was 0.974 (95% CI 0.954-0.993), and the C-index of the external validation of the model was 0.922 (95% CI 0.880-0.966). The results of H-L fitting test showed that the difference was not statistically significant( χ2=0.29, P>0.05). Conclusions:The early critical changes of children with febrile convulsion may be affected by respiratory rhythm disorder, confusion of consciousness, breath rate, heart rate, NLR, RDW, duration of the first convulsion, mean temperature after the first convulsion and other factors. Pediatric emergency department should collect corresponding intervention measures for children with febrile convulsion according to the establishment of prediction model to prevent their early deterioration.

C reactive protein as a prognostic indicator of severity in patients with acute pancreatitis

Background: Acute pancreatitis ranges from a mild illness to a severe disease with high morbidity and mortality. Severity affects the treatment and outcome. The existing scoring systems for assessment of its severity require are time consuming and expensive. This study was an attempt to evaluate the effectiveness of C-reactive protein (CRP) as a prognostic indicator and a marker of severity of acute pancreatitis.Methods: This was a prospective observational study conducted between among 50 patients diagnosed with acute pancreatitis. The Ranson’s score and CTSI was calculated for these patients. CRP levels were measured 48 hours after the onset of symptoms. They were observed for the development of local and systemic complications, and outcome. These were compared with the CRP values. Pearson coefficient was used to study the correlation between the variables. A p value of less than 0.05 was considered to be statistically significant.Results: 30 of the 50 patients had no local complications. 14 patients (28%) had peripancreatic collection and 6 (12%) had pancreatic necrosis. 24 of the 50 patients had systemic complications (48%). 25 patients had mild disease and 25 had severe disease as evidenced by the Ranson’s score. These 25 patients with severe disease also had raised CRP (p<0.05). There was no statistically significant correlation between the CTSI and CRP values. 4 patients with CRP values more than 400 succumbed to the illness.Conclusions: CRP can serve as an inexpensive alternative to the conventional severity assessment methods for the prediction of severity and outcome of patients with acute pancreatitis.

Hyperuricemia and Serum ADA Levels in Psoriasis and their Correlation to Severity of Disease

Introduction: Psoriasis is a chronic inflammatoryautoimmune disease characterized by hyperproliferation ofkeratinocytes with multifactorial pathogenesis includinggenetic, and environmental factors. The aim of this study wasto evaluate serum ADA, SUA, and ESR in psoriatic patientsand their correlations with PASI score.Material and methods: Our study was a case–control study.The sample size was calculated using the Cochran formulaand 50 patients of psoriasis who attended the out patient clinicat SMHS and Government medical college, srinagar wereincluded in the study. These patients were divided accordingto PASI scores into three groups (mild, moderate, and severe).PASI score <10 defined psoriasis as mild, between 10 and 20as moderate, and >20 as severe. A group of 50 healthy subjectsof matched age and sex were included as a control group whowere taken from amongst volunteering hospital staff andrelatives.Results: This study included 50 psoriatic patients classifiedaccording to PASI score into mild, moderate, and severepsoriatic group and 50 age and sex matched controls. Outof these four patients had mild psoriasis, twelve patients hadmoderate psoriasis and thirty four patients had severe psoriasisaccording to PASI. Fifty healthy subjects were includedas a control group. There were no statistically significantdifferences of age and sex between different patients and thecontrol group.Conclusion: ESR, Serum Uric Acid and serum adenosinedeaminase levels are significantly raised in patients withpsoriasis. However there was no association with severity ofdisease in these patients, however, larger studies are neededto elucidate the mechanism and whether this hyperuricemiapredisposes these patients to gout and increased risk ofcardiovascular disease.

Roles of Serum Trypsinogen-2 and Hematocrit in Evaluating Severity of Acute Pancreatitis PAN / 胃肠病学

The incidence of acute pancreatitis (AP) in China is increasing year by year, and the mortality remains high. It is of great significance to explore the blood biochemical parameters which can assess the severity of AP for the diagnosis and treatment of AP. Aims: To explore the value of serum trypsinogen-2 (TAT-2) and hematocrit (HCT) in assessing the severity of AP. Methods: A total of 175 cases of AP from September 2016 to June 2018 at Jiangyin People's Hospital were enrolled. Patients were divided into mild acute pancreatitis (MAP) group, moderate severe acute pancreatitis (MSAP) group, severe acute pancreatitis (SAP) group according to the severity of AP. And 76 healthy individuals undergoing physical examination were served as the control group. The levels of serum TAT-2, HCT were detected. BISAP score, APACHEⅡ score, Balthazar CT score were evaluated. Values of different parameters for diagnosing SAP were analyzed by ROC curve. Results: Differences in TAT-2, HCT, BISAP score, APACHEⅡ score, Balthazar CT score were statistically significant among the four groups (P<0.05). Serum TAT-2 and HCT in SAP group were significantly higher than those in MAP group, MSAP group and control group (P<0.05), serum TAT-2 and HCT in MSAP group were significantly higher than those in MAP group and control group (P<0.05), and serum TAT-2 and HCT in MAP group were significantly higher than those in control group (P<0.05). ROC curve analysis showed that the sensitivity of TAT-2, HCT and the combination of these two indicators for predicting SAP were 69.7%, 84.7%, 88.5%, respectively; specificity were 95.3%, 67.8%, 65.1%, respectively; AUC were 0.858, 0.783, 0.875, respectively. Conclusions: TAT-2 and HCT can effectively evaluate the severity of AP patients, the combined detection of the two indicators can predict the occurrence of SAP further and play a vital role in treatment of AP.

Severity of disease scoring systems and mortality after non-cardiac surgery / Sistemas de classificação da gravidade da doença e mortalidade após cirurgia não cardíaca

Abstract Background: Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Methods: Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). Results: 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Conclusion: Some factors influenced both surgical intensive care unit and hospital mortality.

Resumo Justificativa: A mortalidade após cirurgia é frequente e os sistemas de classificação da gravidade da doença são usados para a previsão. Nosso objetivo foi avaliar os preditivos de mortalidade após cirurgia não cardíaca. Métodos: Os pacientes adultos admitidos em nossa unidade de terapia intensiva cirúrgica entre janeiro de 2006 e julho de 2013 foram incluídos. Análise univariada foi feita com o teste de Mann-Whitney, qui-quadrado ou exato de Fisher. Regressão logística foi feita para avaliar fatores independentes com cálculo de razão de chances (odds ratio - OR) e intervalo de confiança de 95% (IC 95%). Resultados: No total, 4.398 pacientes foram incluídos. A mortalidade foi de 1,4% na unidade de terapia intensiva cirúrgica e de 7,4% durante a internação hospitalar. Os preditivos independentes de mortalidade na unidade de terapia intensiva cirúrgica foram APACHE II (OR = 1,24); cirurgia de emergência (OR = 4,10), sódio sérico (OR = 1,06) e FiO2 na admissão (OR = 14,31). Bicarbonato sérico na admissão (OR = 0,89) foi considerado um fator protetor. Os preditivos independentes de mortalidade hospitalar foram idade (OR = 1,02), APACHE II (OR = 1,09), cirurgia de emergência (OR = 1,82), cirurgia de alto risco (OR = 1,61), FiO2 na admissão (OR = 1,02), insuficiência renal aguda no pós-operatório (OR = 1,96), frequência cardíaca (OR = 1,01) e sódio sérico (OR = 1,04). Os pacientes moribundos apresentaram escores mais altos de gravidade da doença nos sistemas de classificação e mais tempo de permanência em unidade de terapia intensiva cirúrgica. Conclusão: Alguns fatores tiveram influencia sobre a mortalidade tanto hospitalar quanto na unidade de terapia intensiva cirúrgica.

Establishment of diagnosis related group system and its application in the performance man-agement of hospitals / 中国卫生政策研究

The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.

Design and application of the hospital performance assessment indicators based on disease se-verity / 中国卫生政策研究

The performance evaluation is an effective method to guide the public hospitals behavior and pro-mote their sustainable development.The introduction of disease severity could make the performance evaluation sys-tem more scientific and reasonable, and encourage the hospitals to improve their technical skills and services ability. Based on the Shanghai diagnosis related groups system, a case-mix index ( CMI) was introduced and a severity score of disease was developed after the relative weight ( RW) adjustment to evaluate different types of disease severity in hospitals.The results have shown that CMI effectively reflects the patients'disease severity and the intensity of treat-ment in those hospitals taken into consideration.Therefore, the scientific indicators should be selected and the evalu-ation system should be improved thereby establishing an effective monitoring and dynamic adjustment mechanism and further developing the diagnosis related group application.

Comparative analysis on the severity-based diagnosis related group tools / 中国卫生政策研究

The severity of disease can be used to evaluate the current situation of patients as well as to predict the diseases outcome.In the meantime, the severity among different diseases has been more and more applied in the evaluation of the patients at hospital level.This study collected and summarized different types of international disea-ses grouping tools'characteristics and applications based on the severity of disease, and their suitability and practical values in hospital performance evaluation were compared and analyzed.

The establishment of diagnosis related grouping model and grouping tool in hospitals of Shanghai / 中国卫生政策研究

Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.

Stimulation and assessment of the diagnosis related grouping system in Shanghai tertiary hospitals / 中国卫生政策研究

This paper uses the data collected from 138,477 patient discharge records of 37 Shanghai tertiary public hospitals in December 2013 and classifies all the records into different groups by using a localized diagnosis re-lated group tool.The coefficient of variation index ( CV) of each group was used to analyze the dispersion of average hospital cost per inpatient day for each group, in order to evaluate the suitability of diagnosis related group systems and to set the coefficients of difficulty ( relative weights) for each disease.The study has found that severity-based di-agnosis related group systems are more suitable and consistent.However, future studies should collect more detailed information on health costs in order to reflect the value of health professionals and technologies and therefore further improve diagnosis related classification and develop new systems that can be adapted to local conditions by applying the weights of different groups.

Efeito de óleos essenciais de plantas medicinais sobre a antracnose do sorgo / Effect of essential oils of medicinal plants on the anthracnose of sorghum

Objetivou-se avaliar a fungitoxicidade in vitro dos óleos essenciais de capim-limão, citronela, erva-cidreira e hortelã-pimenta sobre o fungo Colletotrichum graminicola (Ensaio I) e o efeito in vivo desses óleos e do óleo comercial de nim sobre a antracnose do sorgo (Ensaio II). No Ensaio I avaliou-se, em cinco épocas (dois, quatro, seis, oito e dez dias de incubação), o crescimento micelial do C. graminicola sob cinco concentrações dos óleos essenciais (C1= 0,25 µL mL-1; C2= 0,50 µL mL-1; C3= 0,75 µL mL-1; C4= 1,0 µL mL-1; C5= 1,25 µL mL-1). No Ensaio II, para avaliar o efeito preventivo, utilizou-se cinco tipos de óleos (capim-limão, citronela, erva-cidreira, hortelã-pimenta e nim) em quatro concentrações (2,5, 5,0, 7,5 e 10,0 µL mL-1). Para o efeito curativo, foram utilizados os mesmos óleos do efeito preventivo em duas concentrações (2,5 e 5,0 µL mL-1). Os óleos essenciais de C. nardus e C. citratus foram os mais eficientes na redução do crescimento micelial de C. graminicola (Ensaio I). No Ensaio II, no efeito preventivo, tanto os óleos essenciais quanto as concentrações reduziram significativamente a severidade da doença, destacando-se os óleos de capim-limão, erva-cidreira e nim. No efeito curativo, os tratamentos reduziram a severidade, porém não apresentaram diferença significativa entre si.

The objective was to evaluate the in vitro fungitoxicity of essential oils of lemongrass, citronella, lemongrass and peppermint on the fungus Colletotrichum graminicola (Test I) and in vivo effects of these oils and neem oil trade on the anthracnose sorghum (Test II). In Test I was evaluated in five seasons (two, four, six, eight and ten days of incubation), the mycelial growth of C. graminicola under five concentrations of essential oils (C1= 0,25 µL mL-1; C2= 0,50 µL mL-1; C3= 0,75 µL mL-1; C4= 1,0 µL mL-1; C5= 1,25 µL mL-1). In Test II, to assess the preventive effect, we used five types of oils (lemongrass, citronella, lemon balm, peppermint and neem) at four concentrations (2,5, 5,0, 7,5 e 10,0 µL mL-1). For curative effect, we used the same oils of preventive effect in two concentrations (2,5 e 5,0 µL mL-1). The essential oils of C. nardus and C. citratus were the most effective in reducing mycelial growth of C. graminicola (Test I). In Test II, the preventive effect, essential oils and concentrations significantly reduced the severity of the disease, especially oils of lemongrass, lemon balm and neem. In the curative effect, treatments reduced the severity, but no significant differences between them.

Clinical study on a novel modified computed tomography severity index for predicting the severity of acute pancreatitis / 中华消化杂志

Objective To introduce a novel modified CT severity index based on the assessment of extrapancreatic inflammation and pancreatic necrosis on CT index (EPIPN) and to evaluate its effect in predicting the severity and prognosis of acute pancreatitis. Methods Seventy-seven consecutive patients diagnosed as acute pancreatitis (AP) from August 2006 to December 2007 were retrospectively analyzed. The clinical data included age, sex, cause, the C-reactive protein(CRP) level with in 72 hours of onset of symptom, Ranson signs, the APACHE I1 score, the disappearing time of the abdominal pain, the presence of organ failure, the length of hospital stay, etc. All patients underwent contrast-enhanced multisection CT scan after admission of 48-72 hours. The CT severity index (CTSI) and EPIPN scores were obtained. The severity of pancreatitis for each patient was then categorized as severe if CTSI≥7 or EPIPN>5. The diagnostic value of EPIPN in predicting the severe acute pancreatitis (SAP) was compared with that of CTSI using ROC curve. The correlation of EPIPN or CTSI with clinical coutcome was conducted. Results Of 77 patients, 34 were males and 43 were females with mean age of 51.79 years (age range 22-92 years). The causes of AP were gallstones (63 cases), hyperlipemia (6 cases), alcohol (1 case) and idiopathic (7 cases). Organ system failure was present in 14 (18.2%) of the 77 patients. The area under the ROC curve of CTSI in predicting the SAP was 0.72 (95% CI: 0.59-0.88) with sensitivity of 80.4% and specificity of 55% when CTSI≥7, and that in EPIPN was 0.82 (95% CI: 0.73-0.91) with sensitivity of 91.3% and specificity of 63% when EPIPN >5. EPIPN was well correlated with hospital stay, APACHE Ⅱ score and CRP levels. Conclusions The EPIPN allows accurate estimation of disease severity and prognosis in AP patients. The diagnostic effect of EPIPN for predicting SAP is superior to CTSI. The EPIPN index is-both convenient and practical, and has clinical value.

Nutritional Status of Chronic Obstructive Pulmonary Disease Patients according to the Severity of Disease

The purpose of the study was to investigate nutritional status of chronic obstructive pulmonary disease (COPD) patients and to find out the differences according to the stages of disease. From March to October, 2006, 41 stable male patients of mild to severe COPD patients were recruited from Seoul National University hospital. The patients' of body weight and fat free mass were assessed by bioelectrical impedance analysis. The nutritional status of the patients was also assessed by 3-day recall, index of nutritional quality (INQ), dietary diversity score (DDS), dietary variety score (DVS), food group index pattern and dietary quality index (DQI). The total of 41 patients were classified into three groups, stage I, stage II and stage III groups according to the classification of Global Initiative for Chronic Obstructive Lung Disease (GOLD) standard. The mean age of the patients in each stage were 67.2-66.9 years showing no significant difference. The ratio of FEV1/FVC were 57.5 +/- 7.3, 46.9 +/- 7.6 and 38.2 +/- 6.8%, respectively showing significant differences according to the stages of disease. The fat free mass of the stage II (48.2 +/- 4.7 kg) and III (47.3 +/- 4.5 kg) was significantly lower than that of stage I (53.1 +/- 6.9 kg) patients. There were significant correlation of fat free mass with FEV1, and BMI (body mass index) with FEV1/FVC ratio (p < 0.05). COPD patients showed the diet-related clinical symptoms of anorexia, dyspnea, dyspepsia, and chewing difficulty. Daily intakes of calorie, K, vitamin B2 and folate of the patients were very low (83.8 +/- 20.7%, 58.9 +/- 14.4%, 70.7 +/- 19.6% and 74.7 +/- 10.2%, respectively) however, they did not significantly different according to the stages of disease. Daily intake of calcium was significantly lower in the stage III patients (p < 0.05). The mean scores of dietary variety score was significantly lower in the stage III patients (p < 0.001). Dietary quality index of the patients were not different among the stages of disease and the scores indicated poor quality of diet. As a summary, we found that body fat free mass, regularity of exercise, frequency of having snacks and dietary variety score were significantly associated with the severity of chronic obstructive pulmonary disease.