INTERPRETATION AND ESTIMATION OF CONDITIONAL POWER IN INTERIM ANALYSES OF CLINICAL TRIALS: OFTEN IGNORED IN DECISION MAKING PROCESS

In group sequential trials, the interim results are more promising in the early termination of a trial either for efficacy or futility of the trial. This reduces the cost and time implications. Moreover, interim analyses play a key role to tackle the problem that arises due to adverse effects. In concern with the early stopping of trials, there are numerous stopping methods among them the Conditional power (CP) approach is best recommended. The CP approach provides the probability of getting significant results at the end of the study given the data observed so far. There are very few Indian studies that had incorporated the concept of CP and made decisions based on the results. This study popularises the CP approach detailing computing and its interpretation and is thereby facilitating clinical researchers to use this approach effectively. We have used real-time and hypothetical examples and illustrated the concept of CP under trend, CP under null, and CP under design. We suggest stopping the study for efficacy when the CP under null is greater than 80% and stopping the study for futility when CP under trend is less than 30%.

Changes in olfaction & quality of life following standard medical therapy in patients with intermittent & persistent allergic rhinitis

Background & objectives: Allergic rhinitis (AR) is an inflammatory disease prevalent worldwide which can affect both olfaction and quality of life (QoL). The objective of the present study was to assess olfaction and QoL changes in patients with AR before and after medical therapy. Methods: Adult participants (>18 yr) with AR were recruited for this study. These patients prospectively underwent olfaction testing using the modified Connecticut Chemosensory Clinical Research Centre Test and QoL assessment using Rhinoconjunctivitis QoL Questionnaire (RQLQ) before and after standard medical therapy with topical steroids and/antihistaminics. Results: Of the 150 patients recruited, 72 per cent had intermittent AR. The symptom of hyposmia was present in 34 patients (22.7%) and was more prevalent in patients with moderate-to-severe type of AR (P<0.001). However, olfaction testing revealed hyposmia/anosmia in 44 patients (29.3%). Mean composite olfaction scores were significantly higher in patients with mild AR compared to moderate/ severe AR (P=0.026). The pre-therapy mean composite olfaction score in the 34 patients with olfaction disturbances was 3.1 standard deviation (±1.06 SD). Following therapy, the mean composite olfaction score rose to 4.3 (±1.34 SD) and this change was found to be significant (P<0.001). Mean pre-therapy RQLQ scores were 2.87 (0.06-5.33) overall. Significant improvement was also found in RQLQ scores following therapy (P<0.001). Mean RQLQ scores were significantly lower in those with moderate-to- severe AR (P<0.001) as well as those with intermittent AR (P=0.004). Nine patients had persistently high RQLQ scores after medical therapy. Interpretation & conclusions: Both olfaction and QoL showed significant improvement after medical therapy in Indian adults with AR. In those patients who do not improve, other causes must be sought for the persistent symptoms.

The anti-synthetase syndrome in a type 1 diabetes

Anti-synthetase syndrome is an autoimmune disease associated with interstitial lung disease (ILD), dermatomyositis and polymyositis. It has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with dermatomyositis. 37-year-old male, known case of type 1 diabetes mellitus, came with complaints of: generalized anasarca, pain in both knees, ankles, wrist and small joints of fingers. He also had dyspnoea on exertion, chronic non-productive cough, and fever off and on, all for 1 month. Initially all involvement was attributed to diabetes. For joint pain an antinuclear antibodies (ANA) was sent. He turned out to be anti-Jo1, antibody positive. Rash on hands was diagnosed by dermatologist as, mechanic’s hand, hence diagnosed as an inflammatory myopathy with dermatomyositis anti-synthetase syndrome. Patient was successfully treated with immunosuppressants and supportive treatment and responded to tablet Prednisolone and Mycophenolate mofetil. The patient had one major and 2 minor criteria-ILD, arthritis and Mechanic’s hand and anti-Jo 1 antibody positive. Thus, diagnosed as anti-synthetase syndrome with type 1 diabetes mellitus.

Role of phosphatase and tensin homolog in pathogenesis of ameloblastoma: An immunohistochemical study

Background: Altered molecular signaling pathways in ameloblastoma have been identified to play a pivotal role in the mechanism of oncogenesis, differentiation, and tumor progression. Phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin pathway is one of the signaling pathways that are associated with the pathogenesis of ameloblastoma. Phosphatase and tensin homolog (PTEN) controls cell migration and proliferation. It monitors the level of the Akt and maintains cellular integrity. The present study was aimed to study the immunoexpression of PTEN in ameloblastoma to understand its role in the pathogenesis of ameloblastoma. Materials and Methods: Twenty cases of ameloblastoma and ten cases of normal tooth germ were subjected to immunohistochemical staining against PTEN. Results: Strong PTEN immunopositivity was seen in the tooth germs, while weak positivity was seen in the ameloblastoma. The immunoscore for PTEN was calculated by adding the percentage score and the intensity score. Seventeen cases showed the reduced PTEN expression in the epithelial component of ameloblastoma. The unpaired t-test showed a statistically significant difference in the mean PTEN immunoscore in tooth germ and ameloblastoma. Conclusion: The study showed reduced PTEN immunoreactivity, which plays a role in the pathogenesis of ameloblastoma, through Akt pathway

Detailed ECG analysis in type 2 diabetes mellitus: a predictor of multitude of complications

Background: Type 2 diabetes mellitus is a systemic disease with life-threatening complications and morbidity. The 12 lead ECG, an easily available investigation, when studied in detail can give a lot of information and predict various microvascular and macrovascular complications apart from coronary artery disease.Methods: A random cross sectional study involving 100 patients of type 2 diabetes mellitus, in the age group of 18-80 years were included in study after applying various inclusion and exclusion criteria. They were subjected to ECG, 2D echocardiography and laboratory tests. Data were collected and analysed.Results: Arrythmia was not detected in any patient. A resting tachycardia (HR >100) in 30 patients correlated with Prolonged QTc (>440 miliseconds) (p=0.04). QRS amplitude was reduced in 26 patients. Prolonged QTc also correlated with presence of diabetic complications, retinopathy of NPDR type and nephropathy (p=0.004). Hence about 30% of the study group did show signs of early diabetic cardiac autonomic neuropathy and cardiomyopathy.Conclusions: The statistically significant utility of electrocardiogram in predicting various complications of diabetes apart from coronary artery disease.

Paediatric invasive pneumococcal disease from two tertiary hospitals in Malaysia

@#Introduction: Invasive pneumococcal disease (IPD) a leading cause of death and morbidity in children below five-yearsold. This study aims to compare the varied presentation and clinical course of IPD in two different tertiary hospitals in Malaysia. Methodology: A retrospective study of all positive Streptococcus pneumoniae isolates consistent with invasive disease from children below 14 years of age hospitalised in two tertiary hospitals; between year 2012 and 2016 was conducted. IPD cases were defined as isolates of S. pneumoniae from a normally sterile body fluid site. Results: Fifty-four patients were identified in both centres, 35 (65%) from HRPB as compared to 19 (35%) from HS. Majority of cases (14/35, 40 %) in HRPB were of Orang Asli in comparison to Malay children (16/19, 84%) in HS. Septicaemia, pneumonia and meningitis were the most common clinical presentation of IPD in both centres. There was a noticeably higher percentage of isolates found to be non-susceptible (NS) in HS (62.5%) as compared to HRPB (37.5%) although of no statistical significance. Mortality rate was higher in HRPB (26%) in comparison to 11% in HS. Conclusion: This study highlighted the varied presentation of IPD in two different hospital settings. Although both deemed as urban centres, this study emphasises the importance of understanding socio-demography, health facility availability and primary care practices as it significantly alters the clinical course of a disease.

End-of-life decisions: A retrospective study in a tertiary care teaching hospital in India

Background & objectives: In developing countries like India, there is a lack of clarity regarding the factors that influence decisions pertaining to life supports at the end-of-life (EOL). The objectives of this study were to assess the factors associated with EOL-care decisions in the Indian context and to raise awareness in this area of healthcare. Methods: This retrospectively study included all patients admitted to the medical unit of a tertiary care hospital in southern India, over one year and died. The baseline demographics, economic, physiological, sociological, prognostic and medical treatment-related factors were retrieved from the patient's medical records and analysed. Results: Of the 122 decedents included in the study whose characteristics were analyzed, 41 (33.6%) received full life support and 81 (66.4%) had withdrawal or withholding of some life support measure. Amongst those who had withdrawal or withholding of life support, 62 (76.5%) had some support withheld and in 19 (23.5%), it was withdrawn. The documentation of the disease process, prognosis and the mention of imminent death in the medical records was the single most important factor that was associated with the EOL decision (odds ratio - 0.08; 95% confidence interval, 0.01-0.74; P=0.03). Interpretation & conclusions: The documentation of poor prognosis was the only factor found to be associated with EOL care decisions in our study. Prospective, multicentric studies need to be done to evaluate the influence of various other factors on the EOL care.

Utility of QuantiFERON®-TB gold In-Tube test compared with tuberculin skin test in diagnosing tuberculosis in Indian children with malnutrition

This prospective cohort study was conducted to compare the accuracy of QuantiFERON®-TB (QFT) Gold In-Tube test and tuberculin skin test (TST) in diagnosing tuberculosis (TB) in predominantly bacille Calmette–Guerin-vaccinated children with a high incidence of malnutrition. The sensitivity of the QFT versus the TST was 69.6% versus 52.9% for WHO-defined TB, with specificity of 86% versus 78.3%, respectively. The concordance of the TST and QFT was 79% overall (? = 0.430), 62.5% in those with WHO-defined TB and 85.7% in those without TB. Majority of the QFT+/TST ? discordance was seen in children with TB, whereas majority of the TST+/QFT ? discordance was seen in those without TB. The TST was more likely to be negative in children with moderate-to-severe malnutrition (P = 0.003) compared to the QFT, which was more likely to be positive in younger children. The significantly better performance of the QFT in malnourished children and those at younger ages supports its use for TB diagnosis in these subpopulations.

Characteristics of treatment-naïve HBV-infected individuals with HIV-1 coinfection: A cross-sectional study from South India

Purpose: Human immunodeficiency virus-1 (HIV-1) and hepatitis B virus (HBV) coinfection has become a major health problem across the globe. The increased life expectancy of HIV-1 patients due to antiretroviral therapy has led to the emergence of liver disease as a major mortality factor among them. The purpose of the study was to examine the baseline characteristics of HBV in treatment-naïve HBV/HIV coinfection from southern India compared to monoinfected individuals. Materials and Methods: The study was cross sectional in design, and samples were examined from 80 HIV-1, 70 HBV and 35 HBV/HIV-coinfected individuals using chemiluminescent microparticle immunoassay, real-time polymerase chain reaction and flow cytometry assays. Results: There was a significant increase in HBV DNA (P = 0.0001), higher hepatitis B e antigen percentage difference (P = 0.027) and lower CD4 counts (P = 0.01) among the HBV/HIV-coinfected individuals, but no difference in the HIV-1 viral load compared to HIV-1-monoinfected individuals. Also, the aspartate aminotransferase levels, prothrombin time and the international normalised ratio were significantly high among coinfected individuals. Conclusion: These findings conclude that HIV-1 coinfection can have serious implications on the outcome of HBV-related liver disease. To the contrary, HBV infection had no consequence on the progression of HIV-1 disease but distinctly lowered CD4+ T-cells.

A Comparative Study of Attempted Suicide in Adolescent, Adult, and Elderly Population

Introduction: The risk factors of attempted suicide vary among different age groups and it varies very much between theadolescent and elderly population. Hence, identifying the suicide risk factors for each population will help in the developmentof suitable prevention strategies for each age group.Aim: This study aims to analyze the differences in sociodemographic data and risk factors involved in adolescent, adult, andgeriatric group.Materials and Methods: Across-sectional analytical study with 90 patients (30 adolescents, 30 adults, and 30 geriatric patientsafter a h/o attempted suicide) was taken. The duration of the study was 3 months (January–March 2018). Sociodemographicdata, details of the suicide attempt, the precipitating stressors, and risk factors were analyzed by a semi-structured pro forma.The intent of the suicide attempt was analyzed by Beck’s Suicide Intent Scale. The lethality of the attempt was analyzed byRisk-Rescue Rating Scale (Weismann and Worden, 1972). Psychiatric morbidity was found out from MINI plus and ICD 10criteria were used to confirm the diagnosis. All the data obtained are analyzed statistically.Results: This study helps us understand that suicide attempts are different in different age groups. In the younger group, thepsychosocial stressors and the support available for handling them determine the attempts. In adults, the major problem wasmarital conflict and substance dependence and the prevention strategies should be directed toward it. Most of the geriatricsuicides were planned not impulsive and they had a comorbid psychiatric illness. This stresses the importance of screening ofmental illness in the elderly and adequate treatment of physical comorbidity as well.Conclusion: This study finds that multiple factors warrant a broadly directed multimodal approach for intervention and the needfor a tailored approach for each population.

Is hysterectomy a risk factor for urinary incontinence?

Background: Hysterectomy is the most common gynecological surgery performed. There are few studies evaluating hysterectomy as a risk factor for urinary incontinence. If hysterectomy is found to be a risk factor for developing urinary incontinence, women undergoing hysterectomy can be well informed prior to the procedure regarding the same. The objective of the present study was to study the prevalence of urinary incontinence in post-menopausal women and its relationship to hysterectomy. To evaluate the association of metabolic syndrome, to urinary incontinence.Methods: This study was a prospective cohort study done in Christian Medical College and Hospital, Vellore, Tamil Nadu between December 2016- December 2017. Postmenopausal women both with natural and surgical menopause, were enrolled into the study after an informed consent. The UDI-6 questionnaire was used to assess urinary incontinence. The categorical variables were presented using frequencies and percentages. The comparison of categorical variables was done using Fisher's exact test. The odds ratio and confidence interval were calculated for the prevalence. P value < 0.05 was considered to be statistically significant.Results: A total of 600 women were enrolled into the study with 300 women having attained natural menopause and 300 women with a surgical menopause. The prevalence of urinary incontinence among these post-menopausal women was 46.24%. The prevalence of urinary incontinence amongst the women with natural menopause was 47.3% and amongst the women with surgical menopause was 45% (p = 0.566). Women with metabolic syndrome suffered from urinary incontinence more than their counterparts without metabolic syndrome (55.8% vs. 36%, p <0.0001).Conclusions: The prevalence of urinary incontinence in the natural menopause and surgical menopause groups was similar, thus proving that hysterectomy is not a risk factor for developing urinary incontinence. However, metabolic syndrome was found to be associated with urinary incontinence.

Evaluation of dried blood spots as a feasible alternative to plasma for the detection and quantification of hepatitis c virus in a tropical setting: A pilot study

Introduction: Confirmatory diagnosis of hepatitis C virus (HCV) infection (HCV RNA detection) is essential before start of the therapy. HCV RNA detection is not available in many parts of India. Shipment of plasma from distant places to referral laboratories may affect HCV RNA titres. Dried blood spots (DBS) provide an easy alternative for transporting samples to centres where HCV RNA testing is done. Aim: Evaluation of DBS as a feasible alternative to plasma for HCV diagnosis. Methods: In this cross-sectional study, 40 consecutive patients' blood samples were collected from patients referred from the Liver Clinic. Whole blood was spotted onto two Whatman 903TM cards. One card was incubated at ?37癈 and other at 4癈 for 15 days, after drying. DBS was eluted and run in Abbott RealTime HCV assay. HCV was also quantified using the Abbott ARCHITECT HCV core antigen assay for 29 of the study patients. Results were compared with normal plasma values. Results: The median log HCV RNA value (in log10IU/mL) of plasma was 5.74, with normalised DBS it was 4.92 (?37癈) and 4.66 (4癈); difference in plasma and DBS median log values was 0.82 (?37癈) and 1.08 (4癈) logs, respectively. Interclass correlation values were 0.943, P < 0.0001 (?37癈) and 0.950, P < 0.0001 (4癈), showing high agreement. The median HCV core antigen value (in fmol/L) for plasma was 325.35, whereas it was 4.77 (?37癈) and 4.64 (4癈) for DBS samples. Conclusions: DBS can be used for sampling patients from distant resource-limited settings as an alternative to plasma for HCV RNA estimation. Larger studies are required to evaluate the feasibility of DBS in the Indian subcontinent, especially for HCV core antigen estimation.

Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study

Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot. Conclusion: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.

Expanded diagnostic approach to hepatitis E virus detection in patients with acute-on-chronic liver failure: A pilot study

Introduction: Acute decompensation of pre-existing chronic liver disease (CLD), known as acute-on-chronic liver failure (ACLF), is associated with high mortality. Hepatitis E virus (HEV) as a potential cause was studied. Objectives: The objectives of this study are to evaluate the role of HEV in ACLF patients using an IgM anti-HEV antibody enzyme-linked immunosorbent assay (ELISA), HEV antigen ELISA, and a quantitative HEV polymerase chain reaction (PCR). Materials and Methods: In this prospective cross-sectional study, blood samples were collected from 50 ACLF (cases) as defined by the standard guidelines (APASL, 2014) and 50 patients with stable CLD (controls) from January 2015 to August 2016, after obtaining informed consent. Two IgM ELISAs (MP Diagnostics HEV IgM ELISA 3.0, Singapore and Wantai HEV IgM ELISA, Beijing, China) were compared using plasma from cases and controls. In addition, an HEV antigen detection by ELISA (Wantai, Beijing, China) and a real-time PCR for quantification of HEV RNA in plasma and stool were employed. Results: Ethanol was the leading cause of acute insult in ACLF (54%) cases. HEV infection accounted for 20% of cases. Ten ACLF patients (20%) had 1–3 markers of HEV versus two (4%) among controls (P = 0.0138). Among ACLF cases, one had HEV viraemia (403 IU/ml), faecal shedding (2790 IU/ml) and detectable HEV antigenaemia. Agreement between the two anti-HEV IgM ELISAs was 0.638 (kappa value). Conclusion: This study shows that alcohol is a major contributing factor for both underlying CLD and ACLF while HEV is the most common infectious cause for ACLF, suggesting a need for a vaccination in such patients, whenever made available.

Survival of Children Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Andhra Pradesh, India.

Objectives: To assess the survival probability and associatedfactors among children living with human immunodeficiency virus(CLHIV) receiving antiretroviral therapy (ART) in India.Methods: The data on 5874 children (55% boys) from one of thehigh HIV burden states of India from the cohort were analyzed.Data were extracted from the computerized managementinformation system of the National AIDS Control Organization(NACO). Children were eligible for inclusion if they had startedART during 2007-2013, and had at least one potential follow-up.Kaplan Meier survival and Cox proportional hazards models wereused to measure survival probability.Results: The baseline median (IQR) CD4 count at the start ofantiretroviral therapy was 244 (153, 398). Overall, the mortalitywas 30 per 1000 child years; 39 in the <5 year age group and 25 in5-9 year age group. Mortality was highest among infants (86 per1000 child years). Those with CD4 count ?200 were six timesmore likely to die (adjusted HR: 6.3, 95% CI 3.5, 11.4) ascompared to those with a CD4 count of ?350/mm3.Conclusion: Mortality rates among CLHIV is significantly higheramong children less than five years when the CD4 count at thestart of ART is above 200. Additionally, lower CD4 count, HIVclinical staging IV, and lack of functional status seems to beassociated with high mortality in children who are on ART

Serum Levels of Copper in Human Leptospirosis Cases

Background: Copper deficiency can weaken immunity and increase the incidence of infections or infections may reduce the serum copper levels. Objectives: The present investigation assessed the serum level of copper in the cases of leptospirosis. Methods: The study involved 55 patients of whom had either icteric or non-icteric type of leptospirosis, 25 as other febrile and 25 as healthy controls. Serum copper was evaluated using commercially available kits. All the 55 patients are serologically confirmed for leptospirosis by using both ELISA and MAT. Twenty five age-matched febrile cases other than leptospirosis and twenty five healthy normal individuals were taken as control. The serum copper level was estimated by calorimetric method of Di-Br-PAESA. Results: The maximum and minimum age of patients was 54 and 18 years respectively; males dominated with 47 cases in this study. Out of 55 cases, 45 cases are considered as high risk groups of having minimum of 10 years of occupational exposure. There was a significant decrease of serum copper level among 55 leptospirosis confirmed cases (ranged from 26 to 63 μg/dl) when compared with controls (ranged from 114.12 to 126.32 μg/dl); whereas in febrile cases other than leptospirosis showed maximum of serum decrease upto 52.7 μg/dl. Conclusion: In all cases including non leptospirosis febrile cases also, the serum copper levels are significantly decreased after treatment with doxycycline and other antibiotics. This indicates that serum copper can be used as a biochemical marker for screening leptospirosis, as a valuable prognostic indicator for monitoring disease

prevalence and characteristics of frequent attenders in primary health care in A'Dakhiliyah governorate of Oman

Objectives: Frequent attenders [FAs] in general practice receive significant attention in primary care research due to the financial costs associated with the higher utilization of health care services. The main objective of this study was to determine the prevalence of FAs in Oman by studying the overall rates of adult patient visits to primary health care centers [PHCs] and identify the characteristics of this group of patients

Methods: We conducted a retrospective longitudinal study including all adults aged 18 years and above who visited general practitioner clinics at four selected PHCs in the A'Dakhiliyah governorate of Oman. Sociodemographic data and number of visits were extracted from the electronic medical records system

Results: A total number of 12 902 adult patients contributed to 42 425 patient visits, with the number of visits made by individual patients ranging from 1 to 62. FAs constituted 2.4% [n = 313] of the total subjects and made 5449 [12.8%] visits. The mean rate of visits per patient per year was 3.2, while the median was two visits. The overall rate of visits per day was more than two-times higher in females [79.6 per day] compared to males [36.6 per day] and was about five-times higher in female FA [12.3 vs. 2.6]

Conclusions: FAs represent a small proportion of patients attending PHCs in Oman. The proportion of females was higher among FAs and they also contributed to a higher number of visits to PHCs

Attention deficit hyperactivity disordern and parental factors in school children aged nine to ten years in Muscat, Oman

Objectives: The objectives of this study were to determine the prevalence of attention deficit hyperactivity disorder [ADHD] and specific parental risk factors that may contribute to the development of ADHD in children

Methods: The study was conducted in Oman among fourth-grade students [aged nine to 10 years]. A standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scale [Teachers questionnaire] was used to determine the presence of ADHD. Parental factors such as socioeconomic status, education, and occupation were documented

Results: The prevalence rate of ADHD was 8.8%. Poor maternal education status, low familial socioeconomic status, and paternal occupation were significantly associated with an increased risk of ADHD

Conclusions: This was the first study that examined familial and parental characteristics of children with ADHD as potential risk factors for the condition. Such psychosocial factors could be employed to further the development of more proficient preventative measures and remedial services

Monitoring Caribbean tobacco use: baseline adolescent smoking prevalence and regional disparities / Monitoreo del consumo de tabaco en el Caribe: línea de base de la prevalencia del consumo de tabaco en adolescentes y disparidades regionales

Abstract: Objective: To provide baseline information on tobacco use among adolescents in the Caribbean for the period before country-level implementation of the Framework Convention on Tobacco Control (WHO-FCTC). Materials and methods: Using Global Youth Tobacco Surveys (GYTS) between 2000 and 2008, we report baseline prevalence, 5-year change, and disparities in tobacco use (ever smoked, currently smoke) among adolescents. Results: The Caribbean prevalence of ever-smoked fell from 33.3 to 29.0% with nine of 14 countries reporting a 5-year decrease, and the prevalence of current smokers fell from 12.1 to 11.7% with eight of 14 countries reporting a 5-year decrease. Between-country disparities in the prevalence of ever smoked decreased, while between-country disparities in currently smoked saw little change. Conclusions: This regional summary of tobacco use provides baseline estimates of adolescent smoking, and cross-country smoking disparities for the period before MPOWER implementation. Subsequent GYTS survey rounds can be used to monitor program success.

Resumen: Objetivo: Proveer un punto base de referencia sobre el uso de tabaco entre adolescentes de los países del Caribe antes de la implementación a nivel nacional del Convenio Marco para el Control de Tabaco (CMCT OMS). Material y métodos: Mediante la utilización de datos procedentes de la Encuesta Mundial de Tabaquismo en Jóvenes (EMTJ), obtenidos entre los años 2000 y 2008, se presenta la prevalencia del consumo de tabaco, el cambio obtenido en cinco años y las disparidades sobre el uso del tabaco entre los adolescentes (probaron el tabaco, fumadores actuales). Resultados: En el Caribe, la prevalencia de personas que han fumado en algún momento disminuyó de 33.3 a 29.0% y en nueve de 14 países se reportó un descenso en los últimos cinco años. Por otro lado, hubo un descenso en la prevalencia de fumadores actuales de 12.1 a 11.7% y en ocho de 14 países reportaron una disminución del consumo actual de tabaco fumado en los últimos cinco años. Las diferencias entre países en la prevalencia de los adolescentes que probaron tabaco en algún momento disminuyeron, sin embargo, hubo pocos cambios en la prevalencia de fumadores actuales. Conclusión: Este resumen regional sobre el consumo de tabaco proporciona unas estimaciones de referencia sobre el consumo de tabaco en adolescentes, así como sobre las diferencias entre los diferentes países en el periodo de tiempo anterior a la implementación del MPOWER. La implementación de nuevas rondas de la EMTJ se podrá utilizar para monitorear el éxito de la aplicación del paquete MPOWER.

accuracy of the broselow[TM] pediatric emergency tape for weight estimation in an Omani paediatric population

Objectives: This study aimed to evaluate the accuracy of the Broselow[TM] Pediatric Emergency Tape [BT] for estimating weight in an Omani paediatric population at a tertiary care hospital

Methods: This retrospective cross-sectional study was conducted during July 2015. The electronic medical records of Omani outpatients <14 years old attending the Sultan Qaboos University Hospital, Muscat, Oman, between July 2009 and June 2013 were reviewed for recorded height and weight data. The BT Version 2002A was used to predict weight based on actual height measurements. Predicted weight measurements were then compared with actual weight to determine the accuracy of the estimation

Results: A total of 3,339 children were included in the study, of which 43.5% were female and 56.5% were male. The mean age was 6.4 +/- 3.1 years and the mean height was 93.2 +/- 23.5 cm. The mean actual weight was 13.9 +/- 6.7 kg while the mean BT-predicted weight was 14.4 +/- 6.9 kg. The BT-predicted weight estimations correlated significantly with actual weight measurements [intraclass correlation coefficient: 0.97; P <0.001]. A Bland-Altman analysis indicated that the BT performed well when estimating weight among Omani children, with an overestimation of only 0.5 kg for the entire cohort

Conclusion: The BT was found to be an effective tool for estimating weight according to body length in an Omani paediatric population. It should therefore be considered for use in emergency situations when actual weight cannot be determined