Development and validation of a risk prediction nomogram for serious arrhythmias in acute digoxin toxicity among pediatrics: A multicenter study.

Digoxin is a cardiac glycoside obtained from the leaves of the foxglove plant, Digitalis lanata. Several studies have described the safety of digoxin including various life-threatening events, notably cardiac arrhythmias. Early identification of high-risk patients and subsequent initiation of the utmost medical care are associated with a better prognosis. The assessment of serum digoxin levels, which is not always convenient, is the only tool used to evaluate the severity of digoxin exposure. However, the feasibility of this tool, particularly in resource-restricted countries, remains unclear. Therefore, the current study aimed to establish and validate a feasible alternative tool, a bedside nomogram, to identify pediatric patients diagnosed with acute digoxin intoxication who are at risk of developing serious arrhythmias. This was a two-phase, multicenter, retrospective study. The prevalence of serious arrhythmias was approximately 17%. Patients diagnosed with serious arrhythmias showed significantly higher serum digoxin, random blood glucose, and potassium levels but lower sodium, magnesium, and hemoglobin levels. Serious arrhythmias were associated with significantly lower P-R intervals, shorter QTc intervals, and more frequent digoxin effects (p < 0.05). The proposed nomogram showed that combining age and initial random blood glucose, sodium, and potassium levels could predict the future incidence of serious arrhythmia with an accuracy of 96.2% (sensitivity = 94.4%, specificity = 96.5%), an area under the curve (AUC) of 0.977, and p < 0.001. Validation of the proposed nomogram yielded an AUC for the nomogram probability of approximately 81%, and the AUC for the predicted probability using the developed model was 98.3%, indicating that both the validated model and the developed nomogram were significant predictors of serious arrhythmia. The utility of using the four-factor nomogram to determine the risk of serious arrhythmia in children exposed to an overdose of digoxin is comparable, if not superior, to the serum digoxin level.

Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients.

BACKGROUND AND AIMS: Malnutrition is highly prevalent in the hemodialysis population. Nutritional screening is important to identify patients at risk of malnutrition. This study aimed to investigate the concurrent validity of BMI cut-offs (BMI < 23 kg/m2 and BMI < 18.5 kg/m2) and DMS, as simple nutritional screening tools, compared to PG-SGA, as the reference standard, in detecting the risk of malnutrition in hemodialysis patients. DESIGN: A Single-centered cross-sectional study design. METHODS: A total of 98 patients on maintenance hemodialysis, who were at least 18 years old (mean age: 51.33 ± 14.12) and subjected to hemodialysis for at least 3 months, were screened. Concurrent validity was assessed using receiver operating characteristic (ROC) curve analysis as well as sensitivity, specificity, accuracy, PPV, NPV, LR+ and LR-, against diagnosed malnutrition. RESULTS: The patients considered malnourished were 71.4% (n = 70), with the majority being females (60%), and possessed a BMI distribution of 28.2 ± 6.3 kg/m2. DMS (score ≥ 14) agreed with diagnosed malnutrition (κ = 0.450 (95% CI 0.26-0.64) <0.0005). Furthermore, DMS (score ≥ 14) showed a sensitivity and a specificity of 84.3% and 60.7%, respectively. However, BMI cut-offs (<23 kg/m2 or < 18.5 kg/m2) did not show any agreement with diagnosed malnutrition. CONCLUSION: DMS is a useful screening tool for detecting the risk of malnutrition in hemodialysis patients. On the contrary, BMI <23 kg/m2 and BMI <18.5 kg/m2 were not valid tools for identifying the risk of malnutrition in hemodialysis patients.

Effect of tramadol dependence on male sexual dysfunction.

Tramadol dependence became an increasing and alarming problem in the Egyptian community. Wide availability of tramadol as a pain killer and its role in the treatment of premature ejaculation may be the most apparent causes of increased magnitude of the problem among youth who believe that tramadol has a positive impact on their sexual functions. This study aimed to explore the real impact of chronic tramadol administration on sexual functions in males dependent on tramadol. The study was carried on 80 subjects (50 subjects were tramadol dependent group and 30 subjects represented the control group). Personal, family and past histories were obtained from all the participants in addition to the toxicological history from tramadol dependent group. Urine screening for tramadol was done for all cases of history of tramadol dependence then confirmation by HPLC technique to measure tramadol blood level was done. Both groups were investigated for serum testosterone and prolactin level. Curiosity (22%) and treatment of premature ejaculation (20%) were the main motives for dependence. Erectile dysfunction and decreased libido occurred in 44% and 48% of tramadol dependent group respectively. Significant increase in erectile dysfunction and decreased libido was noted as the duration of dependence increased. Additionally, significant decrease in serum testosterone level and increase in serum prolactin level as tramadol daily dose and duration increased was found. In conclusion, men who take tramadol for premature ejaculation or any other purpose must know that they are very susceptible to many sexual dysfunctions.