Evidence-based Assessment Research Articles

Population-Based Intraoperative Disease Severity Criteria for Pediatric Appendicitis

A standardized severity assessment approach is needed in children with appendicitis for postoperative adverse event estimation and severity adjustment for hospital-level comparative performance reporting. To examine the association between the presence and number of National Surgical Quality Improvement Program (NSQIP) Pediatric-defined intraoperative criteria for complicated appendicitis and outcomes in a population-based sample of children. This cohort study used data from the American College of Surgeons NSQIP Pediatric Appendectomy Procedure Targeted Participant Use Data File and General Participant Use Data File for children younger than 18 years who underwent appendectomy from January 1, 2019, through December 31, 2022, at 148 hospitals participating in NSQIP Pediatric. The presence of NSQIP Pediatric intraoperative criteria for complicated appendicitis (ie, visible perforation, intraperitoneal abscess, extraluminal fecalith, and diffuse fibrinopurulent exudate). Adverse event outcomes included postoperative rates of any surgical site infection (incisional or organ space), percutaneous drainage, sepsis, and reoperation. Resource use outcomes included operative duration and hospital length of stay, and rates of postoperative imaging, parenteral nutrition use, and revisits. Multivariable regression was used to explore the influence of individual and combinations of intraoperative criteria on outcomes after adjusting for patient characteristics. Of 82 950 patients included, 23 221 (27.9%) had at least 1 finding of complicated appendicitis. Compared with cases without any criteria present, the presence of each finding of complicated appendicitis was independently associated with higher rates of any adverse events; adjusted odds ratios (AORs) by finding were 5.57 (95% CI, 5.04-6.15) for visible hole, 4.83 (95% CI, 4.17-5.59) for diffuse fibrinopurulent exudate, 7.06 (95% CI, 5.77-8.63) for abscess, and 6.62 (95% CI, 4.78-9.15) for fecalith. An increasing number of criteria was associated with a stepwise increase in risk of any adverse events; AOR by number of criteria met were 5.55 (95% CI, 5.09-6.05) for 1 criterion, 8.86 (95% CI, 8.16-9.62) for 2 criteria, and 16.65 (95% CI, 15.10-18.35) for ≥3 criteria. Similar patterns in criteria-specific and cumulative implications for outcomes were observed with each individual adverse event and resource use measure. This cohort study found that postoperative complications and increased resource use are associated with the presence and number of NSQIP Pediatric criteria for complicated appendicitis. These criteria should be considered the gold standard, evidence-based severity assessment framework for estimating risk of adverse events and resource use in children with appendicitis.

Predictive modeling of perioperative patient deterioration: combining unanticipated ICU admissions and mortality for improved risk prediction

ObjectiveThis paper presents a comprehensive analysis of perioperative patient deterioration by developing predictive models that evaluate unanticipated ICU admissions and in-hospital mortality both as distinct and combined outcomes.Materials and MethodsWith less than 1% of cases resulting in at least one of these outcomes, we investigated 98 features to identify their role in predicting patient deterioration, using univariate analyses. Additionally, multivariate analyses were performed by employing logistic regression (LR) with LASSO regularization. We also assessed classification models, including non-linear classifiers like Support Vector Machines, Random Forest, and XGBoost.ResultsDuring evaluation, careful attention was paid to the data imbalance therefore multiple evaluation metrics were used, which are less sensitive to imbalance. These metrics included the area under the receiver operating characteristics, precision-recall and kappa curves, and the precision, sensitivity, kappa, and F1-score. Combining unanticipated ICU admissions and mortality into a single outcome improved predictive performance overall. However, this led to reduced accuracy in predicting individual forms of deterioration, with LR showing the best performance for the combined prediction.DiscussionThe study underscores the significance of specific perioperative features in predicting patient deterioration, especially revealed by univariate analysis. Importantly, interpretable models like logistic regression outperformed complex classifiers, suggesting their practicality. Especially, when combined in an ensemble model for predicting multiple forms of deterioration. These findings were mostly limited by the large imbalance in data as post-operative deterioration is a rare occurrence. Future research should therefore focus on capturing more deterioration events and possibly extending validation to multi-center studies.ConclusionsThis work demonstrates the potential for accurate prediction of perioperative patient deterioration, highlighting the importance of several perioperative features and the practicality of interpretable models like logistic regression, and ensemble models for the prediction of several outcome types. In future clinical practice these data-driven prediction models might form the basis for post-operative risk stratification by providing an evidence-based assessment of risk.

Towards an evidence-based pretrial risk assessment in Mexican juvenile offenders: A systematic review of relevant instruments using COSMIN guidelines

The Mexican Comprehensive Criminal Justice System for Adolescents (Sistema Integral de Justicia Penal para Adolescentes) is in urgent need of validated tools to help diminish the likelihood of pretrial failure, (that is, when juveniles interfere in one way or another with the course of the criminal process before the trial stage). To this end, this article aims to evaluate the measurement properties of relevant instruments to guide and support pretrial risk assessment in Mexican juvenile offenders. Firstly, a systematic review was conducted in PubMed, metasearch engines (DGB-UNAM and Google Scholar), and databases using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. As it was found that no validated pretrial risks assessment instruments had been published earlier in Mexico, we present a proposal based on a preliminary selection of five instruments suitable for pretrial risks assessment taking both analysis and theory into account. Since this is the first systematic review in the field, results provide evidence for developing pretrial risk tools to aid decision-making in the juvenile offenders sector in Mexico.

Developing an Evidence-Based Patient Education Guide on Pain Management for Asian Patients on Hospice.

Asian Americans are the fastest-growing racial group in the United States. This article describes the development of a pain management assessment guide for Asian patients on hospice, their families, and their nurses. Thematic analysis was used to evaluate the applicability of research on pain, pain management, and barriers to pain management from primarily Asian countries to Asian patients on hospice in the United States. Thematic analysis of interviews with such patients concurs with research findings. Four themes emerged: enduring pain, preference for Chinese medicine remedies, fear of addiction, and concern about the side effects of pain medications. Interviews with experienced hospice nurses also aligned with these themes. Hospice nurses were asked to share their strategies for assessing and managing pain among their Asian hospice patients. Thematic analysis of their interviews revealed six strategies: focusing on treatment goals, involving family and caregivers, explaining the physiology of pain, explaining the progression of pain medications, addressing concerns about addiction, and managing the side effects of medications. The themes that emerged from patient and hospice nurse interviews were used to develop an evidence-based pain management assessment guide to support Asian patients on hospice, their family, and the nurses who care for them.

The Equitable Benefit Approach to guide the assessment of medical and psychosocial factors in liver transplant candidacy.

Lack of available organs poses a significant challenge in meeting the needs of patients with life-threatening liver disease who could benefit from liver transplantation (LT). Psychosocial vulnerability markers have been linked to post-transplant outcomes, raising questions about their use in patient selection. However, their incorporation into selection criteria raises concerns about health equity and potential discrimination. As a result, there is a pressing need to refine fair allocation systems that consider both clinical and psychosocial factors to ensure equitable access and optimize post-transplant outcomes. The Equitable Benefit Approach (EBA) proposed in this paper by the multidisciplinary group of clinical experts in LT from the Italian Society for the Study of the Liver seeks to address these concerns. It presents four procedural principles, the two allocative principles usually applied in transplantation (urgency and utility) and introduces a new one, the principle of health equity. The EBA aims to prioritize patients with the highest transplant benefit while addressing health inequalities. It emphasizes evidence-based decision-making and standardized assessment tools to reliably evaluate psychosocial risk factors. Implementing the EBA involves a multi-step process, including stakeholder engagement, prospective studies to validate its efficacy, development of institutional policies and algorithms, and ongoing monitoring and revision. By following these steps, health care providers can ensure that LT allocation decisions are transparent and responsive to evolving clinical and social contexts. Ultimately, the EBA should offer a comprehensive framework for fair patient selection in LT, considering both biomedical and psychosocial aspects.

GAPS phase II: development and pilot results of the global assessment in pediatric surgery, an evidence-based pediatric surgical capacity assessment tool for low-resource settings.

Pediatric surgical care in low- and middle-income countries is often hindered by systemic gaps in healthcare resources, infrastructure, training, and organization. This study aims to develop and validate the Global Assessment of Pediatric Surgery (GAPS) to appraise pediatric surgical capacity and discriminate between levels of care across diverse healthcare settings. The GAPS Version 1 was constructed through a synthesis of existing assessment tools and expert panel consultation. The resultant GAPS Version 2 underwent international pilot testing. Construct validation categorized institutions into providing basic or advanced surgical care. GAPS was further refined to Version 3 to include only questions with a > 75% response rate and those that significantly discriminated between basic or advanced surgical settings. GAPS Version 1 included 139 items, which, after expert panel feedback, was expanded to 168 items in Version 2. Pilot testing, in 65 institutions, yielded a high response rate. Of the 168 questions in GAPS Version 2, 64 significantly discriminated between basic and advanced surgical care. The refined GAPS Version 3 tool comprises 64 questions on: human resources (9), material resources (39), outcomes (3), accessibility (3), and education (10). The GAPS Version 3 tool presents a validated instrument for evaluating pediatric surgical capabilities in low-resource settings.

Speech and Resonance Disorders in Children With Cleft Palate: Diagnostic Evaluation and Current Speech Therapy Modalities.

This article will provide an overview of how speech and resonance can be impacted in children with cleft palate. The authors will outline evidence-based assessment and treatment approaches commonly used for children with cleft palate and provide information on current initiatives to provide speech therapy. The methods discussed will be the use of telehealth to provide access to speech therapy for patients in areas without speech-language pathologists and the use of speech therapy camps to offer intensive, limited-duration speech therapy for groups of children due to the lack of trained providers in certain geographical regions.

Therapeutic relationship elements and therapy session outcomes: Protocol for a longitudinal study of the patient's perspective.

There is a growing recognition of the key role of the therapeutic relationship in the outcomes of psychotherapy. However, current understanding of its specific components, their interplay and related patient-therapist dynamics is limited. (a) To validate two self-report measures to assess subjective affective reactions of patients toward their psychotherapists during specific therapy sessions, and (b) to explore the relationships and dynamics among four elements of the therapeutic relationship: patient reactions toward the therapist, working alliance, alliance ruptures and repairs, and the real relationship. This study uses a nonrandomized, two-time point longitudinal design. The target population is adult patients currently engaged in individual psychotherapy for heterogeneous mental conditions. Participants are recruited through two online recruitment platforms: Research for Me and ResearchMatch. Data collection involves administering two surveys through the Qualtrics online survey platform. The baseline survey assesses information about the most recent therapy session and the preceding week, while the follow-up survey collects data on the subsequent therapy session and the days leading up to it. This research offers three main contributions: (a) it furthers evidence-based assessment in psychotherapy by creating and validating two novel, succinct self-report tools; (b) it enhances theoretical understanding within therapeutic relationship research by exploring the significant impact of patients' perceptions of relationship elements on session outcomes variability; and (c) it will identify therapeutic relationship elements that can either enhance or hinder the overall relationship quality and session outcomes. The study protocol was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill. The results will be published in indexed peer-reviewed journals and presented at relevant psychology and psychiatry conferences.

Evidence-based assessment and treatment of military/Veteran PTSD: Reflections on 15 years of practice

LAY SUMMARY This reflection following 15 years of military/Veteran clinical practice reviews special assessment and treatment considerations, with a focus on prolonged exposure therapy for posttraumatic stress disorder. It discusses common assumptions about evidence-based psychotherapy that can negatively impact treatment outcome and patient motivation and participation in treatment. The widely varying clinical presentations of the Canadian military population and unique nature of military service, as well as its impact on mental health, are reviewed. Key practice suggestions include the importance of identifying the index trauma, using outcome monitoring, and understanding the theory of each of the gold-standard trauma-focused psychotherapies, as well as the rationale for each included intervention, so that clinicians can tailor treatments to patients as clinically required. Common misunderstanding and complexities related to trauma-focused psychotherapies are discussed, including the goal of treatment and clinician hesitation to implement evidence-based psychotherapies. The intention of this reflection is to increase discussion, contribute to a greater understanding and deeper appreciation for the uniqueness of military/Veteran patients, and promote advancement and innovation in research and clinical practice.

Genomic insights into antimicrobial resistant Salmonella in internationally traded chicken meat: First baseline findings in the United Arab Emirates

Non-typhoidal Salmonella is among the most prevalent foodborne zoonoses, challenging food safety and One Health worldwide. A dearth of knowledge exists regarding non-typhoidal Salmonella prevalence and genomic features within the United Arab Emirates (UAE), one of the top markets in chicken meat consumption worldwide. In this study, Salmonella was detected in 16 out of 254 (6.30 %, 95 % confidence interval: 3.64 %, 10.03 %) samples of imported frozen chicken carcasses sampled from UAE retails. Among the recovered serotypes, S. Minnesota; ST 548 (10/16) emerged as the most prevalent, trailed by S. Heidelberg; ST 15 (4/16), and then S. Kentucky; ST 198, and ST 152 (2/16). Antimicrobial resistance (AMR) was most prevalent against tetracycline (93.7 %), followed by ampicillin (68.7 %), and extended-spectrum cephalosporins (ceftriaxone and cefoxitin) (56.2 %); with 68.7 % (11/16) of the isolates classified as multidrug resistant (MDR). Whole-genome sequencing (WGS) analysis revealed the existence of 14 AMR genes, among which the blaCMY-2, an AmpC cephalosporinases resistance gene, presented in 10 of the 16 isolates. Among the ten out of the eleven MDR Salmonella isolates, both IncC and Col(pHAD28) plasmid incompatibility types were concurrently featured. The range of virulence genes varied from 149 to 165 genes, with an average of 168 genes per isolate. Except for one isolate, all other isolates possessed type III secretion system (TTSS) related genes known to be encoded by the Salmonella pathogenicity island-1 (SPI-1). This study contributes to our global understanding of Salmonella epidemiology, specifically focusing on the Middle East. The insights gained from this study are significant in shaping import risk analyses aimed at mitigating Salmonella exposure risks through globally traded chicken. The research underscores the value of WGS as a crucial tool for substantiating evidence-based food safety hazard assessment.

Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT)

PurposeThis project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DesignModified Delphi. MethodsUsing an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FindingsTwo survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. ConclusionsThe Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.

JAAD Game Changers: To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis

JAAD Game Changers: To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when using systemic biologic agents to treat psoriasis and psoriatic arthritis

Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients: a multicentre observational study.

Urinary retention is a healthcare complication putting patients at risk of unnecessary suffering and harm. Orthopaedic patients are known to face an increased such risk, calling for evidence-based preoperative assessment and corresponding measures to prevent bladder problems. The aim of this study was to evaluate healthcare professionals' adherence to risk assessment guidelines for urinary retention in hip surgery patients. This was an observational study from January 2021 to April 2021 with a descriptive and comparative design, triangulating three data sources: (I) Medical records for 1382 hip surgery patients across 17 hospitals in Sweden were reviewed for preoperative risk assessments for urinary retention and voiding-related variables at discharge; (II) The patients completed a survey regarding postoperative lower urinary tract symptoms, and; (III) data were extracted from a national quality registry regarding type of surgery, preoperative physical status, and perioperative urinary complications. Group differences were analysed with Chi-square/Fisher's exact test, t-test, Wilcoxon rank-sum test, or Mann-Whitney U-test. Logistic regression was used to analyse variables associated with completed risk assessments for urinary retention. Of all study participants, 23.4% (n=323) had a preoperative documented risk assessment of urinary retention. Whether a risk assessment was performed was significantly associated with acute surgery [odds ratio (OR) 3.56, 95% confidence interval (CI) 2.48-5.12] and undergoing surgery at an academic hospital (OR 4.59, 95% CI 2.68-7.85). Acute patients were more often affected by urinary retention and had bladder issues and/or an indwelling catheter at discharge. More than every tenth patient (11. 9%, n=53) completing the survey experienced intensified bladder problems after their hip surgery. The study shows a lack of adherence to risk assessment for urinary retention according to evidence-based guidelines, which negatively affects quality of care and patient safety.

Training guidelines and competencies for serious mental illness (SMI) psychology.

Individuals with serious mental illness (SMI) face unique and significant challenges that require evidence-based practices and clinicians who have advanced, comprehensive training to provide them. SMI affects about 5.5% of the U.S. population and results in serious health, social, and economic burdens. Despite advancements in treatment over the past 50 years, training programs for psychologists and other mental health providers have failed to keep up with these advances, underutilizing evidence-based assessments and interventions developed specifically for this population and found to be efficacious. To address this, the SMI Psychology Specialty has developed Training Guidelines to establish consistent, high-quality, and evidence-based training for postdoctoral psychologists. This article highlights selected features of the Training Guidelines for SMI Psychology. Although these were developed for postdoctoral training programs in SMI Psychology, they are applicable to training programs at all levels, and we hope that training programs in psychology and other mental health disciplines will incorporate these advances into their curricula. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and Validation of a Composite Skin Quality Scale.

The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices. To develop and validate a 5-point photonumeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness. The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed through intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs. Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side) and an ICC of 0.903 for both sides, indicating an almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853 and ICCs between 0.657 and 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established. Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products.

Prevalence, Attributes, and Risk Factors of QT-Interval-Prolonging Drugs and Potential Drug-Drug Interactions in Cancer Patients: A Prospective Study in a Tertiary Care Hospital.

Introduction Cancer chemotherapy regimens include multiple classes of adjuvant drugs as supportive therapy. Because of the concurrent intake of other drugs (like antiemetics, antidepressants, analgesics, and antimicrobials), there is a heightened risk for possible QT interval prolongation. There is a dearth of evidence in the literature regarding the usage of QT-prolonging anticancer drugs and associated risk factors that have the propensity to prolong QT interval. The purpose was to explore the extent of the use of QT-interval-prolonging drugs and potential QT-prolonging drug-drug interactions (QT-DDIs) in cancer patients attending OPD in a tertiary-care hospital. Methods This was a hospital-based, cross-sectional, observational study. Risk stratification of QT-prolonging drugs for torsades de pointes (TdP) was done by the Arizona Center for Education and Research on Therapeutics (AzCERT)/CredibleMeds-lists, and potential QT-DDIs were determined with four online DDI-checker-software. Results In 1331 cancer patients, the overall prevalence of potential QT-prolonging drug utilization was 97.3%. Ondansetron, pantoprazole, domperidone, and olanzapine were the most frequent QT-prolonging drugs in cancer patients. The top six antineoplastics with potential QT-prolongingand torsadogenic actions were capecitabine, oxaliplatin, imatinib, bortezomib, 5-fluorouracil, and bendamustine. Evidence-based pragmatic QTc interval prolongation risk assessment tools are imperative for cancer patients. Conclusion This study revealed a high prevalence of QT-prolonging drugs and QT-DDIs among cancer patients who are treated with anticancer and non-anticancer drugs. As a result, it's critical to take precautions, stay vigilant, and avoid QT-prolongingin clinical situations. Evidence-based pragmatic QTc interval prolongation risk assessment tools are needed for cancer patients.

Estimating the risk of SARS-CoV-2 infection in New Zealand border arrivals

BackgroundTravel restrictions and border controls were used extensively during the COVID-19 pandemic. However, the processes for making robust evidence-based risk assessments of source countries to inform border control policies was in many cases very limited.MethodsBetween April 2020 and February 2022, all international arrivals to New Zealand were required to spend 14 days in government-managed quarantine facilities and were tested at least twice. The infection rates among arrivals in the years 2020, 2021 and 2022 were respectively 6.3, 9.4 and 90.0 cases per thousand arrivals (487, 1064 and 1496 cases). Test results for all arrivals were linked with travel history, providing a large and comprehensive dataset on the number of SARS-CoV-2-positive and negative travellers from different countries over time. We developed a statistical model to predict the country-level infection risk based on infection rates among recent arrivals and reported cases in the country of origin. The model incorporates a country-level random effect to allow for the differences between the infection risk of the population of each country and that of travellers to New Zealand. A time dependent auto-regressive component of the model allows for short term correlation in infection rates.ResultsA model selection and checking exercise found that the model was robust and reliable for forecasting arrival risk for 2 weeks ahead. We used the model to forecast the number of infected arrivals in future weeks and categorised countries according to their risk level. The model was implemented in R and was used by the New Zealand Ministry of Health to help inform border control policy during 2021.ConclusionsA robust and practical forecasting tool was developed for forecasting infection risk among arriving passengers during a period of controlled borders during the COVID-19 pandemic. The model uses historical infection rates among arrivals and current infection rates in the source country to make separate risk predictions for arrivals from each country.

Identifying factors that can be used to assess a country’s readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review

ObjectivesIdentifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping...

An assessment of severity of acute bronchiolitis using bronchiolitis severity score and its relation to serum sodium level in children attending Alexandria University Hospital

Background Acute viral bronchiolitis is a significant cause of respiratory morbidity globally. Acute bronchiolitis is a clinical diagnosis based on the clinical judgment of the treating physician. Consequently, management strategies for acute bronchiolitis have great variability. Therefore, valid objective, evidence-based assessment tools were needed to help assess the severity of the illness, therefore reducing variation in management plans and standardizing care. Aim The present work aims to assess the validity of the use of bronchiolitis severity score (BSS) and serum sodium level in predicting the severity of acute bronchiolitis and the relation between them in children attending Alexandria University Children’s Hospital. Patients and methods The study was a comparative cross-sectional study of 131 children clinically diagnosed with acute bronchiolitis, from 1 month to 2 years of age, who presented to the Emergency Department of Alexandria University Children’s Hospital. Measurement of each patient’s BSS and serum sodium level was done on presentation in triage. Admitted and nonadmitted patients were followed up. Longer length of hospital stay and Pediatric Intensive Care Unit (PICU) admission were considered indicators of increased severity of the disease and worse outcomes. Results There was a male predominance and the median age of the studied patients was 3 months. On the basis of BSS, acute bronchiolitis was classified as mild in 19 (14.5%) cases, moderate in 79 (60.3%), and severe in 33 (25.2%). Hyponatremia at presentation was present in 20 (15.2%) cases. Increased severity, as determined by BSS, was statistically significantly associated with higher rates of admissions, longer hospital stays, and increased incidence of PICU hospitalization. There was no statistically significant difference between the hyponatremic status and increased hospital stay or the incidence of PICU admission. By univariate analysis, length of hospital stay and incidence of PICU admission was significantly affected by BSS and by hyponatremia. By multivariate analysis, the only parameter that was significant was BSS. In predicting a longer hospital stay in admitted patients, BSS showed a sensitivity (Se)=77.78%, specificity (Sp)=100%, positive predictive value (PPV)=100%, and negative predictive value (NPV)=42.9 while hyponatremia showed a Se=20.83%, Sp=91.67%, PPV=93.75%, and NPV=16.18. In predicting the need for PICU admission in studied cases, BSS showed a Se=69.23%, Sp=94.92%, PPV=60%, and NPV=96.6 and Se=38.46%, while hyponatremia showed Sp=87.29%, PPV=25%, and NPV=92.79. Conclusion BSS could be used as a valuable tool for assessing the severity of acute bronchiolitis. The presence of hyponatremia on initial presentation, although occasionally observed, cannot be used as a predictor of disease severity, but it could be used as a prognostic factor of a more severe disease course.

Evidence-based study of Hridayarnava Rasa: An Ayurvedic formulation in experimentally induced atherosclerotic cardiovascular disease

Abstract BACKGROUND: Ayurvedic medicine provides fundamental knowledge of the concepts and components involved in traditional medicine. Hridayarnava Rasa (H. Rasa) is an Ayurvedic formulation, composed of herbal constituents and metallo-mineral ingredients. Individual components of H. Rasa were reported to treat various ailments; however, very few evidence-based studies on the formulation were available in other aspects of H. Rasa. The present study was focused on the evidence-based assessment of the test of H. Rasa in experimentally induced atherosclerotic cardiovascular disease (ASCVD). METHODS: A total of 24 male New Zealand rabbits were randomly distributed into six groups of four rabbits each. Group I rabbits were fed with a standard pellet diet; group II was induced with ASCVD; groups III, IV, and V were induced with ASCVD plus different doses of H. Rasa, and group VI was induced with ASCVD plus atorvastatin supplementation. RESULTS: Plasma lactate dehydrogenase, creatine kinase, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, γ-glutamyltransferase, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDLc), very LDLc, AST:ALT ratio, hydroxy-3-methyl glutaryl coenzyme reductase activity, collagen, and elastin were significantly increased, whereas high-density lipoprotein cholesterol levels were significantly decreased in ASCVD induced group. This was supported by CD68 levels of the aorta by immunohistochemistry. Changes were reversed in H. Rasa-treated groups of different doses of the drug. CONCLUSION: These results suggest that a high-fat diet accelerates the development of ASCVD in a time-dependent manner, and H. Rasa protects the aorta by maintaining the lipids, lipoproteins, and marker enzymes in a dose-dependent manner similar to atorvastatin.