Simple Assessment Tool Research Articles

Family Care Indices and Linear Growth Predict INTER-NDA Scores for Child Development at Age 2 Years: Findings From the “Women First” Trial

ObjectivesNutrition during fetal and early postnatal life impacts brain development, however evidence from randomized trials from low-and-middle-income countries (LMIC) is limited. We evaluated effects of maternal nutrition supplementation before and during pregnancy on neurodevelopment and vision in children from 4 LMIC with high rates of stunting, using a simplified assessment tool.MethodsWomen First was an individually randomized trial comparing the impact of maternal nutrition supplementation initiated preconception vs at ∼12 wk gestation vs no supplement; interventions were discontinued at delivery in trial sites in Democratic Republic of the Congo, Guatemala, India, and Pakistan. Neurodevelopment and visual acuity and visual contrast sensitivity were assessed at 24 mo using the INTER-NDA and the Cardiff tests, respectively, in a random sub-set, representing ∼1/3 of infants with valid birth measurements from the WF trial. Anthropometry and Family Care Indicators (FCI) were also obtained at 24 mo.Results667 and 634 children (91% and 86% of sub-set) were included in INTER-NDA and vision analyses. Arm-proportionate contribution was 32.2–32.8%. Overall, we observed the following percentage of children with delays: 66.6% cognitive; 87.4% fine motor; 91.3% gross motor; and 11.7% language; 25.9% had positive behavior problems; and 26.0% and 21.0% had low acuity and contrast sensitivity scores, respectively. WF intervention arm was not significant for INTER-NDA scores, rates of mild-to-moderate or severe delay (F = 0.004–1.518, p = 0.28–0.99; X2 = 3.81–5.92, p = 0.18–0.42; X2 = 3.81–6.33, p = 0.18–0.43); or for low acuity and contrast sensitivity (X2 = 0.91, p = 0.63 and X2 = 1.64, p = 0.44). LAZ24mo was significantly associated with cognitive, motor, language, and behavior scores; maternal education predicted cognitive, language, and vision; and FCI was significantly associated with fine motor, language, and behavior after adjusting for other covariates (R2 0.33 cognitive; 0.40 language; 0.12 motor; 0.05 positive and 0.11 negative behavior; and 0.31–0.34 for vision models).ConclusionsThe findings highlight the association between child development, linear growth, and family environment.Funding SourcesThrasher Research Fund, Bill & Melinda Gates Foundation, NICHD, ODS.

ASSOCIATION BETWEEN TRIGLYCERIDE GLUCOSE INDEX AND LEFT VENTRICULAR HYPERTROPHY AMONG CHINESE POPULATION WITH HIGH CARDIOVASCULAR RISK

Objective: The triglyceride glucose (TyG) index has been proposed to be a reliable surrogate of insulin resistance. In the present study, we aimed to examine the relationship between TyG index and left ventricular hypertrophy (LVH) among Chinese population with high cardiovascular risk. Design and method: This cross-sectional study included 20,921 participants with measurable echocardiographic parameters from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project in Guangdong Province. Participants with high cardiovascular risk, which was defined as a predicted 10-year risk of cardiovascular disease greater than 20%, according to the 2019 cardiovascular disease risk charts for east Asia by WHO, or those with previous myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or stroke, were identified. They were divided into four famine exposure groups according to the quartiles of TyG index. The association between TyG index and LVH was examined by Logistic regression and restricted cubic spline regression, and the results were presented in odds ratio (OR) with 95% confidence interval (CI). Subgroup analyses were also conducted to examine potential interactions between demographics and TyG index. Results: Among 20,921 participants, 1799 (8.6%) of them had LVH. The multivariate OR for every SD increment in TyG index was 1.22 (95% CI, 1.14–1.31). When comparing to the lowest quartile of TyG index, the multivariate ORs for LVH were 1.22 (0.96–1.54) for Q2, 1.61 (1.28–2.01) for Q3, and 1.73 (1.38–2.16) for Q4 (P for trend < 0.001). The restricted cubic spline regression also showed a linear association. No interaction was found between subgroup variables and the association between TyG index and the LVH. Conclusions: Higher TyG index associated with the elevated risk of LVH in Chinese population with high cardiovascular risk. The data suggest that TyG index may serve as a simple and effective tool for LVH risk assessment in daily clinical practice.

The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients

BackgroundThe simple nutritional assessment tools by Mini Nutritional Assessment (MNA) and Patient Generated Subjective Global Assessment (PG – SGA) was proposed to affect the Quality of Life (QOL) in hemodialysis patients. However, currently, no evidence assessed the potency of MNA and PG - SGA for predicting the QOL in hemodialysis patients. ObjectiveTo assess the potential implication of MNA and PG-SGA nutritional tools and the QOL among hemodialysis patients. MethodsA cross - sectional study was performed in Universitas Muhammadiyah Malang Hospital, Malang, Indonesia. A validated Kidney Disease Quality of Life – 36™ (KDQOL – 36™) instrument was used to assess the QOL. The nutritional status was assessed using MNA and PG - SGA checklist. The association between nutritional status and QOL was determined by using multiple logistic regression. ResultsA total of 96 hemodialysis patients was enrolled in our study. Of them, good QOL was observed in 75 patients (78.12%). We found that hemodialysis patients with higher MNA score and lower PG - SGA score was associated with good QOL. We also found that normal MNA nutritional status was associated with good QOL. Moreover, we also found that the score of MNA ≥23.75 and PG - SGA score ≤3,5 were associated with good QOL. ConclusionMNA and PG-SGA nutritional assessment tools are the important indicator in predicting the QOL in hemodialysis patients.

Validation of a Classification Model Using Complete Blood Count to Predict Severe Human Adenovirus Lower Respiratory Tract Infections in Pediatric Cases.

BackgroundHuman adenovirus (HAdV) lower respiratory tract infections (LRTIs) are prone to severe cases and even cause death in children. Here, we aimed to develop a classification model to predict severity in pediatric patients with HAdV LRTIs using complete blood count (CBC).MethodsThe CBC parameters from pediatric patients with a diagnosis of HAdV LRTIs from 2013 to 2019 were collected during the disease’s course. The data were analyzed as potential predictors for severe cases and were selected using a random forest model.ResultsWe enrolled 1,652 CBC specimens from 1,069 pediatric patients with HAdV LRTIs in the present study. Four hundred and seventy-four patients from 2017 to 2019 were used as the discovery cohort, and 470 patients from 2013 to 2016 were used as the validation cohort. The monocyte ratio (MONO%) was the most obvious difference between the mild and severe groups at onset, and could be used as a marker for the early accurate prediction of the severity [area under the subject operating characteristic curve (AUROC): 0.843]. Four risk factors [MONO%, hematocrit (HCT), red blood cell count (RBC), and platelet count (PLT)] were derived to construct a classification model of severe and mild cases using a random forest model (AUROC: 0.931 vs. 0.903).ConclusionMonocyte ratio can be used as an individual predictor of severe cases in the early stages of HAdV LRTIs. The four risk factors model is a simple and accurate risk assessment tool that can predict severe cases in the early stages of HAdV LRTIs.

Point of Care Lung Ultrasound Injury Score-A simple and reliable assessment tool in COVID-19 patients (PLIS I): A retrospective study.

In COVID-19 patients, lung ultrasound is superior to chest radiograph and has good agreement with computerized tomography to diagnose lung pathologies. Most lung ultrasound protocols published to date are complex and time-consuming. We describe a new illustrative Point-of-care ultrasound Lung Injury Score (PLIS) to help guide the care of patients with COVID-19 and assess if the PLIS would be able to predict COVID-19 patients' clinical course. This retrospective study describing the novel PLIS was conducted in a large tertiary-level hospital. COVID-19 patients were included if they required any form of respiratory support and had at least one PLIS study during hospitalization. Data collected included PLIS on admission, demographics, Sequential Organ Failure Assessment (SOFA) scores, and patient outcomes. The primary outcome was the need for intensive care unit (ICU) admission. A total of 109 patients and 293 PLIS studies were included in our analysis. The mean age was 60.9, and overall mortality was 18.3%. Median PLIS score was 5.0 (3.0-6.0) vs. 2.0 (1.0-3.0) in ICU and non-ICU patients respectively (p<0.001). Total PLIS scores were directly associated with SOFA scores (inter-class correlation 0.63, p<0.001), and multivariate analysis showed that every increase in one PLIS point was associated with a higher risk for ICU admission (O.R 2.09, 95% C.I 1.59-2.75) and in-hospital mortality (O.R 1.54, 95% C.I 1.10-2.16). The PLIS for COVID-19 patients is simple and associated with SOFA score, ICU admission, and in-hospital mortality. Further studies are needed to demonstrate whether the PLIS can improve outcomes and become an integral part of the management of COVID-19 patients.

Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool.

Objectives To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process. Methods A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from “not anxious” to “extremely anxious.” The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient. Results A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of (p=0.016), higher education status (p=0.016), and history of previous traumatic dental experience (p < 0.001). Conclusion A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.

A simple assessment model based on phase angle for malnutrition and prognosis in hospitalized cancer patients

Malnutrition in cancer patients is a common but under-diagnosed condition that has negative effects on clinical outcomes. The development of an easy and reliable malnutrition assessment tool is thus critical for identification and nutritional support. We aimed to develop a phase angle (PA)-based prediction model of malnutrition and evaluate it in patient prognosis. A retrospective cohort of data consisting of demographic, clinical parameter and PA test from 702 adult hospitalized cancer patients between June 2020 to February 2021 was analysed. PAs for 6 body sites were measured by a body composition analyser. Patient-generated subjective global assessment (PG-SGA) scale was used as the diagnostic standard of nutritional status (PG-SGA ≥ 4 points defined as malnutrition). Decision tree, mean decrease accuracy of random forest, stepAIC strategy and test of generalized likelihood ratio were employed to select important variables and develop models for predicting PG-SGA binary classification (PG-SGA < 4 or≥4 as a split). Survival curves were plotted by using the Kaplan-Meier method. In all, 490 (69.8%) patients were malnourished according to their actual PG-SGA scores. Except for age, tumor type and body mass index (BMI), PA of the left arm was found to influence malnutrition classification and incorporated in the final predictive model. The model achieved good performance with an AUC of 0.813, 75.9% sensitivity and 73.3% specificity. The actual and predicted survival curves were almost overlapped. This study provides a simple nutritional assessment tool which may be used to facilitate oncology physicians to identify cancer patients at nutritional risk and potentially implement nutritional support. ChiCTR2100047858.

Animal Welfare Assessment in 16 Zoos in South Korea Using the Modified Animal Welfare Assessment Grid.

Various assessment tools that have been proposed thus far have disadvantages in that they are complex, time-consuming, non-objective, and not convenient for assessing multiple zoos. This study aimed to develop a simple, objective, and reliable welfare assessment tool, the modified Animal Welfare Assessment Grid (AWAG), that can be applied in South Korea, where there is no licensing system for zoos. The AWAG has four main sections: physical, psychological, environmental, and procedural. These four sections include 23 welfare factors like general conditions, behaviors, housing, and restraints, for which each individual or group of animals is given a score. The modified AWAG system was applied by converting the 10-point rating scale of the original AWAG to a 6-point Likert scale. Sixteen zoos in Korea were selected based on the zoos with the most animals. Three inspectors assessed the scores of each animal and then averaged the results. The total data surveyed included 16,065 items. Zoos were largely classified into four grades based on the size of the zoo, animal species, and operating organization. In a relatively short period of 14 days, all the zoos were successfully assessed. Despite the shortened and modified assessment tool, the inter-rater reliability among inspectors was 0.942 with high objectivity. The modified AWAG could identify welfare differences between grades of Korean zoos. There were large differences between zoos in most environmental sections and some zoos were evaluated as having inadequate welfare levels. The modified AWAG showed high usability and objectivity. In addition, it was possible to determine which environmental or procedural sections could potentially help improve physical and psychological scores. The modified AWAG is an objective method that could set the direction for the improvement of zoo welfare in the future.

Using Self-Administered Game-Based Cognitive Assessment to Screen for Degenerative Dementia: A Pilot Study.

The earlier detection of dementia is needed as cases increase yearly in the aging populations of Taiwan and the world. In recent years, the global internet usage rate has gradually increased among older people. To expand dementia screening and provide timely medical intervention, a simple self-administrated assessment tool to assist in easily screening for dementia is needed. The two-part goal of this pilot study was, first, to develop a Game-Based Cognitive Assessment (GBCA) tool, and then, to evaluate its validity at early screening for patients with cognitive impairment. The researchers recruited 67 patients with neurocognitive disorders (NCDs) and 57 healthy controls (HCs). Each participant underwent the GBCA and other clinical cognitive assessments (CDR, CASI, and MMSE), and filled out a questionnaire evaluating their experience of using the GBCA. Statistical analyses were used to measure the validity of the GBCA at screening for degenerative dementia. The average GBCA scores of the HC and NCD groups were 87 (SD = 7.9) and 52 (SD = 21.7), respectively. The GBCA correlated well with the CASI (r2 = 0.90, p < 0.001) and with the MMSE (r2 = 0.92, p < 0.001), indicating concurrent validity. The GBCA cut-off of 75/76 corresponded to measurements of sensitivity, specificity, and area under curve of 85.1%, 91.5%, and 0.978, respectively. The positive predictive value was 91.9%, and the negative predictive value was 84.4%. The results of the user-experience questionnaire for the HC and NCD groups were good and acceptable, respectively. The GBCA is an effective and acceptable tool for screening for degenerative dementia.

Tapping the Potential of Resilience to Support an Integrated and Person-Centred Approach to Health and Wellbeing-Developing a Simple Assessment Tool for Practice.

(1) Background: The push towards population health management and the need for new approaches in health services delivery focusing on the prevention and management of chronic diseases has helped in advocating for more person-centred care, and thus for integration of physical and mental health. Resilience plays a key role in supporting sustainable lifestyle changes and promoting health and wellbeing, but most assessment tools available today are too long for widespread use. The purpose of this paper is to describe the development of a new diagnostic tool to capture a person’s resilience and resources. (2) Methods: This paper outlines the interrelatedness of different theories of salutogenesis, social determinants of health and health promotion with resilience and establishes resilience as a key enabler to promote health and wellbeing. (3) Results: A new, short questionnaire is proposed based on the triade of evidence-based medicine, which should be easy to use and give a good assessment of a person’s resilience. (4) Conclusions: There are many reasons why the call for a short and easy-to-use assessment tool for resilience is warranted. In view of the international transition towards integrated, person-centred health systems, such a tool would find many usages. It would also support the strategies to tackle multi-morbidity, complex conditions and the social determinants of health in its focus on strengthening an individual’s ability to cope with adverse events, and actively engage in health promotion and community involvement programmes. The next step is to test the tool in practice and validate it.

A modal decomposition approach for experimental buckling analysis of thin-walled lipped channel columns

This paper presents a method to perform the decomposition of a lipped channel column’s general deformed shape into the three main buckling modes: local, distortional and flexural global modes. Simple shape functions for each buckling mode are assumed and through an error minimization process the participation of each mode in the deformed shape of the column can be assessed. In a first step, the method is validated against numerical results using generalized beam theory (GBT) modal decomposition for columns undergoing L-D interaction. It is shown that the proposed technique provides good estimates for each buckling modes that contributes to the deformed shape. Lastly, an experimental column previously tested by the authors is analyzed using the proposed modal decomposition method. Although simpler than GBT and the constrained finite strip method (cFSM), the obtained results show that the proposed method can be a valuable and simple tool for a quick assessment of columns’ behavior, especially experimental specimens.

OC11: Utility of Pattern Electroretinogram (PERG) in detection of ganglion cell dysfunction in Hypertensive patients

Background: Hypertension is a major health problem in both developing and developed countries. Hypertension causes retinal structural and functional impairment within the ganglion cell layer. Pattern electroretinogram (PERG) offers an objective simple tool for assessment of retinal ganglion cell function. Aim of the work: To assess retinal dysfunction in hypertensive patients with or without signs of retinopathy using PERG. Materials and Methods: This is a case control study, including ninety-eight eyes. Twenty-eight eyes of healthy subjects served as a control group (group I) and seventy eyes of patients with systemic hypertension, who were further subdivided into group II including 39 eyes of hypertensive patients with normal fundus and group III including 31 eyes of patients with signs of hypertensive retinopathy.All subjects were subjected to ophthalmological examination and electrophysiological assessment using PERG. Results: PERG implicit times were significantly prolonged and amplitudes were significantly reduced in patients with established hypertensive retinopathy. PERG abnormalities were detected in 96.8%of hypertensive retinopathy patients and 79.5% of hypertensive patients with normal fundus. Conclusions: PERG can objectively assess retinal dysfunction in hypertensive patients and may be considered a promising tool for early detection of hypertensive retinopathy.

Influence of Preoperative Anxiety Level on Postoperative Pain After Cardiac Surgery

BackgroundPreoperative anxiety is generally neglected in the evaluation of cardiac surgery patients due to various reasons including insufficient literature and lack of simple assessment tools. In addition to this, the association between anxiety and postoperative complications including pain has been scarcely studied. The present study was designed to assess preoperative anxiety levels in all patients coming for cardiac surgery and then evaluate the effect of different levels of anxiety on postoperative pain scores.MethodsThis prospective cohort study was conducted in a single university hospital from March 2018 to December 2019. One hundred consecutive cardiac surgery patients between the ages of 18-65 years were enrolled in this study. The level of preoperative anxiety (assessed by State Anxiety Inventory) and its effect on postoperative pain and morphine consumption was assessed.ResultsThe average age of the patients was 58.24±10.03 years of which 68% were male and 32% were female. Preoperative mild anxiety was observed in 64% of patients and moderate to severe anxiety in 36% of patients. Post-operative mean pain score was significantly high in the moderate to severe anxiety group as compared to the mild anxiety group [Mean pain difference =1.64 (95%CI: 1.38-1.89) p=0.0005], [Mean pain difference =0.51 (95%CI: 0.29-0.73) p=0.0005] at 12 hours and 24 hours respectively. Intraoperative and postoperative morphine consumption was significantly high in patients with moderate to severe anxiety.ConclusionsPatients with moderate to severe anxiety before cardiac surgery experienced higher pain scores at a post-operative period which is significantly different from the mild anxiety group. Intraoperative and postoperative analgesic requirements were also significantly increased.

Detecting delirium in nursing home residents using the Informant Assessment of Geriatric Delirium (I-AGeD): a validation pilot study

Key summary pointsAimThe aims of this study were to record the prevalence of delirium in residents with the DSM-5, to investigate the feasibility of the I-AGeD in a Swiss nursing home and to compare the results of the I-AGeD with the DSM-5 criteria as the reference standard.FindingsThis study shows that the I-AGeD is suitable for detecting delirium in nursing home residents with a sensitivity of 60% and a specificity of 94%.MessageThe I-AGeD is a simple, brief and feasible assessment tool for the detection of delirium in nursing home residents.

Translation and Validation of American Diabetes Association Diabetes Risk Test: The Malay Version.

BackgroundEarly detection of high-risk people for type 2 diabetes mellitus (T2DM) using a simple, non-invasive and cost-effective assessment tool helps to identify and prevent members of the community from developing this disease. Therefore, this study aims to translate the American Diabetes Association (ADA) diabetes risk test for Malaysians and then evaluate its validity.MethodsThis cross-sectional study was conducted between March 2019 and April 2019. The instrument underwent forward and backward translation according to Behling and Law’s technique. Content validity was performed by two experts and face validity was conducted among 35 convenience samples from Kota Bharu, Kelantan. Both were analysed using content validity index and face validity index, respectively.ResultsAll respondents were Malay, and had attained tertiary education with a mean (standard deviation [SD]) age of 20.63 (2.80) years old and BMI of 30.45 (5.99). Among the respondents, 57.1%, 94.3% and 80% were female, single and having a household income below RM1,500, respectively. The Malay translated instrument achieved high I-content validity index (CVI) [0.5–1.0] and S-CVI/Ave [0.93] as well as high I-face validity index (FVI) [0.86–0.97] and S-FVI/Ave [0.91] for understandability, and high I-FVI [0.77–0.91] and S-FVI/Ave [0.85] for clarity.ConclusionThe Malay version of the ADA diabetes risk test was found to be a valid survey instrument to be used for the Malaysian adult population.

The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures.

Objective To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. Methods A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. Results Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). Conclusion Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

Acoustic characteristics of voice and speech in Arabic-speaking stuttering children

BackgroundUsing different methodologies, several researchers have reported certain acoustical and physiological differences between fluent utterances of stutterers and normally fluent speakers. The aim of this study was to determine acoustic characteristics of voice and speech in Arabic-speaking stuttering children in comparison to normal children and correlate these characteristics with stuttering severity. A sample of 80 Arabic-speaking Egyptian children (including 40 typically developing children and 40 stuttering children) in the age range 5–8 years were subjected to acoustic analysis of voice and speech using the Praat software.ResultsThe stuttering children showed significantly higher values of jitter and shimmer in prolonged /a/ vowel sample, as compared to the normal group. This may reflect the subtle differences in laryngeal functioning or in the complex interaction among the laryngeal, respiratory, and the vocal tract systems in stuttering children. Both jitter and shimmer of prolonged /a/ vowel demonstrated significant positive moderate correlation with stuttering severity as assessed by SSI3. F0 was significantly higher in females than in males, both in normal and stuttering children.ConclusionsThe present study revealed significant differences in the acoustic parameters of voice and speech between Arabic-speaking stuttering children and normal children. Some of these acoustic parameters were significantly correlated with stuttering severity. Acoustic analysis can be used as simple, quick, and cheap tool for assessment of stuttering in children and might be a valuable addition to the diagnostic set for assessment of stuttering severity.

Lift the Lip: A Simple Visual Tool for Caries Risk Assessment

Lift the Lip: A Simple Visual Tool for Caries Risk Assessment

A Prospective Review of Preoperative Nutritional Status and Its Influence on the Outcome of Abdominal Surgery.

AimTo assess the incidence of malnutrition in a surgical gastroenterology unit and analyze its impact on postoperative complication rates.MethodData were prospectively accrued from patients admitted for emergency or elective surgery to the gastrointestinal surgery unit at Jaslok Hospital between May 2013 and May 2014. The nutritional status was preoperatively assessed by using anthropometric parameters like body mass index (BMI), midarm circumference (MAC), and tissue skinfold thickness (TSFT). In addition, a subjective global assessment scale (SGA), serum albumin, and absolute lymphocyte count (ALC) were used. Patients with BMI <18.5, MAC <24 cm in males and <22 cm in females, and TSFT <10 mm were considered malnourished. Patients with serum albumin between 3 and 3.5 g/dl were considered mild, 2.4-2.9 g/dl was moderate, and <2.4 g/dl were severely malnourished. Patients with ALC between 1200 and 2000/cm were labelled mild, between 800 and 1199/cm were moderate, and <800/cm were severely malnourished. As per SGA, well-nourished had less than 5% weight loss or if more than 5%, with recent gain and improved appetite, mild/moderately malnourished had 5% to 10% weight loss with no gain, mild subcutaneous fat loss, and those severely malnourished had more than 10% weight loss, severe subcutaneous fat loss, and muscle wasting. Postoperative complications were graded as per the Clavien-Dindo classification. Patients with grades 1 and 2 complications were labelled as minor and the rest as major.ResultMen in the age group of 40-60 years comprised the majority of the study population. The most frequent reason for admission was cholelithiasis. The overall incidence of malnutrition was 22.16%. Out of the 96 patients who had complications, 45 had minor and 41 had significant complications. Amongst the well-nourished, the incidence of complications was 26.62% of which the majority were minor complications. Severely malnourished patients had a high complication rate (63.38%); 32% out of the 63.38% developed significant complications. The majority of the patients suffering from severe malnutrition belonged to the sub-group with chronic pancreatitis and carcinoma of the pancreas. According to the chi-square analysis of the data, ALC, serum albumin, and SGA correlate with the postoperative complication rate with a p-value <0.05 as significant. On the contrary, BMI, MAC, and TSFT did not correlate with postoperative complications.ConclusionPreoperative malnutrition is common among patients undergoing abdominal surgeries in the urban private health care sector. Although there have been studies that have analyzed the incidence of malnutrition in patients undergoing oncological surgeries, there is limited literature on malnutrition among patients subjected to gastrointestinal surgeries. We conclude that simple bedside nutritional assessment tools like serum albumin, absolute lymphocyte count, and SGA can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.

Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction.

Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: <27 (n = 348), 27–36 (n = 360) and >36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p < 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p < 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p < 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p < 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p < 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p < 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p < 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI > 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI > 42.0 had higher 1 year mortality (Log-rank = 79.2, p < 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.