Strategies for reducing maternal mortality.
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Developing Countries↗
Biomedical subjects
Khalid Khan
Publications and source records attributed to Khalid Khan.
Meta-DiSc: a software for meta-analysis of test accuracy data.
BACKGROUND: Systematic reviews and meta-analyses of test accuracy studies are increasingly being recognised as central in guiding clinical practice. However, there is currently no dedicated and comprehensive software for meta-analysis of diagnostic data. In this article, we present Meta-DiSc, a Windows-based, user-friendly, freely available (for academic use) software that we have developed, piloted, and validated to perform diagnostic meta-analysis. RESULTS: Meta-DiSc a) allows exploration of heterogeneity, with a variety of statistics including chi-square, I-squared and Spearman correlation tests, b) implements meta-regression techniques to explore the relationships between study characteristics and accuracy estimates, c) performs statistical pooling of sensitivities, specificities, likelihood ratios and diagnostic odds ratios using fixed and random effects models, both overall and in subgroups and d) produces high quality figures, including forest plots and summary receiver operating characteristic curves that can be exported for use in manuscripts for publication. All computational algorithms have been validated through comparison with different statistical tools and published meta-analyses. Meta-DiSc has a Graphical User Interface with roll-down menus, dialog boxes, and online help facilities. CONCLUSION: Meta-DiSc is a comprehensive and dedicated test accuracy meta-analysis software. It has already been used and cited in several meta-analyses published in high-ranking journals. The software is publicly available at http://www.hrc.es/investigacion/metadisc_en.htm.
Clinical Laboratory Techniques↗
Outbreak of epidemic methicillin-resistant Staphylococcus aureus in a regional burns unit: management and implications.
Colonization of burn patients with methicillin-resistant Staphylococcus aureus (MRSA) is not uncommon, however an outbreak that necessitates closure of a burns unit is relatively rare. The objective of this study was to present the experience of a regional adult burns unit where an outbreak of epidemic MRSA-15 (EMRSA-15) took place. During the studied period, 176 patients were admitted to the unit, 52 with burns, 48 for elective plastic surgery procedures while the remainder belonged to other specialties. Patients admitted under burns and plastic surgery were investigated together with 46 staff members to control the outbreak. MRSA was isolated in 18 patients out of which 12 had EMRSA-15. Among the staff members, MRSA was isolated in nine of which five had EMRSA-15. The burns unit was closed to all admissions to terminate this outbreak. The MRSA positive staff members were sent on "special leave" and underwent treatment with nasal mupirocin and triclosan body wash. All staff members were able to return to work after one week's treatment. The burns unit underwent re-furbishment and decontamination while it was closed. In conclusion, the study shows that an outbreak of EMRSA was controlled successfully, however, it highlights the implications of such an event for a regional burn service with regard to staff, patients and guidelines for management.
Adult↗
Factors predisposing women to chronic pelvic pain: systematic review.
OBJECTIVE: To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. RESULTS: There were 122 studies (in 111 articles) of which 63 (in 64,286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18,601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12,040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. CONCLUSION: Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
Chronic Disease↗
Diagnostic endoscopy in children after hematopoietic stem cell transplantation.
OBJECTIVE: To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT). DESIGN: Data from 191 patients were reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prevalence of acute graft-versus-host disease [GVHD] are highest) and those performed beyond 100 days. RESULTS: Visible endoscopic lesions were found in 63 of 198 (32%) esophagogastroduodenoscopies (EGDs) and 36 of 220 (16%) sigmoidoscopies. Acute GVHD was present in 38 of 121 (31%) biopsy specimens from EGDs within the first 100 days, 15 of 73 (21%) samples from EGDs after 100 days, 52 of 136 (38%) sigmoid biopsy specimens before 100 days, and in 25 of 82 (31%) samples after 100 days. Non-GVHD histologic abnormalities were present in 36 of 124 (29%) biopsy samples from EGDs before 100 days, 32 of 74 (43%) specimens after 100 days, 14 of 136 (10%) sigmoid specimens before 100 days, and 11 of 84 (13%) samples beyond 100 days. COMPLICATIONS: Complications occurred in 13 procedures (3.1%): 8 (4.2%) EGDs, 4 (2.0%) sigmoidoscopies, and 1 (5.5%) colonoscopy. Intestinal bleeding occurred in 12 of the 13 procedures. Thrombocytopenia was a statistically significant association (p < 0.01). One death occurred after splenic flexure perforation. CONCLUSIONS: GI abnormalities other than acute GVHD occurred in children after HSCT. Acute GVHD was diagnosed most commonly on sigmoid biopsy. Postprocedure hemorrhage was related to thrombocytopenia.
Adolescent↗
Congenital lower urinary tract obstruction: to shunt or not to shunt?
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Constriction, Pathologic↗
On the use of prophylactic antibiotics in prevention of toxic shock syndrome.
No consensus exists among burn surgeons on the role of prophylactic antibiotics in prevention of toxic shock syndrome (TSS). We recently reported a series of 71 children admitted with burns to our burn unit. By Centres for Disease Control (CDC) criteria, six of these were 'definite' and four 'probable' cases of TSS. Prior to this report, none of our patients were given prophylactic antibiotics. Thereafter, prophylactic therapy was included in the management of children admitted to the burns unit. The aim of this study was to assess whether prophylaxis with a one off single dose of systemic antibiotics prevented the occurrence of TSS. Data were collected prospectively between 1 January and 31 December 2001, on all children admitted to the burns unit. Out of 50 children admitted to the burns unit, 39 received prophylactic antibiotics in the referring accident and emergency. Two of these became unwell but none fulfilled the CDC criteria. The remaining 11 patients were given antibiotics on admission out of which one child required direct admission to the intensive care unit with a working diagnosis of TSS. Retrospectively, his features did not conform to the CDC criteria. In conclusion, this study suggests that prophylaxis may prevent TSS in children.
Anti-Bacterial Agents↗
Pharmacologic and toxicologic evaluation of C. novyi-NT spores.
Clostridium novyi-NT (C. novyi-NT) spores have been shown to be potent therapeutic agents in experimental tumors of mice and rabbits. In the present study, pharmacologic and toxicologic studies were performed to better understand the factors influencing the efficacy and toxicity of this form of therapy. We found that spores were rapidly cleared from the circulation by the reticuloendothelial system. Even after large doses were administered, no clinical toxicity was observed in healthy mice or rabbits. The spores were also not toxic in mice harboring poorly vascularized non-neoplastic lesions, including myocardial infarcts. In tumor-bearing mice, toxicity appeared related to tumor size and spore dose, as expected with any bacterial infection. However, there was no laboratory or histopathologic evidence of sepsis, and the toxicity could be effectively controlled by simple hydration.
Animals↗
How to interpret the findings of the eVALuate study.
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Data Interpretation, Statistical↗
TRAM flap versus nonautologous breast reconstruction: what do patients really think?
Although there have been many reports of aesthetic outcomes after breast reconstruction, there have been comparatively few studies examining patient satisfaction and related subjective issues. The variables affecting satisfaction are only beginning to be understood, and patient satisfaction issues were explored in a more homogeneous patient population. A questionnaire surveying overall and aesthetic satisfaction, postoperative recuperation time, and symptoms was used to elicit candid patient responses. Fifty-seven patients replied (86 percent response rate), of whom 38 had undergone transverse rectus abdominis musculocutaneous (TRAM) flap (pedicled, n = 29; free, n = 9) reconstruction and 19 had undergone nonautologous reconstruction. Although the median patient satisfaction score was higher for the TRAM flap group, this was not statistically significant (p = 0.92). Recuperation was significantly longer for the TRAM flap group, with only 47 percent of patients being able to resume full activities within 2 months after the surgical procedure, compared with 95 percent of the implant group (p = 0.002). Of the TRAM flap-treated patients, 50 percent described some postoperative abdominal weakness, but only 5 percent of all TRAM flap-treated patients said that abdominal weakness was actually a functional problem. Our results suggest that patients may derive equal satisfaction with the two methods of reconstruction. The postoperative recuperation time after TRAM flap reconstruction is significantly longer than that after nonautologous procedures, although the postoperative abdominal weakness after TRAM flap reconstruction is not as significant a clinical problem as previously thought. The patient-derived information on satisfaction should assist both surgeons and patients in matching reconstructive options with patients' expectations and lifestyle.
Female↗
Electronic searching of the literature for systematic reviews of screening and diagnostic tests for preterm birth.
BACKGROUND: Published systematic reviews on prediction of preterm birth have tended to focus on a limited number of tests and their search strategies have often been relatively simple. Evaluation of all available tests in a systemic review will require a broad search strategy. AIM: To describe a case study of electronic searching for a systematic review of accuracy studies evaluating all tests for predicting preterm birth. METHODS: The search strategy, developed to capture literatures concerning all the tests en-masse consisted of formulation of an appropriate combination of search terms, pilot searches to refine the search term combination, selection of relevant databases, and citation retrieval from the refined searches for selection of potentially relevant papers. Electronic searches were carried out on general bibliographic databases (Biosis, Embase, Medline, Pascal and Scisearch), specialised databases (Database of Abstracts of Reviews of Effectiveness, Medion, National Research Register, Cochrane Controlled Trial Register and Cochrane Database of Systematic Reviews). RESULTS: A total of 30076 citations were identified. Of these 8855 (29%) citations were duplications either within a database or across databases. Of the remaining 21221 citations, 3333 were considered potentially relevant to the review after assessment by two reviewers. These citations covered 19 different tests for predicting preterm birth. CONCLUSIONS: This case study suggests that with use of a concerted effort to organise and manage the electronic searching it is feasible to undertake broad searches for systematic reviews with multiple questions.
Databases, Bibliographic↗
Bacterial toxicosis/toxic shock syndrome as a contributor to morbidity in children with burn injuries.
When a child with a thermal injury suddenly becomes unwell, it is often difficult to obtain an accurate diagnosis in the early stages of the illness. Out of 71 children admitted to our burns unit over a 15-month period, 13 became acutely toxic. Most of the cases had relatively small burns and the exact reason for their sudden deterioration was not apparent in the immediate stages. Several children required admission to the intensive therapy unit and there was one death. The number of children experiencing this significant morbidity over a relatively short period of time prompted us to perform a detailed retrospective study to ascertain the exact cause of the deterioration and to identify any patterns in their presenting signs and symptoms. There was considerable variation in the clinical picture of the children who developed the toxicosis, however, several features were frequently observed which resembled those seen in the toxic shock syndrome (TSS). In order to be more specific, we applied the criteria for TSS as defined by the Centres for Disease Control (CDC) to each of the 13 children. All of the criteria were noted in six children and the majority in the other seven. This was a much higher incidence than we would normally have expected. The clinical features of children with TSS are not always easy to distinguish from those observed in other illnesses. We therefore explored the possibility of alternative diagnoses that may have caused the toxicosis in these children. The mortality associated with TSS can be high, especially if there is a delay in recognition and subsequent management of the disease. Clinicians should be alerted to the fact that TSS is probably more prevalent than previously thought and should practise with a high index of suspicion in any child with a burn whose clinical condition suddenly deteriorates.
Age Distribution↗
Argon plasma coagulation: Clinical experience in pediatric patients.
BACKGROUND: Argon plasma coagulation has potential advantages in pediatric endoscopy. METHODS: Argon plasma coagulation was applied in 13 children (age 0.05-17 years; median 3 years) with significant comorbid conditions including immunosuppression, chemotherapy, acute or chronic organ failure, and coagulopathy. Twelve had bleeding lesions; esophageal granulomatous tissue was coagulated in one. The bleeding lesion was located in the stomach in 9 of 12, the duodenum in 2 of 12 (both with granulomatous tissue), and at an enterocolonic anastomosis in 1 of 12. OBSERVATIONS: In total, 23 procedures were performed, 22 for bleeding (range 1-5 per patient). Hemostasis was achieved in 8 of 12 with one session. Blood loss and transfusion requirement were reduced in 3 of the other 4 patients. Blood loss was not affected in 1. Bleeding recurred in 3 of 12, and additional procedures were performed in 7 of 12. Granulomatous tissue was completely eradicated in 2 of 3; in one, granulomatous tissue associated with surgical staples was only partially removed. Complications occurred in 2 of 13 patients and included submucosal argon gas and scar formation. CONCLUSION: Endoscopic argon plasma coagulation is efficacious for hemostasis and tissue ablation in pediatric patients. Minor complications occurred in 17% (2/13) of cases in this series.
Adolescent↗
Sclerosing cholangitis associated with trichosporon infection and natural killer cell deficiency in an 8-year-old girl:.
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Child↗
The prevalence, diagnosis and treatment of depression in dementia patients in chronic care facilities in the last six months of life.
OBJECTIVE: To assess the prevalence, diagnosis and treatment of depression among dementia patients and normal controls in chronic care facilities in the last six months of life. METHOD: We reviewed perimortal data concerning dementia severity, depressive symptoms and diagnoses, and medication use for 279 dementia patients and 24 normal controls brought to autopsy through an Alzheimer's Disease Resource Center. RESULTS: Major depression was highly prevalent among both dementia patients and normal controls in chronic care facilities in the last six months of life. This depression was under-diagnosed by physicians. Documentation of depressive symptoms by medical support staff has improved over time. However, physician diagnosis of depression has not improved. Recognition of depression was significantly lower for patients with severe dementia. Depression was under-treated in both dementia patients and normal controls, although treatment rates may be increasing. Anxiolytics and hypnotics were often used in lieu of, or in addition to, antidepressant therapy. CONCLUSIONS: Major depression was highly prevalent in both dementia patients and normal controls, indicating that depression is an important issue for the elderly in the last six months of life irrespective of cognitive status. Under-diagnosis of depression may be an important clinical issue. As physician diagnosis of depression has not improved with time, further physician training and/or awareness initiatives may be warranted. Depression, a treatable cause of excess morbidity and mortality, was undertreated in all groups studied. However, treatment rates may be improving. The prevalent use of anxiolytics and hypnotics for depressed patients is problematic.
Aged↗
Norm and associated radiation hazards in bricks fabricated in various localities of the North-West Frontier Province (Pakistan).
The activity concentrations of natural gamma-emitting radionuclides and associated radiation hazards due to 40K, 226Ra and 232Th have been measured in baked brick samples, collected from six highly populated areas of the North-West Frontier Province (NWFP) of Pakistan. For the detection, analysis and data acquisition, a high purity germanium (HPGe) detector coupled with a high resolution multichannel analyser (MCA) was used. The range of the average values of the activity concentrations due to 40K, 226Ra and 232Th were found to be 680.3 +/- 22.2-784.4 +/- 30.7 Bq kg(-1), 36.9 +/- 3.5-51.9 +/- 3.3 Bq kg(-1) and 52.5 +/- 3.6-67.6 +/- 3.1 Bq kg(-1), respectively. Radium equivalent (Ra(eq)) activities and various hazard indices were also calculated to assess the radiation hazards. All the brick samples showed Ra, activities within the limit (370 Bq kg(-1)) set by the Organization for Economic Cooperation and Development (OECD) countries. The results of different criterion formulae also complemented each other in this study. The derived data have been compared with the reported values for other countries of the world.
Aluminum Silicates↗
Lead content of petrol and diesel and its assessment in an urban environment.
Pakistan is one of the few countries in Asia that continues to use only leaded-petrol as vehicular fuel. The concentration of Pb in its petrol reported in 1991 was the highest (1.5-2.0 g Pb L(-1)) of all produced by the various Asian countries and far exceeded the WHO's guideline of 0.15 g Pb L(-1). We have undertaken a study to trace and quantify this toxic element in the environs of Karachi. Pakistan's major metropolis, having more than 30% of the nation's total number of vehicles. In this article we report the Pb contents of petrol and diesel currently manufactured and marketed in the city. Samples of 'Regular' petrol collected in 1999 was found to contain 0.363 g Pb L(-1) (range: 0.335-0.390 g Pb L(-1)), a factor of 5 lower than that marketed prior to 1991. Its concentration in diesel fuel was much lower (0.017 g Pb L(-1)). Based on the available statistical data on the type and volume of vehicular traffic, we assessed that the current lead emission from vehicular traffic into the atmosphere is 391 metric tons a year, which is a factor of 2.7 lower than that estimated for 1989.
Air Pollutants↗
Morbidity from congenital hepatic fibrosis after renal transplantation for autosomal recessive polycystic kidney disease.
Presentation of autosomal recessive polycystic kidney disease (ARPKD) ranges from severe renal impairment and a high mortality rate in infancy to older children and adolescents with minimal renal disease and complications of congenital hepatic fibrosis (CHF), cholangitis and portal hypertension. Renal transplantation improves prognosis but it is unclear whether CHF in transplanted children follows the same clinical course as in older children with less severe renal disease. The aim of this study was to evaluate morbidity from CHF in ARPKD post renal transplantation. Data were analyzed for six males and eight females, transplanted for ARPKD (mean age 8.3 years, range 1-22.3 years) at the University of Minnesota between 1972 and 1998. Follow-up was for a mean of 14.5 years (range 3.1-33.6 years). One and 5 years patient survival rates were 93% and 86%, respectively. Overall five patients (36%) died; 4/5 deaths were related to CHF. Causes of death were hepatic failure immediately post transplant (n = 1), septicemia related to bile duct dilatation (n = 3) and multiorgan failure (n = 1). One and 5years graft survival rates were 87% and 70%, respectively. One patient had a combined liver-kidney transplant and two were re-transplanted. Initial signs of CHF were splenomegaly (n = 5), hepatosplenomegaly (n = 4) and gastrointestinal bleed (n = 2). Progression of CHF through childhood included hypersplenism (n = 7), esophageal varices with gastrointestinal bleeding (n = 5) and bile duct dilatation (n = 5). Portal hypertension was treated with portosystemic shunt (n = 3), sclerotherapy (n = 2), banding of varices (n = 1) and transjugular intrahepatic portosystemic shunt (n = 1). Of the nine survivors (mean age 12.8 years) 78% have functioning grafts (one liver-kidney transplant), 63% have portal hypertension and 22% have asymptomatic biliary dilatation. Complications of CHF developed in 79% of children who received a renal transplant for ARPKD. Mortality related to CHF occurred in 29% and accounted for 80% (4/5) of the deaths.
Adolescent↗