Mihaela Moscalu

Predicting mortality in haemodialysis patients: a comparison between lung ultrasonography, bioimpedance data and echocardiography parameters

BACKGROUND The use of lung ultrasonography to evaluate extravascular lung water and its consequences has received growing attention in different clinical areas, including, in recent years, end-stage renal disease patients treated by haemodialysis (HD). Lung congestion is a direct consequence of either overall overhydration and/or cardiac dysfunction, but the exact contribution of each of these tests to mortality is unknown. METHODS In this prospective observational study, we enrolled 96 patients from a single HD unit undergoing thrice weekly HD. We used three different methods of evaluation: lung ultrasonography (pre- and post-dialysis), bioimpedance spectroscopy (pre- and post-dialysis) and echocardiography (pre-dialysis). The objective of the study was to test for the first time the prognostic value of ultrasound lung comets (ULC) combined with bioimpedance-derived data [total body water (TBW), extravascular water, hydration status-ΔHS] and several echocardiographic parameters. Mortality was analysed after a median of 405.5-day follow-up. RESULTS Pre-dialysis lung congestion was classified as moderate (ULC = 16-30) in 19.8% of the patients and severe in 12.5% of patients (ULC > 30), while only 19.8% appear to be hyperhydrated (ΔHS > 15%). The pre-dialysis ultrasound lung congestion score correlated significantly with all of the bioimpedance-derived parameters. In a multivariate Cox model that included ULC score, demographic, ecocardiographic and bioimpedance parameters, the factors that remained significantly associated with survival time were the pre-dialysis ULC score and left ventricular mass index. The pre-HD ULC score has a significant discriminating power for survival, while the bioimpedance-derived hydration status has no discriminatory abilities in terms of survival. CONCLUSIONS To our knowledge, this study is the first one that compares three different strategies to predict mortality in haemodialysed patients. The lung comet score emerged as the best predictor for the relationship hydration status-mortality, independently of bioimpedance-derived parameters in this population.

High-dose phenobarbital or erythropoietin for the treatment of perinatal asphyxia in term newborns

The aim of this study was to compare two neuroprotective strategies to supportive care in the treatment of perinatal asphyxia.

Assessment of Tumor Parameters as Factors of Aggressiveness in Colon Cancer

Background: Colorectal cancer is a major public health problem worldwide. Tumor volume associated with the number of positive lymph nodes may be a new predictor of 5-year survival in colon cancer. Material and Methods: We conducted a retrospective study of a prospective database that included all patients diagnosed with colon cancer (CC) between May 2012 and September 2013 in the Surgical Oncology Clinic of the Iasi Regional Cancer Institute. The patients underwent surgical resection and two tumor sizes were recorded. Tumor characteristics and their potential role in tumor aggressiveness were analyzed. Results: The study group included 138 patients, of which 38 (27.54%) with metastases and 100 (72.46%) without metastases. Maximum tumor diameter showed significant differences depending on the degree of differentiation and histological type, and was significantly correlated with the total number of evaluated and positive lymph nodes (p=0.009 and p=0.00, respectively). Tumor volume was influenced by male gender (p=0.0404), tumor stage (p=0.0192), and type of tumor invasion (p=0.0159) in 23.02 % of cases (p=0.02809). Maximum tumor diameter and tumor volume had poor discriminatory power in predicting survival. Conclusions: A statistically significant association was found between the metastatic group and advanced disease stages. Maximum tumor diameter and tumor volume could not predict overall survival of patients.

A local sensitivity study for an activated T-cell model

In this paper we carry out a local sensitivity study with respect to parameters and initial conditions for an activated T-cell model describing virus dynamics. Using QR decomposition with column pivoting to the relative sensitivity matrix we compute the relative identifiability and sensitivity of the parameters and establish orderings with respect to their identifiability.

Recurrent respiratory tract infections in children

Respiratory tract infections are one of the major complaints in preschool children. The aim of this study was to highlight the particularities of recurrent respiratory tract infections manifested by ETN and pulmonary infections in children. Materials and methods: The authors performed a retrospective study of 148 patients aged between 2 months and 5 years old, hospitalized with the recurrent respiratory infections. We assessed the risk factor of RRI in children. In the control group were included 40 pediatric patients with abdominal pain sindrome without respiratory infections. Results: The most common clinical forms of RRI in our study included: acute otitis media − 58.31% of cases and/or recurrent pneumonia − 51.16 % of cases, chronic adenoiditis − 60.46% of cases. The authors observed a significant association between RRI and breastfeeding (p=0.0035), school-aged siblings (p=0.0013), immunodeficiencys (p=0.002), recurrent use of antibiotics (p≪0.001), early socialization (in day-care centers) (p=0.0316). In conclusion, the risk factors identified in the study group responsible for RRI were: the duration under 4 months of natural food, the presence of older siblings in the family attending the community, comorbidities (immunodeficiency, malnutrition, iron deficiency anemia, rickets) antibiotics, and early socialization.

Prevention of cardiovascular risk factors in childhood obesity

Childhood overweight and obesity are related to cardiovascular risk (CVR) factors (hypertension, type 2 diabetes mellitus, abnormal lipid profiles and increased risk of adult obesity and high morbidity and mortality rates. Methods: We performed a retrospective study of 78 overweight and obese children, hospitalized in a Pediatric Clinic from Saint Mary Hospital Iasi, 42 girls and 37 boys. The nutritional status was evaluating using BMI (body mass index) and BMI percentiles (overweight was defined as a BMI within the 85th to 95th percentile and obesity > 95th percentile). The cardiovascular risk parameters were defined by age and sex. Results: From the study group, 58% of children were obese (67% of boys and 50% of girls). Elevation of triglycerides was found in 28.2% of the patients and decreased HDL-cholesterol was present only in 2 patients. Medium and high cardiovascular risk was found in 14.1%, respectively 4% of children. Regression analysis of cholesterol showed a significant correlation with the values of systolic blood pressure. Among overweight children (37% of children), medium cardiovascular risk was found in 9% children. Conclusions: Identification and treatment of CVR factors in childhood is important in order to reduce or prevent premature cardiovascular diseases in adults.

Pulse Oximetry During the First 24 Hours as a Screening Tool For Congenital Heart Defects

Abstract Introduction: Although screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged. Aim: To assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD. Material and Methods: In this prospective study, all infants born in “Cuza Voda” Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD. Results: 5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD. Conclusion: Routine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.

The Role of Follow-up in Monitoring the Outcomes of Prematurity in a Cohort of Romanian Infants.

Background: The rate of preterm births in Romania is one of the highest among European countries. However, there is little information regarding the ways in which premature birth affects the outcome in Romanian preterm infants. Aims: To investigate the effects of early developmental intervention after discharge from the hospital on motor and cognitive development in preterm infants. Study Design: Longitudinal observational study. Methods: We performed the Amiel-Tison neurologic evaluation at discharge and the Bayley Scales of Infant Development from 3 to 24 months. Based on these evaluations, an outcome score was formulated. Results: Between 2007 and 2010, 1157 of 2793 premature infants were included into the study. There was a negative correlation between the number of evaluations and the risk of developing neurologic sequelae (p<0.001). The correlation analysis demonstrated a significant association between the final category of risk at the end of the follow up program and the degree of compliance (p<0.01). At 24 months evaluation, there was a correlation between the low gestational age and the risk of developing severe neurologic sequelae (p<0.001). Conclusion: This study shows the importance of follow up program in decreasing the risk of developing neurologic sequelae in preterm infants.

OC-82 The role of cerebral and splanhnic saturation for the outcome of newborns with necrotizing enterocolitis

Near-infrared spectroscopy (NIRS) to measure somatic and cerebral saturations is increasingly used in Neonatal Intensive Care Units for the monitoring of various conditions, including congenital heart defects, renal disease or intestinal conditions. Splanchnic saturation is used for predicting impending necrotizing enterocolitis (NEC), but its’ fluctuations make it rather difficult to analyse. The Somatic-Cerebral Oxygenation Ratio (SCOR) has been developed recently to monitor healthy term and preterm infants as well as sick children as a more stable measurement of overall oxygenation. Material and methods We conducted a prospective study over three years (2014–2016) on 61 newborns, 38 preterm infants with clinical signs of NEC and 23 infants used as control group. We simultaneously measured cerebral and splanchnic saturations through NIRS. We calculated the Receiver Operating Characteristics Curve for all the parameters, in order to assess their value as predictive factors for NEC. Results The preterm infants who developed NEC had a mean gestational age of 31 weeks (IQR=27–33 weeks) and a mean birth weight of 1311 grams (IQR 900–1850). Splanchnic saturations had values between 15% and 69% in infants with NEC and 54%–88% in infants without NEC, with statistically significant differences between the two groups (p<<<0.01). Cerebral saturations had values between 15% and 85% in infants with NEC and 62%–95% in infants without NEC, also with significant differences (p<<<0.01). SCOR had values of 0.25–1.03 when NEC was diagnosed and 0.61–1.16 when NEC was absent (p<<<0.01). The area under the curve (AUC) is 0.914 for splanchnic saturation, 0.840 for cerebral saturation and 0.747 for SCOR (p<<<0.01). Conclusions SCOR is significantly different in infants with and without NEC. Both its’ sensitivity and specificity are lower than those of splanchnic saturation, but SCOR can be preferred in the clinical settings due to its’ smaller variations.

OC-81 Umbilical cord ghrelin levels in newborns with intrauterine growth restriction

Ghrelin is a hormone produced in the gastrointestinal tract which functions in the hypothalamus as an appetite-regulating neuropeptide. It has been linked to inducing appetite and various feeding behaviours. Because of this, ghrelin is involved in the metabolic pathway of the ‘thrifty phenotype’, a condition in which the infant with intrauterine growth restriction (IUGR) develops obesity and metabolic syndrome later in life. Ghrelin is composed of two molecular forms, the acylated and the non-acylated ghrelin (NA-Ghr), which modulate each other’s activity. We aimed to ascertain the values in the umbilical cord blood of NA-Ghr in infants with IUGR and their correlation with anthropometrical parameters at birth. Material and methods We performed a prospective comparative study on two groups of newborns, 19 with IUGR and 20 without IUGR, born between March and July 2016 in the Cuza-Voda Clinical Hospital of Obstetrics and Gynaecology. We collected cord blood samples and we analysed them through ELISA in order to determine NA-Ghr. Data was then interpreted in order to establish correlations between the values we obtained and anthropometrical parameters at birth. The statistical significance was established at p=0.05. Results The two lots were comparable regarding gestational age, but there were significant statistical differences regarding birth weight, length, ponderal index, head and chest circumferences. NA-Ghr had values of 103 pg/ml (0–474 pg/ml) in the study group and 118.6 pg/ml (8.74–293) in the control group, with significant statistical differences (p=0.0003). NA-Ghr is directly correlated with birth weight (p=0.001), length (p=0.01), head circumference (p=0.0001) and chest circumference (p=0.0001), but it is not correlated with gestational age (p=0.087). Conclusion NA-Ghr has lower mean values in newborns with IUGR, although it has a greater variability. Its’ role in the neonatal period is poorly understood. More studies are needed to compare these values with total ghrelin, acylated ghrelin and to monitor the dynamics of these hormones during infancy.