Sandeep Kumar Kanwal

Reporting standards for Bland–Altman agreement analysis in laboratory research: a cross-sectional survey of current practice

Background and objectives To carry out a cross-sectional survey of the medical literature on laboratory research papers published later than 2012 and available in the common search engines (PubMed, Google Scholar) on the quality of statistical reporting of method comparison studies using Bland–Altman (B-A) analysis. Methods Fifty clinical studies were identified which had undertaken method comparison of laboratory analytes using B-A. The reporting of B-A was evaluated using a predesigned checklist with following six items: (1) correct representation of x-axis on B-A plot, (2) representation and correct definition of limits of agreement (LOA), (3) reporting of confidence interval (CI) of LOA, (4) comparison of LOA with a priori defined clinical criteria, (5) evaluation of the pattern of the relationship between difference (y-axis) and average (x-axis) and (6) measures of repeatability. Results and interpretation The x-axis and LOA were presented correctly in 94%, comparison with a priori clinical criteria in 74%, CI reporting in 6%, evaluation of pattern in 28% and repeatability assessment in 38% of studies. Conclusions There is incomplete reporting of B-A in published clinical studies. Despite its simplicity, B-A appears not to be completely understood by researchers, reviewers and editors of journals. There appear to be differences in the reporting of B-A between laboratory medicine journals and other clinical journals. A uniform reporting of B-A method will enhance the generalizability of results.

Accurate Estimation of Body Surface Area in Under-5 Children with Non-Edematous Severe Acute Malnutrition

OBJECTIVE To determine the accuracy of commonly used body surface area (BSA) equations and to devise a new equation for BSA calculation in non-edematous severe acute malnourished (NE-SAM) children. METHODS Children aged between 2 months and 5 years fulfilling World Health Organization criteria for NE-SAM were included. Seven commonly used equations were used for calculating the BSA. Mean BSA from the equations was used as reference for comparison. A new equation SAM Mosteller modified was also derived. RESULTS A total of 471 children were included. Of the seven equations, Mosteller had minimum root mean square error (RMSE) value of 2.89. The goodness of SAM Mosteller modified equation was subsequently compared with Mosteller and Boyd in 66 NE-SAM children. The SAM Mosteller modified showed least RMSE (2.65), whereas Boyd had maximum. CONCLUSIONS Among seven equations, Mosteller is useful for BSA calculation in NE-SAM. SAM Mosteller modified equation (164.551 × [Ht × Wt](0.5)) has least error and can serve as best measure of BSA in SAM children.

Plasmodium vivax malaria complicated by splenic infarct

Abstract An 11-year-old girl presented with Plasmodium vivax malaria complicated by shock and acute renal failure. The diagnosis of malaria was based on demonstration of trophozoites of P. vivax in the peripheral blood smear and a positive rapid malarial antigen test for P. vivax but negative for P. falciparum. She responded to parenteral artesunate and supportive care. During the course of her infection, she developed pain in her left hypochondrium. Ultrasonography showed multiple hypo-echoic lesions in the spleen and CT scan revealed multiple splenic infarcts. Management was restricted to close clinical monitoring and analgesia. We consider that this is the first report of splenic infarct complicating the course of childhood P. vivax malaria in the English literature. Physicians should suspect and investigate for this rare complication if a patient with malaria complains of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during the course of malaria infection.

Hyponatremic-Hypertensive Syndrome: Think of Unilateral Renal Artery Stenosis

Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder, in which hypertension is associated with profound hyponatremia. It is mostly encountered in adults with unilateral renal artery stenosis. Although renovascular hypertension is one of the commonest causes for severe hypertension in children, HHS is rarely reported in childhood. The authors report a 9-y old boy with hypertensive emergency and severe hyponatremia due to unilateral renal artery stenosis who was successfully managed by vascular stenting of the affected vessel. Prompt recognition of this disorder can be life-saving and can subsequently lead to appropriate referral and treatment as in the present case.

Post-diphtheritic neuropathy: a clinical study in paediatric intensive care unit of a developing country.

Summary A retrospective study was done on 48 consecutive patients with clinical diagnosis of postdiphtheritic neuropathy admitted to the paediatric intensive care unit of tertiary care hospital in North India between January 2008 and December 2010 to study the clinical profile of post-diphtheritic neuropathy in children. The case records were reviewed and information regarding personal details, clinical features, recovery parameters and outcome was recorded using a predesigned proforma. Median age was 4.25 years. All cases were unimmunized. Median latency period was 15 days. Of the children, 52% had palatal palsy whereas 48% had limb weakness initially. Median duration of progression of weakness was five days. Limb muscle weakness was present in 94%. Respiratory muscles were involved in 85.4% cases and 60.4% required mechanical ventilation, while 14.6% had fatal outcome and 10.4% had hypoxic neurological injury. Boys were affected more. Median duration of latency was shorter; muscle weakness, progression and recovery were faster as compared with observational studies in adults.

Pseudohypoaldosteronism type 1: management issues.

We report a newborn girl with life-threatening hyperkalemia and salt wasting crisis due to severe autosomal recessive multiple target organ dysfunction pseudohypoaldosteronism type 1 (MTOD PHA1). She was aggressively managed with intravenous fluids, potassiumlowering agents, high-dose sodium chloride supplementation and peritoneal dialysis. Genetic analysis revealed a homozygous mutation of the α- ENaC (epithelial Na+ channel) gene. She had a stormy clinical course with refractory hyperkalemia and prolonged hospitalization. Eventually, she succumbed to pneumonia and septicemia at 4 months of age. This is probably the first case of PHA1 confirmed by genetic analysis from India.

Congenital Central Hypoventilation Syndrome with PHOX2B Gene Mutation: Are We Missing the Diagnosis?

Congenital Central Hypoventilation Syndrome is a rare disorder of autonomic and central nervous system dysfunction with impaired control of breathing. The authors report a 37- d-old girl infant with recurrent apnea requiring repeated mechanical ventilation with no evidence of neuromuscular, cardiac or lung disease. A mutation analysis of PHOX2B gene revealed 25 polyalanine repeat expansion mutation on chromosome 4p12. This article aims at raising awareness among pediatricians about molecular basis and availability of confirmatory genetic testing for diagnosis and to help with prognosis in this disorder.

Multiple splenic abscesses in a child with enteric fever treated by percutaneous aspiration and antibiotics

Multiple splenic abscesses are a condition associated with high mortality if there is delay in the diagnosis and initiation of specific treatment. Salmonella typhi as an etiological cause of multiple splenic abscesses is a distinct rarity. In the past treatment for splenic abscess including in enteric fever was splenectomy however; conservative treatment by percutaneous drainage is increasingly being reported for isolated splenic abscess and now for multiple splenic abscesses. We report a child with enteric fever who presented with multiple splenic abscesses and was successfully treated by percutaneous aspiration and antibiotics.

Reporting quality of trial abstracts—improved yet suboptimal: A systematic review and meta‐analysis

We conducted a systematic review and meta‐analysis of literature to determine if the publication of the Consolidated Standards of Reporting Trials (CONSORT) abstract guideline in 2008 was followed by change in reporting quality of randomized controlled trial (RCT) abstracts.

Predictors of Altered Sensorium at Admission in Children with Diabetic Ketoacidosis: Authors' Reply.

To the Editor: We thank Dr. Rosival for comments on our paper [1]. It was quoted in our article that bicarbonate therapy is associated with risk of cerebral edema (CE) and for that, article by Glaser were referred [2]. However, the recent article by Glaser et al. [3] has reviewed various aspects including treatment associated factors that lead to CE. Authors conclude that there is no clear association between any aspect of DKA treatment and CE. CE cannot be solely attributed as a consequence of DKA treatment, although it is possible that some aspects of treatment may worsen pre-existing cerebral injury. It also acknowledges that most of the studies are retrospective and robust evidence from RCT is lacking. That is very much true and also is the truth that it is difficult to carry out RCT’s on various aspects of DKA management. However, till more comprehensive data is collected various available guidelines recommend that there is possible risk of CE with bicarbonate therapy, which is still conclusively not disproven. Secondly, depending upon severity, majority of children with DKA present with altered sensorium at admission in emergency [1] whereas only 1 % of children develop CE during DKA [3]. The altered sensorium at initial examination in an emergency department could be possibly related to various factors like acidosis, dehydration, ketosis, infections or CE. Overt CE as a cause of altered sensorium is diagnosed in only 5–20 % of children at initial presentation but is known to occur more frequently during subsequent DKA treatment [4]. Few reports also mention subclinical cerebral edema at presentation in emergency [5]. Our study looked at the various factors responsible for altered sensorium at initial admission and acidosis was found to be a significant factor. Altered sensorium seen at initial presentation gradually improves with DKA treatment as the metabolic disturbances get corrected. Lack of improvement or deterioration in mental status during DKA treatment should alert for development of CE besides the clinical suspicion at initial presentation in emergency. How acidosis is causing altered sensorium is not exactly known. Whether it is acidosis per se or ketosis is inducing altered sensorium, cannot be reliably commented upon on basis of this study. Also, the effect of acidosis on muscle phosphofructokinase is known but exact effects on brain cells may be different [6]. Thus, on the basis of current study and other accumulated evidence till date it can not be reliably said whether bicarbonate therapy can be recommended or not for routine management of DKA in children.