Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma

Anukoon Kaewborisutsakul,Thara Tunthanathip 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.3

Background: A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.Methods: In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.Results: The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.Conclusions: SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Comparison of intracranial pressure prediction in hydrocephalus patients among linear, non-linear, and machine learning regression models in Thailand

Trakulpanitkit Avika,Tunthanathip Thara 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.3

Background: Hydrocephalus (HCP) is one of the most significant concerns in neurosurgical patients because it can cause increased intracranial pressure (ICP), resulting in mortality and morbidity. To date, machine learning (ML) has been helpful in predicting continuous outcomes. The primary objective of the present study was to identify the factors correlated with ICP, while the secondary objective was to compare the predictive performances among linear, non-linear, and ML regression models for ICP prediction. Methods: A total of 412 patients with various types of HCP who had undergone ventriculostomy was retrospectively included in the present study, and intraoperative ICP was recorded following ventricular catheter insertion. Several clinical factors and imaging parameters were analyzed for the relationship with ICP by linear correlation. The predictive performance of ICP was compared among linear, non-linear, and ML regression models. Results: Optic nerve sheath diameter (ONSD) had a moderately positive correlation with ICP (r=0.530, P<0.001), while several ventricular indexes were not statistically significant in correlation with ICP. For prediction of ICP, random forest (RF) and extreme gradient boosting (XGBoost) algorithms had low mean absolute error and root mean square error values and high R2 values compared to linear and non-linear regression when the predictive model included ONSD and ventricular indexes. Conclusions: The XGBoost and RF algorithms are advantageous for predicting preoperative ICP and establishing prognoses for HCP patients. Furthermore, ML-based prediction could be used as a non-invasive method.

Venous air emboli during esophagoscopy confirmed by computed tomographic pulmonary angiography -a case report-

Tantisarasart Thadakorn,Tantichamnankul Thara,Kitsiripant Chanatthee,Choochuen Panjai 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.2

Background: Esophagogastroduodenoscopy (EGD) is vital for the diagnosis and treatment of various gastrointestinal conditions but carries a low risk of venous air embolism (VAE). We report a case of VAE during EGD, confirmed by computed tomographic pulmonary angiography (CTPA). Case: A 56-year-old male with a history of hypopharyngeal cancer underwent EGD for dysphagia-related esophageal dilation. Signs of VAE were noted, prompting swift interventions, including oxygen therapy, positional changes, and CTPA. CTPA revealed the Mercedes-Benz sign, pneumomediastinum, and a minimal pneumothorax. The patient’s oxygen saturation improved within 30 min before undergoing CTPA, and he was discharged on postoperative day 4. Conclusions: Timely recognition of VAE, resulting in appropriate interventions supported by CTPA, resulted in favorable patient outcomes.

Bioresource-derived multifunctional carbon quantum dots as a fluorescence and electrochemical sensing platform for picric acid and noncytotoxic food storage application

Bony K. John,Chinnu R. Thara,Binila K. Korah,Neenamol John,Beena Mathew 한국공업화학회 2023 Journal of Industrial and Engineering Chemistry Vol.126 No.-

This work deals with the synthesis of facile, water-soluble, and blue-emitting carbon quantum dots(CQDs) from Plumbago indica leaves by a hydrothermal method with a quantum yield of 16 %. The biomassPlumbago indica leaves exhibit several advances such as easy availability, cost-effectiveness, nontoxic,green source, and not requiring any sophisticated techniques to develop the sensor. The optical,morphological, structural, and compositional properties of the CQDs were confirmed by various characterizationmethods. As a fluorescent probe, CQDs exhibited good linear response to picric acid (PA) with alimit of detection (LOD) of 18 nM. The sensing mechanism involves a combination of static quenching andfluorescence resonance energy transfer (FRET). In the electrochemical sensing method, the differentialpulse voltammetric (DPV) technique was performed using a CQD-modified gold electrode with a LODof 0.35 nM for PA. Using fresh carrots as a model sample, the antioxidant activity of PVA, CQD, and aPVA-CQD mixture was qualitatively determined. The in vitro cytotoxicity analysis of CQDs by MTT assayusing the L6 cell line confirmed its non-toxic behaviour. This work is noteworthy because it offers a newattempt to identify toxic PA from biomass-derived precursor material and finds future applications in thefood industry.

Determinants of Participation in a Breast Cancer Screening Trial in Trivandrum District, India

Frie, Kirstin Grosse,Ramadas, Kunnambath,Anju, Gopan,Mathew, Beela Sara,Muwonge, Richard,Sauvaget, Catherine,Thara, Somanathan,Sankaranarayanan, Rengaswamy Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12

Background: Conspicuous differences in participation rates for breast self-examination (BSE), clinical breast examination (CBE), and referral for further investigations have been observed indicating involvement of a number of different factors. This study analysed determinants for participation in different levels of the breast cancer screening process in Indian females. Materials and Methods: An intervention group of 52,011 women was interviewed in a breast cancer screening trial in Trivandrum district, India. In order to assess demographic, socio-economic, reproductive, and cancer-related determinants of participation in BSE, CBE, and referral, uni- and multi-variate logistic regression was employed. Results: Of the interviewed women, 23.2% reported practicing BSE, 96.8% had attended CBE, and 49.1% of 2,880 screen-positives attended referral. Results showed an influence of various determinants on participation; women who were currently not married or who had no family history of cancer were significantly less likely to attend the screening process at any level. Conclusions: Increasing awareness about breast cancer, early detection methods, and the advantages of early diagnoses among women, and their families, as well as health care workers offering social support, could help to increase participation over the entire screening process in India.