In developing countries, where about three quarters of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. A study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight and those at risk.A study of 520 hospital births showed a strong correlation (p<0-001) between other anthropometric variables and birth weight, but the correlation was maximum for chest circumference (r=0-8696) and mid-arm circumference (r=0-8110). A mid-arm circumference of -t<8-7 cm and a chest circumference of 630 cm had the best sensitivity and specificity for identifying neonates with a birth weight of 2500 g or less. Measurements on 501 consecutive live births in the community were recorded and the infants foliowed up at specified ages. Mid-arm circumference was again significantly correlated to birth weight (r=0-6918). Neonatal mortality showed an inverse relation but postneonatal mortality an inconsistent relation with mid-arm circumference. A mid-arm circumference of <8-7 cm and a birth weight of :2500 g were equally useful in predicting neonatal outcome.Mid-arm and chest circumferences are simple, practicable, quick, and reliable indicators for predicting low birth weight and neonatal outcome in the community and can be easily measured by paramedical workers in developing nations.

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regarding trial sponsor, recruitment by country and other trial characteristics were extracted.

Background. This study aimed to identify risk factors associated with mortality of patients who undergo cardiac surgery for infective endocarditis.Methods. A retrospective review was performed of patients with infective endocarditis who underwent cardiac surgery at a quaternary Australian hospital between 2004 and 2014. Patient data were collected and prospectively analyzed.Results. In all, 465 patients underwent surgery during the study period, with 30 deaths (6.45%). Factors independently associated with in-hospital mortality were increasing age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01 to 1.07; P [ .009), active bacterial endocarditis at time of operation (OR 4.91; 95% CI, 1.01 to 23.8; P [ .048), preoperative invasive positive pressure ventilation (OR 3.65; 95% CI, 1.18 to 11.27; P [ .025), increasing cardiopulmonary bypass time (OR 1.01; 95% CI, 1.006 to 1.014; P < .001), and increasing European System for Cardiac Operative Risk Evaluation score (OR 21.73; 95% CI, 2.12 to 223.11; P < .01). Conclusions. The in-hospital mortality of patients with infective endocarditis remains significant, with potential risk factors including increasing age, active bacterial endocarditis, preoperative invasive positive pressure ventilation, increasing cardiopulmonary bypass time, and high European System for Cardiac Operative Risk Evaluation score.

ObjectiveTo determine the proportion of patients surviving their cardiac surgery who experienced non-home discharge (NHD) over a 16-year period in Australia and New Zealand (ANZ).DesignRetrospective, multicentre, cross-sectional study over the time period 01 January 2004 to 31 December 2019.SettingAdult patients who underwent cardiac surgery from the Australia New Zealand Intensive Care Society Adult Patient Database (APD).ParticipantsAdult patients (age 18 and above) who underwent index coronary artery bypass grafting, cardiac valve surgery or combined valve/coronary surgery.ExposureThe primary exposure variable was the calendar year during the which the index surgery was performed.OutcomeThe primary outcome was NHD after the index surgery. NHD included discharge to locations such as nursing home, chronic care facility, rehabilitation and palliative care.ResultsWe analysed 252 924 index cardiac surgical admissions from 101 discrete sites with a median age of 68 years (IQR 60–76), of which 74.2% (187 662 out of 252 920) were males. Of these, 4302 (1.7%) patients died in hospital and 213 011 (84.2%) were discharged home, 18 010 (7.1%) were transferred to another hospital and 17 601 (7%) experienced NHD. In Australia, 14 457 (6.4%) of patients progressed to NHD, compared with 3144 (11.7%) in New Zealand. The rate of NHD increased significantly over time (adjusted OR per year=1.06, 95% CI, 1.06 to 1.07, p<0.001). Increasing age, female sex, non-elective surgery, surgery type and Acute Physiology and Chronic Health Evaluation III Score were all associated with significant increase in NHD.ConclusionsThere was significant increase in NHD after cardiac surgery over time in ANZ. This has significant clinical relevance for informed consent discussions between healthcare providers and patients, and for healthcare services planning.

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BackgroundPolyarteritis nodosa (PAN) is a necrotizing vasculitis involving medium or small sized vessels. It is characterized by a variable clinical presentation, ranging from a benign cutaneous involvement to a more severe systemic disease with multisystem involvementObjectivesWe describe clinical and laboratory features, treatment and outcome of pediatric PAN patientsMethodsA retrospective case review of all children diagnosed as PAN at a single tertiary care hospital in north India between 1990 to 2014 was done. Diagnosis of PAN was based on European League against Rheumatism (EULAR)/Paediatric Rheumatology European Society (PRES)/Paediatric Rheumatology International Trials Organisation (PRINTO) classification criteria. (1)ResultsA total of 16 children (12 boys and 4 girls) with PAN were identified. Median age of symptom onset and diagnosis was 8 years (range 1–11 years) and 9 years, respectively. The presenting symptoms were fever (68%), CNS complaints [headache, seizures, altered sensorium, stroke or vision loss] (50%), fatigue (44%), myalgia (44%), gangrene (31%), weight loss (31%), gastrointestinal complaints [pain abdomen, bleed] (31%) and bluish black patches over body (19%). Hypertension was present in 88% patients at admission. Various neurological manifestations were seen in 62.5% patients. Skin involvement (digital gangrene, livedo reticularis, bluish black patches, erythema nodosum or necrotic ulcer) was seen in 50% patients. Renal and gastrointestinal involvements were seen in 38% patients each.CT angiography was done in 13 patients. Aneurysmal dilatation of vessels was seen in 6 patients, while 3 patients showed features of renal infarcts. CT angiography was normal in 4 patients. In 2 such patients, digital subtraction angiography (DSA) showed aneurysmal dilatation of vessels. ANCA was positive in 4 patients (c-ANCA in 3 and p-ANCA in 1). HBsAg was positive in 3 patients (not treated as liver function remained normal). ASO was positive in 4 patients (2 patients were given penicillin; one patient had a relapse with high ASO titres on stopping penicillin).Two patients had only a single visit to the clinic; hence their treatment details were not available. Treatment regimen included cyclophosphamide (78%), methylprednisolone pulses (43%), oral prednisolone (93%), maintenance azathioprine (36%), and IVIg and methotrexate (14% each). Mean follow up was for 4.8 years (range 0–25 years).Five patients experienced relapses with more than 1 relapses seen in 2 patients. Relapses were noted as early as 6 months and as late as 22 years after diagnosisConclusionsWe found a significant male preponderance in our cohort. Streptococcal infection can have a pathogenic role in the disease progression and relapse, and penicillin prophylaxis can prevent disease relapse in susceptible patientsReferencesOzen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arterit...