The effect of late-onset sepsis on mortality across different gestational ages in a neonatal intensive care unit: A historical study

ObjectivesLate-onset sepsis is a frequent complication in neonatal intensive care units. This study aims to understand the effect of late-onset sepsis on mortality in hospitalised neonatal patients across different gestational ages.DesignThis is a single-centre, historical cohort study including neonates admitted to hospital during a 10-year period (2002 – 2011). Neonates were stratified by gestational age: extremely preterm (<28 weeks), very preterm (28 to 32 weeks), late preterm (33 to 36 weeks), full term (>37 weeks).SettingTertiary NICU in Ghent, Belgium.Main Outcome MeasuresLogistic regression analysis was used to assess adjusted relationships between late-onset sepsis and mortality, reported as odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 4928 neonates were included, of which 2071 were term (42.0%), 1425 were late preterm (28.9%), 1165 very preterm (23.6%) and 264 were extremely preterm neonates (5.4%). 40 neonates developed late-onset sepsis (8.2 episodes/1000 patient days). Overall, in-hospital mortality was 5.4%. Late-onset sepsis was an independent risk factor for mortality in the total cohort (OR = 2.41; 95% CI = 1.46–3.96). However, when gestational age groups were considered separately, late-onset sepsis was associated with mortality in very preterm neonates (OR = 2.45; 95% CI = 1.03–5.84) and in the late preterm neonates (OR = 3.92; 95% CI = 1.41–10.87), but not in other neonates. Comorbidities burdening neonatal hospital survival include acute lung disease, brain damage, periventricular leukomalacia, surgery, and broncho-pulmonary dysplasia.ConclusionLate-onset sepsis is an independent risk factor for mortality in very preterm and late preterm neonates. Understanding how late-onset sepsis among other factors impact mortality enables a patient and family-centred approach to nursing care including the anticipation of realistic milestones.Implications for clinical practiceLate-onset sepsis is especially detrimental to preterm neonates and this could be taken into consideration by nurses when communicating with families in the perinatal period.     

Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments

BackgroundContradictory evidence exists regarding the clinical course of frozen shoulder (FS).ObjectivesTo explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables.MethodsPatients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR.ResultsInitially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15).ConclusionAlmost all factors improved in the early phase (3–6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.     

Development and Pilot Evaluation of an Educational Tool for the FLACC Pain Scale

BackgroundThe FLACC (Face, Legs, Activity, Cry, Consolability) pain scale is commonly used for pediatric pain assessment; however, no online educational tool exists to facilitate the use of the scale.AimsThis study aimed to develop an online educational tool and evaluate its effect on nurse knowledge, user confidence, and scoring accuracy.Design and MethodsIn phase 1, semistructured interviews were conducted to identify preferred educational features and content. Eight informants were interviewed in phase 1. Recommendations informed the development of the educational tool. Data were analyzed via conventional content analysis. Phase 2 involved a pre-post evaluation of the tool through online surveys. Posteducational data were collected immediately after the tool was completed. Wilcoxon signed rank and McNemar-Bowker tests were used to compare pre- and post-training knowledge, confidence, and FLACC scores. Scoring accuracy was examined using percentage agreement and consensus analysis.ResultsThirty-four nurses participated in phase 2. The educational tool significantly improved knowledge (p < .0001) and increased user confidence, although not to a significant level (p = .06). There was a significant improvement in correct assessment of moderate pain (p = .04). Almost all nurses correctly assessed severe pain before and after education (91%). However, there was a decrease in accurate assessment of mild pain (p = .01).ConclusionsBecause the intervention improved knowledge, user confidence, and assessment accuracy of moderate pain, it would be useful to implement such a tool as part of clinician education. However, further modifications will be needed to improve assessment of mild pain.     

早产儿肺脏的超声特征及超声评分

目的 观察早产儿肺脏的超声表现和超声评分。方法 选取无心肺疾病及低蛋白血症的早产儿37例（早产儿组）及足月儿33例（足月儿组）,并根据患儿年龄将每组分为<1周、1~4周、>4周3个亚组。对所有患儿行双肺超声检查并予以评分,观察早产儿肺脏超声表现,比较早产儿与足月儿及不同年龄间的超声评分差异。结果 早产儿肺脏超声主要表现为弥漫分布密集B线,伴或不伴"瀑布征",提示肺泡内积液。早产儿及足月儿肺部超声评分结果分别为（15.24±2.76）分和（12.21±3.62）分,差异有统计学意义（t=3.962,P<0.001）;年龄<1周的早产儿与足月儿超声评分差异无统计学意义（t=-0.669,P=0.513）,年龄为1~4周及>4周的早产儿与足月儿超声评分差异均有统计学意义（P均<0.05）。早产儿3个亚组间肺超声评分差异无统计学意义（F=0.960,P=0.393）;足月儿3个亚组间肺超声评分差异有统计学意义（F=4.277,P=0.023）。早产儿肺超声评分与胎龄呈负相关（r=-0.352,P=0.033）,其线性回归关方程为Y=33.805-0.548X。结论 早产儿肺脏超声主要表现为弥漫分布密集B线,伴或不伴"瀑布征",提示肺泡内积液,胎龄越小越显著。     

Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS)

BackgroundSeveral pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff.ObjectivesTo develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population.DesignInstrument development and psychometric analysis.MethodsPain assessments (n = 180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n = 5) and nurses (n = 26) participated in the validation of the scale.ResultsA pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses’ expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p < 0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751–0.873). The study also demonstrated high coefficients for inter-rater (r = 0.991–0.997) and intra-rater reliability (r = 0.992–1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the scale was easy to administer and that it helped decision-making in the pain management of infants.ConclusionsThe NIAPAS was shown to be a valid and reliable scale for assessing acute pain in preterm and full-term infants in the NICU. It allows nurses to evaluate infants’ acute pain especially during painful procedures and help to provide pain relief for the infants.     

Effectiveness of banana flower beverage on breast milk production among mothers of preterm neonates

BackgroundIn Thailand, banana flower is a popular galactagogue used for insufficient breast milk among lactating mothers, especially mothers with preterm neonates.AimTo investigate the effects of banana flower beverages on breast milk production among mothers with preterm neonates.MethodA randomized controlled trial was conducted among mothers with preterm neonates who were recruited and randomized into treatment group (n_t = 20) who consumed banana flower beverage and control group (n_c = 21) who received only plain water. The amount of expressed breast milk during three days postpartum was recorded and compared between the two groups.ResultsThe results showed that mothers in the treatment group had higher milk production than those in control group on Day 2 (48 ± 2 h) and Day 3 (72 ± 2 h) of postpartum. No adverse effects were reported.ConclusionBanana flower is a promising galactagogue in augmenting breast milk in mothers with preterm neonates with no adverse effects.     

A More Comfortable Method of Skin Prick Testing in Children Ages 0-2 to Decrease Symptoms of Pain

BackgroundSkin prick testing (SPT) is the best initial diagnostic method for individuals of all ages who have potential allergies.AimWe aimed to investigate if recent breastfeeding has any effect on reducing the pain of children before SPT.DesignProspective, randomized, single-blinded study.SettingsAcademic hospital specialized in pediatrics.Participants/SubjectsSixty-four out of seventy-five children requiring SPT within ages 0-2 were included.MethodsAll participants in this study were breastfed children, and that group assignment randomized them to the control group (n = 32) if children breastfed 30-90 min. prior to arriving for SPT, and study group of children (n = 32) who were also breastfed 30-90 minutes prior to arriving for SPT who were then breastfed again just prior to the beginning of the SPT. The FLACC pain scale was used to test the sensitivity of all children for pain before, during, and 15 minutes after the SPT. The effect of breastfeeding on the pain score and the duration of crying were compared among groups.ResultsBoth groups were similar according to age, gender, and other socio-demographic characteristics (p > .05). The percentage of children that cried during SPT was significantly higher in the control group than the study group (p = .002). The FLACC pain scale values were significantly lower in the study group (p < .001).ConclusionRecent breastfeeding before SPT is correlated with less crying by possibly reducing the perceived pain of children ages 0-2.     

Effect of tactile–kinesthetic stimulation on growth,neurobehavior and development among preterm neonates

BackgroundPreterm neonates are at risk of delayed growth and development. Hence, early tactile–kinesthetic stimulation (TKS) is required to improve their growth and development.ObjectiveTo evaluate the effect of TKS on growth, neurobehavior and development among preterm neonates.MethodAn interventional study was conducted from August 2015 to July 2017 in the neonatal unit of Dr. Cipto Mangunkusumo Hospital. Preterm neonates were recruited via random sampling and divided into two groups (the intervention group and control group). TKS was performed for 15 min, three times a day, for 10 days. The anthropometric measurements, neurobehavior (Dubowitz score) and development (Capute Scale score) of neonates in both groups were assessed.ResultsThere were 126 preterm neonates (n = 63 in each group). During the 10-day TKS period, the intervention group had a significant increment in weight and length compared to the control group (p < 0.05) at 11–14 days, at term and 3 months. Moreover, increased tone, reflexes, and improvement in behavior based on the Dubowitz score were observed during monitoring. However, the result did not differ significantly (p > 0.05). There was no significant difference in terms of cognitive and language development in both groups (Developmental Quotient of Clinical Linguistic Adaptive Milestone Scale, Developmental Quotient of Clinical Adaptive Test and Full Scale Developmental Quotient scores, p > 0.05).ConclusionTKS was significantly effective in promoting growth, particularly weight and length, among preterm neonates. However, it did not significantly influence neurobehavior and development at 3 months of chronological age.     

Do clowns attenuate pain and anxiety undergoing botulinum toxin injections in children?

ObjectiveBotulinum toxin injection (BTI) is the primary treatment for spasticity in children. Anxiety and pain are important concerns to address to attenuate the discomfort of BTI. The aim of this study was to compare the effectiveness of medical clowns and usual distractions, both added to nitrous oxide (N₂O) and analgesic cream, on pain and anxiety during BTI sessions in children.MethodsThe primary outcome was pain evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Secondary criteria were pain rated on a Visual Analog Scale (VAS) by the child and parent, anxiety rated on a VAS before and during BTIs by the child and parent(s), rating of the success of the sessions on a 4-point Likert scale by the physician and parent(s), and rating of the benefits of the distraction by the parent(s). Non-parametric tests were used for between-group comparisons.ResultsBaseline group characteristics of the clown and control groups did not differ. During 88 BTI sessions (40 with clown distraction and 48 with control distraction) in 59 children (35 boys; 52 with cerebral palsy, 12 with moderate to severe cognitive disorders), median maximal FLACC score was 2.5 (interquartile range [IQR]: 1–4) in the clown group and 3 (IQR: 1–4.3) in the control group. VAS self-reported pain score was 2.5 (IQR: 0–5) and 3 (IQR: 1–6.3) in the clown and control groups (P = 0.56), and VAS proxy-reported pain score was 2.5 (IQR: 0.3–3.4) and 3 (IQR: 1–4.5) (P = 0.25). After BTI sessions, the 2 groups did not differ in VAS self- and proxy-reported anxiety (P = 0.83 and P = 0.81). Physician and parent ratings of the success of sessions were similar between the groups (P = 0.89 and P = 0.11). Parent ratings of the perceived benefits of distraction were higher in the clown than control group (P = 0.004).ConclusionsAlthough clown distraction was particularly appreciated by parents, it did not significantly reduce pain or anxiety in children as compared with usual distraction.Trial registrationClinicalTrials.gov ID: NCT03149263.     

Comparison of the repercussions of cLBP in four French-speaking countries

IntroductionSociocultural factors may influence the impact of chronic low back pain (cLBP) on patients. The goal of this study was to compare pain and disability levels, and psychobehavioural parameters in four French-speaking countries in patients with cLBP.MethodsTwo hundred and seventy-eight patients were included: 83 in France, 36 in Morocco, 75 in the Ivory Coast and 84 in Tunisia. Demographic data were collected; pain was assessed using a visual analogue scale (VAS), disability with the Quebec scale, psychobehavioural factors by the hospital anxiety depression scale (HAD), the fear and avoidance beliefs questionnaire (FABQ) and the coping strategy questionnaire (CSQ). A Student t-test was used to compare means. Anova (covariance) was used to test for a “Country Effect”, i.e. the incidence of country on outcomes.OutcomesThere was no difference in disability levels between countries. A “country effect” was found (p < 0.001) for pain (F = 2.707), anxiety (F = 3.467), depression (F = 5.137), fear and avoidance beliefs regarding professional activity (F = 1.974) and physical activity (F = 5.076), strategy of distraction, dramatization, efforts to ignore pain, prayer, seeking social support and reinterpretation (p < 0.01). Pain level was higher in Morocco (p < 0.05); anxiety, depression, fear and avoidance beliefs about physical activities were higher in Tunisia (p < 0.05) and fear and avoidance beliefs about professional activities were higher in the Ivory Coast (p < 0.01). Among the coping strategies used, distraction, dramatization, prayer and search for social support were used more in the Ivory Coast; reinterpretation in Tunisia; seeking social support was less common in France.ConclusionIn this population of patients with cLBP, despite similar disability levels across the four French-speaking countries, there were considerable variations in pain level and psychobehavioural repercussions.     

Reference intervals for preterm thyroid function during the fifth to seventh day of life

BackgroundDue to the lack of reference intervals for serum free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) in preterm neonates during the 5th to 7th day of life, we performed a retrospective study using the chemiluminescence immunoassay system.MethodsA total of 2040 preterm neonates with a gestational age (GA) of 26–35 weeks in the neonatal intensive care unit from 2014 to 2019 were included. Their serum FT3, FT4 and TSH values were calculated and analyzed to establish reference intervals for preterm neonates stratified by GA. The comparisons of FT3, FT4 and TSH were made by sex (males and females) and gestational age (26–28 weeks; 29–32 weeks; 33–35 weeks).ResultsThe reference intervals for FT3, FT4 and TSH in preterm neonates with a GA of 26–35 weeks were (1.65~5.21) pmol/L, (8.64~25.41) pmol/L, and (0.406~12.468) mlU/L, respectively. There were significant differences between serum FT3 and FT4 values and GA, while TSH levels were not significantly different (P < 0.01). The serum FT3 values of males were lower than those of females, especially in the 29–32 weeks group. No significant differences in serum values between sexes were found in FT4 or TSH (P > 0.05).ConclusionReference intervals of thyroid function tests were established to determine the early diagnostic criteria of thyroid diseases for neonates with a GA of 26–35 weeks and to avoid unnecessary retesting and interventions. The reference intervals of FT4 can be used as an indicator to regulate the doses of thyroid hormone supplement in the treatments of congenital hypothyroidism.     

An Analysis of Time to Improvement in Oxygenation in Japanese Preterm and Late Preterm or Term Neonates With Hypoxic Respiratory Failure and Pulmonary Hypertension

PurposeWe analyzed data from an ongoing registry to determine time to improvement in oxygenation in preterm and late preterm or term neonates with hypoxic respiratory failure and pulmonary hypertension receiving inhaled nitric oxide (iNO) in Japan.MethodsRegistry neonates received iNO ≤7 days after birth (February 26, 2010, to October 9, 2012). Efficacy and safety profile data were collected up to 96 h after iNO initiation and, if necessary, every 24 h thereafter and before iNO discontinuation. Patients were stratified by gestational age (GA), oxygenation index (OI), and shunt direction at baseline.FindingsData were evaluated for 1106 neonates (431 with a GA <34 weeks and 675 with a GA of ≥34 weeks). Sixty percent of patients had improved OI; rates were similar for those with GAs of <34 versus ≥34 weeks (61% vs 59%). Overall, mean time to improvement was 11.4 h and tended to be shorter in the groups with a GA <34 weeks versus ≥34 weeks (9.2 vs 12.9 h). Thirty percent of responding neonates required >1 h to achieve improvement in oxygenation. Neonates with higher baseline OI had the greatest decrease in OI during the first hour of treatment. The mortality rate was higher among iNO-treated patients with a baseline OI ≥25 versus those with OI ≥15 to <25 (25% vs 12%; P = 0.0073).ImplicationsiNO treatment provided acute, sustained improvement in oxygenation in neonates with GAs <34 and ≥34 weeks; 70% of patients had improvement within 1 h, but the remaining 30% took >1 h to respond. Initiation of iNO at lower OIs was associated with reduced mortality compared with higher OI.     

Pain during injections of botulinum toxin in children: Influence of the localization technique

ObjectiveIn this study, we consider two localization techniques used in injections of botulinium toxin in children: electrical stimulation and ultrasound. The hypothesis of this work was that injections performed without stimulation would be less painful.Patients and methodsMonocentric prospective study, with 107 sessions of lower limb injections. Two groups of children were compared: localization by ultrasound only (60 children), detection by stimulation only or by stimulation combined with ultrasound (47 children). Pain assessment was performed by the child or an accompanying party using the Visual Analog Scale (VAS) and by a health care team using the Face, Legs, Activity, Cry, Consolability (FLACC).ResultsA significant difference between the two groups was found in both self-report and by means of the behavioral observational pain scale. Indeed, VAS average and FLACC average were significantly higher with detection by stimulation than with ultrasound alone: 4.5 cm ± 2.54 versus 2.7 cm ± 2.27; P < 0.001 for VAS scale and 3.7 ± 2.1 versus 2.7 ± 2.3; P < 0.05 for FLACC scale.ConclusionWhen compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children.     

Reference ranges of presepsin (soluble CD14 subtype) in term and preterm neonates without infection,in relation to gestational and postnatal age,in the first 28 days of life

ObjectiveTo determine the reference ranges of presepsin in term and preterm neonates without infection, with respect to gestational and postnatal age, within the first 28 days of life.MethodsA total of 144 neonates born at 24–42 weeks’ gestation, including healthy term and preterm neonates without clinical signs or symptoms of infection, were included in this prospective observational study. Presepsin measurements included cord blood levels and serum levels on postnatal days 1, 3, 5, 7, 14, 21, and 28.ResultsThe presepsin values corresponding to the 10th percentile ranged from 240.8 pg/mL (on day 1) to 129.9 pg/mL (on day 28), whereas those corresponding to the 90th percentile ranged from 725.8 pg/mL (on day 1) to 471.6 pg/mL (on day 28). Significantly higher presepsin levels were observed in cesarean deliveries than in spontaneous deliveries (p: 0.012 to <0.001), in gestational ages ≤ 32 weeks than in gestational ages ≥37 weeks (p: <0.05 to <0.001), and in cases with a maternal history of chorioamnionitis than in those without (p: <0.05 to <0.001).ConclusionIn conclusion, our findings revealed, for the first time, the reference ranges of presepsin in healthy term and preterm neonates without infection with respect to gestational and postnatal age, sex, and body weight. Presepsin levels within the first 28 days of life seem likely to be affected by the type of delivery, gestational and postnatal age, birth weight, and presence of respiratory distress syndrome or maternal chorioamnionitis.     

Predictors of survival among preterm neonates admitted to Debre Tabor Comprehensive Specialized Hospital,Northwest Ethiopia; Implication for the maternal and neonatal health care-services

IntroductionPreterm neonatal death is one of the world's most pressing problems, especially in Ethiopia, despite the implementation of extensive prevention initiatives. As a result, the goal of the study was to determine the incidence of neonatal mortality among preterm neonatal admissions in the hospital setting.MethodsThe study was conducted among preterm neonatal admissions at Debre Tabor Comprehensive Specialized Hospital from January 1, 2014, to December 30, 2017. Cox regression model was used for analysis. Variables with a p-value of 0.2 in the log-rank test were taken to multivariable cox regression analysis and level of statistical significance was declared at P- value ≤ 0.05.ResultsAccording to current study, the overall rate of premature death was 31.2 per 100 live births (95% CI: 27.3, 35.1). Males ((Adjusted Hazard Ratio (AHR) = 1.38; 95% CI: 1.01, 1.90), neonates under 32 weeks of gestational age (AHR = 1.74; 95% CI: 1.24, 2.46), neonate born from preeclampsia mothers (AHR = 1.95; 95% CI: 1.13, 3.36), neonate with extremely very low birth weight (AHR = 2.94; 95%CI: 1.05, 8.24), and neonate having respiratory distress syndrome (AHR = 1.70; 95% CI: 1.20, 2.41) were significantly associated with preterm mortality.ConclusionThe burden of preterm mortality at hospital setting was high. As a result, reducing and treating preeclampsia is critical in lowering neonatal mortality. In addition, very low birth weight newborns and premature neonates with respiratory distress syndrome should be given special attention. Considering of every premature neonates as a danger of death, essential care such as; kangaroo mother care, feeding, infection prevention, oxygen therapy, thermal care, close follow-up, and medication administration should be considered.     

Soluble receptor for advanced glycation end products in physiological and pathological pregnancy

ObjectiveThe receptor for advanced glycation end products, RAGE, has been implicated in pathogenesis of many diseases. Soluble RAGE, sRAGE, extracellular domain of RAGE, is new biomarker. The aim of the study was to determine sRAGE levels in physiological pregnancy and their changes in pregnancies complicated by preterm labor or preeclampsia.Design and methodsSerum levels of sRAGE were determined in 79 healthy pregnant women, 42 pregnant women in preterm labor or with preeclampsia and 24 non-pregnant controls.ResultssRAGE serum levels are decreased in physiological pregnancy compared to healthy non-pregnant controls (p < 0.001). Serum sRAGE concentrations are higher in the 2nd trimester of physiological pregnancy, compared to the 1st and 3rd trimesters of pregnancy (p < 0.001). sRAGE levels in women with preterm labor are decreased (p < 0.05) and correlate negatively with the leukocyte count (r = -0.47, p < 0.05). In women with preeclampsia, sRAGE is elevated (p < 0.05) and correlates with serum creatinine concentration (r = 0.54, p < 0.05) and with uric acid concentration (r = 0.51, p < 0.05).ConclusionOur results clearly demonstrate significant differences in serum sRAGE levels in physiological pregnancy and in pathological states in pregnancy, however, further studies are required demonstrate the usefulness and significance of sRAGE.     

Validation of an Arabic version of the Oswestry index in Saudi Arabia

ObjectiveThe aim of this study was to adapt and validate the Tunisian version of the Oswestry Disability Index (ODI) within a Saudi Arabian population.MethodThe translation of items 8 and 10 taken out of the Tunisian version was conducted according to Beaton's method. Adaptations were made after a pilot study on 100 patients. The validation study included 100 patients suffering from chronic low back pain aged 18 to 65 years old. Intra-observer reliability was assessed using the intra-class coefficient (ICC). Spearman rank correlation coefficient, the Kruskall–Wallis test and factor analysis were used to evaluate construct validity (convergent and divergent validity). Internal consistency was assessed by Cronbach's alpha coefficient.ResultsOne hundred Saudi patients were included in the study. Intra-observer reliability was excellent (ICC: 0.99). The correlations of the index with the VAS pain scale (r = 0.708), the Roland–Morris Low Back Pain Disability (r = 0.656), and the Quebec Back Pain Disability Scale (r = 0.792) suggest good construct validity. Factor analysis unveiled two main factors explaining a cumulative percentage variance of 63.5%. The first factor represents static activities and the second factor represents dynamic activities.ConclusionThe Arabic version of the ODI adapted to the Saudi population has high metrological qualities. Further studies assessing its responsiveness to change should be conducted.