Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic

Automated external defibrillators (AED) have been recommended for use in outpatient dialysis clinics to improve outcomes from cardiac arrest, the most common cause of death in patients with ESRD. The effectiveness of this policy is unknown. The study cohort consisted of 43,200 hemodialysis patients in the US Gambro Healthcare System from 2002 to 2005. Of these, 729 patients who sustained an in-center cardiac arrest were identified. Baseline characteristics at the time of the event were compared between patients who underwent hemodialysis in clinics with and without an AED on site. Unadjusted survival and survival adjusted for potential confounders was measured using Cox proportional hazards regression models. Unadjusted survival at 30 d was 19 versus 15% (P = 0.12) and 9.5 versus 7.8% at 1 yr (P = 0.39) in the AED-present and AED-absent groups, respectively. AED presence was not associated with outcome in unadjusted analysis (hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.78 to 1.07; P = 0.26). Univariable analysis identified age (HR 1.07 per decade; 95% CI 1.01 to 1.13), serum albumin (HR 0.91 per 0.7-mg/dl increase; 95% CI 0.82 to 1.01), and indwelling dialysis catheters (HR 1.21; 95% CI 1.02 to 1.42) as potential confounders. Medications including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, calcium channel blockers, other BP medications, aspirin, antibiotics, and antiarrhythmics were associated with survival and considered confounders. After controlling for case mix and confounders, AED presence was not associated with outcome (HR 0.98; 95% CI 0.82 to 1.18; P = 0.83). Presence of AED in the dialysis clinic is not sufficient by itself to improve the abysmal outcome from in-clinic cardiac arrest in hemodialysis patients in the United States.     

Vitamin D Deficiency as a Factor Influencing Asthma Control in Children

Objective

To study the association between asthma control and serum 25OH Vitamin D levels in children with moderate persistent asthma on preventer therapy.

Methods

Children aged 6–18 years, with moderate persistent asthma, on preventer therapy for ≥2 months were included. Control was categorized as good, partial or poor as per GINA guidelines. Serum 25 (OH) Vitamin D levels were measured and their relationship with the level of control was studied.

Results

Out of 50 children enrolled, 22 had well-controlled asthma, and 21 had partially controlled asthma. Vitamin D was deficient in 30 children and insufficient in 18 children. Children with vitamin D deficiency had significantly less wellcontrolled asthma as compared to those with insufficient or sufficient levels of 25 (OH) vitamin D (13.3% vs 88.9 % vs 100%).

Conclusion

Vitamin D deficiency is associated with suboptimal asthma control.

     

Correction: Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant

Rereading the article “Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant” (DOI: 10.5306/wjco.v13.i8.688), published on August 24, we observe, with concern, that figures 3 and 4 are wrong. The authors have attached the correct figures for correction.