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  1. Utilizing perfusion index for early identification of circulatory shock in neonates
    Navin U, Varshini C, Lal DV, Vaanmathi AS
    Med J Malaysia, 2025 Jan;80(Suppl 1):65-68.
    PMID: 39773945
    INTRODUCTION: Neonatal circulatory shock poses a significant challenge in intensive care settings and necessitates early recognition and intervention to prevent adverse outcomes. The perfusion index (PI), derived from pulse oximetry signals, is a potential adjunct tool for assessing peripheral perfusion and predicting shock in neonates. This prospective observational study aimed to evaluate the correlation between PI and circulatory shock in neonates with the goal of establishing PI as an objective parameter for early shock identification.

    MATERIALS AND METHODS: Study was conducted in the neonatal intensive care unit (NICU) of Saveetha Medical College Hospital, India, in 2023, between January and June. This study enrolled 100 neonates who underwent hemodynamic monitoring over 48-72 hours. Hemodynamic parameters including heart rate, blood pressure, and PI were systematically recorded. Statistical and Receiver operating characteristic curve analyses were used to assess the relationship between PI and shock.

    RESULTS: Neonates experiencing shock exhibited significantly lower PI values than those without (P < 0.05). ROC curve analysis identified a PI threshold of 0.7 for predicting shock, demonstrating a high sensitivity (92.5%) and specificity (94.78%). Additionally, a significant association was observed between PI and serum lactate level (p < 0.05), underscoring the utility of PI as a predictor of shock severity.

    CONCLUSION: The study suggests that a PI < 0.7 may serve as an indicator of circulatory shock in neonates, offers good sensitivity and specificity. The PI, along with clinical parameters and serum lactate levels, is a valuable tool for early shock identification in neonatal intensive care. Further research, including multicenter studies, are warranted to validate these findings.

  2. European Position Paper on Rhinosinusitis and Nasal Polyps 2020
    Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al.
    Rhinology, 2020 Feb 20;58(Suppl S29):1-464.
    PMID: 32077450 DOI: 10.4193/Rhin20.600
    The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
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