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Objectives The main objective of this meta-analysis was to assess the accuracy of the Sleep-Related Breathing Disorder (SRBD) Scale in the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Patients/methods A literature search of studies comparing SRBD to polysomnography for the diagnosis of OSAS in children was performed. Risks of biases were quantified using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Analyses determined the summary receiver operator characteristic area under the curve (SROC), the pooled sensitivity (Se), the specificity (Sp), and the positive and negative likelihood ratios (LR+ and LR–). Results were graded and are expressed as means [95% confidence interval]. Post-test probabilities were computed for various populations. Results Eleven studies were included; and two were considered to have high risk of bias. The SROC was 0.73 [CI: 0.63; 0.82]. The combined Se, Sp, LR+ and LR– were: 0.72 [CI: 0.68; 0.77], 0.59 [CI: 0.56; 0.63], 1.74 [CI: 1.32; 2.30], 0.53 [CI: 0.39; 0.71], respectively. Sub-group analyses displayed similar results in comparison to overall results. GRADE evidence for the overall analysis was low to moderate. Finally, pre-test to post-test probabilities were estimated to be: 3.5%–1%, 50%–30% and 75%–30%, for the general population, the obese patients and the patients assigned for surgical treatment of OSAS, respectively. Conclusions The current meta-analysis indicates that the SRBD scale has acceptable accuracy in detecting patients with OSAS. It may be useful when evaluating patients with suspected OSAS before surgery. Study registration PROSPERO database (CRD42018088216).

A qualitative screening high resolution mass spectrometry method was developed and validated according to the EU SANTE/12682/2019 guidelines for the analysis of 204 pesticides in seven commercial bivalve species spiked at three concentrations (0.01, 0.05 and, 0.1 mg.kg

Health impact assessment (HIA) is an approach that aims to prospectively assess the potential effects of a policy, program or project on the health of the population and to formulate recommendations to minimize the negative effects, and to maximize the positive effects. In Quebec City, a particular process has been put in place to perform HIA. This paper presents the impacts and outcomes of the performed health impact assessments, based on the HIA participants (stakeholders)’ perceptions. More specifically the aims were to 1) analyze the implementation of the HIA procedure in the urban planning process and to identify levers, constraints and potential for improvement; 2) analyze the deployment of the HIA approach, including the stakeholders' involvement, the ability of HIA to support decision making and to make changes in the stakeholders' practice; and 3) identify success factors and challenges for the integration of HIA into the urban planning process. A survey was developed to question the HIA participants (stakeholders) (response rate 62.5%, n = 25/40). Themes were created according to the provided answers. This study provided a positive feedback on the implemented HIA process. It allowed the identification of issues regarding its use in the urban planning process and a better understanding of the stakeholders' evaluation of HIA. The results indicate the potential HIA has at enhancing the interdisciplinary decision-making process in urban planning. Improvements in the practices used were also identified and many were similar to those presented in other contexts. The obtained results can be useful to HIA practitioners and municipalities wishing to implement HIA.

Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy.This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression.Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (4 years), weight (18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95].Our study found that weight18kg is a major risk factor for predicting a postoperative respiratory complication.

Introduction Blood-saving strategy during spinal surgery in children often includes recombinant erythropoietin (rEPO) and antifibrinolytic therapapy (AFT). The aim of this study was to investigate the efficacy of intraoperative blood salvage in decreasing homologous blood transfusion. Material and methods Using the prospective data from patients operated during a one year period for scoliosis correction, we calculate the predictable hematocrit at day postoperative 1 without the use of blood salvage and compare it to the target hematocrit transfusion according to patient's status. Predictors analyzed were: age, weight, surgical indication, Cobb's angle, ASA status, preoperative hemoglobin, number of level fused, sacral fusion and thoracoplasty. Statistical analyses were performed using a classification tree analysis. Results This study included 147 patients. Blood salvage was estimated avoiding homologous blood transfusion in 17 patients. Predictors of the efficacy of blood salvage were: neuromuscular indications, number of level fused and BMI. Blood salvage was found totally ineffective in: patients with no neuromuscular diseases with either: surgeries interesting 13 levels with a preoperative BMI ≥ 21. In all other cases, blood salvage can decrease homologous transfusion. The model exhibited 97% of accurate for the prediction if the inefficacy of blood salvage. The AUCROC of the model was 0.93 [95% confidence interval 0.9 to 0.99] and the overall validation was 60.1% of explained variability. Conclusion The present study indicates that blood salvage is ineffective under certain circumstances. More studies are mandatory to confirm these results.

Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors.The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery. The data collected included demographics, preoperative ICU bed status, ASA status, a history of cardiac malformation, hyaline membrane disease (HMD) or necrotizing enterocolitis (NEC), preoperative haemoglobin, emergent surgery status, surgery type and duration, duration of anaesthesia and the need for intraoperative fluid boluses. Complications were analysed until the 30th postoperative day. Analyses included descriptive statistics and the determination of factors associated with non-surgical complications using univariate and multivariate statistics.The study included 168 patients. Their postnatal age was 48±48days. Overall, 37 patients experienced major postoperative non-surgical complications. The most common major complications were haemodynamic compromise (n=19, 11.3%), multiple organ dysfunction syndrome (MODS, n=8, 4.8%) and respiratory failure requiring ventilation (n=3, 1.8%). Surgical complications occurred in 8 cases (4.8%). Four factors were identified as being predictive of non-surgical complications: PCA40 weeks, a history of cardiac malformation, HMD or NEC, preoperative ICU status and intraoperative fluid bolus administration.This study describes common non-surgical postoperative complications in neonates and infants, and their risk factors. They were much more common than surgical complications. Further studies should focus on preventive strategies addressing these complications.

Fungal diseases can have a detrimental impact on soybean and corn yield. Foliar fungicides are used to manage fungal diseases and minimize yield loss, along with cultural practices like tillage and crop rotation. Prophylactic foliar fungicide use does not consistently increase yield for corn and soybean, especially when disease pressures are low. Also, there are concerns about the impact of fungicides on non-target organisms, including fungi living in the soil. We tested the effects of tillage, crop rotation, and foliar fungicide use on corn grain and soybean seed yield over three growing seasons. For both crops, rotation was key to achieving high yields, although there was an interaction of tillage × crop rotation for soybean and crop rotation × fungicide for corn. For soybean seed yield, both foliar fungicide treatments showed a small yield increase over untreated plots. Additionally, we assessed bulk soil fungal communities in a subset of treatments (crop rotation and fungicide treatments in no-till plots), using ITS sequencing and PLFA-FAME. We observed distinct fungal communities in the continuously cropped treatments, while annually rotated communities were very similar. There was also greater overall microbial biomass and a higher relative abundance of arbuscular mycorrhizae fungi associated with continuous corn. There were no differences in soil fungal communities or microbial biomass associated with foliar fungicide treatments. Based on our findings, we recommend that farmers use integrated pest management strategies to manage fungal diseases, which may include fungicide applications, if they are justified by economic disease thresholds or prediction tools.

Introduction Blood saving strategies during paediatric spinal surgery often include recombinant erythropoietin (rEPO) and antifibrinolytic therapy (AFT). The goal of this study was to investigate additional preventive factors involved in the risk of blood transfusion. Methods This prospective study was designed with the aim of identifying factors associated with the perioperative (defined as the intraoperative and the first postoperative day) probability of homologous red cell transfusion during scoliosis surgery in children operated during a one year period in our institution. The predictors analysed were: age, weight less than the 3rd percentile (W ), indication for spinal surgery (idiopathic or neuromuscular), Cobb's angle, ASA status, preoperative haemoglobin, number of levels fused, duration of surgery, intraoperative fluid intakes, sacral fusion and thoracoplasty. Statistical analyses were performed using a multivariate logistic regression model. Results One hundred and forty-seven patients were included in the analysis. Multivariate analysis found the following variables to be independent predictors for an increased risk of homologous blood transfusion: W , neuromuscular scoliosis and duration of surgery > 255 minutes. ROC analysis for the latter model found an area under the curve of 0.9 (95% confidence interval: 0.8–0.97). The accuracy of the model was 92.3% (97.4% for non-transfusion and 69.2% for transfusion). Multivariate sensitivity analysis excluding patients with no preoperative administration of EPO found similar results. Conclusion The current results indicate that optimising nutritional status might prevent allogenic blood transfusion and requires further investigation.

Renal haematoma during severe preeclampsia is a rare uneventful event. It is usually associated with other organ injury such as cerebral or liver haematoma. Imaging (ultrasound or tomodensitometry examination) plays an important role in detecting this complication and following its evolution. In the current case report, we describe an isolated renal haematoma during a severe preeclampsia complicated by a HELLP syndrome. This patient was managed with a conservative treatment (control of arterial pressure and induction of delivery) and an imaging follow-up.