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The multinomial logistic regression model (MLRM) can be interpreted as a natural extension of the binomial model with logit link function to situations where the response variable can have three or more possible outcomes. In addition, when the categories of the response variable are nominal, the MLRM can be expressed in terms of two or more logistic models and analyzed in both frequentist and Bayesian approaches. However, few discussions about post modeling in categorical data models are found in the literature, and they mainly use Bayesian inference. The objective of this work is to present classic and Bayesian diagnostic measures for categorical data models. These measures are applied to a dataset (status) of patients undergoing kidney transplantation.

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Damos a conocer una serie de 4 pacientes con rotura hepática, preeclampsia severa y síndrome de HELLP, resuelto su parto y tratada su complicación hepática con taponamiento temporal de compresas, lo que permitió la sobrevida de todas ellas.

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OBJECTIVE: To evaluate a family-focused asthma intervention designed for inner-city children 5 to 11 years old with moderate to severe asthma. STUDY DESIGN: Randomized, multisite, controlled trial to minimize symptom days (wheeze, loss of sleep, reduction in play activity) measured by a 2-week recall assessed at 2-month intervals over a 2-year follow-up period. The intervention was tailored to each family's individual asthma risk profile assessed at baseline. RESULTS: Averaged over the first 12 months, participants in the intervention group (n = 515) reported 3.51 symptom days in the 2 weeks before each follow-up interview compared with 4.06 symptom days for the control group (n = 518), a difference of 0.55 (95% CI, 0.18 to 0.92, P =.004). The reduction among children with severe asthma was approximately 3 times greater (1.54 d/2 wk). More children in the control group (18.9%) were hospitalized during the intervention compared with children in the intervention group (14. 8%), a decrease of 4.19% (CI, -8.75 to 0.36, P =.071). These improvements were maintained in the intervention group during the second year of follow-up, during which they did not have access to the asthma counselor. CONCLUSIONS: We demonstrated that an individually tailored, multifaceted intervention carried out by Masters-level social workers trained in asthma management can reduce asthma symptoms among children in the inner city.

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Airway hyper-responsiveness, or hyper-reactivity, can be identified on clinical evaluation in a number of ways, including a history of wheezing, physician-diagnosed asthma, or the bronchial response to challenge with nonspecific stimuli such as methacholine or histamine. However, wheezing and the responses to these stimuli are not uniform within or across individuals, and in the general population there is a wide range of bronchial responsiveness that follows a normal distribution. Airway hyper-reactivity occurs in a number of settings, including acute viral bronchiolitis. Some, but not all, studies of children years after hospitalization during infancy for respiratory syncytial virus bronchiolitis or another lower respiratory tract infection demonstrate the presence of airway hyper-responsiveness. In contrast, infants studied who are <12 months of age do not have airway hyper-responsiveness after episodes of bronchiolitis. Discrepancies in the study results may reflect the bronchial challenge procedure used and the pulmonary function studies performed. Viral lower respiratory tract infections might alter immune responses to favor immunoglobulin E production, but the results of studies relating respiratory syncytial virus bronchiolitis with subsequent immunoglobulin E production again have been discrepant. Host and environmental factors such as exposure to tobacco smoke or a family history of atopy may be more important than viral lower respiratory tract infections as determinants of bronchial reactivity.

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In recent years, breast-feeding has been strongly recommended, and the decision to breast-feed is made by a large percentage of women before pregnancy. We performed a survey to determine the current recommendations given to mothers in cystic fibrosis (CF) centers. For mothers of infants with CF, 77% of centers recommend breast-feeding alone or with pancreatic enzyme supplements and/or hydrolyzed formula. For mothers with CF, the following responses were given: 11% recommend breast-feeding, 8% do not recommend it, 42% make the recommendation according to the health status of the mother, and 32% make the recommendation according to the personal wishes of the mother. The duration of breast-feeding for mothers of infants with CF was reported to be from 3 to 6 months by 43% of centers, whereas for mothers with CF, 41% of centers reported the duration to be less than 3 months. Several centers reported that their experiences were not always positive, thus indicating a need to establish criteria to predict and ensure a successful outcome.

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We retrospectively reviewed the time course of recovery of pediatric patients in status asthmaticus who were undergoing mechanical ventilation for life-threatening respiratory failure to evaluate the results with current medications and technology. Ten patients between 2 and 18 years of age underwent intubation on 20 occasions. Mechanical ventilation was maintained for a mean of 2 days. Positive end-expiratory pressure was introduced in the recovery phase to prevent hypoxemia. Twelve episodes (Group 1) involved intubation less than 48 hours; in eight episodes (group 2) the patients required ventilatory support greater than 48 hours. The two groups did not differ in regard to age, pharmacologic therapy, preintubation arterial blood gas data, or initial ventilator settings, but the rise in pH and fall in Paco2 differed significantly over the first 12 hours of therapy. In the group 2 patients, peak pressures were not increased greater than 60 cm H2O despite elevated Paco2 values, and aggressive sodium bicarbonate therapy for pH correction was not pursued. Complications were few and all patients survived. We conclude that asthma patients have variable resolution of airway obstruction during mechanical ventilation and that controlled hypoventilation can be a safe therapy for the patients with more severe obstruction.

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Nineteen children who were not steroid dependent and were hospitalized in status asthmaticus were studied to evaluate the effect of corticosteroids. They were randomized into two groups. Each group received salbutamol inhalations and intravenous aminophylline therapy. One group received 7 mg/kg hydrocortisone intravenously every six hours; the other group served as a control. Each group showed significant improvement in clinical score and peak expiratory flow rate after 36 hours; there was no statistical difference in the degree of improvement. Six of ten steroid-treated children and six of nine controls achieved a PEFR of 50% predicted by 36 hours. The response to inhaled salbutamol was similar in each group. The results show that in the first 36 hours of therapy, corticosteroids have no additive effect on the bronchodilator response of aminophylline and salbutamol and do not hasten the recovery of nonsteroid-dependent children in status asthmaticus. Although the results show that an inhaled sympathomimetic drug is beneficial in status asthmaticus, corticosteroid therapy does not increase the responsiveness of the airways to these agents.

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Twenty-five normal and 105 asthmatic children were exercised on a treadmill. Pulmonary function was assessed before and after exercise. The maximum fall from the resting value in normal subjects depended on the test used: PEFR 12.5%; FEV1 10%; MMEF 26%; V50 30%; V25 33%. Using these criteria, PEFR and FEV1 detected 99% of those asthmatic children who had a positive exercise response. The largest fall from the resting value was seen with the MMEF, but this test detected only 70% of the positive responders. The pre-exercise function did not affect the severity of the response but did have an effect on the incidence of exercise-induced bronchospasm.

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