Hyperventilation Research Articles

INTERRUPTED AORTIC ARCH IN A ONE DAY OLD NEWBORN: A CASE REPORT

Interrupted aortic arch (IAA) is a rare congenital heart disease (CHD) which affects approximately 1.5% of CHD patients. It is a serious congenital vascular malformation and accounts severe mortality when associated with other intracardiac defects. This report describes the case of one day old infant with atresia of aortic arch presented with rapid breathing, poor feeding, and lethargy. The diagnosis of IAA and Ventricular septal defect (VSD) was made by two-dimensional echocardiography and conrmed intraoperatively which successfully corrected by immediate surgical intervention.

Polyimide-Based High-Performance Film Bulk Acoustic Resonator Humidity Sensor and Its Application in Real-Time Human Respiration Monitoring

Respiration monitoring is vital for human health assessment. Humidity sensing is a promising way to establish a relationship between human respiration and electrical signal. This paper presents a polyimide-based film bulk acoustic resonator (PI-FBAR) humidity sensor operating in resonant frequency and reflection coefficient S11 dual-parameter with high sensitivity and stability, and it is applied in real-time human respiration monitoring for the first time. Both these two parameters can be used to sense different breathing conditions, such as normal breathing and deep breathing, and breathing with different rates such as normal breathing, slow breathing, apnea, and fast breathing. Experimental results also indicate that the proposed humidity sensor has potential applications in predicting the fitness of individual and in the medical field for detecting body fluids loss and daily water intake warning. The respiratory rates measured by our proposed PI-FBAR humidity sensor operating in frequency mode and S11 mode have Pearson correlation of up to 0.975 and 0.982 with that measured by the clinical monitor, respectively. Bland–Altman method analysis results further revealed that both S11 and frequency response are in good agreement with clinical monitor. The proposed sensor combines the advantages of non-invasiveness, high sensitivity and high stability, and it has great potential in human health monitoring.

Water, Sanitation, and Hygiene and Nutritional Risk Factors for Acute Respiratory Illness in the Democratic Republic of the Congo: REDUCE Prospective Cohort Study.

The objective of this cohort study was to examine the prevalence of acute respiratory illness among children under 5 years of age and to identify water, sanitation, and hygiene (WASH) and nutritional risk factors. This prospective cohort study was conducted in Walungu Territory, South Kivu, and Democratic Republic of the Congo (DRC), and enrolled 512 participants. Spot checks of the household environment were conducted at baseline. Baseline minimum dietary diversity (MDD) was defined by consumption of five or more of the following food groups: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A rich fruits and vegetables; and 8) other fruits and vegetables. Acute respiratory illness was defined as caregiver reported rapid breathing, difficulty breathing, lower chest wall in drawing, or coughing in the previous 2 weeks obtained at a 6-month follow-up based on the use of this definition in previous studies in Bangladesh and Kenya. A total of 58% of children had acute respiratory illness, 19% had soap present in the cooking area, and 4% in the defecation area, and 21% of children met MDD. A decreased odds of acute respiratory illness was associated with soap being present in the cooking area (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.38-0.88) and MDD (OR: 0.62, 95% CI: 0.38-1.00). These findings highlight the need for interventions targeting hygiene and improved dietary diversity among rural DRC households to reduce the rate of respiratory illnesses in children under 5 years.

Cerebral Blood Flow in Healthy Subjects with Different Hypnotizability Scores.

Hypnotizability is a cognitive trait associated with differences in the brachial artery flow-mediated dilatation of individuals with high hypnotizability (highs) and low hypnotizability scores (lows). The study investigated possible hypnotizability-related cerebrovascular differences. Among 24 healthy volunteers, the Stanford Hypnotic Susceptibility Scale Form A identified 13 medium-to-lows (med-lows), 11 medium-to-highs (med-highs), and 1 medium hypnotizable. Hypnotizability did not influence the significant changes produced by the trail making task (TMT), mental arithmetic task (MAT), hyperventilation (HVT), and rebreathing (RBT) on heart rate (HR), arterial blood pressure (ABP), and partial pressure of end-tidal CO2 (PETCO2), but moderated the correlations between the changes occurring during tasks with respect to basal conditions (Δ) in ABP and PETCO2 with middle cerebral artery flow velocity (MCAv). In HVT, med-lows exhibited a significant correlation between ΔMCAv and ΔPETCO2, and med-highs showed a significant correlation between ΔABP and ΔMCAv. Cerebrovascular reactivity (CVR) and conductance (ΔCVCi) were significantly correlated with ΔMCAv only in med-lows during HVT and RBT. For the first time, cerebrovascular reactivity related to hypnotizability was investigated, evidencing different correlations among hemodynamic variables in med-highs and med-lows.

Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries: A systematic review and meta-analysis

BackgroundNon-physician health workers play an important role in identifying and treating pneumonia in children in low- and middle-income countries (LMICs). In this systematic review, we summarized the evidence on whether health workers can accurately measure respiratory rate (RR) and identify fast breathing to diagnose pneumonia in children under five years of age.MethodsWe searched MEDLINE, EMBASE, Web of Science, and Scopus from January 1990 to August 2020 without any language restrictions. Reference lists of included studies were also screened for additional records. Studies evaluating the performance of health workers in measuring RR and/or identifying fast breathing compared to a reference standard were included. The methodological quality of the included studies was assessed using the QUADAS-2 tool. A meta-analysis was conducted to report pooled estimates of sensitivity and specificity. Hierarchical summary receiver operating characteristic curve (HSROC) models were fitted, and subgroup and sensitivity analyses were performed to examine the effects of study variables.ResultsWe included 16 studies, eight of which reported the agreement in RR count between health workers and a reference standard. The median agreements were 39%, 47%, and 67% within ±2, ±3, and ±5 breaths per minute, respectively. Among the 16 included studies, we identified 15 studies that reported the accuracy of a health worker classifying breathing into either fast or normal categories compared to a reference standard. The median sensitivity, specificity, accuracy, and kappa value were 77%, 86%, 81%, and 0.75, respectively. Seven studies reporting the accuracy of identifying fast breathing were included in the meta-analysis. The pooled estimates of sensitivity and specificity were 78% (95% CI = 72-82) and 86% (95% CI = 78-91), respectively.ConclusionsDespite the problematic nature of reference standards and their variability across studies, our review suggests that the health worker performance in accurately counting RR is relatively poor. However, their performance shows reasonable specificity and moderate sensitivity in identifying fast breathing. Improving the detection of fast breathing in children with suspected pneumonia among health workers is an important child health programme objective and should be given appropriate priority.

Recovery of Children from Acute Lower Respiratory Tract Infection(Pneumonia and Bronchiolitis) : In a tertiary Care Hospital

Backgrounds: Children are mostly the victims of pneumonia and bronchiolitis for which they are often hospitalized. Acute respiratory infection(ARI)results in 1.9 million deaths per year in developing countries(Taneja et. al 2009). It is important to know the recovery time of individual acute lower respiratory tract infection (ALRTIs) like pneumonia and bronchiolitis for better understanding the clinical feature and outcome. Knowing the length of stay (LOS) in case of ALRTI has not yet been worked out and studied well.
 Objective: To determine the recovery of different clinical features Length of hospital Stay and outcome of two common LRTIs viz pneumonia and bronchiolitis.
 Methods: A cross-sectional analytical study was done in department of pediatrics of Dhaka Medical College Hospital during the from October 2013 to September 2014. Cases were selected according to selection criteria. Pneumonia was diagnosed on the basis of fever, cough, breathing difficulty, and found chest indrawing, fast breathing, and bronchial breath sound or crackles on examination and consolidation or patchy opacity in chest X-ray and bronchiolitis on the basis of presence of runny nose followed by cough, breathing difficulty and wheeze on auscultation in a child below 2 yrs. Cases of pneumonia were treated with standard protocol of WHO and cases of bronchiolitis were treated with national guideline. The cases were followed up 12 hourly for 8 days using case collection sheet by monitoring 17 clinical features.
 Results : There were 54 cases of pneumonia and 54 cases of bronchiolitis. Baseline selected clinical-sociodemographic parameters of both the cases were similar in terms of sociodemographic status and some clinical features. The following clinical features were similar in both groups viz. cough(100% vs 100%) breathing difficulty (100%vs 100%), feeding difficulty (92.6%vs96.3%), chest indrawing(92.6%vs 96.3%).The dissimilar clinical features were fever (100%vs77.8%, p<0.001), runny nose (40.7%vs 100%, p<0.001%) sleeping difficulty (92.6% vs 77.8% p<0.03) wheeze (29.6% vs 100%, p<0.001) crackles(100% vs 18.5%, p<0.001). Dynamics of improvement in clinical features:Significant number of cases of pneumonia did not improve from breathing difficulty (40.7%) , feeding difficulty(40.7%), restlessness(16.7%), sleeping difficulty(76.9%), chest indrawing (63%), documented fever(54%) within 3 days, but more than 90% cases of bronchiolitis recovered from above mentioned clinical features. (P<0.001). Social smile returned to only 68% in case of pneumonia but 100% cases of bronchiolitis(p<0.001) with in 4 days.
 Conclusion: This study was concluded that almost 89% cases of pneumonia and 100% cases of bronchiolitis recovered. Length of hospital stay(LOS) was 5.8±2.1 days in pneumonia and LOS was 3.2±0.7 in bronchiolitis. Mortality was higher in cases pneumonia (3.7%) than cases of Bronchiolitis(0.0%).
 Sir Salimullah Med Coll J 2021; 29(2): 124-131

Hyponatremia as a Predictor of Adverse Outcome in Children with Severe Lower Respiratory Tract Infection in Tribhuvan University Teaching Hospital (TUTH), Nepal

Introduction: Lower respiratory tract infection (LRTI) is one of the major causes of mortality in children with estimated 1 million deaths every year. Hyponatremia is the most common electrolyte abnormality seen in LRTI. The objective of study was to find association of hyponatremia (serum sodium<135meq/l) with severe LRTI. Prospective cross sectional study design was used for study. Settings: Pediatric Emergency, Ward and Pediatric Intensive Care Unit of Tribhuvan University Teaching Hospital (TUTH). Subjects: Children between 2 months to 16 years presenting with cough for less than 3 weeks, fast breathing and chest in drawing. Methods: Children between 2 month to 16 years of age having cough, fast breathing and chest in drawing admitted in emergency, ward or PICU of TUTH were screened and among them, children having pediatric respiratory severity score of 4-5 were enrolled in the study. Serum sodium was sent during admission and collected within 2 hours. Daily follow up was done to find need of respiratory support, duration to resolve hypoxia, total duration in hospital and final outcome of patient. Statistical test applied were Chi-square test and Fisher exact test. Results: 47.5% of study population had hyponatremia, of whom 65.79% had mild hyponatremia 26.31% had moderate and 7.89% had severe hyponatremia. Association of hyponatremia with need of non rebreathing face mask (p=0.001), ventilatior (p=0.009), duration of hospital stay (p=0.047) were significant. The study also found the association of severity of hyponatremia with need of non rebreathing facemask (p=0.001), ventilator (p=0.01), outcome (p=0.001), duration of stay (0.002). Mean time to resolve hypoxia in children with hyponatremia (4.5 days) was longer compared to normal sodium (2.58 days). Four patients died during the study period and all of them had hyponatremia. Conclusion: Association of hyponaremia and severity of hyponatremia in severe LRTI with need of non-rebreathing face mask, ventilatior, outcome, duration of stay was significant.

Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria

BackgroundThe trio of commonest illnesses and causes mortality among children under five (Malaria, Pneumonia and Diarrhea) are easily treatable through timely exposure to cost effective interventions at the community level. Patent and proprietary medicine vendors (PPMVs) are a leading source of care for illnesses among under-five children in Nigeria. This study was designed to explore child health services offering, particularly commodity stocking patterns and case management knowledge for common childhood illnesses among PPMVs in Ebonyi and Kaduna States.MethodsA descriptive cross-sectional study was conducted among PPMVs in four local government areas across Ebonyi and Kaduna States. Data was collected using semi-structured interviewer-administered questionnaires. Information was obtained on medicine and supplies, knowledge of common childhood illnesses management and referral practices.ResultsA total of 374 PPMVs were interviewed; the mean age was 33.7 ± 9.8 years. Among the 132 health trained respondents, 59.0% offer treatment services for sick children while 83.5% of the non-health trained respondents offer the same service. At least, 88.0% of the respondents keep stock ACTs, Amoxycilin DT, ORS and Zinc. About 38.5% reported stock-out of ACTs in the month preceding the study, 55.1% reported stock out lasting only 0 to 6 days. Only 83 (22.2%) of respondents knew the correct diagnosis of fast breathing among children aged 2 to less than 12 months old. Education and health training background were associated with a good knowledge of common childhood illnesses management (X2 = 44.88, p < 0.001; X2 = 27.14, p < 0.001).ConclusionThe relative constant availability of medicines and commodities for managing childhood illnesses positions PPMVs as a preferred source of care for these illnesses. There is a need to complement steady stock availability with provision of quality services by exposing PPMVs to trainings on integrated community case management of childhood illnesses and implementation of robust supervision mechanism to monitor them.

Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis

Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia. The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05. This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers. The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.

Does communal women empowerment mitigate the risk of acute respiratory infection among under-five children in Pakistan?

ObjectivesGrowing evidence has associated solid/polluted fuel (PF) burning with higher risks of acute respiratory infection (ARI) among under-five children. However, higher usage of PF contributed to upsurge communal air pollution, which may further aggravate ARI. Instead, women empowerment may mitigate the risk of ARI by shifting towards cleaner fuels.This study aimed to estimate the mitigating impact of community-level women empowerment on ARI among under-five children in Pakistan. In addition, the study also aimed to explore the mitigating impact pathway of empowered women community. Study designA cross-sectional study design was used to collect data under 2018 Pakistan Demographic and Health Survey. MethodsRetrieved data used in the analysis comprised 12,295 surviving under-five children suffering from cough coinciding with short and rapid breathing and fever from 561 communities. Because of hierarchical structure of the data, two-level mixed-effects logistic regression was used to compute unbiased odds ratios. ResultsApproximately 58% of total households used PF as a primary fuel, and PF usage by more than 50% of households led to 129 polluted communities. About 19% of children suffered from symptoms of ARI within 2 weeks preceding the survey. After adjusting for individual, household and communal attributes, the odds of suffering from ARI were 1.156 times higher among children from polluted households than their counterparts. The odds of ARI were aggravated to 1.333 for highly polluted communities. Women empowerment mitigated the risk of ARI by odds of 0.708 and 0.671 at individual level and communal levels, respectively. After shifting towards cleaner fuels, highly women empowered community-mitigated ARI risk by odds of 0.765. ConclusionsUnder-five children of highly polluted communities were at higher risk of ARI, while highly women empowered communities mitigated the risk by shifting towards cleaner fuels. We suggest interventional efforts towards empowering poor women in mitigating ARI.

Syndromic surveillance with monthly aggregate health systems information data for COVID-19 pandemic response in Neno, Malawi: a monitoring study

BackgroundIn the context of diminutive COVID-19 screening and testing, syndromic surveillance can be used to identify areas with higher-than-expected SARS-CoV-2 symptoms for targeted public health interventions. We used syndromic surveillance to monitor potential SARS-CoV-2 outbreaks in 14 health facilities in the Neno district of rural Malawi. MethodsWe monitored three indicators identified as potential symptoms of SARS-CoV-2 infection: the proportion of outpatient visits for fast-breathing cases in children under 5 years (FBC<5); the proportion of suspected malaria cases confirmed as non-malaria in children under 5 years (NMC<5); and the same indicator in individuals aged 5 years and older (NMC≥5). We extracted data aggregated by month and at the health facility-level from the District Health Information System. With data from January, 2016, to February, 2020, as a baseline, we used a linear model with a negative binomial distribution to estimate expected proportions for the indicators in absence of the COVID-19 pandemic with 95% prediction intervals (PI) for March, 2020, to July, 2021. We compared the observed proportions to the expected rates, focusing on the first two waves of infections (June to July, 2020, and January to March, 2021). FindingsThe proportion of FBC<5 was consistently higher than expected, with a peak in May, 2020, when 2·5% of outpatient visits were fast breathing cases in children younger than 5 years of age (compared with the expected rate of 0·8% [95% PI 0·4–1·5]). NMC<5 was as expected throughout the study period. The NMC≥5 indicator remained as expected, except for increases in suspected cases tested negative for malaria, to 31·3% (from the expected 18·6% [95% PI 12·3–28·7]) in November, 2020, and to 32·5% (from the expected 21·7% [95% PI 14·2–32·2]) in July, 2021. InterpretationAn increase in FBC<5 and NMC≥5 before observed COVID-19 waves might indicate SARS-CoV-2 infections that were missed before robust testing. This tendency was not seen in NMC<5, which can represent differences in symptomatology leading to decreased health-seeking behaviours for this age group. Syndromic surveillance can allow for real-time responses at facilities, including increased and focused testing and screening to identify potential SARS-CoV-2 infections. FundingSupported by Canadian Institutes of Health Research.

P49 Determinants of trends in reported antibiotic use for sick children from LMICs (2005–17): analysis of 132 national surveys from 73 countries

ObjectivesTo analyse trends in reported antibiotic use for children aged <5 years with fever, diarrhoea or cough with fast or difficult breathing (outcome) from low- and middle-income countries (LMICs) during 2005–17, disaggregated by the following user characteristics: rural/urban residence, maternal education, household wealth and healthcare source visited.MethodsBased on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, the outcome, disaggregated by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model.ResultsAcross LMICs during 2005–17, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% [uncertainty interval (UI): 5.2%–44.9%] in 2005 to 30.6% (11.7%–62.1%) in 2017, compared with a 29% relative increase in urban areas from 27.1% (8.7%–58.2%) in 2005 to 34.9% (13.3%–67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education.ConclusionsThese estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005–17 was driven by gains among groups often underserved by formal health services.

Mechanosensitivity of Murine Lung Slowly Adapting Receptors: Minimal Impact of Chemosensory, Serotonergic, and Purinergic Signaling.

Murine slowly adapting receptors (SARs) within airway smooth muscle provide volume-related feedback; however, their mechanosensitivity and morphology are incompletely characterized. We explored two aspects of SAR physiology: their inherent static mechanosensitivity and a potential link to pulmonary neuroepithelial bodies (NEBs). SAR mechanosensitivity displays a rate sensitivity linked to speed of inflation; however, to what extent static SAR mechanosensitivity is tuned for the very rapid breathing frequency (Bf) of small mammals (e.g., mouse) is unclear. NEB-associated, morphologically described smooth muscle-associated receptors (SMARs) may be a structural analog for functionally characterized SARs, suggesting functional linkages between SARs and NEBs. We addressed the hypotheses that: (1) rapid murine Bf is associated with enhanced in vivo SAR static sensitivity; (2) if SARs and NEBs are functionally linked, stimuli reported to impact NEB function would alter SAR mechanosensitivity. We measured SAR action potential discharge frequency (AP f, action potentials/s) during quasi-static inflation [0–20 cmH2O trans-respiratory pressure (PTR)] in NEB-relevant conditions of hypoxia (FIO2 = 0.1), hypercarbia (FICO2 = 0.1), and pharmacologic intervention (serotonergic 5-HT3 receptor antagonist, Tropisetron, 4.5 mg/kg; P2 purinergic receptor antagonist, Suramin, 50 mg/kg). In all protocols, we obtained: (1) AP f vs. PTR; (2) PTR threshold; and (3) AP f onset at PTR threshold. The murine AP f vs. PTR response comprises high AP f (average maximum AP f: 236.1 ± 11.1 AP/s at 20 cmH2O), a low PTR threshold (mean 2.0 ± 0.1 cmH2O), and a plateau in AP f between 15 and 20 cmH2O. Murine SAR mechanosensitivity (AP f vs. PTR) is up to 60% greater than that reported for larger mammals. Even the maximum difference between intervention and control conditions was minimally impacted by NEB-related alterations: Tropisetron −7.6 ± 1.8% (p = 0.005); Suramin −10.6 ± 1.5% (p = 0.01); hypoxia +9.3 ± 1.9% (p < 0.001); and hypercarbia −6.2 ± 0.9% (p < 0.001). We conclude that the high sensitivity of murine SARs to inflation provides enhanced resolution of operating lung volume, which is aligned with the rapid Bf of the mouse. We found minimal evidence supporting a functional link between SARs and NEBs and speculate that the <10% change in SAR mechanosensitivity during altered NEB-related stimuli is not consistent with a meaningful physiologic role.

Data Augmentation and Transfer Learning for Data Quality Assessment in Respiratory Monitoring.

Changes in respiratory rate have been found to be one of the early signs of health deterioration in patients. In remote environments where diagnostic tools and medical attention are scarce, such as deep space exploration, the monitoring of the respiratory signal becomes crucial to timely detect life-threatening conditions. Nowadays, this signal can be measured using wearable technology; however, the use of such technology is often hampered by the low quality of the recordings, which leads more often to wrong diagnosis and conclusions. Therefore, to apply these data in diagnosis analysis, it is important to determine which parts of the signal are of sufficient quality. In this context, this study aims to evaluate the performance of a signal quality assessment framework, where two machine learning algorithms (support vector machine–SVM, and convolutional neural network–CNN) were used. The models were pre-trained using data of patients suffering from chronic obstructive pulmonary disease. The generalization capability of the models was evaluated by testing them on data from a different patient population, presenting normal and pathological breathing. The new patients underwent bariatric surgery and performed a controlled breathing protocol, displaying six different breathing patterns. Data augmentation (DA) and transfer learning (TL) were used to increase the size of the training set and to optimize the models for the new dataset. The effect of the different breathing patterns on the performance of the classifiers was also studied. The SVM did not improve when using DA, however, when using TL, the performance improved significantly (p < 0.05) compared to DA. The opposite effect was observed for CNN, where the biggest improvement was obtained using DA, while TL did not show a significant change. The models presented a low performance for shallow, slow and fast breathing patterns. These results suggest that it is possible to classify respiratory signals obtained with wearable technologies using pre-trained machine learning models. This will allow focusing on the relevant data and avoid misleading conclusions because of the noise, when designing bio-monitoring systems.

Empyema Thoracis Caused by Klebsiella Spp and Escherichia coli Co-Infection - An Uncommon Isolation with Atypical Presentation

Empyema thoracis is the collection of pus in the pleural space. A 9-year-old boy presented with a 3-day history of high grade continuous fever, a day history of abdominal pain, distension and fast breathing. Examination findings: acutely ill child, febrile, in respiratory distress. Chest findings: tachypnea, dull percussion note and decreased air entry on the right hemithorax. Chest radiograph: massive fluid collection in the right hemithorax. A pleural tap yielded frank pus that was sent for microscopy, culture and sensitivity (MCS). Escherichia coli was cultured which was sensitive to fluoroquinolones. Klebsiella spp was also cultured from the blood sample taken for MCS and yielded the same sensitivity. Patient responded well to tube thoracostomy drainage and administration of antibiotics. Empyema thoracis with the isolation of two-gram negative organisms in a previously healthy child is rare.

Evaluation of the prevalence, prenatal risk factors &amp; clinical profiles of Paediatric Patients with congenital heart disease

Introduction: Congenital Heart Diseases (CHD’s) are amongst the major congenital malformations contributing to infant mortality. Most CHDs are diagnosed in infancy. Later, in childhood or adolescence, CHD patients may present differently. Objectives: To evaluate the prevalence, maternal risk factors and clinical profile of all children with CHD at a tertiary care centre in Bhopal. Materials and Methods: This prospective, observational study was conducted at a tertiary care centre in Bhopal from Feb 2018 to Feb 2020. Approval from the ethical committee was obtained prior to the commencement of the study. Children up to 13 years of age, admitted with the features of CHD for the first time in out institution, were included in this study. A detailed history and clinical examination were carried out and a diagnosis of CHD was confirmed with 2D Echocardiography. Results: A total of 224 patients were admitted with the features of CHD for the first time during the study period. In our study, the commonest lesion was VSD (29.01%) followed by ASD (14.73%), PDA (12.5%), and TOF (9.37%). Among the clinical presentation, fast breathing (90.17%) was the most common symptom. Conclusion: In our study, VSD was found to be the most common acynaotic CHD and TOF was the most common cynotic CHD. The most common presenting feature was breathing difficulty. In order to improve prenatal detection of CHD’s, it is imperative to have a deep understanding of maternal risk factors.

Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt.

The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible. We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data. Of 17600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital. It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.

EPIDEMIOLOGY AND CLINICAL PATTERN OF MYCOPLASMA PNEUMONIA IN CHILDREN HOSPITALISED WITH COMMUNITY ACQUIRED PNEUMONIA

OBJECTIVE: To identify the proportion and clinical pattern of mycoplasma pneumonia among children hospitalised with community acquired pneumonia. METHODS: Study design – descriptive cohort. Children between 2 months to 12 years of age who were hospitalised with symptoms suggestive of community acquired pneumonia were included. Children with community acquired pneumonia whose induced sputum grew mycoplasma in culture were dened as having mycoplasma pneumonia. RESULTS: Among the 268 children included in the study, mycoplasma pneumonia was positive in 33(12.3%) cases. Presenting features like fever (P=0.451), fast breathing (P=0.057), lower chest indrawing (P=0.086) and wheeze (P=0.780) were comparable between the two groups. Signicant cough (P=0.008), crepitations (P=0.024) and hypoxia (P=0.036) were more common in children with non mycoplasma pneumonia. There was no difference in length of stay between Mp patients who did and did not receive an antibiotic with activity against Mp (P=0.680). All mycoplasma positive cases clinically improved and the outcome (ICU admission or invasive mechanical ventilation) was comparable between the two groups (p 0.514). CONCLUSIONS: No clinical or radiological features were characteristic of mycoplasma pneumonia.Clinical course was not altered by use of macrolides.

Mothers experience on neonatal danger signs and associated factors in northwest Ethiopia: a community based cross-sectional study.

Introductioneven though there is a significant decline in neonatal mortality globally, it remained unacceptably high in Ethiopia. The estimated experience of neonatal danger signs affects the outcome more than the perceived knowledge. The main aim of this study was to estimate the experience of mothers on neonatal danger signs and its associated factors in Northwest Ethiopia.Methodsa community-based cross-sectional study was conducted from April 6-16, 2019. All the women who have delivered live birth in the past six months in three districts of Northwest Ethiopia were the source populations. A total of 2424 mothers were selected using two-stage stratified cluster random sampling technique. A pretested and semi-structured interviewer-administered questionnaire was used to collect data from eligible mothers. A multivariable logistic regression model was used to identify independent factors that affected mother´s experiences about neonatal danger signs at a p-value of 5%.Resultsin this study, 2335 (96.3%) mothers completed the interview and 1509 (64.6%) of them have mentioned at least one danger sign. However, only 160 (11.0%) mothers have experienced danger signs in their babies. Of these, about 54 (49.1%) mothers have noticed within 24 hours of delivery and 37 (33.6%) have noticed after 48 hours of delivery. Fifty (45.5%) mothers have noticed the danger signs at home after birth, and 48 (43.6%) have noticed during birth. The frequently reported danger signs were; baby feels hot 106 (66.3%), fast breathing 67(41.9%), and difficulty of breathing 61(38.1%). Mothers who are living in urban, AOR=1.8(95%CI: 1.04,3.0), having multiple pregnancy, AOR=9.8 (95%CI: 2.3,42.0), absence of obstetric danger signs or complication, AOR=0.4 (95%CI: 0.2,0.6), post-term gestational age, AOR=6.5 (95%CI: 2.1,19.5), preterm gestational age, AOR=3.3 (95%CI: 0.8,13.4), assessment by hospital staff during delivery, AOR=2.1 (95% CI: 1.01,4.3), and poor mothers knowledge on neonatal danger signs, AOR=0.7 (95% CI: 0.5,0.9) were the predictors of mothers experience on neonatal danger signs.Conclusioneven though the knowledge of mothers on neonatal danger signs is high, the practice or experience in using their knowledge is very low. We recommend an implementation study to be conducted to bridge this “know-do” gap.

Hypoxia and mortality outcomes in children presenting with pneumonia to a tertiary Hospital: A Retrospective review of records

BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-Income Countries (LMIC). Despite remarkable achievements in global mortality trends in children under 5 nearly 700 000 children die annually from pneumonia. In Ghana, an estimated 4,700 children under 5 died from pneumonia in 2017. Hypoxia is a known predictor of death among children hospitalised with pneumonia. Few studies in Ghana have described the predictors of mortality among children with pneumonia. This study aimed to determine the factors associated with mortality among children hospitalized for pneumonia to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH).&#x0D; MethodsMedical records of children admitted to the PEU of KATH from January 2016 to December 2020 were reviewed. Data was cleaned and exported to STATA version 16 for analysis. Outcomes measures of interest were survival and mortality.&#x0D; Results Records for 482 children hospitalised with pneumonia to the unit were available of which 55 per cent (n=265) were males, 94 per cent (n= 455) were less than five years and 51 per cent (n=265) were younger than 12 months old. In all, 77 per cent (n=301), had received three doses of the pneumococcal conjugate vaccine. Twenty-one percent (n=89), presented with hypoxia and 15% (n= 77), died from pneumonia. There was a significant association between death as an outcome and hypoxia at presentation [?2 (1)= 13.29, p &lt; .001(OR 2.6, 95% CI 1.42 to 4.75)], axillary temperature of 38oC or more at presentation [?2 (1)= 5.03, p = .025 (OR 2.09 (95% CI 1.08 to 4.02)], fast breathing at presentation [?2 (1) = 5.45, p = .020 (OR 2.12 95% CI 1.11 – 4.01)] and having received all 3 doses of pneumococcal vaccine [?2 (1) = 9.78, p = .002 (OR 0.45 95% CI 0.27 – 0.75).&#x0D; Conclusion Hypoxia at presentation, axillary temperature of 38oC or greater, fast breathing, are likely predictors of mortality in children under 5 hospitalised for pneumonia. Pneumococcal conjugate vaccine uptake is high among children with pneumonia, receiving all 3 doses likely protects children with pneumonia from death.