Hyperventilation Research Articles

Potential Risk Factors and Association of Significant Factors of Blood Cancer in Bangladesh Using Data Mining Techniques

Cancer is now one of the leading causes of death globally and in Bangladesh. This research is focused on the blood cancer patients because there are only a few studies in Bangladesh on blood cancer. Initially, we collected 340 data (blood cancer and non-blood cancer) from BSMMU hospital. Then we use data mining to rank 30 factors associated with blood cancer. Our data mining methods include classification, chi-square (χ2) test, P-value, and association rule mining. The most potent predictors (P-value < .001) were muscle pull, inability to control the bladder, unusual bleeding, fever/raised temperature, and weakness in the legs. To predict an association between these significant elements, popular rule mining algorithms such as Apriori or Tertius are used. The results of the experiment show that weakness in the legs, fever and inability to control the bladder are common rules of blood cancer. Again, unusual bleeding, rapid illness, and muscle pull are likely to be associated. A fair skin tone with rapid breathing and leg weakness may also be a danger. Journal of Engineering Science 13(1), 2022, 9-20

Comparison of rapid shallow breathing index versus ultrasonographic guided diaphragmatic thickness fraction as weaning indices on mechanically ventilated patients

Background: The discontinuation or weaning from mechanical ventilation is an important clinical issue which is associated with lot of complications and patient discomfort. So we need a reliable and feasible method for early, safe and effective liberation of patients from mechanical ventilation. The objectives of our study are to determine sensitivity and specificity of rapid sequence breathing index (RSBI) and ultrasonography (USG) guided diaphragmatic thickness fraction (DFT) as weaning indices and to compare their effectiveness. Methods: The study was carried out on mechanical ventilated patients, when they were considered ready for weaning and the underlying disease is stable or resolving. The measurements of RSBI and DFT using USG were carried out. Weaning was taken as successful if the patients could maintain spontaneous breathing at least 48hrs after extubating, otherwise weaning was classified as failed. Results: RSBI and DTF group showed no statistically significant difference in extubation of mechanically ventilated patients in the intensive care unit (ICU). RSBI showed sensitivity of 96%, specificity of 74.4%, positive predictive value of 88.2%, negative predictive value of 80.5%, and accuracy of 87.2%, and DTF showed sensitivity of 96%, specificity of 69.7%, positive predictive value of 82.4%, negative predictive value of 78.9% and accuracy of 81.9%. Conclusion: In our study since there was only one reintubation in each of the groups, that is failure of weaning of one case each in RSBI and DTF groups, both RSBI and DTF has the same sensitivity of 96%, RSBI has better specificity of 74.4% than DTF of 69.7%, RSBI having a better accuracy of 87.2% than DRF which has an accuracy of 81.9%. We conclude that both the methods are equally effective when used as weaning indices for extubation of mechanically ventilated patients.

Risk Factors for the Development of Pneumonia Below 2 Years of Age

Acute respiratory tract illness is the leading cause of death in the developing countries. This case control study was endeavored with an aim to assess the factors that can increase the risk of pneumonia in children. Methodology: This Case-Control study was carried out at the Paediatrics Department of Jalalabad Ragib Rabeya Medical College Hospital (JRRMCH) in Sylhet from January 2018 to July 2018.This study involved 200 children of 6 to 24 months age, among them 100 children who was hospitalized in JRRMCH for pneumonia during the study period as case. The control group included 100 children who was selected purposively came for immunization at JRRMCH EPI centre and at OPD for other problem but free from pneumonia. Sample were selected according to the inclusion & exclusion criteria. A case definition for pneumonia as outlined by the WHO(2014) was used as the criteria for case inclusion. Children with history of low birth weight, congenital cardiovascular or respiratory malformation, chromosomal abnormalities, recurrent wheeze, were excluded from the study. Data were collected by interviews of the parents using a structured questionnaire. Pneumonia (a child with cough or difficult breathing and fast breathing and or chest in-drawing with recently developed radiological pulmonary shadowing)1 affected 100 children included in case group and 100 children free of pneumonia included in control group. SPSS version 22 were used to analyze the data. Independent sample‘t’ test and Chi (x2 ) square test were done. Results: Residential area, socio-economic status, maternal education, H/A score, formula feeding, types of complimentary feeding, passive smoking, birth order >2, family member, crowding index and birth spacing are significantly associated with development of pneumonia. Conclusion: Children belonged to rural area, poor maternal education, low socio-economic status, stunting height for age, formula feeding, types of complimentary feeding, exposure to passive smoking, birth order>2, birth spacing, family member and crowding index were significantly (p<0.05) associated with pneumonia.

Simplified antibiotic regimens for young infants with possible serious bacterial infection when the referral is not feasible in the Democratic Republic of the Congo.

Neonates with serious bacterial infections should be treated with injectable antibiotics after hospitalization, which may not be feasible in many low resource settings. In 2015, the World Health Organization (WHO) launched a guideline for the management of young infants (0-59 days old) with possible serious bacterial infection (PSBI) when referral for hospital treatment is not feasible. We evaluated the feasibility of the WHO guideline implementation in the Democratic Republic of the Congo (DRC) to achieve high coverage of PSBI treatment. From April 2016 to March 2017, in a longitudinal, descriptive, mixed methods implementation research study, we implemented WHO PSBI guideline for sick young infants (0-59 dyas of age) in the public health programme setting in five health areas of North and South Ubangi Provinces with an overall population of about 60,000. We conducted policy dialogue with national and sub-national level government planners, decision-makers, academics and other stakeholders. We established a Technical Support Unit to provide implementation support. We built the capacity of health workers and managers and ensured the availability of necessary medicines and commodities. We followed infants with PSBI signs up to 14 days. The research team systematically collected data on adherence to treatment and outcomes. We identified 3050 live births and 285 (9.3%) young infants with signs of PSBI in the study area, of whom 256 were treated. Published data have reported 10% PSBI incidence rate in young infants. Therefore, the estimated coverage of treatment was 83.9% (256/305). Another 426 from outside the study catchment area were also identified with PSBI signs by the nurses of a health centre within the study area. Thus, a total of 711 young infants with PSBI were identified, 285 (40%) 7-59 days old infants had fast breathing (pneumonia), 141 (20%) 0-6 days old had fast breathing (severe pneumonia), 233 (33%) had signs of clinical severe infection (CSI), and 52 (7%) had signs of critical illness. Referral to a hospital was advised to 426 (60%) infants with CSI, critical illness or severe pneumonia. The referral was refused by 282 families who accepted simplified antibiotic treatment on an outpatient basis at the health centres. Treatment failure among those who received outpatient treatment occurred in 10/128 (8%) with severe pneumonia, 25/147 (17%) with CSI, including one death, and 2/7 (29%) young infants with a critical illness. Among 285 infants with pneumonia, 257 (90%) received oral amoxicillin treatment, and 8 (3%) failed treatment. Adherence to outpatient treatment was 98% to 100% for various PSBI sub-categories. Among 144 infants treated in a hospital, 8% (1/13) with severe pneumonia, 23% (20/86) with CSI and 40% (18/45) with critical illness died. Implementation of the WHO PSBI guideline when a referral was not possible was feasible in our context with high coverage. Without financial and technical input to strengthen the health system at all levels, including the community and the referral level, it may not be possible to achieve and sustain the same high treatment coverage.

MOTHERS KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING ACUTE RESPIRATORY INFECTION IN CHILDREN UNDER FIVE YEARS/ URBAN AND RURAL AREAS - AL MUKALLA CITY-2022

Management and prevention of acute respiratory tract infections are directly linked to the mother's knowledge and attitude, which can be translated into practice and employed as a disease prevention intervention.A community-based cross- sectional study was conducted in the urban and rural area locality in Al Mukalla, Hadhramout Governorate/ Yemen. Five hundred eighty-one mothers were selected randomly used Random Walk Method who had a child aged <5 years. Data were collected using a pre-tested interviewer-administered questionnaire. SPSS version 20 was used for data entry and analysis.In a study of 581 mothers, 52.3 % of urban mothers were knowledgeable of ARI. About a third of mothers were knowledgeable that chest indrawing and rapid breathing are dangerous signs of infection, and this knowledge was high among urban mothers. In relation of mothers' attitudes about antibiotic use, positive attitudes were found to be prevalent among urban mothers (78.4%), while negative attitudes were prevalent among rural mothers (88.7 %). Urban mothers were more likely to use antibiotics without a prescription and to not complete the course (59 % and 57.7%, respectively), whereas rural mothers were more likely to use home remedies (61.3 %).The study reveals good knowledge and positive attitude among urban mothers towards ARI than rural mothers, but this good knowledge did not translate into good practice towards use of antibiotics by rational way.

Increased Direct Current-Electroencephalography Shifts During Induction of Anesthesia in Elderly Patients Developing Postoperative Delirium.

BackgroundChanges in the direct current (DC) electroencephalography (EEG), so-called DC shifts, are observed during hypoxia, hypo-/hypercapnia, anesthetic administration, epileptic seizures, and spreading depolarizations. They are associated with altered cerebral ion currents across cell membranes and/or the blood–brain barrier (BBB). Here, we measured DC shifts in clinical practice during hyperventilation (HV) and anesthesia induction, and investigated whether such DC shifts correlate with the occurrence of postoperative delirium (POD) in older patients.MethodsIn this prospective observational study (subproject of the BioCog study, NCT02265263; EA2/092/14), a continuous pre- and perioperative DC-EEG was recorded in patients aged ≥65 years. The preoperative DC-EEG included a 2 min HV with simultaneous measurement of end-tidal CO2. Of the perioperative recordings, DC-EEG segments were chosen from a 30 s period at the start of induction of anesthesia (IOA), loss of consciousness (LOC), and during a stable anesthetic phase 30 min after skin incision (intraOP). The DC shift at Cz was determined in μV/s. All patients were screened twice daily for the first seven postoperative days for the occurrence of POD. DC-EEG shifts were compared in patients with (POD) and without postoperative delirium (noPOD).ResultsFifteen patients were included in this subproject of the BioCog study. DC shifts correlated significantly with concurrent HV, with DC shifts increasing the more end-tidal CO2 decreased (P = 0.001, Spearman’s rho 0.862). During the perioperative DC-EEG, the largest DC shift was observed at LOC during IOA. POD patients (n = 8) presented with significantly larger DC shifts at LOC [POD 31.6 (22.7; 38.9) μV/s vs. noPOD 4.7 (2.2; 12.5) μV/s, P = 0.026].ConclusionDC shifts can be observed during HV and IOA in routine clinical practice. At anesthesia induction, the DC shift was greatest at the time of LOC, with POD patients presenting with significantly stronger DC shifts. This could indicate larger changes in gas tensions, hypotension and impaired cerebral autoregulation or BBB dysfunction in these patients.Clinical Trial Registrationwww.clinicaltrials.gov, identifier NCT02265263.

Dynamics of the cerebral autoregulatory response to paced hyperventilation assessed using subcomponent and time-varying analyses.

Cerebral blood flow (CBF) can be altered by a change in partial pressure of arterial CO2 (Pco2), being reduced during hyperventilation (HPV). Critical closing pressure (CrCP) and resistance area product (RAP) are parameters that can be studied to understand this change, but their dynamic response has not been investigated during paced HPV (PHPV). Seventy-five participants had recordings at rest and during PHPV. Blood pressure (BP) (Finometer), bilateral CBF velocity (CBFV) (transcranial Doppler), end-tidal CO2 (capnography), and heart rate (HR) were recorded continuously. Subcomponent analysis (SCA) and time-varying CrCP, RAP, and dynamic cerebral autoregulation (autoregulation index, ARI) were estimated by comparing PHPV with poikilocapnia. PHPV caused a change in CBFV (P < 0.01), EtCO2, (P < 0.01), HR (P < 0.001), and RAP (P < 0.01). SCA demonstrated RAP was the main parameter explaining the changes in CBFV due to PHPV. The time-varying step responses for CBFV and RAP during PHPV demonstrated considerable nonstationarity compared with poikilocapnia (P < 0.00001). Although time-varying ARI was temporarily depressed, after 60 s of PHPV it was significantly higher (6.81 ± 1.88) (P < 0.0001) than in poikilocapnia (5.08 ± 1.86). The mean plateau of the RAP step response was -98.3 ± 58.8% 60 s after the onset of PHPV but -71.7 ± 45.0% for poikilocapnia (P = 0.0026), with no corresponding changes in CrCP (P = 0.6). Further work is needed to assess the role of sex and aging in our findings, and the potential for using RAP and CrCP to improve the sensitivity and specificity of CO2 reactivity studies in cerebrovascular conditions.NEW & NOTEWORTHY The dynamic response of critical closing pressure (CrCP) and resistance-area product (RAP) of the cerebral circulation to a step change in mean arterial pressure can shed light on the nonstationary changes induced by paced hyperventilation and the effects of hypocapnia on the autoregulation of cerebral blood flow. Contrary to hypercapnia, where the response is dominated by CrCP, hypocapnia shows an initial depression of cerebral autoregulation, followed by improvements controlled by changes in RAP.

Clinical and Echocardiographic Profile of Congenital Heart Diseases in the 0-12-Year Age Group in a Tertiary Care Medical Institute in Eastern India: A Retrospective, Cross-Sectional Study.

BackgroundThis study aimed to determine the clinical and echocardiography profile of congenital heart diseases (CHDs) among admitted children as well as patients presenting to the outpatient department of the Indira Gandhi Institute of Medical Sciences, Patna, which is a tertiary care and apex institute located in Bihar, India.MethodologyA retrospective, cross-sectional study was conducted in a tertiary care hospital from January 2019 to January 2021. In total, 200 patients aged 0-12 were enrolled in the study. The study design was exploratory, with a proforma drafted to study patients with features suggestive of CHDs. All pediatric echocardiography was performed by a trained cardiologist. Records were obtained from the departmental record-keeping register, and reports were available for analyzing the data. For data collection, cardiology and pediatric department registers were reviewed and all CHD data were collected. Data analysis was done using SPSS software version 25.0 (IBM Corp., Armonk, NY, USA).ResultsOf the 200 children with CHDs, 142 were diagnosed to have acyanotic heart disease (ACHD), while 58 had cyanotic congenital heart disease (CCHD). Among 200 cases of CHD, ventricular septal defect (VSD) constituted 62 cases comprising 31% of the total CHD cases and 44% of all ACHD cases. Atrial septal defect (ASD) was the second most common CHD comprising 23% of all CHD cases. Tetralogy of Fallot (TOF) constituted 23 cases accounting for 11.5% of all CHD cases. It was the most common CCHD. Based on the age at the time of presentation, 90 (45%) cases were diagnosed below one year of age. Congestive heart failure (CHF) was most common in ACHD comprising 30% compared to CCHD in which only 7% of cases had CHF. This finding was statistically significant (p < 0.05). Analyzing the symptoms of different CHDs, of both ACHDs and CCHDs, the common symptoms were fast breathing (38%).ConclusionsAmong ACHD patients, 31% VSD and 21% ASD were noted. In CCHD, TOF was the most common with 11.5% of cases. Respiratory tract conditions were the most common comorbidities encountered. Because this is one of the first studies conducted in Bihar in the pediatric age group, it can help know the prevalence of CHDs in this region and will be useful for developing policies by stakeholders.

Under-five children's acute respiratory infection dropped significantly in Bangladesh: An evidence from Bangladesh demographic and health survey, 1996-2018.

This study aims to systematically identify and review the most significant risk factors and the trends that follow acute respiratory infection (ARI) among children under five in Bangladesh. A total of 6863 under-five children were eligible for our analysis, retrieved from Bangladesh Demographic and Health Survey (BDHS), 2014. ARI cases were defined if a child experienced coughing with short and rapid breathing at the chest that occurred during 2 weeks prior to the study. Logistic regression and systematic review methods were appraised to explore the various risk factors involving ARI in Bangladesh. Furthermore, a trend analysis was performed to overlook the historical trend of ARI prevalence and affiliated determinants from 1996/97 to 2017/18 in Bangladesh. Over the past two decades, Bangladesh experienced a significant drop in ARI prevalence from 12.8% in 1996 to only 3.0% in 2018. The cross-sectional findings revealed that boys (OR=1.35, 95% CI: 1.03-1.78), stunted children (OR=1.35, 95% CI: 1.03-1.78) and mothers with primary or no education (OR=2.53, 95% CI: 1.43-4.90) and secondary education (OR=1.77, 95% CI: 1.00-3.44) have the higher odds of ARI than their counterparts. Acute respiratory infection prevalence significantly declined in Bangladesh, while boys, stunted children and uneducated or primary educated mothers were identified as potential risk factors.

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

BackgroundIn an effort to improve population health, many low- and middle-income countries (LMICs) have expanded access to public primary care facilities and removed user fees for services in these facilities. However, a growing literature suggests that many patients bypass nearby primary care facilities to seek care at more distant or higher-level facilities. Patients in urban areas, a growing segment of the population in LMICs, generally have more options for where to seek care than patients in rural areas. However, evidence on care-seeking trajectories and bypassing patterns in urban areas remains relatively scarce.MethodsWe obtained a complete list of public health facilities and interviewed randomly selected informal sector households across 31 urban areas in Lusaka District, Zambia. All households and facilities listed were geocoded, and care-seeking trajectories mapped across the entire urban area. We analyzed three types of bypassing: i) not using health centers or health posts for primary care; ii) seeking care outside of the residential neighborhood; iii) directly seeking care at teaching hospitals.ResultsA total of 620 households were interviewed, linked to 88 health facilities. Among 571 adults who had recently sought non-emergency care, 65% sought care at a hospital. Among 141 children who recently sought care for diarrhea, cough, fever, or fast breathing, 34% sought care at a hospital. 71% of adults bypassed primary care facilities, 26% bypassed health centers and hospitals close to them for more distant facilities, and 8% directly sought care at a teaching hospital. Bypassing was also observed for 59% of children, who were more likely to seek care outside of the formal care sector, with 21% of children treated at drug shops or pharmacies.ConclusionsThe results presented here strongly highlight the complexity of urban health systems. Most adult patients in Lusaka do not use public primary health facilities for non-emergency care, and heavily rely on pharmacies and drug shops for treatment of children. Major efforts will likely be needed if the government wants to instate health centers as the principal primary care access point in this setting.

A multi-country implementation research initiative to jump-start scale-up of outpatient management of possible serious bacterial infections (PSBI) when a referral is not feasible: Summary findings and implications for programs.

IntroductionResearch on simplified antibiotic regimens for outpatient treatment of ‘Possible Serious Bacterial Infection’ (PSBI) and the subsequent World Health Organization (WHO) guidelines provide an opportunity to increase treatment coverage. This multi-country implementation research initiative aimed to learn how to implement the WHO guideline in diverse contexts. These experiences have been individually published; this overview paper provides a summary of results and lessons learned across sites.Methods summaryA common mixed qualitative and quantitative methods protocol for implementation research was used in eleven sites in the Democratic Republic of Congo (Equateur province), Ethiopia (Tigray and Oromia regions), India (Haryana, Himachal Pradesh, Maharashtra, and Uttar Pradesh states), Malawi (Central Region), Nigeria (Kaduna and Oyo states), and Pakistan (Sindh province). Key steps in implementation research were: i) policy dialogue with the national government and key stakeholders, ii) the establishment of a ‘Technical Support Unit’ with the research team and district level managers, and iii) development of an implementation strategy and its refinement using an iterative process of implementation, programme learning and evaluation.Results summaryAll sites successfully developed and evaluated an implementation strategy to increase coverage of PSBI treatment. During the study period, a total of 6677 young infants from the study catchment area were identified and treated at health facilities in the study area as inpatients or outpatients among 88179 live births identified. The estimated coverage of PSBI treatment was 75.7% (95% CI 74.8% to 78.6%), assuming a 10% incidence of PSBI among all live births. The treatment coverage was variable, ranging from 53.3% in Lucknow, India to 97.3% in Ibadan, Nigeria. The coverage of inpatient treatment ranged from 1.9% in Zaria, Nigeria, to 33.9% in Tigray, Ethiopia. The outpatient treatment coverage ranged from 30.6% in Pune, India, to 93.6% in Zaria, Nigeria. Overall, the case fatality rate (CFR) was 14.6% (95% CI 11.5% to 18.2%) for 0-59-day old infants with critical illness, 1.9% (95% CI 1.5% to 2.4%) for 0-59-day old infants with clinical severe infection and 0.1% for fast breathing in 7–59 days old. Among infants treated as outpatients, CFR was 13.7% (95% CI 8.7% to 20.2%) for 0-59-day old infants with critical illness, 0.9% (95% CI 0.6% to 1.2%) for 0-59-day old infants with clinical severe infection, and 0.1% for infants 7–59 days old with fast breathing.ConclusionImportant lessons on how to conduct each step of implementation research, and the challenges and facilitators for implementation of PSBI management guideline in routine health systems are summarised and discussed. These lessons will be used to introduce and scale-up implementation in relevant Low- and middle-income countries.

Omitting Hyperventilation in Electroencephalogram during the COVID-19 Pandemic May Reduce Interictal Epileptiform Discharges in Patients with Juvenile Myoclonic Epilepsy.

Background: To prevent the spread of coronavirus disease 2019 (COVID-19), hyperventilation (HV) activation has been avoided in electroencephalograms (EEGs) since April 2020. The influence of omitting HV in EEG on epilepsy diagnosis remains uncertain for patients with epilepsies other than child absence epilepsy. We hypothesized that EEGs with HV would show more interictal epileptiform discharges (IEDs) than EEGs without HV in patients with juvenile myoclonic epilepsy (JME). Methods: We reviewed the EEGs of seizure-free patients with JME who underwent EEG, both with and without HV, from January 2019 to October 2021, in our institution, and compared IEDs between EEG with and without HV. Results: This study analyzed 23 JME patients. The IED-positive rate was significantly higher in EEG with HV (65.2%) than in EEG without HV (34.8%, p = 0.016). The mean ± standard deviation number of IEDs per minute was significantly larger during HV (1.61 ± 2.25 × 10−1) than during non-activation of both first EEG (0.57 ± 0.93 × 10−1, p = 0.039) and second EEG (0.39 ± 0.76 × 10−1, p = 0.009). Conclusions: In JME patients, performing HV during EEG may increase IEDs and appears to facilitate the accurate diagnosis of epilepsy.

Disseminated histoplasmosis in a 17-year-old Nigerian male patient

Rationale: Disseminated histoplasmosis is the most severe form of histoplasmosis and often associated with fatal outcomes. Both pulmonary and disseminated forms mimics tuberculosis (TB) and may be misdiagnosed. Patient concerns: A 17-year-old male patient compliant with anti- tuberculosis therapy with complaints of fever, cough productive of thick yellowish sputum, fast breathing, abdominal pain, swelling and jaundice. HIV status was negative. Diagnosis: Disseminated histoplasmosis. Interventions: Antimicrobials including anti-TB therapy, ceftriaxone, gentamicin, azithromycin and ciprofloxacin. Outcomes: He was responding to anti-TB drugs until about 4 and a half months on treatment when he fell ill. Peripheral blood film done 2 days prior to his demise revealed florid yeast like organisms in monocytes with eccentric chromatin suggestive of Histoplasma capsulatum. Lessons: Histoplasmosis can both mimic and coexist with TB and so a high index of suspicion is needed for its diagnosis.

Household food insecurity and unimproved toilet facilities associate with child morbidity: evidence from a cross-sectional study in Bangladesh

BackgroundDespite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh.MethodsWe used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6–59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders.ResultsA total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95).ConclusionsOur study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Analysis of Changes in Flow Setting Against Rise Time Using Gas Board 7500E Sensor on Bubble CPAP

Respiratory distress in neonates is one of the biggest problems encountered on a daily basis. Respiratory distress looks like rapid breathing in a newborn. CPAP Bubble is the right treatment in this case. Rise time is the time for airway pressure to reach the maximum standard value. A fast time value can make it possible to bring the breath pressure to a standard level. This study aims to analyze changes in setting flow to rise time using a gasboard sensor 7500E on a CPAP bubble device. The main advantage of this proposed method is that the results are displayed in the form of graphics, portable and there is data storage. This design uses a Gasboard 7500E sensor as a detector of oxygen concentration, a TFT LCD as a graphic display and an SD Card as data storage. The data collection is in the form of the average rise time of oxygen concentration followed by changes in its rate. Data were taken five times with three different CPAPs. The results showed that the increase in the rate affect the rise time of the CPAP oxygen concentration.

0861 Sleepy in the Mountains

IntroductionCentral sleep apnea (CSA) is a rare disorder caused by a reduction of airflow and ventilatory effort during sleep. CSA is rarely idiopathic and associated with medical conditions including heart failure, opioid medications, treatment emergent and high-altitude periodic breathing. At higher altitudes, hypoxemia induces periodic breathing with periods of deep and rapid breathing alternating with central apnea. Patients with high-altitude periodic breathing experience fragmented sleep, poor sleep quality, excessive daytime sleepiness, morning headaches and witnessed apnea. We discuss a patient with obstructive sleep apnea (OSA) who developed new-onset central sleep apnea after relocating to a higher altitude location. Report of Cases: A 75-year-old male with a history of moderate obstructive sleep apnea well controlled on CPAP for eight years, with no known cardiovascular or pulmonary disease, presented with new-onset excessive daytime sleepiness. He had recently relocated to an area in the Colorado mountains (7000 ft elevation) from his previous home in Los Angeles (sea level). His residual apneahypopnea index (r-AHI) displayed on his CPAP machine increased to 7-14/hr from his normal of 1-2/hr after his relocation. Review of his compliance data revealed his central apnea index was elevated, contributing to his high r-AHI. A one-night nocturnal oximeter was mailed to the patient to use while on CPAP. Data revealed oxygen desaturation to less than 88% for about 2 hours of the night, worse during the early morning hours. The patient was advised to undergo a polysomnography and adaptive servo-ventilation titration if significant central sleep apnea was present. The patient declined due to concern about the COVID-19 pandemic. Supplemental nocturnal oxygen was initiated at 2L/min with normalization of the r-AHI.ConclusionPatients with OSA who experience worsening symptoms or increased r-AHI despite excellent compliance with PAP therapy should be considered for repeat polysomnography or titration study. While it is expected that high-altitude central sleep apnea will improve with acclimatization, nocturnal supplemental oxygen in addition to PAP therapy is indicated for patients with high-altitude central sleep apnea to diminish hypoxemia and improve residual AHI and sleep quality.Support (If Any)

Congenital nasal pyriform aperture stenosis with holoproencephaly: Diagnosis and surgical management

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal nasal obstruction that clinically mimics choanal atresia. It occurs as a result of abnormal development of primary palate and maxilla, either in isolation or in association with other anomalies. Differentiation between CNSPAS and choanal atresia is critical as management approachers are quite different from one another. Diagnosis can be made clinically and with characteristics CT findings. Management options include both conservative and surgical approaches depending on the patient’s initial condition. Here is reported a case of 33 days infant who was admitted to our NICU with a working diagnosis of CNPAS after she presented with two days of fast breathing and failure to suckle, managed surgically and discharged improved.

Effects of chlorine particle concentration on the human airway

For COVID-19, chlorine has lately been utilised as a home disinfectant. Given that chlorine is hazardous to the human airway, the current research investigates the effects of chlorine mass fraction and droplet size on the human airway. The effects are investigated at chlorine mass ratios of 2% (24 ppm), 10% (120 ppm), 15% (180 ppm), and 20% (240 ppm), as well as chlorine particle diameters of 10 nm, 20 nm, 30 nm, and 50 nm, and three inhalation rates (15 l/min, 30 l/min, and 60 l/min). The results reveal that when the chlorine mass fraction is 2% and the inhalation rate is low, the chlorine volume fraction decreases. Furthermore, at 2% chlorine and a rapid breathing rate, chlorine particles are accelerated to escape into the lungs.

The Invisible Voice.

During my overnight shift in the emergency department, around 0230, I had finished up with another patient when I saw that a sexual assault victim had just been checked in for evaluation. After quickly skimming the patient's chart, I entered the room to find a petite young woman, sitting timidly on the stretcher with an emotional reservation creased into her face. With tight yoga pants and a loose fitting satin top, she seemed inappropriately dressed for the piercing, subzero winter night in New Hampshire. Her companion stood in stark contrast: a tall obese male wearing a down jacket, with distracting facial piercings, disheveled hair, and multiple stenciled tattoos on his hands and neck. In the initial silence, the peculiarity of the dynamics between the two suffocated the room. The man displayed a forced distress, as he clasped the patient's hand and moaned, “Does my size even matter if I cannot protect my wife?!” I gently pulled my chair next to the stretcher, trying to convey compassion and engender the patient's trust. As I started the interview, I became unnerved that whenever I asked the patient a question, her eyes would dart nervously toward her looming companion, and he would answer. Sensing my concern, he preemptively stated, “She had a violent boyfriend previously and so she feels uncomfortable around males.” Nodding gingerly, I requested to do a physical exam: once again, the patient looked to her companion for approval, which he gave. While my role focused on medical concerns, I felt incomplete without more situational context, and so I asked her to elucidate what had happened that night, a role typically left to the sexual assault nurse examiner (SANE). The companion promptly narrated an illogical, essentially implausible story, of a rape that left me feeling flabbergasted; thankfully my face mask and eye-pro hid my facial expressions. I looked at the patient for any engagement, her head had remained bowed during the companion's narration, but she glanced up at me; her eyes spoke volumes for her silence. Excusing myself, I communicated my concern for coercion and possible human trafficking to our SANE nurses. The SANE nurses spent 2 h in the patient's room and returned stating, “I am pretty sure he is prostituting her out.” The man had become increasingly more aggressive: refusing to leave the room for any part of the examination, preventing the collection of serum samples but allowing the collection of a urine sample. In addition, during their physical examination of the patient, the SANE nurses had found multiple “defensive wounds” and had discerned an additional history of strangulation. As a result, we ordered a CTA neck to rule out a dissection, but also to separate the patient from her companion and provide her with resources. When the attending and I entered the room, I sat next to the victim and the attending sat closer to the door. As the attending began to speak about obtaining advanced imaging, the companion interjected with incredulity, stating that they had “been there for hours.” Despite our calm explanation regarding the imaging and offering them food vouchers, the man perpetually interrupted my attending, demanding an antibiotic prescription for the patient for any possible STIs. He fomented increasing hostility in the room and assumed a threatening posture against my attending, a petite woman. “You are not listening to her,” he yelled, referencing his “wife” whom we had not heard from the entire night, “We will walk right out of here. Give us the paperwork!” In the subsequent seconds, I felt an uncomfortable warmth layer the back of my neck, as I mentally prepared myself for a physical confrontation to protect my attending. Thankfully, my attending defused the situation saying that the imaging could be obtained as an outpatient and that they could be discharged. I felt nauseous leaving the room. As she was escorted by her companion into the frigid morning, the patient's silhouette rapidly enveloped into darkness the farther she walked from the gleam of the illuminated red emergency room sign. When she stepped into the pick-up truck some distance away and shut the door, the passenger window fogged up in a staccato of rapid breaths: tearful pleas, her phonation appeared hobbled and pitiful, … but we never heard her voice.

The Clinical Profile and Risk Factors of Pneumonia in Children

Background: The problem of increased ARI morbidity and mortality has arisen as a result of modernization, industry, and urbanization. There is a deficiency of epidemiological studies on risk factors and treatment. There is a significant vacuum in our understanding of these issues, which must be filled by methodical research. The purpose of this study is to evaluate the risk factors developing pneumonia in our area.Material &amp; Methods:This was a prospective clinical study of pneumonia conducted on 90 children who were admitted to Paediatric ward in Abdul MalekUkil Medical College, Noakhali, Bangladesh in study duration. Epidemiological factors affecting the same were studied and bronchoscopy was done whenever it was needed. A detailed history of the relevant symptoms, such as fever, cough, rapid breathing, refusal of feeds, noisy breathing, bluish discolouration etc., was collected.Results:The most affected children belonged to the age group of 1 year to 3 years (64.9%). Bronchopneumonia (86.2%) was the most common clinical diagnosis made at admission. According to WHO ARI control programme, 28.7% had pneumonia, 54.3% had severe pneumonia and 17% very severe pneumonia. It was found that younger age group, malnutrition, kutcha house, crowding, poor sanitation facilities, cooking with fuel other than LPG (indoor pollution) and low socio economic status and high respiratory rate were significant risk factors for pneumonia in children.Conclusions:One of the leading causes of mortality and death in children is particularly pneumonia. In newborns and preschool children, bronchopneumonia is the most common symptom.