Respiratory Obstruction Research Articles

Modified technique of extracorporeal septoplasty in severe septal deviation

ObjectivesSeptal deviation represent a major cause of aesthetic disorders and respiratory obstruction. The traditional septoplasty techniques may often be inadequate to treat severe deviations. This study was designed to evaluate the effectiveness of the modified technique of extracorporeal septoplasty in terms of subjective improvement in validated NOSE score post-operatively and complications in short term (3months). MethodsA total of 20 patients with severe septal deviation were evaluated in the Otolaryngology Outpatient Department in Al-Immamain Al-Khadimain Medical City, from March 2017 to February 2018. All were undergoing extracorporeal septoplasty (ECS) and assessed pre and post-operatively clinically and endoscopically and subjective evaluation of the respiratory function was obtained by mean of Nasal Obstruction Symptom Evaluation (NOSE) scale which compared with the results obtained preoperatively and at 1 and 3 months post-intervention. ResultsNOSE scores at 1 and 3 months follow-up demonstrated a statistically significant improvement (P < 0.0001) compared to preoperative values. There were no complications recorded. ConclusionsThe modified extracorporeal septoplasty technique proved to be functionally effective at 3-month follow-up in cases of severe septal deviation.

Evaluation of the effect of free fibular flap transplantation in repairing mandibular osteoradionecrosis defect in 151 cases

Objective: To investigate the clinical effect of free fibula flap transplantation in repairing the defect of mandibular osteoradionecrosis (ORN). Methods: A total of 151 mandibular ORN patients undergoing free fibular flap transplantation were selected from August 2005 to September 2020 in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Among them, 109 patients were males and 42 patients were females, aged (54.1±10.1) (ranged 31-85) years old. The clinical data of the patients was collected and the survival rate of the flaps and postoperative function were calculated to evaluate the surgical efficacy. The χ2 test was used for difference analysis. Results: Among the 151 patients, mandibular ORN caused by radiotherapy for nasopharyngeal carcinoma accounted for 79.5% (120/151). The average time for mandibular ORN appeared was 5(6) years after radiotherapy. Facial artery [57.2%(87/152)] and superior thyroid artery [32.9%(50/152)] were the main anastomotic arteries in the recipient area. There was no significant difference in the necrosis rates of the two flaps [10.3%(9/87) and 12.5% (5/50), respectively, P=0.949]. The main anastomotic veins in the recipient area were the external jugular vein [48.4%(135/279)] and the common facial vein [26.5%(74/279)]. Twenty-five cases (16.6%) had one vein anastomosed, and 126 cases (83.44%) had two veins anastomosed. There was no significant difference in the flap necrosis rate between the two conditions [20.0%(5/25) and 7.1%(9/126), respectively, P=0.100]. Ninety-seven cases (64.2%) used the peroneal musculocutaneous-fascia composite flap to repair the maxillofacial soft and hard tissue defects. Thirteen cases (8.6%) underwent the restorations with digital virtual surgery design, of which 5 cases were repaired with dental implants at the same time. After the operations, lower respiratory tract infection occurred in 17 patients (11.3%), and upper respiratory tract obstruction occurred in 3 cases (2.0%). The survival rate of the flap after operation was 90.7% (136/151), and 21 patients (13.9%) had flap vascular crisis. Delayed healing of maxillofacial wounds occurred in 33 cases (21.9%). After 3 to 24 months of follow-ups, 110 patients (76.9%) had no fistula inside/outside the oral cavity, 118 patients (82.5%) had an improvement in opening mouth of increasing (≥0.5 cm) after surgery, 135 patients (94.4%) had pain relief, 97 cases (67.8%) could eat normal diet, semi-liquid or soft food, and 137 cases (95.8%) were satisfied or basically satisfied with the treatment effects. Conclusions: The free fibular flap transplantation is an effective method to repair mandibular ORN defects. Preoperative vascular assessment is helpful for the selection of recipient vessels. Facial artery, superior thyroid artery, external jugular vein and common facial vein can be used as the main recipient vessels. The repair of the peroneal musculocutaneous-fascia composite flap facilitates the closure of internal and external fistulas. Digital technology can help to restore the maxillofacial shape more accurately, improve the patient's occlusal and chewing function and enhance the quality of life of mandibular ORN patients.

Recurrent giant fibrovascualr oesophageal polyp: Benefits and pitfalls of a multimodal approach.

Fibrovascular polyp of the cervical esophagus represents about 0.5% to 1% of all benign oesophageal tumours. Usually asymptomatic, when FP protrudes into the oesophageal lumen, this may cause respiratory obstruction and provoke dysphagia, vomiting, dyspnoea, and retrosternal pain. In this article, we describe a multimodal approach in the treatment of a complex recurrent FP, for which surgical resection represents the safer and less invasive procedure.

Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019).

Further development of surgical techniques for equine cervical stabilisation is necessary to make the procedure less technically demanding, reduce complications and improve outcomes. To describe clinical outcomes and owner reports in horses undergoing placement of an interbody fusion device and polyaxial pedicle screw and rod construct for cervical vertebral fusion in horses with cervical vertebral compressive myelopathy. Retrospective case series. Data were retrieved from medical records of 10 horses undergoing cervical vertebral fusion (2015-2019). Records were evaluated for signalment, duration of clinical signs, number and location of compression sites, grade of ataxia, duration of hospitalisation and complications. Long-term follow-up was obtained through clinical re-evaluation, postoperative radiographs and owner contact. Breeds were mixed. Median age was 24 (range 12-168) months. There were 2/10 mares, 4/10 geldings and 4/10 stallions. Preoperative grade of ataxia ranged from 1-3/5. Fusion was performed at one (n=3) or two (n=7) sites. Two horses were euthanised within the first year. In 6 of 8 horses with ≥1-year follow-up, ataxia improved by 1-3 grades, with an average improvement of 1.25 grades. In four horses, ataxia improved to grade 0-1. In two horses the gait was unaffected, but neck comfort improved. Complications included seroma formation (n=9), pain (n=5), fever (n=4), upper respiratory tract obstruction (n=2), azotemia (n=2), screw breakage (n=2), progression of neurological signs (n=1), Horner's Syndrome (n=1), dysphagia (n=1), hives (n=1), implant infection (n=1) and nondisplaced fracture (n=1). Small case series, heterogeneous patient population. This technique resulted in ≥1 grade gait improvement in 6/10 cases operated and 6/8 cases for which ≥1-year follow-up was available, similar to other methods. Fatal complications related to implant placement did not occur. This technique may represent a safer alternative to current techniques of ventral interbody fusion with similar outcomes.

844 Pediatric Vagus Nerve Stimulator-Induced Obstructive Sleep Apnea

Abstract Introduction Vagus nerve stimulation (VNS) is an adjunct treatment for seizures refractory to medications. VNS in children with epilepsy can reduce seizures by up to 90%. VNS settings include stimulation on-time, off-time, frequency and output current. Complications of VNS include sleep-disordered breathing due to laryngopharyngeal dysfunction, which can also cause voice alteration, hoarseness, and cough. Both obstructive apneas (more common) and central apneas can be seen in those patients who have VNS-induced sleep-disordered breathing. Report of case(s) A 14-year-old male with Lennox-Gastaut syndrome treated with multiple antiepileptic drugs and VNS was admitted to the PICU with worsening seizures. He developed acute respiratory failure due to status epilepticus, requiring intubation. After extubation, he was observed to have repetitive respiratory obstruction at regular intervals, occurring throughout the day and night, and associated with mild oxygen desaturations. Polysomnography showed cyclical obstructive respiratory events lasting 30 seconds followed by approximately 2-minute intervals of regular breathing. Interrogation of his VNS device revealed the following settings: output current of 1.75 mA, 30 seconds on, and 1.8 minutes off. CPAP therapy improved his oxygen saturations, but he continued to clinically exhibit the repetitive obstructive apneas even on positive pressure. However, after his VNS device settings were decreased, repeat polysomnography showed resolution of his obstructive breathing. Conclusion This case report demonstrates pediatric VNS-induced obstructive sleep apnea. Activation of the vagus nerve can cause laryngopharyngeal dysfunction, including laryngospasm and vocal cord dysfunction, with subsequent upper airway obstruction, causing obstructive apneas or hypopneas. Treatment options for pediatric VNS-induced OSA include CPAP, decreasing the VNS settings and adenotonsillectomy. Support (if any):

Рекурентні епізоди гострого обструктивного ларингіту в дітей: можливі причини та підходи до профілактики

Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup. Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention. Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years. Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (&gt;6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D&gt;30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D&gt;30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29). Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to &gt;30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: recurrent episodes, viral croup, children, causes, prevention.

Impact of the spirometric definition on comorbidities in chronic obstructive pulmonary disease

BackgroundLittle is known about how the spirometric definition of airway obstruction affects the association between COPD and comorbidities and whether these associations might be due to genetic predisposition. Aim1) To examine the impact of the spirometric definition on the associations between COPD and its comorbidities and 2) To examine whether these associations can be explained by shared genetic or environmental factors. Methods11,458 twins, aged 40–80 years, from the Danish Twin Registry were recruited who completed a questionnaire on medical history, life style factors and had a clinical examination. COPD was defined by respiratory symptoms (RS) plus airway obstruction according to either GOLD (FR-COPD) or ERS/ATS guidelines (LLN-COPD). Self-reported physician diagnoses were used to identify comorbidities. ResultsThe mean age of participants was 58.4 years ±SD 9.7, mean BMI was 26.6 kg/m2 ± SD 4.4, 52% were female and the prevalence of LLN2.5-COPD and FR-COPD was 2.5% and 6.3%, respectively. Among eight major comorbidities, multivariate logistic regression showed COPD was only associated with heart failure, whereas RS alone were associated with 6 out of 8 comorbidities after Bonferroni-correction. There was an increased risk of heart failure, ischemic heart disease, depression and pulmonary embolism in twin individuals with RS compared with the co-twin without RS. ConclusionsCOPD was only associated with an increased risk of heart failure. Discordant COPD-individuals (FR-COPD+/LLN5-COPD-) were at increased risk of heart failure. Sub-analyses showed that RS, but not airway obstruction were associated with an increased risk of comorbidities.

P19.11 Endobronchial Brachytherapy as Curative Therapy for Postoperative Intrabronchial Oligometastasis in Non-Small Cell Lung Cancer

Lung cancer is a major health problem and a leading cause of cancer mortality worldwide. Although intratracheal/bronchial oligometastasis is a very rare type of recurrence after surgery of lung cancer, such patients often suffer with symptoms of respiratory tract obstruction, including cough, bloody sputum and dyspnea. Surgical intervention might be difficult to perform due to reduced postoperative general condition and invasiveness associated with reoperation. In such cases of medically inoperable intratracheal/bronchial oligometastasis, endobronchial brachytherapy (EBB) plays an important role as curative treatment. We present 3 cases with recurrent intrabronchial oligometastasis who were curatively treated with a combination of external beam radiotherapy (ERBT) and EBB from May 2013 to October 2018. Patient characteristics are listed in Table1. In accordance with the present Japanese guideline1) for curative EBB, our radiation schedule is composed of 40 Gy of EBRT and 18 Gy in three fractions of EBB. We use a special source-centralizing applicator for EBB developed by Nomoto Y et al.2) to avoid eccentric distribution of the radiation dose and to protect the mucosal membrane of the bronchus from high-dose irradiation. EBB was performed in cooperation with radiologists under mild sedation without hospitalization. There were no complications in all cases using the applicator. Local control was confirmed by bronchoscopic evaluation in all cases. All patients are alive after 17, 24 and 78 months of follow-up, respectively, without evidence of recurrence. In the case of adenocarcinoma (Case 1), two metastatic lung cancers were discovered in the untreated lobe 3 years after EBB and cured by partial wedge resection. As both cases (Case 2,3) of squamous cell carcinoma were intrabronchial metastasis on the operated side which was accompanied with intrathoracic adhesions, the endobronchial brachytherapy was beneficial to avoid extreme invasive redo-surgery. Although good therapeutic result was also obtained in the case of adenocarcinoma (Case 1), it might be a subject for future debate whether local therapy with radiation or systemic therapy such as molecular targeted drugs should be ideal.

Tongue shaped oropharyngeal teratoma with cleft palate in a neonate: A case report

Background: Atypical presentation of an atypical abnormality makes the diagnosis challenging. Oropharyngeal teratoma (epignathus) is a rare, potentially life-threatening neonatal tumor. Its atypical presentation may cause a delay in diagnosis and increase morbidity and mortality. Case presentation: A newborn girl with oropharyngeal teratoma and cleft palate presented with feeding difficulty. The airway was patent. The tumor was tongue-shaped, smooth-walled, displacing the native tongue, and prevented the fusion of two palatine halves resulting in cleft palate. On the 4th day of life, complete excision was done transorally. Histopathology revealed a mature teratoma. There was no sign of recurrence at three months of follow-up. Conclusion: Presentation of the oropharyngeal teratoma varies according to its site, size, and extension. Timely diagnosis is essential to avoid life-threatening respiratory obstruction. Complete excision of the mass is usually associated with a good prognosis.

Anaesthetic Challenges in a Child Presenting with A Large Epiglottic Cyst for Excision

Laryngeal cysts are relatively rare benign lesions that represent approximately 5% of benign laryngeal lesions.1 Though benign, they can present with severe respiratory obstruction. We present one such rare case in a child aged 6yrs presenting with a large epiglottic cyst highlighting the anaesthetic challenges related to management of the airway in this age group. Fiberoptic intubation was planned in our case keeping all the necessary equipments in case of airway crisis.

WITHDRAWN: Nasal high flow oxygen for acute severe asthma patients: The best can be the enemy of the good

It was with great interest that we read the article by Ruangsomboon et al. [1] comparing nasal high-flow (NHF) oxygen and conventional oxygen therapy (COT) for the treatment of acute severe asthma patients. The usefulness of NHF in asthma does not seem obvious at first glance; indeed, asthma is a chronic inflammatory disease of the airways characterized by respiratory symptoms and airway obstruction of varying severity. Hypoxia is therefore the primary result of the physiopathology of asthmatic disease in cases of exacerbation.

Application Value of Broadband 3-Dimensional Impulse Oscillometry in COPD.

ObjectiveTo explore the correlation of respiratory resistance in stable COPD patients measured by broadband 3-dimensional impulse oscillometry (3D-IOS) and traditional pulmonary function test (PFT). To access the diagnostic value of 3D-IOS in COPD.MethodsA total of 107 COPD patients and 61 healthy subjects as controls were chosen to collect and statistically analyze the data of R5, R5–R20, R20, X5 and Fres measured by broadband 3D-IOS and FEV1%pred, FVC%pred and FEV1/FVC by PFTs. The diagnostic value of broadband 3D-IOS parameters in COPD was evaluated by receiver operating characteristic curve (ROC). 3D-colored images used to show dynamic changes of respiratory resistance in COPD.ResultsThe COPD group showed significant increases in R5, R20, R5–R20 and Fres, and a decrease in X5 (P<0.05). With the increase of GOLD grade, R5, R5–R20 and Fres increased whereas X5 decreased (P<0.05). Compared with FEV1%pred, FVC%pred and FEV1/FVC in the COPD group, R5, R5–R20 and Fres were negatively collated (P<0.05), whereas X5 was positively collated (P<0.01). R20 was uncorrelated with the traditional lung function parameters (P>0.05). Fres and FEV1/FVC (r=−0.467), and X5 and FEV1%pred (r=0.412) showed the strongest correlation. The AUC of R5, R5–R20, X5 and Fres was 0.7808, 0.7659, 0.8947 and 0.9095, respectively. Typical 3D-colored images of COPD displayed a green pattern in the inhalation phase and yellow–red–blue graduation in the expiration phase.ConclusionR5, R5-R20, X5 and Fres measured by broadband 3D-IOS can reflect the change of respiratory resistance in COPD. And they have good correlation with the traditional lung function parameters (FEV1%pred, FVC%pred, FEV1/FVC). Fres has the highest diagnostic accuracy. Comprehensive analysis of R5, R5–R20, Fres and X5 helps to determine the degree of respiratory obstruction in COPD. X5 and Fres can reflect changes in lung tissue compliance. 3D-colored images can visually show the change of respiratory resistance and reactance in COPD.

The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly.

Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.

Microfiber Content in Freshwater Mussels from Rural Tributaries of the Saint John River, Canada

Microfibers are now ubiquitous in the environment largely due to the widespread use of natural and synthetic textiles. Many enter aquatic systems through wastewater treatment plant (WWTP) effluent, surface water runoff, and atmospheric deposition, where they persist and may be ingested by filter-feeding organisms. In addition to causing physical damage (e.g., digestive and respiratory obstructions), microfibers are often carriers of chemical pollutants that may also harm biota. This exploratory study aimed to determine whether freshwater mussel (Margaritifera margaritifera L.) microfiber content varied between two rural tributaries of the Saint John River, whether microfiber content was related to WWTP discharge points or potential diffuse microfiber sources, and whether mussel size was associated with microfiber content. Mussels were collected both upstream and downstream of five WWTP discharge points and at 11 other points along two rivers within rural watersheds of maritime Canada. Microfiber content differed significantly between the two rivers; however, no trends were observed in microfiber content in relation to WWTP discharge points on either river. Smaller mussels contained significantly more microfibers than larger mussels, despite differences in mussel size ranges between tributaries. These results reveal a potential pathway for microfibers to enter aquatic food webs and highlight important implications for the use of freshwater mussels as bioindicators of microfiber contamination.

Adenotonsilectomia e Classe II esquelética – estudo de casocontrole

Introduction: The maxillomandibular lateral growth imbalance with mandibular retrusion related to the maxilla indicates the skeletal Class II pattern. This craniofacial morphological abnormality is often attributed to nasorespiratory obstruction due to pharyngeal and palatine tonsils hypertrophy. The adenotonsillectomy is indicated to young patients with respiratory obstruction. However, there is no information in the scientific literature concerning the impact of tonsils surgically removal on craniofacial growth and development. Objective: To identify the association between adenotonsillectomy and skeletal Class II. Material and Methods: An unpaired case-control study was performed. Adult subjects who agreed to participate filled a questionnaire and after identification of the skeletal pattern through radiographic cephalometric analysis were allocated into two groups: CASE GROUP composed of 23 subjects with skeletal Class II malocclusion and CONTROL GROUP composed of 27 subjects without skeletal Class II malocclusion. With specific software the images were evaluated and measured to compare craniofacial measurements between the experimental groups and this data was interpreted to verify the association between skeletal Class II and the occurrence of adenotonsillectomy in early childhood. Results: the adenotonsillectomy demonstrated protective potential for skeletal Class II development due to a strong epidemiological association between adenotonsillectomy and skeletal Class II anteroposterior discrepancy (ORC = 0.33), without gender interference (ORA = 0.91). Conclusions: Among the long-term benefits of performing adenotonsillectomy in early childhood, it may be considered the prevention of craniofacial growth alterations such as Class II maxillomandibular discrepancy.

Modern causes of tracheostomy in children

Retrospective analysis of case of children treated in a multidisciplinary urgent hospital - GBUZ «Morozovskaya CCCH of MDH», which in the period from 01.01.16 to 31.12.18 was made operation «tracheostomy» was conducted. Tracheostomy was performed in 138 (0.064%) among 216 469 hospitalized children. Age at the time of tracheostomy ranged from 2 weeks to 17.5 years (on average 67.9±59.84 months, Me=47.5 months), and 36.2% of children had tracheostomy was done on the 1st year of life. 126 (91.3%) patients required prolonged tracheal intubation prior to tracheostomy placement; the duration of intubation ranged from 1 to 95 days (on average 19.9±13.42 days, Me=14 days). The main reasons of tracheostomy were the need for long-term mechanical ventilation/respiratory support; the need for constant sanitation of the lower respiratory tract with bulbar/pseudobulbar disorders; upper respiratory paths obstruction. The diseases that led to this condition can be grouped into 4 categories: CNS pathology - 76 (55.1%) patients; brain / spinal cord tumors - 36 (26.1%); neurodystrophy and stenosis of the upper respiratory tract of various etiology - 13 (9.4% each) patients. 68.1% of patients were found incurable and required palliative care. Mortality among patients with a known catamnesis was 39.1%, mainly due to progression of the underlying disease; the lethality associated with tracheal cannulation was 1.4%. Currently, pediatric tracheostomy is moving into the category of predominantly planned surgical interventions. More than 2/3 of children requiring tracheostomy are patients in need of palliative care with severe pathology of the central nervous system; in which the main indications for surgery are the need for respiration support and regular tracheobronchial care..

Study on Inborn and Outborn Neonatal Admissions in Relation to Gestational Maturity in Neonatal Intensive Care Unit at a Tertiary Care University Hospital in Upper Egypt

AbstractNeonatal morbidity and mortality rates indicate a country's socioeconomic status and the quality, and effectiveness of its health care system. This research aimed to identify the clinical pattern and causes of neonatal admission for inborn and outborn babies in a tertiary care university hospital and their outcomes. Over a year, this prospective hospital-based research was conducted in the neonatal intensive care unit (NICU) of Assiut Children's Hospital in Upper Egypt (January 1st to December 31st, 2020). Gender, birth weight, gestational age, postnatal age, delivery mode, delivery place, admission cause, hospital stay period, and neonatal outcomes were collected. A total of 1,638 newborns were admitted; 930 (56.8%) were preterm and 708 (43.2%) full-term. Inborn admissions were 1,056 (64.5%) and outborn 582 (35.5%). The majority of inborn admissions were preterm 726 (68.8%), and outborn were full-term 378 (64.9%). The commonest admission causes among inborn and outborn preterm infants were respiratory distress syndrome (84.3%) and congenital intestinal obstruction (22.5%), respectively, while multiple congenital anomalies were the commonest cause for admission among both inborn and outborn full-term babies. The mortality rate was 708 (43.2%), higher among inborn (50%) versus outborn (30.9%). The leading cause of death was respiratory distress syndrome among premature inborn with case fatality rate of (56.9%) and multiple congenital anomalies among premature outborn (60%), as well as inborn (67.4%), and outborn (42.6%) full-term neonates. In conclusion, the neonatal mortality rate was high among studied cases. Morbidity and mortality of respiratory distress syndrome and congenital anomalies were alarmingly high. Therefore, all health care providers must devote a considerable effort to improve health care delivered to these neonates.

Respiratory System Impairments in Children with Cerebral Palsy: Outpatient Surveillance, Diagnosis, and Treatment

Introduction: Cerebral palsy is the most common physical disability of childhood. Respiratory problems are the main causes of morbidity and mortality in cerebral palsy. Methods: The study is characterized by a scoping review. The search for articles was carried out in August 2021 in the PubMed, Medline, SciELO, LILACs and Google Schoolar databases, with the keywords "cerebral palsy” and "respiratory". Results: Overall, 1037 articles were found, 10 duplicates were removed and 167 were pre-selected after the analysis of titles and abstracts. Then, 90 were excluded due to lack of appropriateness after reading the full-texts, thus yielding a total of 77 studies. Discussion: Risk of respiratory disease should be screened at least every 12 months based on the following criteria: a hospital admission for respiratory illness in the past 12 months; a Gross Motor Function Classification System level V; a Eating and Drinking Ability Classification System level III–V. The screening aims to lead to early diagnosis and treatment, and consists in actively evaluate the risk factors for emergency department visits and hospital admissions. A Gross Motor Function Classification System level V is the strongest predictor, but dysphagia and seizures are the strongest potentially modifiable factors. Aspiration pneumonia is the main cause of death. The main risk for aspiration are dysphagia; uncontrolled seizures; gastroesophageal reflux disease; and drooling. Other comorbidities should also be actively screened: undernutrition; tone disorders; skeletal malalignment; upper respiratory obstruction; airway clearence impairment; and restrictive lung disease. Conclusion: Respiratory impairments in CP results from a complex multifactorial process influenced by several interrelated pathophysiological factors, directly and indirectly influenced by other common comorbidities in CP. Active and early surveillance, diagnosis and treatment, involving multiple medical specialties and rehabilitation professionals is essential for success in improving the quality of life and reducing morbidity and mortality of these patients.

Anesthetic management of a patient presenting with huge neck lymphatic cyst

Lymphatic cyst in the cervical region presents a great challenge to the anesthesiologist. The anesthetic difficulties are because of the extension of the cyst, difficult airway, postoperative respiratory obstruction, and coexisting anomalies. The management of such patients depends on direct communication between the surgeon and anesthesiologist. We hereby present a case of a 53-year-old male presenting with lymphatic cyst of the cervicothoracic region with dysphagia and dyspnea, posted for direct laryngoscopy and biopsy under general anesthesia. Awake fiberoptic intubation was done in this patient successfully in spite of totally distorted airway anatomy.

Kovid 19 - intrapulmonalni alkalni hidrogen-peroksid može trenutno da poveća oksigenaciju krvi

It has been shown that the new coronavirus infection is life-threatening for patients not because of the COVID-19 virus, but because of the complications it causes. The most dangerous complication of this disease is the airway obstruction syndrome, which occurs with atypical pneumonia. Blockage of the airways occurs due to the accumulation of excessively large amounts of mucus and pus in them and swelling of the lung tissue, so ventilation of the lungs with air becomes almost impossible. The sad outcome of respiratory obstruction is hypoxia and hypoxic brain damage. Under these conditions, extracorporeal membrane oxygenation remains the only known way to increase blood oxygenation. However, in 2021, it was shown that intra-pulmonary administration of a warm alkaline solution of hydrogen peroxide immediately turns mucus and pus into oxygen foam and increases blood oxygen saturation. The proposed technology is a new variant of emergency blood oxygenation in severe suffocation caused by blockage of the respiratory tract with mucus, pus and blood.