Respiratory System Dysfunction Research Articles

Outcome of continuous renal replacement therapy in critically ill children.

Objective: To determine the outcome of critically ill children undergoing CRRT. Study Design: Prospective Observational Study. Setting: Pediatric Intensive Care Unit at Aga Khan University Hospital. Period: Jan 2021 to Dec 2022. Material & Methods: The study comprised of collection of data of critically ill children from the age 1-18 years who were subjected to CRRT from Jan 2021 to December 2022. We reported primary diagnosis, demographics, indications, modality, and outcomes of CRRT. Statistical analyses were utilized to relate risk factors correlating with mortality among patients who underwent CRRT. Our main outcome measures were mortality among critically ill pediatric patients who were subjected to CRRT and its associated risk factors. Results: 42 patients underwent CRRT from Jan 2021 to December 2022. Mean age was 11.97 ± 4.3 years, with 64% male population. Most common primary diagnosis was infectious etiology (36%) followed by genitourinary system (27%). 83% patients were in failure according to pRIFLE criteria. 81% patients had multiorgan dysfunction (MODS) with renal, cardiovascular, and respiratory dysfunction sequentially being most common. The mean ionotropic score before & after CRRT was 38.57 & 49.71 respectively. Mean ICU duration of admission was 11.6 days. The most common indication for CRRT was fluid overload (85.71%). Median length of CRRT was 62 hours with a mean circuit life of 47.87 hours. Most common CRRT catheter site was the femoral vein (83%) followed by the internal jugular vein (14%). CVVHDF was the most used modality (64%) followed by CVVH (19%). We report an overall mortality of 71.4%, with a positive correlation with use of norepinephrine post CRRT, presence of multiorgan dysfunction, presence of cardiovascular dysfunction, respiratory dysfunction, and low platelet count (<150,000 per microliter) on univariate analysis. Only respiratory dysfunction was statistically significantly associated with mortality on multivariate analysis. Conclusion: The gross mortality in patients who underwent CRRT was high (71.4%). Norepinephrine use post-CRRT, multi-organ dysfunction, cardiovascular system, respiratory system dysfunction and low platelet counts were associated with high mortality while association of respiratory dysfunction with mortality was independently statistically significant.

Associated organs and system with COVID-19 death with information of organ support: a multicenter observational study

BackgroundThe organ dysfunction that is associated with death in COVID-19 patients has not been determined in multicenter epidemiologic studies. In this study, we evaluated the major association with death, concomitant organ dysfunction, and proportion of multiple organ failure in deaths in patients with COVID-19, along with information on organ support.MethodsWe performed an observational cohort study using the Japanese multicenter research of COVID-19 by assembling a real-world data (J-RECOVER) study database. This database consists of data on patients discharged between January 1 and September 31, 2020, with positive SARS-CoV-2 test results, regardless of intensive care unit admission status. These data were collected from the Diagnosis Procedure Combination and electronic medical records of 66 hospitals in Japan. The clinician identified and recorded the organ responsible for the death of COVID-19.ResultsDuring the research period, 4,700 patients with COVID-19 were discharged from 66 hospitals participating in the J-RECOVER study; of which, 272 patients (5.8%) from 47 institutions who died were included in this study. Respiratory system dysfunction (87.1%) was the leading association with death, followed by cardiovascular (4.8%), central nervous (2.9%), gastrointestinal (2.6%), and renal (1.1%) dysfunction. Most patients (96.7%) who died of COVID-19 had respiratory system damage, and about half (48.9%) had multi-organ damage. Of the patients whose main association with death was respiratory dysfunction, 120 (50.6%) received mechanical ventilation.ConclusionThis study showed that although respiratory dysfunction was the most common association with death in many cases, multi-organ dysfunction was associated with death due to COVID-19.

Loss of compensation afforded by accessory muscles of breathing leads to respiratory system compromise in the mdx mouse model of Duchenne muscular dystrophy.

Despite profound diaphragm weakness, peak inspiratory pressure-generating capacity is preserved in young mdx mice revealing adequate compensation by extra-diaphragmatic muscles of breathing in early dystrophic disease. We hypothesised that loss of compensation gives rise to respiratory system compromise in advanced dystrophic disease. Studies were performed in male wild-type (n=196) and dystrophin-deficient mdx mice (n=188) at 1, 4, 8, 12 and 16months of age. In anaesthetised mice, inspiratory pressure and obligatory and accessory respiratory EMG activities were recorded during baseline and sustained tracheal occlusion for up to 30-40s to evoke peak system activation to task failure. Obligatory inspiratory EMG activities were lower in mdx mice across the ventilatory range to peak activity, emerging in early dystrophic disease. Early compensation protecting peak inspiratory pressure-generating capacity in mdx mice, which appears to relate to transforming growth factor-β1-dependent fibrotic remodelling of the diaphragm and preserved accessory muscle function, was lost at 12 and 16months of age. Denervation and surgical lesion of muscles of breathing in 4-month-old mice revealed a greater dependency on diaphragm for peak inspiratory performance in wild-type mice, whereas mdx mice were heavily dependent upon accessory muscles (including abdominal muscles) for peak performance. Accessory EMG activities were generally preserved or enhanced in young mdx mice, but peak EMG activities were lower than wild-type by 12months of age. In general, ventilation was reasonably well protected in mdx mice until 16months of age. Despite the early emergence of impairments in the principal obligatory muscles of breathing, peak inspiratory performance is compensated in early dystrophic disease due to diaphragm remodelling and facilitated contribution by accessory muscles of breathing. Loss of compensation afforded by accessory muscles underpins the emergence of respiratory system morbidity in advanced dystrophic disease. KEY POINTS: Despite diaphragm weakness, peak inspiratory performance is preserved in young dystrophin-deficient mdx mice revealing adequate compensation by extra-diaphragmatic muscles. Peak obligatory muscle (diaphragm, external intercostal, and parasternal intercostal) EMG activities are lower in mdx mice, emerging early in dystrophic disease, before the temporal decline in peak performance. Peak EMG activities of some accessory muscles are lower, whereas others are preserved. There is greater recruitment of the trapezius muscle in mdx mice during peak system activation. In phrenicotomised mice with confirmed diaphragm paralysis, there is a greater contribution made by extra-diaphragmatic muscles to peak inspiratory pressure in mdx compared with wild-type mice. Surgical lesion of accessory (including abdominal) muscles adversely affects peak pressure generation in mdx mice. Diaphragm remodelling leading to stiffening provides a mechanical advantage to peak pressure generation via the facilitated action of extra-diaphragmatic muscles in early dystrophic disease. Peak accessory EMG activities are lower in 12-month-old mdx compared to wild-type mice. Peak inspiratory pressure declines in mdx mice with advanced disease. We conclude that compensation afforded by accessory muscles of breathing declines in advanced dystrophic disease precipitating the emergence of respiratory system dysfunction.

Pulmonary Function Tests in the Evaluation of Early Lung Disease in Cystic Fibrosis.

Properly evaluating respiratory system dysfunction is essential in children with cystic fibrosis (CF). This prospective study aimed to assess the course of early lung disease based on multiple breath nitrogen washout (MBNW), impulse oscillometry (IOS), and conventional techniques, such as spirometry and body plethysmography. Over a 2 year recruitment period, subjects with CF aged 7-18 performed pulmonary function tests (PFTs). Moreover, the nutritional and microbiological status, frequency of pulmonary exacerbations (PExs), and patients' health-related quality of life (HRQoL) were assessed. The mean age of the children (n = 69) was 14.09 ± 3.26 years; F/M 37/32. Spirometry-based diagnoses of normal lung function (forced expiratory volume in 1 s, FEV1 ≥ 90%pred), mild (FEV1 70-89%pred) and moderate (FEV1 40-69%pred) lung diseases were established in 34 (49.3%), 25 (36.2%), and 10 (14.5%) patients, respectively. An elevated lung clearance index (LCI > 6.98) was observed in 85% of the subjects with normal FEV1. The presence of Pseudomonas aeruginosa infection (n = 16) and the number of PExs treated with IV antibiotics were associated with significantly worse PFT results. MBNW and IOS are more helpful tools than conventional techniques in assessing early lung disease in CF. LCI is a more useful parameter for detecting functional abnormalities than FEV1 in school-age children.

Prevalence of Encephalitozoon cuniculi Infection in Guinea Pigs (Cavia porcellus) in Poland with Different Clinical Disorders—A Pilot Study

Encephalitozoonosis is a disease caused by E. cuniculi. It is diagnosed primarily in rabbits but is less frequently so in other animal species. E. cuniculi is classified among Microsporidia—fungi frequently found in the environment, that are resistant to numerous external factors. Apart from rabbits, rodents form the next group of animals most exposed to infection with these pathogens. The objective of the study was to analyze the prevalence of E. cuniculi infection in guinea pigs with different clinical disorders. The study included 67 animals with E. cuniculi infection confirmed via real-time PCR. The infected animals most frequently exhibited nervous and urinary system symptoms, as well as issues with vision organs, while several animals were also recorded as having problems with the respiratory system and thyroid gland dysfunction. The study shows that encephalitozoonosis constitutes a significant problem in rodents kept as domestic animals, which in turn may be a source of infection for humans.

Guillain-Barré Syndrome in Children: A Narrative Review

Among the most typical reason of sudden, acquired weakness is Guillain-Barré Syndrome characterized by symmetrical ascending paralysis which is frequently sparked by an earlier illness. “Acute Inflammatory Demyelinating Polyneuropathy,” one of the prevailing kinds of Guillian-Barre Syndrome, is divided into four subtypes: acute inflammatory demyelinating polyradiculoneuropathy, Miller Fisher syndrome, acute motor sensory axonal neuropathy, and acute motor axonal neuropathy. Guillain-Barré syndrome can happen at any age, but it is frequently seen in persons over 40 years. More often, males are impacted. This syndrome lasts for 4 weeks, but if it is prolonged than that, it can be categorized as subacute, and if it lasts longer than 8 weeks, it can be classified as chronic. An antecedent infection is present in 70% of patients. The most frequent trigger for Guillain-Barré Syndrome is Campylobacter jejuni, along with the Cytomegalovirus, Zika virus, mycoplasma, hepatitis A and B, and human immunodeficiency virus. The antecedent infection generally occurs 1 to 3 weeks before. The pathogenesis of the disease solely based on the molecular mimicry. In some circumstances, collapse of respiratory system and autonomic dysfunction might make Guillain-Barré Syndrome more difficult to treat.

A COUGH-BASED COVID-19 DETECTION SYSTEM USING PCA AND MACHINE LEARNING CLASSIFIERS

In 2019, the whole world is facing a health emergency due to the emergence of the coronavirus (COVID-19). About 223 countries are affected by the coronavirus. Medical and health services face difficulties to manage the disease, which requires a significant amount of health system resources. Several artificial intelligence-based systems are designed to automatically detect COVID-19 for limiting the spread of the virus. Researchers have found that this virus has a major impact on voice production due to the respiratory system's dysfunction. In this paper, we investigate and analyze the effectiveness of cough analysis to accurately detect COVID-19. To do so, we performed binary classification, distinguishing positive COVID patients from healthy controls. The records are collected from the Coswara Dataset, a crowdsourcing project from the Indian Institute of Science (IIS). After data collection, we extracted the MFCC from the cough records. These acoustic features are mapped directly to the Decision Tree (DT), k-nearest neighbor (kNN) for k equals to 3, support vector machine (SVM), and deep neural network (DNN), or after a dimensionality reduction using principal component analysis (PCA), with 95 percent variance or 6 principal components. The 3NN classifier with all features has produced the best classification results. It detects COVID-19 patients with an accuracy of 97.48 percent, 96.96 percent f1-score, and 0.95 MCC. Suggesting that this method can accurately distinguish healthy controls and COVID-19 patients.

Insuficiencia respiratoria aguda

Acute respiratory failure is the expression of respiratory system dysfunction, which causes abnormality in the gas exchange of oxygen and carbon dioxide. It is a common entity that has a high mortality and potential mortality rate. Therefore, knowledge of the entity and its proper management is fundamental for good medical practice.

Chest Computed Tomography Is an Efficient Method for Initial Diagnosis of COVID-19: An Observational Study.

Coronavirus disease (COVID-19) is an infectious disease that can lead to pneumonia, pulmonary oedema, acute respiratory distress syndrome, multiple organ and system dysfunction, and death. This study aimed to verify the efficacy of chest computed tomography (CT) for the initial diagnosis of COVID-19. This observational, retrospective, cross-sectional study included 259 individuals who underwent clinical evaluation, blood collection, chest CT, and a reverse transcription polymerase chain reaction (RT-PCR) diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during their course of treatment at a reference hospital in Belém, Pará, Brazil between April and June 2020. Inclusion criteria were flu-like symptoms in adults of both sexes. Individuals with an inconclusive COVID-19 molecular test or who had artifacts in the chest CT images were excluded. Parametric data were analyzed using Student-t-test and non-parametric data were analyzed using average test and Fisher exact test. Participants were divided into two groups: Group 1 (COVID-19 positive), n = 211 (124 males, 87 females), 51.8 ± 17.9 years old and Group 2 (COVID-19 negative), n = 48 (22 males, 26 females), 47.6 ± 18.6 years old. Most frequent symptoms were cough [Group 1 n = 199 (94%)/Group 2 n = 46 (95%)], fever [Group 1 n = 154 (72%)/Group 2 n = 28 (58%)], myalgia [Group 1 n = 172 (81%)/Group 2 n = 38 (79%)], dyspnoea [Group 1 n = 169 (80%) / Group 2 n = 37 (77%)], headache [Group 1 n = 163 (77%)/Group 2 n = 32 (66%)], and anosmia [Group 1 n = 154 (73%)/Group 2 n = 29 (60%)]. Group 1 had a higher proportion of ground-glass opacity [Group 1 n = 175 (83%)/Group 2 n = 24 (50%), 0.00], vascular enhancement sign [Group 1 n = 128 (60%)/Group 2 n = 15 (31%), 0.00], septal thickening [Group 1 n = 99 (47%)/Group 2 n = 13 (27%), 0.01], crazy-paving pattern [Group 1 n = 98 (46%) / Group 2 n = 13 (27%), 0.01], consolidations [Group 1 n = 92 (43%)/Group 2 n = 8 (16%), 0.00], and CO-RADS 4 and 5 [Group 1 n = 163 (77.25%)/Group 2 n = 24 (50%), 0.00] categories in chest CT. Chest CT, when available, was found to be an efficient method for the initial diagnosis and better management of individuals with COVID-19.

Consequences and health effects of toxic air pollutants emission by industries

Emission large amounts of air pollutants can cause many problems in the environment and human health. The purpose of this review study was evaluating consequences and health effects of toxic air pollutants and expressing strategies for controlling these pollutants.
 A narrative review of the literature was done based on searched databases. All relevant studies published 1998 until 2021 gathered. According to the databases, 360 articles were retrieved. 24 studies were screened after review and 16 full-text articles entered into the analysis process. Finally, 9 articles were selected in this study.
 The results of this study showed that industrialization, increasing urbanization, technological development, rapid population growth, increased desertification and deforestation, occurrence of dust phenomenon, uncontrolled growth of motor vehicles, entry of various pollutants and environmental degradation cause a phenomenon called air pollution. Based on the results, the toxic air pollutants causes many health endpoints in human such as respiratory disease, asthma, chronic lung disease, respiratory and cardiovascular system dysfunction, decreased immune system, headache, dizziness, gastrointestinal disease and increased risk of cancer (lung, stomach, intestine, eye, liver and brain).
 According to research related to the subject, air pollution is a positive function of energy consumption, volume of industrial activities, and the uncontrolled increase of human activities. The most vital factors are increasing the level of public awareness, reducing the exposure to toxic air pollutants, improving quality of the products and consumption of consumed fuels.

Anxiety and depression in school-age patients with spinal muscular atrophy: a cross-sectional study

BackgroundSpinal muscular atrophy (SMA) is a rare neurogenetic disease which involves multisystem dysfunctions such as respiratory, digestive, and motor disorders. Anxiety, depression and other psychological disorders often accompany severe chronic physical diseases. The aim of this study was to investigate the prevalence of anxiety and depression along with their influencing factors among school-age patients with SMA.MethodsWe conducted a cross-sectional study on school-age SMA patients in China. Patients aged 8–18 years with a genetic diagnosis of 5qSMA were invited to answer a questionnaire composed of sociodemographic and clinical questions, then to complete the Screen for Child Anxiety-Related Emotional Disorders and Depression Self-Rating Scale for depression and anxiety level evaluation. At the end of the questionnaire, further questions assessed the subjective anxiety and subjective depression of patients’ caregivers and their expectations for their child’s future.ResultsComplete data were available for 155 patients. The sample included 45.8% boys and 54.2% girls; 65.2% were type II, 27.1% were type III, and the remainder were type I SMA. Rates of anxiety and depression in these school-age SMA patients were 40.0% and 25.2%, respectively. Gender, age, and disease type were not associated with anxiety or depression, but respiratory system dysfunction, digestive system dysfunction, skeletal deformity, rehabilitation exercise, academic delay, specialized support from school, household income level, caregivers’ subjective anxiety, and caregivers’ expectations were significantly related to both anxiety and depression.ConclusionsThere was a high prevalence of anxiety and depression in school-age SMA patients in China. Professional psychological care maybe included in the standard of care. These results also call for possible targets for intervention such as reducing complications, improving drug accessibility, retaining normal schooling, strengthening school support, and enhancing the ability of the caregivers of SMA patients to assist in the diagnosis and treatment of the disease, so improving the mental health of SMA patients.

The Influence of Antibiotics Usage on Extended-spectrum β-lactamase-producing Enterobacter Colonization among Intensive Care Unit Patients

BACKGROUND: The prevalence of extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae has increased throughout the world and is a major cause of treatment failure in intensive care unit (ICU). ESBL-producing Enterobacteriaceae exhibit resistance to cephalosporins which is one of the most commonly used and effective group of antibiotics.
 AIM: The goal of this study was to identify the variables that influence the colonization of Enterobacteriaceae in patients treated at ICU.
 PATIENTS AND METHODS: A prospective study involving randomized 70 patients was conducted at ICU of Sanglah General Hospital from October 2018 to March 2019. Specimens were obtained from rectal swabs on admission to and discharged from ICU. Initial bivariate analysis was conducted using Pearson’s Chi-square and considered significant if p <0.05. Adjusted relative risk ratio (RR) was used to estimate the influence of the variables to ESBL colonization.
 RESULTS: Respiratory system dysfunction (p = 0.012, RR = 2.828) and antibiotic prescription before ICU admission (p < 0.001) influence ESBL-producing Enterobacteriaceae colonization on patient who was admitted to ICU. On discharged from ICU, ESBL colonization was associated to respiratory system dysfunction (p = 0.008, RR = 1.987), third-generation cephalosporin usage (p = 0.009, RR = 2.909), cefoperazone prescription (p < 0.001, RR = 8.471), ceftriaxone prescription (p = 0.007, RR = 6.316), and antibiotics usage duration ≥3 days (p < 0.001, RR = 7.071). The logistic regression results on influence of antibiotics usage and respiratory system dysfunction to ESBL colonization rate shows that both variables are independent risk factor to EBLS colonization both on admitted to and discharged from ICU.
 CONCLUSION: The antibiotics usage and respiratory system dysfunction are independent risk factors to EBLS colonization in ICU patients.

Ефективність засобів фізичної терапії в корекції ознак дисфункції дихальної системи у жінок з абдомінальним ожирінням

Respiratory disorders in obesity occur even in the absence of bronchopulmonary pathology, and in their presence, an excess of adipose tissue worsens the prognosis of the disease. Obese people have a high risk of obstructive sleep apnea syndrome, hypoventilation syndrome, bronchial hyperreactivity, pneumonia, pulmonary hypertension. The purpose of the study was to determine the effectiveness of using physical therapy in the correction of signs of respiratory system dysfunction in women with abdominal obesity. Material and methods. The study involved 172 women with abdominal obesity of I-III degrees, diagnosed by body mass index and the ratio of waist and hip circumferences. According to the results of the definition of the rehabilitation (therapeutic) alliance, they were divided into two groups. The comparison group consisted of women with a low level of alliance that refused to actively participate in the program of weight loss. The main group consisted of women with a high level of alliance; they underwent a one-year correction program using nutritional modification, increased physical activity, lymphatic drainage, psychocorrection, and elements of respiratory physical therapy. The control group consisted of 32 women with normal body weight. Subjective state, dyspnea intensity, pulsоoximetry and spirometry parameters were studied. Results and discussion. We revealed the respiratory system dysfunction in women with abdominal obesity: subjective signs of impaired respiratory function, a decrease in arterial blood oxygenation, and a decrease in spirometry volumes. Their content and severity were proportional to the severity of obesity. Using respiratory therapy elements in the program of complex physical therapy aimed at reducing body weight let us normalize the studied parameters of the respiratory system function in women of the main group. The low level of the rehabilitation alliance of women in the comparison group led to unsatisfactory implementation of the recommendations provided and was associated with a lack of rehabilitation effect. Improvement in the state of the bronchopulmonary system in women with abdominal obesity is justified both by primary changes in the respiratory system – an increase in spirometry volumes and reserves, improved blood oxygenation, and indirectly – by an increase in the range of motion of the diaphragm, a decrease in the amount of visceral fat and general fitness, which is confirmed by the leveling of signs of restrictive and mixed respiratory failure. Conclusion. It is advisable to include the elements of respiratory rehabilitation in the programs for restoring the health of women with abdominal obesity

Hematological changes in patients with COVID‑19 (Review).

In December 2019, an emergence of pneumonia was detected in patients infected with a novel coronavirus (CoV) in Wuhan (Hubei, China). The International Committee on Taxonomy of Viruses named the virus severe acute respiratory syndrome‑CoV‑2 and the disease CoV disease‑19 (COVID‑19). Patients with COVID‑19 present with symptoms associated with respiratory system dysfunction and hematological changes, including lymphopenia, thrombocytopenia and coagulation disorders. However, to the best of our knowledge, the pathogenesis of COVID‑19 remains unclear. Therefore, understanding the mechanisms underlying the hematological changes that manifest during COVID‑19 may aid in the development of treatments and may improve patient prognosis.

Aggregate Prevalence of Chemosensory and Sinonasal Dysfunction in SARS-CoV-2 and Related Coronaviruses.

Much of the published literature regarding the novel coronavirus disease 2019 (COVID-19) constitutes lower respiratory system symptomatology, while there exists a paucity of data describing the complicated sequelae of the upper respiratory system, including chemosensory and/or sinonasal dysfunction. This study utilized the National Library of Medicine's PubMed/MEDLINE database to query for articles describing COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, and other coronaviruses, with any mention of smell, taste, or other chemosensory or sinonasal dysfunction. Aggregate analysis demonstrated an incidence of 49.6% (n = 497 of 1002; 95% CI, 46.5%-52.7%), 47.9% (n = 480 of 1002; 95% CI, 44.8%-51.0%), and 17.9% (n = 880 of 4909; 95% CI, 16.9%-19.0%) for smell loss, taste loss, and smell or taste loss, respectively, in patients infected with SARS-CoV-2. Additionally, there were significantly higher incidences of runny nose/rhinorrhea/rhinitis and nasal congestion/obstruction/blockage in other coronaviruses as compared with SARS-CoV-2 (P < .001). Understanding these less well-characterized symptoms may help develop measures for estimating early markers of disease prevalence and/or resolution. Level of evidence: 4.

Diagnosis and methods of correction of organ dysfunction in newborns with perforation peritonitis

Introduction : necrotic enterocolitis and stomach perforation belong to pressing issues of neonatal surgery and intense therapy. A set of clinical and laboratory values can be interpreted subjectively due to polyetiology of necrotic enterocolitis and stomach perforation. Indications and surgical management of perforation peritonitis in newborns are still contradictory. Purpose : diagnostics objectivization, treatment of perforation peritonitis and organ dysfunction in necrotic enterocolitis, intestinal and stomach perforation in newborns. Materials and methods : a retrospective, observational, cohort study with 46 5–14-days-old newborns (2007–2017). Inclusion criteria: clinical symptoms of necrotic enterocolitis (Bell (1978) modified by Kliegman (1986)), pneumoperitoneum in stomach perforation. Shock syndrome gradation was done based on FEAST (Fluid Expansion as Supportive therapy) (2017) criteria, while organ failure was evaluated using pSOFA (Pediatric Sequential (Sepsis-related) Organ Failure Assessment) score (2017) with lethality prediction (Vincent J. L., 1998). Statistical analysis uses descriptive statistics and non-parametric Mann-Whitney U test (P<0.05). Results : specific diagnostic criteria of perforation peritonitis such as intestinal pneumatosis, multiple levels of air/ liquid, pneumoperitoneum were distinguished, whereas dysfunction of GIT and respiratory system were the principal links of multiple organ dysfunction. Conclusion : midline laparotomy is a basic method of surgical treatment at institutions providing III level medical aid. In newborns with perforation peritonitis, restrictive strategy of GIT dysfunction intensive treatment based on ESICM (2012) recommendations decreased a short-term lethality to 6.3%.

Immediate effect of thoracic manual therapy on respiratory parameters, chest expansion and rom of thorax and cervical spine in mild to moderate COPD-A randomized clinical trial

Background: COPD is one of the non-communicable diseases related to lung parenchyma and airways which are one of the leading causes of death and disability in India. COPD is not only considered as lung disease but also it has systematic effects that lead to co-morbidities contributing to poor performance in functional level and decreased quality of life. COPD has considerable effects in musculoskeletal system. It ranges from muscle dysfunction of respiratory system to skeletal muscle system to reduced bone density. It is also associated with decreased range of motion in cervical and thoracic region. Physiotherapy plays vital role in preventing and managing the complications in COPD patients. It has been long since exercises that consists of breathing techniques, thoracic expansion exercise and techniques to clear the secretion has been used for management of COPD. One of the emerging techniques for management of musculoskeletal dysfunctions is manual therapy. Hence current study is intended to compare the acute effects of breathing exercises and thoracic expansion exercises with high velocity low amplitude thrust.

SCOPE OF UNANI MEDICINE IN THE PROPHYLAXIS AND MANAGEMENT OF COVID-19

Coronavirus disease (COVID-19) is an acute infectious disease caused by infection with a novel coronavirus SARSCoV-2. The disease severity can range from mild to developing into critical with pneumonia and even life-threatening complications such as Acute Respiratory Distress Syndrome (ARDS), shock, or multi-organ system dysfunction. The clinical picture of Nazla-e-Wabaiya is almost similar to that of Covid-19 like body ache, sore throat, nasal irritation, burning sensation in eyes sneezing, cough, and fever. As per the Unani scholars, the prophylaxis and management include various single and compound drugs to be used orally. They also prescribed various drugs as disinfectants to be used for fumigation, incense, and spray. Ibn Sina advised that houses should be sanitized daily by spraying Arq Gulab (Rosa damascene), Arq Bed Sada (Salix caprea), or Arq Nilofer (Nymphaea alba) and recommended Bukhoor (incense) of Sa'ad Kufi (Cyperusrotundus), Habb-ul-Aas (Myrtuscommunis), Kundur (Boswelliaserrata), and Sandalwood (Santalum spp.). For the treatment of Nazla-e-Wabaiya, the decoction (Joshanda) of Unnab, Sapistan, and Behidana along with Sharbat Banafsha have been recommended by many eminent Unani scholars. They have also recommended using various types of Khamiras like Khamira Gaozaban, Khamira Abresham SheeraUnnabWala, Khamira Marwareed to improve general health and immunity.

Dysfunction of respiratory system in patients with diabetes mellitus and coronary artery disease

Aims: we aimed to estimate the main parameters characterizing respiratory pulmonary function in patients with isolated type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD), as well as with their combination.&#x0D; Materials and methods: the study included 198 patients divided into 3 groups: I with isolated CAD [94 (47.5%)], II with T2DM without the signs of CAD [64 (32.3%)], III with combined CAD and T2DM [40 (20.2%)]. The assessment of carbohydrate and lipid metabolism, as well as the measurement of inflammatory markers were performed using unified clinical and biochemical methods. Respiratory pulmonary function and diffusion lung capacity (Dlco) were assessed using Elite Dl-220v body plethysmograph.&#x0D; Results: the parameters reflecting the respiratory pulmonary function and the level of gas diffusion through alveolar-capillary membrane (ACM) in patients with CAD both with and without diabetes was within the normal values. The exception was the level of residual volume, which was below the prognostic values in all the studied groups. At the same time, in diabetic patients with CAD the values of forced and slow vital lung capacity, forced expiratory volume for 1-second, as well as the level of diffusion were significantly lower as compared to the corresponding values in patients with isolated CAD and didnt differ in comparison with the values of diabetic patients except for the level of diffusion. It should be noted that a number of respiratory parameters had a correlation relationships with glycemic level, inflammatory markers and with the indicators characterizing dyslipidemia and myocardial dysfunction.&#x0D; Conclusions: in the course of the study it was found out that the diabetic patients had respiratory system dysfunction in comparison to the patients with isolated CAD. The presence of diabetes in patients with CAD worsens not only the somatic background but probably contributes to the respiratory dysfunction in the form of lower velocity and volumetric parameters, but also in the indicator showing respiratory metabolism.

Role of thoracic ultrasound in children with chronic kidney disease

Background Chronic kidney disease (CKD) and dialysis may affect different body systems such as the cardiovascular, respiratory, and musculoskeletal system dysfunction. Pulmonary complications reported in patients with CKD include pulmonary edema, pleural effusion, pulmonary hypertension, respiratory infections, pulmonary fibrosis, and hypoxemia. Ultrasound (US) is a simple noninvasive method that is available at the bedside. It can be used to guide diagnostic and therapeutic decisions and monitor efficacy of treatment; in addition, sonographic signs are simple to learn. Aim The aim of the work was to evaluate thoracic ultrasound (TUS) findings in children of CKD and those on regular hemodialysis. Patients and methods This was a cross-sectional comparative study that was carried out on 90 children; their age ranged from 4 to 17 years. We included two groups: the first group comprised 60 patients with CKD: 30 of them on regular hemodialysis and the other 30 children with CKD not on hemodialysis. The second group was the control group (30 children). Medical history, clinical examination, anthropometric measurement, and routine laboratory studies were done. Chest radiograph and TUS were done for all patients. Computed tomography (CT) chest was done when indicated, whereas TUS in dialysis cases was done before and after dialysis. All groups were age and sex matched. Results Among the dialysis group patients, there was no significant difference between CT, US, and radiograph regarding lung congestion, consolidation, pericardial effusion, and pleural effusion. On the contrary, air trapping, cavity, granuloma, and calcified nodules were detected only with CT. US was sensitive to detect fluid overload even when body weight was below the estimated dry weight by 300 g, and B-lines more than 14 is a cutoff point with high sensitivity. In patients with CKD not on dialysis, there was no significant difference between radiograph, CT, and US chest findings regarding lung congestion, consolidation, pleural effusion, and atelectasis. Conclusion Chest US is a useful tool for the detection of pulmonary complications in pediatrics on regular hemodialysis. The technique is sensitive for detecting fluid overload and can be used for follow-up.