Signs Of Respiratory Distress Research Articles

Aanbevelingen voor de behandeling van urgente aandoeningen in de eerste lijn: acuut cardiogeen longoedeem, acuut coronair syndroom en hypoglykemie met verminderd bewustzijn

Recommendations for the treatment of emergencies in primary care: acute cardiogenic pulmonary oedema, acute coronary syndrome and acute hypoglycaemia with reduced consciousness General practitioners are frequently confronted with urgent medical situations both during and outside office hours, requiring a quick and accurate response. This article presents a summary of the recommendations for the treatment of emergencies (part 2), specifically addressing the management of acute cardiogenic pulmonary oedema, acute coronary syndrome (ACS) and acute hypoglycaemia with reduced consciousness. These recommendations are an update of the 2008 guidelines of Domus Medica and were developed by the national Working Group for the Development of Guidelines in Primary Care (WOREL) according to internationally recognized methods for guideline development. The focus of the recommendations is the pharmacological management by the general practitioner. If necessary, diagnostics are briefly discussed. The aim is to inform general practitioners about the recommended content of the emergency kit, as well as the recommended dosages and administration routes for the most common indications. For the 3 topics discussed, an emergency intervention is generally indicated. In the meantime, the general practitioner can already administer medication. For acute cardiogenic pulmonary oedema, the use of intravenous diuretics and oxygen is necessary. Opiates are not routinely administered. Nitrates can be considered when blood pressure is elevated. For the treatment of ACS, acetylsalicylic acid should be administered. Oxygen is recommended only if there are signs of respiratory distress or hypoxemia. Morphine is indicated if analgesia is required. In cases of acute hypoglycaemia with decreased consciousness, intravenous glucose is the first choice. Referral is not always necessary when the patient recovers consciousness after adequate management. This decision should be based on clinical judgment. Via https://www.ebp-guidelines.be/home the English guideline is available.

COVID-19 related acute necrotizing encephalopathy presenting in the early postoperative period

Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgΑ), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.

Urinary NT-proBNP: A Useful Biomarker for the Diagnosis of Respiratory Distress in the Neonatal Population.

To determine the diagnostic accuracy of urinary NT-proBNP levels in the detection and classification of the severity of respiratory distress in neonates after birth. We compared the urinary NT- proBNP levels between the respiratory distress (RD) group and the control group on the 1st, 3rd, and 5th day of life (DOL). The RD group (55 neonates) showed higher levels of NT-proBNP compared to the control group (63 neonates) on DOL1 (585.4 pg/ml vs 396.1 pg/ml (p=0.014)), DOL3 (805.1 pg/ml vs 271.9 pg/ml (p<0.001)) and DOL5 (409.7 pg/ml vs 94.4 pg/ml (p<0.001)). Especially, on DOL5, the area under the ROC curve was 0.884 and the NT-proBNP cut-off value (221.8 pg/ml) showed a sensitivity of 71% and specificity of 79%. The RD group was subclassified into neonates with mild (21 neonates), moderate (19 neonates), and severe (15 neonates) disease. NT-proBNP cut-off point of 668 pg/ml for DOL5 can safely differentiate neonates with severe disease from those with mild and moderate disease (combined subgroups) since the sensitivity was 80% and specificity was 77.5% for DOL5. Urinary NT-proBNP levels are a useful biomarker in detectingclinical signs of respiratory distress in neonates that are born within the first week of life; they can also detect neonates that are vulnerable to severe forms of the disease.

Pneumopericardium associated with blunt trauma in a dog

AbstractPneumopericardium due to blunt trauma in the thorax is rarely described in veterinary literature. The pathogenetic mechanism of pneumopericardium is not always clear. In the present case, a 15‐year‐old dog was referred by the local veterinarian due to walking disability after a fall from height of 2 m. The dog was paralysed in pelvic limbs with increased spinal reflexes, compatible with thoracolumbar syndrome. Plain radiographs of the thorax revealed pneumopericardium. The dog was monitored during hospitalisation for signs of respiratory distress. It remained asymptomatic, so pericardiocentesis was not performed. Computed tomography or magnetic resonance imaging was recommended for diagnosis of the thoracolumbar syndrome, but owners declined for financial reasons. The dog was discharged 10 days after admission. The last day of hospitalisation thoracic radiographs revealed resorption of pneumopericardium. In conclusion, the aim of this study was to describe a case of incidentally found pneumopericardium that is rarely reported after a blunt trauma.

Diabetic Ketoacidosis in Children Before and During COVID-19 Pandemic: A Cross-sectional Study.

Coronavirus disease 2019 (COVID-19) has spread quickly. Comorbidities, such as diabetes, have been determined as critical risk factors for COVID-19. This study aimed to determine the frequency and severity of diabetic ketoacidosis (DKA) in children before and during the COVID-19 pandemic. This retrospective study examined children aged less than 18 years diagnosed with DKA hospitalized in Yazd Shahid Sadoughi Hospital from February 20, 2020, to November 21, 2021. The collected information was compared to those obtained during the same period in 2019 (pre-pandemic). According to the inclusion criteria, only children with suspected symptoms of COVID-19 or an infected family member underwent PCR. The study included 70 children with confirmed DKA during the COVID-19 pandemic and 33 children hospitalized during the pre-pandemic period. The findings showed that the rate of DKA was higher during the pandemic than in the pre-pandemic period. In the DKA subgroups (during the COVID-19 pandemic vs. pre-pandemic), 35.7% vs. 21.2% were severe, 37.1% vs. 36.4% were moderate, and 27.1% vs. 42.4% were mild. Of 70 children, 30 underwent PCR tests for COVID-19, showing six positive cases. Among positive cases, five had mild symptoms, while one was hospitalized with signs of respiratory distress, polyuria, and polydipsia. All physical examinations of this patient were normal, except for the chest exam. A remarkable increase was observed in the frequency and severity of DKA in children during the pandemic.

Pain in the neck: Bench press injury.

A 49-year-old man with a history of hepatitis C infection presented to the emergency department with neck pain and hoarseness immediately after a blunt neck injury. He was bench pressing a 100 kg barbell when the safety bar broke. The bar slowly landed on his neck and remained there for a few seconds. On examination, his vital signs were normal except for hypertension, 167/106 mm Hg. His neck was tender to palpation, without swelling or ecchymosis. He had hoarseness, but the airway was patent without stridor. He showed no signs of respiratory distress. Computed tomography (CT) scan showed thyroid cartilage fracture and right arytenoid hematoma (Figure 1). Flexible fiberoptic laryngoscopy performed in the emergency department confirmed a right arytenoid hematoma with intact airway (Figure 2). Platelet count and prothrombin time-international normalized ratio were normal. Due to concerns of an impending airway emergency from the hematoma, he stayed in the observation unit for 12 hours. A second fiberoptic laryngoscopy on the next day showed no enlargement of the hematoma. He was discharged with close follow-up and recovered without any adverse events. Blunt laryngeal trauma is a rare but potentially life-threatening condition often caused by motor vehicle collisions, sport-related injuries, physical assaults, and strangulation. Clinically, it can cause neck pain, hoarseness, dyspnea, stridor, ecchymosis, crepitus, and airway obstruction.1 The first step in management is to assess and, if necessary, secure the airway. CT scan and flexible fiberoptic laryngoscopy are the key diagnostic tests for suspected laryngeal injury.2 A high index of suspicion and judicious use of diagnostic modalities are required as some patients with significant injuries may not have obvious signs of trauma, as in this case. Patients with high-grade injuries may require surgical intervention.3 Early intervention is the key to a good functional outcome.4

Sociodemographic and Clinical Characteristics Associated with Early Detection of COVID-19 in Kinshasa: Democratic Republic of Congo

Objective: COVID-19 is a disease that, as of 2020, has affected the whole world. Its spread being rapid, early detection would contribute to its control. This study aims to determine the sociodemographic and clinical characteristics associated with this detection fast in Kinshasa. Material and methods: A cross-sectional, descriptive study with an analytical aim is carried out on 713 people suspected of COVID-19 upon their admission to the Covid Treatment Center of the University Clinics of Kinshasa (CTC / CUK) between 2020 and 2021 through the exploitation of the database registering these patients. Data are analyzed using jamovi software version 2.3.18. Frequencies, Fisher's Exact test then logistic regression with α = 0.05 are used. Results: In total, we recorded 713 cases, 459 or 64.4% tested positive at the first screening. The median age is 59.0 years. The sex ratio is 1.7 in favor of men. The following characteristics are associated with early detection of COVID-19: advanced age (OR = 2.9 *1.03 – 8.29+); arterial hypertension (OR = 1.7 *1.15 – 2.52]); diabetes mellitus (OR = 3.66 [1.92 – 6.98]); body aches (OR = 0.41 [0.20 – 0.83]) as well as signs of respiratory distress (OR = 2.4 [1.44 – 3.87]). Conclusion: This study shows that elderly patients, those with a history of hypertension, diabetes and signs of respiratory distress tested positive at the first screening upon arrival at the CTC/CUK, unlike those with body aches. These cases would therefore require special attention from all staff of the COVID-19 response team for appropriate care.

Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report

Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery. Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66. Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.

Comparison of the Clinical Profile and Severity Factors of COVID-19 during the First 4 Waves in a Paediatric Population of Yaounde

Introduction: COVID-19 is an infectious disease that has been causing a global pandemic since 2019. Although clinical forms are generally less severe in children than in adults, children nevertheless present polymorphous clinical forms and severe cases that can lead to death. Objective: To describe the clinical presentations found in the different waves of COVID-19, and to highlight the different factors of severity. Materials and Methods: We conducted a cross-sectional study with retrospective and prospective data collection which lasted 7 months (from November 2021 to June 2022) and covered a study period from 6 March 2020 to 22 June 2022, i.e. 27 months. All patients aged 0 to 18 years, suspected of having COVID-19, confirmed by real-time RT-PCR or an antigenic Rapid Diagnostic Test or antibody were included. These patients were to be managed in the Mother and Child Centre of the Chantal Biya Foundation, as well as in the Specialised Centre for the Management of COVID patients, annex number II of the Yaoundé Central Hospital. The results were analysed using IBM SPSS.23 software. Results: We included 163 patients in our study. No paediatric patients were registered during the 3rd wave. The mean age of the patients in the study population was 13 ± 5 years with extremes from 15 days to 18 years. We had a female predominance with a sex ratio of 0.83. The most common comorbidity was asthma. The first wave presented mainly with respiratory symptoms such as dry cough and signs of respiratory distress. The second wave presented mainly with digestive symptoms such as diarrhoea, abdominal pain and vomiting. The fourth wave presented with ENT signs such as sore throat, and rhinorrhea. Factors associated with severity were mainly age less than five years (OR = 17.69), vomiting (OR = 6.50), presence of comorbidities (OR = 3.39), and alteration of vital parameters such as bradypnoea (OR = 19.68), bradycardia (OR = 6.34), tachycardia (OR = 3.73), oxygen saturation Conclusion: Clinical presentations varied between waves and the main risk factor was age under 5 years. The fourth wave was less severe than the second wave, which in turn was less severe than the first. (4th nd st) which allows us to humbly recommend more screening for patients under 18 years of age with respiratory, ENT and digestive signs and special attention for those under 5 years of age.

Intravenous Immunoglobulin (IVIG) Therapy for COVID-19 Omicron (B.1.1.529) Variant with Acute Respiratory Distress Syndrome

Background: COVID-19 become the pandemic and infect more than million people. The World health organization and other clinical institutions have not yet established a definitive therapy to treat this disease due to a rapid virus mutation and anomaly. Case: A 78-year-old man who had previously confirmed COVID-19 was referred to the COVID-19 intensive care unit (ICU), the patient had geriatrics comorbid, cerebrovascular accident (CVA) infarction, and hypertension. The patient came with unresponsive awareness, and complaints of right hemiparesis and dysarthria. Other symptoms included cough, shortness of breath, and fever. Shortness of breath aggravates, blood pressure increases, and SpO2 was 86%. We decide intubated the patient because have a sign of respiratory distress. Patients receive standard therapy for COVID-19. On the second day, patient receive intravenous immunoglobulin (IVIG) gamaras 20 g. IVIG therapy perform for five days. On the fifth day of treatment in the ICU, the patient’s complaints had decreased and the patient breathed spontaneously with high flow nasal cannula (HFNC). Conclusion: Intravenous immunoglobulin (IVIG) therapy on the COVID-19 Omicron variant patient with ARDS produce a positive outcome. Patients treat with IVIG for 5 days show an improvement in breathing, laboratory result and chest x-ray.

Age and Weight no Bars for Congenital Diaphragmatic Hernia

Background: Congenital diaphragmatic hernia (CDH) of the left side may clinically manifest as chronic wheezing or gastrointestinal reflux disease in older children. Misdiagnosis of CDH is common in later age groups. Case Description: An 11-year-old boy presented to the outpatient department with a history of intermittent cough for 2 years and acid reflux. He was treated with a case of bronchial asthma and received symptomatic treatment for the same, but he continued to have symptoms without much relief. On examination, he was found obese with no signs of respiratory distress. On auscultation, there were reduced breath sounds in the left inframammary, infra-axillary, and infrascapular region with a normal examination of other systems. Management: The chest X-ray was suggestive of heterogeneous opacities engulfing more than half of the left hemithorax in the middle and lower zone of the left lung area with nonvisualization of the left dome of the diaphragm and the presence of abdominal gas shadows in the opacity. Considering the possibilities of diaphragmatic hernia or eventration, high-resolution computed tomography of the thorax was done, and left-sided Bochdalek hernia was confirmed. The child underwent surgical repair uneventfully and was discharged home with no complications. Conclusion: An adolescent boy has a late diagnosis of left-sided CDH. Considering the wide spectrum of clinical presentation, a high index of suspicion is crucial for the diagnosis of CDH since it might develop into a life-threatening condition. An excellent prognosis can be achieved with early diagnosis and effective therapy.

Treatment of high-output cardiac failure secondary to anemia in three cats

Case series summary Three cats presented for clinical signs of respiratory distress and varying etiologies of anemia. Echocardiograms revealed evidence of cardiac dilation without other significant structural or functional heart disease. Thoracic imaging via point-of-care ultrasound and/or radiographs confirmed evidence of volume overload by pleural effusion. Each cat was diagnosed with presumed high-output cardiac failure secondary to anemia. Mainstays of treatment included controlling congestion and correcting the anemia with transfusions in the short-term while addressing the underlying etiology of the anemia in the long-term. Relevance and novel information Reports, treatment and management of high-output failure in the veterinary literature are limited. Extrapolating from human medicine, cats presenting with anemia and findings consistent with volume overload will benefit from treatment of their anemia to reduce neuroendocrine activation and the associated sodium and water retention. Therefore, blood transfusion should neither be avoided nor delayed in anemic cats with changes consistent with volume overload and congestive heart failure.

Refining triage practices by predicting the need for emergent care following major trauma: the experience of a level 1 adult trauma center.

We examined the predictability of selected parameters for establishing the need for urgent care following multi-trauma as a means to warrant the highest level of trauma activation and potentially improve over- and under-triage rates. In this retrospective cohort study of multi-trauma patients aged ≥ 16years performed at a level 1 trauma center, trauma activation criteria and additional characteristics were examined with respect to treatment urgency, defined as: a direct disposition to the operating room or intensive care unit, initiating acute intervention in the trauma room, and in-hospital death within 7days of admission. We enrolled 1373 patients (median age 36.0years). The following parameter were inserted into the final multivariable model: age > 75years, male sex, Charlson comorbidity index, trauma circumstances and mechanism, signs of respiratory distress, systolic BP ≤ 110 and GCS ≤ 13. Adjusted independent predictors of acute care requirement were as follows: GCS ≤ 13 (aOR 5.27 [95% CI 3.45-8.05], p < 0.001), systolic BP ≤ 110mmHg (aOR 2.15 [95% CI 1.45-3.21], p < 0 .001), respiratory distress (aOR 2.05 [95% CI 1.53-2.77], p < 0.001), and age ≥ 75years (aOR 1.90 [95% CI 1.18-3.08], p = 0.008). A GCS ≤ 13, systolic BP < 110mmHg, signs of respiratory distress, and age > 75years best predicted the need for acute care following multisystem trauma. Prospective studies are warranted to confirm the predictability of these criteria and to assess the extent to which their implementation will refine over- and under-triage rates.

Follow-Up Chest X-rays in Minor Chest Trauma with Fewer Than Three Rib Fractures: A Justifiable, Habitual Re-Imaging Industry?

Objective: We evaluated the necessity of follow-up chest X-rays (CXRs) to exclude a pneumothorax after 1 week of initial hospital presentation in patients with no signs of respiratory distress and fewer than three rib fractures. Materials and Methods: Adult patients with fewer than three fractured ribs who presented at our Level I trauma center between 2015 and 2017 were evaluated retrospectively. Patients with sternal fractures, who had suffered a polytrauma, or were primarily treated with a chest tube were excluded. The patients' and fractures' characteristics, trauma mechanism, median follow-up time, and the number of required secondary interventions were recorded. Results: This study included 249 patients, 137 (55.0%) of whom were male, with a median age of 64.34 years. In 150 patients (60.2%) one rib was affected, in 99 patients (39.8%) two ribs were affected, with the fractured ribs being true ribs (1-7) in 72 cases (28.9%), false ribs (8-12) in 151 cases (60.6%), and both in 26 cases (10.4%). The affected thorax half was the left side in 124 cases (49.8%) and both thorax halves in 4 cases (1.6%). The median follow-up time was 9 ± 4 days. In the follow-up CXRs, six patients (1.6%) required delayed intervention (tube thoracostomy): one case of hemopneumothorax and five cases of pneumothorax. All of the patients fully recovered. Conclusions: Planned CXR follow-ups revealed only a small number of complications that needed intervention and therefore seem not to be necessary. Symptom-triggered reappearance seems to be more sufficient and economical compared to habitual reimaging.

Utility of rapid shallow breathing index in progressive weaning of adult patients from mechanical ventilation using pressure support ventilation

Introduction: Many weaning indices have been proposed to evaluate readiness of a patient to tolerate discontinuation of mechanical ventilation. Aim: This study evaluated the utility of these indices in progressive weaning from mechanical ventilation. Methods: All patients receiving mechanical ventilation and assessed to be ready to wean clinically were included in the study. They were initially placed on pressure support, positive end expiratory pressure (PEEP) of 5-8 cm H2O and FiO2 0.4. Tidal volume, respiratory frequency, minute ventilation and rapid shallow breathing index (RSBI) were measured at baseline, 5 min, 30 min and at 2 h. The patient was also monitored for clinical signs of respiratory distress. If the patient remained stable, the pressure support was reduced by 2 cm H2O and the weaning process repeated till PSV reached 5-8 cm H2O. Results: Respiratory rate (&lt; 35/min) and tidal volume corrected to weight (&gt; 5 mL/kg) had high sensitivity (100% and 98.5% respectively) but lacked specificity. Minute volume of &lt; 10 L/min lacked both sensitivity (73.1%) and specificity (50%). The RSBI (&lt; 105 b/min/L) had very high sensitivity (99.1%), reasonable specificity (83.3%) with a positive predictive value 98.4% and a negative predictive value 90.9%. RSBI corrected to weight (7 breaths/min/mL/kg) was not useful. RSBI rate of &lt; 20% was found to be a good weaning index even for progressive decrease in ventilatory support. Conclusion: RSBI &lt; 105 b/min/L and RSBI rate &lt; 20% are reliable criteria to predict success of progressive weaning from mechanical ventilation using pressure support.

Comparison of pressure support ventilation and proportional assist ventilation plus for weaning from mechanical ventilation in critically ill patients

Background: Pressure support ventilation (PSV) is a widely used weaning mode that provides varying amount of support with changing lung characteristics. Proportional-assist ventilation plus (PAV+) is a new mode that automatically adjusts to changes in the respiratory system. Aim: This study compared PSV and PAV+ for weaning from mechanical ventilation. Methods: This was a prospective, randomised, control study enrolling 23 adult patients, mechanically ventilated for at least 48 h after passing SBT criteria and a PSV trial of 30 min. They were randomised to receive either PAV+ (Group 1) or PSV (Group 2). A washout time of 30 min was given for patients in either of the group in order to nullify the effect of the previous PSV mode. Two arterial blood gas samples were taken, during the assessment of SBT readiness, and after 60 min on the randomised weaning mode. Clinical signs of respiratory distress and objective weaning criteria were noted. Success and duration of weaning, rapid shallow breathing index (RSBI), rapid shallow breathing index rate (RSBI rate), haemodynamic and respiratory parameters were noted. Results: 13 patients were randomised to PAV+ group; 10 patients to PSV group. Demographic data were similar in both groups. RSBI, RSBI rate, arterial blood gas analysis, peak and mean inspiratory pressure were not different in either group. The average length of ICU stay, duration to wean and days to extubate were almost similar in both groups. Conclusion: Both PAV+ mode and PSV can be used with equal efficiency in patients ready for weaning.

Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series.

Retrospective observational study. The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement. After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care. Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation. The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.

SARS-CoV-2 and Dengue Virus Coinfection in a Mexican Pediatric Patient: A Case Report from Early Molecular Diagnosis

Mexico is an endemic region for dengue virus (DENV). The increase in this disease coincides with outbreaks of COVID-19, both of which are single-stranded positive RNA viruses. These characteristics make it difficult to distinguish each disease because they share clinical and laboratory features, which can consequently result in misdiagnoses. This is why the use of precision confirmatory tests (qRT-PCR) are crucial for early diagnosis. We herein report a pediatric patient who presented a coinfection for DENV and COVID-19, "SARS-CoV-2/Dengue". This patient initially presented a fever, cough, and headache and, three days later, developed generalized pain and epistaxis. Blood studies revealed thrombocytopenia and leukopenia, and the patient was admitted to the hospital for a probable DENV infection. Within 48 h, qRT-PCR tests specific for SARS-CoV-2 and DENV were performed and resulted as positive. The patient immediately received pharmacological treatment with azithromycin, oseltamivir, and metamizole. During hospitalization (9 days), the patient had no signs of respiratory distress and maintained normal body temperature and normal blood oxygen saturation. This case warns of the need for early diagnosis and adequate clinical and pharmacological management in the face of a "SARS-CoV-2/Dengue" coinfection. Early molecular detection of both viruses and timely treatment helped the patient to achieve a favorable recovery.

Infrahyoid Thyroglossal Duct Cyst Causing Airway Compromise in a Neonate: Surgical Management and Review of Literature.

Thyroglossal duct cyst (TGDC) rarely becomes symptomatic in the neonatal period unlike other congenital neck swellings which present with high airway obstruction. An infrahyoid TGDC presenting with airway compromise in a neonate is even rarer. We hereby report a newborn with significant respiratory distress necessitating intubation and ventilation since birth. He had multiple extubation failures and signs of upper airway obstruction post-extubation. Computed tomography demonstrated a cystic lesion, probably an infrahyoid TGDC compressing the laryngeal lumen. The cyst was removed by Sistrunk procedure and histopathology confirmed the diagnosis. The child was discharged 5days after surgery and was asymptomatic on follow-ups.

Self-Assembled Bubble Continuous Positive Airway Pressure (CPAP) Device as Primary Respiratory Support for Neonatal Respiratory Distress in Low-Resource Settings

Background: Self-assembled, bubble continuous positive airway pressure is a low-cost noninvasive respiratory support modality used to manage newborns with respiratory distress. Very few local studies have been conducted regarding its use in the management of neonatal respiratory distress. This study was conducted to evaluate the effectiveness of this device as a primary treatment modality for neonatal respiratory distress. Methods: This cross-sectional study was conducted in the Department of Pediatrics, Ziauddin Hospital, Karachi from 1st February 2018-31st July 2018 on neonates (n=200) admitted with respiratory distress, in whom self-assembled bubble continuous positive airway pressure was used as a primary respiratory support. The effectiveness of its use was determined, based on the absence of associated complications, signs of respiratory distress, and oxygen saturation at room air of 94% or more. Data were analyzed by SPSS version 20. The Chi-square test was used for categorical variables and a p-value &lt;0.05 was considered statistically significant. Results: The mean gestational age was 34.3+2.73 weeks, the mean age at initiation of bubble continuous positive airway pressure was 7.7 4 hours, and the mean duration of hospital stay was 4.2 days. The observed failure rate in the study population was 8.5%, while the mortality was only 2%. The finding of respiratory distress syndrome on chest- X-ray with (FiO2) &gt; 60% was observed. In addition, bubble CPAP after 6 hours of the onset of respiratory distress showed significant results (p&lt;0.001). Conclusion: Self-assembled bubble continuous positive airway pressure is a significant and effective treatment modality (p=0.001) in neonatal respiratory distress. Keywords: Bubble Continuous Positive Airway Pressure; Neonates; Respiratory Distress.