Hyperventilation Research Articles

Beating the odds: Rare prolonged survival of truncus arteriosus: A case report with literature review.

Truncus arteriosus is a cyanotic congenital heart disease in which the great vessels of the heart fail to separate in utero. Consequently, a single truncal vessel arises from the heart to supply the systemic, coronary, and pulmonary circulations. This lesion causes the total mixing of oxygenated and deoxygenated blood, with an early onset of pulmonary vascular disease. Patients rarely survive beyond the first year of life. This case report highlights a rare survival without intervention up to the ninth year of life. We present the case of a 9-year-old male child with a history of dark discoloration of the lips and digits, easy fatigability, and fast breathing since birth. The patient is currently small for his age, with a bulging anterior chest wall, displaced apex beat, and cardiac murmur. Oxygen saturation was 57% in room air. A chest radiograph showed peri-hilar lymphadenopathy with prominent pulmonary trunks. Pack cell volume was 62%, and the gene expert test was negative. A diagnosis of cyanotic congenital heart disease, truncus arteriosus type III with pulmonary hypertension, was made after diagnostic evaluation with echocardiography. To manage congestive heart failure, the patient was put on diuretics, including furosemide and spironolactone. Parents could not carry out a definitive surgical repair due to financial constraints. Although the patient was able to survive the past year, the child had developed cardiomegaly, signs of pulmonary congestion, decreased oxygenation, and a compensatory increase in red blood cell volume. Truncus arteriosus is a critical congenital heart defect that has a high potential for morbidity and mortality within the first year of life. It requires immediate intervention and surgical repair in the immediate neonatal period. In rare cases, patients have been able to survive beyond the first year, especially if they also developed pulmonary stenosis. However, this patient had been a survivor for 9 years without another structural anomaly. Given the unique presentation and its rarity, further research is needed into compensatory mechanisms and possible low-cost and accessible alternatives in resource-constrained settings. It also demonstrates that pharmacologic therapy alone is insufficient to prevent mortality.

Case Report, A 74-year-old female with cellulitis ET causa abscess (Cruris, Dorsum, And Tarsal) dextra

Cellulitis is an inflammation of the subcutaneous tissue often caused by infection with Staphylococcus aureus and Streptococcus bacteria A 74-year-old woman with complaints of pain and swelling of the right leg, accompanied by weakness and rapid breathing (Kussmaul), was diagnosed with cellulitis cruris, dorsum, and tarsal dextra. The patient had a history of uncontrolled type 2 diabetes mellitus, as well as complications such as acute kidney injury and hypokalemia. Physical examination showed edema, redness, tenderness, and warmth in the affected area. Laboratory examination indicated severe infection, iron deficiency anemia, and kidney damage. Management included debridement to remove necrotic tissue, combined antibiotic therapy (ampicillin and metronidazole) and postoperative care. This report highlights the association of diabetes mellitus with increased risk and severity of cellulitis, and the importance of a collaborative approach in managing comorbidities.

P-183. Barriers and Facilitators to Identifying and Treating Neonatal Sepsis in Ethiopia

Abstract Background Neonatal sepsis is a major cause of death of children under the age of 5 years globally and in Ethiopia. The high mortality associated with neonatal sepsis is especially pronounced in low-birth weight infants (LBW). Antimicrobial resistance (AMR) further contributes to high mortality. Many hospitalized LBW newborns with sepsis are admitted to NICUs but mortality remains high, partly due to increasing AMR but also due to delayed identification and treatment. Thus, evaluating and describing the existing barriers to sepsis diagnosis and management is urgently needed. This may guide targeted innovations to predict, diagnose, and treat neonatal sepsis earlier and avert newborn deaths. Methods Utilizing structured chart review and focus groups we conducted a convergent mixed methods study evaluating facilitators and barriers to early identification and care of neonates admitted with sepsis to the neonatal intensive care unit at Tibebe Ghion Specialized Hospital in Bahir Dar, Ethiopia. Results 6 resident physicians and 6 nurses participated in 2 focus groups, and 142 charts were reviewed. Chart review revealed that infants with documented warning signs (such as fast breathing or failure to suck) begin an empiric course of ampicillin and gentamycin. Further diagnostic workup is often limited, and blood cultures are rarely performed. Qualitative interviews reenforced and expanded these results. Key barriers identified included limited physical resources (monitoring equipment, laboratory capacity, and imaging) and personnel barriers (limited staffing, low morale, and frequent staff transfer). Primary facilitators included understaffing, retention of experienced staff, and access to necessary equipment and diagnostics. Conclusion Even in a higher-level hospital in Ethiopia, neonatal sepsis is challenging to identify due in part to limited diagnostic capacity and understaffing. The absence of cultures and sensitivities and other diagnostics present barriers to early identification and targeted treatment. Future studies could focus on interventions to expand lab capacity and diagnostics, including point of care diagnostics for sepsis or AMR, capacity building of neonatal nursing, and expansion of access to low-cost vital sign monitoring. Disclosures All Authors: No reported disclosures

Development of CPAP Overlay Interfaces for Efficient Administration of Aerosol Surfactant Therapy to Preterm Infants

The administration of surfactant aerosol therapy to preterm infants receiving continuous positive airway pressure (CPAP) respiratory support is highly challenging due to small flow passages, relatively high ventilation flow rates, rapid breathing and small inhalation volumes. To overcome these challenges, the objective of this study was to implement a validated computational fluid dynamics (CFD) model and develop an overlay nasal prong interface design for use with CPAP respiratory support that enables high efficiency powder aerosol delivery to the lungs of preterm infants when needed (i.e., on-demand) and can remain in place without increasing the work of breathing compared with a baseline CPAP interface. Realistic in vitro experiments were first conducted to generate baseline validation data, and then the CFD model, once validated, was used to explore key design parameters across a range of preterm infant nose-throat geometries and aerosol delivery conditions. The most important factors for efficient aerosol delivery were shown to be (i) maintaining the aerosol delivery flow rate below the tracheal flow rate (to minimize CPAP line loss) and (ii) concentrating the aerosol within the first portion of the inhalation waveform. An optimized design was shown to deliver approximately 37–60% of the nominal dose through the system and to the lungs with low intersubject variability (1050–2200 g infants) across two modes of device actuation (automated and manual) with room for further improvement. Ergonomic curvatures and streamlining of the prong geometries were also found to reduce work of breathing and flow resistance compared with a commercial alternative.Graphical

Examining the use of interoceptive exposure exercises in people with and without a history of chronic physical health problems

ABSTRACT Interoceptive exposure (IE) exercises are underused, especially in people with chronic physical health problems. Secondary data analyses were conducted to examine the use of and acute responses to IE exercises in individuals with and without a history of chronic physical health problem(s). Participants (N = 413; Mage = 38.6, 56.1% with chronic physical health problems) enrolled in a 6-month randomized controlled trial that aimed to reduce anxiety and depression. Participants had access to a smartphone-based intervention that included on-demand access to IE exercises: head rush, straw breathing, chair spinning, fast breathing, and running in place. Utilization of the IE exercises and acute responses to the exercises were evaluated in the context of chronic physical health problem history. Participants with versus without a chronic physical health problem completed statistically significantly more IE exercises. Acute effects of IE exercises on distress and physical sensations were similar for those with and without a history of chronic physical health problems, as well as those who were versus were not taking medication. There is no evidence that chronic disease history influences the acute response to IE exercises. Continued research is needed to further assess the safety of IE exercises in people with various medical conditions.

Unusual Case of a Hyperosmolar Hyperglycemic State in a Young Adult with Type 1 Diabetes Mellitus

Abstract Hyperosmolar hyperglycemic State (HHS) is a severe acute complication primarily associated with type 2 diabetes but very rare in type 1 diabetes mellitus (T1DM). T1DM necessitates consistent insulin management to prevent acute complications such as HHS. HHS is characterized by extreme hyperglycemia (exceeding 600 mg/dL), significant dehydration, and hyperosmolarity, typically without the presence of significant ketosis or acidosis. This condition leads to an altered mental status, which can range from confusion to coma, whereas diabetic ketoacidosis (DKA) is more commonly observed in T1DM and is characterized by hyperglycemia (generally lower than in HHS), ketosis, and metabolic acidosis due to the breakdown of fats into ketones. DKA presents with symptoms such as abdominal pain, nausea, vomiting, and deep, rapid breathing (Kussmaul respirations). The presence of acidosis distinguishes DKA from HHS and necessitates a different treatment approach. HHS has a higher mortality rate than that of DKA due to its more insidious onset and the severity of dehydration and electrolyte imbalance that often accompany it. We present the case of an 18-year-old male with T1DM, who experienced HHS due to irregular insulin use caused by work and financial constraints, alongside a diet high in sugary foods, necessitating emergency intervention.

Lethal Pertussis with Hyperleukocytosis in an Ethiopian Toddler and Challenges of treatment: A Case Report and Literature Review

Rationale: Pertussis, a highly contagious infectious disease, is a major public health problem even in countries with a high rate of vaccine coverage [1-4]. The mortality and morbidity of pertussis are greater in children, mainly infants aged less than 4 months [5]. Hyperleukocytosis, WBC > 100×109/L, is a rare complication that strongly predicts mortality and morbidity in severe pertussis patients [2–4,6–8]. Hyperhydration, exchange transfusion and hydroxyurea have been used in management trials for hyperleukocytosis caused by fatal pertussis [3,4,6–9]. Patient concerns: Here, we report a case of fatal pertussis in an Ethiopian toddler who initially presented with paroxysmal whooping cough associated with post tussive vomiting, flushing of the face and cyanosis. She had fast breathing, grunting and a low-grade fever. On the third day after hospital admission, she deteriorated and was transferred to the pediatric intensive care unit. Her white blood cell counts on the first day after admission was 137×109 /L, her neutrophil count was 51%, her platelet count was 700×109/L, and her hemoglobin (Hb) level was 14 g/dL. Tests done for hematologic malignancy were not suggestive of malignant/tumor cells, and echocardiography was normal at the time of admission.

Duration of the effect of breathing and speech training under excess oxygen pressure

This article presents the assessment of the duration of the effect of a 5-day course of breathing and speech training under excess oxygen pressure in 12 Vietnamese volunteer subjects. The follow-up assessment was conducted six months after the training, with rapid aircraft cabin depressurization being simulated with excess oxygen pressure (500 mm H2O) supplied through an oxygen mask. The training and the present study were carried out using the “BARS-GD” hardware/software system developed by the Russian company Konstel. All Vietnamese volunteer subjects were found to retain high tolerance to excess oxygen pressure, maintained speech formation abilities and work capacity. A statistically significant increase in systolic and diastolic blood pressure (by 25% and 34.2%, respectively), heart rate and respiratory rate (14.4% and 41.7%, respectively) was recorded. Analysis of psychophysiological performance at the peak of excess oxygen pressure revealed a 45.2% (p 0.01) increase in simple sensorimotor reaction time, which is 27% (p 0.01) higher than immediately after the training. No significant changes were observed in the psychological component. Therefore, the functional state of the Vietnamese volunteer subjects under simulated rapid cabin depressurization and breathing under excess oxygen pressure was considered normal, with higher involvement of the body’s adaptive mechanisms than immediately after the training. The 5-day course of training in breathing and speech under excess oxygen pressure effectively developed sustainable psychological readiness in the volunteer subjects, breathing and speech skills, and professional reliability under extreme conditions of stratospheric cabin depressurization. Overall, this training course is considered promising for inclusion in the program of psychophysiological preparation of Vietnamese pilots for stratospheric flights.

The impact of obesity on sleep, pulmonary and chest wall restriction in Osteogenesis Imperfecta: a pilot study

IntroductionOsteogenesis Imperfecta (OI) is characterised by brittle bones, severe skeletal deformities, low sleep quality, and restricted breathing. We aimed to distinguish how disease and obesity affect these results.MethodsAccording to BMI, we considered four groups of peer adults (median age: 35.0 years): 13 subjects affected by moderate or severe OI without obesity (OIno), 14 affected by moderate or severe OI with obesity (OIob), 10 without obesity not affected by OI (OB) and 10 without obesity not affected by OI.ResultsObstructive Sleep Apnoea Syndrome was diagnosed in 4 OIno (30%) and 9 OIob (64%). Restricted lung pattern (z-score of total lung capacity < − 1.64) was diagnosed in 10 OIno (77%); 9 OIob (65%), and 1 OB (10%) subjects. In the seated position, OIob breathed with reduced tidal volume and higher respiratory rate, resulting in hypoventilation. Both OIno and OIob were characterised by rapid and shallow breathing and lower ribcage expansion (negative in 3 (23%) OIno and 3 (21%) OIob). In the supine position, the ventilatory pattern was similar among the four groups, while both OIno and OIob were characterised by reduced ribcage contribution, which was negative in 6 (46%) OIno, 11 (78%) OIob and 1 (10%) OB.ConclusionsThis is a pilot study on a small sample, the findings and conclusions apply only to this study population. The preliminary results suggest that in subjects with moderate or severe OI per se implies (1) a 30% prevalence of obstructive sleep apnoea syndrome, (2) a restricted lung pattern, (3) a lower ribcage expansion, and (4) rapid and shallow breathing in the seated position. The additional impacts of obesity on OI seem to determine (1) a higher incidence of obstructive sleep apnoea syndrome, (2) hypoventilation in the seated position, and (3) a higher incidence of paradoxical breathing lying supine. Reversing obesity in OI is even more challenging as knowledge of the diet and the physical activity suited for these patients is still scarce.

Effectiveness of Endorphin Massage and Positive Affirmations in Reducing Anxiety Levels Among Pre-Sectio Caesarea Patients

Introduction: Facing a Caesarean section (C-section), patients often imagine the surgical process and various discomforts, leading to anxiety. Anxiety can result in both physical and psychological changes, such as an increased heart rate, elevated blood pressure, rapid breathing, fatigue, and an increase in fetal heart rate. Endorphin massage and positive affirmations offer benefits such as comfort and pain relief. This sense of relaxation and comfort is expected to reduce the anxiety experienced by patients before delivery. Objective: This study aimed to evaluate the effectiveness of endorphin massage and positive affirmations in reducing anxiety levels among pre-C-section patients. Method: This experimental study employed a pre-experimental design with a one-group pretest-posttest approach. The respondents included 30 pre-C-section patients at Sayang Hospital, Cianjur, selected through a total sampling technique. The research instrument used was the Hamilton Anxiety Rating Scale (HARS) questionnaire, which assessed the patients' anxiety levels before and after the intervention. Result: The study results, analyzed using the Paired Samples T-Test, showed a p-value of 0.000, which is &lt;0.05. Conclusion: The findings indicate a significant reduction in anxiety levels among pre-C-section patients before and after receiving endorphin massage and positive affirmation interventions.

Viral Acute Lower Respiratory Tract Infections (ALRI) in Rural Bangladeshi Children Prior to the COVID-19 Pandemic.

Acute lower respiratory tract infections (ALRIs) remain the leading infectious cause of death among children < 5 years, with viruses contributing to a large proportion of cases. Little is known about the epidemiology and etiology of viral ALRI in rural Bangladesh. We enrolled 3- to 23-month-old children with ALRIs attending a subdistrict hospital outpatient clinic in Sylhet district in Bangladesh. Trained study physicians ascertained the cases and obtained nasopharyngeal swabs to detect 19 respiratory viruses by multiplex PCR using the Luminex Integrated System NxTAG Respiratory pathogen panel. Between August 2016 and September 2017, we enrolled 1477 children. Median age was 10 months; 58.1% were male. Forty-seven percent presented during autumn (mid-June to mid-October). About a third had temperature ≥ 101°F, 95.4% had cough in the previous 3 days, 72.0% had fast breathing, and 80.0% had chest indrawing. Alveolar consolidation occurred in 23.9%, and 4.4% were hypoxemic (saturation < 90% on room air). Nineteen percent required hospitalization; 79.1% of them were discharged within 48 h. A respiratory virus was identified in 81.8%, majority (75.8%) with single virus isolation. Rhinoenterovirus was most commonly identified (HRV/HEV, 37.9%), followed by respiratory syncytial virus (RSV, 20.2%) and human metapneumovirus (hMPV, 11.7%). Rhinoenterovirus was detected year-round; RSV was detected during August-November and hMPV during December-March. Respiratory viruses were identified in a majority (82%) of children under 2 years of age presenting with ALRI in rural hospitals of Bangladesh. These findings have implications for future study and potentially for surveillance, antimicrobial stewardship, vaccine program planning, and policy.

Clinical profile of dilated cardiomyopathy in children enrolled in chronic cardiac care: a decade review in a sub-Saharan African tertiary center

BackgroundDilated cardiomyopathy (DCM) is a myocardial disease characterized by a dilated left ventricle (LV) and reduced LV systolic function. The clinical profile of DCM is not well studied in Africa with no reports from Ethiopia. This study aimed to describe the clinical profile of DCM and the factors associated with its clinical outcome in a tertiary center.ResultsThis study included 75 DCM patients, males 52%. The median age at DCM diagnosis was 18 months (Interquartile range/IQR: 7–46). The major DCM clinical presentations were cough, 84%, fast breathing, 64% and shortness of breath, 56%. The median left ventricular systolic ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) at diagnosis were 30% (IQR: 24–36) and 14% (IQR: 11–18), respectively. The majority don’t have a cause labeled or documented, 81.3% while HIV and anthracycline-related DCM accounted for 6.7% each. Concerning outcomes, the majority didn’t show any clinical status change or were static, 62.7% while one-third, 32%, showed improvement. The case fatality rate in this series was 5.3% [4] (95% CI: 1.47–13.1). The presence of severe acute malnutrition (wasting) at presentation, p 0.017; the latest LV systolic function (LVEF, p 0.000 and LVFS, p 0.000) and the use of enalapril, p 0.017, were associated with DCM clinical outcome.ConclusionBoys in their second birth year were most affected by DCM. The major DCM presentations were a mix of respiratory and cardiac symptoms with severely depressed LV systolic function. Nutritional status at presentation, recent LV systolic function and enalapril use were associated with DCM clinical outcome. Timely nutritional assessment, treatment and support, and enhanced HF medical treatment are recommended to improve DCM clinical outcomes.

Thermal Manipulation During the Embryonic Stage and the Post-Hatch Characteristics of Broiler Chickens.

The objective of this study was to evaluate the influence of thermal manipulation during incubation on the hatchability, the performance, the carcass characteristics, the intestinal villi, the nutrient metabolizability, and some physiological parameters in broiler chickens. Ross eggs were randomly distributed into four commercial automatic incubators. The treatments were as follows: incubator kept at 37.5 °C throughout the incubation period (Ctrl-control), and incubator temperature increased to 39 °C on days 16, 17, and 18 of incubation for 3 (T3h), 12 (T12h), or 24 h (T24h). The chicks were housed in an experimental performance barn and kept until 42 days of age under standard rearing conditions. The hatchability was lower when T24h was used. During the time after hatching, T3h caused higher levels of heat shock protein 70 (HSP70) in the liver, a faster breathing rate, and a drop in the cloacal temperature and hematocrit. T12h increased the respiratory rate. T24h decreased the hematocrit, the weight gain, and the feed intake. The thermal manipulation during incubation did not affect the carcass characteristics, intestinal villi, or metabolizability of nutrients. It was concluded that raising the incubator temperature for 3 h during late incubation may be beneficial for thermoregulation, but raising it for 24 h during this period impairs animal performance.

Breathing Modulates Network Activity in Frontal Brain Regions during Anxiety.

Anxiety elicits various physiological responses, including changes in the respiratory rate and neuronal activity within specific brain regions such as the medial prefrontal cortex (mPFC). Previous research suggests that the olfactory bulb (OB) modulates the mPFC through respiration-coupled oscillations (RCOs), which have been linked to fear-related freezing behavior. Nevertheless, the impact of breathing on frontal brain networks during other negative emotional responses, such as anxiety-related states characterized by higher breathing rates, remains unclear. To address this, we subjected rats to the elevated plus maze (EPM) paradigm while simultaneously recording respiration and local field potentials in the OB and mPFC. Our findings demonstrate distinct respiratory patterns during EPM exploration: slower breathing frequencies prevailed in the closed arms, whereas faster frequencies were observed in the open arms, independent of locomotor activity, indicating that anxiety-like states are associated with increased respiratory rates. Additionally, we identified RCOs at different frequencies, mirroring the bimodal distribution of respiratory frequencies. RCOs exhibited higher power during open-arm exploration, when they showed greater coherence with breathing at faster frequencies. Furthermore, we confirmed that nasal respiration drives RCOs in frontal brain regions and found a stronger effect during faster breathing. Interestingly, we observed that the frequency of prefrontal gamma oscillations modulated by respiration increased with breathing frequency. Overall, our study provides evidence for a significant influence of breathing on prefrontal cortex networks during anxious states, shedding light on the complex interplay between respiratory physiology and emotional processing.

Imaging error reduction in radial cine-MRI with deep learning-based intra-frame motion compensation

Objective.Radial cine-MRI allows for sliding window reconstruction at nearly arbitrary frame rate, promising high-speed imaging for intra-fractional motion monitoring in magnetic resonance guided radiotherapy. However, motion within the reconstruction window may determine the location of the reconstructed target to deviate from the true real-time position (target positioning errors), particularly in cases of fast breathing or for anatomical structures affected by the heartbeat. In this work, we present a proof-of-concept study aiming to enhance radial cine-MR imaging by implementing deep-learning-based intra-frame motion compensation techniques.Approach.A novel network (TransSin-UNet) was proposed to continuously estimate the final-position image of the target, corresponding to end of the frame acquisition. Within the radial k-space reconstruction window, the spatial-temporal dependencies among the sinogram representation of the spokes were modeled by a transformer encoder subnetwork, followed by a UNet subnetwork operating in the spatial domain for pixel-level fine-tuning. By simulating motion-dependent radial sampling with (tiny) golden angles, we generated datasets from 25 4D digital anthropomorphic lung cancer phantoms. The network was then trained and extensively evaluated across datasets characterized by varying azimuthal radial profile increments.Main Results.The method required additional 4.8 ms per frame over the conventional approach involving direct image reconstruction with motion-corrupted spokes. TransSin-UNet outperformed architectures relying solely on transformer encoders or UNets across all the comparative evaluations, leading to a noticeable enhancement in image quality and target positioning accuracy. The normalized root mean-squared error decreased by 50% from the initial value of 0.188 on average, whereas the mean Dice similarity coefficient of the gross tumor volume increased from 85.1% to 96.2% in the investigated cases. Furthermore, the final-positions of anatomical structures undergoing substantial intra-frame deformations were precisely derived.Significance.The proposed approach enables an effective intra-frame motion compensation, offering an opportunity to reduce errors in radial cine-MR imaging for real-time motion management.

Advocating for planetary health is an essential part of advocating for children's health.

Burning of fossil fuels along with deforestation and ecological disruption have led to the warming of the Earth and climate change. Children are especially vulnerable to adverse health effects of climate change associated changes in the air, soil, and water as their organs are still developing, have a faster breathing rate, higher per pound ingested and inhaled exposures, and greater relative body surface area. To protect this vulnerable population, health care professionals need to play a leading role. In 2015, the American Academy of Pediatrics (AAP) updated their original 2007 Global Climate Change and Children's Health policy statement (again updated in 2024) stating that, "failure to take prompt, substantive action would be an act of injustice to all children." Health care professionals need to educate themselves and their patients of the health risks posed by climate change and incorporate climate change counseling into their practice. They also need to go beyond the framework of the healthcare system and work collaboratively with communities, corporations, and governments to advocate for policies and solutions to mitigate and adapt to climate change. The health and wellbeing of future generations rests upon the actions we take today. IMPACT: Summarizes the adverse effects of increased anthropogenic activity and burning of fossil fuels on planetary and human health Details the increased vulnerability of children to environmental assaults and their long-term effects Provides guidance and resources to health care professionals to empower them to act as advocates for systemic and structural changes that protect children's health.

Noninvasive identification of ANOCA endotypes by stepwise, multi-stress, multi-marker stress echocardiography

Abstract Background Angina with non-obstructive coronary artery disease (ANOCA) is increasingly recognized in clinical practice, but effective therapy is difficult due to the heterogenity of pathophysiological substrates: organic coronary microvascular dysfunction (CMD), functional (vasospastic) CMD, epicardial artery vasospasm, non-cardiac chest pain. Current guidelines recommend invasive coronary function testing with the inherent cost of catheterization time, radiation exposure, iodinated contrast effects and risks of invasive procedures. Objective To evaluate the feasibility of a step-wise, multi-marker, multi-stress assessment of ANOCA patients by stress echocardiography (SE). Methods In a prospective study design, we enrolled 54 ANOCA patients (age =54±14 years, 14 men, 25 %), without significant coronary artery disease (CAD) on invasive or noninvasive angiography. In all patients hyperventilation (HYPER) test (30 deep breaths/min for 5 min) was performed, followed by semi-supine exercise (EX) if negative. All patients underwent adenosine (ADO) test with coronary flow velocity reserve (CFVR) measurement in the mid-distal left anterior descending artery (LAD). Positivity criteria were a coronary flow velocity (CFV) decrease during HYPER despite the increase in the double product (DP) indicating functional CMD i.e. vasoconstriction); the presence of inducible regional wall motion abnormality (RWMA) with HYPER-EX (microvascular/epicardial spasm), and CFVR ≤2.0 with ADO hyperemia (organic CMD). Results Fifty one pts (94%) had normal increase in CFV at ADO: CFV rest 0.264±0.078 vs ADO 0.608±0.133, p&amp;lt;0.001, while 3pts (5%) showed decrease in CFV at ADO suggesting organic CMD. Double product (DP) increased during HYPER (rest 10061 ±2406 vs. HYPER 13580 ±3356, p&amp;lt;0.001). Twenty-nine pts (53%) showed a paradoxical vasoconstrictor response during HYPER despite the increase in DP (CFV decreased during HYPER: CFV rest 0.261±0.059 vs HYP 0.216±0.057, p&amp;lt;0.001). With HYPER-EX, RWMA was induced in 15 patients (27%), while 7 patients had also RWMA during HYPER. Conclusion In patients with ANOCA, a stepwise multi-marker (CFVR and RWMA) and multi-stress (ADO, HYPER and EX) SE identifies CMD phenotypes and actionable therapeutic targets. According to our results functional vasospastic CMD (paradoxical decrease of CFV with HYPER), is more frequent than organic CMD (reduced CFVR with ADO) in patients with ANOCA. Inducible RWMA with HYPER-EX indicate severe vasoconstrictor response.

Physical activity as a predictor of activities of daily living in older adults: a longitudinal study in China.

This study aimed to assess the prevalence of physical activity and its association with the progression of difficulty performing activities of daily living among older adults in China. A population-based prospective cohort study based on China Family Panel Studies (CFPS) data was conducted in 2018 and 2020. This study used a logistic model to empirically estimate the effects on daily living activities among older adults. A total of 2073 older adults aged 60 years and above were included, 78.0% of whom did not exercise. The logistic regression model revealed several predictive factors for activity of daily living decline among older adults. These included residence status (OR = 0.672; 95% CI 0.519-0.869; p = 0.002), age (OR = 0.307; 95% CI 0.169-0.557; p < 0.001), ethnicity (OR = 0.511; 95% CI 0.338-0.773; p = 0.001), education level (OR = 2.180; 95% CI 1.366-3.479; p < 0.001), job (OR = 0.601; 95% CI 0.447-0.810; p = 0.001), chronic disease (OR = 0.769; 95% CI 0.604-0.978; p = 0.032) and physical activity (less: OR = 0.464; 95% CI 0.300-0.720; p = 0.001; adequate: OR = 0.512; 95% CI 0.321-0.816; p = 0.005). Our findings indicate that insufficient physical activity is particularly acute among the older adults. Physical activity has emerged as a significant predictor of decreased daily living activities among older adults. Our research underscores that less and adequate physical activity can prevent a reduction in daily living activities, in contrast to a lack of exercise. The most effective threshold for daily exercise frequency is a session per day, while the ideal exercise duration is 15 min. Additionally, the desired intensity for exercise is characterized by rapid breathing and a noticeable heartbeat, accompanied by slight perspiration. Community nurses play a pivotal role in providing health education on daily exercise to the older adults. It is crucial for nurses in community hospitals to closely monitor the daily exercise habits of the older adults, actively disseminate the benefits of exercise, and enhance their current exercise regimens through effective health education, ultimately improving their quality of life.

Quality of neonatal health care in comprehensive specialized hospitals, Amhara Region, Ethiopia: a retrospective study with neonatal death audit

BackgroundNeonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region.MethodsA multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner.ResultsFrom 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates’ mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm.ConclusionHigher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers’ complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths.

Complications and long-term impact of early life pneumonia.

Pneumonia is an infection affecting the lower airway, where the air sacs are filled with mucus and pus; and typically presents with cough, fever, and fast breathing. Pneumonia is estimated to be the leading cause of mortality in children under five worldwide with 120 million episodes result in 1 million deaths globally. The Low-Income and Middle-Income Countries (LMICs) are more affected. In a study in southeast Nigeria, bronchopneumonia accounted for 41.9%, of the cases admitted in the tertiary hospitals and in another hospital based study among children, pneumonia had the highest respiratory admission rates at 34.0%. Pneumonia can be caused by various organisms: Bacterial (Streptococcus, staphylococcus etc), Viral (RSV) and recently COVID 19 pneumonia. RSV has been noted globally to be a major cause of childhood lower respiratory tract infection, with morbidity/mortality occurring in 99% of (LMICs). Some of the long term sequalae are discussed.