Low Pressure Low Frequency Jet Ventilation: Techniques, Safety and Complications

Objective: Manual jet ventilation is a specialized oxygenation and ventilation technique that is not available in all facilities due to lack of technical familiarity and fear of complications. The objective is to review our center’s 15 year experience with low pressure low frequency jet ventilation (LPLFJV). Methods: Retrospective review of procedures utilizing LPLFJV from 2005 to 2019 were performed collecting patient demographic, surgery type and complications. Fisher exact test, Chi square, and t-test were used to determine statistical significance. Results: Four hundred fifty-seven patients underwent a total of 891 microlaryngeal surgeries—279 cases for voice disorders, 179 for lesions, and 433 for airway stenosis. The peak jet pressure for all cases did not exceed 20 psi and average peak pressure for the last 100 procedures in this case series was 14.9 ± 4.6 psi. The average lowest oxygen saturation for all cases was 95% ± 0.6%. Brief intubation was required in 154 cases (17%). Surgical duration was significantly longer for cases requiring intubation P < .001. The need for intubation was not associated with smoking or cardiopulmonary disease, but was strongly associated with body mass index (BMI). Intubation rates were 7% for normal weight (BMI < 25, N = 216), 13% for overweight (BMI 25-30, N = 282), 24% for obese (BMI 30-40, N = 342), and 37% for morbidly obese (BMI > 40, N = 52) patients. Three patients developed respiratory distress in the recovery unit and 2 patients required intubation. Conclusion: LPLFJV assisted by intermittent endotracheal intubation is an exceedingly safe and effective intraoperative oxygenation and ventilationmodality for a broad variety of laryngeal procedure.

A Retrospective Study Assessing the Effect of Infections in Myocardial Infarction Patients: Mortality and Complications

Background: There is a well-established relationship between myocardial infarction and infection. Multiple articles describe the increased risk of myocardial infarction, both type 1 and 2, following an infectious process. However few articles have described the relation between concomitant myocardial infarction and infections on same admission mortality and complications. Methods: The aim is to assess the effect of an acquired or concomitant infection on complications and mortality during hospitalized cases of myocardial infarction. 1197 patients of different types of myocardial infarction were studied in correlation to infectious processes. Cultures from different sites were collected and isolation of various bacterial agents were studied. Mortality and various complications were compared between infected and non-infected subjects. Pearson's chi squared test was used to compare percentages (or the Fisher exact test when expected values were lower than 5). Moreover, means were compared through ANOVA, after checking data normality and homoscedasticity. A likelihood ratio backward stepwise method was used to conduct dichotomous logistic regressions, taking dichotomous outcomes as dependent variables, and sociodemographic and biological characteristics as independent variables (potential confounders).Results: Wound, sputum, blood and urine infections were associated with increased same admission mortality and complications. Microorganisms were then studied alone regardless of the site of infection and it was shown that Escherichia Coli, Escherichia Coli ESBL, Candida Albicans, Pseudomonas Aeruginosa and Staphylococcus of any type were significantly associated with same admission complications when associated with myocardial infarction. Length of stay was significantly elevated in patients with concomitant infection and it increased with the addition of positive cultures from different sites. Conclusion: Concomitant infections with myocardial infarction significantly increase the risk of same admission complications, mortality and length of stay regardless of the site of infection and type of microorganisms.

Relationship between C-Reactive Protein and Cardiovascular Diseases in Patient with ESRD

Background- Cardiovascular mortality is significantly higher in ESRD patient.There are various risk factors for development of cardiovascular diseases including traditional risk factors, factors unique to ESRD patients and emerging risk factors.It is believed that their combined actions are integrated in the progression of atherosclerosis and inflammation plays a central role. C-reactive protein is a valuable marker of inflammation. Determination of serum creactive protein levels may be a useful predictor of cardiovascular diseases in ESRD patients Objective-To find out relationship between c-reactive protein and cardiovascular diseases. Methods- This cross sectional study was carried out into department of Nephrology, Dhaka Medical College Hospital, Bangladesh following fulfillment of inclusion and exclusion criteria. For analytical purpose total study population were divided into two groups on the basis of creactive protein level. Patients having c-reactive protein £6 mg/L were considered as group A and >6 mg/L were considered as Group B. The differences between groups were analyzed by unpaired t-test, fisher’ exact test or chi-square (X2) test. Multivariable regression analysis was done to see the association between c-reactive protein and cardiovascular diseases. Results- Patients with raise c-reactive protein have significantly higher cardiovascular disease than that of normal c-reactive protein. Multivariable linear regression analysis after adjusting for age, sex, smoking and diabetes shows that subject with CRP £6 mg/L vs >6 mg/L had 1.51 (95% CI 1.02 to 2.19) times increase risk of having cardiovascular disease. Conclusion- Inflammatory process has a role in development of cardiovascular diseases in ESRD patient. J Shaheed Suhrawardy Med Coll 2020; 12(2): 95-99

Antibody profiling reveals gender differences in response to SARS-COVID-2 infection

<abstract> <p>The recent emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an ongoing global COVID-19 pandemic and public health crisis. Detailed study of human immune response to SARS-CoV-2 infection is the important topic for a successful treatment of this disease. Our study was aimed to characterize immune response on the level of antibody profiling in convalescent plasma of patients in Georgia. Antibodies against the following SARS-CoV-2 proteins were studied: nucleocapsid and various regions of spike (S) protein: S1, S2 and receptor binding domain (RBD). Convalescent plasma of patients 6–8 weeks after initial confirmation of SARS-CoV-2 infection were tested. Nearly 80% out of 162 patients studied showed presence of antibodies against nucleocapsid protein. The antibody response to three fragments of S protein was significantly less and varied in the range of 20–30%. Significantly more females as compared to males were producing antibodies against S1 fragment, whereas the difference between genders by the antibodies against nucleocapsid protein and RBD was statistically significant only by one-tailed Fisher exact test. There were no differences between the males and females by antibodies against S2 fragment. Thus, immune response against some viral antigens is stronger in females and we suggest that it could be one of the factors of less female fatality after SARS-CoV-2 infection.</p> </abstract>

Hubungan Dukungan Orang Tua dan Sekolah terhadap Sexual Abstinence pada Remaja

Background: Reproductive health problems such as STI and HIV/AIDS, and Unwanted Pregnancy are vulnerable to be experienced by adolescents if they do not have the ability and confidence to perform sexual abstinence. Parents and schools are considered appropriate parties to provide support to adolescents to perform sexual abstinence. Objective: This study was to analyze the relationship between parental and school support for sexual abstinence in high school adolescents in Pugung District, Lampung Province. Methods: this type of research is analytic observational with a cross sectional approach. Sampling using Proportional Random Sampling technique, with a total sample of 130 respondents. The statistical test of this study used the Fisher exact test. Results: there is no relationship between parental support (p-value 0.672 > 0.05) and school (p-value 1,000 > 0.05) with sexual abstinence in high school adolescents in Pugung District. Conclusion: It is necessary to explore other appropriate sources of support for adolescents and to expand the scope of research for further research, both in urban and rural areas.

Factor Analysis of Caesarean Section at Panti Waluya Hospital, Malang

The incidence of caesarean section in Indonesia has increased every year. Caesarean section is an alternative to delivery when vaginal delivery cannot be done. The problems studied are the factors that influence the action of cesarean section delivery. The purpose of the study was to analyze the factors of delivery by caesarean section at Panti Waluya Hospital, Malang. The design of the study used cross sectional. The population in this study was all parturition mothers who were in the medical records of Panti Waluya Hospital Malang in January-May 2021. The sampling technique in this study used Simple Radom sampling, obtained 55 samples that met the inclusion criteria (ie data in the medical record). The study was carried out at the Panti Waluya Hospital in Malang in May 2021. The instrument used observation sheet. The data taken came from secondary data, namely the patient's medical record. The independent variables of the study were maternal age, gestational age, employment status, parity, disease history, income, insurance, education, delivery distance. The dependent variable of the study was caesarean section. The data analysis used Fisher exact test and logistic regression test. The results showed that history of disease and delivery interval had a significant correlation with delivery, and the variable that was the determinant of CS delivery was history of disease (p=0.012; OR=8.463). It is necessary to carry out routine ANC for pregnant women, in order to avoid risk factors for childbirth by caesarean section.

“THE STUDY TO ASSESS AN INCIDENCE OF FEVER IN POST-OPERATIVE PATIENTS ADMITTED IN SURGICAL ICU AT NATIONAL CANCER INSTITUTE, DHARAMPETH, NAGPUR.”

INTRODUCTION: Postoperative fever is one of the most common problems seen in the postoperative ward. Most cases of fever immediately following surgery are self-limiting. The appearance of postoperative fever is not limited to specic types of surgery. Fever can occur immediately after surgery and seen to be related directly to the operation or may occur sometime after the surgery as a result of an infection at the surgical site or infections that involve organs distant from the surgery. Objectives: To study the common causes of post operative fever in general surgery patients. To study the correlation between the cause and the day of onset of fever. To study the risk factors associated with post operative fever. Material and Method: In this study Descriptive Research Design was used. The samples were 30 Post operative patients which fulls inclusion criteria. Setting of the study was surgical ICU, National cancer Institute, Dharampeth, Nagpur. RESULTS:-The result of this study shows that There 6 patients in the age group of 41yrs to 60 yrs having increase WBC count. Fisher exact test statistic value is 0.0449. The result is signicant at p < .05. so the post operative fever is signicantly associated with gender of the patient, Types of surgery and increase WBC count in Patient.

Genotype Effects on β-Carotene Conversion to Vitamin A: Implications on Reducing Vitamin A Deficiency in the Philippines

Background: The study aimed to identify two beta-carotene 15,15′-monooxygenase (BCMO1) mutations, namely R267S and A379V, and determine their association with vitamin A status among Filipinos 6 to 19 years old respondents of the 2013 Philippine National Nutrition Survey living in the National Capital Region. Materials and Methods: This study followed cross-sectional design. Whole blood specimen was collected in the morning and was used as source of genomic DNA and serum for retinol concentration determination. Fisher exact test was performed to determine whether genotype frequencies were associated to retinol concentrations/vitamin A deficiency status. A level of P < .05 was identified as significant. Results: A total of 693 Filipino children and adolescents were included. Of the 693, there were at least 7.6% who bears the combined mutations for R267S + A379V. Association analysis showed that an inverse relationship exists between the A379V TT variant and vitamin A status. Although the exact role of these identified polymorphisms on retinol/carotenoid metabolism need to be confirmed in dedicated functional studies. Conclusion: This study has identified for the first time the presence of 2 nonsynonymous genetic variants/mutations in the coding region of BCMO1 gene. Interestingly, one of these two variants, the A379V T, was found to be associated with vitamin A status. It is, therefore, warranted to investigate the role of BCMO1 variants for the success of supplementation programs and fortification efforts among vulnerable populations in this region. Genetic variability should be considered for future provitamin A supplementation recommendations among children and adolescents in the Philippines.

Outcome of Tuberculosis Case Surveillance at Kano Central Correctional Center, North-west Nigeria: A Need for Routine Active Case Findings for TB in Nigerian Correctional Centers

Aim: To demonstrate the need for routine active TB case finding in Nigerian correctional centers through a TB case surveillance intervention at the largest correctional centre in the most populous state in Nigeria by KNCV Tuberculosis Foundation Nigeria. Study Design: It was a retrospective review of public health intervention data derived from the mass TB screening of Kano central correctional centre inmates in Kano state, Nigeria. Methodology: A digital X-ray with artificial intelligence (AI) was used for mass TB screening of 1,967 consenting inmates at the Kano central correctional centre in Kano state, Nigeria, from 21st September to 2nd October 2020. Participants with CAD4TB score ≥ 60 had a GeneXpert assessment of their sputa for TB diagnosis. Where sputum production was not possible, or GeneXpert result was negative, expert clinical evaluation of the presumptive radiogram was carried out by experienced radiologist. Data from the project were extracted and analysed for this report. Proportions and means were compared with Fisher Exact test and Student t-test, respectively. A p-value of < 0.05 was considered statistically significant. Results: Overall, 1,967 inmates were screened for TB and 92 (4.7%) presumptive were identified - males (4.8%, 91/92), females (1.9%, 1/92). Out of the 92 presumptive, 21 males were diagnosed as TB cases giving a TB prevalence of 1.1% among the inmates and 22.8% among presumptive. One of the TB cases had multi-drug resistant TB. The number needed to screen (NNS) was 94. All TB cases were enrolled in treatment. Conclusion: The prevalence of TB at the Kano central correctional centre during the mass TB screening project was high. The National Tuberculosis Control Programme of Nigeria should accelerate the planned paradigm shift from passive to active case-finding for TB in Nigerian correctional centers.

Comparative Analysis of Anal Colposcopy with Histology in the Follow-Up of Patients under Treatment for Anal Condyloma

Objectives To compare morphological abnormalities on anal colposcopy against histology to determine anal high-grade squamous intraepithelial lesions (HSILs). Methods This is a retrospective data assessment of HIV-negative and HIV-positive patients undergoing outpatient follow-up. The sample comprised 54 patients presenting acetowhite lesions on anal colposcopy. Acetowhite lesions were classified according to their morphology into punctation, verrucous, mosaic, ulcerated, or hypervascularized, and biopsies of these specimens were classified as anal HSIL, low-grade squamous intraepithelial lesion (LSIL), or normal. The data were analyzed using SPSS for Windows version 13.0 (SPSS Inc., Chicago, IL, USA). The results were analyzed using the nonparametric Mann-Whitney test, the Fisher exact test and the chi-squared parametric test. A 95% confidence interval (CI) was used and a level of significance < 5% was adopted for all statistical tests. Results Fifty-four patients (50 males, 80% HIV + ) with biopsied acetowhite lesions were assessed. There were 31 punctation lesions, 1 classified as HSIL (3.2%; 95%CI: 0–40.0), 17 verrucous lesions, 3 HSIL (17.7%; 95%CI: 0–10.7), and 1 ulcerated, classified as HSIL (100%), and 4 mosaic and 1 atypical vessel lesion, all classified as LSIL. The results showed no association of presence of anal HSIL with positivity for HIV infection or with counts above or below 500/µl in HIV+ patients. Statistical analysis was performed using the Mann-Whitney nonparametric test, the Fisher exact test, and the chi-squared parametric test. Conclusion The comparison of morphological findings on anal colposcopy against histology revealed no morphological pattern suggesting anal HSIL.