Umbilical cord blood culture for early onset sepsis in preterm infants.

BACKGROUND: Umbilical cord blood culture (UCBC) may have a diagnostic utility for early onset sepsis (EOS) detection in preterm infants. It may prevent sampling the newborn and collect a higher volume of blood for pathogenic identification. METHODS: Retrospective analysis at a tertiary care center in Canada of preterm infants ≤ 34 0/7 weeks' gestation with UCBC taken at birth. RESULTS: Of 505 admitted infants, 195 had UCBC. 170 UCBCs were negative; 44 of these had also negative neonatal blood culture (NBC). No infants with negative UCBC showed EOS symptoms in the first week of life. 25 UCBCs were positive: 18 were contaminants (all with negative NBC) and 7 were confirmed as EOS. 18 infants with UCBC contaminants remained asymptomatic. 7 EOS cases were identified, with varying bacteriological profiles; 5 displayed sepsis symptoms while 2 were asymptomatic. Risk of EOS increased with prolonged rupture of membranes. CONCLUSIONS: UCBC effectively detected EOS establishing it as a method with possibly better diagnostic performance than NBC in high-risk neonates. Further studies are needed to improve UCBC technique and lower contamination rates. IMPACT: Umbilical cord blood culture has a higher bacterial identification rate than peripheral venous blood culture for the early identification of early-onset sepsis in preterm infants. Umbilical cord blood cultures that showed no growth were reliable predictors of not developing early onset sepsis. Umbilical cord blood culture should be considered as part of the evaluation for early onset sepsis in the preterm infants.

Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial.

OBJECTIVE: There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning. STUDY DESIGN: A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping. Healthy newborns ≥36 weeks gestational age and born vaginally with cephalic presentation were included. The newborn was randomized to prone or supine position. Umbilical cord clamping was delayed in both groups to 1 minute after birth. The primary outcome was hematocrit at 30 hours of life. As a secondary outcome, cerebral tissue oxygenation (CrSO2) values were compared between both groups by near infrared spectroscopy. RESULTS: There was no difference in hematocrit at 30 hours of life between supine and prone positions with a mean at 52 and 53.1, respectively, mean difference -1.1 (95% confidence interval:-2.7, 0.5), p = 0.17. Newborns in supine and prone positions had comparable level of CrSO2 at 30 hours of life with a mean at 84.1 and 82.2, respectively, mean difference 1.9 (-0.2, 4.0), p = 0.07. There was no correlation between hematocrit and CrSO2 at 30 hours of life (r = 0.14). CONCLUSION: There was no difference between prone and supine positioning immediately after birth during delayed cord clamping on hematocrit at 30 hours of life. In the absence of clear findings, further studies with assessment of the effect of position on breastfeeding success in the case room, on maternal satisfaction and outcome beyond 30 hours are needed to make adequate recommendations on positioning. KEY POINTS: · Delayed cord clamping at 60 seconds is recommended at birth, but optimal positioning is unknown.. · A randomized trial was conducted to compare hematocrit at 36 hours of life of prone versus supine position.. · No difference in hematocrit was found in prone versus supine position during delayed cord clamping..

The effect of evolocumab alone and in combination with atorvastatin on atherosclerosis progression and TLRs expression.

Evolocumab, a PCSK-9 inhibitor, is known for its ability to reduce low-density lipoprotein cholesterol (LDL-C). This study aimed to investigate the effects of evolocumab, alone or in combination with atorvastatin, on the progression of atherosclerosis. Fifty male domestic rabbits were randomly assigned to five groups: control, high cholesterol diet, evolocumab vehicle (dimethyl sulfoxide, DMSO), evolocumab alone, and evolocumab plus atorvastatin. Serum levels of interleukin 10 (IL-10), IL-17, IL-1ß, intracellular adhesion molecule (ICAM), and vascular adhesion molecule (VCAM) were measured. Toll-like receptor (TLR) expression on monocytes was evaluated using flow cytometry. Histopathological examination and measurement of intimal thickness (IT) were also conducted. The results revealed that the evolocumab produced a statistically significant (p<0.05) reduction in lipid profile at 5 weeks, with the peak effect occurring at 10 weeks. Furthermore, the inhibitor reduced TLRs at 10 weeks to 10.83±1.8 and intimal thickness to 160.66±9.45. IL-17, IL-1ß, ICAM, and VCAM were significantly reduced by evolocumab treatment, with the improvement of the histopathological changes in the aortic wall. The combination of evolocumab and atorvastatin caused a more statistically significant reduction in TLRs at 10 weeks to 5.08±1.2 and intimal thickness to 121.79±5.3. IL-17, IL-1ß, ICAM, and VCAM were significantly (p<0.05) reduced by the combination, and the histopathological changes in the aortic wall were significantly improved. In conclusion, evolocumab delays the progression of atherosclerosis by modulating inflammatory pathways.

Identification of Thermostable Xylose Reductase from Thermothelomyces thermophilus: A Biochemical Characterization Approach to Meet Biofuel Challenges.

The constant rise in energy demands, costs, and concerns about global warming has created a demand for new renewable alternative fuels that can be produced sustainably. Lignocellulose biomass can act as an excellent energy source and various value-added compounds like xylitol. In this research study, we have explored the xylose reductase that was obtained from the genome of a thermophilic fungus Thermothelomyces thermophilus while searching for an enzyme to convert xylose to xylitol at higher temperatures. The recombinant thermostable TtXR histidine-tagged fusion protein was expressed in Escherichia coli and successfully purified for the first time. Further, it was characterized for its function and novel structure at varying temperatures and pH. The enzyme showed maximal activity at 7.0 pH and favored  d-xylose over other pentoses and hexoses. Biophysical approaches such as ultraviolet-visible (UV-visible), fluorescence spectrometry, and far-UV circular dichroism (CD) spectroscopy were used to investigate the structural integrity of pure TtXR. This research highlights the potential application of uncharacterized xylose reductase as an alternate source for the effective utilization of lignocellulose in fermentation industries at elevated temperatures. Moreover, this research would give environment-friendly and long-term value-added products, like xylitol, from lignocellulosic feedstock for both scientific and commercial purposes.

Elucidating the Role of Santalol as a Potent Inhibitor of Tyrosinase: In Vitro and In Silico Approaches.

This research work focuses on the potential application of an organic compound, santalol, obtained from santalum album, in the inhibition of the enzyme tyrosinase, which is actively involved in the biosynthesis of melanin pigment. Over-production of melanin causes undesirable pigmentation in humans as well as other organisms and significantly downgrades their aesthetic value. The study is designed to explain the purification of tyrosinase from the mushroom Agaricus bisporus, followed by activity assays and enzyme kinetics to give insight into the santalol-modulated tyrosinase inhibition in a dose-dependent manner. The multi-spectroscopic techniques such as UV-vis, fluorescence, and isothermal calorimetry are employed to deduce the efficiency of santalol as a potential candidate against tyrosinase enzyme activity. Experimental results are further verified by molecular docking. Santalol, derived from the essential oils of santalum album, has been widely used as a remedy for skin disorders and a potion for a fair complexion since ancient times. Based on enzyme kinetics and biophysical characterization, this is the first scientific evidence where santalol inhibits tyrosinase, and santalol may be employed in the agriculture, food, and cosmetic industries to prevent excess melanin formation or browning.

The role of cytokines, adhesion molecules, and toll-like receptors in atherosclerosis progression: the effect of Atorvastatin.

Inflammatory cytokines, cell adhesion molecules, and toll-like receptors (TLRs) play an important role in atherosclerosis. The aim of this study was to further evaluate the role of inflammatory cytokines, cell adhesion molecules, and toll-like receptors in atherosclerosis. Forty local breed domestic male rabbits were divided randomly into 4 groups, 10 rabbits each. Group I was the control group, group II received a high cholesterol diet, group III received the drug solvent dimethyl sulfoxide (DMSO), and group IV received Atorvastatin (3.5 mg/kg/day). Blood samples were collected at 0 times, 5 weeks, and at the end of 10 weeks. TLRs expression on monocyte was measured by flow cytometry, IL-10, IL-17, IL-1ß, intracellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM) were measured by ELISA. In group II, a high cholesterol diet led to a statistically significant elevation of lipids profile (TC, TG, and LDL) at both 5 weeks and 10 weeks compared to the control. The expression of TLRs was also increased compared to the control (13.53±2.5 to 25.79±6.5). The intimal thickness increased from 103.46±13.85 to 248.43±11.11. IL-17 increased significantly from 3.4±0.4 to 7.7±1.00, and IL-1ß increased from 1.04±0.19 to 9.66±1.4 (P 0.05) at 10 weeks. ICAM and VCAM increased from 1.7±0.16 to 8.2±0.74 and from 0.89±0.07 to 5.2±0.45, respectively. Atorvastatin significantly reduced TLRs at 10 weeks to 21.98±3.4 and intimal thickness to 191.6±15.59. IL-17, IL-1ß, ICAM, and VCAM were significantly reduced by Atorvastatin. Cytokines, cellular adhesion molecules, and probably TLRs have a role in the pathogenesis of hyperlipidemia and atherosclerosis.

A novel hybrid approach to develop bioresorbable material.

The need for bioresorbable implants that are able to dissolve within the body is rising, unlike their traditional counterparts. Bulk metallic glasses (BMGs) can perhaps serve this need, since they possess incredible properties, including high biocompatibility by virtue of their amorphous structure and absence of dislocations. However, the fabrication of BMGs is challenging, since, to achieve an amorphous structure, fast cooling is a pre-requisite which is very difficult to achieve for casting due to the fact that fast cooling rate and adequate rate of filling of the mold possess a trade-off relationship. Therefore, purpose of this work is to develop a simple novel hybrid approach that is cost effective and attempts to synthesize BMG based on Mg-Ca-Zn constituent. Synthesis of bioresorbable material was attempted by hybridizing friction stir processing (FSP) technique with gas tungsten arc welding (GTAW). FSP was performed with Magnesium as base material and Calcium granules as reinforcement. After FSP, GTAW process was performed by using Zn as filler material. The added Ca and Zn were found to effectively intermix with the Mg matrix in the FSP and GTAW steps, respectively. Especially, a relatively invariable distribution of Ca phases was observed in the stirred microstructure after FSP. Finally, a wide bead consisting of mixed dendritic and columnar cast structure was obtained. The current work is expected to alleviate the physiological issues pertaining to orthopaedic fixations and decrease the need for secondary surgeries in geriatric fractures.

Parkinson's Disease: A Current Perspectives on Parkinson's Disease and Key Bioactive Natural Compounds as Future Potential Drug Candidates.

Parkinson's disease (PD) is one of the most common types of neurological disorder prevailing worldwide and is rapidly increasing in the elderly population across the globe. The cause of PD is still unknown, but a number of genetic as well as environmental factors contributing to the pathogenesis of Parkinson's disease have been identified. The hallmark of PD includes dopamine deficiency (neurotransmitter imbalance) due to the gradual loss of dopaminergic nerves in the substantia nigra in the midbrain. Studying the mutation of associated genes is particularly informative in understanding the fundamental molecular and pathogenic changes in PD. Intracellular accumulation of misfolded or degraded protein due to mutated genes leading to the manifestation of mitochondrial dysfunction, oxidative stress followed by multifaceted patho-physiologic symptoms. Other studies include the appearance of both motor and non-motor responses like resting tremor, muscle stiffness, slow movement and anxiety, anaemia, constipation, rapid eye movement sleep behaviour disorder. Many bioactive natural compounds have shown positive pharmacological results in treating a number of extensive disease models of PD. Despite the availability of end number of potent medicinal plants around the world, limited research has been done associated with various neurological disorders, including PD. The currently available dopamine-based drug treatments have several side-effects, further, not effective enough to combat PD completely. Therefore, various plant-based compounds with medicinal benefits have grabbed lots of attention of researchers to deal with various life-threatening neurodegenerative disorders like PD. On the basis of literature available till date, here, we have discussed and addressed the molecular basis, current scenario, and the best possible treatment of PD for the future with minimal or no side-effects using various key bioactive compounds from natural origin/medicinal plants.

EEG feature fusion for motor imagery: A new robust framework towards stroke patients rehabilitation.

Stroke is the second foremost cause of death worldwide and is one of the most common causes of disability. Several approaches have been proposed to manage stroke patient rehabilitation such as robotic devices and virtual reality systems, and researchers have found that the brain-computer interfaces (BCI) approaches can provide better results. Therefore, the most challenging tasks with BCI applications involve identifying the best technique(s) that can reveal the neuron stimulus information from the patients' brains and extracting the most effective features from these signals as well. Accordingly, the main novelty of this paper is twofold: propose a new feature fusion method for motor imagery (MI)-based BCI and develop an automatic MI framework to detect the changes pre- and post-rehabilitation. This study investigated the electroencephalography (EEG) dataset from post-stroke patients with upper extremity hemiparesis. All patients performed 25 MI-based BCI sessions with follow up assessment visits to examine the functional changes before and after EEG neurorehabilitation. In the first stage, conventional filters and automatic independent component analysis with wavelet transform (AICA-WT) denoising technique were used. Next, attributes from time, entropy and frequency domains were computed, and the effective features were combined into time-entropy-frequency (TEF) attributes. Consequently, the AICA-WT and the TEF fusion set were utilised to develop an AICA-WT-TEF framework. Then, support vector machine (SVM), k-nearest neighbours (kNN) and random forest (RF) classification technique were tested for MI-based BCI rehabilitation. The proposed AICA-WT-TEF framework with RF classifier achieves the best results compared with other classifiers. Finally, the proposed framework and feature fusion set achieve a significant performance in terms of accuracy measures compared to the state-of-the-art. Therefore, the proposed methods could be crucial for improving the process of automatic MI rehabilitation and are recommended for implementation in real-time applications.

Cold-Injection Molded Gentamicin-Impregnated Polymethyl Methacrylate Implants for Cranioplasty.

BACKGROUND: Cranioplasty can be carried out using either fresh, frozen autologous bone or synthetic substitutes. Ordering artificial 3 dimensional (3D) implants is challenging and time consuming depending on geographical location. In this article, we share our experience using a streamlined process of producing 3D computer-assisted design (CAD) implants using commercially available 3D printers and silicone molds that can be easily replicated with consistent results and are associated with good outcomes. OBJECTIVE: To develop patient-specific implants for patients with cranial defects that are accurate, consistent, low cost, and easy to replicate while reducing operator-dependent factors. METHODS: We present data from 15 patients who underwent cranioplasty with 3D CAD-designed gentamicin-impregnated bone cement implants that were molded using the cold injection technique. RESULTS: The technique was consistent in result production, required little postdemolding manipulation, and showed no dimensional variation in design. Postoperative computed tomography scans showed excellent implant fit, and patients had a low complication rate. CONCLUSION: We have demonstrated a technique of mold preparation that is efficient and that produces a reliable result. Polymethyl methacrylate implants molded using this technique showed better reproducibility, higher accuracy, and precision than other types of implants and required minimal postdemolding clean-up.

THE EFFECT OF EVOLOCUMAB ALONE AND IN COMBINATION WITH ATORVASTATIN ON LIPID PROFILE.

OBJECTIVE: The aim: In this study, we try to investigate whether evolocumab or its combination with atorvastatin has potent effect on lipid profile? PATIENTS AND METHODS: Materials and methods: Forty local domestic male rabbits were included in this study, and categorized into four group, two untreated group (nohypercholostermic and untreated hypercholostermic) and treated groups (evolocumab treated group at dose 6.1mg/kg/2Wk and atorvastatin treated group at dose 3.5 mg/kg/day),the blood samples were analyzed at base line and after 5week and at the end of the study after 10 weeks for lipid profile by standard enzymatic methods. RESULTS: Results: The serum levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C),were increased after 10 weeks of administration of the atherogenic diet significantly (p<0.05) as compared with other groups (group I: 61.19 ± 14, group ΙΙ: 1301 ± 443, group ΙΙΙ 41.01 ± 5.81: 280 ± 50, group ΙV: 190 ± 38 group Ι: 46 ± 15.0, group ΙΙ: 256.0 ± 24.0, group ΙΙΙ: 101.0±28, group ΙV: 48.18 ± 15.27, group Ι: 29±14.50, group ΙΙ: 929±251.0, group ΙΙΙ: 283.0±36, group ΙV: 209.0±33mg/dl) respectively while the levels of high-density lipoprotein cholesterol (HDL-C) decrease (18.0±4.1 to 15.0±3.0mg/dl). Compared with evolocumab monotherapy, combination of evolocumab and atorvastatin reduce serum level of total cholesterol, triglyceride and low density lipoprotein more than that of evolocumab. CONCLUSION: Conclusions: Preproteins convert as esubtilisin/kexin type 9 inhibitor regulates the serum levels of lipid and cholesterol by lowering LDL-C, and the results also indicate that combination of evolocumab and atorvastatin are more potent in lowering the lipid profile and then reduce progression of atherosclerosis than evolocumab alone in rabbits suggesting that this combination might be beneficial for treatment of atherosclerosis.

Observational Study of Pulse Transit Time in Children With Sleep Disordered Breathing.

Background: Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We also compare the sensitivity and specificity of oximetry with the findings of a multi-channel study. Methods: We performed a cross-sectional observational study of 521 children with SDB admitted for multi-channel sleep studies (pulse oximetry, ECG, video, sound, movement, PTT) in a secondary care centre. PTT data was available in 368 children. Studies were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea (OSA), and "abnormal other." Receiver operator characteristic curves were constructed for different PTT (Respiratory swing; Arousal index) thresholds using a random sample of 50% of children studied (training set); calculated thresholds of interest were validated against the other 50% (test set). Study findings were compared with oximetry categories (normal, inconclusive, abnormal) using data (mean and minimum oxygen saturations; oxygen desaturations > 4%) obtained during the study. Results: Respiratory swing of 17.92 ms identified SDB (OSA/UARS) with sensitivity: 0.80 (C.I. 0.62-0.90) and specificity 0.79 (C.I. 0.49-0.87). PTT arousal index of 16.06/ hour identified SDB (OSA/UARS) with sensitivity: 0.85 (95% C.I. 0.67-0.92) and specificity 0.37 (95% C.I. 0.17-0.48). Oximetry identified SDB (OSA) with sensitivity: 0.38 (C.I. 0.31-0.46) and specificity 0.98 (C.I. 0.97-1.00). Conclusions: PTT is more sensitive but less specific than oximetry at detecting SDB in children. The additional use of video and sound enabled detection of SDB in twice as many children as oximetry alone.

Clinically important associations of pleurodesis success in malignant pleural effusion: Analysis of the TIME1 data set.

BACKGROUND AND OBJECTIVE: Chemical pleurodesis is performed for patients with MPE with a published success rate of around 80%. It has been postulated that inflammation is key in achieving successful pleural symphysis, as evidenced by higher amounts of pain or detected inflammatory response. Patients with mesothelioma are postulated to have a lower rate of successful pleurodesis due to lack of normal pleural tissue enabling an inflammatory response. METHODS: The TIME1 trial data set, in which pleurodesis success and pain were co-primary outcome measures, was used to address a number of these assumptions. Pain score, systemic inflammatory parameters as a marker of pleural inflammation and cancer type were analysed in relation to pleurodesis success. RESULTS: In total, 285 patients were included with an overall success rate of 81.4%. There was a significantly higher rise in CRP in the Pleurodesis Success group compared with the Pleurodesis Failure group (mean difference: 19.2, 95% CI of the difference: 6.2-32.0, P = 0.004) but no significant change in WCC. There was no significant difference in pain scores or analgesia requirements between the groups. Patients with mesothelioma had a lower rate of pleurodesis success than non-mesothelioma patients (73.3% vs 84.9%, χ2 = 5.1, P = 0.023). CONCLUSION: Change in CRP during pleurodesis is associated with successful pleurodesis but higher levels of pain are not associated. Patients with mesothelioma appear less likely to undergo successful pleurodesis than patients with other malignancies, but there is still a significant rise in systemic inflammatory markers. The mechanisms of these findings are unclear but warrant further investigation.

Purification, modeling and structural insights of calmodulin-binding receptor like cytoplasmic kinase 2 from Oroxylum Indicum.

Calmodulin binding receptor like cytoplasmic kinase 2 (CRCK2) belongs to the family of receptor like kinases (RLKs) which is mainly implicated in pathways associated with the stress responses in plants. The protein from the stem of Oroxylum indicum was isolated and purified using anion-exchange followed by gel filtration chromatography. The purity of protein was checked using SDS-PAGE, which showed a single band of 50 kDa. The purified protein was identified as CRCK2 using MALDI-TOF. Using I-TASSER, a bioinformatics tools, the model of protein was constructed and its secondary structure was predicted using VADAR. The secondary structure content was also determined by far-UV CD, which indicated that the CRCK2 is mainly ß-sheet dominating protein (43% ß-sheet). The secondary structural content predication from computational method is in close agreement with the result obtained by CD spectropolarimeter. This study validates I-TASSER model for determination of structure of a protein. Moreover, stability of CRCK2 was monitored against heat- and guanidinium chloride (GdmCl)-induced denaturation by using circular dichroism (CD) and fluorescence spectroscopy. Denaturation curve analysis gave values of 2.88 ±â€¯0.12 kcal mol-1and 4.11 ±â€¯0.09 M for ∆°GD (Gibbs free energy change at 25 °C) and Cm (midpoint of denaturation), respectively. It has been observed that purified CRCK2 is quite stable protein against both heat-induced as well as GdmCl-induced denaturation. This is very first report of purification and biophysical characterization of CRCK2 protein from medicinal plant O. indicum.

Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial.

BACKGROUND: Neonatal intubation is a stressful procedure taught to trainees. This procedure can attract additional observers. The impact of observers on neonatal intubation performance by trainees has not been studied. Our objective was to evaluate if additional observers present during neonatal mannequin endotracheal intubation (NMEI) by junior trainees, affects their performance and their stress levels. METHODS: A randomized cross over trial was conducted. First year residents with no experience in neonatal intubation were assigned to NMEI condition A or B randomly on day 1. Subjects were crossed over to the other condition on day 2. Condition A: Only one audience member was present Condition B: Presence of an audience of 5 health care providers. Differences in the time to successful NMEI was recorded and compared between conditions. A portable heart rate monitor was used to measure peak heart rate above baseline during NMEI under both conditions. RESULTS: Forty nine residents were recruited. 72% were female with a median age of 25 years (IQR: 24-27). Time to successful intubation was comparable under both conditions with a mean difference of - 3.94 s (95% CI: -8.2,0.4). Peak heart rate was significantly lower under condition A (mean difference - 11.9 beats/min, 95% CI -15.98 to - 7.78). CONCLUSION: Although the time required to NMEI did not increase, our results suggest that presence of observers significantly increases trainee stress. The addition of extraneous observers during simulation training may better equip residents to deal with such stressors. TRIAL REGISTRATION: Date of registration: March 2016, NCT 02726724 .

Resilience Rather than Medical Factors: How Parents Predict Quality of Life of Their Sick Newborn.

OBJECTIVE: To assess the influence of resiliency and stress on parental perspectives of the future quality of life (QOL) of neonatal intensive care unit (NICU) newborns at high risk of neurodevelopmental disability. STUDY DESIGN: We conducted a prospective multicenter questionnaire study. Perspectives from parents of newborns at high risk of disability as per neonatal follow-up criteria were compared with a low-risk group consisting of parents of all other NICU newborns. Parental anxiety and resiliency, measured using Brief Symptom Inventory and Sense of Coherence scales, respectively, were associated with QOL projections. RESULTS: Parents returned 129 (81%) questionnaires. Parents considering their newborn as currently sicker were more stressed (P = .011) and worried about future physical (P < .001) and mental (P < .001) health, QOL (P < .001), coping (P = .019), and financial (P < .001) and emotional (P = .002) impact on the family. Ooverall, there was no difference between parents of high-risk and low-risk newborns on QOL projections. Almost all parents projected a good future QOL. Less resilient parents projected more pain (P = .04), more financial (P = .019), and emotional (P = .031) impact on their family, and were 10 times more likely to predict that their newborn would remain chronically ill. CONCLUSIONS: Parental projection of future QOL of NICU newborns is not associated with risk of disability. Most parents predict overall a good future QOL and focus more on familial impact. The Sense of Coherence scale may be used in clinical settings to identify less resilient parents.

Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh.

BACKGROUND: A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project. METHODS: A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities. RESULTS: Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project's transport doubled and referral compliance from distant zones similarly increased. CONCLUSIONS: The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial.

BACKGROUND: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. OBJECTIVE: The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). METHODS: A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 280/7 and 356/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). RESULTS: All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. CONCLUSION: Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.

24/7 in house attending staff coverage improves neonatal short-term outcomes: A retrospective study.

OBJECTIVES: to compare short-term outcomes of newborns over 36 weeks with Apgar scores≤3 at 1min, following the adoption of a 24/7 in house coverage schedule STUDY DESIGN: A retrospective chart review comparing two 12-month epochs. Epoch 1: coverage provided by residents with availability on call at home of attending staff. Epoch 2: On site coverage by attending staff. RESULTS: 71 and 60 charts were reviewed from Epoch 1 and 2 respectively. The number of infants receiving chest compressions was reduced during Epoch 2 (from 19% to 1.6%, p<0.0001). The proportion of infants admitted to the NICU (81% vs 61%, p<0.01), and the median length of stay in hospital (61 vs 48h, p=0.03) were significantly reduced in Epoch 2. CONCLUSION(S): Continuous coverage by attending staff decreased the number of admissions to intensive care as well as the duration of hospitalization stay for newborns with low Apgar scores.

Assessment of patient-reported outcome measures in pleural interventions.

INTRODUCTION: There is a lack of data evaluating the clinical effect on symptoms of pleural intervention procedures. This has led to the development of patient-reported outcome measures (PROMs) to define what constitutes patient benefit. The primary aim of this paper was to prospectively assess the effect of pleural procedures on PROMs and investigate the relationship between symptom change and clinical factors. METHODS: We prospectively collected data as part of routine clinical care from 158 patients with pleural effusion requiring interventions. Specific questionnaires included two patient-reported scores (a seven-point Likert scale and a 100 mm visual analogue scale (VAS) to assess symptoms). RESULTS: Excluding diagnostic aspiration, the majority of patients (108/126, 85.7%) experienced symptomatic benefit from fluid drainage (mean VAS improvement 42.6 mm, SD 24.7, 95% CI 37.9 to 47.3). There was a correlation between symptomatic benefit and volume of fluid removed post aspiration. A negative association was identified between the number of septations seen on ultrasound and improvement in dyspnoea VAS score in patients treated with intercostal chest drain. CONCLUSION: The results of our study highlight the effect of pleural interventions from a patient's perspective. The outcomes defined have the potential to form the basis of a clinical useful tool to appraise the effect, compare the efficiency and identify the importance of pleural interventions to the patients.