Radiologic study of the nasal septal swell body and its relationship to septal deviation

Objective@#To compare the radiographic features of the nasal septal swell body (NSB) with the laterality of nasal septal deviation and investigate whether there is a correlation between the severity of the septal deviation and difference in NSB size.@*Methods@#Design: Retrospective Observational Study. Setting: Tertiary Private University Hospital. Participants: 30 paranasal sinus computerized tomography scans from January to October 2017.@*Results@#A septal deviation was present in 60% of the subjects. In 78% of cases with septal deviation, the NSB was noted to be significantly larger on the side opposite the nasal septal deviation (p < .05). @*Conclusion@#The correlation between the severity of the septal deviation and difference in NSB size had a value of (r = 0.37) therefore, no positive correlation was established. Subjects with almost symmetric NSB measurements tend to have no septal deviation. On the other hand, the NSB is more prominent contralateral to a septal deviation.

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial.

BACKGROUND/OBJECTIVE: Guatemala's indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates. METHODS: A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume. RESULTS: Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22-58) compared to the later-access arm (median 20 per 100, IQR 0-30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5-50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10-9.86). CONCLUSIONS: Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts. TRIAL REGISTRATION: Clinicaltrials.gov NCT02348840 .

Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting.

Technology provides the potential to empower frontline healthcare workers with low levels of training and literacy, particularly in low- and middle-income countries. An obvious platform for achieving this aim is the smartphone, a low cost, almost ubiquitous device with good supply chain infrastructure and a general cultural acceptance for its use. In particular, the smartphone offers the opportunity to provide augmented or procedural information through active audiovisual aids to illiterate or untrained users, as described in this article. In this article, the process of refinement and iterative design of a smartphone application prototype to support perinatal surveillance in rural Guatemala for indigenous Maya lay midwives with low levels of literacy and technology exposure is described. Following on from a pilot to investigate the feasibility of this system, a two-year project to develop a robust in-field system was initiated, culminating in a randomized controlled trial of the system, which is ongoing. The development required an agile approach, with the development team working both remotely and in country to identify and solve key technical and cultural issues in close collaboration with the midwife end-users. This article describes this process and intermediate results. The application prototype was refined in two phases, with expanding numbers of end-users. Some of the key weaknesses identified in the system during the development cycles were user error when inserting and assembling cables and interacting with the 1-D ultrasound-recording interface, as well as unexpectedly poor bandwidth for data uploads in the central healthcare facility. Safety nets for these issues were developed and the resultant system was well accepted and highly utilized by the end-users. To evaluate the effectiveness of the system after full field deployment, data quality, and corruption over time, as well as general usage of the system and the volume of application support for end-users required by the in-country team was analyzed. Through iterative review of data quality and consistent use of user feedback, the volume and percentage of high quality recordings was increased monthly. Final analysis of the impact of the system on obstetrical referral volume and maternal and neonatal clinical outcomes is pending conclusion of the ongoing clinical trial.

Synthesis, Characterization, and Antimicrobial Efficacy of Photomicrobicidal Cellulose Paper.

Toward our goal of scalable, antimicrobial materials based on photodynamic inactivation, paper sheets comprised of photosensitizer-conjugated cellulose fibers were prepared using porphyrin and BODIPY photosensitizers, and characterized by spectroscopic (infrared, UV-vis diffuse reflectance, inductively coupled plasma optical emission) and physical (gel permeation chromatography, elemental, and thermal gravimetric analyses) methods. Antibacterial efficacy was evaluated against Staphylococcus aureus (ATCC-2913), vancomycin-resistant Enterococcus faecium (ATCC-2320), Acinetobacter baumannii (ATCC-19606), Pseudomonas aeruginosa (ATCC-9027), and Klebsiella pneumoniae (ATCC-2146). Our best results were achieved with a cationic porphyrin-paper conjugate, Por((+))-paper, with inactivation upon illumination (30 min, 65 ± 5 mW/cm(2), 400-700 nm) of all bacterial strains studied by 99.99+% (4 log units), regardless of taxonomic classification. Por((+))-paper also inactivated dengue-1 virus (>99.995%), influenza A (∼ 99.5%), and human adenovirus-5 (∼ 99%). These results demonstrate the potential of cellulose materials to serve as scalable scaffolds for anti-infective or self-sterilizing materials against both bacteria and viruses when employing a photodynamic inactivation mode of action.

Light-driven hydrogen evolution by BODIPY-sensitized cobaloxime catalysts.

We report four photocatalytically active cobaloxime complexes for light-driven hydrogen evolution. The cobaloxime catalysts are sensitized by different meso-pyridyl boron dipyrromethene (BODIPY) chromophores, bearing either two bromo- or iodo-substituents on the BODIPY core. The pyridine linker between the BODIPY and cobaloxime is further modified by a methyl substituent on the pyridine, influencing the stability and electronic properties of the cobaloxime catalyst and thus the photocatalytic efficiency of each system. Four cobaloxime catalyst complexes and three novel BODIPY chromophores are synthesized and characterized by absorption, fluorescence, infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry, and electrochemistry. Crystal structures for the BODIPY-cobaloxime complexes 2 and 3 are presented. In contrast to the photocatalytically inactive, nonhalogenated reference complex 1, the four newly reported molecules are active for photocatalytic hydrogen evolution, with a maximum turnover number (TON) of 30.9 mol equiv of H2 per catalyst for the meso-methylpyridyl 2,6-diiodo BODIPY-sensitized cobaloxime complex 5. We conclude that accessing the photoexcited triplet state of the BODIPY chromophore by introducing heavy atoms (i.e., bromine or iodine) is necessary for efficient electron transfer in this system, enabling catalytic hydrogen generation. In addition, relatively electron-donating pyridyl linkers improve the stability of the complex, increasing the overall TON for hydrogen production.