Pectus updates and special considerations in Marfan syndrome.

Congenital chest wall or pectus deformities including pectus excavatum (funnel chest) and pectus carinatum (pigeon chest) affect a significant proportion of the general population and up to 70% of patients with Marfan syndrome. Patients often experience significant morbidity and psychological distress, which can worsen with age. Here we discuss new techniques for both operative and non-operative treatment of pectus deformity, the importance of a welltimed intervention and special considerations in patients with Marfan syndrome

A Novel, Contactless, Portable “Spot-Check” Device Accurately Measures Respiratory Rate

Respiratory rate (RR) is an important vital sign used in the assessment of acutely ill patients. It is also used as to predict serious deterioration in a patient's clinical condition. Convenient electronic devices exist for measurement of pulse, blood pressure, oxygen saturation and temperature. Although devices which measure RR exist, none has entered everyday clinical practice. We developed a contactless portable respiratory rate monitor (CPRM) and evaluated the agreement in respiratory rate measurements between existing methods and our new device. The CPRM uses thermal anemometry to measure breath signals during inspiration and expiration. RR data were collected from 52 healthy adult volunteers using respiratory inductance plethysmography (RIP) bands (established contact method), visual counting of chest movements (established non-contact method) and the CPRM (new method), simultaneously. Two differently shaped funnel attachments were evaluated for each volunteer. Data showed good agreement between measurements from the CPRM and the gold standard RIP, with intra-class correlation coefficient (ICC): 0.836, mean difference 0.46 and 95% limits of agreement of -5.90 to 6.83. When separate air inlet funnels of the CPRM were analysed, stronger agreement was seen with an elliptical air inlet; ICC 0.908, mean difference 0.37 with 95% limits of agreement -4.35 to 5.08. A contactless device for accurately and quickly measuring respiratory rate will be an important triage tool in the clinical assessment of patients. More testing is needed to explore the reasons for outlying measurements and to evaluate in the clinical setting

Anthropometric indices of Gambian children after one or three annual rounds of mass drug administration with azithromycin for trachoma control.

BACKGROUND: Mass drug administration (MDA) with azithromycin, carried out for the control of blinding trachoma, has been linked to reduced mortality in children. While the mechanism behind this reduction is unclear, it may be due, in part, to improved nutritional status via a potential reduction in the community burden of infectious disease. To determine whether MDA with azithromycin improves anthropometric indices at the community level, we measured the heights and weights of children aged 1 to 4 years in communities where one (single MDA arm) or three annual rounds (annual MDA arm) of azithromycin had been distributed. METHODS: Data collection took place three years after treatment in the single MDA arm and one year after the final round of treatment in the annual MDA arm. Mean height-for-age, weight-for-age and weight-for-height z scores were compared between treatment arms. RESULTS: No significant differences in mean height-for-age, weight-for-age or weight-for-height z scores were found between the annual MDA and single MDA arms, nor was there a significant reduction in prevalence of stunting, wasting or underweight between arms. CONCLUSIONS: Our data do not provide evidence that community MDA with azithromycin improved anthropometric outcomes of children in The Gambia. This may suggest reductions in mortality associated with azithromycin MDA are due to a mechanism other than improved nutritional status

Transport suction apparatus and absorption materials evaluation

The specific objectives were as follows. The effectiveness and function was evaluated of the hand held, manually powered v-vac for suction during microgravity. The function was evaluated of the battery powered laerdal suction unit in microgravity. The two units in control of various types of simulated bodily fluids were compared. Various types of tubing and attachments were evaluated which are required to control the collection of bodily fluids during transport. Various materials were evaluated for absorption of simulated bodily fluids. And potential problems were identified for waste management and containment of secretions and fluids during transport. Test procedures, results, and conclusions are briefly discussed

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: A systematic review and meta-analysis of cohort studies

BackgroundIn 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.MethodsCohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).ResultsEleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I-2=99.7; P=0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR=0.56, 95% CI=0.37 to 0.84), abdominal injuries (RR=0.87; 95% CI=0.78 to 0.98) and, spinal injuries (RR=0.56, 95% CI=0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR=0.49; 95% CI=0.22 to 1.08), neck injuries (RR=0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR=1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR=0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.ConclusionIn sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type

Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration.

BackgroundCurrent neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid.MethodsWe evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping.ResultsTracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm(2) lung area) compared to no suction (499 ± 109 particles/mm(2); n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao2/FiO2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/µg protein) compared with the no-suction group (0.47 ± 0.06).ConclusionTracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia

Optimum nutrition of the pregnant ewe : a meta-analytic approach : a thesis presented in partial fulfillment of the requirements for the degree of Doctorate of Philosophy in Animal Science at Massey University, Manawatū, New Zealand

Formal systematic review guidelines and meta-analytic methods were used in the present study to achieve three main objectives. Firstly, literature on the effect of ewe nutrition during pregnancy on fetal and postnatal lamb growth was reviewed and effect sizes estimated for fetuses/lambs at three stages of their life: 1) late gestation fetal weight (LGFW), 2) lamb birth weight (BW) and 3) weaning weight (WW). Secondly, the contribution of experimental factors responsible for variation in study results was determined. Thirdly, a field trial was conducted to increase understanding in an area identified by the meta-analyses as requiring further experimentation. Overall, early- and mid-pregnancy undernutrition had no significant effect on LGFW (β[Early-pregnancy] = -0.0007, 95% Highest posterior density (HPD) = -0.26 to 0.28; β[Mid-pregnancy] = -0.07, 95% HPD = -0.27 to 0.16), BW (β[Early-pregnancy] = 0.01, 95% HPD = -0.36 to 0.34; β[Mid-pregnancy] = -0.02, 95% HPD = -0.36 to 0.33) and WW (β[first 100 days of pregnancy] = -0.008, 95% HPD = -0.42 to 0.18), suggesting that short to moderate periods of undernutrition in these stages are tolerated by ewes with limited impact on their offspring, when nutrition is re-established to pregnancy maintenance (PM) or above levels during late-pregnancy. Late-pregnancy undernutrition can significantly decrease LGFW and BW by up to 1.15 kg at birth, with residual effects at weaning resulting in weaned lambs that are up to 18% lighter than their control counterparts and thus, should be avoided. The present study also considered the effect of maternal above PM feeding on LGFW, BW and WW. The combined effects across these studies were variable, as few experiments investigated above PM feeding at each stage of pregnancy, and thus it was not possible to draw definitive conclusions. A field experiment was undertaken to determine the effects of ad-libitum (AL) feeding at various stages of pregnancy and for differing lengths of time on twin lamb BW and WW. Results showed that providing ewes with AL feeding significantly (p0.05) the BW or WW of their lambs relative to their control counterparts. This study also suggested that AL feeding during late-pregnancy may have negative consequences to the survival of twin lambs and requires further examination. Thus, AL feeding is not justified as a management tool to increase twin lamb BW and WW, when nutrition is adequate during lactation. The present study represents the first meta-analytic approach examining the effect of changes in the ewe nutrition during pregnancy on the growth of offspring at various developmental stages. Given the complex interrelationship between nutrition of the pregnant ewe, her reproductive success, fetal growth and development, and offspring post-natal performance, no single study can provide a definitive understanding of responses to a particular treatment and there is value in combining available experimental evidence to elucidate a more global picture. A meta-analytic approach can find trends in combined data that would otherwise be overlooked using traditional review methods and can also identify gaps in current knowledge