Use of rescue high frequency oscillation ventilation in neonates with acute respiratory failure after failing conventional ventilation

Background: High frequency oscillatory ventilation (HFOV) is a newer mode of ventilation in neonates. The objective of this study was to study the efficacy of rescue HFOV in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing synchronised intermittent mandatory ventilation (SIMV).Methods: A prospective observational study was conducted over a period of 12 months. Neonates with respiratory distress requiring ventilation on SIMV mode based upon the unit protocol were included in the study. Babies who have failed on SIMV were then switched over to HFOV. The primary outcome measures were oxygenation index (OI), ventilation: alveolar-arterial oxygen gradient (AaDO2) and duration of ventilation with a secondary outcome measure of mortality and complications associated with ventilation.Results: A total of 65 babies were ventilated out of which 11 babies required high frequency oscillatory ventilation as per the study protocol. Of 11 neonates who were oscillated eight (72.7%) improved and survived. Among the babies who survived OI<13 was seen in a total of six babies in the first three hours of oscillation and OI<10 was seen in two babies. There was no statistically significance difference in the incidence of intra-ventricular haemorrhage (IVH) and pneumothorax between HFOV and SIMV group.Conclusions: High frequency oscillatory ventilation was found to improve short term oxygenation and ventilation in neonates who failed SIMV. HFOV is not associated with increased risk of pneumothorax or IVH

YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY

ABSTRACTObjectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application ofYale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Caseswere selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sampledrawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, andmortality.Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospitalstay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significantinterobserver variability in YOS assessment (Cronbach's alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia atYOS &gt;20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS &gt;21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling upantibiotics at YOS &gt;21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS &gt;21 (90.9%, 85.4%, 6.2, 0.106, 0.878).Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value inmonitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.Keywords: Yale observation scale, Bacteremia, Febrile patients

Morphological and biochemical evidence for partial nuclear localization of annexin 1 in endothelial cells

International audienc

Clinical and genetic spectrum of 104 Indian families with central nervous system white matter abnormalities

Genetic disorders with predominant central nervous system white matter abnormalities (CNS WMAs), also called leukodystrophies, are heterogeneous entities. We ascertained 117 individuals with CNS WMAs from 104 unrelated families. Targeted genetic testing was carried out in 16 families and 13 of them received a diagnosis. Chromosomal microarray (CMA) was performed for three families and one received a diagnosis. Mendeliome sequencing was used for testing 11 families and all received a diagnosis. Whole exome sequencing (WES) was performed in 80 families and was diagnostic in 52 (65%). Singleton WES was diagnostic for 50/75 (66.67%) families. Overall, genetic diagnoses were obtained in 77 families (74.03%). Twenty‐two of 47 distinct disorders observed in this cohort have not been reported in Indian individuals previously. Notably, disorders of nuclear mitochondrial pathology were most frequent (9 disorders in 20 families). Thirty‐seven of 75 (49.33%) disease‐causing variants are novel. To sum up, the present cohort describes the phenotypic and genotypic spectrum of genetic disorders with CNS WMAs in our population. It demonstrates WES, especially singleton WES, as an efficient tool in the diagnosis of these heterogeneous entities. It also highlights possible founder events and recurrent disease‐causing variants in our population and their implications on the testing strategy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170794/1/cge14037.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170794/2/cge14037_am.pd