Nasopharyngeal tubes in paediatric anaesthesia: is the flow-dependent pressure drop across the tube suitable for calculating oropharyngeal pressure?

Background: Nasopharyngeal tubes (NPTs) are useful in paediatric anaesthesia for insufflating oxygen and anaesthetics. During NPT-anaesthesia, gas insufflation provides some positive oropharyngeal pressure that differs from the proximal airway pressure (Paw) owing to the flow-dependent pressure drop across the NPT (ΔPNPT ). Aims: This study aimed to investigate whether ΔPNPT could be used for calculating oropharyngeal pressure during NPT-assisted anaesthesia. Methods: In a physical model of NPT-anaesthesia, using Rohrer's equation, we calculated ΔPNPT for three NPTs (3.5, 4.0, and 5.0, mm inner diameter) under oxygen and several sevoflurane in oxygen combinations in two ventilatory scenarios (continuous positive airway pressure and intermittent positive pressure ventilation). We then calculated oropharyngeal pressure as Paw minus ΔPNPT . Calculated and measured oropharyngeal pressure couples of values were compared with the root mean square deviation (RMSD) to assess accuracy. We also investigated whether oropharyngeal pressure accuracy depends on the NPT diameter, flow rate, gas composition, and leak size. Using ΔPNPT charts, we tested whether ΔPNPT calculation was feasible in clinical practice. Results: When we tested small-diameter NPTs at high flow or high peak inspiratory pressure, Paw measurements markedly overestimated oropharyngeal pressure. Comparing measured and calculated maximum and minimum oropharyngeal pressure couples yielded RMSDs less than 0.5 cmH2 O regardless of ventilatory modality, NPT diameter, flow rate, gas composition, and leak size. Conclusion: During NPT-assisted anaesthesia, Paw readings on the anaesthetic monitoring machine overestimate oropharyngeal pressure especially for smaller-diameter NPTs and higher flow, and to a lesser extent for large leaks. Given the importance of calculating oropharyngeal pressure in guiding NPT-ventilation in clinical practice, we propose an accurate calculation using Rohrer's equation method, or approximating oropharyngeal pressure from flow and pressure readings on the anaesthetic machine using the ΔPNPT charts

Handgrip strength and health related quality of life in individuals with copd

In individuals with chronic obstructive pulmonary disease (COPD), skeletal muscle wasting and changes in muscle fiber composition limit the muscle strength with consequences on daily physical activities. In the present study we aimed to investigate about the interconnection among upper limb strength, body composition and health related quality of life (HRQoL) in patients with COPD to verify the impact of muscle mass loss on HRQoL. Twenty-six consecutive patients (69.2% male; age: 69.7±7.29 years) with COPD were included. Patients underwent pulmonary function tests. Body composition was evaluated through Bioelectrical Impedance Analysis (BIA); handgrip test was used for measure upper limb strength. St George’s Respiratory Questionnaire (SGRQ) was used to evaluate patients’ HRQoL. Upper limb muscle strength was negatively correlated with SGRQ (Pearson=-0.571; p=0.002) in particular with activity and impact domains (Pearson=-0.668; p<0.001 and Pearson =-0.461; p=0.02). Multivariate linear regression confirm that poor handgrip strength is a predictor of worse SGRQ after adjusting for gender, age, fat free mass index and inhaled corticosteroids use (p=0.012). Upper limb muscle strength and body composition are two essential tools in the multisystemic assessment of patients with COPD. © 2020, Segretariato Italiano Giovani Medici - Associazione Italiana Medici. All rights reserved

Analisi di settore: sostanze farmaceutiche di base

Indice: Quadro generale - Ciclo di vita e diffusione - Struttura della domanda - Struttura dell'offerta - Andamento dell'attivita' - Fattori critici di successo - Prospettive ambientali e tendenz

Desenvolvimento de podcasts educativos para a educação de jovens e adultos

A pandemia de COVID-19 evidenciou a necessidade de ampliação de práticas letradas digitais no país, sobretudo para a população idosa que ficou isolada por longo período. O presente relato tem como objetivo descrever as atividades desenvolvidas para mitigar os efeitos da ausência de contato presencial em aulas oferecidas à população idosa atendida pelo Programa de Educação de Jovens e Adultos (PEJA) promovido pela Universidade Estadual Paulista de São José do Rio Preto. As atividades foram desenvolvidas por meio de videoaulas e podcasts criados para veicular conteúdos sobre Matemática básica e Língua Portuguesa voltados à alfabetização digital. Foram criados nove episódios de videoaulas e dez episódios de podcasts e enviadas instruções aos alunos sobre como acessar essas mídias na internet. O desenvolvimento desse material foi articulado ao Objetivo de Desenvolvimento Sustentável 4 – Educação de Qualidade – da Organização das Nações Unidas. O desenvolvimento do material didático beneficiou diretamente a licencianda bolsista do projeto, pois ela adquiriu habilidades para sua futura prática docente, e, principalmente, a população atendida pelo PEJA-Rio Preto, além da comunidade local, que ampliou suas práticas letradas digitais e tiveram acesso gratuito a conteúdos da educação básica durante o período de isolamento social

Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort

Background. Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk event