Measurement of Knowledge and Performance of Pediatric ICU Nurses about Endotracheal Suctioning

Introduction: Safe and aseptic endotracheal suctioning has been a major health challenge in ICU setting, Endotracheal suction is a procedure to insert a suction catheter into the endotracheal tube to remove the secretion. Where endotracheal tube suctioning is essential for a patient with mechanical ventilation to keep their airway clean and infection free, it has also been associated with some adverse effect like hypoxia and ventilator associated pneumonia.in this regard ICU nurses knowledge and competences should be according to set criteria of ETT suctioning procedure. Methods: Target population of this study was ICU nurses of one of the children hospital, Lahore. Sample size was 98.Results: The findings of this research was beyond our expectation as nurses practices was good and their knowledge was fair. Conclusions: This study gives an overview of the ICU nurses knowledge and performance related to ETT suctioning and demonstrates that intensive care nurses' performance regarding endotracheal suctioning is good enough despite fair knowledge. With concerning to these finding there is a need for educational courses, especially theoretical education and motivational session to follow the standard protocol for ETT suction. Keywords: Pediatric, ICU, Knowledge, Performance DOI: 10.7176/JHMN/73-09 Publication date: April 30th 202

Synthesis, single crystal X-ray diffraction, Hirshfeld surface and biological activity of quinolone derivatives

Two new quinolone derivatives, 5-nitroquinolin-8-yl-3-bromobenzoate (1) and 5-nitroquinolin-8-yl-3-chlorobenzoate (2), were synthesized and their structures were elucidated using X-ray diffraction techniques. Both compounds crystallized in P21/n (monoclinic) space group having four independent molecules in asymmetric unit. The dihedral angle between benzene and planner quinoline rings in compounds 1 and 2 were found to be 117.7(2) and 117.4(2)ᵒ, respectively. No intermolecular hydrogen bonding was observed in compound 1. However, C-H···O intermolecular interaction was found to connect the molecules in crystal lattice of compound 2. Hirshfeld surfaces analysis was performed to evaluate the directions, and strength of interactions of molecules of compounds and 1 and 2 with neighbouring molecules, and the major contribution in the crystal packing was due to O-H (1, 24.6% and 2, 25.1%) interactions. The synthesized quinoline derivatives were found as potent anti-bacterial agents against E. coli reference (ATCC25922 and ATCC 35218) and multi-drug resistant strains (M2 and M3) with 91.42 to 94.72% inhibition. Both compounds 1 and 2 showed weak antileishmanial activity against L. Major promastigotes in vitro with IC50 values 73.2±3.1 and 72.2±2.3 mg/mL, respectively, and also found as cytotoxic in nature against 3T3 fibroblast cell line

COMPARISON OF MAMMOGRAPHY AND ULTRASOUND COMBINED VERSUS ULTRASOUND ALONE IN EARLY EVALUATION OF SYMPTOMATIC BREAST CANCERS IN PAKISTAN

Purpose: The purpose of this study was to detect diagnostic accuracy of mammography and ultrasound combined versus ultrasound alone in early evaluation of symptomatic breast lesions.Materials and Methods: All new patients who presented to the breast clinic with symptomatic breast lesions, during the year 2012, were included in the study. A total of 695 patients were registered. Their clinical findings, mammogram, ultrasound and histopathology were reviewed.Results: Mammogram and ultrasound combined detected 693 (99.71%) lesions in total. Mammogram failed to detect lesions in 1.43% of patients, whereas the failure rate of ultrasound was 0.43%. The incidence of microcalcifications on mammogram was 19.13%.Conclusion: Ultrasound is a useful tool in the initial evaluation of symptomatic breasts. For places such as Pakistan where mammogram is not available at every centre, ultrasound can be used as an effective alternative for the assessment of symptomatic breast lesions.Key words: Breast cancer, mammography, ultrasoun

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Crystal structure of p-toluenesulfonylmethyl isocyanide

The molecule of the commercially available title compound, C9H9NO2S, has crystallographically imposed mirror symmetry, the mirror plane passing through the isocyanide group and the para-C atoms, the methyl C atom and the S atom of the methyl 4-tolyl sulfone moiety. In the crystal, C—H...O hydrogen-bond interactions link the molecules into chains running parallel to the b axis

Cystal structre of 5-hydroxy-2-nitrobenzaldehyde

In the title compound, C7H5NO4, the nitro group and the aldehyde group are inclined to the benzene ring by 16.6 (3) and 15.6 (3)°, respectively. In the crystal, molecules are linked via O—H...O hydrogen bonds, forming chains along [100]. The chains are linked by C—H...O hydrogen bonds, forming a three-dimensional structure

Crystal structure of 6-amino-4-(3-bromo-4-methoxyphenyl)-3-methyl-2,4-dihydropyrano[2,3-c]pyrazole-5-carbonitrile dimethyl sulfoxide monosolvate

In the pyrazole molecule of the title solvate, C15H13BrN4O2·C2H6OS, the dihedral angle between the benzene ring and the mean plane of the dihydropyrano[2,3-c]pyrazole ring system [r.m.s deviation = 0.031 (2) Å] is 86.71 (14)°. In the crystal, the pyrazole molecules are linked by N—H...N hydrogen bonds, forming a layer parallel to (10-1). The pyrazole and dimethyl sulfoxide molecules are connected by an N—H...O hydrogen bond

Crystal structure of 2-[2-(benzyloxy)benzylidene]malononitrile

In the title benzylidenemalononitrile derivative, C17H12N2O, the dihedral angles between the central benzene ring and the Y-shaped C=C(CN)2 group (r.m.s. deviation = 0.006 Å) and the terminal benzene ring are 12.72 (8) and 37.60 (11)°, respectively. The Car—O—Csp3—Car torsion angle is −174.52 (13)° and the major twist between the aromatic rings occurs about the Csp3—Car bond. Weak aromatic π–π stacking [centroid–centroid separation = 3.7784 (13) Å; slippage = 1.21 Å] between inversion-related pairs of the central benzene rings is observed in the crystal