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[en] Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients. Study Design: Prospective observational study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019. Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia. Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option. Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing and poor infection control in the emergency setting. Policies must be instituted to improve infection control and minimize emergency room stay of patients. (author)
[en] In this study, we found that machine learning was able to effectively estimate student learning outcomes geo-spatially across all the campuses in a large, urban, independent school district. The machine learning showed that key factors in estimating the student learning outcomes included the number of days students were absent from school. In turn, one of the most important factors in estimating the number of days a student was absent was whether or not the student had asthma. This highlights the importance of environmental public health for student learning outcomes.
[en] Highlights: • Asthma is a complex condition affecting 7.4% of U.S. adults. • Asthma may be driven by multiple exposures operating in tandem. • The Environmental Quality Index measures 5 environmental domains simultaneously. • Worsening overall environmental quality is associated with increasing asthma. • Patterns vary by domain (air, water, land, built, sociodemograhic) and rurality. As of 2014, approximately 7.4% of U.S. adults had current asthma. The etiology of asthma is complex, involving genetics, behavior, and environmental factors. To explore the association between cumulative environmental quality and asthma prevalence in U.S. adults, we linked the U.S. Environmental Protection Agency's Environmental Quality Index (EQI) to the MarketScan® Commercial Claims and Encounters Database. The EQI is a summary measure of five environmental domains (air, water, land, built, sociodemographic). We defined asthma as having at least 2 claims during the study period, 2003–2013. We used a Bayesian approach with non-informative priors, implementing mixed-effects regression modeling with a Poisson link function. Fixed effects variables were EQI, sex, race, and age. Random effects were counties. We modeled quintiles of the EQI comparing higher quintiles (worse quality) to lowest quintile (best quality) to estimate prevalence ratios (PR) and credible intervals (CIs). We estimated associations using the cumulative EQI and domain-specific EQIs; we assessed U.S. overall (non-stratified) as well as stratified by rural-urban continuum codes (RUCC) to assess rural/urban heterogeneity. Among the 71,577,118 U.S. adults with medical claims who could be geocoded to county of residence, 1,147,564 (1.6%) met the asthma definition. Worse environmental quality was associated with increased asthma prevalence using the non-RUCC-stratified cumulative EQI, comparing the worst to best EQI quintile (PR:1.27; 95% CI: 1.21, 1.34). Patterns varied among different EQI domains, as well as by rural/urban status. Poor environmental quality may increase asthma prevalence, but domain-specific drivers may operate differently depending on rural/urban status.
[en] Bronchiolitis with obliterans organizing pneumonia (BOOP)is now established as a distinct clinicopathologic entity, yet it may be overlooked by clinicians due to unfamiliarity and and its nonspecific presentation.It can be either idiopathic or associated with variety of causes, such as infections, drugs, radiation or connective tissue diseases. A lung biopsy is needed to provide histopathologic confirmation. Usually prognosis is good, and the response to steroids may be dramatic but occasionally BOOP may be fatal or runs a chronic relapsing course. This article is an updated review on current knowledge regarding BOOP. (author)
[en] Humid drilling and water spraying are the two main means to fight against dusts in underground works. The presence of radon involves ventilation, what complicates the problem. A total protection against dusts is still difficult for certain work posts
[en] Ammi visnaga (bisnaga, toothpick weed or khella) belongs to the family Apiaceae and it is a herbaceous medicinal plant. It is found mainly in the Mediterranean regions and also distributed abundantly throughout the world as introduced species. Many times, A. visnaga is weed as well as used in many countries as herbal medicine for different purposes. Ancient records reveal various medicinal properties of A. visnaga as a popular source to cure variety of different ailments. The plant is used directly as a herb or as a component for production of a number of herbal medicines used in the cure of renal colic, ureteric stones, angina pectoris, the coronary vessels, cardiovascular disorders and asthma. Also it is used as a folk medicine for vitiligo and psoriasis. This review highlights the commonly recognized medicinal uses of A. visnaga, its chemistry and ethnobotanical uses and will also serve as ready reference for future research. (author)
[en] An educative intervention destined to increase the knowledge in asthma allows the children and/or its parents to acquire abilities that allow to prevent and/or to handle the asthmatic attacks, decreasing the morbidity produced by the disease, nevertheless we do not account with a validated instrument that allows us to quantify the level of asthma knowledge. The objective is to develop and to validate a questionnaire of knowledge about asthma to be filled out by the parents and/or people in charge of the care of the asthmatic pediatric patients. The 17 items that conform the questionnaire were obtained alter literature review, realization of focal groups the professional experience of the investigators and the realization of pilot studies. The face content and concurrent validity of the instrument was evaluated; we also determined the factor structure, test-retest reproducibility, and sensitivity to change of the questionnaire. We included 120 patients with average age of 4.5 %3.7 years the factor analysis demonstrated a probable structure of three factors that altogether explain 85% of the total variance of the results the face and content validity was based on the concept of a multi-disciplinary group of experts in the field the concurrent validity was demonstrated by the ability of the questionnaire to distinguish low from high knowledge parents. Test-retest reproducibility and sensitivity to change were demonstrated comparing scores of the questionnaire filled out in two different occasions. The questionnaire of knowledge of asthma developed in the study is a useful and reliable tool to quantify the basal level of asthma knowledge in parents of asthmatic children and to determine the effectiveness of an educative intervention destined to increase the knowledge and understanding of the disease
[en] Radiography was performed in 94 patients whose initial condition was assessed as acute respiratory disease. Radioscopy with x-ray image amplifier, roentgenography and zonography were used. Pulmonary changes were found in 61 persons. In 45 of them acute pneumonia was revealed, in 16 changes in the pulmonary pattern assessed as residual manifestations of pneumonia. Changes in 30 patients with pneumonia and 16 patients with residual manifestations were detected by zonography only