Birds with this disease display bornaviral antigen in neural and extraneural tissues.

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28

Real-time ultrasound guidance for any intervention relies on visualization of needle advancement towards a target. Unfortunately, correct identification of the needle tip is not straightforward, as artifacts always distort the image. The ultrasonic appearance of the needle is often degraded by reverberation, comet tail, side-lobe, beam-width, or bayonet artifacts, which can easily confuse an unprepared operator. Furthermore, the typical needle image, that is, a dot or a straight line (out-of-plane and in-plane approaches, respectively), is also a result of artifacts that hide the real dimensions of the needle. Knowledge and correct interpretation of these artifacts is important for safe practice and is paramount to success when precise needle manipulation is mandatory, for example, when the target is small. In this review, authors discuss the most important needle-related artifacts and provide a physical explanation focusing on implications for everyday practice. Recent advances that allow increased needle visualization and reduction of artifacts are also discussed.

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO 2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions:The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

Elimination of lymphatic filariasis, which infects 120 million people worldwide, is now thought to be feasible. 1 In order for control programmes to be designed around a strategy of community diagnosis and repeated annual mass chemotherapy, efficient surveillance procedures will be needed.2 Testing for circulating filarial antigen has now emerged as the method of choice for the detection of Wuchereria bancrofti infections.3 ELISA-based antigen testing can be done on blood collected at any time of day or night, but is not easy to do in the field. In retrospective testing of frozen serum, a self-contained 5 min immunochromatographic card test for filarial antigen (ICT Diagnostics, Balgowlah, Australia) has been shown to be comparable to ELISA. 3 We report on a trial of the card test under field conditions.We studied 847 residents of a W bancrofti-endemic community of Recife, Brazil. In the card test, 50 µL of untreated daytime serum are added to a small pad on the 7·5ϫ6·5 cm card which has dried colloidal-gold-labelled polyclonal antifilarial antibodies. Addition of two drops of buffer to the card allows antibody and antigen (if present) to flow across a nitrocellulose strip precoated with a monoclonal antifilarial antibody. Positive serum samples cause a pink line that is read by eye in the field and each card is labelled as a permanent record. Specificity of the card test has been shown to be greater than 99%.3 Prevalence of infection in men and women was higher than had previously been reported from any community in the greater Recife area (table). 4 Further blood was obtained from a sample of those studied with both positive and negative card tests for direct comparison with other methods. Had we conducted the survey with the surveillance technique most widely used in control programmesexamination of stained thick films of night blood specimenswe would have underestimated infection prevalence by more than four-fold in this population. Use of the more cumbersome technique of membrane filtration of night blood specimens decreased sensitivity by 50%. The card test was slightly less sensitive than ELISA. Serum that had been tested then frozen and thawed gave the same results when re-tested by card assay.The rapid card test for filarial antigen requires no additional equipment, so can be carried out under true field conditions. The test should facilitate implementation of new strategies proposed by WHO for the control and elimination of lymphatic filariasis.

Background: It has been shown that home mechanical ventilation improves quality of life, but it has not been widely studied which particular patient groups benefit the most from starting this type of therapy. The purpose of this prospective observational study was to evaluate quality of life change patterns 6 months after initiation of home mechanical ventilation in patients suffering from chronic respiratory failure using patient reported outcomes. Methods: We enrolled 74 chronic respiratory failure patients starting invasive or noninvasive home mechanical ventilation through the Semmelweis University Home Mechanical Ventilation Program. Quality of life was evaluated at baseline and at 6 months after initiation of home mechanical ventilation using the Severe Respiratory Insufficiency Questionnaire. Results: Overall quality of life showed 10.5% improvement 6 months after initiation of home mechanical ventilation (p < 0.001). The greatest improvement was observed in Respiratory complaint (20.4%, p = 0.015), Sleep and attendant symptoms (19.3%, p < 0.001), and Anxiety related subscales (14.4%, p < 0.001). Interface (invasive versus noninvasive ventilation) was not associated with improvement in quality of life (p = 0.660). Severely impaired patients showed the greatest improvement (CC =-0.328, p < 0.001). Initial diagnosis contributed to the observed change (p = 0.025), with chronic obstructive pulmonary disease and obesity hypoventilation syndrome patients showing the greatest improvement, while amyotrophic lateral sclerosis patients showed no improvement in quality of life. We found that patients who were started on long term ventilation in an acute setting, required oxygen supplementation and had low baseline quality of life, showed the most improvement during the six-month study period. Conclusions: Our study highlights the profound effect of home mechanical ventilation on quality of life in chronic respiratory failure patients that is indifferent of ventilation interface but is dependent on initial diagnosis and some baseline characteristics, like acute initiation, oxygen supplementation need and baseline quality of life. Trial registration: This study was approved by and registered at the ethics committee of Semmelweis University (SE TUKEB 251/2017; 20th of December, 2017).

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