Background:Early initiation of appropriate noninvasive respiratory support is utmost important intervention to avoid mechanical ventilation in severe bronchiolitis.Aim:This study aims to compare noninvasive continuous positive airway pressure (nCPAP) and hot humidified high-flow nasal cannulae (HHHFNC) as modes of respiratory support in infants with severe bronchiolitis.Methods:Prospective, randomized, open-label pilot study done in a tertiary-care hospital Pediatric Intensive Care Unit (PICU). Participants: 31 infants (excluding neonates) clinically diagnosed with acute bronchiolitis having peripheral capillary oxygen saturation (SpO2) <92% (with room air oxygen); Respiratory Distress Assessment Index (RDAI) ≥11. Intervention: nCPAP (n = 16) or HHHFNC (n = 15), initiated at enrollment. Primary outcome: Reduction of need of mechanical ventilation assessed by improvements in (i) SpO2% (ii) heart rate (HR); respiratory rate; (iii) partial pressure of carbon dioxide; (iv) partial pressure of oxygen; (v) COMFORT Score; (vi) RDAI from preintervention value. Secondary outcome: (i) total duration of noninvasive ventilation support; (ii) PICU length of stay; and (iii) incidence of nasal injury (NI).Results:Mean age was 3.41 ± 1.11 months (95% confidence interval 2.58–4.23). Compared to nCPAP, HHHFNC was better tolerated as indicated by better normalization of HR (P < 0.001); better COMFORT Score (P < 0.003) and lower incidence of NI (46.66% vs. 75%; P = 0.21). Improvements in other outcome measures were comparable for both groups. For both methods, no major patient complications occurred.Conclusion:HHHFNC is an emerging alternative to nCPAP in the management of infants with acute bronchiolitis.
Background: Covid-19 pandemic is a rapidly spreading outbreak which has caused sudden respiratory distress and death all over the world. This pandemic situation is a major concern for all the health related professionals globally. Treating patients, reducing spread of infection and side by side protecting themselves during rendering care to patients is the main concern for health care workers. Objectives: The study is aimed at assessing training status, correctness of use, problems faced during use of Personal Protective Equipment (PPE) and occurrence of Covid-19 positivity among health care workers at Pediatric Covid-19 ward at Medical College, Kolkata. Patients and methods: 194 doctors, nurses, technician, house -keeping staffs from Pediatrics department of Medical College Kolkata, engaged in Covid-19 related care from June 2020 to October, 2020, were included in this prospective observational study. A self administered questionnaire was used to collect data. Statistical analysis was done in MS-Excel. Descriptive statistics were calculated in terms of number & proportions.Results: 84(43.3%) doctors, 70 (36.1 %) nurse, 20 (10.3%), scavengers, 20(10.3%) technician participated in the present study. Headache and difficulty in vision due to fogging, 'fear of infection', 'early irritability' are main health problems as stated by the participants after wearing PPE. Availability of PPE in different sizes, quality improvement was some of the key suggestions. 10.5% of participants contracted COVID-19 in three months follow up period. Conclusion: Adequacy of supply and familiarity with PPE was not a concern for the study subjects but there was poor comfort and difficulty in doffing.
Congenital malaria can be acquired by transmission of parasite from mother to child during pregnancy or perinatally during labor. Placental barrier and maternal immunoglobulin G antibodies, which cross the placenta, may protect the fetus to some extent. However, it is much more common in non-immune population and the incidence goes up during epidemics of malaria. We report a rare case of congenital malaria due to mixed species in a neonate who presented with fever, pallor and hepatosplenomegaly.
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