Does Low FEV1 in Addition to Fixed Ratio and/or Lower Limit of Normal of FEV1/FVC Improve Prediction of Mortality in COPD? The NHANES-III-linked-mortality Cohort

Purpose

There is presently an ongoing debate on the relative merits of suggested criteria for spirometric airway obstruction. This study tests the null hypothesis that no superiority exists with the use of fixed ratio (FR) of forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.7 versus less than lower limit predicted (LLN) criteria with or without FEV1 <80% predicted in regards to future mortality.

A Retrospective Analysis on Cervical Spine Magnetic Resonance Imaging Findings in Patients with Neck Pain in a Tertiary Hospital,Addis Ababa,Ethiopia

BackgroundNeck pain is a common health problem throughout the world causing significant individual disability and economic burden on health care facility. Many factors are mentioned as a cause or association in relation to neck pain, of which degenerative and posttraumatic cause are the main ones. The aim of this study is to assess cervical spine Magnetic Resonance Imaging (MRI) patterns in patients presented with neck pain.MethodsA retrospective analysis of 160 patients who had cervical spine Magnetic Resonance Imaging (MRI) for evaluation of a neck pain was done. The study was conducted between February to August 2018 at Tikur Anbessa Specialized Hospital. The patients'' clinical history and magnetic resonance imaging reports were reviewed from their medical records. All patients who have cervical spine Magnetic Resonance Imaging (MRI) for a neck pain were included in the study. Those patients with acute traumatic neck pain were excluded.ResultsFrom a total of 160 patients, 71(44.4%) were males and 89(55.6%) were females. Degenerative cervical spine findings such as intervertebral disc degenerations were seen in 127(79.4%) patients. Non-degenerative imaging findings such as neoplasm and infection were seen in 10(6.3%) patients only. The MRI was normal in 23(14.4%) of them.ConclusionThe most common cause of neck pain from this study is degenerative changes of the cervical spine, which was predominant in the older age groups. Non-degenerative causes such as neoplasm and infection were less common findings.     

Antimicrobial susceptibility pattern of Helicobacter pylori strains isolated from adult dyspeptic patients in Tikur Anbassa University Hospital, Addis Ababa, Ethiopia

Presently, there is no published information on the antimicrobial susceptibility pattern of H. pylori strains in Ethiopia to guide the choice of drug for therapy. Therefore, it is becoming clinically relevant to test the in vitro susceptibility of H. pylori clinical isolates prior to treating patients. Susceptibility testing was performed on 50 clinical H. pylori isolates obtained from adult dyspeptic patients referred to the gastrointestinal (GI) Clinic of Tikur Anbassa University Hospital. Five antibiotics were evaluated, by using the Episolmeter test (E-test). The antibiogram of 50 H. pylori clinical isolates showed that all strains were sensitive to clarithromycin, erythromycin and tetracycline, while 38/50 (76%) and 3/50 (6%) of the strains were resistant to metronidazole and amoxicillin, respectively. Infection by metronidazole or amoxicillin resistant H. pylori is an important factor leading to treatment failure. Testing of all H. pylori clinical isolates to metronidazole and amoxicillin is recommended. If it is not possible to perform susceptibility tests on each clinical isolate, a program to survey the prevalence of resistance should be implemented in a given area or population. When treatment of H. pylori infection is indicated in dyspeptic patients, the potential availability, simplicity of use, safety and low cost of the antimicrobial agents have to be taken into account.     

Seasonal abundance, vector behavior, and malaria parasite transmission in Eritrea

Entomological studies were conducted over a 24-month period in 8 villages to establish the behavior patterns, seasonal densities, and variation in entomological inoculation rates (EIRs) of Anopheles arabiensis, the main vector of malaria in Eritrea. A total of 5,683 anopheline mosquitoes were collected through indoor sampling (1,613), human-landing catches (2,711), and outdoor pit shelters (1,359). Overall, An. arabiensis was the predominant species at all of the study sites, with its population density increasing during the rainy season. Peak indoor-resting densities was observed during September and October. Human landing indices for An. arabiensis averaged 1.9 and 3.8 per person per night in October and September, respectively. Peak biting and landing rates occurred between 2000-2200 h and 0100-0300 h. Of the total number of bites, 44.7% occurred between 1800 and 2300 h, and at least 56.5% of the total bites occurred outdoors, indicating that the species was partially exophagic. The fed to gravid ratio for An. arabiensis in indoor-resting collections was 2:1, indicating some degree of exophily. The sporozoite rates (SRs) for An. arabiensis ranged from 0.54% in the Anseba zone to 1.3% in the Gash-Barka zone. One mosquito each of An. d'thali (SR = 0.45%) and An. cinereus (SR = 2.13%) was found to be positive. Of the total positive An. arabiensis (n = 64), 18.2% came from human-landing collections outdoors. Blood-meal analysis by enzyme-linked immunosorbent assay for An. arabiensis indicated that this species was partially zoophilic with a human to bovine ratio of 2:1 being recorded. The EIR profiles indicated that malaria transmission is highly seasonal, increasing during the wet season and declining drastically during the dry season. On average, the greatest risk of infection occurs in Hiletsidi, in the Gash-Barka zone (6.5 infective bites per month). The exophilic behavior and early evening biting of An. arabiensis present obstacles for control with treated bed-nets and indoor residual spraying within the context of integrated malaria control, and call for greater focus on strategies such as larval control.     

Predicting Phenotype and Emerging Strains among Chlamydia trachomatis Infections

Chlamydia trachomatis is a global cause of blinding trachoma and sexually transmitted infections (STIs). We used comparative genomics of the family Chlamydiaceae to select conserved housekeeping genes for C. trachomatis multilocus sequencing, characterizing 19 reference and 68 clinical isolates from 6 continental/subcontinental regions. There were 44 sequence types (ST). Identical STs for STI isolates were recovered from different regions, whereas STs for trachoma isolates were restricted by continent. Twenty-nine of 52 alleles had nonuniform distributions of frequencies across regions (p<0.001). Phylogenetic analysis showed 3 disease clusters: invasive lymphogranuloma venereum strains, globally prevalent noninvasive STI strains (ompA genotypes D/Da, E, and F), and nonprevalent STI strains with a trachoma subcluster. Recombinant strains were observed among STI clusters. Single nucleotide polymorphisms (SNPs) were predictive of disease specificity. Multilocus and SNP typing can now be used to detect diverse and emerging C. trachomatis strains for epidemiologic and evolutionary studies of trachoma and STI populations worldwide.     

Distribution of anopheline mosquitoes in Eritrea

The spatial distribution of anopheline mosquito species was studied throughout Eritrea during the 1999-2001 malaria transmission seasons from October to December for the highlands and western lowlands and February to April for the coastal region. Of the 302 villages sampled, 59 were visited in both the first and second year. Overall, 13 anopheline species were identified, with the Anopheles gambiae complex predominating during the first year (75.6%, n = 861) and the second year (91.9%, n = 1,262). Intrazonal variation accounted for 90% of the total variation in mosquito distribution. Polymerase chain reaction results indicated that 99% (n = 1,309) of the An. gambiae s.l. specimens were An. arabiensis, indicating that this was the only member of the gambiae complex present. There was a high degree of aggregation of anophelines within zones and villages, with more than 80% of the total anophelines being collected from less than 20% of the villages and from only 10% of the houses sampled. At least 80% of the anopheline mosquitoes were collected from grass-thatched Agudo-type housing. Vector abundance showed an inverse relationship with elevation, with highest densities in the low-lying western lowlands. Multiple regression analysis of log-transformed mean density of An. arabiensis with rainfall and the normalized difference vegetation index (NDVI) (average NDVI, minimum NDVI, and maximum NDVI) showed that these independent variables were not significantly associated with mosquito densities (R2 = 0.058). Our study contributes to the basic understanding of the ecology and distribution of malaria vectors with respect to species composition and spatial heterogeneities both that could be used to guide vector control operations in Eritrea.     

The incidence of oxygen desaturation during rapid sequence induction and intubation

BACKGROUND:

Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII.

METHODS:

An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection.

RESULTS:

A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO₂<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively.

CONCLUSION:

The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.KEY WORDS: General anesthesia, Rapid sequence induction and intubation, Oxygen desaturation