Pediatric pulmonology year in review 2019: Sleep medicine

Pediatric Pulmonology publishes original research, review articles as well as case reports on a wide variety of pediatric respiratory disorders. In this article, we summarize the past year's publications in sleep medicine and we review selected literature from other journals within this field. Articles highlighted are topics on risk factors of sleep‐disordered breathing, diagnosis, and treatment of obstructive sleep apnea as well as the utility of polysomnography in various complex conditions.     

扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学及肝毒性标志物的影响（英文）

目的：研究扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学、肝脏氧化性应激标志物及部分肝脏酶类的影响。方法：大鼠腹腔注射链脲佐菌素致糖尿病。不同治疗组大鼠分别口服扁桃斑鸠菊及非洲印楝叶的提取物（500mg/kg）或二甲双胍（150mg/kg）,疗程8周,每周测量大鼠的血糖水平及体质量变化。8周后麻醉处死大鼠。取肝组织制成切片,希夫染色法染色,并测量肝匀浆中丙二醛和谷胱甘肽过氧化物酶的含量;下腔静脉采血,分离血浆,检测血浆中丙氨酸氨基转移酶和天冬氨酸氨基转移酶的活性。结果：二甲双胍及植物提取物均能显著改善糖尿病大鼠的血糖水平,且与糖尿病模型组相比,治疗组的体质量明显增加（P〈0.05）。光学显微镜下,各组大鼠的肝脏形态学无明显差别。植物提取物治疗组大鼠的血浆丙氨酸氨基转移酶及天冬氨酸氨基转移酶的活性与正常对照组相比无明显变化（P〉0.05）,而丙二醛含量明显下降（P〈0.05）。结论：扁桃斑鸠菊及非洲印楝叶的提取物对糖尿病大鼠有明显的降糖作用,而肝脏形态学及肝毒性标志物没有明显变化。     

Effect of Vaccine Direct Delivery (VDD) on vaccine stockouts and number of vaccinations: Case study from Bauchi State,Nigeria

ObjectiveVaccine stockouts are prevalent in Africa. Despite the importance of this as a barrier to universal vaccination coverage, rigorous studies looking at ways to reduce vaccine stockouts have been limited. We causally evaluated the effect of Vaccine Direct Delivery (VDD), an intervention to ensure the vaccine stock availability at health facilities, on the reduction of stockouts in Bauchi state, Nigeria.MethodsEmploying the interrupted time-series method, we evaluated the change in the occurrence of vaccine stockouts before and after the introduction of VDD in July 2015. We used health facility level data from January 2013 to December 2018 among 175 facilities in Bauchi state, collected through the District Health Information Software 2 (DHIS2) for monthly information on stockouts and stock balances in all the health facilities in Nigeria. Data were analyzed using Stata 15 SE. To validate the causal relationship between VDD and vaccine stockouts, we conducted two sets of robustness checks. First, we evaluated the effect of VDD on the stockouts of other commodities. Second, we compared the trend of the prevalence of vaccine stockouts among health facilities between Bauchi state where VDD was introduced and another state (Adamawa state) where VDD was never introduced.ResultsAfter the introduction of VDD, vaccine stockouts in Bauchi state decreased by 9 percentage points on average, and they have been decreasing monthly by 0.4 percentage points more than pre-VDD. In Adamawa state, where VDD was never introduced, the prevalence of vaccine stockouts did not change over time. In Bauchi state after VDD introduction, the stock balances of target vaccines all increased, and the number of vaccinations carried out increased in neighboring health facilities.ConclusionsVDD intervention resulted in a significant reduction of vaccine stockouts as well as in an increase in the number of vaccinations performed. However, we should consider how to improve the system to provide vaccination service to the population in a sustainable way.     

Cobalt chloride exposure dose‐dependently induced hepatotoxicity through enhancement of cyclooxygenase‐2 (COX‐2)/B‐cell associated protein X (BAX) signaling and genotoxicity in Wistar rats

Cobalt chloride (CoCl₂) is one of the many environmental contaminants, used in numerous industrial sectors. It is a pollutant with deadly toxicological consequences both in developing and developed countries. We investigated toxicological impact of CoCl₂ on hepatic antioxidant status, apoptosis, and genotoxicity. Forty Wistar rats were divided into four groups, 10 rats per group: Group 1 served as control and received clean tap water orally; Group 2 received CoCl₂ solution (150 mg/L); Group 3 received CoCl₂ solution (300 mg/L); and Group 4 received CoCl₂ (600 mg/L) in drinking water for 7 days, respectively. Exposure of rats to CoCl₂ led to a significant decline in hepatic antioxidant enzymes together with significant increase in markers of oxidative stress. Immunohistochemistry revealed dose‐dependent increase in cyclooxygenase‐2 and BAX expressions together with increased frequency of Micronucleated Polychromatic Erythrocytes. Combining all, CoCl₂ administration led to hepatic damage through induction of oxidative stress, inflammation, and apoptosis.     

Connective tissue disease-–associated interstitial lung disease: an underreported cause of interstitial lung disease in Sub-Saharan Africa

Clinical Rheumatology - Interstitial lung disease (ILD) occurs in 15% of connective tissue disease (CTD) patients causing considerable morbidity and mortality. Data is scarce regarding its clinical...     

Adherence to CPR guidelines during perioperative cardiac arrest in a developing country

BACKGROUND AND GOAL OF STUDY: Cardiopulmonary resuscitation (CPR) is an integral part of anaesthetic training. In Nigeria, these skills are taught mainly during medical school and postgraduate training. International guidelines were introduced in 2000 and new guidelines were produced in November 2005. The study sought to assess how closely anaesthetists in a Nigerian teaching hospital abide by the 2000 guidelines. MATERIALS AND METHODS: All perioperative cardiac arrests in adults that occurred in a 1-year-period were studied prospectively. All patients <15 years and cardiac arrests occurring outside the direct supervision of the anaesthetists were excluded. Time and duration of arrest, cardiac arrest rhythm and management were documented along with immediate outcome. RESULTS: Thirteen cardiac arrests occurred in 2147 perioperative cases (incidence: 6/1000). Seven patients had non ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) rhythms. The mean age of patients was 30.23+/-11.06 years. Orotracheal intubation, manual ventilation with 100% O(2) and external chest compressions were instituted in all cases. The mean duration of arrest was 25.66+/-13.34 min. All patients received adrenaline (epinephrine) and atropine. The median interval between adrenaline doses was 7.5 min. Only one cycle of defibrillation was given to patients in VF/VT. Immediate survival occurred in five patients (38.46%). CONCLUSION: Anaesthetists in our hospital are not applying proper resuscitation guidelines. The lack of organised simulation practice resulted in deficient knowledge and skills. There is a need for continuing training in basic and advanced resuscitation for all anaesthetists according to the guidelines.     

Invasive pneumococcal disease in children with sickle cell disease in the pneumococcal conjugate vaccine era

Invasive pneumococcal disease (IPD) in children with sickle cell disease (SCD) can be devastating. We sought to assess the impact of IPD in children with SCD since licensure of the pneumococcal conjugate vaccines (PCVs). We found 11 cases of IPD giving an incidence of 417 per 100,000 person‐years, much higher than that reported in children without SCD. Although all isolates were sensitive to penicillin, 89% of isolates were nonvaccine serotypes. Further study is needed to characterize the incidence of and risk factors for the development of IPD in SCD in the PCV era to help drive better prevention strategies.