Heated and humidified high flow therapy (HHHFT) in extreme and very preterm neonates with respiratory distress syndrome (RDS): a retrospective cohort from a tertiary care setting in Pakistan

OBJECTIVE

To determine the role of heated humidified high flow therapy (HHHFT) as primary respiratory support in spontaneously breathing moderate-late, very and extreme preterm neonates with respiratory distress syndrome (RDS) at a tertiary care hospital from a developing country.

DESIGN

Retrospective cohort study.

SETTING

Neonatal intensive care unit of Indus Hospital and Health Network, Karachi, Pakistan.

PATIENTS

All preterm neonates with RDS and who received HHHFT as primary respiratory support were included retrospectively, while neonates with orofacial anomalies, congenital heart and lung diseases other than RDS, abdominal wall defects, encephalopathy, congenital pneumonia and received continuous positive airway pressure or invasive ventilation were excluded.

INTERVENTIONS

HHHFT as primary respiratory support for RDS.

MAIN OUTCOME MEASURES

Effectiveness, duration, failure rate and complications of HHHFT as a primary respiratory support in moderate-late, very and extremely preterm neonates were evaluated.

RESULTS

The cohort included 138 neonates during a period of 12 months. The median gestational age was 32 weeks, and the median birth weight was 1607 g. Grade 1-2 RDS was seen in 97%, surfactant instillation was done in 10.8% and HHHFT was provided in all the neonates as primary respiratory support. The total duration of HHHFT support was <1 week in 94% of neonates. Bronchopulmonary dysplasia and pneumothorax until discharge or death were observed in one neonate, haemodynamically significant Patent Ductus Artriosus (HsPDA) in two neonates and intraventricular haemorrhage Grade ≥2 in five neonates, while only one neonate died.

CONCLUSION

This study appears to show that HHHFT is a simple, safe, efficient and cheap mode of primary respiratory support that can be given to spontaneously breathing moderate-late, very and extremely preterm neonates with RDS, especially in low- or middle-income countries.

Cervical Cancer Awareness Campaign in Qatar: A Population-Based Campaign

Background: In 2012, it has been estimated that almost 527,600 new patients were diagnosed with cervical cancer causing over 265,000 deaths worldwide. Locally, the disease is affecting a substantial number of women in Qatar, placing it fifth in terms of the most common cancers among females in the country. Unfortunately, most cases are diagnosed at advanced stages, making the treatment more challenging. This is mainly due to the poor knowledge of the disease and the lack of awareness campaigns about cervical cancer. Aim: To raise the awareness about cervical cancer among women in Qatar to promote prevention and early detection. Methods: Qatar Cancer Society (QCS) launched a population-based campaign aimed at raising the public awareness about cervical cancer. In January 2018, health educators from QCS conducted 15 workshops in numerous public and private sectors across Qatar including companies, hotels, hospitals, and healthcare centers to educate the public about the signs and symptoms of the disease, its risk factors, as well as methods of prevention and early detection. In addition, the campaign was advertised in 10 local newspapers, 4 TV programs, 3 radio programs, social media, and 2 Web sites to deliver the educational material to a larger audience as possible. A hotline number was also reserved to answer women's questions and concerns about the disease. To promote the prevention and early detection of cervical cancer, women were encouraged to do Pap tests for free in Al-Ahli and Al-Emadi hospitals. Moreover, QCS organized a closing ceremony at the end of the campaign for all women who did the Pap test and a raffle draw was done to appreciate their participation. Results: A total of 635 women attended the various awareness workshops that were delivered over a month period. Interestingly, 100 women aged 21-65 years visited Al-Ahli and Al-Emadi hospitals to have Pap tests for cervical cancer screening. All of these women reported that they have never done the test before and they became aware of it from QCS campaign. Of note, participants indicated that it was the first time for them to learn about human papilloma virus (HPV) vaccine which prevents 70% of all cervical cancer cases. In addition, about 150 calls were received inquiring about different aspects of the disease. The closing ceremony came to reinforce the awareness messages delivered by QCS where an educational video about cervical cancer was presented, followed by a speech by a cervical cancer survivor who talked about her battle with the disease and her treatment journey. Conclusion: Despite the widespread of cervical cancer among women in Qatar, little was known about its signs and symptoms, prevention, and early detection methods. This population-based awareness campaign was very effective in raising the awareness about cervical cancer, which will help in detecting the disease at earlier stages, and will ultimately result in higher survival rates.

Mapping the Sinorhizobium meliloti 1021 solute-binding protein-dependent transportome

The number of solute-binding protein-dependent transporters in rhizobia is dramatically increased compared with the majority of other bacteria so far sequenced. This increase may be due to the high affinity of solute-binding proteins for solutes, permitting the acquisition of a broad range of growth-limiting nutrients from soil and the rhizosphere. The transcriptional induction of these transporters was studied by creating a suite of plasmid and integrated fusions to nearly all ATP-binding cassette (ABC) and tripartite ATP-independent periplasmic (TRAP) transporters of Sinorhizobium meliloti. In total, specific inducers were identified for 76 transport systems, amounting to approximately 47% of the ABC uptake systems and 53% of the TRAP transporters in S. meliloti. Of these transport systems, 64 are previously uncharacterized in Rhizobia and 24 were induced by solutes not known to be transported by ABC- or TRAP-uptake systems in any organism. This study provides a global expression map of one of the largest transporter families (transportome) and an invaluable tool to both understand their solute specificity and the relationships between members of large paralogous families.