Pseudoaneurysms of the mitral-aortic intervalvular fibrosa are a well-described complication of aortic valve prosthetic endocarditis. Pseudoaneurysms in this location may be complicated by formation of fistulous tracts with adjacent structures. Herein we describe a case in which fistulous flow into the left atrium produced an eccentric jet on color flow Doppler imaging which masqueraded as severe mitral regurgitation.

Aim: Primary hyperparathyroidism (PHPT) is an endocrine disease that poses a risk for cardiac arrhythmias. Atrial electromechanical delay (EMD) has been known as an early marker of atrial fibrillation (AF). This study aimed to evaluate the atrial EMD in PHPT. Methods: Fifty PHPT patients (45 females, 5 males) aged 30-75 years and 38 controls (35 females, 3 males) aged 31-73 years were included in the study. Atrial EMD parameters were measured by using tissue Doppler imaging (TDI). Inter-atrial EMD was calculated as the difference between PA lateral and PA tricuspid, intra-atrial EMD was calculated as the difference between PA septum and PA tricuspid, and left-atrial EMD was calculated as the difference between PA lateral and PA septum Results: Atrial EMD parameters (PA lateral, PA septum, PA tricuspid) significantly increased in PHPT group compared to control group (p<0.001, for all). Also, inter-atrial and intra-atrial EMD were higher in PHPT group compared to control group (p<0.001, for all). In correlation analysis, calcium was well associated with PA lateral (r=0.748, p<0.001), PA septum (r = 0.720, p <0.001), inter-atrial EMD (r = 0.670, p <0.001) and intra-atrial EMD (r = 0.616, p <0.001). There was the same correlation relationship between PTH levels with PA lateral (r=671, p<0.001), PA septum (r=0.660, p<0,001), inter-atrial EMD (r=0.674, p<0,001) and intra-atrial EMD (r=0.732, p<0.001) Conclusions: Atrial EMD parameters were prolonged in PHPT. The measurement of atrial EMD parameters might be used to determine the risk of development of AF in PHPT

The proposed approach presents substantial scientific evidence based on physics and clinical data to support a clinical trial of an energetic SARS-CoV-2 vaccine. This is particularly imperative in the absence of a pharmaceutical vaccine as well as its uncertain future efficacy and safety, considering the limited time for testing and rapid mutations of the virus. Some of the vaccine trials have already been halted due to volunteers falling ill. Physics and biophysics of the fundamental electromagnetic nature of the living matter, including microbes as well as water, support the imprinting of electromagnetic fields of microbes in water that elicits an immune response. Energetic vaccines can be rapidly mass-produced for both prophylaxis and treatment of the public and healthcare personnel against the original as well as mutated viral strains. These can be prepared through a standard homeopathic process, as well as an energy field imprinting device,* offering a unique potential in versatility, speed, and low cost in mass protection against the current and future public health emergencies. Other viral infections, epidemics, antibiotic-resistant, and vector-borne infections could be similarly addressed. Paradoxically, in spite of a general perception of homeopathy by physicians as the most alien and least scientific, among complementary and alternative medicine (CAM), it is just the opposite. Homeopathy carries formidable scientific support, with the specific proposed homeopathic model being fully in line with physicians’ superior knowledge of infectious diseases and medicine, making its adaptation into their practice intuitive and more effective than in the hands of non-MDs or DOs homeopaths. The practical advantage of the proposed homeopathic model in acute infections versus its oldest one of multisystemic, totality approach, yielding mixed results in chronic diseases, parallels a similar prevailing success of the corresponding conventional modalities in acute versus chronic diseases.

Diagnostic failure has emerged as one of the most significant threats to patient safety, and it is important to understand the antecedents of such failures. A consensus has developed in the literature that the majority are due to individual or system factors or some combination of the two. A major source of variance in individual clinical performance is due to cognitive and affective biases, however, their role in clinical decision making has been difficult to assess partly because they are difficult to investigate experimentally. A significant drawback has been that experimental manipulations appear to confound assessment of the context surrounding the diagnostic process itself. The present qualitative study uses a detailed narrative account of selected actual cases of diagnostic error to explore the effect of biases in the ‘real world’ emergency medicine (EM) context. Thirty anonymized EM cases were analysed in depth through a process of root cause analysis that included an assessment of error producing conditions, knowledge-based errors, and how clinicians were thinking and deciding during each case. A prominent feature of the study was the identification of specific cognitive and affective biases – through a process called cognitive autopsy. The cases covered a broad range of diagnoses across a wide variety of disciplines. A total of 24 discrete cognitive and affective biases that contributed to misdiagnosis were identified and their incidence recorded. 5-6 biases were detected per case, and observed on 168 occasions across the 30 cases. Thirteen error-producing conditions (EPCs) were identified. Knowledge-based errors were rare, occurring in only 5 definite instances. The ordinal position in which biases appeared in the diagnostic process was recorded. This study provides a base-line for understanding the critical role that biases play in clinical decision making and sheds light on important aspects of the diagnostic process.

The cotton-melon aphid, Aphis gossypii Glover, an extremely polyphagous pest insect, comprises of sympatric populations specialized on deferent host plants. The life history of A. gossypii infesting cucurbit crops remains elusive because oviparous aphids from overwintering hosts (often hibiscus) cannot colonize cucurbit crops. We verified that the hibiscus-specialized lineage (HI) suffered high mortality and gave birth to very few nymphs developing into yellow dwarfs when transferred to fresh cucumber because the HI lineage was unable to ingest phloem sap from fresh cucumber. However, the HI lineage ingested phloem sap successfully when cucumber leaves were pre-infected with Pseudoperonospora cubensis, a biotrophic phytopathogen, accompanied by significant fitness improvement. More surprisingly, the HI lineage with feeding experience on pre-infected cucumber for two generations performed as well as the cucumber-specialized lineage (CU) did on fresh cucumber, and inflicted typical damage symptom to healthy cucumber plant. This phytopathogen mediated host plant adaptation may be widespread in polyphagous aphids.

Coexistence between humans and wildlife is possible when animals are able to meet their ecological requirements while managing human-induced risks. Other than large carnivores, examination of fine-scale spatiotemporal interactions with humans have rarely been applied to threatened wildlife such as great apes, whose conservation relies on persistence in dynamic, shared landscapes. Using a landscape of fear framework with Bayesian INLA spatiotemporal modelling we investigate risk-mitigation and optimal foraging trade-offs in western chimpanzees (Pan troglodytes verus). Although humans and chimpanzees used the same locations within the agroforest landscape, chimpanzee space use was negatively mediated by villages and agriculture. However, chimpanzees responded to wild fruit scarcity by intensifying their use of village areas with cultivated fruits. Our data demonstrate dynamic spatiotemporal interactions in shared landscapes. An INLA-based landscape of fear approach generates a clear model output to examine risk mitigation/optimal foraging strategies, that can inform conservation interventions to promote human-wildlife coexistence.

In order to reveal the mechanical characteristics of the unsaturated undisturbed Ili loess in westerly region, the isotropic compression tests controlling suction, the triaxial shrinkage tests controlling net mean stress and consolidation shear tests controlling net confining pressure and suction were carried out under different soluble salt contents. The objective of investigation is to explore the normalized characteristics of compression curve, soil water characteristic curve and critical state line. The results show that the ratio of void ratio to initial void ratio and the ratio of net mean stress to yield net mean stress are suitable to normalize the compression curves under different suctions in the isotropic compression test. The soil water characteristic curves under different net mean stresses in the triaxial shrinkage test can be normalized by the ratio of water content to saturated water content and the ratio of suction to air entry value. In the consolidation shear test controlling constant suction, the unsaturated critical state lines under different suctions can be normalized by the corresponding saturated critical state line in the plane of effective net mean stress and deviator stress. The unsaturated critical state lines under different suctions in the plane of void ratio and net mean stress can be normalized by means of degree of gas saturation and the ratio of unsaturated void ratio to saturated void ratio under the same effective net mean stress. The results provide potential benefits for the constructions of large-scale water conservancy projects in the special area of Central Asia.

Soil CO2 and CH4 concentrations are crucial determinants of crop physiology and soil environment. This study aimed to investigate the dynamics of soil CO2 and CH4 concentrations and their correlations with soil nutrient content, enzymatic activities and root biomass at shallow groundwater levels. Lysimeter experiments were conducted at five groundwater depths (20, 40, 50, 60, and 80 cm) and three fertilizer application rates (low, 75%; normal, 100%; high, 125%). Soil CO2 and CH4 concentrations, physicochemical properties, and enzymatic activities were determined in the three growth stages of winter wheat crop, and plant biomass was measured post-harvest. Groundwater depth significantly (P ≤ 0.001) affected CO2 and CH4 concentrations and root parameters, and their critical values appeared at the groundwater depth of 50–60 cm. Soil water content presented quadratic function relation with CO2 concentration, and exhibited the linear correlation with CH4 concentration. As an aerobic respiration product, soil CO2 concentration showed significant positive correlations with organic matter and total N levels, urease, phosphatase and sucrase activities, and root biomass in winter wheat. Soil CH4 concentration depending on anaerobic microbial activity showed significant correlations with soil nutrients, such as soil organic matter, total N, and available K. Fertilization significantly impacted root parameters (P ≤ 0.001) and shoot biomass (P ≤ 0.05) instead of CO2 and CH4 concentrations. In contrast, groundwater depth emerged as a crucial factor as it affected soil physicochemical properties, soil enzymatic activities, root respiration, and winter wheat growth at shallow groundwater levels.

Objective To evaluate the accuracy of 35-37 weeks‘ ultrasound for fetal growth restriction (FGR) detection and the impact of 30th-33rd weeks vs 35th-37th weeks ultrasound on perinatal outcomes. Design A prospective randomized trial Setting Tertiary referral hospital in Portugal. Population Low risk pregnant women Methods We enrolled 1061 women: 513 in the control group (ultrasound at 30th-33rd weeks) and 548 in the study group (with an additional ultrasound at 35th-37th weeks). FGR was defined as an estimated fetal weight (EFW) below 10th percentile. We calculated the overall accuracy of the 35-37 weeks’ ultrasound and compared perinatal outcomes between both groups. Main outcome measure Detection of late FGR Results The ultrasound at 35-37 weeks had an overall accuracy of FGR screening of 94%. Spearman’s correlation coefficient between EFW and birthweight centile was higher for at 35-37 weeks’ ultrasound (ρ = 0.75) compared with 30-33 weeks’ ultrasound (ρ = 0.44). The study group had a lower rate of operative vaginal deliveries (24.4% vs 39.3%, p = 0.005) and cesarean deliveries for nonreassuring fetal status (16.8% vs 38.8%, p < 0.001). For FGR prediction, the area under the receiver-operating characteristics curve of EFW centile at 35-37 weeks’ ultrasound was 0.90 (95% CI, 0.86-0.95). Conclusions A later ultrasound (35-37 weeks) had a higher correlation between EFW and birthweight centiles and was associated with a lower rate of cesarean and operative deliveries for nonreassuring fetal status compared to an earlier ultrasound, which reinforces that antenatal identification of FGR allows close monitoring and appropriate management.

Steviol glycosides, mostly extracted from Stevia rebaudiana Bertoni, are non-caloric, safe natural sweeteners. Steviosides make up more than 50% of total steviol glycosides but possess a bitter aftertaste, which limits their application as food additives. Trace amounts of rubusosides are acceptable sweeteners, but their supply is limited. In this study, we screened an endophytic bacteria (Lelliottia LST-1) that can specifically convert stevioside into rubusoside and reach a conversion rate of 75.4% after response surface optimization. Potential β-glucosidases GH3-1, GH3-2, GH3-3, and GH3-4 based on whole genome sequencing were expressed and interacted with steviol glycosides to explore principle and process of biological transformation. High-performance liquid chromatography revealed that all enzymes hydrolyzed stevioside and generated rubusoside, but substrate specificity analysis indicated that GH3-2 is the most suitable choice for the durative, steady, and high-efficiency production of rubusoside

The conventional flood control design analysis usually focuses on a specific aspect like flood peak discharge or the volume of flood, with the development of technology, hydrological analysis tends to be multi-dimensions research. The multivariate frequency analysis of a flood has been widely investigated, while there is lack of literatures about flood control design under multiple floods. In this study, taking the Guiping Shipping Hub as a study case, a Copula-based approach is proposed to investigate the flood control design under multiple floods, comparison between the proposed method and conventional approach is investigated, the sampling uncertainty is analyzed. The results indicate that (1) the joint distribution of main and tributary floods is modeled by Clayton Copula with PE3 as the best-fit marginal distributions. The proposed Flood Control return period (FC-RP) can describe the different role of main and tributary floods in flood control design. (2) flood combinations uncertainty analysis indicates that the uncertainty of the joint design combinations under the effect of multiple floods decreases with the increase of sample size n, but increases with the increase of the design return period. (3) the 95% confidence interval and standard deviation of the design value of flood control design water level calculated by Flood Control RP is smaller than that of OR RP, which means the Flood Control RP can reduce the uncertainty of flood control design under the condition of multiple floods.

Per poter realizzare un progetto verificando coerentemente la compatibilità dello stesso con i comparti ambientali con cui quest’ultimo interagisce, è necessario eseguire correttamente le varie fasi inerenti alla valutazione ambientale.  Prefissata quindi la determinata opera che si intende realizzare, è fondamentale scegliere anzitutto tra le alternative a disposizione quella che minimizzi le pressioni negative esercitate sul territorio. Scelta l’alternativa idonea si passa allo studio delle interazioni tra la stessa e i comparti ambientali inerenti all’area in questione. La seguente analisi passa rispettivamente per l’identificazione, la stima e quindi la valutazione dei potenziali impatti. Eseguite le suddette fasi è possibile valutare se siano necessari o meno eventuali interventi di mitigazione o compensazione e quindi, effettuata la valutazione degli impatti residui, verificare la compatibilità ambientale del progetto con i comparti interagenti con esso. In caso di impatti negativi significativi è necessario valutare un’alternativa al progetto o di localizzazione. Viceversa, constatata dall’ imprenditore la sostenibilità economica dell’opera, è possibile passare alla redazione dello Studio di Impatto Ambientale.La fase di identificazione degli impatti è fondamentale per garantire la considerazione di tutti gli aspetti ambientali con cui l’opera interagisce direttamente e indirettamente, oltre che evitare di trascurare eventuali azioni progettuali comportanti potenziali impatti.

A 59-year old gentleman with transformation of myelodysplastic syndrome to acute megakaryoblastic leukemia was treated with standard intensive chemotherapy. His poor outcome was attributed to advanced age, aggressive disease biology, underlying myelodysplastic syndrome, poor response to induction chemotherapy, high lactate dehydrogenase and lack of good cytogenetic and molecular mutations.

A 50-year-old male presented with HIV and an ulcerative mass on the hypopharynx. Initially thought to be malignant, multiple biopsies and surgeries over 19 months did not resolve the lesion. Discovery of the cytopathic effect on biopsy led to diagnosis of HSV pseudotumor. The lesion resolved with valacyclovir treatment.

We present a 47-year-old with Ehlers-Danlos syndrome (EDS) type IV (vascular subtype) referred with recurrent episodes of severe biliary colic requiring elective cholecystectomy. Successful surgical management required extensive planning and multidisciplinary teamwork. This report is intended as a guide for clinicians in the perioperative planning of elective EDS typeIV patients.

The interactions of simple and Al, B, N, S, P and Si-doped carbon nanotubes with three sulfur-containing molecules (H2S, SO2 and thiophene) have been investigated to assess their adsorption potencies and sensor abilities. DFT calculations were used to calculate the adsorption energies and NBO parameters. Besides, Population analyses were performed to calculate the energy gaps and reactivity parameters and to obtain DOS plots. The results showed an exothermic interaction of H2S, SO2 and thiophene with simple and doped CNTs while the maximum negative adsorption energies were belonged to Al and B containing complexes. Furthermore, evaluation of second order perturbation energies (obtained from NBO calculations) confirmed that the highest energies were related to B and Al containing intramolecular interactions. The results revealed the favourability of adsorption of SO2 by nanotubes (B and Al doped carbon nanotubes, in particular), in comparing with the other examined adsorbates.

This study was conducted to investigate how early childhood children perceive and define various concepts of value. Phenomenology, which is one of the qualitative research patterns, was used in the study. The study group of the study consisted of 20 5-year-old children who continue preschool education. While determining the children, a typical case sampling, which is one of the purposeful sampling methods, was used. It was noted that the entire sample was not educated in the same socio-economic level and planned value education before. A data collection tool that consist of open-ended questions with 7 value concepts (responsibility, sharing, benevolence, friendship, respect, honesty and courtesy), selected by researchers, was applied to the children with a semi-structured interview technique. The data obtained were evaluated by content analysis method. The data obtained from the answers given by the participants to the questions about value concepts were coded and themes were created and arranged in tables. In the results obtained by defining and interpreting the findings, it was seen that the perceptions and definitions of children of responsibility, sharing, benevolence and respect values are similar. In defining the value of responsibility, children often try to make definitions over the tasks that are assigned to them at home; in the definitions of sharing and benevolence values, they were influenced by the experiences of sharing and solidarity they had previously experienced; In their definitions of respect value, it is seen that they are affected by the behaviors and teachings of adults around them. As a result of the research, the answers given by the children to the questions about the value concepts were grouped. It has been observed that the perceptions and definitions of children about responsibility, sharing, benevolence and respect values are similar. It was seen that they tried to explain the value of friendship through sharing and benevolence values. It has been found that the concepts of honesty and kindness are the least perceived and undefined ones.  

Background: Hemoglobin H (HbH) is usually recognized as mild thalassemia. However, a wide range of clinical manifestations, from fatal hydrops fetalis to asymptomatic mild anemia, is observed. A severity scoring system to guide the management of patients with HbH is needed. Objective: To develop a scoring system to predict the necessity of regular transfusion among patients with HbH. Methods: Patients were classified into 2 groups according to transfusion requirement: severe among transfusion-dependent thalassemia (TDT) and nonsevere among nontransfusion-dependent thalassemia (NTDT). Clinical and hematological parameters associated with transfusion dependency were identified and β-coefficients of significant parameters from multiple logistic regression analysis were used to develop a scoring system. Results: A total of 247 pediatric patients (24 severe, 223 nonsevere) with a median age of 14.3 (IQR 9.9-18.4) years were included. Multiple logistic regression analysis revealed 3 significant parameters associated with regular transfusion requirement including 1) age at diagnosis <2 years, 2) spleen size ≥3 cm and 3) Hb at steady-state <8 g/dL. Coefficients of the respective parameters were used to define the scores as 1, 2 and 2, respectively. A total score of ≥3 was associated with regular transfusion requirement among severe HbH (sensitivity 88%, specificity 83%). The newly developed scoring system was validated in the second cohort of 134 pediatric patients with HbH treated at another center. The cut-off score ≥3 yielded comparable sensitivity and specificity for the prediction.

Granulocyte colony stimulating factor (G-CSF) has been widely used as a mobilizing agent to rapidly increase peripheral blood stem and progenitor cells. Limited data is available for G-CSF-associated late-onset coronary thrombosis and thrombocytosis. We report a case of a 23-year-old Chinese Han patient who presented with acute myocardial infarction and thrombocytosis after finishing bone marrow harvesting and peripheral blood stem cell collection following G-CSF treatment several days later. By using antiplatelet drugs and undergoing percutaneous transluminal coronary angioplasty, the patient’s symptoms were relieved and his platelet level decreased to normal. This is the first suspected case report of late-onset coronary thrombosis and thrombocytosis related to G-CSF. Caution should be taken for the delayed adverse reactions in patients undergoing G-CSF mobilizing.

A document by Musa Bardak. Click on the document to view its contents.

Erken çocukluk dönemi olarak adlandırılan 0-6 yaş dönemi, gelişim ve öğrenmenin en hızlı olduğu yıllardır. Bu nedenle 21. yüzyıl becerileri ile STEM alanlarına yönelik temel becerilerin kazandırılmasına erken çocukluk döneminde başlanmalıdır. Bu bölümde 'Erken Çocukluk Dönemi ve STEM' başlığı altında erken çocukluk dönemi ve önemi, okul öncesi eğitiminin tanımı, önemi ve amacına değinilmiştir. Gelişim ve öğrenme açısından erken çocukluk dönemi, bu dönemde çocuklara kazandırılabilecek 21. yüzyıl becerileri ile STEM alanlarına yönelik becerilere ilişkin açıklamalara yer verilmiştir. Okul öncesi eğitimde STEM yaklaşımının gerekliliği ve uygulanabilirliği, STEM programlarının okul öncesi eğitimine entegrasyonu, dünyada ve Türkiye'de okul öncesi eğitimde STEM Uygulamaları, MEB 2013 Okul öncesi Eğitim Programı ve programda yer alan kazanım ve göstergelerde 21. yüzyıl becerileri ile STEM kavramları açıklanmıştır. Okul Öncesi STEM eğitiminde öğretmenlerin yetiştirilmesi sürecinden bahsedilerek, çocuklara STEM alanlarına yönelik beceri ve kavramların kazandırılmasında öğretmenlere yönelik yararlı ipuçları sunulmuştur. 1.1.Erken Çocukluk Dönemi ve Önemi Erken çocukluk dönemi, doğumdan başlayarak zorunlu eğitim yaşına kadar olan yılları (0-6 yaş) kapsayan dönemdir. Erken çocukluk dönemi, okul öncesi dönem olarak da adlandırılır. Bu dönem, çocuğun gelişiminin en hızlı olduğu evredir. Okul öncesi dönem, gelişimsel açıdan değerlendirildiğinde 2 ana evrede ele alınmaktadır. İlk evre, 0-2 yaşı kapsayan yenidoğan ve oyun çocukluğu (toddlerhood) dönemidir. Bu dönemde algılama ile zihinsel ve motor becerilerde gelişmeyi sağlayan vücut ve beyinde önemli değişiklikler meydana gelir. Ayrıca, bu dönemde konuşma başlar, çocuk bağımlı ama yeteneklidir. Bebeklik ilk 1 yılı, oyun çocukluğu ise ikinci yılı kapsamaktadır. Çocuklar bu süreçte ilk bağımsız adımlarını atmaya başlar. İkinci evre, erken çocukluk dönemi denilen 3-6 yaşı kapsamaktadır. Bu evrede hızlı bir süreç gösteren gelişim alanları öz bakım becerileri, motor, sosyal, duygusal, dil ve bilişsel gelişimdir. Erken çocukluk döneminde çocuğun motor becerileri daha çok gelişir ve çocuklar kendi kendilerini daha iyi kontrol ederek, kendilerine yetebilecek duruma gelirler. Ayrıca bu dönemde çocuklar, gelişim alanlarının tümünü destekleyen hayali oyunlar oynar. Düşünce yapısı, kavram edinimi ve dili çok hızlı bir şekilde gelişir. Ahlak duygusu oluşmaya başlar ve çocuklar akranları ile arkadaşlıklar kurarlar (Ceylan, 2009, s.1). Okul öncesi dönemde erken yaşam deneyimleri çocuğun okula, öğrenmeye ve kendi becerilerine dair geliştireceği tutumları da belirler ve bu da çocuğun okul başarısını etkiler.

Background. Median survival age in cystic fibrosis (CF) has increased in developed countries. Scarce literature exists about survival in Latin American, especially in Mexico. The aim of our study was to assess the median age of CF patients’ survival in Mexico over a 20-year period. Methods. We conducted a retrospective study, with all patients registered and followed in the CF Center in Monterrey, Mexico from 2000 to 2020. Median survival age was the primary outcome, assessed with the Kaplan-Meier analysis. Influence of clinical, biological, and demographic factors on survival were analyzed with the Cox regression model. Results. Two-hundred five patients were included. Median survival for the cohort was 21.37 years (95% CI 17.20 – 25.55). In the multivariate Cox regression model, low socioeconomic status (hazard ratio [HR] 4.21, 95% CI 2.43 – 7.27), chronic Pseudomonas aeruginosa (P. aeruginosa) infection at 6 years (HR 10.45, 95% CI 5.66 – 19.28), and pancreatic insufficiency (HR 3.13, 1.38 – 7.13) were independent risk factors for mortality. Conclusion. Median survival in Mexican patients with CF is lower than in high-income countries, and socioeconomic status plays a conspicuous role in the disparity. To increase patient survival for those residing in low-income countries, public health authorities must design policies that fully cover diagnosis and treatment strategies for the CF population.

Background and Objectives: Extubation failure in preterm infants is associated with increased risk of mortality and morbidities. There is limited evidence to suggest if the increased morbidities are due to inherent differences among infants who fail or succeed; or whether these are due to a true respiratory setback among those who fail extubation. The aim of this study was to evaluate the respiratory status of infants who fail extubation and to assess the time taken for these infants to achieve pre-extubation respiratory status. Methods: This was a retrospective study of infants with birth weight ≤1,250 g who were born between January 2009 and December 2016. Infants were eligible if they failed first elective extubation. Extubation failure was defined as need for re-intubation within 5 days of extubation. Ventilator settings, blood gas parameters, respiratory severity score and ventilation index were used to assess respiratory status of infants. Results: Of 384 infants, 76% were successful and 24% failed extubation. Among those who failed extubation 91%, 77% and 56% infants remained intubated at 24 hours, 72 hours and 7 days, respectively. Respiratory status was worse at 24 hours and 72 hours after re-intubation when compared to pre-extubation levels. The median times for respiratory severity score and ventilation index to reach pre-extubation levels were 4 days and 7 days respectively. Conclusion: Among preterm infants, failed elective extubation is associated with a significant setback in the respiratory status. Infants who fail an extubation attempt may not achieve pre-extubation respiratory status for many days after reintubation.

Background and Objectives: Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia is important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. Methods: Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. Results: Aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2 % of the patients. Complications were not seen during any of the procedures. Conclusions: The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.