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Background: Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation. Methods: We queried a multicentre registry for children who experienced “difficult” or “impossible” facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed. Results: The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with “difficult” mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening. Conclusions: Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

Babayemi OO, Oke EA, Bayode MT. 2021. Antibacterial activity of Jatropha tanjorensis leaf extracts against bacteria associated with wound infections from the clinical setting. Nusantara Bioscience 13: 260-267. The use of microbial agents to treat infectious wounds based on ethnobotanical knowledge is still minimal. Antibacterial activity of Jatropha tanjorensis J.L.Ellis & Saroja leaf crude extracts and commercial antibiotics were evaluated against bacterial isolates associated with wound samples using agar well diffusion and disc diffusion techniques, respectively. Phytochemical analysis of the sections was carried out using standard methods. Saponin (58 mg/g) was the highest phytochemical in the methanol extract while flavonoid (0.1 mg/g) was the lowest percentage in the coldwater extract. Methanol extract had had the highest Zone of Inhibition (ZOI) of 33 mm against Staphylococcus aureus coagulase-positive, while the lowest ZOI (5 mm) against S. aureus coagulase-positive was obtained from cold water extract. Methanol extract resulted in the highest ZOI ranging from 16 mm to 17 mm against Escherichia coli while the lowest ZOI was obtained from coldwater extract (3-4 mm). The highest Minimum Inhibitory Concentration (MIC) value of all extracts (100 mg/mL) was obtained against P. aeruginosa while the lowest MIC value was obtained against coagulase-positive S. aureus (12.5 mg/mL). All extracts contain Octadecanoic acid, n-hexadecanoic acid, and phytol. The study's outcome revealed that methanol extract had the highest inhibitory activity against bacteria isolated from wound samples compared to other crude extracts and ciprofloxacin. Jatropha tanjorensis could be used as a potent herbal remedy to reduce the adverse effects of wound infection.

Cystic fibrosis (CF) commonly affects those of European descent; however, it can also be found in those of Asian, African, and Caribbean descent. Patients with CF may have significant lung disease, and their perioperative management can be challenging for the anesthesiologist. In this case report, we describe the use of serratus anterior plane block (SAPB) and IV sedation as an alternative to general anesthesia with an endotracheal tube in a patient with CF pulmonary exacerbation presenting to the operating room for a video-assisted thoracic surgery (VATS).

The wide range of applications of β-galactosidase has made it a candidate enzyme of study for improved yield. Most studies focused on expressing this enzyme in expressible vector(s) while sources of this enzyme are rarely investigated. Aquatic habitats harbor arrays of microorganisms that can participate in demineralization, nutrient restoration, circulation and hence confer significant properties on the habitats and significantly influence microbial interactions and metabolism. In view of this, aquatic fungal isolates were qualitatively and quantitatively screened for intracellular and extracellular β-galactosidase production. Four fungal isolates tagged SB01 and SC02 from stream identified as Aspergillus oryzae and Aspergillus niger and SC01 and SA01 from pond identified as A. oryzae and A. niger were studied. β-galactosidase gene was successfully amplified from the four isolates and their enzyme production levels were further studied. All the isolates showed considerably higher extracellular secretion than the intracellular synthesis on glucose-based medium. The production level was probed by xylose supplementation but surprisingly, the intracellular synthesis was higher than the extracellular secretion for all the isolates. In an attempt to boost the enzyme production, temperature was varied and 25 °C showed improved β-galactosidase synthesis and secretion than the 30 °C. This study revealed these filamentous fungi as candidates for β-galactosidase production and broaden the understanding of harnessing microorganisms from an aquatic reservoir for bio-production, and more importantly, revealed the intracellular accumulation of the enzyme as a bottleneck for industrial production. HIGHLIGHTS The wide range of applications of β-galactosidase has made it a candidate enzyme of study for improved yield Most studies focused on expressing this enzyme in expressible vector(s) while sources of this enzyme are rarely investigated Aquatic fungal isolates were qualitatively and quantitatively screened for intracellular and extracellular β-galactosidase production All the isolates showed considerable higher extracellular secretion than the intracellular synthesis on glucose-based medium, and vice-versa on xylose-supplemented medium, with the highest β-galactosidase synthesis and secretion efficiency occurring at 25 °C in both instances This study revealed these filamentous fungi as candidates for β-galactosidase production and broaden the understanding of harnessing microorganisms from an aquatic reservoir for bio-production GRAPHICAL ABSTRACT