Meconium aspiration syndrome is a respiratory distress in infants born through meconium-stained amniotic fluid. Risk factors include maternal health problems, post-term pregnancy, and fetal stress. Meconium obstructs airways, causes chemical pneumonitis, and inactivates surfactant. Affected infants have respiratory distress, and chest X-rays show hyperinflated lungs. Management includes suctioning meconium during delivery, pulmonary toilet, oxygen therapy, ventilation if needed, antibiotics, and treatments for pulmonary hypertension. Complications are common and outcomes range from full recovery to long-term issues like cerebral palsy.
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
Normal newborn care, by Dr Amal Khalil, Dean of Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
Normal newborn care, by Dr Amal Khalil, Dean of Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
4. Meconium
pH of meconium : 5.5-7
A sterile, viscous, dark green, odorless substance
Component :
- 75-80% water
- desquamated cells from the intestine and epithelial
cell
- Lanugo hair
- Fatty material from vernix caseosa
- Mucus
- Bile
Description :
Light - amniotic fluid thinly stained
Moderate - opaque without patricles
Thick - pea soup particles
5. Physiology
Meconium 1st found in the fetal ileum between the 10th
and 16th week of gestation
In utero passage of meconium uncommon due to :
- lack of strong peristalsis (low motilin level)
- good anal sphinter
- a cap of viscious meconium in the rectum
Meconium passage uncommon before 36 weeks but
occurs more than 30% beyond 42 weeks due to :
- Fetal maturation post term (high motilin level).
- In utero stress (hypoxia, acidosis) producing
relaxation of anal sphincter.
6. Risk factors for MAS
Maternal HPT
Maternal DM
Maternal heavy cigarette smoking
Maternal chronic respiratory or
cardiovascular disease
Post date pregnancy
Pre-eclampsia/eclampsia
Oligohydromnions
IUGR
Abnormal fetal HR pattern
7. Pathophysiology
1. Mechanical obstruction of airways
Thick and viscous meconium lead to complete or partial
airway obstruction.
With onset of respiration- meconium migrates from central to
peripheral airways
Complete obstruction -> atelectasis
Partial Obstruction -> ball valve -air trapping (risk of
penumothorax 15-33%)
2. Chemical pneumonitis
Distal progressing of meconium chemical pneumonitis ->
bronchiolar edema and narrowing of the small airway.
8. 3. Surfactant inactivation
Bilirubin, fatty acid, triglycerides, cholestrol
content of meconium inhibit surfactant
function and inactivation.
4. Pulmonary hypertension
Meconium in lung stimulate - >
proinflammatory cytokines and vasoactive
substance which cause pulmonary
vasoconstriction
Hypoxia, acidosis, hyperinflation ->
pulmonary hypertension
9.
10.
11.
12.
13.
14.
15. CLINICAL FEATURES
History
Infant with MAS must have a history of MSAF
Often are term or post-term
IUGR
Many are depressed at birth
Physical Examination
Evidence of postmaturity ; peeling skin, long fingernails, reduced
vernix
Vernix, umbilical cord and nails may be meconium-stained,
depending how long the infant has been exposed in utero
Generally
nails stained after 6 hrs
vernix after 12-14 hrs
umbilical cord staining thick 15 min, thin 1 hour
16. Respiratory distress with marked tachypnea and cyanosis
Use of accessory muscles of respiration (ICR, SCR and abdominal
breathing) , grunting and nasal flaring.
Chest : appears barreal shape with increase AP diameter due to
overinflation
Auscultation : rhonchi immmediately after birth
Sign of cerebral irritation from cerebral edema or hypoxia :
jitteriness, seizures
Some patient are asymptomatic at birth and develop worsening
signs of respiratory distress as the meconium moves from large
airways into the lower tracheobronchial tree.
Meconium found below vocal cord defines MAS
25. MANAGEMENT
Prenatal
1. Identification of high risk pregnancies
- recognition of predisposing maternal factors
- post dates pregnancy inductions as early as 41
weeks
2. Monitoring
- careful observation and fetal monitoring during labour
- corrective measures should be undertaken to
identifiy
compromised fetus.
3. Amnioinfusion
- relieved umbilical cord compression during labor ->
reducing occurrence of variable fetal heart rate
decelerations
- efficiency not well demonstrated.
27. American Academy of
Paediatric NRP guidelines:
If the baby is not vigorous :
- direct suction immediately after delivery
- suction for no longer than 5 sec
- If no meconium retrieved, do not repeat
intubation and suction
- If meconium is retrieved and no bradycardia
present, re-intubate and suction.
- If HR low, administer IPPV and consider
suctioning again later.
If baby is vigorous :
- Clear secretions and meconium from the
mouth and nose with a bulb syringe or a large
bore suction catheter.
28. Management of newborn with MAS
1. General management
Maintain a neutral thermal environment
Minimal handling protocol to avoid agitation
Maintain adequate BP and perfusion
Correct any abnormalities
Sedation
2. Respiratory management
Pulmonary toilet - from the ETT + chest physiotherapy
every 30 min to 1 hr
Arterial blood gas level - to assess infant ventilatory
compromise
Frequent blood taking -> UAC + UVC
3. Oxygen monitoring
Severity of infant’s respiratory status and to prevent
hypoxemia
Compare pre ductal and post ductal o2 saturation
identifies infant with right to left ductal shunting secondary
to MAS associated pulmonary hypertension
29. 4. Antibiotic coverage
Start on broad spectrum antibiotic
5. Supplemental Oxygen
To prevent episodes of alveolar hypoxia leading to
hypoxic pulmonary vasoconstriction and PPHN.
maintain arterial oxygen tension 80-90mmHg
6. CPAP
7.Mechanical ventilation
In MAS with impending respiratory failure with
hypercapnia and persistent hypoxemia
Volume targeted ventilation decreased lung
overdistention
Use of relatively short inspiratory time limit potential air
trapping
Requires high pressure and faster rate
30. 8. Surfactant
infant with severe MAS
who require mechanical ventilation
and radiologic findings of parenchymal
lung disease benefit from early
surfactant therapy
9. Inhaled nitric oxide
MAS with pulmonary hypertension
31.
32. Prognosis
Complications are common and
associated with significant mortality
Neurodevelopmental sequelae
including , CP, and autism -long
term follow up
33.
34. • ROAMS BY VD AGARWAL 13TH ED
• ESSENCE OF PAEDIATRICS BY PROFF
DR M R KHAN