Paediatric resuscitation for nurses working in Ghana: an educational intervention.

BACKGROUND: Deficiencies in the paediatric emergency systems of developing countries may contribute to avoidable paediatric mortality. Studies suggest that nurses and doctors may not be educationally prepared to provide immediate paediatric resuscitative care to acutely ill children. The purpose of this study was to determine if a 1-day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) Program in paediatric resuscitation would increase Ghanaian nurses' knowledge and self-efficacy of paediatric resuscitation. METHODS: A pre-experimental, one-group, pre-test, post-test design was used to assess differences in the nurses' knowledge of paediatric resuscitation, and their perceived self-efficacy of paediatric resuscitation after completing a 1-day educational intervention in paediatric resuscitation. Forty-one nurses from a public teaching hospital in Ghana were recruited and participated in the study. RESULTS: Using a paired samples t-test, there was a statistically significant increase in the nurses' perceived self-efficacy of paediatric resuscitation in general (P < 0.000), perceived self-efficacy of bag and mask ventilation (P < 0.000), and knowledge of paediatric resuscitation (P < 0.000). CONCLUSIONS: Findings from this study suggest that a 1-day WHO ETAT Program may increase self-efficacy of paediatric resuscitation and knowledge of paediatric resuscitation. CLINICAL RELEVANCE: Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.

Ordered metal nanotube arrays fabricated by PVD.

In this work we report a simple method to fabricate ordered arrays of metal nanotubes. This method is based on the deposition of a metal by PVD onto an anodized aluminum oxide (AAO) template. The dimensions of the synthesized nanotubes depend both on the AAO template and on the deposited metal. In fact, it is observed that the aspect ratios of the nanotubes clearly depend significantly on the metal, ranging from 0.6 (Fe) to at least 3 (Zr).

Hemopoietic stem cell transplantation in childhood: reduction in mortality and improvement of survival over the years.

Stem cell transplantation (SCT) is an effective treatment for life-threatening hematologic and nonhematologic pediatric diseases. Reducing transplant-related mortality (TRM), a major complication of SCT, to improve long-term survival, therefore, is one of the main objectives of transplantation teams. We analyzed TRM and overall survival (OS) over the years in children undergoing SCT in our center. From June 1998 to October 2002, 156 consecutive children, 105 boys and 51 girls, median age 10 years (range, 2-18), with different diagnoses underwent SCT (100 autologous and 56 allogeneic). OS and TRM were analyzed in 2 different periods (June 1989-December 1998 and January 1999-October 2002) and grouped according to the different SCT modalities. The median follow-up was 18 months (range, 1-160). Autologous TRM showed a statistically significant improvement within 1999-2002 (0%) compared with 1989-1998 (12.2%) (P < .05). There were no statistical differences for allogeneic SCT. OS was 34% in the first period and 80.4% in the second period (P < .01), the improvement being for both autologous and allogeneic SCT. In our study, TRM decreased significantly for those children receiving autologous SCT in recent years. OS was significantly better in the latter period (1999-2002), both globally and for each SCT modality.

Prevalencia de diabetes mellitus gestacional en una población de Medellín de 1999 - 2000. Valor predictivo positivo de la prueba tamiz y comparación de los criterios de la NDDG y la ADA / Prevalence of gestational diabetes mellitus in Medelli's population of 1999 - 2000. The positive predictive value of the screening test and comparation of criteria in the NDDG and ADA

Introducción: En 1997 la Asociación Americana de Diabetes (ADA), recomendó cambiar los criterios de tamización y diagnóstico para la diabetes gestacional, no tamizando a las pacientes de bajo riesgo y adoptando para el diagnóstico los criterios de Carpenter y Coustan. En nuestro medio no conocemos la incidencia de la diabetes, ni los niveles de riesgo. Métodos: Se realizó una descripción prospectiva de pacientes gestantes que realizaron control prenatal de agosto de 1999 a julio de 2000, en el CAA central del ISS de la ciudad de Medellín; a todas estas se les realizó la prueba tamiz (prueba de O'Sullivan) entre las semanas 24 - 28 de la gestación y la prueba oral de tolerancia a las que lo requirieron. Se realizó una encuesta telefónica luego del parto para obtener los datos del resultado materno y neonatal. Resultados: Se evaluaron 1726 pacientes de manera consecutiva, encontrando una prevalencia de diabetes gestacional de 1.43 por ciento, la cual aumentó a 2.03 por ciento cuando se aplicaron los nuevos criterios. Se determinó el valor predictivo positivo de la prueba tamiz, demostrando que no es diagnóstica con ningún valor. En cuanto al resultado neonatal el 20.5 por ciento de los bebés presentaron macrosomía, 13 por ciento en el grupo que cumplió los criterios de la NDDG y de 40 por ciento en los que cumplieron los de la ADA. Conclusiones: En este grupo de pacientes se encontró una prevalencia baja de diabetes gestacional en comparación a poblaciones de otras regiones, no se logró demostrar que el adoptar los nuevos criterios mejore el pronóstico materno neonatal; se deben realizar nuevos estudios que permitan una mejor selección de la población que se va a someter a la prueba tamiz para optimizar los recursos.

[Polymorphism of the gene of vitamin D receptor and bone mineral density in postmenopausal women]. / Polimorfismo del gen del receptor de la vitamina D y densidad mineral ósea en mujeres posmenopáusicas.

BACKGROUND: Conflicting results have been reported on the association between restriction fragment length polymorphism at the vitamin D receptor (VDR) gene locus and bone mineral density (BMD). Population differences in environmental factors, such as calcium intake and calcidiol levels which have strong influence in BMD, may alter this association. PATIENTS AND METHODS: We analyzed the Bsml RFLP at the eight introm of the VDR gene in a population sample (n = 204) of postmenopausal Spanish women aged 50-65 years being seen clinically and studied calcium intake (dietetic questionnaire) and biochemical parameters (PTH and calcidiol). In parallel bone densitometry were measured in lumbar spine and proximal femur. RESULTS: We identified low BMD of the proximal femur in the BB group. This effect was not observed at other body locations. The calcium intake was lees than 500 mg/day in 60% of the studied population as calcidiol levels were lower than 10 ng/l in 36% of it. The total group population with normal calcium intake (> 1,000 mg/day) showed higher BMD (proximal femur and spine) than the group with low calcium intake, this variation not being observed in group BB alleles. Interestingly, we observed significant differences in BMD proximal femur between genotype groups BB versus Bb + bb when calcidiol levels were < 10 ng/l. Moreover, within the BB subgroup, those subjects with normal calcidiol levels have higher proximal femur BMD compared with those with low calcidiol levels. CONCLUSIONS: Our results indicate an effect of the VDR genotype on BMD proximal femur which is clearly influenced by calcium intake and calcidiol serum levels.

Large-volume liposuction in 181 patients.

Liposuction is a commonly performed cosmetic surgery procedure that is associated with complications, including fatalities. Many of these have been associated with large-volume liposuction. During 1998 the American Society of Plastic Surgery Task Force on Lipoplasty and the Plastic/Cosmetic Surgery Committee of the Medical Board of California have both arbitrarily defined large-volume liposuction as greater than 5000 cc and asked that surgeons not remove any more than this volume except in specific circumstances such as a hospital-type setting [1]. This study includes 181 patients who have had greater than this amount of total aspirate removed in a single procedure. From January 1, 1996, to February 11, 1997, we used tumescent liposuction only (31 patients). From February 12, 1997, to June 30, 1998, we used a combination of ultrasonic liposuction using the Lysonix 2000 Ultrasonic Liposuction Unit and tumescent liposuction (150 patients). During the last part of the latter series we calculated the blood loss of 45 patients derived from preop and 5-day postop hematocrits. The results show that (1) there is no correlation between the aspirate volume and the calculated blood loss; (2) the majority of the calculated blood loss is not in the cannister; and (3) no deaths occurred, but one patient suffered a deep venous thrombosis and two patients suffered pulmonary emboli. As others have pointed out [2-6] large-volume liposuction can be performed relatively safely if this procedure is treated with the respect it deserves and the practitioner exercises sound surgical judgment, uses appropriate technique, and does not try to cut corners to save money for the patient by performing this surgery in minimal settings.

C-terminal parathyroid hormone-related protein inhibits proliferation and differentiation of human osteoblast-like cells.

Parathyroid hormone-related protein (PTHrP) is synthesized by osteoblasts, although its local role in bone is not completely understood. The C-terminal (107-111) region of PTHrP seems to be a potent inhibitor of osteoblastic bone resorption. We studied the effect of this PTHrP domain on the proliferation and synthesis of osteoblastic markers in osteoblast-like cells from adult human bone. We found that the human (h)PTHrP(107-139) fragment, between 10 fM and 10 nM, inhibited 3H-thymidine incorporation into these cells. The antiproliferative effect of the latter fragment, or that of hPTHrP(107-111), was similar to that induced by [Tyr34] hPTHrP(1-34) amide, bovine PTH(1-34), and hPTHrP(1-141), while hPTHrP(38-64) amide was ineffective. Human PTHrP(7-34) amide, at 10 nM, and 1 microM phorbol-12-myristate-13-acetate also significantly decreased DNA synthesis in human osteoblast-like cells. Neither hPTHrP(7-34) amide nor hPTHrP(107-139), at 10 nM, stimulated protein kinase A (PKA) activity in these cells. Moreover, 100 nM H-89, a PKA inhibitor, did not eliminate the inhibitory effect of hPTHrP(107-139) on these cells' growth. However 100 nM calphostin C, a PKC inhibitor, blunted this effect of PTHrP(107-139). In addition to their antimitogenic effect, hPTHrP(107-139) and hPTHrP(107-111) inhibited basal and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3)-stimulated alkaline phosphatase activity in these cells. Both fragments, like 1,25(OH)2D3, decreased C-terminal type I procollagen secretion into the cell-conditioned medium, but osteocalcin secretion by these cells was unaffected by the C-terminal PTHrP fragments. These findings suggest that PTHrP may act as a local regulator of bone formation.

[Informatics support to medical diagnosis. General information obtained from a first structured contact with the patient]. / Ayuda informática al diagnóstico médico. Información general obtenida en un primer contacto estructurado con el paciente.

BACKGROUND: The methods and characteristics of clinical data gathered at the initial steps of development of a computerized system to aid medical diagnosis are reported. The objectives of the study were as follows: to describe the overall method and to set a framework for developing an intellectual model of the medical diagnosis procedure. MATERIAL AND METHODS: A structured medical interview and physical examination using an informatic program on PC compatible portable computers were completed in a sample 1,238 patients attending the outpatient clinics of our institution. Data obtained were compared with information in the patient's medical record taking as reference pattern the record of physicians in charge of the patients. Diagnosis were codified according to WHO International Classification of Diseases (ICD-9-CM). RESULTS: The distribution of symptoms and signs corresponding to the different organs and systems was analyzed. Each subdivision afforded a range of 1.3 to 3.9 abnormal findings per patient. A total of 3,571 diagnoses were codified for the whole group 1,238 patients with a mean (standard deviation) of 3 (2) diagnoses per patient (range 0-12). The distribution of diagnostic groups varied depending on the consideration of the main diagnosis or the concomitant diagnoses that defined the patient's clinical context. The most frequent main diagnoses included tumors, cardiovascular diseases, gastrointestinal disorders, and genitourinary tract diseases. CONCLUSIONS: As shown by results obtained in a sample of 1,238 patients, there is a very complex situation in clinical practice due to the simultaneous occurrence of several clinical patterns. This finding should be taken into account when developing clinical decision making support systems. The use of a structured medical interview or a structured and standard medical visit may be an adequate tool to clarify this matter and to contribute to standardization of clinical concepts and situations.

Prevalence of antibodies against enterically transmitted viral hepatitis (HAV and HEV) among adolescents in an inland territory of central Italy.

A study on the seroprevalence of HAV and HEV infections among adolescents in an inland territory of central Italy (Molise region) was carried out. The prevalence of antibodies was respectively 3.3% and 0.4%. The results indicated that (1) anti-HAV prevalence in children is low but HAV infection is always present, and (2) HEV infection could be endemic and not necessarily imported.

[Applicability of the Spanish version of the Belloc's Physical Status Inquiry-PSI: a perceived health status measurement scale]. / Aplicabilidad de la versión española del Cuestionario de Salud Física-PSI-de Belloc: una escala de medida del estado de salud percibida.

The objective of this work is to present the adaptation into Spanish of the Belloc's Physical Status Inventory-PSI-, and to describe the results of the preliminary validity of the Spanish version of this instrument. The process of translation and back-translation of the PSI revealed a high linguistic compatibility of the English and Spanish versions of the instrument. The construct validity was verified, on the same patients, by comparison of the PSI's data with the diagnostic categories and the presence of chronicity reported by the primary care practitioner, with the mental health status established by the GHQ-28, and with the utilization of health resources. We could say dat, in general, the PSI is a reliable measure of health status, being especially useful for its application on the general population and in patients in contact with medical agencies. It is thus justifiable to continue analyzing, by means of more specific methodological designs, the performance of this instrument in different Spanish populations.

[Immunotherapy with interleukin-2 and allogenic LAK cells in a patient with acute myeloblastic leukemia]. / Inmunoterapia con interleucina-2 y células LAK alogénicas en un paciente con leucemia aguda mieloblástica.

At the present time the effectiveness of interleukin-2 (IL-2) administered together with IL-2 in vitro activated lymphocytes (LAK) in the treatment of malignant neoplasias is being assessed. We report the case of an 8 -year- old patient suffering from acute myeloid leukemia (AML) who had relapsed from an autologous bone marrow transplant (ABMT) and received a second ABMT in partial remission. After the second ABMT, the patient, who entered into a phase of complete remission (CR) but with a severe thrombocytopenia, was treated with IL-2 and allogeneic LAK cells obtained from his father. During treatment the lymphocyte subpopulations and cytolytic activity were assayed. Increases in the patient's lymphocytes with CD3- CD4- CD8- CD16+, CD3- CD4- CD8- CD56+, CD3- CD4- CD8+ CD56+ and CD3- CD4- CD8+ CD56+ phenotypes were observed and these were correlated with cytolytic activity measured against the K562 cell line. The patient remained in CR for longer (14 months) than after the first ABMT (5 months). The immune activation produced by this therapy could have had an antileukemic effect in the patient.

The anesthetic management of the severely burned patient.

The anesthetic management of patients with major burns must be based on pathophysiological knowledge of the disease. In the immediate post-burn period hemodynamic changes are of major importance. Because in severe cases any of the determinants of cardiac output can be implicated in these changes, precise physiological measurements are required. Arterial pressure, urinary output, central venous pressure and right heart catheterization can help in choosing the appropriate intervention. The metabolic response to the injury is initially protective, providing enough substrate, but later will lead to extreme levels of catabolism which can impair wound healing and immunological response. The anesthesiologist can decrease that response by providing calories, adequate room temperature, a reduction of the NPO period to the minimum necessary, and avoiding stress situations. Respiratory injury can either affect the upper airway or produce the picture of ARF, which may require special treatment before, during and after surgery. Several technical problems are usually present in the anesthetic management of these patients: 1) difficult airway, 2) scarce venous access, 3) no places available for monitoring, 4) drug dependency, 5) multiple anesthetics, 6) tendency to hypothermia, 7) inaccurate estimation of blood loss, 8) hyperkalemia after succinylcholine administration, and 9) systemic effect of topical medications.

Technical and pharmacologic management of distal hypotension during repair of coarctation of the aorta.

Neurologic and abdominal complications can occur in the postoperative period of aortic coarctation repair, ischemia being the pathogenic factor most likely to be involved. This study was designed to evaluate the extent of the hemodynamic changes proximal and distal to the coarctation at the time of cross-clamping, as well as the effects of pentolinium and isoproterenol upon the hemodynamic changes. Included in the study were 17 patients with adult type coarctations who had dual hemodynamic monitoring. During cross-clamping, there was an increase in the gradient between proximal and distal pressures, with severe distal hypotension (< 50 mm Hg) occurring in six patients. Isoproterenol corrected the hypotension in five patients, but the sixth required a surgical shunt. Pentolinium was effective for the treatment of proximal hypertension; however, it also decreased distal pressure. The ligation of collateral vessels was associated with a decrease in distal pressures as well. During cross-clamping, pentolinium was useful for the management of proximal hypertension and isoproterenol increased the distal pressures in some of the patients who presented distal hypotension. However, because of the difficulties in predicting the individual response, their administration would be best guided by dual pressure monitoring. It is postulated that the recognition and proper treatment of distal hypotension may be an important factor in the prophylaxis of postoperative complications.

Lumbar epidural anaesthesia and sensory profiles in term pregnant patients.

Sensory profiles of lumbar epidural anaesthesia were studied in 57 patients, during active labour. The local anaesthetics used were chloroprocaine three per cent with and without epinephrine, chloroprocaine two per cent, bupivacaine 0.25 per cent and a mixture of chloroprocaine three per cent and bupivacaine 0.5 per cent. A common pattern of spread was found for all local anaesthetic solutions with the onset of the block affecting the dermatomes innervated by the thinnest nerve roots (T12L1). There was a percentage of failure to block the thickest nerve root (S1). Inguinal and suprapubic discomfort ("missing segment") occurred when S1 was not blocked. Under the conditions of this experiment, the addition of bupivacaine to chloroprocaine did not increase the duration of the blockade significantly.

The effect of short-term discontinuation of high-level PEEP in patients with acute respiratory failure.

PEEP is the most important therapeutic intervention in the management of acute respiratory failure. Transitory PEEP disconnection to perform clinically relevant maneuvers is often necessary, but its effect upon PaO2 and physiological shunt in patients requiring high-level PEEP is not clear from the literature. Nine adult patients in severe respiratory failure requiring high-level PEEP therapy were studied. The elimination of PEEP decreased the PaO2 and increased the physiological shunt. Maximum values were reached in about 4 min. Restoration of PEEP after 7.4 min in zero and end-expiratory pressure caused an increase in the PaO2 and decrease in the physiological shunt. Baseline values were restored in about 5 min. In 4 patients having endotracheal suction under hand ventilation with 100% oxygen, the continuous PaO2 recording showed an increase in PaO2 during the maneuver. Therefore, necessary manipulations can be accomplished without fear of negating the salutory effects gained by high-level PEEP therapy.