Evaluation of the retention of knowledge, skills and competency of post-neonatal resuscitation training among house officers.

INTRODUCTION: The Neonatal Resuscitation Programme (NRP) was first introduced in Malaysia in 1996 to train doctors and nurses working in paediatrics and obstetrics departments who are involved with the care of newborns soon after delivery. Prompt and effective neonatal resuscitation has been documented to reduce mortality and neonatal asphyxia. The programme has been revised every five years and is now in the 8th edition. NRP training was made into a key performance indicator (KPI) by the Ministry of Health in 2016 for all house officers to be trained in this programme during their 2-year posting and this is usually conducted during the paediatric posting. This study aims to evaluate the retention of their knowledge, skills and competency at 3, 6, and 9 months after the initial NRP training. MATERIALS AND METHODS: A total of 34 house officers were enrolled in the study on joining the paediatric unit of Hospital Kulim. They were given the "Textbook of NRP" to prepare for the theory paper that consisted of 30 multiplechoice questions (MCQs). Two to four weeks later they went through a day of training on the resuscitation of the newborn using low-fidelity simulation manikins. They were taught to recognise a newborn who needed resuscitation after delivery, prepared the equipment for resuscitation and learned the skills of resuscitation. The skills included the initial steps, bag valve mask ventilation, intubation, cardiac massage, umbilical vein cannulation and use of medications. They were also taught the performance of objective structured clinical examination (OSCE) A and B. They were evaluated at 3, 6, and 9 months after the completion of their training using the MCQs and the performance checklist in the NRP textbook. RESULTS: The results showed that there was a significant reduction in their knowledge retention as shown by their performance in multiple choice questions. Similarly, there was a significant loss of competency in their skills and competency in resuscitation using bag mask ventilation, intubation and performance of OSCE A and OSCE B. However, their performance at initial steps showed no significant reduction. CONCLUSION: In view of the observed deterioration a refresher course in NRP before transferring out to the districts is recommended to improve their overall performance.

Role of Seasonal Variation on The Prevalence and Risk Factors of Trichuriasis Among the Aboriginal Community in Malaysia.

Trichuris trichiura is a soil-transmitted helminth prevalent in developing countries with poor, inadequate sanitation and unsafe water sources. In Malaysia, the prevalence of trichuriasis is relatively high among the aboriginal community due to poverty and poor sanitation. However, there are few studies to determine the seasonal variation on the prevalence and risk factors to acquire Trichuris trichiura infection in Malaysia. The present study found higher Trichuris trichiura infection during the dry season (63.6%; 138/217) in comparison to the wet season (55.5%; 142/256). Low household income, low education level and practice of open defecation were significant risk factors to acquire Trichuris trichiura infection during the wet season. Usage of untreated water supplies for daily activities was a risk factor to acquire trichuriasis during the dry season. This study highlighted that poverty and poor sanitation practices as well as drinking untreated water put the aborigines at high risk to acquire trichuriasis. Therefore, health education, improved sanitation and provision of treated water supply are recommended for the prevention and control of Trichuris trichiura infections in the aboriginal community.

Birth outcomes in women with gestational diabetes managed by lifestyle modification alone: The PANDORA study.

AIMS: To assess outcomes of women in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort with gestational diabetes mellitus (GDM) managed by lifestyle modification compared with women without hyperglycaemia in pregnancy. METHODS: Indigenous (n = 97) and Europid (n = 113) women managed by lifestyle modification were compared to women without hyperglycaemia (n = 235). Multivariate linear and logistic regressions assessed whether GDM-lifestyle women had poorer outcomes compared to women without hyperglycaemia. RESULTS: Women with GDM-lifestyle had higher body mass index and lower gestational weight gain than women without hyperglycaemia. On univariate analysis, gestational age at delivery was lower and induction rates were higher in women with GDM-lifestyle than without hyperglycaemia. On multivariable regression, GDM-lifestyle was associated with lower gestational age at delivery (by 0.73 weeks), lower birthweight z-score (by 0.26, p = 0.007), lower likelihood of large for gestational age (LGA) [OR (95% CI): 0.55 (0.28, 1.02), p = 0.059], and greater likelihood of labour induction [2.34 (1.49, 3.66), p < 0.001] than women without hyperglycaemia. CONCLUSION: Women with GDM managed by lifestyle modification had higher induction rates and their offspring had lower birthweight z-scores, with a trend to lower LGA than those without hyperglycaemia in pregnancy. Further studies are indicated to explore reasons for higher induction rates.

Blastocystis spp. contaminated water sources in aboriginal settlements.

Blastocystis has been increasingly reported in water bodies. However, lack of studies to determine the presence of Blastocystis in water used by the aborigines in Malaysia has led to the birth of this research. This study was therefore aimed to determine the occurrence of Blastocystis in water samples in aboriginal settlements in Pahang, Malaysia. Water samples collected from seven sampling points of two rivers and other water sources in the villages were subjected to filtration and cultivation followed by trichrome staining. The trichrome stained slides were observed microscopically under 1000X magnification for the presence of Blastocystis. River samples were also measured for physicochemical parameters. From this study, 42.9% of the river water and 6.25% of other water samples were positive for Blastocystis. All river samples showed presence of Escherichia coli and Enterobacter aerogenes, indicating faecal contamination. Statistical analysis showed Blastocystis occurrence in the river were significantly correlated conductivity, turbidity, chemical oxygen demand (COD), total dissolved solid (TDS), concentration of sulfate and faecal coliforms. The river water used by the aborigines is a probable source for Blastocystis transmission in this community. Therefore, protection of the river from organic material and faecal contaminations are highly required in order to control the contamination by Blastocystis.

Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial.

OBJECTIVE: To evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding. DESIGN: Multicentre, three-arm, cluster randomised controlled trial. POPULATION: A cohort of 722 primiparous breastfeeding mothers with uncomplicated, full-term pregnancies. METHODS: The three study interventions were: (1) standard postnatal maternity care; (2) standard care plus three in-hospital professional breastfeeding support sessions, of 30-45 minutes in duration; or (2) standard care plus weekly post-discharge breastfeeding telephone support, of 20-30 minutes in duration, for 4 weeks. The interventions were delivered by four trained research nurses, who were either highly experienced registered midwives or certified lactation consultants. MAIN OUTCOME MEASURES: Prevalence of any and exclusive breastfeeding at 1, 2, and 3 months postpartum. RESULTS: Rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow-up points, when compared with those who received standard care. Participants receiving telephone support were significantly more likely to continue any breastfeeding at 1 month (76.2 versus 67.3%; odds ratio, OR 1.63, 95% confidence interval, 95% CI 1.10-2.41) and at 2 months (58.6 versus 48.9%; OR 1.48, 95% CI 1.04-2.10), and to be exclusively breastfeeding at 1 month (28.4 versus 16.9%; OR 1.89, 95% CI 1.24-2.90). Participants in the in-hospital support group were also more likely to be breastfeeding at all time points, but the effect was not statistically significant. CONCLUSIONS: Professional breastfeeding telephone support provided early in the postnatal period, and continued for the first month postpartum, improves breastfeeding duration among first-time mothers. It is also possible that it was the continuing nature of the support that increased the effectiveness of the intervention, rather than the delivery of the support by telephone specifically.

Predominance of Blastocystis sp. subtype 4 in rural communities, Nepal.

Blastocystis sp. is a common intestinal parasite. To date, there have been sporadic and scanty studies on Blastocystis sp. carried out in rural communities in Nepal. We surveyed the prevalence of Blastocystis sp. and its possible associated risk factors, and reported the predominant Blastocystis sp. subtype in two rural communities, Bolde Phediche and Bahunipati, in Nepal. Human faecal samples were collected from 241 participants, cultured using in vitro cultivation and examined for Blastocystis sp. The presence of Blastocystis sp. in faecal samples was further confirmed by polymerase chain reaction (PCR) and subsequently genotyped using subtype-specific sequence tagged site (STS) primers. There were 26.1% (63/241) of the participants that were infected by Blastocystis sp. We detected 84.1% (53/63) of Blastocystis sp. subtype 4 infections in these rural communities. The unusually high prevalence of Blastocystis sp. subtype 4 can be attributed to the rearing of family-owned animals in barns built close to their houses. Eighty one percent (51/63) of the Blastocystis sp. infected participants drank not boiled or unfiltered water. The present study revealed that Blastocystis sp. could pose a health concern to the communities and travellers to the hilly area in Nepal. Infection may be transmitted through human-to-human, zoonotic and waterborne transmissions. We provide recommendations to ensure good public health practices.

Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer.

BACKGROUND AND STUDY AIMS: Subepithelial tumors of the stomach used to be considered as benign, but they do have malignant potential, especially when they originate from the muscularis propria layer. The aims of this study were to determine the feasibility of endoscopic submucosal dissection (ESD) for the removal of subepithelial tumors from the muscularis propria layer and to evaluate the efficacy and safety of ESD for this indication. PATIENTS AND METHODS: A total of 12 lesions in 11 patients were eligible for inclusion in the study during the period between December 2004 and February 2006. ESD using an insulated-tip knife was used to remove gastric subepithelial tumors from the muscularis propria where this was possible. Endoscopic mucosal resection using a suction and cap method ("EMR-c") was used to obtain a sufficiently large specimen for tissue diagnosis if complete resection by ESD was not possible. RESULTS: Nine tumors were resected completely by ESD (success rate 75 %). The mean tumor size as determined by endoscopic ultrasound as 20.7 mm (range 6 - 40 mm). The histological diagnosis was gastrointestinal stromal tumor for eight lesions and leiomyoma for four tumors. The mean operation time was 60.9 minutes (range 20 - 170 minutes), and the average blood loss was 30 ml. No patient developed perforation or massive hemorrhage requiring surgical treatment, and there were no other immediate postprocedure complications. CONCLUSIONS: ESD can be used for the resection of intraluminal gastric subepithelial tumors and could replace treatment by surgical resection in some cases. EMR-c is an alternative method that can be used to obtain sufficient tumor tissue for histological diagnosis if complete resection by ESD fails.

Less patient discomfort by one-man colonoscopy examination.

A randomised prospective trial compared safety and patient tolerance for one-man method with two-man method undergoing colonoscopy. Eighty patients were randomized to 1 of 2 groups: the two-man method group (n = 40); or the one-man method group (n = 40). All colonoscopic examinations were performed by the same endoscopist to reduce skill-based variation. Patient tolerance for colonoscopy was evaluated with a numerical rating scale ranging from 0 for painless to 5 for maximal pain. Cardiopulmonary parameters were recorded during the procedure. Patients receiving one-man method had lower pain score than two-man method. The length of the scope reach to the cecum was shorter in the one-man group than the two-man group. The patients underwent two-man colonoscopy had higher maximum increase in heart rate during the procedure compared with one-man group. One-man colonoscopy can improve patient tolerance and reduces patient pain by decreasing the redundancy of colonoscope during the procedure.

Macular hole surgery with and without indocyanine green assistance.

PURPOSE: To compare the results of macular hole surgery with the use of indocyanine green (ICG) to assist internal limiting membrane (ILM) peeling and macular hole surgery without indocyanine green use. METHODS: A retrospective, comparative, consecutive study of 68 patients with macular holes. In total, 34 patients underwent vitrectomy and ILM peeling, and 34 patients underwent vitrectomy and ILM peeling with the assistance of indocyanine green. The main outcome measures were postoperative visual acuity and macular hole status. RESULTS: Indocyanine green increased the ability to visualise and peel the ILM. The average preoperative visual acuity in the group where ICG was used was 6/36 and the group where ICG was not used was 6/60. The average follow-up was 25 weeks for the ICG group and 53 weeks for the group with no ICG. Both groups were also compared at 25 weeks follow-up. Hole closure rate for the group with ICG was 97% compared to 91% without ICG. The mean postoperative visual acuity was 6/24 for the group with ICG and 6/12 for the group without ICG, a difference of two lines on the Snellen chart when compared with the preoperative acuity (P-value 0.299, Student's t-test). Both groups had a mean improvement of Snellen acuity of two lines (ICG group: P-value 0.0002, Student's t-test; no ICG group: P-value 0.00004, Student's t-test). In all, 83% of patients in the ICG group maintained or improved their visual acuity compared to 91% in the group without ICG. DISCUSSION: There is no doubt that indocyanine green stains and assists in visualisation and therefore increases the ease of peeling the ILM in macular hole surgery. Initially, there was concern regarding a poorer outcome for patients with the use of ICG, which has also been previously discussed in the literature. When the two groups were compared at a similar follow-up time of approximately 25 weeks, it was shown that there was no statistically significant difference between the outcomes in the two groups. This study had an improved hole closure rate for the group where ICG was used, although it was not statistically significant.

Smooth muscle myosin heavy chains are developmentally regulated in the rabbit bladder.

PURPOSE: In smooth muscle (SM), myosin heavy chain (MHC) is expressed predominantly as two isoforms, SM1 and SM2, which are encoded by a single gene and expressed by alternative splicing mechanisms. Although functional differences of these isoforms are unknown, changes in SM1/SM2 ratio have been reported in various pathophysiologic conditions. We analyzed MHC composition of bladder detrusor SM from rabbits of different ages to determine whether SM1 and SM2 isoform expressions are developmentally regulated. MATERIALS AND METHODS: Rabbit bladders on the -11, -4, 1, 7, 14, 21, and 90th days of life were analyzed for SM MHC isoform expression at protein and mRNA levels. Porous sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), S1 protection assay, and histological analysis were employed. RESULTS: The predominant MHC isoform in fetal and neonatal bladders was SM1. In the third postnatal week, the SM1/SM2 ratio decreased from 2.3 to 1.0. A stable SM1/SM2 ratio of 0.6 was observed in the adult animal. Although expression of SM1 mRNA was 2.6-fold greater than that of SM2 in the fetus, the relative amount of SM2 mRNA increased rapidly after birth and remained the predominant isoform throughout adult life. Developmental changes in relative amounts of SM1 and SM2 protein in bladder tissues were virtually identical to those of SM1 and SM2 mRNA. SM cell growth and disappearance of primitive mesenchyme from the bladder occurred concomitantly with the MHC isoform shift. CONCLUSIONS: The parallel temporal course of MHC mRNA and protein isoform levels suggests detrusor SM MHC expression may be developmentally regulated at the mRNA level.

Myosin heavy chain gene expression in normal and hyperplastic human prostate tissue.

BACKGROUND: Benign prostatic hyperplasia (BPH) is common among aging men. Over 80% of males 50-60 years and older have various degrees of bladder outlet obstruction secondary to BPH. Despite the tremendous medical impact of BPH, its molecular pathophysiology remains unclear. Current BPH research focuses on steroid hormonal effects, stromal-epithelial cell interaction, and oncogenes and growth factors. But little is known about the potential prostatic smooth muscle (SM) alterations that may occur during stromal hyperplasia. METHODS: To study SM phenotypic modulation in hyperplastic prostatic growth, we isolated and characterized the 3' end of human SM myosin heavy chain (SMMHC) cDNA as a molecular probe. Expression of SMMHC and nonmuscle myosin heavy chain (NMMHC) in human prostates was analyzed using Western blot, Northern blot, and in situ hybridization to determine if BPH tissue expresses significantly less SMMHC and more NMMHC than a normal prostate. In addition, a competitive, reverse transcription (RT) polymerase chain reaction (PCR) method was adapted to quantify SMMHC and NMMHC mRNA expression at the sensitivity level of 10(-21) mole per mg of wet tissue. RESULTS: Western blot, Northern blot, and in situ hybridization results reveal that both SMMHC and NMMHC are expressed in the human prostate, while SMMHC is the predominant form found in normal prostate stroma. Results from competitive RT-PCR analysis indicate that NMMHC mRNA expression is approximately 10(-20) mole/mg of tissue. The SMMHC mRNA expressed is approximately 10(-18) mole/mg. No significant difference was found when NMMHC mRNA expression was compared between normal and BPH periurethral tissues. However, SMMHC expression was reduced almost fivefold in BPH compared to normal prostate, despite an increase in prostatic stromal mass. CONCLUSIONS: Our results suggest the pathogenesis of BPH is associated with a unique type of SM proliferation. Such proliferation is characterized by downregulation of SMMHC mRNA expression but without upregulation of NMMHC mRNA expression, the pattern seen in proliferating SM cells in culture and in other pathologic forms of SM hyperplasia (e.g., atherosclerosis). These findings support a model of BPH typified by active smooth muscle proliferation early in the disease process, and supports clinical observations that suggest ongoing prostate growth of the prostate is minimal in older men. Therapeutic strategies to prevent disease progression should therefore focus on early phases of prostatic growth.

Haemophilus influenzae resistentes a ampicilina. / Ampicillin resistance in Haemophilus influenzae

Desde alguns anos vem sendo descritos em todo o mundo cepas emergentes de Haemophilus influenzae resistentes a ampicilina.Apos uma analise ampla do problema, suas causas e consequencias, os Autores apresentam um estudo de 90 casos de criancas com meningite por Haemophilus influenzae, cepas estas que se mostraram resistentes a ampicilina em 64,4% dos casos, utilizandose o metodo de disco de Kirby-Bauer. E estudada e analisada a evolucao dessas criancas, das quais 60,34% tinham menos de um ano de idade. A terapeutica alternativa proposta foi o cloranfenicol e o resultado final revelou letalidade de 12,l%. Sao discutidas as implicacoes terapeuticas de tal achado e os diversos esquemas que podem ser adotados no sentido de se obter melhores resultados no tratamento das criancas infectadas com o Haemophilus

Single dose treatment with Tiberal of Giardia lamblia infection in children.

A new metronidazole derivative, Tiberal (Ro-07-0207, Roche Laboratories), was evaluated in 22 children with Giardia lamblia infection. Seven patients received an oral dose of 1 g twice daily for one day; the remaining 15 patients received a single dose of 50 mg/kg. Parasitological cure was noted in all 22 patients. Significant side effects were observed only in those children who received the drug at the higher dosage regime. The present study also confirms the findings of other authors that a mucosal imprint method is more reliable than examination of stools, duodenal juice or jejunal biopsy material for the detection of G. lamblia infection.