Preparing future Indian medical graduates for emergencies at the Foundation Course: Do the knowledge and self-confidence increase after basic cardiac life support training?

Background and Aims: Medical professionals must be able to perform life-saving skills like cardiopulmonary resuscitation (CPR) during emergency situations, even outside the hospital. The foundation course for the first-year medical students includes first aid and CPR training. This quasi-experimental study was conducted to assess the effectiveness of basic cardiac life support (BCLS) training based on Indian guidelines, on the self-confidence and knowledge regarding CPR of first-year medical students. Methods: This study was conducted during the foundation course for first-year medical students. The training included a common lecture for all the students followed by a 4 day long practical training in groups of 45-46 students, each day. BCLS training was carried out in three skill stations - airway, chest compressions and full sequence CPR. Students' skills were recorded real time on a skill assessment manikin after completion of the hands-on training. The students were asked to fill a questionnaire regarding knowledge and self-confidence, before and after the training. The outcome measures were the difference in knowledge and self-confidence with regard to CPR before and after the training. Results: Out of the 199 students, 181 were included in the analysis. There was significant improvement in the knowledge score (pre-test - 1.46 versus post-test - 8.27, P < 0.001). The overall confidence regarding first aid skills, BCLS knowledge and self-confidence for performing BCLS improved significantly. Conclusion: There is improvement in knowledge and self-confidence regarding CPR and the students develop an acceptable level of skills after the training.

Levosimendan in Cardiac Surgery: Evaluating the Evidence.

Levosimendan, a calcium-sensitizing and Adenosine triphosphate-sensitive potassium channel opening inodilator, has the potential to improve cardiac function without increasing oxygen consumption. The evidence supporting the use of levosimendan in the cardiac surgical perioperative period is not well-established. Recently, large-scale randomized controlled trials studying the utility of levosimendan in cardiac surgery have been conducted. This review examines the physiological and pharmacologic properties of levosimendan and evaluates the literature regarding the use of levosimendan in patients undergoing cardiac surgery.

Author Correction: Salinity stratification controlled productivity variation over 300 ky in the Bay of Bengal.

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Salinity stratification controlled productivity variation over 300 ky in the Bay of Bengal.

The unique hydrographic setting of the Bay of Bengal (BoB) makes it an ideal tropical marine system to study the influence of regional and global forcings on productivity and [CO2aq] through the late quaternary. Enormous fresh water flux into the BoB and consequent salinity stratification significantly weaken the convective mixing and wind driven processes which are commonly responsible for transport of nutrients to the euphotic zone driving primary productivity. Here we present a high resolution organic carbon-CaCO3 MAR and δ13CTOC records for the last 300 ky from the BoB. The results show significant productivity variation at marine isotope sub-stages and millennial timescales. Colder sub-stages and stadials (Dansgard-Oeschger cycle) show a boost in productivity which may be attributed to thinning of low salinity cap, thereby facilitating efficient nutrient transport across the euphotic zone by the combination of wind driven processes (entrainment and upwelling), convective mixing and cold core eddies. The [CO2aq] was a net result of global pCO2 variation and regional processes. Our long term high-resolution data indicates a possibility of marked change in productivity/biogeochemistry of BOB in the future due to global warming, thus affecting the coastal economy.

Microleakage in Resin Composite Restoration following Antimicrobial Pre-treatments with 2% Chlorhexidine and Clearfil Protect Bond.

AIM: To evaluate microleakage in resin composite restorations after antimicrobial pre - treatments. MATERIALS AND METHODS: Forty freshly extracted non carious human premolars were procured. In all forty premolar specimens, class V preparation of standard dimension were prepared and were randomly divided into three experimental and one control group. In all control and experimental groups the class V preparations were restored with FILTEK Z350 composite restorative material. The experimental groups included different self etching primers and 2% Chlorhexidine gluconate. The control group included Xeno III and no antimicrobial pre-treatment was done for the control group. Thereafter these specimens were thermocycled, dried and sealed with nail varnish, leaving 1mm around the restoration and immersed in 0.5% basic fuchsin for 24 hours and then the specimens were subjected for microleakage evaluation. The results were statistically analyzed by Kruskal Wallis Test and Mann Whitney 'U' test. RESULTS: Results indicate that group II (2% chlorhexidine gluconate group) had the minimum mean value (15.05) and group III(Clearfil protect Bond group) and IV(control group) had the maximum mean microleakage at the enamel margin (23.00). At the gingival margin the lowest mean microleakage values were obtained with group I (Clearfil SE bond group) and group II (2% chlorhexidine gluconate) (20.25) and highest with group III and group IV (20.85). The difference was not statistically significant both at the enamel margin and the dentin margin (p>0.05). INTERPRETATION & CONCLUSIONS: Within the limitations of this in-vitro study, we conclude that: None of the materials tested in this study completely eliminated microleakage at the enamel and at the gingival margin.All of the tested materials provided better sealing at the enamel margin than at the gingival margin.

Lasers: The Magic Wand in Esthetic Dentistry!!

In this era of fast developing technologies and innovative ideas, the need for faster treatment has become a necessity. Treatment with lasers that is much less time-consuming and painless is accepted and appreciated by the patient. Use of Lasers is not new; they have been in use for decades since their development by Maiman in 1960. Lasers have travelled a long way from ruby lasers to erbium lasers and are being fondly used in every aspect of dental treatment. This article aims at elaborate the use and applications of lasers in the field of esthetic dentistry.

Irrigation-coupled bipolar cautery unit: A practical, economical, and simple version.

Hemostasis is a fundamental principle of surgery for which electrocoagulation is universally used. Bipolar electrocautery has an advantage over monopolar electrocautery in terms of the precision of the extent of tissue coagulation and the lateral extent of thermal tissue injury. However, secondary to the thermal changes induced in the tissue due to electric current passage, there is charring of tissue, which adheres to the cautery tip. This, not only decreases its effectiveness, but also, by getting avulsed while removing the cautery tip from the surgical field, causes rebleeding and more trauma to the tissue. Irrigation of the surgical field during application of cautery reduces the charring effect, thereby improving the efficiency and efficacy. Irrigation-coupled electrocautery devices are available but are costly to acquire and maintain. We describe a simple and reliable version of an irrigation-coupled cautery device, which is of immense functional utility in our experience. It decreases the amount of charring of the tissue and its adherence to the bipolar forceps tips, thereby decreasing the frustrating loss of effectiveness and also increases the life of the bipolar forceps as cleaning needs to be less frequent. By virtue of its simplicity and cost-effectiveness, it can be used in almost all hospitals and situations.

Melatonin provides signal 3 to unprimed CD4(+) T cells but failed to stimulate LPS primed B cells.

Growing evidence has supported the conclusion that melatonin, a pineal hormone, modulates the immune function. In our previous study, we evaluated in vivo the potential role of melatonin in the regulation of the antigen specific T and B cells. In the present study, we observe that melatonin down-regulated the expression of the co-stimulatory molecule B7-1 but not B7-2 on macrophages. Further, melatonin encouraged the proliferation of anti-CD3 antibody activated CD4(+) T cells only in the presence of antigen-presenting cells and promoted the production of Th2-like cytokines. Furthermore, it failed to influence the activity of B cells in a T-independent manner. Melatonin suppressed the release of TNF-alpha by LPS or IFN-gamma activated macrophages but failed to inhibit nitric oxide (NO) release. Thus the study shows that melatonin can engineer the growth of unprimed CD4(+) T cells if both the signals are provided by antigen-presenting cells. However, it could not regulate the function of B cells.

Central nervous system depressant activities of melatonin in rats and mice.

Melatonin (10 and 20 mg/kg) potentiated pentobarbitone (45 mg/kg) induced hypnosis; it (50 and 100 mg/kg) decreased both total and ambulatory activity; produced (10, 25 and 50 mg/kg) hypothermia and possessed (10-400 mg/kg) significant analgesic property both in tail-flick and acetic acid-induced writhing tests. Melatonin in low dose (10 mg/kg) significantly reduced the forced-swimming induced immobility period per se and also reserpine induced immobility. While the antinociceptive effect of melatonin was sensitive to reversal by naloxone (2 mg/kg), other CNS depressant profile resembled the effects of benzodiazepines.

Evidence of GABAergic modulation in melatonin-induced short-term memory deficits and food consumption.

Many of the pharmacological effects of melatonin have been found to be similar to those of benzodiazepines. In the present study, we analyzed the role of melatonin on short-term memory retrieval on transfer latency in elevated plus maze and food consumption behavior, and the effects were compared with those of diazepam. Melatonin dose-dependently (10-100 mg/kg) produced short-term memory deficit and it potentiated diazepam- (1 mg/kg) induced cognitive deficit in mice. Flumazenil (1 and 4 mg/kg) could reverse enhancement in diazepam-induced memory deficit by melatonin. Chronic treatment with melatonin (10 mg/kg/7d) produced a similar profile in transfer latency on elevated plus maze compared with that of diazepam. In a food consumption behavior study, melatonin (25 and 50 mg/kg) produced a significant hyperphagic effect compared to control. Flumazenil (4 mg/kg) could significantly reverse the hyperphagic effects induced by diazepam (2 mg/kg), but would be insignificant with regard to that due to melatonin. These findings provide further evidence that some of the pharmacological effects of melatonin are comparable with those of diazepam and may involve central GABAergic mechanism.

Regulation of secretion of IL-4 and IgG1 isotype by melatonin-stimulated ovalbumin-specific T cells.

In the present study, we describe the potential role of melatonin, a pineal hormone, in regulating the activation of the antigen-specific T cell response. Melatonin encouraged the proliferation of Th cells and improved their ability to secrete IL-4, but down-regulated the levels of IL-2 and interferon-gamma (IFN-gamma). Melatonin, however, could not exert any influence on the T cells of unprimed mice. On studying the regulation of subclass of IgG isotype, melatonin specifically enhanced the secretion of antigen-specific IgG1 antibodies and decreased the yield of IgG2a isotype. The results suggest that melatonin possibly acts by selectively activating a Th2-like immune response.