Non-invasive ventilation in neonates: a review of current literature

Moving from an era of invasive ventilation to that of non-invasive respiratory support, various modalities have emerged resulting in improved neonatal outcomes. Respiratory distress is the commonest problem seen both in preterm and term neonates, and the use of appropriate respiratory support could be lifesaving. This article reviews the currently available non-invasive ventilation (NIV) strategies in neonates including nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation (NIPPV), bi-level CPAP, heated humidified high flow nasal cannula, nasal high-frequency ventilation (NHFV) and non-invasive neutrally adjusted ventilatory assist (NIV-NAVA). Though multiple systematic reviews and meta-analyses have indicated the superiority of synchronized NIPPV over the other forms of non-invasive respiratory support in neonates, there is no single NIV modality that universally suits all. Hence, the choice of NIV for a neonate should be individualized based on its efficacy, the disease pathology, resource settings, the clinician's familiarity and parental values. Future studies should evaluate emerging modalities such as NIV-NAVA and NHFV in the respiratory management of neonates as the evidence pertaining to these is insufficient

ANTITHROMBOCYTOPENIA ACTIVITY OF PEANUT SHELL (Arachis hypogea L.) EXTRACT AND INFUSA ON HEPARIN INDUCED BALB/C MICE

ABSTRACT Certain group of people empirically use peanut shell stew in the treatment of thrombocytopenia due to dengue fever. The active compounds suspected to play a role in the activity of thrombocytopenia from peanut shell are flavonoids. Flavonoids can be extracted using heat and cold methods. This study aims to determine the antithrombocytopenia activity of peanut shell extract and infusa on heparin induced Balb/C mice. This study is an experimental research with randomized matched pre and postest control group design. Peanut shell extraction was done in a cool way by maseration using 70% ethanol solvent, and hot way by infundation using aquadest solvent. Forty-eight Balb/C mice were divided into 8 groups consisting of control group CMC Na 0.5 mL/20gBW/day, control group aquadest 0,5mL/20gBW/day, 3 groups of peanut shell ethanol extract (0.019, 0.038, and 0.076) g/20gBW/day, and 3 groups of peanut shell infusa (0.026, 0.052; 0.104) g/20gBW/day. All treatments were given orally. The decrease of platelet count in Balb/C mice using 26 UI/20gBW subcutan heparin induction. The measurement of the platelet count is performed by taking blood samples in the lateral veins of the tail. Platelet counts data before and after treatment was tested with dependent T-test. Differences in platelet increases across the groups were tested by 2 way anova and continued with a LSD test with 95% confidence level. The results showed that peanut shell ethanol extract had better antitrombocytopenia activity than peanut shell infusa

TOKSISITAS AKUT INFUSA KULIT ARI KACANG TANAH (Arachis hypogea L.) PADA MENCIT BALB/ C

ABSTRACTPeanut shell (PS) infusion has been shown to be antithrombocytopenia, but there has been no research on safety standards. This study aims to identify the symptoms of toxic effects, the potency of toxicity and histopathology of liver male Balb/C mice after a single dose of PS infusion. This research uses randomized matched posttest only control group design. Twenty five mice were divided into 5 orally dosage groups, ie, PS infusion with a dose of 0,026; 0.052; 0.104; 0.208 g/20gBW; and negative control of CMC Na 0.5%. The observation period is for 14 days. The results showed that single dose of PS infusion had a pseudo LD50 value ie > 0.208g/20gBW which was practically non toxic. Symptoms to watch out for the BW infusion were passive behavior, bradycnea, hair color change, hair loss, and weight loss at doses of 3 and 4. It is unclear whether liver damage ie inflammation, necrosis, and albuminous degeneration caused by PS infusion or other causes.keywords: acute toxicity, infusion, peanut shel

Toksisitas Akut Infusa Kulit Ari Kacang Tanah (Arachis Hypogea L.) Pada Mencit Balb/ C

Peanut shell (PS) infusion has been shown to be antithrombocytopenia, but there has been no research on safety standards. This study aims to identify the symptoms of toxic effects, the potency of toxicity and histopathology of liver male Balb/C mice after a single dose of PS infusion. This research uses randomized matched posttest only control group design. Twenty five mice were divided into 5 orally dosage groups, ie, PS infusion with a dose of 0,026; 0.052; 0.104; 0.208 g/20gBW; and negative control of CMC Na 0.5%. The observation period is for 14 days. The results showed that single dose of PS infusion had a pseudo LD50 value ie > 0.208g/20gBW which was practically non toxic. Symptoms to watch out for the BW infusion were passive behavior, bradycnea, hair color change, hair loss, and weight loss at doses of 3 and 4. It is unclear whether liver damage ie inflammation, necrosis, and albuminous degeneration caused by PS infusion or other causes

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline