Efficacy of T piece resuscitator Versus self inflating bag and self inflating bag with peep valve in newborn resuscitation: A Randomised control trial

The American Academy of Paediatrics formulated the Neonatal resuscitation guidelines and published it in 2010 and suggested modification based on local needs1 .These guidelines primarily apply to neonates undergoing transition from intrauterine to extrauterine life with difficulty. About 1 in 10 neonates require some form of resuscitation and fewer than 1% require extensive resuscitation 2. Ventilation of the lungs is the most important step for successful resuscitation. Ineffective ventilation is an important cause of prolonged or unsuccessful resuscitation. Effective resuscitation needs proper anticipation, adequate preparation, accurate evaluation and prompt initiation. The first minute of neonatal resuscitation is known as the golden minute where active steps are taken to ventilate the newborn lungs. Each step in resuscitation is performed for 30 seconds along with assessment of heart rate, respiration and oxygen saturation at the end of every step. The decision to administer positive pressure ventilation (PPV) is taken at the end of 30 seconds of starting resuscitation when the neonate is apneic or gasping or with heart rate less than 100/min. 1. Use of T piece resuscitator resulted in higher number of neonates achieving a Heart rate _ 100/min at 2 minutes of age when compared to self inflating bag and self inflating bag with PEEP valve. Hence T piece resuscitator seems to be more effective than self inflating bag and self inflating bag with PEEP valve in delivery room newborn resuscitation of babies more than 28 weeks gestation. This was statistically insignificant. A larger sample size may be needed to clearly demonstrate the advantage of T piece resuscitator over self inflating bag and self inflating bag with PEEP valve. 2. Resuscitation with T piece resuscitator achieves a Heart rate _ 100 at a significantly lesser time than self inflating bag and self inflating bag with PEEP valve . 3. T piece resuscitator and self inflating bag with PEEP valve enables a newborn to achieve significantly higher oxygen saturation at 5 minutes of age than self inflating bag. The effect is more pronounced in more than 34 weeks gestational age. 4. T piece reduces the number of babies requiring delivery room intubation, chest compressions and medications compared to self inflating bag and self inflating bag with PEEP valve though statistically insignificant. 5. T piece resuscitator reduces the number of babies requiring invasive ventilation but the effect is not significant statistically. 6. There is no difference in complications like air leaks between the three devices. 7. Provision of PEEP by T piece resuscitator or self inflating bag with PEEP valve improves the short term outcomes in neonatal resuscitation but requires further adequately powered studies with higher sample size to test for statistical significance if any. 8. In settings where T piece resuscitator may not be available use of self inflating bag with PEEP valve could be an alternative resuscitation device in newborn resuscitation

DRUG UTILIZATION PATTERN IN PAEDIATRIC PATIENTS IN A SECONDARY CARE HOSPITAL

Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator. Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization. Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO). Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well

Consumer Purchasing Decision towards Skin Care Products

The global trend of using skin care products is growing at accelerator rate. As a result of which number of skin care products are emerging as consumer options. The purpose of this study is to analyse the factors influencing consumers decision to purchase skin care products. The study is about the purchasing pattern of people in and around Coimbatore city. A self- designed questionnaire has been designed to collect the information from the respondent. Around 120 samples have been collected for this research. For identifying the purchasing behaviour of the consumer, the respondent was asked to rank the variables based on the Likert scale. The influence of social media on consumer behaviour is also analysed. The statistical analysis that has been done is regression. The insights gained will help the skin care marketers to develop the better growth strategy to sustain the market. This study provides the better understanding of how different variables influence purchasing behaviour

Dirofilaria repens Infection and Concomitant Meningoencephalitis

Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. Clinical symptoms are usually restricted to a subcutaneous nodule containing a single infertile parasite. Here, we report a case of D. repens infection with a subcutaneous gravid worm and the patient’s concomitant meningoencephalitis and aphasia

Manufacturing process of a brain aneurysm biomodel in PDMS using rapid prototyping

Cerebral aneurysm is an abnormal dilatation of the blood vessel into a saccular form. They can originate in congenital defects, weakening of the arterial wall with increasing age, atherosclerotic changes, trauma and infectious emboli. The in vivo experiments are an effective way of investigating the appearance, validating new practices and techniques, but beyond ethical issues, these types of experiments are expensive and have low reproducibility. Thus, to better understand the pathophysiological and geometric aspects of an aneurysm, it is important to fabricate in vitro models capable of improving existing endovascular treatments, developing and validating theoretical and computational models. Another difficulty is in the preoperative period of the non-ruptured cerebral aneurysm, known for the success of the skilled acts because there is an anatomical structure of the aneurysm as its current position. Although there are technologies that facilitate three-dimensional video visualization in the case of aneurysms with complex geometries the operative planning is still complicated, so the development of the real three-dimensional physical model becomes advantageous. In this work, the entire process of manufacturing an aneurysm biomodel using polydimethylsiloxane (PDMS) is disassembled by rapid prototyping technology. The manufactured biomodels are able to perform different hemodynamic studies, validate theoretical data, numerical simulations and assist in the preoperative planning.info:eu-repo/semantics/publishedVersio

An open-label, 1-year extension study of the long-term safety and efficacy of once-daily OROS® hydromorphone in patients with chronic cancer pain

<p>Abstract</p> <p>Background</p> <p>Opioid analgesics have proven efficacy in the short-term management of chronic cancer pain, but data on their long-term use is more limited. OROS^®hydromorphone is a controlled-release formulation of oral hydromorphone that may be particularly well suited to long-term management of chronic cancer pain because it provides stable plasma concentrations and consistent analgesia with convenient once-daily dosing. The objective of this study (DO-118X) was to characterise the pain control achieved with long-term repeated dosing of OROS^®hydromorphone in patients with chronic cancer pain.</p> <p>Methods</p> <p>In this multicentre, phase III, open-label, single treatment, 1-year extension study, OROS^®hydromorphone was administered to 68 patients with moderate-to-severe chronic cancer pain, who had successfully completed a short-term equivalence study, and whose pain was controlled with a stable dose of medication (≥ 8 mg OROS^®hydromorphone or equivalent controlled-release morphine). Patients were started on the dose of OROS^®hydromorphone equivalent to the opioid dose on which they achieved dose-stable pain control in the equivalence study; dose adjustments were made as necessary and breakthrough pain medication was permitted. Efficacy was assessed with the Brief Pain Inventory (BPI) and patient and investigator global evaluations of treatment effectiveness. No formal statistical analysis was done.</p> <p>Results</p> <p>The mean (standard deviation) duration of exposure to study medication was 139 (129.9) days and the mean (standard deviation) average daily consumption of OROS^®hydromorphone was 43.7 (28.14) mg/day. All scores were maintained at a mild to moderate severity throughout the study; however, BPI scores for pain at its worst, pain at its least, pain on average, pain right now, and pain relief were slightly worsened at end point compared with baseline. Mean BPI pain interference with daily activities and patient and investigator global evaluation scores also remained generally stable. Treatment effectiveness was rated as fair to good throughout the study. The most frequently reported adverse events were nausea (n = 24, 35.3%), constipation (n = 22, 32.4%), and vomiting (n = 15, 22.1%).</p> <p>Conclusion</p> <p>The results of this extension study suggest that long-term repeated dosing with once-daily OROS^®hydromorphone can be beneficial in the continuing management of persistent, moderate-to-severe cancer pain.</p

A randomized, double-blind comparison of OROS® hydromorphone and controlled-release morphine for the control of chronic cancer pain

<p>Abstract</p> <p>Background</p> <p>Long-acting opioid formulations are advocated for maintaining pain control in chronic cancer pain. OROS^®hydromorphone is a sustained-release formulation of hydromorphone that requires dosing once daily to maintain therapeutic concentrations. The objective of this study was to demonstrate the clinical equivalence of immediate-release and sustained-release formulations of hydromorphone and morphine for chronic cancer pain.</p> <p>Methods</p> <p>200 patients with cancer pain (requiring ≤ 540 mg/d of oral morphine) participated in this double-blind, parallel-group trial. Patients were randomized to receive hydromorphone or morphine (immediate-release for 2–9 days, sustained-release for 10–15 days). Efficacy was assessed with the Brief Pain Inventory (BPI), investigator and patient global evaluations, Eastern Cooperative Oncology Group performance status, and the Mini-Mental State Examination. The primary endpoint was the 'worst pain in the past 24 hours' item of the BPI, in both the immediate-release and sustained-release study phases, with treatments deemed equivalent if the 95% confidence intervals (CI) of the between-group differences at endpoint were between -1.5 and 1.5. No equivalence limits were defined for secondary endpoints.</p> <p>Results</p> <p>Least-squares mean differences (95% CI) between groups were 0.2 (-0.4, 0.9) in the immediate-release phase and -0.8 (-1.6, -0.01) in the sustained-release phase (intent-to-treat population), indicating that the immediate-release formulations met the pre-specified equivalence criteria, but that the lower limit of the 95% CI (-1.6) was outside the boundary (-1.5) for the sustained-release formulations. BPI 'pain now PM' was significantly lower with OROS^®hydromorphone compared with controlled-release morphine (least-squares mean difference [95% CI], -0.77 [-1.49, -0.05]; <it>p </it>= 0.0372). Scores for other secondary efficacy variables were similar between the two sustained-release treatments. At endpoint, > 70% of investigators and patients rated both treatments as good to excellent. The safety profiles of hydromorphone and morphine were similar and typical of opioid analgesics.</p> <p>Conclusion</p> <p>Equivalence was demonstrated for immediate-release formulations of hydromorphone and morphine, but not for the sustained-release formulations of OROS^®hydromorphone and controlled-release morphine. The direction of the mean difference between the treatments (-0.8) and the out-of-range lower limit of the 95% CI (-1.6) were in favor of OROS^®hydromorphone.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: NCT0041054</p

Mir-21-Sox2 Axis Delineates Glioblastoma Subtypes with Prognostic Impact.

UNLABELLED: Glioblastoma (GBM) is the most aggressive human brain tumor. Although several molecular subtypes of GBM are recognized, a robust molecular prognostic marker has yet to be identified. Here, we report that the stemness regulator Sox2 is a new, clinically important target of microRNA-21 (miR-21) in GBM, with implications for prognosis. Using the MiR-21-Sox2 regulatory axis, approximately half of all GBM tumors present in the Cancer Genome Atlas (TCGA) and in-house patient databases can be mathematically classified into high miR-21/low Sox2 (Class A) or low miR-21/high Sox2 (Class B) subtypes. This classification reflects phenotypically and molecularly distinct characteristics and is not captured by existing classifications. Supporting the distinct nature of the subtypes, gene set enrichment analysis of the TCGA dataset predicted that Class A and Class B tumors were significantly involved in immune/inflammatory response and in chromosome organization and nervous system development, respectively. Patients with Class B tumors had longer overall survival than those with Class A tumors. Analysis of both databases indicated that the Class A/Class B classification is a better predictor of patient survival than currently used parameters. Further, manipulation of MiR-21-Sox2 levels in orthotopic mouse models supported the longer survival of the Class B subtype. The MiR-21-Sox2 association was also found in mouse neural stem cells and in the mouse brain at different developmental stages, suggesting a role in normal development. Therefore, this mechanism-based classification suggests the presence of two distinct populations of GBM patients with distinguishable phenotypic characteristics and clinical outcomes. SIGNIFICANCE STATEMENT: Molecular profiling-based classification of glioblastoma (GBM) into four subtypes has substantially increased our understanding of the biology of the disease and has pointed to the heterogeneous nature of GBM. However, this classification is not mechanism based and its prognostic value is limited. Here, we identify a new mechanism in GBM (the miR-21-Sox2 axis) that can classify ∼50% of patients into two subtypes with distinct molecular, radiological, and pathological characteristics. Importantly, this classification can predict patient survival better than the currently used parameters. Further, analysis of the miR-21-Sox2 relationship in mouse neural stem cells and in the mouse brain at different developmental stages indicates that miR-21 and Sox2 are predominantly expressed in mutually exclusive patterns, suggesting a role in normal neural development