Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest

Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days-3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p  = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups ( p  = 0.036). Time to defibrillation was longer in the 3 days group than the other groups ( p  = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.

Effect of suppression of plasma prolactin on luteinizing hormone concentration, intersequence pause days and egg production in domestic hen

The aim of this study was to investigate the effects of suppression of plasma prolactin (PRL) concentration on circulating concentrations of luteinizing hormone (LH), progesterone (P(4)), estradiol (E(2)beta), pause days and egg production in birds later in the reproductive period. Twenty-four White Leghorn birds of same age group were divided into two groups of 12 in each. Birds of each group were administered s/c either with placebo (control group) or equal volumes of anti PRL agent (2-bromo-alpha-ergocriptine) solution containing at 100 microg/kg body weight/hen/week (treated group) from 72 to 82 weeks of age. Egg production and inter sequence pauses were recorded daily from both the groups. Plasma PRL, LH, E(2)beta and P(4) concentrations were estimated in blood samples collected at weekly intervals. At 77th weeks of age, blood samples from treated and control birds were obtained every 3h for 36h to study the surges of LH. It was found that plasma PRL concentration was lower (p<0.01) in bromocriptine treated birds with high concentrations of LH, its 3h LH surges, E(2)beta and P(4) in plasma. Higher egg production, less pause days in treated birds may be the result of low PRL concentration, associated with positively correlated responses of high concentrations of LH (with regular interval and duration of LH surges), E(2)beta and P(4) concentration required for completion of egg formation and oviposition. In conclusion, bromocriptine administration decreased (p<0.01) PRL concentration increased (p<0.01) steroid hormones and LH surges, for egg formation and oviposition and enabled the birds to lay more eggs even later in the productive period with the available resources under normal husbandry practices.

Roxithromycin potentiates the effects of chloroquine and mefloquine on multidrug-resistant Plasmodium falciparum in vitro

Chloroquine (CQ) and mefloquine (MQ) are no longer potent antimalarial drugs due to the emergence of resistant Plasmodium falciparum. Combination therapy has become the standard for many regimes in overcoming drug resistance. Roxithromycin (ROM), a known p-glycoprotein inhibitor, is reported to have antimalarial activity and it is hoped it will potentiate the effects of both CQ/MQ and reverse CQ/MQ-resistance. We assayed the effects of CQ and MQ individually and in combination with ROM on synchronized P. falciparum (Dd2 strain) cultures. The IC(50) values of CQ and MQ were 60.0+/-5.0 and 16.0+/-3.0 ng/ml; these were decreased substantially when combined with ROM. Isobolograms indicate that CQ-ROM combinations were relatively more synergistic (mean FICI 0.70) than MQ-ROM (mean FICI 0.85) with their synergistic effect at par with CQ-verapamil (VRP) (mean FICI 0.64) and MQ-VRP (mean FICI 0.60) combinations. We conclude that ROM potentiates the CQ/MQ response on multidrug-resistant P. falciparum.

Effect of Azadirachta indica on paracetamol-induced hepatic damage in albino rats

Azadirachta indica, a plant used widely in Ayurveda, has been reported to have anti-inflammatory, immunomodulatory and adaptogenic properties. The present study evaluates its hepatoprotective role. Fresh juice of tender leaves of Azadirachta indica (200 mg/kg body wt. p.o.) inhibited paracetamol (2 g/kg body wt. p.o.)-induced lipid peroxidation and prevented depletion of sulfhydryl groups in liver cells. There was an increase in serum marker enzymes of hepatic damage (aspartate transaminase, alanine transaminase and alkaline phosphatase) after paracetamol administration. Azadirachta indica pretreatment stabilized the serum levels of these enzymes. Histopathological observations of liver tissues corroborated these findings.

Effect of fluoxetine on maximal electroshock seizures in mice: acute vs chronic administration

There are no definite reports regarding the effects of chronic fluoxetine on animal models of epilepsy. Since chronically administered fluoxetine, in comparison to acutely administered fluoxetine has different effects on CNS, the present study was undertaken to investigate the effect of acute and chronic fluoxetine pretreatment, on a median anticonvulsant dose (ED50) of phenytoin in male ICR albino mice. Additionally, the effects of fluoxetine pretreatment on median convulsive current (CC50) in the presence and absence of phenytoin were investigated and results were compared. The maximal electroshock seizure (MES) test was used to estimate the ED50of phenytoin. The electroshock threshold test was used to estimate CC50. ED50and CC50values were calculated by probit analysis. The effects of the chronic and acute fluoxetine groups on the ED50of phenytoin were significantly different (P<0.05), and on CC50this difference was not statistically significant. Chronic fluoxetine insignificantly increased the ED50of phenytoin and decreased the CC50while acute fluoxetine decreased the ED50of phenytoin and increased the CC50. Our results indicate that chronic fluoxetine does not have an antiepileptic property and it may have dubious proconvulsant properties, contrary to acute fluoxetine.

Effect of propranolol and nifedipine on maximal electroshock-induced seizures in mice: individually and in combination

A comparative effect of propranolol and nifedipine administered individually and in combination at graded dose levels; and that of phenytoin at 30 mg kg-1 on maximal electroshock (MES)-induced seizure in mice was investigated. Propranolol in doses of 10 mg kg-1 and 20 mg kg-1, and nifedipine in doses of 8 mg kg-1 and 16 mg kg-1 significantly modified MES activity. Propranolol (40 mg kg-1), and a combination of propranolol (20 mg kg-1) and nifedipine (8 mg kg-1), produced antiMES activity, which was comparable to that of phenytoin (30 mg kg-1). In mice treated with propranolol and nifedipine combination, the tonic flexor and tonic extensor phase ratios (F/E ratio) were significantly higher than individual drug responses. Our findings suggest that a combination of propranolol and nifedipine has either synergistic or an additive effect in controlling MES-induced seizures in mice.

Impact of substance abuse comorbidity on psychopathology and pattern of remission in mania

This prospective study was conducted to assess the prevalence of substance abuse comorbidity and its impact on psycho pathology and pattern of remission in mania. Hundred consecutive inpatients with a diagnosis of manic episode were followed up for three months using structured clinical interview schedule for DSM III R (SCID-P), DSM IIIR check list for mania. Bech-Rafaelsan Mania Rating Scale and a questionnaire concerning sociodemographic and clinical profile. The prevalence of substance abuse comorbidity was 52%. Substance abusers were significantly younger, had early age of onset of mood disorder, unmarried, unemployed, had more dysphoric and irritate mood states and grandiose and persecutory delusions. Risk factor analysis showed substance abuse as being consistently associated with poor outcome in mania.

Prevalence of soft neurological signs : a study among Indian school boys

"PANESS" battery was administered to a total sample of 120 students of five age specific groups of children from two schools catering to the needs of different socio-economic classes. Most commonly observed item was overflow/higher movements (5, N = 24) followed by motor inco-ordination and dysdiadochokinesia, maximally present in the age group of 7 to 8 (6, N = 24). Further results suggest different patterns across various age groups and that there may be a significant correlation between handedness and soft neurological signs. The implications of these findings have been discussed in the paper.

Psychiatric disorders in non - ulcer dyspepsia

Systematic studies of psychiatric disorders in non -ulcer dyspepsia are rare. The aim of the present study was to find out the nature and prevalence of psychiatric morbidity in non-ulcer dyspepsia. Thirty three patients with non-ulcer dyspepsia and thirty with duodenal ulcer were assessed for psychiatric morbidity with the help of the regular version of the SADS, and diagnosed according to DSM-IIIR criteria. Non-ulcer dyspepsia was defined precisely and investigators who made the psychiatric diagnosis were blind to the gastroenterological diagnosis. In the non-ulcer dyspepsia group, 69.7% of patients had psychiatric morbidity, compared to 26.7% in the ulcer group. The difference between the two groups in the frequency of psychiatric morbidity was statistically significant. Dysthymic disorder (39.4%) was the most frequent psychiatric disorder in the non-ulcer dyspepsia group.

Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors

BACKGROUND

The long-term survival of cadaveric renal allografts is lower in black recipients than in white recipients, although the one-year graft survival is similar in these racial groups. We sought to determine what factors account for this disparity.

METHODS

We studied 100 consecutive recipients of primary cadaveric renal allografts (57 were black and 43 white) at least 1 year after transplantation (mean, 40 months); all had received identical immunosuppressive therapy. We evaluated differences in the cause and duration of end-stage renal disease, the number of pretransplantation transfusions, age, matching for HLA-A, B, and DR antigens, race of the donor, insurance coverage, and compliance to assess their effect on graft survival in both groups.

RESULTS

Allograft survival after one year was significantly lower in black than in white patients (P = 0.025). According to univariate analysis, only the recipient's age at transplantation, the number of mismatches for HLA antigens, the type of insurance coverage, the source of referral for transplantation, and the degree of compliance correlated significantly with the rate of graft survival. The frequency of all variables that reduced graft survival was higher among the blacks. According to proportional-hazards analysis, the only factors contributing to a lower rate of graft survival were age of less than 30 years at transplantation (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.6), mismatches for all six HLA antigens as compared with three or fewer mismatches (relative risk, 5.6; 95 percent confidence interval, 3.3 to 9.6), and coverage by Medicaid or Medicare (relative risk, 2.2; 95 percent confidence interval, 1.5 to 3.2). Race had no additional effect. Noncompliance was more frequent among blacks (16 percent vs. 2 percent) and could substitute for insurance status in the model.

CONCLUSIONS

When immunosuppression is equivalent in black and white transplant recipients, apparently race-related differences in the long-term survival of renal cadaveric allografts appear to be related to other factors that affect graft survival unfavorably, notably poor HLA matching and unfavorable socioeconomic factors.

Renal transplantation in Mississippi

The present article reviews the results of cadaveric renal transplantation and organ donation in Mississippi during the years 1984-88. Patient and graft survival in cadaveric renal transplantation have continued to improve since the introduction of cyclosporine as an immunosuppressive agent. In the Mississippi Transplant Program recipients of primary cadaveric renal transplants currently demonstrate 93% patient and 82.3% graft survival rates. Despite this improvement in outcome slightly more than 1% of ESRD patients in the state undergo transplantation annually compared to 7.5% nationally.

Depressive disorders in schizophrenia

146 cases of schizophrenia, fulfilling Research Diagnostic Criteria and a regular followup of 6 months or more, were studied concerning depressive mood disorders at the onset of illness and over a period of time following neuroleptic treatment. There was no significant difference in the total number of cases depressed at the onset of illness (49) and at final follow up (56). Following 8 weeks of neuroleptic treatment, depressive symptoms disappeared in 47 per cent of the depressed schizophrenics and these cases did not evince depression subsequently. However, 53 per cent of schizophrenics manifesting depression at final followup had no depressive symptoms at the onset of illness and in these cases depression occurred following neuroleptic treatment. It is contended that depression may be intrinsic of schizophrenia and neuroleptics may have a role in the causation of depressive disorders in schizophrenia.

Case report : carbamazepine therapy in schizophrenia

9 cases of schizophrenia meeting Spitzer's Research Diagnostic Criteria and nonrespondent to conventional treatment were treated with carbamazepine, either alone or in combination with neuroleptics and 7 cases had shown improvement.

Schizo-affective psychosis : is it an entity?

The nature of schizo-affective psychos is remains elusive even nearly 5 decades after its recognition. A brief review of the controversies in the nosological status of schizo-affective psychosis is presented and the observations made by the authors in 9 cases of schizo-effective psychosis are discussed.

Socio-demographic factors of depressive disorders in India: a comparative appraisal

Socio-demographic study of 173 cases of depression was carried out prospectively over one year's period from January 1977 to December 1977, at the psychiatric out-patient department of Kasturba Medical College Hospital, Manipal, Karnataka. The findings are compared with the data reported from other centres in India and the results are discussed.