Submandibular nodal schwannoma: where did it come from?

SummarySchwannoma, a type of benign neurological tumour arising from Schwann cells, is commonly seen in the head and neck region. However, the incidence of cervical lymph node schwannoma is extremely rare, with only two cases reported in the literature. Schwannomatosis is a disease characterised by a constellation of multiple schwannomas seen in a patient, guided by at least one confirmational histological diagnosis. This is a case of a painless progressively enlarging submandibular swelling which is confirmed as a schwannoma based on histology. The patient is also diagnosed with schwannomatosis as the patient has multiple neurological tumours. Nodal schwannoma has a good prognosis and no documentation of recurrence in the literature. It may arise from sympathetic nerves located within the lymph node.

Assessment of TB underreporting by level of reporting system in Lagos, Nigeria

BACKGROUND: Nigeria has an estimated TB prevalence of 219 per 100,000 population. In 2019, Nigeria diagnosed and notified 27% of the WHO-estimated cases of all forms of TB and contributed 11% of the missing TB cases globally.OBJECTIVE: To assess TB underreporting by type and level of health facility (HF), and associated factors in Lagos State, Nigeria.METHODOLOGY: Quantitative secondary data analysis of TB cases was conducted in 2015. χ2 test was used to assess the association between treatment initiation, TB underreporting, local government area (LGA) and HF characteristics.RESULTS: Overall, 2,064 persons with bacteriologically confirmed TB (15.5%) were not matched to patients in sampled TB registers. Treatment status was unknown for 86 cases (IQR 55–97) per LGA. LGAs with higher case-loads had higher proportions of cases with unknown TB status. Discrepant reporting of treated TB was also common (60% HFs). Primary-level TB treatment facilities and unengaged private facilities were less likely to notify.CONCLUSION: There was TB under-reporting across all types and levels of HFs and LGAs. There is a need to revise or strengthen the process of supervision and data quality assurance system at all levels

Rare cause of voice muffling: pyogenic vallecular cyst

A vallecular cyst is a benign laryngeal cyst that rarely causes symptoms in adults. We report a rare case of an infected vallecular cyst in a man who is in his 60s with diabetes mellitus. The patient presented to us with acute onset of voice muffling and respiratory distress. He showed signs of sepsis and upper airway obstruction. He had spikes of high-grade fever with an elevated total white cell count (predominantly neutrophil count) and C reactive protein level. Plain cervical X-ray revealed a large, smooth, lobulated mass in the vallecular area. Direct laryngoscopic findings supported the diagnosis of an infected vallecular cyst with suppuration, which originated from the vallecula fossa. The cyst was drained and excised completely, and the pus culture revealed the presence of Klebsiella pneumoniae The patient responded well to the administration of intravenous cefuroxime for 2 weeks according to the sensitivity and culture test. He was discharged after the completion of the course of antibiotics, having recovered fully. This case illustrates the versatility of a plain cervical X-ray in giving clues about this rare, unexpected pathology.

Does patient age and BMI affect temporal changes in depth-force relationship during CPR?

Introduction

A strong non-linear relationship exists between chest compression (CC) force and depth during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest events. A decrease in the depth-force (DF) relationship over time and cumulative number of CC has been described for both human and animal subjects. The effect of patient demographics such as age and body mass index (BMI) in the DF relationship during CPR is not as widely explored.

Purpose

The aim of the present study was to analyse the temporal effect of patient demographics (i.e. age and BMI) in the DF relationship during the performance of CPR.

Methods

Data were collected from a first responder group based in Texas, USA. Responders were instructed to use a CPR depth feedback device (Laerdal CPRmeter) and an automated external defibrillator (AED; HeartSine SAM 350P) when attending sudden cardiac arrest events. The AED was configured with a shock protocol separated by 2-minute episodes of CPR and rescuer CC depth and rate were guided by the CPR depth feedback device. Patient demographic data was captured at the cardiac arrest scene.

CC depth and force data were extracted from Laerdal CPRmeter and processed for 171 patient events. The depth-force ratio (DFR) was calculated as mean depth local maxima divided by mean force local maxima (mm/kgf). Data processing and statistical analyses were performed with R version 3.7.3.

Patient age was available for 169 events (median (IQR) = 63 (53–76) years). Age was categorised in two groups: 18–64 (n=87) and 65+ years (n=82). Patient BMI was estimated for 149 patients (median (IQR) = 25.84 (22.58–31.05) kg/m2). BMI was categorised as: Underweight (gUW, BMI <18.5, n=13), Normal (gN, 18.5 ≤ BMI <25, n=54), Overweight (gOW, 25 ≤ BMI <30, n=37) and Obese (gOB, BMI ≥30, n=45).

Results

No statistically significant differences in mean event duration were found in the age groups (t-test, p=0.368) or the BMI groups (ANOVA, p=0.309).

A multiple linear regression model was applied to the data to assess the effect of time and age or BMI on the DFR. At the beginning of the events, no statistically significant differences were found in DFR between age groups (p=0.092). Time had no effect on the change in DFR for 18–64 age group (p=0.110) but the rate of change between the 18–64 and 65+ age groups was significantly different (p<0.010).

For BMI and using gN as reference, there were significant differences in DFR between all BMI groups except gUW at the beginning of the events. Time had a significant effect in DFR during events for gUW, gN and gOB (p<0.050), but no common trend in temporal change was identified.

Conclusions

Temporal changes in DFR appear to be significantly affected by patient age. Tailoring CC force or depth to patient demographics during CPR events may be required for some patients.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): HeartSine Technologies Ltd, Belfast, UK

Isolation and identification of halophilic microorganisms in soy sauce

Microorganisms play an important role in the fermentation of soy sauce as they produce flavoring compounds which contribute to the desired taste and quality of soy sauce. The aim of this study was to isolate and identify halophilic microorganisms that are involved in the first stage (Koji) and second stage (Moromi) of soy sauce fermentation. In this study, soy sauce samples were collected from a local company located in Johor Bahru. The microorganisms were identified using Analytical Profile Identification (API) system and 16s ribosomal RNA (bacteria)/Internal Transcribed Spacer region (fungi and yeast) sequencing. In the koji fermentation, one fungus was isolated and identified as Aspergillus oryzae. During the moromi fermentation, one lactic acid bacteria and two yeasts were identified, including Tetragenococcus halophilus, Candida versatilis and Candida etchellsii. These halophilic microorganisms can be used as starter culture in moromi stage to shorten the fermentation period.

Patient derived xenografts as models for head and neck cancer

Translational cancer research has benefitted significantly from the generation of preclinical models that recapitulate the native tumour environment. While conventional cell models have contributed substantially to the current understanding of cancer biology and therapeutic development, a missing link between cell culture and their clinical applications is evident. Patient derived xenograft (PDX) models represent this missing link as they enable the examination of patient tumour tissue in a native environment without significantly affecting the cellular complexity, genomics, and stromal architecture of the neoplasms. The use of PDXs to model head and neck cancer (HNC) begets the development of novel therapeutics, increased understanding of tumorigenesis and the advent of personalised treatments cancer patients. There has been an increase in attempts to generate viable PDXs for HNCs in recent years. This concise review summarizes the current developments in the field of PDXs for HNCs.

High prevalence of multiple drug resistant staphylococci observed in macaque-populated locations in Brunei Darussalam

The spread of antibiotic resistant bacteria is a growing problem worldwide. Staphylococci bacteria is recognized as a genus of bacteria often closely related to human and animal hosts. Macaques are one type of non-human primate host that could potentially spread antibiotic resistant bacteria in an environment in close proximity to humans. Bacteria isolated from locations in Brunei Darussalam with and without the presence of long-tailed macaques revealed the existence of multiple drug resistant staphylococci bacteria with a higher prevalence observed in locations with a presence of long-tailed macaques. These findings have important zoonotic implications on infectious disease control and surveillance in public spaces frequented by macaques.

Intracellular Delivery of Synthetic dsRNA to Leukemic Cells Induces Apoptotic and Necrotic Cell Death

The type of tumour cell death dictates the type of adaptive immune response mounted against the tumours. In haematological malignancies such as acute myeloid leukaemia (AML), immune evasion due to the poor immunogenicity of leukemic cells is a major hurdle in generating an effective immune response. Transfection of synthetic dsRNA, poly I:C, into leukemic cells to trigger tumour cell death and enhance immunogenicity of the tumour is a promising immunotherapeutic approach. However, the temporal cell death kinetics of poly I:C-electroporated AML cells has not been thoroughly investigated. Electroporation of U937 cells, a human AML cell line, with a high dose of poly I:C resulted in cytotoxicity as early as 1 h post-transfection. Flow cytometric analysis revealed the temporal switch from early apoptosis to late apoptosis/secondary necrosis in poly I:C-electroporated cells in which the nuclear morphology at later time points was consistent with necrotic cell death. Our brief findings demonstrated the temporal cell death kinetics of dsRNA-transfected leukemic cells. This finding is an important development in the field of dsRNA immunotherapy for leukaemia as understanding the type of cell death elicited by transfected dsRNA will dictate the type of immune response to be directed against leukemic cells.

Representation of flat EEG images via fuzzy limit

Sugeno type intuitionistic fuzzy generator is one of the way to compute the non-membership value in the theory of intuitionistic fuzzy set (IFS).  It can be extended to the concept of fuzzy limit in order to determine the hesitation value.  The value of parameter, namely , in the non-membership function will influence the hesitation value and the results will be demonstrated in the form of images.  Hence, by implementing the definition of fuzzy limit, different value of  will be tested in obtaining the values of parameter  that will determine the value of .  Moreover, the relationship between hesitation and membership value will be demonstrated graphically.

Introduction of Cotton leaf curl Gezira virus into the United Arab Emirates

Severe leaf curl and small vein thickening symptoms were observed in okra fields in Al-Ain, United Arab Emirates (UAE) during the winter season, 2013. These symptoms were reminiscent of those often associated with begomovirus infection. Based on the symptoms observed in okra plants growing in adjacent fields (20 × 20 m) on two small holding farms, the disease incidence ranged from 90 to 100%. The fields were infested with the whitefly Bemisia tabaci (Genn.), the insect vector of begomoviruses. Total DNA was extracted from four symptomatic okra leaves collected from two plants per field and used for PCR amplification of the core region of the begomovirus coat protein gene using the degenerate primers AVcore 3'-GCCHATRTAYAGRAAGCCMAGRAT-5' and ACcore 3'-GGRTTDGARGCATGHGTACANGCC-5'. Amplicons of the expected size (~579 bp) were cloned and sequenced. BLASTn analysis of the partial coat protein sequences against the NCBI database revealed that the closet match to the four okra isolates was the Cotton leaf curl Gezira virus (CLCuGeV). CLCuGeV is a widespread Old World monopartite begomovirus described from the Nile Basin, sub-Saharan Africa, and southwestern Arabia (1). Recently, this virus has been reported in Jordan (GU945265) and Pakistan (3). To obtain the full-length viral genomic DNA for cloning and sequencing, total DNA extracts were enriched for circular dsDNA by rolling circle amplification (RCA) using Illustra TempliPhi (GE Healthcare, Life Sciences, Piscataway, NJ). The RCA products from each sample were digested with PstI, resulting in ~2.7 and 1.3 kbp molecules, respectively, and cloned into the pGEM plasmid vector (Promega, Madison, WI), linearized with PstI. Two inserts were selected from each cloning event and subjected to DNA sequencing using primer walking. The four resultant sequences of the 2.7 kbp (identified as virus genome) and the 1.3 kbp (betasatellite) inserts shared 99 to 100% nucleotide (nt) identity with each other, respectively. Therefore, only two representative genome and betasatellite sequences of 2,772 bp (KJ939446) and 1,356 bp (KM279620) were deposited in GenBank. Analysis using the Species Demarcation Tool (SDT) (v.1.0) (2) showed that the CLCuGeV UAE isolate sequence shared its highest nt identity (96 to 97%) with isolates from Egypt (AF155064), Pakistan (FR751142), and Jordan (GU945265). In contrast, it was only 93% identical to an isolate of CLCuGeV (HG530540) from the west coast of Saudi Arabia, nonetheless indicating they are all isolates of the same species. Analysis of the CLCuGeV sequence indicated that it was like other monopartite begomoviral genomes, containing a predicted hairpin, REP-binding iterons (GGTACTCA), and a TATA-box in the intergenic region. The genome contained six open reading frames encoding proteins with high homology to other CLCuGeV isolates. The 1,356-bp betasatellite shared its highest nt identity, at 97%, with the Okra leaf curl Oman betasatellite (KF267444) reported from infected okra plants in a neighboring country, Oman. The recent practice of transporting plants between the Gulf countries represents an important means and route for introducing begomoviruses among neighboring countries, compared to the long-distance aerial dispersal of viruliferous whiteflies, which is less likely because the Arabian desert poses a major barrier to long-distance whitefly flights. References: (1) A. Idris et al. Viruses 6:1219, 2014. (2) B. M. Muhire et al. Arch. Virol. 158:1411, 2013. (3) M. N. Tahir et al. PLoS ONE 6:E20366, 2011.

Effect of storage of shelled Moringa oleifera seeds from reaping time on turbidity removal

Moringa oleifera is an indigenous plant to Malaysia whose seeds are used for water purification. Many studies on Moringa oleifera have shown that it is highly effective as a natural coagulant for turbidity removal. In this study, two different methods for extraction of Moringa's active ingredient were investigated. Results of sodium chloride (NaCl) and distilled water extraction of Moringa oleifera seeds showed that salt solution extraction was more efficient than distilled water in extracting Moringa's active coagulant ingredient. The optimum dosage of shelled Moringa oleifera seeds extracted by the NaCl solution was comparable with that of the conventional chemical coagulant alum. Moreover, the turbidity removal efficiency was investigated for shelled Moringa oleifera seeds before drying in the oven under different storage conditions (i.e. open and closed containers at room temperature, 27 °C) and durations (fresh, and storage for 2, 4, 6 and 8 weeks from the time the seeds were picked from the trees). Our results indicate that there are no significant differences in coagulation efficiencies and, accordingly, turbidity removals between the examined storage conditions and periods.

A preliminary study on Jatropha curcas as coagulant in wastewater treatment

Many coagulants, mainly inorganic, are widely used in conventional water and wastewater treatment. Recent studies reported the occurrence of some chronic diseases associated with residual coagulant in treated wastewater. The use of alternative coagulants which are biodegradable and environmentally friendly could alleviate the problem associated with these diseases. This work investigates the capability of Jatropha curcas seed and presscake (the residue left after oil extraction) to reduce the turbidity of wastewater through coagulation. The coagulant was prepared by dissolving Jatropha curcas seed and presscake powder into solution. Then jar tests were conducted on kaolin solution as the model wastewater. The Jatropha seed was found to be an effective coagulant with more than 96% of turbidity removal at pH 1-3 and pH 11-12. The highest turbidity removal was recorded at pH 3 using a dosage of 120 mg/L. The flocs formed using Jatropha were observed to be bigger and to sediment faster when compared with flocs formed using alum. The turbidity removal was high (>98%) at all turbidities (100 NTU to 8000 NTU), suggesting its suitability for a wide range of industrial wastewater. The performance of Jatropha presscake after extraction of oil was also comparable to the fresh seed and alum at highly acidic and highly alkaline conditions. The addition of Jatropha did not significantly affect the pH of the kaolin samples after treatment and the sludge volume produced was less in comparison to alum. These results strongly support the use of Jatropha curcas seed and presscake as a potential coagulant agent.

Performance of cellulose acetate - polyethersulphone blend membrane prepared using microwave heating for palm oil mill effluent treatment

The objective of this research is to investigate the performance of blend cellulose acetate (CA)-polyethersulphone (PES) membranes prepared using microwave heating (MWH) techniques and then compare it with blend CA-PES membranes prepared using conventional heating (CH) methods using bovine serum albumin solution. The superior membranes were then used in the treatment of palm oil mill effluent (POME). Various blends of CA-PES have been blended with PES in the range of 1-5 wt%. This distinctive series of dope formulations of blend CA/PES and pure CA was prepared using N, N-dimethylformamide (DMF) as solvent. The dope solution was prepared by MW heating for 5 min at a high pulse and the membranes were prepared by phase inversion method. The performances of these membranes were evaluated in terms of pure water and permeate flux, percentage removal of total suspended solids (TSS), chemical oxygen demand (COD) and biochemical oxygen demand (BOD). The results indicate that blend membranes prepared using the microwave technique is far more superior compared to that prepared using CH. Blend membranes with 19% CA, 1-3% PES and 80% of DMF solvent were found to be the best membrane formulation.

Patients' assessment of quality of eye care in a nigerian teaching hospital

BACKGROUND

Patients' assessment of quality of health care despite its importance in uptake of available services is not frequently examined in developing countries.

METHOD

This descriptive cross-sectional study was conducted at the Eye clinic in a Tertiary health facility to find out patients' perception of quality of care received in the facility. A questionnaire instrument was used, and it included patients' socio-demographic data, patients' perception of waiting time, charges, supportive services such as ease of movement from one service point to the other and pharmacy. Respondents' suggestions on any area of service rendered to them were also captured.

RESULT

A total of 124 respondents were interviewed. Majority (89.4%) reported long waiting time particularly for doctors' consultation. Missed clinic appointment was mostly due to health workers strike. Two-thirds of patients procured their prescribed drugs outside the Hospital due to hospital bureaucracy. However, most patients reported having received adequate explanation on their ailment from the health workers. Despite the shortcomings in services received most of the patients expressed satisfaction with the quality of care received.

CONCLUSION

There is need to frequently examine the quality of health care received by patients in developing countries with the aim of identifying areas of services that should be improved. Key words: patients' assessment, eye care, quality.

Drying kinetics and stabilization of sewage sludge in lagoon in hot climate

A sludge lagoon has been adopted as a simple and cost effective method for dewatering of sludge. The processes occurring in a sludge lagoon include thickening, dewatering, storage and stabilization; all happening simultaneously. The objective of this study is to determine the dewatering and drying rates at pilot-scale which occur in a lagoon having different design configurations. Two types of sludge lagoons with different initial sludge depth (0.75 m and 0.375 m) were investigated to measure the drying behavior and drying efficiency. The first design is a sludge lagoon with a clay bottom where the dewatering mechanisms are decanting supernatant and evaporation. The second design is a sludge lagoon installed with a sand and underdrains system, where the dewatering mechanisms are filtration or draining and evaporation. Sludge drying kinetic models with high fitness were plotted to describe the sludge drying behavior. Drying of sludge in a sludge lagoon with a clay bottom can best be described by an exponential function. Whereas, drying of sludge in a sludge lagoon with sand and underdrains system followed a logarithmic function. A lagoon designed with sand and underdrains system and having shallower sludge depth was the most efficient. The reduction in volatile solids was lower than 4% during the study period. The drying process proceeded with an increase in dryness and decline in pH value.

Performance of an extended aeration-microfiltration (EAM) reactor in treating high strength industrial wastewater

A laboratory study was conducted on an Extended Aeration-Microfiltration (EAM) reactor in treating a food industry wastewater. The reactor contained horizontally laid hollow fibre microfiltration (MF) units that were fully submerged. The MF units were connected to a peristaltic pump that was used to extract permeate continuously under suction pressure. Continuous aeration from beneath the modules provided the crossflow effect to the MF units. Active activated sludge was used in the start-up where the sludge was mixed together with the feed water at a Food/Microorganisms (F/M) value of about 0.1. Primary effluent with Chemical Oxygen Demand (COD) values ranged between 1,500 and 3,000 mg/l was used as feed water. The EAM reactor was operated for nearly three months without initiating cleaning of the MF units. A suction pressure of 0.9 bar and Mixed Liquor Suspended Solids (MLSS) of over 5,500 mg/l were reached when nearing the end of the three month operation period. Permeate COD and turbidity reduction of over 97% and 99% respectively, were achieved. Prior to this, the MF module arrangements were studied; where vertically arranged modules were found to perform poorly as compared to the horizontally laid modules, in terms of clean water permeate flux.

Some microbiological and biochemical studies on the fermentation of 'awaze' and 'datta', traditional Ethiopian condiments

The microbial and some biochemical changes during the fermentation of two Ethiopian condiments were studied. The aerobic mesophilic microflora of the ingredients of 'awaze' were dominated by Bacillus species (1.1 x 10(6) cfu/g) and lactic acid bacteria (4.5 x 10(4) cfu/g). The counts of aerobic mesophilic bacteria declined during the fermentation period. Lactic acid bacteria (LAB) reached the maximum count of 5.9 x 10(9) cfu/g at day 4 and the count remained > 10(8) cfu/g throughout the fermentation. The heterofermentative LAB dominated until day 3; thereafter the homolactics dominated the fermentation. Yeasts appeared at day 6 and increased to 2.5 x 10(6) cfu/g. In 'datta' fermentation, the count of aerobic mesophilic bacteria remained unchanged during the fermentation. LAB initiated the fermentation at a level of 7.1 x 10(4) cfu/g and reached 1.2 x 10(9) cfu/g at day 7. The homolactic LAB initiated and dominated the fermentation for the first 2 days and the heterolactics took over thereafter. Both fermentations were accompanied by declining pH and increasing titratable acidity. Salmonella typhimurium was inhibited during both fermentations within 48 h. Both 'awaze' and 'datta' had low initial contents of available protein and reducing sugars and these did not show marked differences throughout the fermentation.

Genotypic and phenotypic relationship in Burkholderia pseudomallei indicates colonization with closely related isolates

Seven isolates of Burkholderia pseudomallei from cases of melioidosis in human (2 isolates) and animal (2 isolates), cat (one isolate) and from soil samples (2 isolates) were examined for in vitro sensitivity to 14 antimicrobial agents and for presence of plasmid DNA. Randomly amplified polymorphic DNA (RAPD) analysis was used to type the isolates, using two arbitrary primers. All isolates were sensitive to chloramphenicol, kanamycin, carbenicillin, rifampicin, enrofloxacin, tetracycline and sulfamethoxazole-trimethoprim. No plasmid was detected in all the isolates tested. RADP fingerprinting demonstrated genomic relationship between isolates, which provides an effective method to study the epidemiology of the isolates examined.

The performance and kinetic study of membrane anaerobic system in treating POME. Palm oil mill effluent

The application of the three known kinetic models on MAS (membrane anaerobic system) process treating the POME and the overall MAS treatment efficiency were investigated. The MAS consists of a cross-flow ultrafiltration membrane (Model Micro 240) for solid-liquid separation. Six steady states were attained over a range of mixed liquor suspended solids of 12,681 - 30,460 mg/l. The study showed a good fitting of the Monod Model (91.1%), Contois Model (98.5%) and Chen and Hashimoto Model (95%) for the MAS treating raw POME at organic loadings between 1.5 kgCOD/m3/d to 6.5 kgCOD/m3/d. The growth yield coefficient, Y, was found to be 0,604 kg VSS/kgCOD while the specific microorganism decay rate was 0.099 day(-1). The k values were in the range of 0,242 to 0.425 mg COD/mg VSS.d and the microm values were between 0.145 to 0.257 day(-1). Throughout the study, the removal efficiency of COD was 83.2 to 97.97%. The methane production rate was between 0.262 to 0.473 l/g-COD-utilised/d. The MAS treatment efficiency was greatly affected by SRT and OLRs. In the study, membrane fouling and polarization at the membrane surface played a significant role in the formation of the strongly attached cake layer limiting membrane permeability

Intraosseous and central venous blood acid-base relationship during cardiopulmonary resuscitation

OBJECTIVE

The objectives of this study were: 1) to determine whether obtaining intraosseous (IO) blood samples was practical during cardiopulmonary resuscitation (CPR), and 2) to compare the acid-base status (pH and partial pressure of CO2 (PCO2) of venous and IO blood during CPR.

DESIGN

A prospective repeated measure study.

SETTING

An animal laboratory at a university medical center.

INTERVENTIONS

Nine mixed breed piglets (mean weight 43 kg) were anesthetized, tracheotomized, and placed on a ventilator (Siemens 900C Elema, Sweden). Placement of a pulmonary artery catheter was done via a surgical incision in the neck. An IO cannula was then placed in the tibial marrow cavity. The animals were positioned under a mechanical thumper (Thumper, Michigan Instruments, Grand Rapids, MI) for chest compressions. Blood gases were analyzed during steady state (baseline) after five minutes of ventricular fibrillation and during CPR at seven, nine, 11, 13, 15 and 18 minutes.

MAIN RESULTS

Blood samples for acid-base analysis were easily obtained from the IO sites during all sampling times. Mixed venous blood was slightly more acidic than IO blood, especially at 13, 15, and 18 minutes. However, there were no significant differences in pH and Pco2 values between IO and central venous (CV) gases at all time intervals except the PCO2. At nine minutes, a significant difference (P < 0.006) was found in PCO2 (59 +/- 4 vs 47 +/- 5 torr) for the CV versus IO sample, respectively. As the duration of CPR progressed, the differences in PCO2 between IO and CV sites were clinically relevant (though not statistically significant).

CONCLUSION

Obtaining blood from the IO site is practical during CPR. The divergence in values as CPR progresses suggests that, during longer periods of CPR, IO blood may reflect local acidosis and yield lower PCO2 and higher pH values that CV blood. This finding may limit the usefulness of IO blood to judge acid base status as CPR progresses.

Fat embolism with the use of intraosseous infusion during cardiopulmonary resuscitation

The objective of this prospective study was to assess the incidence and magnitude of fat emboli after cardiopulmonary resuscitation and intraosseous infusions. An animal laboratory at a university center was used to study 33 mixed-breed piglets. The piglets underwent hypoxic cardiac arrest followed by chest compressions and mechanical ventilation for a minimum of 30 minutes. The animals were divided in groups: group 1 (n = 5), which had no intraosseous cannulas, group 2 (n = 6), which had intraosseous cannulas with infusion, groups 3 (n = 6), 4 (n = 6), and 5 (n = 8), which had intraosseous cannulas with infusion of epinephrine, normal saline, and sodium bicarbonate respectively, and group 6 (n = 2), which was a sham group with no intraosseous cannulas and no cardiopulmonary resuscitation. At cessation of cardiopulmonary resuscitation, representative lung samples were collected from upper and lower lobes of each lung and observed for fat globules and bone marrow elements. Fat globules were seen in the peribronchial blood vessels and intravascular areas throughout all lung fields of groups 1 through 5. There was no difference in appearance or distribution of fat globules among the 5 treatment groups. Analysis of variance showed no statistical significance (P < 0.05) within or among groups 1 through 5. The use of the intraosseous cannula for infusion of emergency drugs and fluids did not increase the magnitude of fat embolization over cardiopulmonary resuscitation alone in this animal model. The benefits of using this procedure in critically ill children as a means of rapid vascular access for resuscitation is well established. However, the risk of fat embolism in this population needs further study.