Laryngeal mask ventilation with chest compression during neonatal resuscitation: randomized, non-inferiority trial in lambs

BACKGROUND

Effective positive-pressure ventilation is a critical factor in newborn resuscitation. Neonatal endotracheal intubation (ETT) needs considerable training and experience, which poses a human factor challenge. Laryngeal mask airway (LMA) ventilation can be a secure and viable alternative during the initial stages of newborn resuscitation. However, there is limited evidence for its use during chest compression (CC).

METHODS

Seventeen lambs were randomized into LMA or ETT ventilation post cord occlusion induced cardiac arrest. After 5 min of cardiac arrest, resuscitation was initiated as per NRP recommendations. Ventilation, oxygenation, systemic and pulmonary hemodynamic parameters were recorded till the return of spontaneous circulation (ROSC) or 20 min.

RESULTS

Baseline characteristics were similar between the groups. The incidence of ROSC was 75% (6/8) in the LMA group and 56% (5/9) in the ETT group (p = 0.74). The median (IQR) time to achieve ROSC was 6.85 min (6 min-9.1 min) in the LMA group and 7.50 min (5.33 min-18 min) in the ETT group (p = 0.65).

CONCLUSION

LMA ventilation during CC is feasible and non-inferior to ETT in this model.

IMPACT

Laryngeal mask airway (LMA) ventilation with chest compression is feasible and non-inferior to endotracheal tube ventilation in this experimental near-term lamb model of asphyxial cardiac arrest. First translational study to evaluate the use of LMA as an airway device with chest compression. Evidence primer for clinical studies to evaluate and confirm the feasibility and efficacy of LMA ventilation with chest compression are necessary before randomized clinical trials in neonates. LMA use in neonatal cardiopulmonary resusciation (CPR) could have the potential to optimize advanced resuscitation, especially in resource-limited healthcare settings.

Amelioration of Gamma-hexachlorocyclohexane (Lindane) induced renal toxicity by Camellia sinensis in Wistar rats

AIM

A study to assess the toxic effects of gamma-hexachlorocyclohexane (γ-HCH) (lindane) and ameliorative effects of Camellia sinensis on renal system has been carried out in male Wistar rats.

MATERIALS AND METHODS

Four groups of rats with 18 each were maintained under standard laboratory hygienic conditions and provided feed and water ad libitum. γ-HCH was gavaged at 20 mg/kg b.wt. using olive oil as vehicle to Groups II. C. sinensis at 100 mg/kg b.wt. was administered orally in distilled water to Group IV in addition to γ-HCH 20 mg/kg b.wt. up to 45 days to study ameliorative effects. Groups I and III were treated with distilled water and C. sinensis (100 mg/kg b.wt.), respectively. Six rats from each group were sacrificed at fortnight intervals. Serum was collected for creatinine estimation. The kidney tissues were collected in chilled phosphate buffer saline for antioxidant profile and in also 10% buffered formalin for histopathological studies.

RESULTS

γ-HCH treatment significantly increased serum creatinine and significantly reduced the renal antioxidative enzymes catalase, superoxide dismutase, and glutathione peroxidase. Grossly, severe congestion was noticed in the kidneys. Microscopically, kidney revealed glomerular congestion, atrophy, intertubular hemorrhages, degenerative changes in tubular epithelium with vacuolated cytoplasm, desquamation of epithelium and urinary cast formation. A significant reduction in serum creatinine levels, significant improvement in renal antioxidant enzyme activities and near to normal histological appearance of kidneys in Group IV indicated that the green tea ameliorated the effects of γ-HCH, on renal toxicity.

CONCLUSION

This study suggested that C. sinensis extract combined with γ-HCH could enhance antioxidant/detoxification system which consequently reduced the oxidative stress thus potentially reducing γ-HCH toxicity and tissue damage.

<b>Pathological and immunohistochemical studies on hemangiosarcoma in tigers <I>Panthera tigris</I> and lions <I>Panthera Leo</I></b>

Five cases of hemangiosarcoma were documented in three tigers and two lions during post-mortem examinations.  Grossly, reddish-black coloured elevated masses were noticed with metastasis to the spleen.  In one tiger, an enlarged liver with severe oozing of blood on a cut section was noticed without any elevated masses.  In a white tiger, the tumour mass was located near the abdominal region.  Histopathological features revealed the presence of immature plump endothelial cells forming blood filled irregular vascular spaces. Immunohistochemically, strong immunoreactivity in the cytoplasm of neoplastic endothelial cells with vascular endothelial growth factor (VEGF) was noticed.  No positive reaction was noticed with the proliferative markers, i.e., Ki67 and p53, indicating VEGF is the appropriate marker to diagnose hemangiosarcoma. 

Titrimetric determination of iodine-bromine numbers of some edible oils using three N-chloroimides

Three simple titrimetric methods have been developed to determine iodine-bromine numbers of some edible oils, such as coconut, gingelly, groundnut, mustard, olive, palm olein, and sunflower, using 3 N-chloroimides. The 3 N-chloroimides are N-chlorophthalimide, N-chlorosuccinimide, and N-chlorosaccharin, all of which have recently been developed as potential oxidimetric titrants for use in aqueous acetic acid medium. The proposed excess back-titration methods have advantages over existing methods in terms of ease of extraction into aqueous acetic acid layer, shorter reaction time of NCSA method, and stability of N-chloroimides in solid state.