Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country

OBJECTIVE: To evaluate the outcome and quality of in-hospital cardiopulmonary resuscitation (CPR), and factors affecting the outcome. SETTING: A 2300-bed university hospital in Thailand. METHOD: A 1-year prospective audit according to the Utstein style. RESULTS: A total of 639 cardiac arrests (370 male, 269 female, age 1 day-96 years, mean+/-S.D.=53.3+/-24.12 years) were included. Four hundred and thirty-three cardiac arrests (67.8%) occurred in non-monitored areas and 200 (31.3%) occurred in monitored areas. Five hundred and thirty-six cardiac arrests (84%) were witnessed. The majority of cardiac arrests occurred in medical patients (68.4%) and surgical patients (21.4%). The most common underlying causes of arrest were respiratory failure (24.7%) and septic shock (23.3%). Initial ECG rhythms were ventricular fibrillation 79 (12.4%), asystole 272 (42.6%) with pulseless electrical activity 225 (35.2%). Most patients received basic life support within 1 min (86.7%) and advanced life support (ALS) within 4 min (92.6%) but only 25% of patients received defibrillation within 3 min. Following resuscitation, 394 (61.7%) achieved restoration of spontaneous circulation and 44 patients (6.9%) survived to discharge. Only 162 post-arrest patients were treated in the critical care area. The initial survival rate was not associated with sex, age and time to ALS, but was significantly related to the monitored area. CONCLUSION: In our setting, survival to discharge is 6.9%. Initial survival rate was strongly associated with being in a monitored area. Defibrillators and the critical care areas were insufficient.     

成人ADHD自评量表(ASRS-V1.1泰国版)的信度和效度研究

背景:18项成人ADHD自评量表(ASRS-V1.1)是一份针对成人ADHD的筛查量表.目标:旨在测试泰国版18项成人ADHD筛查量表(ASRS-V1.1)的信度和效度.方法:将原版18项成人ADHD筛查量表翻译为泰语.经翻译、回译、对比,并通过国内的文化调适、现场测试和最终确认等一系列步骤完成.对1500名来自曼谷幼儿园、小学的家长采用泰国版18项成人ADHD自评量表进行阳性结果和阴性结果筛查,并从中随机选取各50例进行诊断性访谈.最终由3名精神科医生进行临床访谈,根据DSM-5注意缺陷多动障碍诊断标准明确诊断为成人ADHD患者.结果:泰国版18项成人ADHD筛查量表有较好的内部一致性(Cronbach alpha=0.86:其中注意缺陷型Cronbach alpha=0.78,多动/冲动型Cronbach alpha=0.76).泰国版18项成人ADHD自评量表效度检验显示问卷有较好敏感性(90.9％)和特异性(62.5％).前6项的AUC为0.80 (95％ CI:0.68-0.92),18项的AUC为0.71(95％ CI:0.55-0.86).结论:18项ASRS-V1.1泰国版对成人ADHD筛查量表具有较好的信度和效度,特别是量表前6项.     

Production of monoclonal antibodies against partially purified surface tegument antigens of Fasciola gigantica

Monoclonal antibodies (MAbs) were produced by the in vitro fusion of Balb/C mice spleen cells immunized with partially purified surface tegument antigens of Fasciola gigantica. The surface membrane and tegument antigens were purified by using gel filtration chromatography. SDS-PAGE performed on the processed proteins demonstrated that the proteins had molecular weights of 20 to 97 kDa. In this study, fifteen monoclonal antibody clones were selected from the hybridoma clones, namely: 1B7, 1B11, 1B12, 1C9, 1D4, 1G2, 1H7, 2B6, 2C3, 2C9, 2D11, 2F11, 2G2, 2G5, and 2G11. They were evaluated by immunoblot assay and were differentiated into two groups. In the first group were found 60 and 38 kDa proteins; in the second group were found 66, 60, and 38 kDa proteins. All were found to secrete IgM, kappa light-chain antibodies. These MAbs were tested for their cross-reactivity with other trematodes commonly found to infect cattle and man. All of these MAbs showed some degree of cross-reactivity with other trematode species.     

The implication of assessing a polymorphism in estrogen receptor alpha gene in the risk assessment of osteoporosis using a screening tool for osteoporosis in Asians

Both genetic and environmental factors interact to determine bone mass and the risk for developing postmenopausal osteoporosis. Recently, an Asian-specific tool, the Osteoporosis Self-Assessment Tool for Asians (OSTA), has been developed to assess the risk of osteoporosis in women. An index is calculated by multiplying the difference in body weight in kilograms and age in years by 0.2 and disregarding the decimal digits. The risk of osteoporosis is classified as high, intermediate or low according to the OSTA index less than –4, –4 to –1 and greater than –1. In the present study we examined how a single nucleotide polymorphism (SNP) in exon 8 of the estrogen receptor (ER) gene affected the predictive value of the OSTA index. Subjects consisted of 358 postmenopausal women who were at least 55 years old. BMDs were measured by DXA, and the SNP in the ER gene was assessed by PCR-RFLP. When considering both the OSTA index and ER genotype in a logistic regression model, it was found that both the OSTA index and the ER genotype independently contributed to the risk of osteoporosis. The odds ratios were 1.58 (95% CI 1.26–1.91) and 2.51 (95% CI 1.42–4.44) for one unit decrement in the OSTA index and each copy of the A allele of the ER genotype, respectively. The joint effect conformed more to a multiplicative model of interaction than an additive model. This suggests that persons with the high-risk genotype are at far greater risk of developing osteoporosis with advancing age or decreasing body weight, the two variables from which the OSTA index is derived. Targeting preventive measures for osteoporosis subjects with risk factors and also disease-susceptibility alleles is likely to be more cost effective.     

Effect of wound infiltration with bupivacaine on postoperative analgesia in neonates and infants undergoing major abdominal surgery: a pilot randomized controlled trial

Purpose

Postoperative pain management is essential in the perioperative care of neonates and infants but it requires a high level of care. Wound infiltration with bupivacaine, a long-acting local anesthetic, is a simple method with minimal complications. However, studies on the effectiveness of wound infiltration in neonates and infants are lacking. The purpose of this study was to investigate the effectiveness of wound infiltration with bupivacaine for postoperative analgesia in neonates and infants undergoing abdominal surgery.

Methods

A prospective, randomized controlled trial was conducted in 34 neonates and infants. The patients were randomized into two groups: the bupivacaine (B) group and the control (C) group. A standardized anesthetic protocol was used for each patient. Before wound closure, the surgical site of each patient in the B group was infiltrated with 2?mg/kg of bupivacaine, whereas no surgical site anesthetic infiltration was used in the C group. The neonatal infant pain scale (NIPS) score was used to evaluate postoperative pain, and fentanyl 0.5–1.5?μg/kg was administered when the NIPS score was ≥4. In regard to the fentanyl requirement, the NIPS score and the numbers of patients whose NIPS score was ≥4 were compared between the two groups.

Results

The median fentanyl dose requirements in the B group and C group were 1 and 0.5?μg/kg, respectively; and the difference was not statistically significant (p?=?0.255). The postoperative NIPS scores in the two groups were not significantly different. In addition, there were no significant differences in the numbers of patients whose NIPS score was ≥4 at 6, 12, 18, and 24?h postoperatively.

Conclusions

In neonates and infants, wound infiltration with bupivacaine had no significant effect on pain relief or fentanyl requirement during the first 24?h after major abdominal surgery.     

Size distribution,characterization and risk assessment of particle-bound polycyclic aromatic hydrocarbons during haze periods in Phayao Province,northern Thailand

This study aims to investigate the concentrations and distributions of particulate matters and particle-bound polycyclic aromatic hydrocarbons (p-PAHs) in different inhalable fractions during haze periods in Phayao Province, northern Thailand and identify their possible emission sources through the characteristic ratios of selected PAHs, then determine an estimate of the potential lung cancer risk. The particulate samples were collected during haze periods between February 18 and April 8, 2014 and non-haze period from June 17 to 22, 2014 using an eight-stage cascade impactor. Each filter sample was weighed, ultrasonically extracted with acetonitrile, and then analyzed by SIM-GC-MS to identify 16 PAHs. The experimental results show that the concentrations of ultrafine (d _ae < 0.4 μm), fine (0.4 μm < d _ae < 2.1 μm), and coarse (d _ae > 2.1 μm) particles during haze periods were in the range of 14.98–26.52 μg m^?3, 62.57–101.52 μg m^?3, and 55.27–89.68 μg m^?3, respectively; whereas, their concentrations of 16 PAHs were in the range of 7.82–36.06 ng m^?3, 26.66–61.89 ng m^?3, and 9.35–30.93 ng m^?3, respectively. The p-PAH distribution profiles during the haze periods were bimodal in coarse and accumulation modes, which are closely related to their particle size distributions. The characteristic ratios of BaP/BgP and INP/(BgP+InP) adsorbed on ultrafine and fine particles were 0.81–0.88 and 0.38–0.86 and 0.54–0.57 and 0.44–0.52, respectively. The values of B[a]P_eq observed during haze periods varied from 9.57 to 29.05 ng m^?3. Estimated lifetime cancer risks during haze periods ranged from 8.324 to 25.27 additional cases per 10,000 people exposed, which is about 10 times higher than that during non-haze period.