Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks

Objective

To evaluate the pediatric residents’ cardiopulmonary resuscitation (CPR) skills, and their improvements after recorded video feedbacks.

Methods

Pediatric residents from a university hospital were enrolled. The authors surveyed the level of pediatric resuscitation skill confidence by a questionnaire. Eight psychomotor skills were evaluated individually, including airway, bag-mask ventilation, pulse check, prompt starting and technique of chest compression, high quality CPR, tracheal intubation, intraosseous, and defibrillation. The mock code skills were also evaluated as a team using a high-fidelity mannequin simulator. All the participants attended a concise Pediatric Advanced Life Support (PALS) lecture, and received video-recorded feedback for one hour. They were re-evaluated 6 wk later in the same manner.

Results

Thirty-eight residents were enrolled. All the participants had a moderate to high level of confidence in their CPR skills. Over 50 % of participants had passed psychomotor skills, except the bag-mask ventilation and intraosseous skills. There was poor correlation between their confidence and passing the psychomotor skills test. After course feedback, the percentage of high quality CPR skill in the second course test was significantly improved (46 % to 92 %, p = 0.008).

Conclusions

The pediatric resuscitation course should still remain in the pediatric resident curriculum and should be re-evaluated frequently. Video-recorded feedback on the pitfalls during individual CPR skills and mock code case scenarios could improve short-term psychomotor CPR skills and lead to higher quality CPR performance.

     

A Novel H572R Mutation in the Transforming Growth Factor-β-Induced Gene in a Thai Family with Lattice Corneal Dystrophy Type I

Purpose

To describe a large Thai family with lattice corneal dystrophy (LCD) type I and to determine whether this LCD is associated with mutations within the transforming growth factor-β-induced (TGFBI) gene.

Methods

A six-generation family with LCD type I was identified and diagnosed on the basis of clinical and/or histopathologic evaluation. Visual acuity testing and slit-lamp biomicroscopic evaluation were carried out and corneal photography was documented. All 17 exons and flanking intron sequences of the TGFBI gene were sequenced.

Results

Thirty-three participants demonstrated LCD in both eyes, most of which was symmetrical. Age at onset of decreased vision was the mid- to late twenties. Visual acuity varied from 6/6 to no light perception. Two patients, 74 and 42 years of age, demonstrated a thick yellowish plaque covering the corneal surfaces. DNA sequencing revealed a heterozygous mutation in exon 13 (A1762G), changing histidine to arginine at codon 572 (H572R). Ten of 42 clinically unaffected family members, all under 25 years of age, exhibited the same mutation.

Conclusions

This is the first report of a molecular analysis of LCD type I in Thai patients. The novel mutation identified is associated with distinct phenotypes and later onset of the disease compared with the more common R124C mutation.?Jpn J Ophthalmol 2006;50:403–408 © Japanese Ophthalmological Society 2006     

Two new antimalarial quassinoid derivatives from the stems of <Emphasis Type="Italic">Brucea javanica</Emphasis>

Phytochemical investigation of the stems from Brucea javanica led to the isolation of two new quassinoids, brujavanol C (1) and brujavanol D (2), together with six known compounds (3–8). The chemical structures were elucidated by means of various spectroscopic methods. All the isolated compounds were evaluated for antimalarial activity against Plasmodium falciparum and compounds 6 and 7 exhibited the most potent activity against the K1 strain, with IC₅₀ values of 1.41 and 1.06 μM, respectively.     

Cell death gene expression profile: role of RIPK2 in dengue virus-mediated apoptosis

Dengue virus (DENV) is a major emerging arthropod-borne pathogen, which infects individuals in both subtropical and tropical regions. Patients with DENV infection exhibit evidence of hepatocyte injury. However, the mechanisms of hepatocyte injury are unclear. Therefore we examined the expression of cell death genes during DENV-infection of HepG2 cells using real-time PCR arrays. The expression changes were consistent with activation of apoptosis and autophagy. Expression of the up-regulated genes, including RIPK2, HRK, TGF-β, PERK, and LC3B, was confirmed by quantitative real-time PCR. RIPK2 belongs to the receptor-interacting protein family of serine/threonine protein kinases, which is a crucial mediator of multiple stress responses that leads to the activation of caspase, NF-κB and MAP kinases including JNK and p38. RIPK2 activity is inhibited by the p38 MAPK pathway inhibitor SB203580. The effect of SB203580 on RIPK2 expression and DENV-induced apoptosis was tested in DENV-infected HepG2 cells. The inhibition of RIPK2 expression by SB203580 significantly reduced apoptosis. SB203580 also significantly reduced DENV capsid protein (DENVC)-mediated apoptosis. Suppression of endogenous RIPK2 in DENV-infected HepG2 cells by small interfering RNA (siRNA) significantly decreased apoptosis suggesting for the first time that RIPK2 plays a role in DENV-mediated apoptosis.     

Efficacy of separated system continuous venovenous hemofiltration in critical acute kidney injury

Integrated system continuous venovenous hemofiltration (CVVH), the most popularly utilized mode for continuous renal replacement therapy (CRRT), needs a sophisticated and expensive machine that is available only in limited critical care units. Separated system CVVH, which can be simply set up, might be an effectively alternative to CRRT. A one-year prospective observational study regarding the efficacy of separated system CVVH was conducted with 192 critically ill patients with acute kidney injury. All patients underwent separated system CVVH with the pre-dilution mode and a mean CVVH dose of 34.9±2.7mL/kg/h. The APACHEII score was 23.2±8.4 and the Sequential Organ Failure Assessment score was 12.0±4.3. No complications, including air-embolism or circuit clotting, were observed and the survival rate was 32.3%. Separated system CVVH is simple, safe, and efficient and could provide cheaper treatments than the integrated system. It could thus be an effective, alternative treatment for critical acute kidney injury patients when the integrated mode is unavailable.     

Melioidosis in animals, Thailand, 2006-2010

We retrospectively estimated the incidence of culture-proven melioidosis in animals in Thailand during 2006-2010. The highest incidence was in goats (1.63/100,000/year), followed by incidence in pigs and cattle. The estimated incidence of melioidosis in humans in a given region paralleled that of melioidosis in goats.     

Development and validation of point‐of‐care testing of albuminuria for early screening of chronic kidney disease

IntroductionChronic kidney disease (CKD) is a significant global health issue. As the prevalence of renal replacement therapy (RRT) in Thailand is increasing, early detection and management of CKD is the most important step to prevent CKD progression and the need for RRT. Current diagnostic tests for CKD are non‐specific and expensive. We aimed to develop and validate antibody‐based‐albumin point‐of‐care testing (POCT) to detect patients with impaired kidney function at early stage.MethodsThe prototype strip test was developed under the concept of competitive lateral flow immunochromatography assay, or strip test. Monoclonal antibodies (MAbs) to human serum albumin (HSA) were harvested from the hybridomas of spleen cells from immunized mice and mouse myeloma cells. Presence of MAbs was detected by enzyme‐linked immunosorbent assay (ELISA). Spot urine was obtained from patients with kidney disease, type I, or type II Diabetes Mellitus upon their visit at King Chulalongkorn Memorial Hospital during 2018–2019. All samples were analyzed for urine albumin with our POCT (CU microalbumin) and the other two commercial POCTs (Microalbu PHAN and MICRAL). The results were validated against standard method for urine microalbumin measurement. A urine microalbumin concentration of less than 20 ug/ml was defined as normal. The sensitivity, specificity, and predictive values were calculated in comparison with the standard laboratory method.ResultA total of 100 adult patients were included. CU microalbumin had a sensitivity of 86%, a specificity of 94%, and a positive predictive value of 96%. Our POCT showed good correlation with the laboratory results.ConclusionCU microalbumin correlated well with the standard method for quantitative measurement of urine albumin. Therefore, it has the potential for early screening of CKD, especially in primary health care facilities in resource limited settings.