Material and human resources for neonatal resuscitation in public maternity hospitals in Brazilian state capitals

CONTEXT AND OBJECTIVE: In 2002, the early neonatal mortality rate in Brazil was 12.42 per thousand live births. Perinatal asphyxia was the greatest cause of neonatal death (about 23%). This study aimed to evaluate the availability of the resources required for neonatal resuscitation in delivery rooms of public hospitals in Brazilian state capitals. DESIGN AND SETTING: Multicenter cross-sectional study involving 36 hospitals in 20 Brazilian state capitals in June 2003. METHODS: Each Brazilian region was represented by 1-4% of its live births. A local coordinator collected data regarding physical infrastructure, supplies and professionals available for neonatal resuscitation in the delivery room. The information was analyzed using the Statistical Package for the Social Sciences, version 10. RESULTS: Among the 36 hospitals, 89% were referral centers for high-risk pregnancies. Each institution had a monthly mean of 365 live births (3% < 1,500 g and 15% < 2,500 g). The 36 hospitals had 125 resuscitation tables (3-4 per hospital), all with overhead radiant heat, oxygen and vacuum sources. Appropriate equipment for pulmonary ventilation was available for more than 90% of the 125 resuscitation tables. On average, one pediatrician, three nurses and five nursing assistants per shift worked in the delivery rooms of each institution. Out of the 874 pediatricians and 1,037 nursing personnel that worked in the delivery rooms of the 36 hospitals, 94% and 22%, respectively, were trained in neonatal resuscitation. CONCLUSIONS: The main public maternity hospitals in Brazilian state capitals have the resources to resuscitate neonates at birth.     

Using the observer-based psychophysical procedure to assess localization acuity in toddlers who use bilateral cochlear implants.

HYPOTHESIS: Localization acuity will emerge in deaf children who receive bilateral cochlear implants (BI-CIs) before the age of 3 years but not in age-matched children who use a single device. BACKGROUND: There is a growing clinical trend in which infants with severe-to-profound sensorineural hearing loss are receiving BI-CIs by 3 years. Although there is general agreement that better communicative and educational outcomes are achieved when the first implant is provided at a young age, there are few behavioral data showing the functional benefits of providing infants with BI-CIs. One potential benefit of BI-CIs is improved localization acuity, which develops within the first few years of life. METHODS: Two groups of children with chronological ages ranging from 26 to 36 months participated: 1) children with normal hearing (n = 8) and 2) children with severe-to-profound sensorineural hearing loss (n = 18). Of the children who are deaf, 10 used BI-CIs, and 8 used unilateral cochlear implants. Localization acuity was measured with a single interval 2-alternative-forced choice right/left discrimination task, and minimum audible angles were computed at a performance level of 80% correct. Behavioral data were collected using the observer-based psychophysical procedure. RESULTS: Preliminary results show that the observer-based psychophysical procedure is a feasible method to measure localization acuity in children with normal hearing and in deaf children with cochlear implants and that localization acuity is emerging in toddlers with BI-CIs but not yet in toddlers with unilateral cochlear implants. CONCLUSION: These data are among the first to show localization acuity in young children who use BI-CIs.     

Rapid Hair Cell Loss: A Mouse Model for Cochlear Lesions

In comparison to other mammals, mice have proved extremely resistant to aminoglycoside-induced hair cell ablation in vivo. In this paper we examine the pattern and extent of cochlear lesions rapidly induced with a combination of a single dose of aminoglycoside (kanamycin) followed by a loop diuretic (bumetanide). With this protocol, the vestibular system was unaffected, but in the cochlea, there was extensive loss of outer hair cells (OHC) that commenced in the basal coil and progressed apically so that, by 48 h, OHC loss was almost complete. TUNEL-positive nuclei and activated caspase-3 labeling demonstrated that most OHC died via a classical apoptotic pathway. However, scattered debris within the OHC region suggested that many apoptotic cells ruptured prior to completion of apoptosis. Following lesion repair, supporting cells retained characteristics of differentiated cells but positional shift occurred. In comparison to OHC loss, inner hair cell (IHC) death was delayed and only observed in 50% of all cochleae examined even after extensive reorganization of the tissue. The coadmininstration of diuretic with FM1-43, used as a tracer for aminoglycoside uptake, indicated entry into IHC as readily as OHC, suggesting that the differential response to aminoglycoside was not due to differential uptake. Where IHC death was ongoing, there were indications of different modes of cell death: cells with morphological features of autophagy, necrosis, and apoptosis were apparent. In addition to damage to the organ of Corti, there was a significant and progressive decrease in strial thickness beginning as early as 7 days posttreatment. This was due predominantly to degeneration of marginal cells. The strial pathology resembled that reported after noise damage and with aging. This in vivo protocol provides a robust model in which to obtain extensive OHC loss in the mature cochleae of mice and is a means with which to examine different aspects of cochlear pathology in transgenic or mutant strains.     

Absent otoacoustic emissions predict otitis media in young Aboriginal children: A birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia

Background  

Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM.     

Workforce participation among international medical graduates in the National Health Service of England: a retrospective longitudinal study

Background  

Balancing medical workforce supply with demand requires good information about factors affecting retention. Overseas qualified doctors comprise 30% of the National Health Service (NHS) workforce in England yet little is known about the impact of country of qualification on length of stay. We aimed to address this need.     

Nurse–Patient Sexual Contact in Psychiatric Hospitals

Sexual contacts between nurses and patients in psychiatric hospitals have not been investigated systematically. The aim of the present study was to determine the frequency of nurse–patient sexual relationships and their prominent characteristics on the one hand and the nurses' attitudes towards these contacts on the other. A questionnaire was mailed to 714 nurses employed at two psychiatric hospitals. Although 94% of the 279 respondents considered sexual contact (defined as physical contact between a patient and a nurse, in which sexual arousal occurred in the nurse) to be inappropriate, 17% of the male and 11% of the female responding nurses reported having had such contacts with patients.     

Xanthogranulomatous cholecystitis in a 10-year-old boy

A 10-year-old boy presented with a 5-month history of recurrent abdominal pain, fever, and jaundice. Ultrasound examination revealed a thick-walled gallbladder and dilatation of the biliary tree. Endoscopic retrograde cholangiography showed irregular common bile duct dilatation. After cholecystectomy for acalculous cholecystitis, histological examination of the operative specimen revealed the features of xanthogranulomatous cholecystitis. The abnormalities observed in the bile duct were secondary. This unusual destructive inflammatory process has previously only been described in adults.     

Encephalopathy in Acute Leukaemia Associated with Methotrexate Therapy

Seven patients are described in whom dementia developed during treatment with methotrexate for meningeal leukaemia. The patients presented with confusion, tremor, ataxia, irritability, and somnolence. There were major epileptic fits in two cases and in one case there was progression to coma and death. Necropsy findings in the latter showed infarcted areas in the temporal and parietal lobes, with no evidence of active leukaemic disease or of viral encephalitis. The condition has not responded to radiotherapy and no positive evidence of viral encephalitis has been obtained. On the other hand, when treated with folinic and folic acid the deterioration has been arrested and there has been some improvement; thus the condition appears to be due to methotrexate. The occurrence of so many cases within the past year of a condition not previously described is probably attributable to the introduction of intensive cytotoxic therapy directed against meningeal leukaemia.     

Anionic PAMAM Dendrimers Rapidly Cross Adult Rat Intestine In Vitro: A Potential Oral Delivery System?

Purpose. To investigate systematically the effect ofpolyamidoamine (PAMAM) dendrimer size, charge, and concentration on uptakeand transport across the adult rat intestine in vitro using theeverted rat intestinal sac system. Methods. Cationic PAMAM dendrimers (generations 3 and 4)and anionic PAMAM dendrimers (generations 2.5, 3.5, and 5.5) that weremodified to include on average a single pendant amino group wereradioiodinated using the Bolton and Hunter Reagent. ¹²⁵I-Labelleddendrimers were incubated with everted sacs in vitro and thetransfer of radioactivity into the tissue and serosal fluid was followedwith time. Results. The serosal transfer rates seen for all anionicgenerations were extremely high with Endocytic Indices (EI) in the range3.4–4.4 mL/mg protein/h. The concentration-dependence of serosaltransfer was linear over the dendrimer concentration range 10–100mg/mL. For ¹²⁵I-labelled generation 5.5 the rate of tissueuptake was higher (EI = 2.48 ± 0.51 mL/mg protein/h) thanseen for ¹²⁵I-labelled generations 2.5 and 3.5 (0.6–0.7mL/mg protein/h) (p < 0.05). The ¹²⁵I-labelled cationicPAMAM dendrimers (generations 3 and 4) displayed a tissue uptake (EI= 3.3–4.8 mL/mg protein/h) which was higher (p < 0.05)than the rate of serosal transfer (EI = 2.3–2.7 mL/mgprotein/h), probably due to nonspecific adsorption of cationic dendrimer tothe mucosal surface. Conclusions. As the anionic PAMAM dendrimers displayedserosal transfer rates that were faster than observed for other syntheticand natural macromolecules (including tomato lectin) studied in the evertedsac system, these interesting nanoscale structures may have potential forfurther development as oral drug delivery systems.     

Stromal Decidual Change in the Pregnant Cervix: Colposcopic, Cytological and Histological Considerations

Summary: Forty-two pregnant patients with cytology smears suggesting cervical intra-epithelial neoplasia were examined in a special clinic by colposcopy, cytology and biopsy. This study was concerned with the recognition of decidual change in the cervical stroma in these patients, establishing its incidence and deterrnining whether its presence influenced interpretation of the colposcopic and cytological findings.
Intense decidual change was seen in die biopsy from 6 patients (14.3%); in 4 of these the change was colposcopically apparent, and in 1 decidual cells were present in the cytology smear. Colposcopically, decidual alteration can be distinguished from atypical transformation zone changes suggestive of cervical intra-epithelial neoplasia. Similarly, in cytology smears, die well preserved decidual cells of cervical origin are not difficult to distinguish from atypical squamous cells.