Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

INTRODUCTION: The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. AIM: This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. METHOD: The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. RESULTS: Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. CONCLUSION: Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.     

The opposing roles of NOTCH signalling in head and neck cancer: a mini review

NOTCH signalling can exert oncogenic or tumour suppressive effects in both solid and haematological malignancies. Similar to T‐cell acute lymphoblastic leukaemia (T‐ALL), early studies suggested a pro‐tumorigenic role of NOTCH in head and neck squamous cell carcinoma (HNSCC), mainly based on the increased expression levels of the genes within the pathway. Recently, data from exome sequencing analyses unexpectedly pointed to a tumour suppressor role for NOTCH in HNSCC by identifying loss‐of‐function mutations in the NOTCH1 gene in a significant proportion of patients. These data have questioned the accepted role of NOTCH in HNSCC and the possible rationale of targeting NOTCH in this disease. This review summarises the current information on NOTCH signalling in HNSCC and discusses how this pathway can apparently exert opposing effects within the same disease.     

Clinical and epidemiological predictors of transmission in Severe Acute Respiratory Syndrome (SARS)

Background  

Only a minority of probable SARS cases caused transmission. We assess if any epidemiological or clinical factors in SARS index patients were associated with increased probability of transmission.     

Human immunodeficiency virus-associated nephropathy (HIVAN) in Nigerian children

Human immunodeficiency virus-associated nephropathy (HIVAN) has rarely been reported in African children. In this single-center study, we analyzed ten children diagnosed with HIVAN from January 2000 to October 2006. There were eight boys and two girls, with a male:female ratio of 4:1. Their ages were from 5 months to 15 years (mean 6.8 ± 6.2 years), with a peak age of 5–9 years. The presenting complaints included generalized edema (60%) and hypertension (50%). All patients had proteinuria on urine dipstick, with four (40%) at nephrotic range (proteinuria ≥500 mg/dl). Nine (90%) patients were in renal failure, with elevated serum creatinine (6.3–24 mg/dl) and serum urea (70–120 mg/dl). Renal disease was the first manifestation of HIV infection in six patients, whereas the diagnosis was made on autopsy in three. The duration from HIV infection to development of HIVAN ranged from 5 months to 10 years. CD4⁺ cell count, done in only three patients due to financial constraints, was below 200/mm³. The kidneys were hyperechoic on abdominal ultrasound in all patients, and three (30%) showed grossly enlarged kidneys. Histology of renal tissues available by autopsy in three patients showed mainly collapsing focal segmental glomerulosclerosis. Treatments given were angiotensin-converting enzyme (ACE) inhibitors and highly active antiretroviral therapy (HAART) in four and two patients, respectively, and one patient underwent peritoneal dialysis. On outcome analysis, seven (70%) patients died, two were lost to follow-up, and one was alive on HAART therapy at the writing of this article. In conclusion, HIVAN occurs in Nigeria children, and the mortality is very high from uremia.     

Acute renal failure in Nigerian children: Port Harcourt experience

Acute renal failure (ARF) is a significant cause of morbidity and mortality in children. It may be pre-renal, intrinsic, or post-renal (obstructive) in aetiology. ARF was investigated in children in the south-southern part of Nigeria to determine the prevalence, aetiology, management and outcome of ARF. A retrospective review of data from all children from birth to 16 years of age admitted into the Department of Paediatrics, University of Port Harcourt Teaching Hospital (UPTH), with the diagnosis of ARF over an 18 year period (January 1985 to December 2003) was performed. Information was obtained about the age, sex, clinical features, blood pressure, laboratory and radiological investigations, aetiology, and treatment received including dialysis. Information on the outcome, factors influencing outcome, and possible causes of death were reviewed. There were 211 patients, 138 (65.4%) males and 73 (34.6%) females (M:F, 1.9:1), with a hospital prevalence of 11.7 cases/year. The patients were aged 5 days to 16 years (mean 5.6±4.7 years). Oliguria was the most common clinical presentation in 184 (87.2%) patients. Hypertension was seen in only 39 (18.5%) patients. The causes were age-related. The neonates had ARF from severe birth asphyxia 27 (35.5%), septicaemia 17 (22.4%), with tetanus 4 (5.3%) and congenital malformations 11 (14.5%). Sixty-one (28.9%) and 29 (13.7%) patients had ARF from gastroenteritis and malaria respectively. The patients with leukaemia were all more than 10 years old and had acute lymphoblastic leukaemia. Two patients (1.9%) had Burkitts lymphoma involving the abdomen and 3 patients had HIVAN. 112 (53%) patients had anaemia with a mean haematocrit of 20.25±6.9%. Dialysis was indicated in 108 patients, but only 24 patients (22.2%) had peritoneal dialysis (PD), because of financial constraints and lack of dialysis equipment. Mortality rate was 40.5%. The causes of death were uraemia 60 (70.6%), overwhelming infection 5 (5.9%), and recurrent anaemia 20 (23.5%). Hypertension (X² 15.7, P<0.001) and lack of dialysis (X² 7.96, P<0.01) significantly affected outcome. Other factors associated with demise were delayed presentation (58.8%), use of herbal treatment (35%), and unaffordability of treatment (40%). ARF is a significant cause of mortality in Nigerian children. The patients are not adequately managed because of poverty and lack of facilities for dialysis. The causes of ARF in our environment are preventable, and should be expected.