Training neonatal skills with simulators?

Aim: To compare two different ways of learning (self-study vs. simulation sessions) the adequate steps to resuscitate a neonate in the 5th year undergraduate medical curriculum.
Methods: One hundred and eighty students attending the 5-week paediatrics rotation were enrolled; 115 were invited to participate in this study, but only 45 students completed it. After a 50-min 'neonatal resuscitation' theoretical interactive class, students were randomly assigned into two groups: the first (n = 21) participated in a 30-min supervised self-study session, while the second (n = 24) attended a 30-min neonatal resuscitation session using the Zoe (Gaumard^® Inc., Miami, FL, USA) simulator.
Results: Tests consisting of 50 multiple-choice questions were taken before the theoretical class (pre-theoretical test), before the self-study or simulation session (pre-test) and after this session (post-test). Pre-test and post-test scores were similar in both groups (p = 0.118 and p = 0.263, respectively).
Conclusion : Simulation-based training of medical students in management of neonatal resuscitation do not led to significant differences on short-term knowledge comparing with traditional method.     

In vivo photodynamic inactivation of Candida albicans using chloro‐aluminum phthalocyanine

This study evaluated the photoinactivation of Candida albicans in a murine model of oral candidiasis using chloro‐aluminum phthalocyanine (ClAlP) encapsulated in cationic nanoemulsions (NE) and chloro‐aluminum phthalocyanine (ClAlP) diluted in DMSO (DMSO) as photosensitizer (PS). Seventy‐five 6‐week‐old female Swiss mice were immunosuppressed and inoculated with C. albicans to induce oral candidiasis. PDT was performed on the tongue by the application of the photosensitizers and LED light (100 J cm^?2–660 nm). Twenty‐four hours and 7 days after treatments, microbiological evaluation was carried out by recovering C. albicans from the tongue of animals (CFU ml^?1). Then, mice were sacrificed and the tongues were surgically removed for histological and biomolecular analysis of pro‐ and anti‐inflammatory cytokines. Data were analyzed by ANOVA followed by Tukey's post hoc test. ClAlP‐NE‐mediated PDT reduced 2.26 log₁₀ of C. albicans recovered from the tongue when compared with the control group (P?L?) (P < 0.05). PDT did not promote adverse effects on the tongue tissue. Seven days after treatment, all animals were completely healthy. In summary, PDT mediated by chloro‐aluminum phthalocyanine entrapped in cationic nanoemulsions was effective in reducing C. albicans recovered from the oral lesions of immunocompromised mice.     

Duodenopancreatectomía en ancianos. Evaluación de resultados

IntroductionWith the increase in life expectancy, more and more resectable periampullary tumours are being diagnosed in the geriatric population. Despite the decrease in post-operative mortality, there continues to be a debate on the risk-benefit of cephalic duodenopancreatectomy (CPD) in the elderly.ObjectiveTo analyse the morbidity and mortality of CPD in patients over 70 years-old.DesignProspective observational study.PatientsA total of 54 duodenopancreatectomies were performed between January 2005 and December 2010. Two groups of patients were compared: Group 1 (patients > 70 years-old, n: 24), and Group 2 (patients < 70 years-old, n: 30). The morbidity and mortality, transfusion, reinterventions, mean hospital stay, and survival were analysed.ResultsThe > 70 years group included more ASA 2 and 3 patients (P=.010), and had a higher number of previous medical problems per patient (P=.037). The post-operative mortality was higher in the older age group, although the difference was not significant (8.3 vs 3.3%). There were also no significant differences in post-operative morbidity (45.8 v. 46.6%), reintervention rate (16.6 vs 13.3%), length of hospital stay (18 vs 13%), and survival at 6 and 12 months (84 and 72% vs 90 and 86%).ConclusionsAge, in itself, does not seem to be a contraindication for CPD, but the elderly do have a higher risk of complications due to the physiological changes associated with ageing. The disparity of results demonstrates the need for more population studies at national level that may give an overall view of morbidity and mortality in CPD.     

Allogeneic marrow grafting for treatment of aplastic anemia: a follow- up on long-term survivors

Eleven of twenty-four patients with severe aplastic anemia given marrow grafts from HLA-identical siblings between October 1970 and March 1973 are alive with normal marrow function and continued evidence of engraftment 3-5 yr later. Ten have been leading normal lives with no immunosuppressive or other drug therapy since day 100 postgrafting. One has had chronic graft-versus-host disease of the skin which is now slowly improving with no therapy. He returned to full-time employment in the summer of 1975. The long-term well-being of almost half of our initial patients emphasizes the importance of marrow transplantation for the treatment of severe aplastic anemia.     

Management of colorectal cancer liver metastasis in a patient with immune thrombocytopaenia

Immune thrombocytopaenia (ITP) was referred to previously as idiopathic thrombocytopaenic purpura and is usually of autoimmune or viral aetiology. Colorectal cancer liver metastasis with concomitant ITP is rare and only three cases have been reported in the English literature. Adverse effects of adjuvant chemotherapy may aggravate ITP. The sequencing of chemotherapy, operation for the primary and liver metastasis, and a decision on splenectomy is important. We present our experience in the management of a 52-year-old man who, having undergone anterior resection one year earlier for carcinoma of the rectum, presented with liver metastasis and ITP. He underwent splenectomy with hepatectomy prior to chemotherapy.     

Predicting patterns of adolescent alcohol use: a longitudinal study

OBJECTIVE: Because most studies of adolescent alcohol use have focused primarily on the frequency and quantity of consumption, we know little about how adolescent drinking patterns change during the high school years. The purpose of this article is to provide such data, as well as to identify some of the individual, family, social life and community predictors of changes in drinking patterns over time. METHOD: A sample of 1,253 students in grades 9 through 12 (57% female) in a large metropolitan school district participated. Three ethnicities were represented: African American, European American and Mexican American. Students completed questionnaires every 6 months for a 2-year period (n = 743 at Time 4). RESULTS: Cluster analyses of the drinking variables yielded one problem-drinking group (heavy, multiple-context drinking), two high-risk groups (i.e., date and outdoor drinking) and three normative groups (light, family/parent, moderate/ party drinking). The most predictable patterns of longitudinal changes in adolescent drinking were consistent with the following progression (or the reverse): abstainer --> normative drinker --> high-risk drinker --> problem drinker. Paternal attitudes toward adolescent drinking and peer involvement in antisocial behavior predicted movement into normative drinking; social activity with peers predicted movement into high-risk drinking; and emotional distress predicted the transition into problem drinking. CONCLUSIONS: These findings are consistent with the multistage social learning model, demonstrating that the predictors of adolescent alcohol use vary across different levels of adolescent alcohol involvement.