The Effect of CPR and Abdominal Thrust Education on Teachers in Child Care Centers

PURPOSE: Education of adult laypersons in cardiopulmonary resuscitation (CPR) has been done frequently and done worldwide. Effective performance of bystander CPR has a decisive effect on outcomes for children as well as for adults. Although the chance of coming into contact with cardiac arrest and acute airway obstruction in a child is relatively high, there are only a few studies of the performance of CPR and abdominal thrust (Heimlich maneuver) done by teachers in child care centers. Therefore, we investigated the effects of CPR and abdominal thrust (Heimlich maneuver) education on teachers in child care centers, especially on their confidence and attitude while performing CPR and Heimlich maneuvers. METHODS: Between August 2009 and October 2009, 245 participants who worked in child care centers received 2 hours of education regarding CPR & emergency procedures for airway obstruction (Heimlich maneuver, abdominal thrust). Participants were asked questions (using a questionnaire) about their confidence and willingness to perform bystander CPR & the Heimlich maneuver. These questions were asked both before their education session and afterwards. Those who answered that they wouldn't perform bystander CPR & Heimlich maneuvers were asked to state the reason. In addition, participants were asked if they were aware of the law exempts from liability bystanders who are not health care providers and who provide CPR or Heimlich as an emergency procedure. RESULTS: The 'definitely yes' answer to 'willingness to perform CPR and abdominal thrust on a child increased from 33.1%, 41.2% before the education session to, respectively, 82.9%, 86.9% afterward (p<0.001). If we included 'yes' and 'relatively yes' answers, the accuracy of performance of acute airway obstruction (abdominal thrust, Heimlich maneuver) increased from 36% before education to 86.9% after. Meanwhile, the reasons for not performing bystander CPR and abdominal thrust, the ratio of 'fear of disease transmission' and 'fear of legal liability' was high in comparison to the ratio of 'fear of poor knowledge/performance'. Only 20.8% answered 'yes' to 'awareness that the law provided exemptions from liability for bystanders doing such emergency procedures. CONCLUSION: Adequate, constant education, including theoretical and practical child CPR and emergency maneuvers for acute airway obstruction of non-health care providers increased their confidence, accuracy and willingness to perform bystander CPR and abdominal thrust maneuvers.

Neurological Manifestations of Acute Intermittent Porphyria

BACKGROUND: Acute intermittent porphyria (AIP) is an autosomal dominant disorder characterized by recurrent abdominal pain with neuropsychiatric symptoms and motor dominant polyneuropathy. The purpose of this study is to characterize neurological manifestations and clinical course of AIP in Korean. METHODS: Medical records from 1984 to 2001 were reviewed retrospectively. There were 23 cases of laboratory confirmed AIP. RESULTS: The clinical characteristics of AIP are the acute abdominal pain without fever or leukocytosis. Neuropsychiatric symptoms or polyneuropathy occurred in 13 cases (56.5%). Among the 13 cases, there were 4 cases with neuropsychiatric symptoms only, 3 with polyneuropathy only and 6 with both of them. Polyneuropathy was usually preceded by neuropsychiatric symptoms. Severe sensori-motor polyneuropathy with respiratory failure occurred in 4 cases, where one expired. Hyponatremia was seen in 14 cases (60.8%) and 7 of them had the neuropsychiatric symptoms. CONCLUSIONS: The clinical characteristics of AIP include acute abdominal pain without leukocytosis or fever, and hyponateremia. The neuropsychiatric symptoms and peripheral neuropathy in AIP may occur by improper treatment for the acute abdominal pain, and can worsen by wrong treatment without clinical suspicion.

Effect of Tetracycline Analogues on The Activity of Matrix Metalloproteinase-3 in Gingival Fibroblasts / 대한치주과학회지

Extracellular matrix component is degraded by enzymes of thematrix metalloproteinases(MMPs). MMPs are produced by both hemopoietic and structural cells. Increased activity of MMP-3 in periodontium is strongly associated with inflammatory periodontal disease. The purpose of the present study was to determine the effect of tetracycline analogues on the activity of MMP-3. Tetracycline-HCl, doxycycline-HCl, and minocycline-HCl were applied to huamn gingival fibroblasts at various concentrations of 10, 25, 50, 100, 200microgram/ml, and 1 hour later IL-1beta of 25ng/ml was added. After incubation for 24 hours the cells were reacted by enzyme-linked immunosorbent assay using proMMP-3 ELISA kit. The optical density was measured by microwell plate reader at 450nm. The relative activity of MMP-3 was calculated as the percentage of the optical density of each experimental group to that of the control. The difference of the optical density and the relative activity of MMP-3 between the experimental groups and the control wasstatistically analyzed by one way ANOVA. The results were as follows: 1. Tetracycline-HCl showed the tendency to inhibit the activity of MMP-3 at the concentration lower than 25 microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 2. Doxycycline-HCl inhibited significantly the activity of MMP-3 at the concentration lower than 100microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 3. Minocycline-HCl inhibited the activity of MMP-3 at the concentration in the range of 10 to 200microgram/ml. Within the limit of the present study, the above results suggested that the low concentration of tetracycline analogues could inhibit the activity of MMP-3 induced by IL-1beta in human gingival fibroblasts.