Promoting developmental supportive care in preterm infants and families in a level III neonatal intensive care unit (NICU) setting in India.

Despite evidence of short- and long-term benefits of developmental care, several studies have documented nurses' lack of knowledge and skills related to developmental care concepts. This study aims to enhance neonatal nurses' abilities to acquire care practices (knowledge and skills) regarding Developmental Supportive Care (DSC). A nonrandomized before and after intervention design was adopted to improve the knowledge and skills of staff nurses in DSC practices for preterm infants in Level III B NICU. The study included 50 level III B NICU nurses (25 in interventional group, 25 in control group) located within a tertiary care hospital in India. A significant increase in the mean knowledge score was seen among participants in the intervention group (pre-test: 16.6 ±â€¯3.1, post-test: 29.9 ±â€¯4.1, p = 0.01) but not in the control group (pre: 16.4 ±â€¯2.2, post: 18.6 ±â€¯3.6, p = 0.98). The improvement in the skills of providing DSC among neonatal nurses was also higher in the intervention group (106.4 ±â€¯7.4) relative to the control group (65.8 ±â€¯3.6), p < 0.01, at 0.05 level of significance. The Developmental Supportive Care Program (DSCP) had a significant impact in improving the knowledge and skills of nurses in providing care and preventing complications in preterm infants.

Correlation between 99mTc-pertechnetate uptakes and expressions of human sodium iodide symporter gene in breast tumor tissues.

We investigated a correlation between the expression of human sodium iodide symporter (hNIS) mRNA and the uptake of 99mTc-pertechnetate in 25 breast tumors. 99mTc-pertechnetate scintigraphy revealed positive uptake in 4 patients. The normalized mRNA expression of hNIS was higher in tumors with positive uptake on the scintigraphy (n=4, median 0.97, range 0.78-1.27) than that in negative uptake tumors (n=21, median 0.46, range 0.10-1.03, p < 0.005). 99mTc-pertechnetate uptake is correlated with the hNIS expression in the breast tumor.

Hepatopulmonary syndrome in Gaucher disease with right-to-left shunt: evaluation and measurement using Tc-99m MAA.

Hepatomegaly is a common manifestation in Gaucher disease. In some patients with the disease, hepatic fibrosis and portal hypertension are observed. A patient with Gaucher disease with the hepatopulmonary syndrome associated with severe cyanosis and hypoxemia was examined for intrapulmonary right-to-left shunt using Tc-99m MAA. Quantitative evaluation revealed an approximately 50% right to left shunt as indicated by Tc-99m MAA activity in the lungs and systemic organs.

Extracorporeal membrane oxygenation in the neonate.

ECMO is a modified heart-lung bypass system for treatment of moribund neonates. The techniques are described. Our experience with 19 patients reveals a survival rate of 79 percent. In the future, with advances in technology, ECMO may become less invisible and extended to a larger population of newborns.

The interaction between noradrenaline and angiotensin II in man: evidence for a postsynaptic and against a presynaptic interaction.

Recent evidence from animal studies suggests an interaction between the renin-angiotensin system (RAS) and the sympathetic nervous system (SNS). We sought evidence for a similar interaction in man, to determine whether this interaction is presynaptic, whereby angiotensin II (ANG II) facilitates noradrenaline (NA) release, or postsynaptic, whereby ANG II facilitates the effect of NA. In our first study, a subpressor dose of ANG II was infused and NA release stimulated by physiological tests. The haemodynamic responses and plasma NA responses to SNS stimulation were not augmented by ANG II. In the second study normal volunteers were infused with either saline, ANG II, or a combination of ANG II and NA. Analysis of variance showed that ANG II interacts synergistically with NA to increase systolic blood pressure (SBP). Plasma NA and ANG II levels were not altered by the coincidental presence of NA or ANG II. These results suggest that there is a pharmacodynamic interaction between NA and ANG II which acts synergistically at a postsynaptic site to maintain SBP.

Gentamicin vs cefotaxime for therapy of neonatal sepsis. Relationship to drug resistance.

An outbreak of serious infections due to gentamicin-resistant Klebsiella pneumoniae occurred in a neonatal intensive care unit in which the combination of gentamicin sulfate and ampicillin sodium had been used for standard initial therapy for suspected sepsis for nearly 11 years. After institution of control measures that included the substitution of cefotaxime sodium for gentamicin in the standard regimen, the outbreak promptly subsided. Nevertheless, a second outbreak of serious infections due to cefotaxime-resistant Enterobacter cloacae began ten weeks later. Sequential stool cultures from patients in the unit confirmed the disappearance of gentamicin-resistant K pneumoniae and the emergence of cefotaxime-resistant E cloacae after the change in antibiotic policy. These observations suggest that routine use of newer cephalosporins for therapy of suspected sepsis may lead to the emergence of drug-resistant microorganisms more rapidly than has occurred with the aminoglycosides.