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PubMed2004

Compatibility testing without a centrifuge: the slide Polybrene method.

BACKGROUND: A simple and rapid slide Polybrene method (SP) for pretransfusion compatibility testing is described. SP is particularly suitable for use in developing countries where, due to limited resources, centrifuges and biologic reagents may not be readily available. STUDY DESIGN AND METHODS: The original manual Polybrene method (MP) was modified for use on glass microscope slides, eliminating the need for test tubes and centrifugation. The sensitivity of SP for detecting alloantibodies to RBC antigens was compared with that of MP and the IAT. RESULTS: Both SP and MP were more sensitive than the IAT for detecting anti-E. SP detected 21 of 23 examples of anti'-Mi(a)' and 7 of 8 examples of anti-E. Kidd and Diego system antibodies were also readily detectable by SP, although the reactions were weaker than those observed with both MP and IAT. However, both SP and MP failed to detect some examples of antibodies to Kell system antigens. CONCLUSIONS: SP is an acceptable method for compatibility testing in developing countries, particularly in populations where the frequency of K is low (e.g., southeast Asia). The reagents are inexpensive and can be prepared in-house. SP is simple to use, does not require a centrifuge, and can be performed by personnel with minimal training.

Antibodies↗
PubMed1996

Evaluation of Alamar colorimetric broth microdilution susceptibility testing method for staphylococci and enterococci.

We compared the results of the Alamar broth microdilution susceptibility testing method with the results of the National Committee for Clinical Laboratory Standards reference broth microdilution method for 119 gram-positive organisms. The strains were tested for their susceptibilities to 20 antimicrobial agents. Only appropriate antimicrobial agents were evaluated for each species of bacteria. Absolute categorical agreement between the reference method and the test method was 91.5% for enterococci, 99.8% for oxacillin-susceptible staphylococci, and 97.4% for oxacillin-resistant staphylococci. Essential agreement (percent complete agreement plus percent minor errors) was > 99% for all organisms tested. The results for enterococci showed no very major errors, one major error with ofloxacin, and numerous minor errors with the quinolones. However, all except one of the minor errors were within +/- 1 log2 dilution of the reference result. For staphylococci, only 2 very major errors (one each with chloramphenicol and oxacillin), 1 major error (chloramphenicol), and 15 minor errors (multiple drugs) were observed. The Alamar colorimetric system was easy to use and the results were easy to read. It appears to be an acceptable method for antimicrobial susceptibility testing of staphylococci and enterococci.

Colorimetry↗
PubMedDate not supplied

[Current knowledge on resorption of the edentulous alveolar ridge].

INTRODUCTION: Due to inside physiological processes of the bone tissue of the residual ridge, the above is identical with the bone tissue in other parts of the body. All bones which contain a larger percentage of substance spongiosa are very sensitive to the changes in remodelation. In mandibula the arrangement of the bone trabeculas is in the same direction with the spongious bone traectoria. In maxillae, functional demands for transmitting the forces, are fulfilled by a larger number of trabeculas per square unit. The atrophia of the residual ridge was a result of teeth loss, which means that there was no working tension on the bone, affected by the periodontal ligament in a physiological way. MATERIAL AND METHODS: The resent knowledge of the above problems indicates that inflammation and pressure which develop under the mobile denture cause an intensive process of resorption of edentulous arch. In periodontitis the connection between lymphocytes and other inflammatory cells on one side, and the residual bone resorption level on the other side, were proved by stereometrical methods. The ELISA method proved that cytokine interleukin-1 beta (IL-1 beta), IL-1 beta and the tumor necrosis factor alpha, were the major factors in the stimulation of bone resorption, and inhibitatory of the above, as well. Mononucleous blood cells under the influence of the Porphyromonas gingivalis were forming interleukin-1 which explains that the etiology of bone resorption can be affected by the infection, too. DISCUSSION: It has been proved that there is a direct relation between the pressure under the mobile denture and the residual ridge resorption level on the other side. It seems that the frontal areas of the edentulous are more susceptible to resorption. It is considered that the orthopantomography is the most acceptable method in level measuring of the reduction of residual ridge. The advantages of the above method are simplicity, precision, repeating possibilities, and comparation of the radiographs in time interval which makes it possible to control the development of changes. Densitometric measuring of osteoporotic changes is also possible, due to above method. CONCLUSION: The scientific contribution to research and prevention of negative consequences of the residual ridge resorption is the most valuable. Tere were many possibilities in using the indirect physiological role of piezoelectric field on the osteoclasts and activation by the AKMA. The effect of the fluor in drinking water as the element which has preventive role in reduction of the residual ridge, has been established. Due to the fact that the occlusal pressure which transmits itself through the mobile denture has an important role in resorption of the residual ridge, acts of terciare prevention include application of soft acrylates and reduction of occlusal surface.

Alveolar Bone Loss↗
PubMed2002

Performance evaluation of an 85-cm-bore X-ray computed tomography scanner designed for radiation oncology and comparison with current diagnostic CT scanners.

INTRODUCTION: The demand for computed tomography (CT) virtual simulation is constantly increasing with the wider adoption of three-dimensional conformal and intensity-modulated radiation therapy. Virtual simulation CT studies are typically acquired on conventional diagnostic scanners equipped with an external patient positioning laser system and specialized planning and visualization software. Virtual simulation technology has matured to a point where conventional simulators may be replaced with CT scanners. However, diagnostic CT scanner gantry bores (typically 65-70 cm) can present an obstacle to the CT simulation process by limiting patient positions, compared to those that can be attained in a conventional simulator. For example, breast cancer patients cannot always be scanned in the treatment position without compromising reproducibility and appropriateness of setup. Extremely large patients or patients requiring special immobilization or large setup devices are often unable to enter the limited-bore gantry. A dedicated 85-cm-bore radiation oncology CT scanner has the potential to eliminate these problems. The scanner should provide diagnostic-quality images at diagnostic-comparable dose levels. The purpose of this study was to independently evaluate the performance of a novel 85-cm-bore CT X-ray scanner designed specifically for radiation oncology and compare it against diagnostic-type, 70-cm-bore scanners that may be used in the same setting. MATERIALS AND METHODS: We performed image quality and dosimetric measurements on an 85-cm-bore CT scanner (AcQSim CT, Marconi Medical Systems, Inc., Cleveland, OH) and a 70-cm-bore, diagnostic-type scanner (UltraZ CT, Marconi Medical Systems, Inc.). Image quality measurements were performed using a manufacturer-supplied phantom (Performance Phantom, Marconi Medical Systems, Inc.), following the manufacturer's suggested testing procedures, and an independent image quality phantom (CATPHAN 500, The Phantom Laboratory, New York, NY). The standard image quality parameters evaluated for the purpose of comparison were as follows: slice thickness accuracy, high-contrast resolution (limiting spatial resolution), low-contrast resolution, uniformity and noise, and CT number accuracy and linearity. Standard head and body protocols were employed throughout most of our measurements and were kept equal between the two scanners. The computed tomography dose index was measured for standard head and body imaging protocols using accepted methods and procedures. For comparison purposes, data for a diagnostic-type, 70-cm-bore scanner (GE HighSpeed CT/i) were extracted from the literature. The results obtained for the 85-cm-bore scanner are compared with the following: (1) manufacturer-provided autoperformance phantom test results (validating its use for routine quality assurance), (2) a similar set of measurements performed on a conventional 70-cm-bore, diagnostic-type CT scanner (UltraZ CT, Marconi Medical Systems, Inc.), and (3) current available data on other diagnostic-type CT scanners (GE HighSpeed CT/i). RESULTS: Head and body doses seem on average to be slightly (1-2 cGy) higher for the 85-cm-bore unit than for conventional 70-cm units. Measured slice thickness was within acceptable criteria, +/-0.5 mm. There does not seem to be any significant difference in high-contrast resolution. Both units render a limiting value of approximately 7-8 lp/cm for slice thickness 8-10 mm. Both units exhibit comparable CT number uniformity, accuracy, and linearity. Noise levels seem to be slightly increased (by approximately 0.05-0.2%) for the large-bore geometry. Low-contrast resolution for both units was comparable (4.5-5.5 mm @ 0.35%). All image quality parameters are well within diagnostic acceptable levels. CONCLUSION: The overall imaging performance and mechanical integrity of the 85-cm-bore scanner are comparable to those of conventional diagnostic scanners that may be employed in a radiation oncology setting.

Computer Simulation↗
PubMed2000

Trade-offs between location and waiting times in the provision of health care: the case of elective surgery on the Isle of Wight.

BACKGROUND: Recent UK government documents have stated that, within the National Health Service, consumers should be more involved in decision-making. This study considered the technique of discrete choice conjoint analysis (DCCA) for eliciting community views regarding the importance of reducing waiting times. More specifically, the study aimed to establish whether residents living on the Isle of Wight are prepared to travel to the mainland for elective surgery where waiting times are shorter but travel costs may be greater, and, further, if residents are willing to travel, what reduction in waiting time and increase in travel costs would be acceptable. METHODS: A DCCA questionnaire was sent to a random sample of 1,000 individuals living on the Isle of Wight. RESULTS: Seventy-eight per cent of respondents were willing to travel to the mainland for elective surgery. Of these, 48 per cent always chose the mainland and 30 per cent traded between island and mainland, depending on the levels of waiting time and travel costs. Whereas 'traders' preferred the Isle of Wight, they would forgo their preferred location if waiting times were reduced by at least 3.9 months, and they were willing to pay over 12 for a 1 month reduction in waiting time. Different combinations of waiting time reductions and travel cost increases that were acceptable to traders were estimated. CONCLUSIONS: Carrying out elective surgery on the mainland offers the potential to reduce waiting lists for island residents. The majority of respondents would be willing to travel to the mainland. However, one-fifth of respondents were not willing to travel to the mainland for elective surgery. The preferences of this group are important in policy decisions. More generally, the paper demonstrates the potential application of DCCA to public health issues.

Adolescent↗
PubMed1996

[Criteria for the selection of surgical technic in patients with anatomical urinary stress incontinence].

In this paper it is described the minimum necessary investigation in the evaluation of the incontinent patient, the surgical methods accepted up to date for the treatment of genuine incontinence as well as the facts to be considered and the interrogatives to be solved for the candidate patient ready for surgery as a guide for the election of the most adecuate surgical procedure for the patient. This stands out that the position that the preoperatory measurement of pressure of the urethral closing can lead to the evolution in the operated patients.

Female↗
PubMed2006

Necessity breeds invention: a study of outpatient management of low velocity gunshot wounds.

BACKGROUND: Since the late 1980s, the emergency department (ED) at the Mater Hospital, Belfast, has implemented a policy of treating conservatively patients who sustain low velocity gunshot wounds to the lower limbs. Wounds are cleaned and minimally debrided under local anaesthetic in the ED. Patients are given oral antibiotics, and reviewed 48 hours later at the ED review clinic. OBJECTIVE: To investigate the outcome of outpatient ED management of low velocity gunshot wounds to the lower limbs. METHOD: This was a retrospective, observational study from January 2000 to September 2004 inclusive. Notes were retrieved of those patients who had gunshot wound mentioned in the triage text. Patients were included if they presented with a low velocity gunshot wound to the lower limbs. Demographics and treatment regimen were recorded. RESULTS: In total, 90 patients sustained low energy injuries to the lower limb, with 70.5% of wounds involving the skin and soft tissue only. Most patients (n = 67) were treated as outpatients, which included 80% of unilateral injuries and 46.6% of bilateral injuries presented. There were 56 patients reviewed at clinic. Three patients developed minor complications CONCLUSION: Irrigation and minimal debridement in the outpatient setting is an acceptable method of treatment for low energy gunshot wounds to the lower limbs, without orthopaedic or vascular involvement.

Adolescent↗
PubMed2006

Measuring the user acceptance of a Web-based nursing documentation system.

OBJECTIVES: The development of an ICNP web-based nursing documentation system, and its evaluation for its usability, and its user acceptance. METHODS: A web-based nursing documentation system was designed and implemented by using the Greek translation of ICNP beta 2 version nursing terminology. The system integrates the steps of nursing process for providing and documenting nursing care, while ICNP terminology is used for the description of nursing concepts. The system was evaluated by nurses in a computer laboratory. We measured the user interaction satisfaction mainly by using questionnaires and scenarios. RESULTS: The nurses who evaluated the system possessed adequate basic computer skills; but low-to-moderate experience in clinical or hospital information systems; and insufficient experience with nursing vocabularies, and especially ICNP. Overall, they were satisfied enough with the system's usability and usefulness, while the acceptance level increased as the level of their training in computers, nursing process and ICNP was also increased. The integration and use in the system of predefined, or standardized, nursing concepts and care plans seems to increase the acceptance of the documentation system and also the ICNP. CONCLUSION: The subjective satisfaction and response of the users towards the system is specified. The described system was evaluated under "laboratory conditions" and revealed some of its strong and weak points and some of the factors that influenced its success and acceptance by its users.

Diffusion of Innovation↗
PubMed2004

Assessing the need to update prevention guidelines: a comparison of two methods.

BACKGROUND: An important concern for developers of clinical practice guidelines is how best to determine when guidelines require updating to ensure they remain current and evidence based. Because of the high costs associated with updating guidelines, recent attention has focused on approaches that can reliably assess the extent of updating required. Recently, Shekelle and colleagues proposed a model of limited literature searches with modest expert involvement as a way to reduce the cost and time requirements for assessing whether a guideline needs updating. METHODS: The main objective of this study was to compare the Shekelle et al. assessment model (review approach) and a conventional process using typical systematic review methods (traditional approach) in terms of comprehensiveness and effort. We modeled the review approach on that by Shekelle and colleagues but refined it iteratively over three phases to achieve greater efficiency. Using both methods independently, we assessed the need to update six topics from the 1996 Guide to Clinical Preventive Services from the US Preventive Services Task Force. Main outcomes included completeness of study identification, importance of missed studies and the effort involved. RESULTS: Although the review approach identified fewer eligible studies than the traditional approach, none of the studies missed was rated as important by task force members acting as liaisons to the project with respect to whether the topic required an update. On average, the review approach produced substantially fewer citations to review than the traditional approach. The effort involved and potential time saving depended largely on the scope of the topic. CONCLUSIONS: The revised review approach provides an efficient and acceptable method for judging whether a guideline requires updating.

Bacteriuria↗
PubMed2005

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative.

PURPOSE: Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education. MATERIALS AND METHODS: Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program. RESULTS: The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study. CONCLUSIONS: Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.

Adult↗
PubMed2006

Reconstruction of the tongue with reinnervated rectus abdominis musculoperitoneal flaps after hemiglossectomy.

Reconstruction of the tongue after glossectomy is a primary objective in the process of improving the life quality of patients suffering from tongue cancer. We developed a new method of surgical reconstruction of the tongue after hemiglossectomy, with reinnervated rectus abdominis musculoperitoneal flaps. The rectus abdominis musculoperitoneal flap consisted of the rectus muscle, posterior rectus sheath, peritoneum, the 10th, 11th and 12th intercostal nerves, and the deep inferior epigastric artery and veins. Five patients underwent immediate reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy. The intercostal nerves were anastomosed to the descending branch of the hypoglossal nerve. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium eight weeks after surgery. During the follow-up period, the contour and function of the reconstructed tongues was satisfactory. Our experience indicates that reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method.

Electromyography↗
PubMed1994

Axillofemoral grafting with externally supported polytetrafluoroethylene.

OBJECTIVE: To evaluate the results of axillofemoral bypass grafting using externally supported polytetrafluoroethylene. DESIGN: Consecutive patients who were operated on by us from 1983 to the present were prospectively followed up in a vascular registry. The results of surgery with respect to morbidity and mortality, patency, limb salvage, and patient survival were determined by life-table methods. PATIENTS: A standardized operative technique was used to perform 184 axillofemoral bypass procedures in 164 consecutive patients (age range, 14 to 90 years; mean age, 67 years; female, 33%). Follow-up ranged from 0 to 95 months (mean, 23 months). RESULTS: Ischemia was the indication for 83% of the procedures, and aortic sepsis was the indication for 16%. There were nine operative deaths (5%) and 17 major complications. Life-table primary patency, limb salvage, and survival rates at 5 years were 71%, 92%, and 52%, respectively. Indication for surgery, patency of the superficial femoral artery, and the performance of multilevel procedures did not significantly influence patency. CONCLUSIONS: The results of axillofemoral grafting using polytetrafluoroethylene are equivalent to those achieved with other accepted methods of treatment for lower extremity ischemia, including balloon angioplasty, aortofemoral bypass, and infrainguinal bypass. Axillofemoral bypass is an appropriate technique that is deserving of more widespread use.

Adolescent↗
PubMed2002

Atmospheric deposition of phosphorus to the everglades: concepts, constraints, and published deposition rates for ecosystem management.

This paper summarizes concepts underlying the atmospheric input of phosphorus (P) to ecosystems, published rates of P deposition, measurement methods, and approaches to future monitoring and research. P conveyed through the atmosphere can be a significant nutrient source for some freshwater and marine ecosystems. Particle sources and sinks at the land-air interface produce variation in P deposition from the atmosphere across temporal and spatial scales. Natural plant canopies can affect deposition rates by changing the physical environment and surface area for particle deposition. Land-use patterns can alter P deposition rates by changing particle concentrations in the atmosphere. The vast majority of P in dry atmospheric deposition is conveyed by coarse (2.5 to 10 m) and giant (10 to 100 m) particles, and yet these size fractions represent a challenge for long-term atmospheric monitoring in the absence of accepted methods for routine sampling. Most information on P deposition is from bulk precipitation collectors and wet/dry bucket sampling, both with questionable precision and accuracy. Most published annual rates of P deposition are gross estimates derived from bulk precipitation sampling in locations around the globe and range from about 5 to well over 100 mg P m(-2) year(-1), although most inland ecosystems receive between 20 and 80 mg P m(-2) year(-1). Rates below 30 mg P m(-2) year-1 are found in remote areas and near coastlines. Intermediate rates of 30 to 50 mg P m(-2) year(-1) are associated with forests or mixed land use, and rates of 50 to 100 mg P m(-2) year(-1) or more are often recorded from urban or agricultural settings. Comparison w ith other methods suggests that these bulk precipitation estimates provide crude boundaries around actual P deposition rates for various land uses. However, data screening cannot remove all positive bias caused by contamination of bucket or bulk collectors. As a consequence, continued sampling with these standard collectors in a region will not reduce the large uncertainty in rates derived from existing data. Calibrated surface accumulation methods hold promise as a primary means to estimate P flux in future monitoring. New methods for long-term P deposition monitoring will require an intercomparison of P flux estimates from surrogate surfaces, impactor sampling of particle concentrations combined with deposition models, and "throughfall" estimates for natural canopies. With better sampling methods and more long-term monitoring data, the importance of atmospheric P deposition in ecosystem dynamics and management can be better understood and predicted.

Atmosphere↗
PubMed1996

High-performance liquid chromatography assay for N-acetylcysteine in biological samples following derivatization with N-(1-pyrenyl)maleimide.

N-Acetylcysteine is a thiol antioxidant with expanding clinical importance. A sensitive, rapid method for determining reduced N-acetylcysteine (NAC) concentration in biological samples has been developed which uses a modified reversed-phase high-performance liquid chromatography (HPLC) technique in conjunction with the derivatizing agent N-(1-pyrenyl)maleimide (NPM). The NAC-NPM adduct was analyzed by HPLC with fluorescence detection. The calibration curve for NAC was linear over the range 8-2500 nM and the coefficient of variation obtained for the within-run precision and the between-run precision for 0.5 mM NAC was 1.5% and 2.7%, respectively. Relative recovery of NAC from biological materials ranged between 86% and 96% and the limit of quantitation from biological samples was 32 nM. These results suggest practical advantages relative to other widely-accepted methods of NAC measurement.

Acetylcysteine↗
PubMed2006

Simultaneous Exposure Using 532 and 860 nm lasers for visible lesion thresholds in the rhesus retina.

The growth of commercially available, simultaneous multi-wavelength laser systems has increased the likelihood of possible ocular hazard. For example, many systems utilize frequency multiplying methods to produce combinations of visible, near-infrared, and ultraviolet wavelengths. Unfortunately, very little data exists to substantiate the current methods for estimating hazards from simultaneous lasing. To properly assess the retinal hazards from these wavelengths, the retinal effects of 10-s laser irradiation from 532 and 860 nm were determined in non-human primates for four different relative dosage combinations of these wavelengths. This pair of wavelengths represents the typical problem of a visible-wavelength laser combined with an in-band, infrared wavelength that is not as well focused at the retina-a situation difficult to address. To add confidence to the experimental results obtained, a theoretical thermodynamic model was developed to predict the minimal damage threshold for simultaneous wavelengths at 1 h post exposure. The new model calculations and the data obtained are compared with results from one currently accepted method of predicting relative exposure limits from multi-wavelength systems. In addition, the current ANSI-Z136-2000 standard was used to compute the combined MPEs for comparison with measured visible lesion thresholds. A total of 12 eyes were exposed using four different ratios of power levels (532/860 power rations) to determine the contribution to the damage levels from each wavelength. The experimental data were analyzed using probit analysis at both 1-h and 24-h post exposure to determine the minimum-visible-lesion (MVL) thresholds at ED50 values, and these thresholds at 24 h varied from 5.6 mW to 17 mW total intraocular power.

Animals↗
PubMed1996

Nasal rather than rectal benzodiazepines in the management of acute childhood seizures?

Benzodiazepines are routinely used by the rectal route for the treatment of acute epileptic seizures: if a benzodiazepine was absorbed from nasal administration this could provide a more acceptable alternative to rectal administration. Nineteen children (age range 7 months to 14 years) with intractable epilepsy were chosen. The EEG's showed unequivocal epileptic activity persisting during the recording. The midazolam was dripped slowly into the anterior nares. Fifteen had a positive response, a dramatic improvement in their EEG or cessation of fits. Drug induced beta activity occurred in 14 children. The mean time to appearance of beta activity was 111.5 secs (SD = 95.3 secs). The reduction in spike count pre and post midazolam was statistically significant (p < 0.01). The improvement in EEG background was also statistically significant. Midazolam is absorbed via the i.n. route. With the dosages used it suppressed epileptic activity and produced an improvement in EEG background. The children and parents found the method acceptable. This is the first study to use the i.n. route for anti-convulsant drugs.

Acute Disease↗
PubMed1985

Ventilation during cardiopulmonary resuscitation: which method?

A questionnaire was circulated to assess the influence of the presence of vomitus, secretions and infection on the willingness of 70 hospital staff members to use methods of ventilation during cardiopulmonary resuscitation (CPR). The responses showed that only 13% would use mouth-to-mouth and 59% mouth-to-mask ventilation in the presence of these features. Thirty-five of these subjects were then tested for their ability to ventilate a manikin adequately (tidal volume, 800 mL). The best performance was seen with mouth-to-mouth ventilation. After instruction, their performance was satisfactory with mouth-to-mouth and mouth-to-mask resuscitation and with the Robertshaw resuscitator. Bag-valve-mask ventilation had a 97% failure rate before and after instruction and may be inappropriate for CPR. A resuscitation mask which allows effective ventilation without contamination and with oxygen supplementation is the most cost-effective and best accepted method of emergency ventilation.

Attitude of Health Personnel↗
PubMed2000

A pilot study on the role of intralesional triamcinolone acetonide in the treatment of pitted nails in children.

BACKGROUND: Pitted nails is a non-specific entity seen in children that is often associated with various underlying skin disorders such as atopic dermatitis, psoriasis, alopecia areata and lichen planus; and those without such associations are labelled as idiopathic pitted nails. Spontaneous resolution is common but may take several years. Treatment options so far have not been encouraging. This pilot study sought to determine the safety and efficacy of intralesional steroid in the treatment of pitted nails in children. METHOD: Children with pitted nails below the age of 12, seen between January 1994 and December 1997, were invited to participate in this study. Symmetrically affected fingernails were selected, topical anaesthetic cream applied and a single dose of triamcinolone acetonide was introduced intralesionally to the proximal nailfold while the contralateral nail acted as control. The degree of pitting of nail surface was documented at months 0, 2 and 4. RESULTS: Four children were enrolled, and their ages ranged from 4 to 9 years. The degree of pitting was reduced to a mean of 15% of the nail surface in the second month, and 42% in the fourth month. The procedure was fairly well tolerated and no adverse effects were noted. CONCLUSION: Intralesional steroid is a safe and acceptable method of treating pitted nails in children with a maximum effect seen in 2 months. In order to sustain a continuous therapeutic effect, a bimonthly treatment is suggested.

Child↗