Modulation of the effects of methylmercury on rat neurodevelopment by co-exposure with Labrador Tea (Rhododendron tomentosum ssp. subarcticum)

Seafood is an important source of nutrients for many populations worldwide. Unfortunately the contamination of seafood with methylmercury (MeHg) has raised health concerns, particularly for developing infants. The modification of MeHg toxicity by nutrients, including antioxidants, has been reported in both epidemiological and animal exposure studies. We used a rat perinatal exposure model to investigate the modulation of developmental MeHg toxicity by an extract of Rhododendron tomentosum ssp. subarcticum, a plant rich in antioxidants traditionally consumed by Inuit. Sprague-Dawley rat dams were exposed daily to 2 mg MeHg/kg bw and 100 mg R. tomemtosum extract/kg bw administered either separately or jointly, from the first day of gestation until weaning. MeHg exposure was associated with impaired pup growth and survival, decreased grip strength, hyperactivity and altered exploratory behaviour, delayed acoustic startle response, elevated brain N-methyl-d-aspartate receptor (NMDA-R) levels, and increased serum lipid peroxidation. R. tomemtosum extract co-exposure modulated MeHg’s effects on oxidative stress and brain NMDA-R levels and may have affected MeHg pharmacokinetic. However, modulation of these molecular endpoints did not lead to significant alterations of MeHg’s effects on rat neurobehaviour.     

Development of atropine sulphate nasal drops and its pharmacokinetic and safety evaluation in healthy human volunteers

IntroductionThe increased use of organophosphate (OP) insecticides and the ever increasing possibility of terror groups using nerve agents underscore the need to develop effective and safe antidotes against OP poisoning. While intramuscular administration of nerve gas antidotes like atropine sulphate has certain lacunae, intravenous route is neither practical nor feasible in the field conditions for mass casualties. The objective was to develop a novel atropine sulphate nasal drop formulation, evaluate and characterize it using scintigraphy and to carry out safety–efficacy study in human volunteers with a view to obtain early pharmacological effects in comparison to the existing options, particularly the conventional intramuscular route.MethodsPermeability studies were done using atropine sulphate solution containing variable amount of chitosan. Radiometric method was developed for scintigraphy studies while standard spectroscopy was used for the quantification of atropine sulphate in fluids. Concentration of atropine sulphate in nasal drops to produce therapeutic concentration in blood was calculated. Six volunteers (age range 18–53 years) were administered the formulation delivering 6 mg of atropine sulphate each. Bioavailability and atropinization were noted serially.ResultsBased on the results of in vitro, human scintigraphy and analytical data, 1% atropine sulphate–0.5% chitosan was chosen as the final nasal formulation. Human bioavailability curve was created which showed that the therapeutic concentration of the drug in blood was reached within 5 min with nasal drops suggesting that drug delivery through the nasal route is significantly better than the intramuscular route. Unpaired t-test between the means of baseline value of heart rate and that of each time interval showed that increase in heart rate of all the volunteers became significant at 15 min (P < 0.01) and extremely significant at 30 min (P < 0.001). Correlation was evident from 5 min (c > 0.7). Pupil diameter showed maximal increase at 30 min (P < 0.01).ConclusionsThis novel product, 1% atropine sulphate–0.5% chitosan nasal drops might be a safe and efficacious emergency treatment of organophosphorous poisoning with several advantages over the present management, including early atropinization and capability of mass treatment in least amount of time.     

Level of knowledge regarding hepatitis-B immunization amongst health personnel in Delhi, India

Hepatitis B infection is endemic throughout the world. Government of India started Hepatitis B immunization project for children less than one year of age in 15 cities and 32 selected districts in the country in the year 2002. This study was carried out to ascertain the level of knowledge regarding Hepatitis B immunization amongst primary care provider working in urban government dispensaries. Out of 12 municipal zones in Delhi [India], one was selected randomly i.e. South Municipal zone and all the 32 government dispensaries operational in this zone were covered. The study subjects were medical officer and health worker female. A single investigator carried out the survey during the period Oct-Dec' 05 using interview schedule bearing 15-item question based on WHO & GOI guidelines & broadly divided into three sub-groups and analysis carried through software statistical package [SPSS ver. 7]. Out of 172, a total of 141 [82%] primary care provider i.e. 73 medical officers and 68 health worker female were contacted. The overall mean score amongst medical officer for Hepatitis B infection, Hepatitis B immunization & Cold chain component for Hepatitis B vaccine was found to be 89.33 [SD 1.21], 87.25 [SD 1.56] and 40.80 [SD 3.07]. Similarly for health worker female, mean score was found to be 59.75 [SD 2.08], 97.37 [SD 0.85] & 70.0 [SD 2.77] respectively. A clear difference was found between theoretical and practical knowledge aspect on the subject area with cold chain being identified as a weak link. It needs to be emphasized that Hepatitis B is "freeze-sensitive" vaccine and should be strictly preserved between 2-8 degrees C temperatures as freezing has a detrimental effect on its potency.     

Safe introduction of new procedures and emerging technologies in surgery: education, credentialing, and privileging

Ongoing horizon scanning is needed to identify new procedures and emerging technologies that should be evaluated for introduction into surgical practice. Following evidence-based evaluation, if a new modality is found ready for adoption in practice, surgeons need education in the safe and effective use of the new modality. The educational experience should include structured teaching and learning, verification of new knowledge and skills, preceptoring or proctoring, and monitoring of outcomes. Credentialing and privileging to perform a new procedure or use an emerging technology should be based on evaluation of knowledge and skills and outcomes of surgical care, and not merely on the numbers of procedures performed. Education of the surgical team is also essential. The entire process involving education, verification of knowledge and skills, credentialing, and privileging must be transparent. Patients need to play a central role in making informed decisions regarding their care that involves use of a new procedure or an emerging technology, and they should participate actively in their perioperative care.     

THE DERMATOSES OF PREGNANCY

The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classification, clinical features and treatment of the specific dermatoses of pregnancy.     

Support for Simulation-based Surgical Education through American College of Surgeons – Accredited Education Institutes

The American College of Surgeons (ACS) recently launched a new program to provide regional support for simulation-based surgical education through the establishment of a consortium of accredited education institutes. The goals of the program are to enhance surgical patient safety, support efforts of surgeons to meet the requirements for Maintenance of Certification, address the core competencies that all surgeons and surgical residents need to achieve and demonstrate, and enhance access to contemporary surgical education. The ACS-accredited institutes will comprehensively address the needs of a broad spectrum of learners and advance the science of simulation-based surgical education. Accreditation is being offered at two levels—Level I (Comprehensive) and Level II (Basic)—based on three standards that focus on the learners served, the curricula offered, and the technological support and resources available. Initial plans of the consortium of ACS-accredited Education Institutes include development and dissemination of innovative curricula, peer review of new educational programs and products, sharing of limited educational resources, and pursuit of collaborative research and development. This program should be of great value in supporting the professional activities of surgeons, surgical residents, medical students, and members of the surgical team, and in delivering surgical care of the highest quality.     

Correlation of antioxidants and fitness levels in undergraduate medical students

Fitness is the ability of the organism to maintain the various internal equilibriums as closely as possible to the resting state during strenuous exercise and to restore promptly after exercise. The aim of the present study was to evaluate the fitness and correlate it with anti-oxidant levels of 50 male medical students in the age group of 18 to 25 years. Fitness was assessed by Harvard Step Test. The antioxidant status was assessed by Vitamin C and Vitamin E levels in the blood. Three groups were formed on the basis of fitness score. The mean values of fitness scores were 95.33 +/- 7.66, 68.5 +/- 9.22 and 37 +/- 10.9, in-group A, B and C, respectively. Between the three groups, Vitamin E values were significantly different but not the Vitamin C levels. Thus, it is concluded that Vitamin E levels influence the fitness state of an individual.     

Clinicopathological Profile of Myelomatous Pleural Effusion: Single-center Real-world Experience and Review of Literature

Background

Multiple myeloma (MM) is a hematologic malignancy of plasma cell origin. MM primarily affects bone marrow, but extramedullary sites can also be involved. Myelomatous pleural effusion (MPE) is an atypical and rare complication of MM. We aimed to systematically study the incidence and clinicopathologic profile of patients with MPE in a real-world setting.

Burnout and work‐life balance among pediatric cardiologists: A single center experience

Background: Physicians are exposed to workplace factors that may result in acute or chronic stress resulting in burnout. This may impact the productivity and result in suboptimal patient care practices.
Methods: We surveyed pediatric cardiology attending physicians at our institution to assess their perception of burnout and work-life balance using the Maslach Burnout Inventory and the Areas of Work-Life Survey.
Results: Forty-five out of the 50 pediatric cardiology attendings responded to the survey. They were divided into 4 groups: Interventional/Electrophysiology [n = 3], Cardiac Intensive Care/Inpatient [n = 8], Non-Invasive Imaging [n = 6], and Outpatient [n = 28]. The Maslach Burnout Inventory demonstrated group-specific scores in the areas of emotional exhaustion, depersonalization, and personal accomplishment that were all significantly better than the general population. However, group-specific Areas of Work-Life Survey results demonstrated concerning findings with respect to the perception of work-life balance.
Conclusions: Although the Maslach Burnout Inventory did not demonstrate significant burnout among the attending physicians, the Areas of Work-Life Survey results demonstrated reduced work engagement, which can impact patient care and lead to burnout in the future. Based on these results, we plan to implement strategies to help increase work engagement and improve overall organizational effectiveness.