Management of Pre-eclampsia and Eclampsia: A Simulation

Urinary protein and coagulation-fibrinolysis indicators in preeclampsia: Expression and significance

This study investigates the expression and significance of urinary protein and coagulation-fibrinolysis indicators in preeclampsia, categorized into mild preeclampsia (109 cases) and severe preeclampsia (97 cases) based on disease severity. Additionally, 110 patients with gestational hypertension (gestational hypertension group) were included for comparative analysis. General information, laboratory indicators, urinary protein, and coagulation-fibrinolysis indicator levels were collected for each group. Significant differences were observed in blood pressure among groups (P < .05), while uric acid, serum creatinine, aspartate transaminase, alanine transaminase, and triglycerides showed no significant differences (P > .05). Total cholesterol, triglycerides, and low-density Lipoprotein levels in severe preeclampsia were higher than those in mild preeclampsia and gestational hypertension groups, whereas high-density lipoprotein, albumin, and platelet levels were lower in severe preeclampsia. No significant differences were observed in prothrombin time or D-dimer levels among groups (P > .05). Urinary protein, urinary protein quantification, activated partial thromboplastin time, thrombin time, and fibrinogen were identified as influencing factors for adverse maternal and infant outcomes in severe preeclampsia patients. The study concludes that urinary protein and coagulation-fibrinolysis indicators are elevated in preeclampsia, particularly in severe preeclampsia cases, suggesting their potential use as diagnostic influencing factors for severe preeclampsia.

Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

MMP-9 and miR-181a-5p in serum and placenta are associated with adverse outcomes of patients with severe preeclampsia and their infants

This study explored the correlation of MMP-9 with miR-181a-5p in severe preeclampsia (SPE). Placental tissues and serum were collected from 30 pregnant SPE patients (aged 29.42 ± 3.75) and 30 normal pregnant women (aged 27.72 ± 2.21), followed by detecting MMP-9 and miR-181a-5p fold changes using RT-qPCR, and grouped as follows: high expression groups (≥median value): H-MMP-9 and H-miR-181a-5p vs. low expression groups (<median value): L-MMP-9 and L-miR-181a-5p. MMP-9 was weakly expressed (F = 709.99, p < 0.001; F = 670.45, p < 0.001) (serum: 0.41 ± 0.06 (fold changes); placenta: 0.42 ± 0.09 (fold changes)), whereas miR-181a-5p was highly expressed (F = 284.93, p < 0.001; F = 353.78, p < 0.001) (serum: 2.26 ± 0.39; placenta: 2.02 ± 0.29) in SPE patients. MMP-9 was negatively correlated with miR-181a-5p (serum: r = -0.5767, p = 0.0009; placenta: r = -0.5667, p = 0.0011) in SPE patients. MMP-9 showed positive-correlation with gestational week at delivery (r = 0.7625; p < 0.0001) and infant weight (r = 0.4947; p < 0.0001) of SPE patients. miR-181-5p showed negative-correlation (gestational week at delivery: r = -0.5614, p = 0.0012; infant weight: r = -0.4081, p = 0.0252). H-MMP-9 group had lower adverse outcome than L-MMP-9 group (p = 0.0006), and H-miR-181a-5p group had higher adverse outcome than L-miR-181a-5p group (p = 0.0036). In brief, MMP-9 was negatively correlated with miR-181a-5p in serum and placenta of SPE patients. MMP-9 and miR-181a-5p affected gestational week at delivery and infant weight, providing novel targets for SPE treatment.

Hes-related family BHLH transcription factor with YRPW motif 1-activated proteasome 26S subunit, non-ATPase 14 regulates trophoblast function and endometrial angiogenesis

Proteasome 26S subunit, non-ATPase 14 (PSMD14) expression has been previously reported to be reduced in patients with pre-eclampsia (PE). The present study investigated the interaction network associated with the role of PSMD14 in PE. Reverse transcription-quantitative PCR (RT-qPCR) and western blotting were performed to determine the transfection efficacy following plasmid-based gene transfer of PSMD14 into HTR-8/SVneo cells. Cell proliferation was measured using an MTT assay and 5-ethynyl-2'-deoxyuridine staining. The expression of proliferation-related proteins, including Ki67 and PCNA, was determined using western blotting. Wound healing and Transwell assays were performed to measure cell invasion and migration, whilst the expression of migration-related proteins, including MMP2 and MMP9, was measured using western blotting. The angiogenesis of HUVECs following treatment with the HTR-8/SVneo cell culture supernatant was examined using tube formation assay. Following overexpression of Hes-related family BHLH transcription factor with YRPW motif 1 (HEY1) by transfection of pcDNA3.1 expression vector containing full-length human HEY1 or knockdown by transfection of shRNA plasmids targeting HEY1, the expression of HEY1 and PSMD14 was detected using RT-qPCR and western blotting. The potential interaction between HEY1 and the PSMD14 promoter was examined using dual-luciferase reporter and chromatin immunoprecipitation assays. PSMD14 overexpression was found to promote the proliferation, invasion, migration of HTR-8/SVneo cells and the angiogenesis of HUVECs following treatment with the HTR-8/SVneo cell culture supernatant, accompanied by enhanced expression of proliferation and migration-related proteins. Furthermore, the transcription factor HEY1 activated the expression of PSMD14. Knocking down HEY1 expression partially reversed the promoting effects of PSMD14 overexpression on the proliferation, invasion, migration, angiogenesis, proliferation and migration-related protein expression in trophoblasts. In conclusion, HEY1-activated PSMD14 promoted trophoblast proliferation, invasion and angiogenesis. Therefore, HEY1 and PSMD14 can be potential targets for PE treatment.

Comparison of In-Person and Telesimulation for Critical Care Training during the COVID-19 Pandemic

Background

The coronavirus disease (COVID-19) pandemic has disrupted medical education for trainees of all levels. Although telesimulation was initially used to train in resource-limited environments, it may be a reasonable alternative for replicating authentic patient experiences for medical students during the COVID-19 pandemic. It is unclear whether a more passive approach through telesimulation training is as effective as traditional in-person simulation training.

Objective

Our aim was to evaluate the effectiveness of in-person versus remote simulation training on learners’ comfort with managing critical care scenarios.

Methods

This was a prospective observational cohort study assessing the impact of an in-person versus remote simulation course on volunteer fourth-year medical students from February to April 2021 at the University of California San Diego School of Medicine. Precourse and postcourse surveys were performed anonymously using an online secure resource.

Results

In the in-person learners, there was statistically significant improvement in learner comfort across all technical, behavioral, and cognitive domains. In remote learners, there was a trend toward improvement in self-reported comfort across technical and cognitive domains in the telesimulation course. However, the only statistically significant improvement in postcourse surveys of telesimulation learners, compared with baseline, was in running codes. Regardless of the training modality, the students had a positive experience with the critical care simulation course, ranking it, on average, 9.6 out of 10 (9.9 in in-person simulation vs. 9.3 in telesimulation; P = 0.06).

Conclusion

We demonstrated that implementation of a telesimulation-based simulation course focusing on critical care cases is feasible and well received by trainees. Although a telesimulation-based simulation course may not be as effective for remote learners as active in-person participants, our study provided evidence that there was still a trend toward improving provider readiness across technical and cognitive domains when approaching critical care cases.