Notes

Association between asthma attack and the body size directory along with socioeconomic status: A cross-sectional study on 849,659 young people.
Understanding risk factors for driving under the influence of alcohol (DUIA) informs development of effective interventions. This study examined the association between ethnicity, immigration status, and DUIA, exploring psychological distress and hazardous drinking as additional contributors.

Data were derived from the 2003-2011 cycles of the Centre for Addiction and Mental Health (CAMH) Monitor of 16,101 adults from Ontario, Canada. Hierarchical binary logistic regression analysis assessed self-identified ethnicity and immigration status as predictors of DUIA, adjusting for sociodemographics and driving exposure (Model 1), psychological distress (Model 2), and hazardous drinking (Model 3).

In Model 1, respondents born outside of Canada had reduced odds of engaging in DUIA compared to those born in Canada (AOR = 0.72, 95%CI = 0.56 - 0.92). Relative to those identifying as Canadian, the odds of DUIA were significantly reduced for those identifying as East Asian (AOR = 0.28, 95%CI = 0.13 - 0.61) and Southwill improve prevention initiatives and remedial measures programming.Busulfan (Bu) is commonly used in myeloablative conditioning regimens for children undergoing hematopoietic stem cell transplantation. The standard target area under the concentration-time curve (AUC) of Bu is approximately 900-1500 µM min. In previous studies using five fixed doses (0.8-1.2 mg/kg) for Bu without dose adjustment, 75% patients achieved the target AUC. The aim of this pilot study was to determine the percentage of target AUC for intravenous (IV) Bu in Thai children. IV Bu was administered every 6 h over 16 doses. Blood samples were collected for pharmacokinetic (PK) analysis after the first, ninth, and thirteenth doses of Bu. Azaindole 1 Seven patients (2-14 years; median 6 years) were diagnosed with thalassemia (n = 4), acute myeloid leukemia (n = 2), and pure red cell aplasia. Three, two, and two patients received Bu at 1.1, 1.2, and 0.8 mg/kg, respectively. The AUC of Bu varied from 292-1714 µM min (median = 804). Nine (42.86%), eleven (52.38%), and one (4.76%) AUC values were within, below, and above the target, respectively. The median (range) Bu clearance was 5.93 (1.91-14.65) mL/min/kg. In this study, 42.86% AUC value achieved the target, which was lower than that in previous studies. Therapeutic drug monitoring (TDM) of Bu should be considered in Thai children receiving five fixed doses of IV Bu, and dose adjustment should be performed as necessary. Further PK studies for Bu with a larger sample size are warranted for confirming the necessity of TDM in every step dose of Bu.(Trial registration numbers; TCTR20190528003).Background Intranasal (IN) midazolam allows for rapid, painless treatment of pediatric seizures in the prehospital setting and may be a preferred administration route if determined to be non-inferior to intravenous (IV) or intramuscular (IM) routes. We sought to evaluate the effectiveness of IN midazolam for terminating prehospital pediatric seizures compared to midazolam administered by alternate routes. Methods We performed a retrospective, non-inferiority analysis using data from a regional Emergency Medical Services (EMS) database. We included pediatric patients ≤ 14 years treated with midazolam (0.1 mg/kg) by EMS for non-traumatic seizures. The primary outcome was the proportion of patients requiring redosing of midazolam after initial treatment with IN midazolam compared to those that received IV or IM midazolam. We established a priori a risk difference of 6.5% as the non-inferiority margin. Results We evaluated outcomes from 2,034 patients (median age 6 years [interquartile range 3 - 10 years], 55% male). Initial administration routes were 461 (23%) IN, 547 (27%) IM, 1024 (50%) IV, and 2 (0.1%) intraosseous (IO). Midazolam redosing occurred in 116 patients (25%) who received IN midazolam versus 222 patients (14%) treated initially with midazolam via alternate routes (risk difference 11% [95%CI 7 - 15%]). The age-adjusted odds ratio for redosing midazolam after intranasal administration compared to alternate route administration was 2.0 (95% CI 1.6 - 2.6). Conclusion Prehospital treatment of pediatric seizure with intranasal midazolam was associated with increased frequency of redosing compared to midazolam administered by other routes, suggesting that 0.1 mg/kg is a subtherapeutic dose for intranasal midazolam administration.Introduction In Japan, etoposide or sobuzoxane, a type of topoisomerase II inhibitor, is orally administered in patients with lymphoma who cannot tolerate conventional combination chemotherapy. However, the related clinical data remain to be fully summarized.Areas covered We evaluate the efficacy and toxicity of etoposide and sobuzoxane.Expert opinion Previous studies on etoposide or sobuzoxane monotherapy, including those among patients who could not tolerate conventional chemotherapy, suggested a favorable overall response rate (ORR) with moderate gastrointestinal or liver/renal toxicity. As for adult T-cell leukemia/lymphoma, a clinical trial with a limited sample size exhibited an ORR of >70%. Remarkably, the percentage of patients with a poor performance status was high among those receiving etoposide/sobuzoxane. Given a lack of randomized studies, etoposide/sobuzoxane might be a therapeutic option for lymphoma in a palliative setting. In the future, prospective trials with a homologous treatment schedule are warranted, in which the association between clinical efficacy and characteristics of lymphomas, such as specific gene alterations, should be elucidated.IntroductionPostoperative pain is one of the most common adverse events after surgery and has been shown to increase the risk of other complications. On the other hand, liberal opioid use in the perioperative period is also associated with risk of adverse events. The current consensus is therefore to provide multimodal, opioid minimizing analgesia after surgery.Areas CoveredIn this review, we will discuss the benefits and risks associated with non-opioid analgesics, including non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine, α-2 agonists, and corticosteroids. In addition, we will discuss the general and block-specific risks associated with regional anesthestic techniques.Expert OpinionAdverse events associated with non-opioid analgesics are rare outside their specific contraindicated patient groups, especially when dosed appropriately. α-2 agonists can cause transient hypotension and bradycardia, and gabapentinoids may cause sedation in higher risk patient populations. Regional anesthesia techniques are generally safe when done by an experienced practitioner. We therefore encourage the development of standardized multimodal analgesic protocols, which may facilitate opioid minimization and lead to better patient outcomes.
Double coronary artery is a rare anomaly with just a few cases reported in the literature. This anomaly started being reported recently with the wide use of coronary angiography. Before the advent of advanced imaging and catheterization facilities most of the available data came from the work of anatomists. Two patients were recently operated in our department. In the first patient the preoperative coronary angiography showed two right coronary arteries. In the second patient a double ostium of the right coronary artery was encountered intraoperatively. We wanted to know the incidence of this anomaly and the available data in the literature.

A PubMed research was conducted by using the term 'double right coronary artery'. More than 50 case reports and small case series were identified.

The review of the literature revealed a lot of controversy and debate. When using the term 'double right coronary artery' authors do not always refer to the same entity. Different definitions and classifications have proposed without, however, gaining wide acceptance. In fact, there is a lot of confusion in the literature and cases that are rather common are presented as being 'extremely rare'.

Even though the real incidence could be over or underestimated due to variability in coronary angiography interpretation, clinicians must be aware of this entity in order to avoid troubleshooting during percutaneous coronary interventions and cardiac surgery. There is need for a close collaboration between interventional cardiologists, anatomists and cardiac surgeons in order to standardize the nomenclature.
Even though the real incidence could be over or underestimated due to variability in coronary angiography interpretation, clinicians must be aware of this entity in order to avoid troubleshooting during percutaneous coronary interventions and cardiac surgery. There is need for a close collaboration between interventional cardiologists, anatomists and cardiac surgeons in order to standardize the nomenclature.Morphological studies suggest that the major pathogen causing basal stem rot of oil palm in Papua New Guinea and Solomon Islands is Ganoderma boninense. This study presents the first evidence for conspecificity of G. boninense from four countries where basal stem rot is prevalent. Seventy-three dikaryotic isolates of Ganoderma boninense from Indonesia, Malaysia, Papua New Guinea, and Solomon Islands were studied via mating tests, analyses of nuc internal transcribed spacer ITS1-5.8S-ITS2 sequences, and microsatellite genotyping. Sequence similarity in the ITS1-5.8S-ITS2 region was >99%, and all exotic isolates successfully mated with Papua New Guinea tester strains. Transfer of nuclei during mating was also confirmed via microsatellite markers for the first time in this species. Four microsatellite primers were used to generate evidence for 33 alleles in the four populations. All isolates studied had unique genetic fingerprints but alleles were also shared, suggesting gene flow. Heterozygosities were lower than expected in Indonesian and Papua New Guinea populations, consistent with the possibility of localized inbreeding.In the second half of the seventeenth century, vascular injection was introduced in anatomy for the study of the mechanism of secretion of bodily fluids, a phenomenon into which the lymphatic system plays an important role. Injection became a routine procedure in the second half of the seventeenth century. Reinier de Graaf developed an appropriate syringe to inject liquid into minuscule tubules. He was the first to observe that water injected into seminiferous tubules was partially repelled by transudation to be absorbed by neighbouring lymph vessels. He also injected lymph vessels in and around the uterus and ovaries. His study friend Johannes Swammerdam developed a coloured hardening wax and Ruysch injected coloured hardening wax into vessels and ducts of lymph nodes and excretory glands. Ruysch introduced combined injection - corrosion procedures which resulted in delicate structures, including capillaries. He denied the presence of glandular structures in organs as described by Malpighi, and made blood vessels inclusive lymph vessels agents instead of aids to fluid secretion. His ideas resulted in the concept of the body being completely vascular, a theory which became commonplace in Dutch medical circles. Antony Nuck, the professor in medicine at the Leiden University, injected an amalgam of quicksilver and tin for further evaluation of the lymphatic system. He thought that lymph vessels originated from distal arteries and sustained that the shape of pores in these arteries determined the mechanisms of secretion in secretory glands and in lymph glands. He introduced lymphography.
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