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Preserving living and brain along with extracorporeal cardiopulmonary resuscitation: The single-center investigation regarding in-hospital cardiac arrests.
ew• In obese Turkish pediatric population, unlike other European countries, MC4R gene variants are quite common as we found a variant rate of 8.6%• We believe it is necessary to screen the variants in MC4R gene in patients with severe childhood-onset obesity and who had early-onset obesity in at least one of their first-degree relatives in Turkish population.Lack of availability of age-appropriate dosage forms for children often results in use of adult dosage forms, which are administered to children after crushing or breaking. This can result in inappropriate doses being given to the children. This study was done to assess the prescribing pattern of use of medicines that had to be fragmented or crushed for use in relation to the age of the child. A prescription audit of 1200 outpatients and 400 inpatient records was done in the pediatric department of Lok Nayak tertiary care teaching hospital in the National Capital New Delhi, India. A structured pro forma was used for collecting the data. The total medicines prescribed, use of adult formulations, and number of adult medicines that had to be fragmented or broken for administration to pediatric patients were assessed. A total of 880 medicines were prescribed among inpatients and 2701 in outpatients. In inpatients, 230 (26.1%) medicines and in outpatients, 1013 (37.5%) medicines were fragmented before use. Some ofregularly prescribed medicines (14) including amoxicillin, albendazole, chloroquine, carbamazepine, valproate, and phenytoin that had to be fragmented were available in liquid oral dosage forms in the Delhi Essential Medicine List (DEML).• Despite being included in the EML, the patient has been denied access to appropriate medicines. It indicates a lack of concern and sensitivity about what is required for rational prescribing to children.OBJECTIVE The authors performed a retrospective review of children diagnosed with multiloculated hydrocephalus (MLH) in our institute. The goal was to analyze the different diagnostic and therapeutic modalities used with special emphasis on CT ventriculography (CTV). METHODS Male and female patients below the age of 18 years diagnosed with MLH were included. Cases of uniloculated hydrocephalus like entrapped temporal horn or isolated fourth ventricle were excluded. We used iohexol for CTV and gadodiamide for MR ventriculography. Neuroendoscopic procedures performed were endoscopic fenestration, endoscopic third ventriculostomy (ETV), endoscopic septostomy, endoscopic aqueductoplasty, or a combination of the above. The cohort was divided into two groups (endoscopic or shunt) based on initial surgical intervention. RESULTS A total of 52 patients were included, with 43 boys and 9 girls. The average age of presentation was 7.7 months. The most common predisposing factor for MLH was neonatal meningitis seen in 30 patients. Mean duration of follow-up was 39 months. CTV was used in 26 patients and MR ventriculography in three patients. In one patient, the diagnosis of MLH was ruled out after ventriculography. Patients who underwent ETV only had the best outcome with 71.4% success rate. Staurosporine purchase At the end of follow-up, 14 patients (27%) were shunt independent. CONCLUSIONS The present study indicates that CTV helps to accurately define the anatomy of the ventricles and determine the site of physiological CSF obstruction. This helps in therapeutic planning and in avoiding misdiagnoses. Further, neuroendoscopy has the potential to lead to shunt independence in some patients.INTRODUCTION Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. AIM To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. METHODS We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records were reviewed for lateralitoperative assessment of peroneal tendons in patients with the fleck sign.BACKGROUND This study assesses survival improvement across a decade (2004-2013) among patients with metastatic gastrointestinal cancers in a real-world setting. METHODS Surveillance, Epidemiology and End Results (SEER) database was accessed and patients with metastatic gastrointestinal carcinomas who have received any form of systemic therapy were included. Patients were grouped into three cohorts based on the year of diagnosis (cohort-1 2004-2006; cohort-2 2008-2010; cohort-3 2012-2013). Overall survival was compared among the three cohorts for each disease site using Kaplan-Meier survival estimates. RESULTS A total of 54,992 patients with metastatic gastrointestinal cancers were included in the current analysis. Using Kaplan-Meier survival comparison for the three temporal cohorts, the following survival observations were noted for patients with metastatic esophageal adenocarcinoma median survival for cohort-1 8 months, cohort-2 9 months, cohort-3 9 months; P  less then  0.001; for patients with metastatic esophageal squamous cell carcinoma median survival cohort-1 8 months, cohort-2 8 months, cohort-3 8 months; P = 0.689; for patients with metastatic gastric adenocarcinoma median survival for cohort-1 8 months, for cohort-2 9 months, for cohort-3 9 months; P  less then  0.001; for patients with metastatic colorectal carcinoma median overall survival for each of the three cohorts 21 months; P = 0.131; for patients with metastatic pancreatic carcinoma median survival for cohort-1 5 months, cohort-2 5 months, cohort-3 6 months; P  less then  0.001; for patients with metastatic hepatocellular carcinoma median survival of 5 months for each of the three cohorts; P = 0.534); and for patients with metastatic biliary carcinomas median survival for cohort-1 7 months, cohort-2 7 months, cohort-3 8 months; P = 0.031). CONCLUSION Limited (if any) survival improvement has been observed among patients with metastatic gastrointestinal carcinomas treated with systemic therapy in the decade from 2004 to 2013.
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