The effect of patient observation on cranial computed tomography rates in children with minor head trauma

BackgroundManagement of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Our objective was to estimate the effect of planned observation on CT use for each Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk group among children with minor head trauma.MethodsThis was a secondary analysis of a prospective observational study at 10 emergency departments (EDs) in Australia and New Zealand, including 18,471 children 24 hours for head trauma, or hospitalization for ≥ 2 nights in association with a positive cranial CT scan. We estimated the odds of cranial CT use with planned observation, adjusting for patient characteristics, PECARN TBI risk group, history of seizure, time from injury, and hospital clustering, using a generalized linear model with mixed effects.ResultsThe cranial CT rate in the total cohort was 8.6%, and 0.8% had ciTBI. The planned observation group had 4,945 (27%) children compared to 13,526 (73%) in the no planned observation group. Cranial CT use was significantly lower with planned observation (adjusted odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.1 to 0.1), with no difference in missed ciTBI rates. There was no difference in the odds of cranial CT use with planned observation for the group at very low risk for ciTBI (adjusted OR = 0.9, 95% CI = 0.5 to 1.4). Planned observation was associated with significantly lower cranial CT use in patients at intermediate risk (adjusted OR = 0.2, 95% CI = 0.2 to 0.3) and high risk (adjusted OR = 0.1, 95% CI = 0.0 to 0.1) for ciTBI.ConclusionsEven in a setting with low overall cranial CT rates in children with minor head trauma, planned observation was associated with decreased cranial CT use. This strategy can be safely implemented on selected patients in the PECARN intermediate‐ and higher‐risk groups for ciTBI

LIQUID CHROMATOGRAPHY TANDEM-MASS SPECTROMETRY METHOD DEVELOPMENT AND VALIDATION FOR SIMULTANEOUS ANALYSIS OF PARACETAMOL, GUAIFENESIN, PHENYLEPHRINE HYDROCHLORIDE, CHLORPHENIRAMINE MALEATE, AND AMBROXOL HYDROCHLORIDE IN BULK AND IN TABLET DOSAGE FORM

Objective: The objective is to study liquid chromatography tandem-mass spectrometry (LC/MS/MS) method for simultaneous quantification of paracetamol (PCM), guaifenesin (GUA), phenylephrine hydrochloride (PE), chlorpheniramine maleate (CPM), and ambroxol hydrochloride (AMB) in tablet dosage form developed and validated as per the International Conference on Harmonization Q2 (R1) guideline. Methods: The chromatograms were developed using a gradient mobile phase of WATER:methanol. Flow rate used was to 0.3 ml/min. Quantitation was performed using multiple reaction monitoring (MRM) mode to study parent to product ion transition, for paracetamol. (m/z 152.0 ≥ 110.0), guaifenesin (m/z 199.0 ≥163.0), phenylephrine hydrochloride (m/z 168.0≥ 150.0), chlorpheniramine maleate (m/z 275.0 ≥ 230.0) and ambroxol hydrochloride (m/z 379.0 ≥ 263.8). Results: The retention times were found to be 1.76, 1.81, 1.90, 2.10, and 2.33 min for PCM, GUA, PE, CPM, and AMB, respectively. The linearity of the method was found to be in the concentration range of 10–200 ng/ml for PCM, GUA, PE, CPM, and AMB. Percentage relative standard deviation values for repeatability and intermediate precision studies were below 2%. Conclusion: Developed method was found to be robust, precise, accurate, rapid and can be used to analyze fixed-dose tablet formulation used in the study.Â

Gastroretentive drug delivery systems a potential approach for antihypertensive drugs: An updated review

Oral drug delivery system (DDS) is the preferred route of administration of drugs, but poor bioavailability (BA) of orally administered drugs is still a challenging one, though extensive advancements in drug discovery process are made. Drugs with narrow absorption window in the gastrointestinal tract have poor absorption. Gastric emptying of dosage forms is an extremely variable process and ability to prolong and control the emptying time is a valuable asset for dosage forms, which reside in the stomach for a longer period of time than conventional dosage forms. Therefore, gastroretentive DDSs (GRDDSs) have been developed, which prolong the gastric emptying time. Most of the antihypertensive drugs have short half-life, short gastric residence time, low BA, and narrow absorption window. GRDDS can be a viable option for management of hypertension for several antihypertensive drugs. Several techniques such as floating DDS, low-density systems, raft systems, mucoadhesive systems, high-density systems, super porous hydrogels, and magnetic systems have been employed. These forms are expected to remain buoyant on gastric content without affecting the intrinsic rate of emptying. This results in prolonged gastric retention time of floating forms which improve BA of drug and also improve clinical situations. Prolonged gastric retention not only improves the BA and reduces drug waste but also improves solubility for drugs that are less soluble in a high pH environment. It has applications also for local drug delivery to the stomach and proximal small intestines. Gastroretention helps to provide better availability of new products with new therapeutic possibilities and substantial benefits for patients. Hence, it can be concluded that GRDDS promises to be a potential approach for antihypertensive drugs. This review mainly focuses on the different types of GRDDS used for management of hypertension and also includes the updated compiled study of different antihypertensive drugs explored as GR dosage forms

Polypoidal choroidal vasculopathy: Naked polyp

We present an unusual case of polypoidal choroidal vasculopathy (PCV) lying above the retinal pigment epithelium (RPE) in a 60-year-old Caucasian female. PCV lesions are typically located beneath the RPE layer. However, they may rarely lie above the level of the RPE due to a discontinuity in the RPE and Bruch’s membrane.David I.T. Sia, Andreas Ebneter, Swati Sinkar, Jagjit Gilhotr

A contemporary biological pathway of islet amyloid polypeptide for the management of diabetic dementia

© 2019 Elsevier B.V. Major challenges of dealing elder patients with diabetes mellitus (DM) are the individualization of consideration in persons with various comorbid types of conditions. In spite of the fact that microvascular and macrovascular problems associated with DM are well documented, there is only a few numbers of reports viewing different conditions, for example, cognitive dysfunction. Cognitive dysfunction is of specific significance due to its effect on self-care and quality of life. All in all, the etiology of cognitive dysfunction in the maturing populace is probably going to be the grouping of ischemic and degenerative pathology. It is likewise trusted that Hyperglycemia is engaged with the system of DM-related cognitive dysfunction. At present, it isn't certain in the case of enhancing glycemic control or utilizing therapeutic agents can enhance the risk of cognitive decay. Amylin was later characterized as an amyloidogenic peptide, confined from a beta cell tumor and called islet amyloid polypeptide (IAPP), and after that, amylin. Conversely, we investigate the beneficial role and hypothesizing the mechanism of amylin related expanding the level and activation of CGRP receptor to enhance the cognition declination amid diabetic dementia

Accuracy of physician practice as compared with PECARN, CATCH and CHALICE head injury clinical decision rules in children. A PREDICT prospective cohort study

Aims Clinical decision rules (CDRs) can assist in determining the need for computed tomography (CT) in children with head injuries (HIs). We assessed the accuracy of 3 high quality CDRs (PECARN, CATCH and CHALICE) in a large prospective cohort of head injured children. However in addition to CDR accuracy, the baseline physician accuracy is one of a number of factors which are also important when determining whether a particular rule should be implemented. The objective of this study was to assess the diagnostic accuracy of physician practice in detecting clinically important traumatic brain injuries.Methods Prospective observational study of children<18 years with HIs of any severity at 10 mainly tertiary Australian/New Zealand centres. We extracted a cohort of children with mild HIs (GCS 13–15, presenting <24 hour) and assessed physician accuracy for the standardised outcome of clinically important traumatic brain injury (ciTBI); we compared this with the diagnostic accuracy of the PECARN, CATCH and CHALICE CDRs. Physician accuracy was calculated based on whether CT was obtained during the initial Emergency Department (ED) visit.Results Of 20 137 children, 18 913 had a mild HI as defined. Of these 1578 (8.3% = actual CT rate) received a CT scan during the ED visit; 160 (0.8%) had a ciTBI and 24 (0.1%) underwent neurosurgery. Physician practice accuracy for detecting ciTBI based on whether CT was performed had a sensitivity of 157/160 ((98.1% (94.6%–99.6%) and a specificity of 17,332/18,753 (92.4% (92.0%–92.8%)). Sensitivity of PECARN <2 years was 42/42 (100.0%, 91.6% to 100.0%), PECARN >=2 years 117/118 (99.2%; 95.4% to 100.0%), CATCH (high/medium risk) 147/ 160 (91.9%; 86.5% to 95.6%) and CHALICE 148/160 (92.5%; 87.3% to 96.1%). Projected CT rates for PECARN =2 years were 8.0%/9.4% (high risk only) to 41.4%/48.5% (high and intermediate risk factors, considering the unlikely scenario that all patients in the intermediate risk group receive a CT scan), for CATCH 30.2% (medium and high risk) and for CHALICE 22.0%.Conclusions Physician accuracy was high. The implementation of PECARN, CATCH or CHALICE CDRs in this setting has the potential to increase the CT rate with limited potential to increase the accuracy of detecting ciTBI

Ten concerns about blood pressure measurement and targets in paediatric sepsis

Current paediatric sepsis guidelines suggest that resuscitation is titrated against clinical markers of hypovolaemia and end organ perfusion [1], including blood pressure (BP), heart rate and capillary refill time (CRT). BP is used both as a defining feature of shock and as a target for therapy. This paper will focus on the measurement of BP, the definition of hypotension and on the target BP for therapy in children with sepsis