Video assisted thoracoscopy surgery a viable alternative for duplication cyst excision: a case report on foregut duplication cyst

Alimentary tract duplication is a relatively uncommon congenital abnormality. It can be found anywhere from the mouth to the anus and can be symptomatic or undetectable. Although congenital duplication can happen anywhere in the gastrointestinal tract, the ileum, oesophagus, and colon are the most common locations. The foregut, which includes the stomach, and first and second segments of the duodenum, is the source of one-third of all duplications. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Furthermore, excision through surgery is required for pathological examination of the resected specimen for definitive diagnosis. The most promising surgical approach for cyst excision has been thought to be open surgical resection through a posterolateral thoracotomy incision. However, video assisted thoracoscopy surgery has recently emerged as a viable surgical option for duplication cyst removal In paediatric surgery, video assisted thoracoscopy surgery has been established to facilitate the removal of mediastinal masses. However there is a limitation of research in the literature regarding the best surgical technique for oesophageal duplication cyst excision. In girls, foregut duplication is more common, especially in cases when bronchopulmonary involvement is present. While many duplications result in issues in early development, some are discovered by accident. When foregut duplication involves the bronchial tree, respiratory symptoms are often present. Haemoptysis and respiratory distress may be present in specific cases of the patient. Here, we described a 5-year-old male infant's case of foregut duplication with bronchial involvement and its management

A succinct medical safety: periodic safety update reports

In the rapidly developing era of advanced of medical sciences, pharmacovigilance plays an important role to put necessary brakes and help the medical fraternity to prescribe in a safe manner. Unanimously PSUR contributes in an essential way to regulate the drug marketing agencies to make sure that biological products which are marketed do not harm the general population by its adverse drug reactions. As we all know that the regulatory agencies like EMA, US FDA, CDSCO etc. are very stringent in approving the drugs, they have framed several rules and imposed strict timelines for reporting the necessary documents pertaining to drugs. Inevitably several new drugs like immunomodulators, anticancer drugs are on the raise which further adds a huge responsibility on the regulatory agencies regarding the risk and benefits of such biological products. Thus, the regulatory agencies have added several new implementation and amendments in the existing rules for the marketing of new drugs as well as already prevailing drugs. Hence, it is of paramount importance for the drug companies to follow the guidelines and abide by the rules of regulatory agencies for the benefit of mankind. However, several factors can impede the process of PSUR like improper data retrieval, inadequate training of resource personnel concerned with the development of PSUR. To overcome such difficulties, the field of advanced technology extended its arms for the regulatory authorities to implement electronic documentation and databases for the development of PSURs. In spite of all these efforts several challenges are to be met in the future in the field of pharmacovigilance. In this review several aspects of PSUR in different countries, necessary processes and format in which it needs to be submitted, pitfalls and ways to overcome such situations have been discussed in brief. Therefore, it is the collective responsibility of both Regulatory agencies and the drug companies to ensure a good quality PSUR is produced with its benefits outweighing the risk of the drug for the suffering human population.

A case report on penicillin/co-trimoxazole induced Jarisch Herxheimer reaction in secondary syphilis with human immunodeficiency virus

The Jarisch-Herxheimer reaction (JHR) typically occurs after the initiation of antibiotic treatment in syphilis. Although JHR was identified and looked at over many years, the prevention and management of JHR remain unclear. Previous reports have described the occurrence of JHR due to antibiotic treatment in syphilis, we presented a case of a young man with recurrence of JHR in syphilis, first due to penicillin which later was worsened due to co-trimoxazole

A study of drug utilization pattern using WHO prescribing indicators in pediatric patients

Background: The study aimed to get drug utilization pattern using WHO prescribing indicators in pediatric patients. Methods: It was an observational prospective study carried out in pediatric in-patients with a sample size of 280 patients based on inclusion, and exclusion criteria for a period of 6 months. The study data were collected using patient case record and analysis was done. Results: Out of 280 patients data collected, majority of patients were in the gender male category 168 (60%) and many were from the age group of early childhood (1-5 years) 126 (45%). Respiratory tract infections were the major diagnosis made among the sample size. The drug class commonly prescribed were oral antibiotics 261 (28.38%). The average number of drugs per prescription were 3.28%. Among the total number of prescription percentage of drugs prescribed by generic name and antibiotics were 2.7%, 76.07%. Percentage of patients prescribed with injection were 79.28%. Conclusions: This study highlights WHO prescribing core indicators in evaluating the usage of rational prescription. It helps in reinforcing rational prescribing practices and increases awareness among physicians and medical students. Irrational prescriptions may result in harmful events. A rational prescription should follow the standard treatment guidelines of WHO. The assessment of these indicators can also help us to decrease the cost burden on the patient. Continuous education with focus on rational drug usage and evidence-based medicine can further increase the understanding and improves health care policies

Super refractory seizures with autoimmune encephalitis and ventilator associated pneumonia: a case report

Autoimmune encephalitis is an immune-mediated syndrome with sub-acute to chronic presentations, such as memory impairment, altered sensorium, behavioral abnormality, psychosis, and seizures. Treatment as such must not be procrastinated due to pending laboratory workup, as early recognition and initiation of therapy prevents long term neurological sequelae. This is a case report of an 11-year-old male who presented with neuropsychiatric symptoms, altered sensorium and high-grade fever which evolved into refractory status epilepticus and autonomic dysfunction. While his MRI had positive findings of encephalitis, he tested negative for infectious diseases and antibody panels.

Clinical management and outcome of extreme preterm infant with respiratory distress syndrome, early onset sepsis and necrotizing enterocolitis stage 1: a case report

Respiratory distress syndrome, although it is common in extreme preterm infants, early and effective management will aid in better outcome. Preterm also comes with multiple co- morbidities which has to be considered and stepwise treatment is utmost important in tackling them. Here, we report a case of an extreme preterm baby who experienced respiratory distress syndrome with early onset sepsis along with necrotizing enterocolitis. Early diagnosis and management helped in the discharge of the infant in stable condition

An approach of clinical pharmacist pertaining to solve drug related problems in pediatric patients

Background: The objectives of the study were to assess the outcomes of clinical pharmacist intervention in solving drug related problems in pediatric patients and to identify the drug related problems in accordance with the causes observed.Methods: It was a prospective observational study done over a period of six months (October 2019 to March 2020) at Apollo children’s hospital in Chennai.Results: Total of 480 subjects were enrolled into the study, out of which 248 were male children and 232 were female children. The patients were divided into 4 age groups. In this study 60.41% pediatric patients were prescribed with less than 5 drugs 290 (60.41%). Drug related problems which were identified during the study was classified according to Pharmaceutical Care Network Europe (PCNE) and drug-related problem (DRP) classification (v9.00). The most frequent DRP was drug choice problem 37 (33.33%). The total number of caused drug related problems was 73 and same number of interventions was given by clinical pharmacist. The most frequent cause of drug related problems was identified as dose selection 31 (42.46%). Outcomes of interventions revealed that 70 (95.89%) problems were solved overall.Conclusions: In this study, clinical pharmacist’s level of involvement has shown interesting results. Moreover, they play an essential role in improving patient safety and outcome, reducing cost and providing quality of care for ill patients

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Evaluation of cultivated and wild genotypes of Lens species under alkalinity stress and their molecular collocation using microsatellite markers.

In this study, 285 lentil genotypes were phenotyped under hydroponic and alkaline field conditions. Significant genotypic variation for alkalinity stress was observed among the six Lens species screened hydroponically and in the field having pH up to 9.1. The crucial parameters, like whole Na+ and K+ contents and the Na+/K+ ratio at 40 mM NaHCO3 were found significantly correlated with seedling survivability under hydroponics (r = -0.95, r = 0.93 and -0.97). Genotypes, ranked on the bases of seed yield, restricted uptake of Na+ with thick pith area, increased vascular bundles, less H2O2 production and low Na+/K+ ratio, were found important physio-anatomical traits for alkalinity stress tolerance. The proper regulation of Na+ uptake was found for maintaining higher K+. This relationship is probably the main factor responsible for a better mechanism for tolerance to high pH up to 9.1 in tolerant breeding lines PDL-1 and PSL-9 (cultivars) and ILWL-15, ILWL-192 and ILWL-20 (wild accessions). Based on UPGMA dendrogram, all the genotypes were clustered into four diverse groups. DMRT was implied within the group to differentiate genotypes based on phenotypic response under alkalinity stress. These results can be utilized for selecting diverse parents for developing alkalinity tolerant genotypes

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

Summary: Background: Evidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation. Methods: In this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149. Findings: Between March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: −1·6 (SD 1·2) in the 4 month group versus −1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI −0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group. Interpretation: Although there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation. Funding: Indian Council of Medical Research supported the study until Nov 14, 2015. Subsequently, Shuchita Gupta's salary was supported for 2 months by an institute fellowship from All India Institute Of Medical Sciences, and a grant by Wellcome Trust thereafter