Questions related to Patent ductus arteriosus

What is patent ductus arteriosus why is it more common in neonates

What is frequency of patent ductus arteriosus opening after fluid bolus does every patent ductus arteriosus need to be treated what are medicinal treatment options to treat patent ductus arteriosus and what are the surgical options what to do if if a baby presents late with patent ductus arteriosus how to manage if a baby presents in early hours with patent ductus arteriosus what is the differential diagnosis of patent ductus arteriosus what are han long term or later in life consequences of untreated patent ductus arteriosus what are by acute consequences of patent ductus arteriosus what are correlations or associations of of patent ductus arteriosus

Bleeding in a neonate

What could be the presentations of bleeding in a neonate both free terms and terms what could be the causes related to environment that lead to bleeding in a neonate what could be e causes related to drugs that cause bleeding in a neonate such as the drugs that are given to the neonate which cause bleeding and the drugs which are not given to a neonate and this results in bleeding how do to bleeding manifestations occur in a neonate are they always obvious or is there hidden manifestation alsodress subsys calls Mili manifestations more than vitamin K deficiency or more than thrombocytopenia or is coagulation disorder apart from my tomakei deficiency common cause what are the differential diagnosis of platelet related disorders causing bleeding manifestations what is the differential diagnosis for extrinsic pathway coagulation disorder causing bleeding in a neonate what is the differential diagnosis for intrinsic pathway coagulation disorder causing bleeding in a neonate what is the differential diagnosis of platelet disorders related to platelet number function that cause bleeding in a neonate is calcium deficiency a cause of bleeding in a neonate how do we treat bleeding in a neonate how do we prevent bleeding in an unit common causes such as fall hyperthermia at 17 do this cause bleeding in a neonate is cranial scan a useful skill and technique to diagnose intracranial hemorrhage is scan of abdomen for liver hematoma or renal vein thrombosis original hematoma or abdominal hematoma or pulmonary hamartoma valuable tool for diagnosing bleeding manifestations in the respective sides does bleeding or thrombosis related to kidney almost always present with blood in urine is disseminated intravascular coagulation a big cause of mortality in neonates how do we manage disseminated intravascular coagulation in neonates is aggressive treatment for bleeding in your nails almost always warranted how much vigilant should a neonatologist be in the management of bleeding disorder

Neonatal Septicemia , Question Bank

Is the definition of success is same for neonates infants older children and adults how do we define sepsis in a neonate what is is the most common cause of septicemia in neonates what are the organisms in Pakistan that cause septicemia and units what is the empirical treatment for septicemia in neonates is the flora for preterms that causes septicemia different from that in turn babies what are clinical features including symptoms and science that mark septicemia what are laboratory parameters pointing towards septicemia what are points in history of a neonate aur his mother that point toward the risk factors for developing septicemia what is the differential diagnosis of causes of septicemia neonate what are the markers of infection and inflammation in a neonate what are the feasible markers of infection and inflammation in a neonate that we can afford how valuable is ultrasound as a diagnostic tool for septicemia in neonates the most common cause is that cause sepsis include urinary tract infection nimonia acute diarrhoea septic arthritis infected umbilical cord meningitis Hospital acquired infections called the nose a communal infections ventilator associated pneumonia what could be the closest differential to septicemia in a neonate what should be the rational to start antibiotics in a patient with suspected sepsis what should be the rational to stop antibiotics in an unit how do we e diagnose septic shock in a neonate is it the same as that for paediatric age group how do we manage septic shock in a neonate is it the same for preterms terms and older children's

Are there rare causes of septicemia that you missing and unit such as perinephric abscess hepatic abscess ventilator associated lung trauma is a closed differential of sepsis pyelonephritis is ultrasound very valuable in making a diagnosis of sepsis in a neonate is fungal infection a significant cause of septicemia in neonates apart from virus bacteria and fungi do protozoa cause septicemia in neonates

Neonatal Hypoglycemia, Question set

What is is the value of blood glucose to label hypoglycemia in a neonate

Is a symptomatic hypoglycemia really asymptomatic

How hypoglycemia affects general metabolism in a neonate

How how are brain heart lungs gastrointestinal system renal system genitourinary system skin in and bones affected due to hypoglycemia what are are or what should be the normal endocrinol response to hypoglycemia in a neonate

What is an abnormal endocrinol response to hypoglycemia in a neonate what is non-invasive treatment for hypoglycemia what is invasive treatment for hyperglycemia and when is it indicated what are the symptoms as stated by mother of neonate suffering from hypoglycemia and what are the signs that a neonatologist May observe what are acceptable blood glucose levels according to age in hours of a neonate is the blood glucose measured by glucometer absolutely equal to that in in serum or could it be fictitious lelo or hai due to to some drugs electrolyte imbalances temperature changes changes in blood pressure how do we treat hyperglycemia not responding to increasing feeding how do we treat hypoglycemia that does not respond to intravenous dextrose water how much strength of dextrose water may be given by a peripheral intravenous line and in how much strength it may be given by a Central line what if hypoglycemia is not responding 2 IV dextrose what are other treatment options and what would be the differential diagnosis in such neonate

Acidemia and Alkalemia discussion

Acidemia is blood pH less than 7.35. Urinary pH and Urinary electrolytes to be advisd for RTA. Which urinary electrolytes ? If there is acidosis, do get serum Anion Gap. Anion Gap is due to unmeasured anions. Hyperchloremia occurs in metabolic acidosis with a normal anion gap. Anion gap lower than expected can occur in the presence of hyperkalemia, hypercalcemia, hypermagnesemia,hypolabuminemia, bromide intoxication, lab error. Blood lactate levels ? Toxicity with ethylene glycol, methanol, salicylates, starvation, GSD type 1, lactic acidosis due to (sepsis, hypotension and hypovolemia), acute kidney injury, chronic kidney disease, hypoaldosteronism, renal tubular acidosis, late metabolic acidosis of prematurity (will persist for 3 to 4 weeks due to abnormal HCO3- scavenging in preterms).

Alkalemia is urine pH > 7.45. Renal hypokalemia syndrome (Barter Syndrome), next, volume depletion results in aldosterone mediated sodium retention in exchange for potassium and H+ secretion which maintains alkalosis, next, hypokalemia is a stimulus for additional renal H+ secretion. In Bartter syndrome there is hypokalemin metabolic alkalosis, urinary chloride wasting, increased plasma renin and aldosterone levels, and normal to low BP.

old r4 card nintendo firmware kernel

The kernel firmware for your old r4 or rfi card may be found ath one of the following links:

https://www.r4wood.com/

http://www.linfoxdomain.com/nintendo/ds/

The method to use these is simple,
format your sd card,
copy the extracted files to the root of your card.
Copy any of the games , recommended that you play copy or use only legal copies if you have or the open source programs and games in your nintendo console.
Both the links have awesome collection.
Good luck.

Obesity in children, Nocturnal enuresis

Obesity in children:
It could be syndromic or a normal varient.
Nocturnal Enuresis:
Treat the cause if found !!!! Reassure the parents and the child. Advise the parents that there should be no punitive measures. Most of the children have a control over their bladder by the age of 5 years.
Kid must not consume caffeinated and sweet drinks after 5 PM , and no extra liquids after 7 PM. Alarm Therapy could be the initial choice. It is a form of conditional therapy. A sensor is placed in the diapers such that it senses the urine in diapers and alrams. Usually everyone other than the kid who urinated in the bed, wakes up due to the sound of the alarm. STARs may be given to the child for every dry night. A chart may be placed in his room, or hung up on the wall, showing a star for every dry night.
Desmopressin oral formulation may be advised. Intranasal therapy is no more recommended.
Oxybutynin may be useful for overactive bladder.
Tolterodine may be useful for overactive bladder.
Imipramine, a tricyclic antidepressant is no longer advised due to its bigg side effect profile.

Using a ventilator to ventilate multiple patients

Anesthesia Patient Safety Foundation has issued a statement against the use of a single ventilator for such purposes.

https://www.apsf.org/news-updates/joint-statement-on-multiple-patients-per-ventilator/?fbclid=IwAR05DEFOSbJz65SgT0Sy9vOhypr4iw6NGio7T5jvdV9CAL7QryK9iPMeOmk

Live Offspring after Testis Tissue Transplantation

Live Offspring after Testis Tissue Transplantation
NEJM
October,2019

Kids treated for malignancies such as leukemia often lose their fertility as adverse response to chemo/radiotherapy.

In Post pubertal patients,saving sperms is one method to secure reproductive potential.

However,this can't be done in prepubertal patients.

In prepubertal monkeys, testicular tissues were biopsied and frozen/preserved in liquid nitrogen(cryopreservation). The monkeys were castrated. As they reached pubertal age,testicular tissue was grafted in scrotum. This tissue grew in size and viable spermatoza were produced. Using these sperms in vitro fertilization was done,embryo was transferred to healthy female monkey which resulted in healthy baby being born.

Fluoroquinolones could cause arrhythmias

Fluoroquinolones are associated with increased risk of sudden cardiac death, via the mechanism of cardiac arrhythmias due to QT prolongation.

This study published in July, includes 7657 cases of serious arrhythmia out of 2million total participants. Out of 7657 cases it was found that those patient who were advised fluroquinolones had 50percent more odds to have deadly arrhythmia irrespective of duration of onset of arrhthymia (7 days to 90 days).

Published in Resuscitation by Elsevier.

https://www.resuscitationjournal.com/article/S0300-9572(18)30736-6/fulltext

*FDA* has warned previously that fluoroqyinolones

Ciprofloxacin/Levofloxacin/Moxifloxacin etc may cause agitation/delirium/memory issues/ or even hypoglycemic comma.

So if we have a kid/adult patient having such symptoms we should keep in mind history of  ciprofloxacin prescription specifically.

Lastly FDA had also issued a warning last year that these drugs can cause aortic dissection.

I couldn't assess here if these effects are dose dependant or just related to chemical nature of these drugs.

BCG vaccine is preventive against lung cancer

BCG vaccine is preventive against lung cancer. This retrospective study shows that person aged 60 yr and plus who were given BCG vaccine had lower rates of lung cancer specifically as compared to those who were not given BCG at birth or in childhood.

Infact 2.5 times lower rate of lung cancer in vaccine group.

BCG vaccine causes immense immunomodulations in human body and it is due to immune regulation effects that it is preventive against lung cancer by 2.5 times.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2751896

There have been similar studies previously where analysis of retrospective data showed that those Diabetics who had received BCG vaccine,it was easier to establish glycemic control in them.

Or in case of multiple viral infections such as yellow fever,BCG vaccine weakened the disease activity because T lymphocytes directed against TB would also target other virii or even plasmodium !

I think that over the next decade BCG vaccination would be encouraged not only as being protective against TB., but as an opportunity to boost immune system against cancers

Love and Sex - Victor Frankl's - Man's Search for Meaning

“Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware of the very essence of another human being unless he loves him. By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he should become, he makes these potentialities come true. In logotherapy, love is not interpreted as a mere epiphenomenon of sexual drives and instincts in the sense of a so-called sublimation. Love is as primary a phenomenon as sex. Normally, sex is a vehicle of expression for love. Sex is justified, even sanctified, as soon as, but only as long as, it is a vehicle of love. Thus love is not understood as a mere side-effect of sex; rather, sex is a way of expressing the experience of that ultimate togetherness which is called love.”

3 types of biliary atresia

https://img.medscapestatic.com/pi/meds/ckb/82/21782tn.jpg

https://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/Untitled_12_0.png

Prematurity and biliary atresia (is prematurity protective) ?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668326/

"We hypothesized that correcting for prematurity would have no effect on the degree of fibrosis at surgery, with post-natal age being the most important factor; however, that was not the case. There was indeed good correlation of liver fibrosis scores (in both PBA and control groups) with both post-natal and with post-conceptual age, though some of the infants (predominantly in the PBA group) who were many weeks old had very little liver fibrosis for their post-natal age. This was reflected in the observation that both fibrosis and APRi scores were less in the PBA cohort compared to their controls born around term, implying some kind of “protection” of prematurity perhaps. A possible explanation is that the lack of early enteral feeding seen in some of our groups was in some way contributory."

fat soluble vitamin doses in neonatal cholestasis

 Fat-Soluble Vitamin Supplementation in the Cholestatic Infant
Vitamin Laboratory Sign of Deficiency Clinical Sign of Deficiency Treatment/Prevention
Vitamin A Retinol: retinol-binding
protein <0.8 mol/mol
Xerophthalmia, keratomalacia Vitamin A: 3,000–10,000 U/d
Vitamin D 25-Hydroxyvitamin
D <14 ng/mL [ deficiency;
<30 ng/mL [ insufficiency
Rickets, osteomalacia Cholecalciferol: 800–5,000 IU/d;
1,25 OH2 cholecalciferol:
0.05–0.2 mg/kg per d
Vitamin K Prolonged prothrombin time,
elevated protein in
vitamin K absence
Coagulopathy Phytonadione: 2.5–5 mg twice
a week to every day
Vitamin E Vitamin E: total serum
lipid ratio <0.6 mg/g
Neurologic changes,
hemolysis
TPGS: 15–25 U/kg per d; D-a
tocopherol: up to 100 U/kg
per d
TPGS¼D-a-tocopheryl polyethylene glycol 1,000 succinate.

liver biopsy fibrosis scoring for biliary atresia

Mean fibrosis scores (Ishak) for biliary atresia
(liver biopsy with samples fixed in formalin)
___________________________________________________
secondly,
Aspartate Aminotransferase-to-Platelet ratio index (APRi) in infants with biliary atresia: prognostic value at presentation.

Grieve A, Makin E, Davenport M

J Pediatr Surg. 2013 Apr; 48(4):789-95.

________________________________________________________

How do we fortify expressed breast milk with preterm formula

Take one level scoop of preterm formula and mix it in 7 ml of water this will give 24 kilo calories per 7 ml.
Now add 4 ml from this in 30 ml of expressed breast milk and it will become 24 kilo calories per ounce.

If we had added whole 7 ml of this in EBM it would have become 27 kilo calorie per ounce.

Glucose 6 phosphate dehydrogenase diagnostic tests differences

To diagnose glucose 6 phosphate dehydrogenase there are qualitative tests quantitative tests and cytochemical assays.

In qualitative tests it is distinguished if an individual has G6PD deficiency above or below a certain level and this level is 30% of normal G6PD levels. So if a person has more than 30% of G6PD activity it is considered normal.

In quantitative G6PD test the exact amount of G6PD enzyme activity is measured and it is normalised against the red blood cell count or hemoglobin concentration.

In cytochemical essays the G6PD activity at individual red blood cell level is measured by the through microscope or through flow cytometry analysis.

dymo label writer paper

Paper has dark squares, measuring 0.3mm by 10mm
Spacing between the squares is 8mm,
And the placement of square from paper margin is 8.5mm
This format tell the printer that paper is compatible with label writer.
It also ,perhaps, gives the machine an idea of whereabouts of paper, i mean guide for printer about the paper flow speed.

Now, the cut mark in paper, tells the printer and perhaps the pc software is communicated too, about the size of label.
This cut piece measures 2.5mm by 8mm.
It is for sensor of printer perhaps.
It is placed 2mm from paper margin.

Silver reed type writer

type writer typewriter

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