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