Indian pediatrics
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Obesity is a growing worldwide health problem affecting both adults and children. Effective prevention and treatment modalities can be achieved by understanding the pathogenesis of obesity better. This review addresses some of the issues related to the hormones and cytokines taking part in the pathogenesis of obesity, energy balance and inflammation. ⋯ Development, pathogenesis and complications of childhood obesity consist of complex mechanisms including numerous cytokines and hormones. New treatment modalities depend on understanding these complex mechanisms.
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Acute respiratory distress syndrome (ARDS) is a common diagnosis among children admitted to pediatric intensive care units. This heterogeneous disorder has numerous pulmonary and non-pulmonary causes and is associated with a significant risk of mortality. Many supportive therapies exist for ARDS. SEARCH: Literature search was performed by using the key words ARDS and related topics on the Pubmed search engine maintained by the National Heart, Lung, Blood Institute. Pediatric randomized controlled trials that have been published in the last 10 years were included. Emphasis was placed on pediatric literature, although sentinel adult studies have been included. Most of the evidence presented is of levels I and II. ⋯ Low tidal volume is the only strategy that has consistently improved outcome in ARDS. A tidal volume of ≤ 6 mL/kg predicted body weight should be used. Ventilator induced lung injury may result in systemic effects with multi-system organ failure, and all efforts should be made to minimize this. Positive end-expiratory pressure should be used to judiciously maintain lung recruitment. There is insufficient evidence to routinely use high frequency ventilation, prone positioning, or inhaled nitric oxide. Calfactant therapy is promising and may be considered in children with direct lung injury and ARDS. Current literature does not support routine use of corticosteroids for non-resolving ARDS.
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Dopamine and dobutamine have been widely used to treat shock with variable success in newborns. In this retrospective data analysis, we report on the use of adrenaline in 20 neonates with birth asphyxia and shock that was refractory to dopamine and dobutamine. We concluded that adrenaline is a safe and effective drug that can be used as an add-on therapy to dopamine and/or dobutamine in newborns with shock secondary to birth asphyxia.