Indian journal of pediatrics
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The majority of severely head injured children will not require neurosurgery. For the pediatrician, the central question must be whether medical interventions are effective in limiting morbidity and treating the problem of cerebral oedema. However, in order to address this issue we need to give some thought to the system of care in which we practice, how we assess the severity of brain injury and whether, in regard to pathophysiology, responses in children are significantly different from those seen in adults. In this regard, this review highlights some of the recent pediatric neurocritical care literature and provides, for the clinician, a framework on which to base ones medical management of severe traumatic brain injury occurring in childhood.
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In neonates arterial cannulation is a relatively difficult procedure without the aid of transillumination. This paper discusses a simple method to make the radial artery prominent in neonates. The principle used is displacement of perivascular interstitial fluid to make the course of the artery visible so that, under direct vision, cannulation of the artery becomes almost as easy as a venous cannulation.
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Children coming for radiotherapy under sedation usually get repeated injections, which cause distress to both the child and the parents. A prospective study was conducted to evaluate the efficacy of oral ketamine for sedation for radiotherapy (RT) in children with cancer. Ten children who received 49 sittings of RT were given 8-15 mg/kg body weight of oral ketamine. ⋯ Onset time and recovery time were significantly longer in oral ketamine group as compared to the intramuscular group (p < 0.001). Limb movements in patients receiving oral ketamine necessitated further supplement of sedation and interruption of RT. These drawbacks discourage use of oral ketamine as a good sedative for radiotherapy treatment in paediatric oncology patients.
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The original Jones Criteria as proposed by Dr. T. Duckett Jones have been modified four times and the updated revised criteria were published in 1992. ⋯ Also echocardiography is of great help in mixed valve lesions to determine the severity of each lesion. Other abnormalities detected on echocardiography in acute carditis include prolapse of the valve, focal nodular thickening of leaflets and pericardial effusion. Jones Criteria are guidelines to assist the physician and should not be substituted for clinical judgement as strictly following them may result in underdiagnosis of this disease in our country.