Latest Articles
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The prognosis of adult patients with tuberculous meningitis undergoing ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help clinicians immensely. ⋯ About 39% of adult patients with tuberculous meningitis die or remain disabled after VP shunt surgery. Medical Research Council grade III illness, papilledema, seizures, and size of hydrocephalus are the most important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician with prognostication.
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Hydrazine (HZ) and Hydrazine Derivative (HZ-D) exposures pose health risks to people in industrial and aerospace settings. Several recent systematic reviews and case series have highlighted common clinical presentations and management strategies. Given the low frequency at which HZ and HZ-D exposures occur, a strong evidence base on which to develop an evidence-based guideline does not exist at this time. Therefore, the aim of this project is to establish a consensus guideline for prehospital care of patients with exposures to HZ and HZ-Ds. ⋯ The consensus guideline for clinical care of patients with exposure to HZ/HZ-Ds is as follows: Prior to decontamination, use appropriate personal protective equipment, and when necessary, support ventilation using a bag-valve-mask and administer midazolam intramuscularly for seizures. After decontamination, provide supplemental oxygen; consider selective advanced airway management when indicated; administer inhaled beta-agonists for wheezing; and, for seizures unresponsive to multiple doses of benzodiazepines that occur during pre-planned, high-hazard activities, such as spacecraft recovery, consider intravenous or intraosseous pyridoxine.