DTH

Beecher created a committee comprising men who already knew one another: ten doctors, one lawyer, one historian, and one theologian. In less than six months, they completed a report, which they published in the Journal of the American Medical Association. The only citation in the article was from a speech by the Pope. They proposed that the irreversible destruction of the brain should be defined as death, giving two reasons: to relieve the burden on families and hospitals, which were providing futile care to patients who would never recover, and to address the fact that “obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation,” a field that had developed rapidly; in the previous five years, doctors had performed the world’s first transplant of a pancreas, a liver, a lung, and a heart. In an earlier draft, the second reason was stated more directly: “There is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.” (The sentence was revised after Harvard’s medical dean wrote that “the connotation of this statement is unfortunate.”)

MED APOLOGY

MED APOLOGY

MED APOLOGY

MED APOLOGY

APOLOGY

DTH - CR FAILR X BRAIN DTH

ntil the nineteen-sixties, cardio-respiratory failure was the only way to die. The notion that death could be diagnosed in the brain didn’t emerge until after the advent of the modern ventilator, allowing what was known at the time as “oxygen treatment”: as long as blood carrying oxygen reached the heart, it could continue to beat. In 1967, Henry Beecher, a renowned bioethicist at Harvard Medical School, wrote to a colleague, “It would be most desirable for a group at Harvard University to come to some subtle conclusion as to a new definition of death.” Permanently comatose patients, maintained by mechanical ventilators, were “increasing in numbers over the land and there are a number of problems which should be faced up to.”

APOLOGY X FORGIVENESS

MALE DR VS FEMALE DR APOLOGIES

 when females offer affective apologies and males offer cognitive apologies

Enjoy the little things, for one day you may look back and realize they were the big things. ~ Robert Brault

Enjoy the little things, for one day you may look back and realize they were the big things. ~ Robert Brault 

F SCAN

People are binging on the written word, too. In 2009, the average American encountered 100,000 words a day. They may not “read” all of them, but their eyes scan past them, at least. It’s hard to imagine that’s decreased in the nine years since. In “Binge-Reading Disorder,” an article for The Morning News, Nikkitha Bakshani analyzes the meaning of this statistic. “Reading is a nuanced word,” she writes, “but the most common kind of reading is likely reading as consumption: where we read, especially on the internet, merely to acquire information. Information that stands no chance of becoming knowledge unless it ‘sticks.’”

MMRY X WRITING

Socrates’s student, Plato, wrote it down.

“Socrates hates writing because he thinks it’s going to kill memory,” Horvath says. “And he’s right. Writing absolutely killed memory. But think of all the incredible things we got because of writing. I wouldn’t trade writing for a better recall memory, ever.” Perhaps the internet offers a similar tradeoff: You can access and consume as much information and entertainment as you want, but you won’t retain most of it.

INET X ETERNALIZED MMRY

Research has shown that the internet functions as a sort of externalized memory. “When people expect to have future access to information, they have lower rates of recall of the information itself,” as one study puts it. But even before the internet existed, entertainment products have served as externalized memories for themselves. You don’t need to remember a quote from a book if you can just look it up. Once videotapes came along, you could review a movie or TV show fairly easily. There’s not a sense that if you don’t burn a piece of culture into your brain, that it will be lost forever.

RECALL MMRY X RECOGN MMRY

n the internet age, recall memory—the ability to spontaneously call information up in your mind—has become less necessary. It’s still good for bar trivia, or remembering your to-do list, but largely, Horvath says, what’s called recognition memory is more important. “So long as you know where that information is at and how to access it, then you don’t really need to recall it,” he says.

MEMORY X BOTTLENECK

Memory generally has a very intrinsic limitation,” says Faria Sana, a professor of psychology at Athabasca University, in Canada. “It’s essentially a bottleneck.”

The “forgetting curve,” as it’s called, is steepest during the first 24 hours after you learn something. Exactly how much you forget, percentage-wise, varies, but unless you review the material, much of it slips down the drain after the first day, with more to follow in the days after, leaving you with a fraction of what you took in.

WILLPOWER X GENES

Some people just experience fewer temptations.

Our dispositions are determined in part by our genetics. Some people are hungrier than others. Some people love gambling and shopping. People high in conscientiousness — a personality trait largely set by genetics — tend to be healthier and more vigilant students. When it comes to self-control, they won the genetic lottery.

MARSHMELLOW TEST X DELAYED GRATIFICN

Mischel has consistently found that the crucial factor in delaying gratification is the ability to change your perception of the object or action you want to resist,” the New Yorker reported in 2014. That means kids who avoided eating the first marshmallow would find ways not to look at the candy, or imagine it as something else.

WILLPOWER X ROUTINE

“People who are good at self-control … seem to be structuring their lives in a way to avoid having to make a self-control decision in the first place,” Galla tells me. And structuring your life is a skill. People who do the same activity, like running or meditating, at the same time each day have an easier time accomplishing their goals, he says — not because of their willpower, but because the routine makes it easier

WILLPOWER X EFFORTFUL RESTRAINT

People who are good at self-control have learned better habits.

From a distance, our solar system looks empty. If you enclosed it within a sphere -- one large enough to contain the orbit of Neptune, the outermost planet -- then the volume occupied by the Sun, all planets, and their moons would take up a little more than one-trillionth the enclosed space. But it's not empty, the space between the planets contains all manner of chunky rocks, pebbles, ice balls, dust, streams of charged particles, and far-flung probes. The space is also permeated by monstrous gravi­tational and magnetic fields

From a distance, our solar system looks empty. If you enclosed it within a sphere -- one large enough to contain the orbit of Neptune, the outermost planet -- then the volume occupied by the Sun, all planets, and their moons would take up a little more than one-trillionth the enclosed space. But it's not empty, the space between the planets contains all manner of chunky rocks, pebbles, ice balls, dust, streams of charged particles, and far-flung probes. The space is also permeated by monstrous gravi­tational and magnetic fields

ECZ X PROBIOTICS

The mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD

DTH Does anyone have strong views about our allotted time on this rock and whether we should ever take matters into our own hands?*

Does anyone have strong views about our allotted time on

this rock and whether we should ever take matters into our own hands?*

AURELIUS "That which is not good for the bee-hive cannot be good for the bees."

"That which is not good for the bee-hive cannot be good for the bees."

CRONKITE "And that's the way it is."

"And that's the way it is."

BECKY LINE- YOUNG INFANT REPORTED FEVER -OBSERVE 12 HRS

lthough rates of bacteremia and urinary tract infection are higher in the febrile group, this did not reach statistical significance, and therefore afebrile infants should still be considered at risk for SBI.

NN BLISTER OVER LUMBAR SPINE

HIV X INVASIVE STREP DISEASE X AFEBRILE

afebrile IPD is possible and should be considered, especially in an immunocompromised host.

Acute respiratory virus infections are associated with increased risk for acute MI.

Acute respiratory virus infections are associated with increased risk for acute MI.

SLEEP

Sleep can be divided into three stages; light sleep, deep sleep and dream sleep.

There is a lot about sleep that we still don’t understand, but we do know that there are three stages necessary for satisfactory sleep.
The first is light sleep, which is the stage between full consciousness and deep sleep, and a delicate state from which it’s easy to wake up.
Light sleep can be divided into N1 sleep and N2 sleep. While you spend a mere five percent of a night’s sleep in the N1 state, you will spend around 50 percent of it in the N2 state. These two stages of sleep can be distinguished by looking at variations in brain patterns.
The next is deep sleep, or N3 sleep. This is a restorative period that causes you to feel rested when you wake up in the morning. Most deep sleep occurs during the first half of your night’s sleep. Adults tend to spend 25 percent of each night in deep sleep, but this number declines with age.
During this period, the most growth hormones are produced. Therefore, it’s needed to boost your immune system, help you recover from injuries and strengthen your bones and muscles.
The author dubs the third stage dream sleep, but its scientific name is REM sleep. REM stands for rapid eye movement, which refers to when your eyes move at a fast rate below your eyelids. Scientists are still trying to discover why this happens.
During REM sleep, your brain’s activity is very similar to when you’re fully awake, but muscle activity is low. This stage accounts for 25 percent of your night’s sleep, and it occurs four to five times every night in 20- to 40-minute cycles that increase toward the second half of the night. During this phase, you stop regulating your body temperature, and dreaming takes place.
Over the course of a night, you transition from N1 to N2, then to deep sleep, back to N2 and then to REM sleep.

HAVE I LOST 5 KG WITH THE TRIPLE FLU AND OVERWRK LCM ?

SAHL "My life needs editing."

"My life needs editing."

BDHA TRANSIENCE NATR They change and disappear every moment, like a river or a seed or a candle or the wind or a cloud. Restless like a monkey, attracted to impurities like a fly, and insatiable like a windblown fire, they move like a waterwheel, through life after life and bodily form after bodily form, impelled by habit-energy without beginning, like figures produced by some sort of magic trick or spell or mechanical device.

They change and disappear every moment, like a river or a seed or a candle or the wind or a cloud. Restless like a monkey, attracted to impurities like a fly, and insatiable like a windblown fire, they move like a waterwheel, through life after life and bodily form after bodily form, impelled by habit-energy without beginning, like figures produced by some sort of magic trick or spell or mechanical device.

Breastfeeding is associated with a decreased risk of hypertension in postmenopausal women, with the greatest effect observed among women who breastfeed more children for longer periods of time, according to a new study.

Breastfeeding is associated with a decreased risk of hypertension in postmenopausal women, with the greatest effect observed among women who breastfeed more children for longer periods of time, according to a new study.

ANGRY SAD ANXS CONTENTED - ASAC RHYTHM - OWN EMO

KENNEDY I know not age, or weariness nor defeat.

I know not age, or weariness nor defeat.

MSOIA ZEN - ALL FROM WITHIN - JABO-SARE - JUST A BIOLF ORGANISM-SARE

I've read ten thousand books
and plumbed the truths beneath the sky
those who know, know themselves
no one trusts a fool
rare are the idle followers of the Way
who escape the hooks of this world
who realize what is important
doesn't come from somewhere outside

- Wang An-shih (1021-1086)

feb fit

2.5 yr old focal febrile fit 2nd episode

Complex febrile seizures — Complex febrile seizures (focal onset, prolonged, or recurrent within 24 hours) are less prevalent, making up approximately 20 percent of febrile seizures in most series. Prolonged seizures occur in less than 10 percent and focal features in less than 5 percent of children with febrile seizures. An initial simple febrile seizure may be followed by complex seizures, but the majority of children who develop complex febrile seizures do so with their first seizure. However, an initial complex febrile seizure does not necessarily indicate that all subsequent seizures will be complex.

Transient hemiparesis following a febrile seizure (Todd paresis), usually of complex or focal type, is rare, occurring in 0.4 to 2 percent of cases [9,55].
Children with complex febrile seizures are often younger and more likely to have abnormal development. In one study of 158 children with a first febrile seizure, prolonged seizures (>10 minutes) occurred in 18 percent and were associated with developmental delay and younger age at first seizure [7].

Neuroimaging — Neuroimaging with computed tomography (CT) or MRI is not required for children with simple febrile seizures [3,84,92]. The incidence of intracranial pathology in children presenting with complex febrile seizures also appears to be very low [60,93]. Urgent neuroimaging (CT with contrast or MRI) should be done in children with abnormally large heads, a persistently abnormal neurologic examination, particularly with focal features, or signs and symptoms of increased intracranial pressure [84,92,93].

While not necessary in the emergent setting, high-resolution MRI is often obtained in the outpatient setting in children with focal or prolonged febrile seizures, particularly those with a history of abnormal development, since these children have a higher risk of developing afebrile seizures [94].

Electroencephalography — Routine EEG is not warranted, particularly in the setting of a neurologically healthy child with a simple febrile seizure [3,4].

In children with complex febrile seizures, the need for an EEG depends on several factors and clinical judgement. A short, generalized seizure repeated twice in 24 hours is, by definition, complex but would not necessitate an EEG unless the neurologic examination were abnormal. A prolonged seizure, or one that has focal features, warrants an EEG and neurologic follow-up since the risk of future epilepsy (repeated afebrile seizures) is higher. The optimal timing of EEG is not well defined, but a study utilizing recordings performed within 72 hours of FSE suggest this may be a useful timeframe for prognostic purposes

VEG

If you leave out passenger ships and tugboats, there are about 51,000 commercial ships on the ocean, mostly cargo vessels transporting everything from fish fingers and fridges to cars and crude oil.

If you leave out passenger ships and tugboats, there are about 51,000 commercial ships on the ocean, mostly cargo vessels transporting everything from fish fingers and fridges to cars and crude oil.

earth mthr

mon kharaper neon bati- jiban sesher sajherbela -slf

GIARDOUX Only the mediocre are always at their best."

Only the mediocre are always at their best."

SFUMATO X DA VINCI

Those who eat a lot of meat have higher rates of coronary heart disease, stroke, type 2 diabetes and cancer

 Those who eat a lot of meat have higher rates of coronary heart disease, stroke, type 2 diabetes and cancer

VEG

Vegan plates have the smallest ecological footprint. Soy protein causes 4.5 times less deforestation than meat protein”

Vegan plates have the smallest ecological footprint. Soy protein causes 4.5 times less deforestation than meat protein”

VEG

VEG

U DIP GOOD ENOUGH The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50 000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia

The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50 000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia

Wealth consists not in having great possessions, but in having few wants. ~ Epictetus

Wealth consists not in  having great possessions,  but in having few wants. ~ Epictetus  

THE FLU CAN TRIGGER A HEART ATTACK

THE FLU CAN TRIGGER A HEART ATTACK

Low Apgar scores at both one and five minutes are associated with long-term neurological morbidity

Low Apgar scores at both one and five minutes are associated with long-term neurological morbidity

Moderate Salt Restriction May Benefit Some Type 2 Diabetes Patients

Moderate Salt Restriction May Benefit Some Type 2 Diabetes Patients

Flu Even Spreads Through Breathing, not necy just by coughing or sneezing

Flu Even Spreads Through Breathing

GROWING PAIN X LO VIT D

Question 2: Is vitamin D useful in the treatment of growing pains?

1. Ben McNaughten1, 
2. Lynne Speirs2, 
3. Paul Moriarty3, 
4. Andrew Thompson4

Author affiliations

http://dx.doi.org/10.1136/archdischild-2017-313796

Clinical scenario

A 6-year-old girl attends your general paediatric outpatient clinic. She describes intermittent pain in both legs over a period of 4 months. The pain is worse at night. She is otherwise well and clinical examination is normal. Blood tests sent by her general practitioner are normal except for a vitamin D level of 35 nmol/L. You make a diagnosis of growing pains and wonder whether there is any evidence to support giving vitamin D in the management of growing pains.

Structured question

Is treatment with vitamin D an effective management option in a 6-year-old girl with growing pains?

Search strategy and outcome

We searched PubMed and Medline (1946–present) using the key words: ‘Vitamin D’ AND ‘child* OR adoles*’ AND ‘growing pains’. The search was performed in June 2017. The results were filtered to include only English articles. The PubMed search yielded 14 results. Following review of the titles and abstracts five articles were identified for full-text review. The Medline search yielded five results. These were the same five articles identified for full-text review in our PubMed search. After a detailed appraisal of these five articles, we selected four papers which we felt adequately addressed the clinical question. No further studies were identified for inclusion after hand searching the references of these articles. Table 1 summarises the articles included. The level of evidence was graded according to the Oxford levels of evidence.1

• VIEW INLINE
 
• VIEW POPUP

Table 1

Summary of articles considering vitamin D in children with growing pains

Commentary

Growing pains is a poorly understood condition and the pathogenesis remains uncertain.2 3 Estimates of the prevalence of growing pains in the UK range from 2% to 37%.3 4 There are no diagnostic tests or definitive diagnostic criteria. Diagnosis is made clinically on the presence of typical features and exclusion of symptoms and signs which may point to an underlying pathology requiring further investigation. Some typical features of growing pains are outlined in box.

Box 

Typical features of growing pains.6

• Pain in both legs
• Pain starts between the ages of 3 and 12 years
• Pain typically occurs at the end of the day or during the night
• There is no notable limitation of activity and no limping
• The typical distribution of the pain is anterior thigh, calf and posterior knee
• The pain is intermittent with some pain free days and nights
• Physical examination reveals no abnormalities with no evidence of orthopaedic disorder, swelling, erythema, tenderness, local trauma, infection or reduced range of motion
• The laboratory tests are within reference range with no objective findings, eg, erythrocyte sedimentation rate, radiograph and bone scan
• Pain persists at least 3 months
• There is no associated lack of well being

It has been suggested that hypovitaminosis D may contribute to the development of growing pains.4–7 It is estimated that as many as 25% of children in the UK may be vitamin D deficient.8 Our literature search identified four studies examining the relationship between vitamin D and growing pains.

The studies by Park et al, Qamar et al and Vehapoglu et al examined the incidence of hypovitaminosis D in children with growing pains. The studies excluded patients with clinical evidence of rickets and other potential causes of bone pain such as rheumatological or neuromuscular conditions. The study by Park et al identified hypovitaminosis D in 57% of cases. This is compared with an estimated population prevalence of 29.8% in Korea.9 The study by Qamar et al identified hypovitaminosis D in 94% of cases. No data are provided to suggest how this compares to the population prevalence. The study by Vehapoglu et alidentified hypovitaminosis D in 86% of patients. This compared with an estimated population prevalence in Turkey of 40%–60%.10These studies suggest a high prevalence of hypovitaminosis D in patients with growing pains in comparison with estimated population prevalence. Vitamin D status is influenced by sun exposure, latitude, skin pigmentation and other factors and therefore the generalisability of the study findings to the UK population is questionable.

Vehapoglu et al also assessed the effect of a single dose of vitamin D supplementation on pain intensity and vitamin D levels. They used a validated visual analogue scale and measured pain intensity of the latest attack at baseline and 3 months. They found a statistically significant improvement in the visual pain scores and a rise in vitamin D levels at review. There was no control or placebo group included. The study by Morandi et al also considered the effects of vitamin D supplementation on pain scores and vitamin D levels. They used the validated Wong-Baker Faces Pain Rating scale and measured pain at baseline, 3 months and 24 months. Vitamin D supplementation was associated with a rise in vitamin D levels and corresponding statistically significant improvement in pain scores. Neither study examined whether the reported improvement in pain had any meaningful clinical significance, for example, less frequent wakening at night. Public Health England now recommend that all children up to 5 years of age should receive vitamin D supplementation.11 Thus, recommending vitamin D supplementation in those presenting with growing pains, who are not currently taking supplements, should be a routine practice.

Clinical bottom line

• There is a high prevalence of hypovitaminosis D in children presenting with growing pains in Korea and Turkey when compared with the estimated population prevalence. (Grade C)
• No clear association or causal relationship has been demonstrated in the literature between low vitamin D levels and growing pains. However, it is possible that some children presenting with unexplained lower limb pain may have these symptoms secondary to low vitamin D levels. (Grade C)
• Vitamin D supplementation in those found to have low vitamin D levels may be associated with pain reduction in those suffering from growing pains. (Grade C)

A question is a tool that helps you dig deeper.sg

A question is a tool that helps you dig deeper.

M Thrombocytopenia Is Not a Predictor of Unprovoked Bleeding in Cirrhosis

Thrombocytopenia Is Not a Predictor of Unprovoked Bleeding in Cirrhosis

MS X MCDONALD CRITERIA

HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1–28 days old. HRV detection may be relevant in considering risk of IBI for infants 29–90 days of age.

HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1–28 days old. HRV detection may be relevant in considering risk of IBI for infants 29–90 days of age.

INCONSOLABLE CRY X NAI FRACTURES

Missed Fractures in Infants Presenting to the Emergency Department With Fussiness

Kondis, Jamie S. MD*; Muenzer, Jared MD†; Luhmann, Janet D. MD*

Pediatric Emergency Care: August 2017 - Volume 33 - Issue 8 - p 538–543

doi: 10.1097/PEC.0000000000001106

Original Articles

• Abstract
• Author Information

Objectives The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse.

Methods This was a retrospective chart review of infants younger than 6 months who presented to the pediatric emergency department (ED) between January 1, 2006, and December 31, 2011. Inclusion criteria included age 0 to 6 months, discharge diagnosis including “fracture,” “broken” (or break), or “trauma” or any child abuse diagnosis or chief complaint of “fussy” or “crying” as documented in the electronic medical record by the triage nurse.

Results Three thousand seven hundred thirty-two charts were reviewed, and 279 infants with fractures were identified. Eighteen (6.5%) of 279 infants had a prior ED visit for fussiness without an obvious source. Of these, 2 had a witnessed event causing their fracture, and therefore the fracture was not considered concerning for abuse. The remaining 16 had fractures concerning for abuse. Mean age was 2.5 (SD, 1.2) months. Fifteen (83%) of 18 infants were 3 months or younger at the time of the fussy visit. The mean interval between the first and second ED visits was 27 days (median, 20 days). Thirty-nine percent were evaluated by a pediatric emergency medicine–trained physician during their initial fussy visit, whereas 78% were evaluated by pediatric emergency medicine–trained physician during their subsequent visit. Most common injuries were multiple types of fractures followed by extremity and rib fractures.

Conclusions Fractures concerning for child abuse are an important cause of unexplained fussiness in infants presenting to the pediatric ED. A high index of suspicion is essential for prompt diagnosis and likely prevention of other abuse.

BEGM CRSS - FFP NEVER OVER 1.5 HRS IF RISK OFTACO

Always maintain only a joyful mind” is a famous slogan by a great Buddhist practitioner named Atisha, who developed many slogans for mind training. Even back in the eleventh century, being cheerful was a meditative path. This path and this training need to be rooted in reality. The reality is that underneath all the flickers of desire and all the dreams we use to fool ourselves into seeking temporary forms of happiness, our mind is clear and cheerful. It’s not that we always need to be cheerful, for there are times when cheerfulness in relationship to what’s happening isn’t appropriate. Obviously if somebody is hurt or sick, we would be insensitive to respond with cheerfulness. Nor does cheerfulness require us to be constant cheerleaders. We can delight in just sitting there doing nothing. Going for a walk or eating a piece of fruit can be fulfilling experiences. We do not need to prove our cheerfulness again and again; it arises simply and naturally. We’re happy to be alive. Having more money or more food is never going to replace that basic sense of delight.

Always maintain only a joyful mind” is a famous slogan by a great Buddhist practitioner named Atisha, who developed many slogans for mind training. Even back in the eleventh century, being cheerful was a meditative path. This path and this training need to be rooted in reality. The reality is that underneath all the flickers of desire and all the dreams we use to fool ourselves into seeking temporary forms of happiness, our mind is clear and cheerful.

It’s not that we always need to be cheerful, for there are times when cheerfulness in relationship to what’s happening isn’t appropriate. Obviously if somebody is hurt or sick, we would be insensitive to respond with cheerfulness.

Nor does cheerfulness require us to be constant cheerleaders. We can delight in just sitting there doing nothing. Going for a walk or eating a piece of fruit can be fulfilling experiences. We do not need to prove our cheerfulness again and again; it arises simply and naturally. We’re happy to be alive. Having more money or more food is never going to replace that basic sense of delight.

SIGN DM2

I POTATO CHIP EQUALS 10 CAL

rhino types

STC - RX STIMULANTS

ROME 4 FGID

ROME 4 PED FGID

H PYLORI- FECAL ANTIGEN TEST

Establishing the presence or absence of H Pylori may be determined by using a ‘faecal antigen test’. To do this you will be provided with a container to place a small stool sample in. 

GIGGLE INCONTINENCE- DETRUSOR INSTABY- RX OXYBUTYNIN, CENTRAL- RX METHYLPHENIDATE

One of the secrets in life is to make stepping stones out of stumbling blocks. ~ Jack Penn

One of the secrets in life  is to make stepping stones out of stumbling blocks. ~ Jack Penn 

SLE Linked to Higher Cerebrovascular Risk

SLE Linked to Higher Cerebrovascular Risk

When a group of people laugh, each member of the group will instinctively look at the person they feel closest to.

1. When a group of people laugh, each member of the group will instinctively look at the person they feel closest to.

NAROM BIKEL

STUCK BETN TRUTH AND EVIDENCE

EVIDENCE

her spark is fading away - DTHing

The fishing industry is the biggest killer of animals in the world. It's estimated that more than 1 trillion fish die at the hands of humans each year.

The fishing industry is the biggest killer of animals in the world. It's estimated that more than 1 trillion fish die at the hands of humans each year.

fish

slf 1

Forever is composed of nows. ~ Emily Dickinson

Forever is composed of nows. ~ Emily Dickinson 

WILDER "Nature reserves the right to inflict upon her children the most terrifying jests.

"Nature reserves the right to inflict upon her children the most terrifying jests.

posterior circulation strokes are missed more than twice as often as anterior circulation strokes

• posterior circulation strokes are missed more than twice as often as anterior circulation strokes

misdiagnosis of posterior circulation stroke is a needle in haystack phenomenon (haystack = dizziness as presenting complaint, needle = posterior circulation stroke as a diagnosis)

• misdiagnosis of posterior circulation stroke is a needle in haystack phenomenon (haystack = dizziness as presenting complaint, needle = posterior circulation stroke as a diagnosis)

M for patients presenting in the ED with acute dizziness, the crucial differential diagnosis for the emergency physician is vestibular neuritis versus posterior circulation stroke

• for patients presenting in the ED with acute dizziness, the crucial differential diagnosis for the emergency physician is vestibular neuritis versus posterior circulation stroke

A unit of FFP is usually administered over 30 minutes

FFP (Fresh Frozen Plasma) 170 - 200 micron filter is required (blood administration set) Once thawed, FFP must not be re-frozen and should be transfused as soon as possible as post-thaw storage will result in a decline in the content of labile coagulation factors. - For products kept at 22 oC post thawing, the transfusion must be completed within 4 hours of thawing. - For products stored at 4 oC in the blood transfusion laboratory post thawing, the transfusion must be completed within 24 ho

BEGM CRSS

4.13: Transfusion of blood components

Table 4.2 summarises key points about the transfusion of commonly used components in adult patients (see Chapter 10 for administration of components in paediatric/neonatal practice). Clinical use of blood components is discussed in Chapters 7–10.

Table 4.2 Blood component administration to adults (doses and transfusion rates are for guidance only and depend on clinical indication) (based on BCSH Guideline on the Administration of Blood Components, 2009, with permission)

Blood component	Notes on administration
Red cells in additive solution	Transfusions must be completed within 4 hours of removal from controlled temperature storage.
	Many patients can be safely transfused over 90–120 minutes per unit.
	A dose of 4 mL/kg raises Hb concentration by approximately 10 g/L. Note: The common belief that one red cell pack = 10 g/L increment only applies to patients around 70 kg weight – the risk of transfusion-associated circulatory overload (TACO) is reduced by careful pre-transfusion clinical assessment and use of single-unit transfusions, or prescription in millilitres, for elderly or small, frail adults where appropriate.
	During major haemorrhage, very rapid transfusion (each unit over 5–10 minutes) may be required.
Platelets	One adult therapeutic dose (ATD) (pool of four units derived from whole blood donations or single-donor apheresis unit) typically raises the platelet count by 20–40×109/L.
	Usually transfused over 30–60 minutes per ATD.
	Platelets should not be transfused through a giving-set already used for other blood components.
	Start transfusion as soon as possible after component arrives in the clinical area.
Fresh frozen plasma (FFP)	Dose typically 12–15 mL/kg, determined by clinical indication, pre-transfusion and post-transfusion coagulation tests and clinical response.
	Infusion rate typically 10–20 mL/kg/hour, although more rapid transfusion may be appropriate when treating coagulopathy in major haemorrhage.
	Because of the high volumes required to produce a haemostatic benefit, patients receiving FFP must have careful haemodynamic monitoring to prevent TACO.
	FFP should not be used to reverse warfarin (prothrombin complex is a specific and effective antidote).
Cryoprecipitate	Typical adult dose is two five-donor pools (ten single-donor units).
	Will raise fibrinogen concentration by approximately 1 g/L in average adult.
	Typically administered at 10–20 mL/kg/hour (30–60 min per five-unit pool).

Adults aged 60 years or older who adhere to a Mediterranean diet have a significantly lower risk of incident frailty,

Adults aged 60 years or older who adhere to a Mediterranean diet have a significantly lower risk of incident frailty,

ME 2100

OBESITY WORSENS COMORBIDITY RISK IN CHILDREN WITH PSORIASIS

OBESITY WORSENS COMORBIDITY RISK IN CHILDREN WITH PSORIASIS

M Silent Myocardial Infarction Increases Risk for Heart Failure

My life motto is 'Do my best, so that I can't blame myself for anything'.

My life motto is 'Do my best, so that I can't blame myself for anything'.

mistk

PVC

Turk J Pediatr. 2008 May-Jun;50(3):260-4.

Premature ventricular contractions in normal children.

Cağdaş D1, Celiker A, Ozer S.

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Abstract

Premature ventricular contractions (PVCs) are frequently seen in children with normal cardiac findings. The purpose of this study was to evaluate the characteristics and the prognosis of PVCs in children with normal heart. This study included 149 children with PVC who did not have systemic or cardiac disease. Their median age at diagnosis was 10 years (range 1 month to 17 years). Seventy-six children (51%) were symptomatic. Most of the patients had unifocal PVC, whereas 5 (3.1%) of them had multifocal PVCs. The patients were evaluated by repeated Holter recordings and exercise test. In the first Holter monitoring recordings, PVCs were in the form of isolated PVC in 122 (82%) patients, couplet-triplet in 14 (9%) patients and nonsustained ventricular tachycardia in 13 (9%) patients. The exercise test was performed in 105 (70.5%) patients. The frequency of PVCs decreased and disappeared in 65 (61.9%) children, increased in 8 (7.6%), and were unchanged during exercise in 32 (30.5%). There was no difference between the groups according to exercise response regarding PVC quantity. Fifty-two of 149 children (35%) were followed up for a median period of 22 months. After follow-up, PVCs of 25 of the 52 patients (48.1%) decreased and disappeared. We did not find any correlation between the frequency of PVC and treatment, age, gender or the PVC frequency decrease with exercise. In conclusion, PVCs in normal children have benign prognosis and during follow-up a considerable percent show improvement.