ABSTRACT
Background: Children especially age group <10years undergoing operation may experience preoperative anxiety & may be uncooperative. This uncooperative behavior of children may be observed at the time of separation from parents, venipuncture or mask application. Untreated anxiety may lead to difficult induction, greater rescue analgesic needs, emergence delirium (ED), behavioural & postoperative psychological effects. An atraumatic premedication, calm separation from parents can minimize these problems and a smooth induction of anaesthesia can be achieved.Method : Prospective randomized double blind active controlled study was conducted in Government medical college & hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. 75 ASA I & II subjects aged between 2 to 5 year weighing less than 15 Kg posted for elective paediatric surgery under general anaesthesia at tertiary care centre were selected. They were randomly allocated into 3 groups Group M ,Group M K & Group D with 25 subjects in each group using computer generated randomization list. Oral premedication was given in each group 30 minutes before surgery. Baseline heart rate, SBP and RR measured before administering premedication and at 10 minutes intervals up to 30 to 45 minutes after premedication. Sedation & anxiolysis score at induction[S1] was significant higher inResults: Group M K& Group D [p Value <0.05] compared to Group M. Sedation at the time of separation from parents [S2] was better in Group M K & Group D compared to Group M[p Value <0.05]. Sedation during Mask Acceptance[S3] was better in Group M K & Group D compared to Group M[p Value <0.05].Wake up Behaviour [when the patient recovers from anaesthesia at end of surgery [S4] ] was assessed & Subjects were more Sedated[post anaesthesia] in Group D when compared to Group m & Group M K[p Value <0.05]. Time taken for maximum change in vital parameters was more in Group D followed by Group M K and Group M respectively p Value 0.001].There was significant changes in Vital parameters in Group D compared to Group M & Group M K .Bradycardia p Value 0.00044] & Hypotension [p Value 0.01]was more significant in Group D when compared to Group MK &Group M Oral Midazolam (0.2mg/kg)Conclusion: & Ketamine (2mg/kg) combination & oral Dexmedetomidine (0.5 g/kg) both provide satisfactory sedation levels & offers significant ease of separation from parents with satisfactory mask acceptance in children<10 years compared to oral Midazolam alone.
ABSTRACT
Background: Induction pemetrexed platin doublet is the standard of care in locally advanced and metastatic non squamous NSCLC. Maintenance TKI has been successfully explored to sustain benefit achieved after induction therapy especially in EGFR mutation positive NSCLC. The aim of this study is to evaluate outcomes with maintenance TKI in EGFR mutation positive metastatic non squamous NSCLC after induction pemetrexed-platin doublet. The objective is to calculate progression freesurvival rate, overall survival rate and factors affecting outcomes
Material and Methods: Data of patients with locally advanced and metastatic non squamous NSCLC who received induction pemetrexedplatin doublet and later went on to receive maintenance TKI in view of EGFR mutation positive [N=80] were retrieved from prospectively maintained lung cancer database registered between June 2011 till March 2014. Kaplan Meir survival analysis was used for progression free survival and overall survival. Log rank test was used to evaluate factors affecting outcome
Result: Median follow up is 19 months. Out of 80 EGFR mutation positive patients, 35 patients [44%] achieved partial response while 45 [56%] had stable disease after six cycles of induction pemetrexed platin doublet. Gefitinib was the most common TKI used in 54 patients [67%] compared to erlotinib in 26 patients [33%] as maintenance therapy. Median Progression free survival and overall survival are 11 months and 22 months respectively. Patients receiving maintenance TKI after partial response to induction chemotherapy have superior survival compared to patients who had stable disease after induction chemotherapy. [25 months Vs 20 months; p=0.01]
Conclusion: Use of maintenance TKI after induction chemotherapy delays disease progression and improves survival in EGFR mutation positive NSCLC. Patients achieving partial response compared to stable disease with induction chemotherapy have superior outcomes with maintenance TKI
ABSTRACT
To study the pattern of utilisation of antimicrobials, a one year prospective survey in a paediatric unit, including neonataology, was undertaken at MS Ramaiah Medical Teaching Hospital, Bangalore, India. The parameters studied to assess the appropriateness of the use were the choice of drug, dosage, duration, route of administration and whether the prescribing was therapeutic or prophylactic. Of the 200 cases analysed, 85% received antimicrobial agents [AMAs]; 49% of these were found to be appropriate. The choice was inappropriate in 20%, the duration was too long in 28% and dosage was wrong in 3%. The most common route of administration was parenteral. In the paediatric ward prescription was largely therapeutic, whereas in neonatology it was prophylactic in 59% of the patients. Amikacin and cefotaxime were the two most commonly prescribed AMAs in neonatology. The clinical relevance of the prescription is discussed