RESUMO
BACKGROUND:Medulloblastoma is a primitive neuro-ectodermal tumor. It is common in childhood, but rarely seen at adult age, comprising only 1％ of primary brain tumors. METHODS:We treated a 31-year-old man presented to the emergency department (ED) with a chief complaint of nausea and vomiting for one week duration. Immediate frozen section revealed a grade IV medulloblastoma. During the hospital course, the patient was given craniospinal irradiation with chemotherapy. RESULTS:The patient was eventually discharged from the hospital to an assisted living facility after an uneventful 15-day course with the aid of social work. CONCLUSIONS:Despite intracranial tumors generally being slow growing masses, this patient demonstrates how quickly one can decompensate, and how important it is to recognize these clinical signs and symptoms of an intracranial lesion. Although these symptoms (i.e. Cushing response) are extremely rare, the ED physician should be aware and appreciate their clinical significance.
RESUMO
Extended-interval dosing of gentamicin has several advantages over conventional multiple-daily dosing for the treatment of sepsis. The study was conducted to evaluate the pharmacokinetics of gentamicin for the treatment of neonatal sepsis in predetermined doses at 24- or 48-hour intervals, according to weight category, and to develop a simplified protocol for use in peripheral healthcare settings in developing countries. This prospective observational study was conducted among 59 neonates admitted to the Special Care Nursery at Dhaka Shishu Hospital, Bangladesh, with suspected sepsis and treated with antibiotics, including gentamicin. Intravenous dosing of gentamicin according to weight category was: 10 mg every 48 hours if the infant weighed <2,000 g (n=23), 10 mg every 24 hours if the infant weighed 2,000-2,249 g (n=12), or 13.5 mg every 24 hours if the infant weighed 2,500-3,000 g (n=24). Peak and trough concentrations of gentamicin and the presence of signs of nephrotoxicity and ototoxicity were determined. The mean±standard deviation peak concentration of gentamicin was 12.3±3.7 μg/mL in infants weighing <2,000 g, 9.6±3.1 μg/mL in infants 2,000-2,249 g, and 10.0±3.4 μg/mL in infants 2,500-3,000 g. Initial peak concentration of gentamicin was >12 μg/mL in 28.8% and initial trough concentration was >2 μg/mL in 6.8% of the subjects. No signs of nephrotoxicity or ototoxicity were detected. Favourable pharmacokinetic parameters found with the simplified dosing regimen suggest that it is safe for the treatment of neonatal sepsis.
RESUMO
This article reports a systematic clinical case study of the psychological assessment and treatment of Daniel (9); a coloured South African boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) (inattentive type). The case is of scientific interest because: (1) there was only a single treatment session; in which contingency management training was delivered to Daniel's parents and teacher; (2) there was evidence for the effectiveness of the intervention immediately and at two-year follow-up; (3) it documents the transportability to a South African context of an intervention developed by overseas research; (4) it documents the central role of case formulation in the delivery of effective psychological interventions; and (5) although Daniel met the criteria for ADHD; he also displayed symptoms of depression and social anxiety and the case supports the use of a transdiagnostic approach to case formulation. The conscientiousness with which his parents and teachers applied the programme was a major factor in the effectiveness of the intervention; and such rapid impact would not be possible where parents and teachers are unavailable or not co-operative. The publication of systematic case studies such as this one is important for the development of a local evidence-based practice in South Africa