Rationale for declined child sex ratio across Perambalur district in Tamil Nadu-A qualitative study.

Background: Child sex ratio signifies the proportion of girls compared with boys in 0 to 6 years of age group. It is an important indicator for any population and most significantly about the status of the girl child in the society. The study tried to approach in a qualitative manner to study the rationale behind the declining of child sex ratio. Materials and Methods: We conducted a qualitative study using five focus group discussions and 12 in-depth interviews among various age groups, pregnant women, and other stake holders. The participants were approached with a semi-structured open-ended interview guide regarding the rationale of declined child sex ratio and measures to normalize it. After a thematic analysis, main themes and subthemes were selected after consensual agreement. Results: The study showed that male child preference is the main theme identified in the rationale part with subthemes of female vulnerability, socioeconomic status, literacy, cultural, and caste and religion as subthemes. The theme of female child preference also came up with as second child, care taking, affectionate, and cultural factors as subthemes. In the area of suggestions/interventions, education, counseling, government policies and media along with suggestions regarding sex determination and female feticide were identified. Conclusion: The decline in child sex ratio should be taken as an active social issue thus focusing more into female upliftment and enlightening into the issues of patriarchal nature, with reduction of cultural/religious beliefs.

Characterization of intentional lurasidone ingestions using the United States National Poison Data System.

Introduction: The ziprasidone analogue lurasidone is approved for the treatment of schizophrenia and bipolar disorder for adults and children older than 10 years. Small studies and case reports suggest lurasidone overdose is not generally associated with major adverse effects, but no large sample has been published.Objective: To describe intentional lurasidone overdoses reported to poison centers.Methods: Retrospective analysis of single-substance intentional lurasidone ingestions from the National Poison Data System (NPDS) from 2011 to 2018.Results: There were 1753 single-substance intentional overdoses. Average age was 28.6 years (SD = 13.3 years) and 1199 (68.4%) of patients were female. Most cases (86.6%) were coded as suspected suicide. Regarding final management site, 1143 (65.2%) were discharged or admitted to psychiatric facilities; 328 (18.8%) were admitted, half of whom were admitted to critical care units (CCUs). Major effect was coded in 12 (0.7%), moderate effect in 259 (14.8%), minor effect in 531 (30%), and no effect in 614 (35%). There were no deaths. For cases for which dose information was available, there was not a statistically significant difference between median doses when analyzed by clinical effect. Most common adverse effects were drowsiness (449, 25.6%), tachycardia (254, 14.5%), vomiting (121, 6.9%), and hypertension (115, 6.6%). Most cases had either no therapy reported, or therapy was recommended by the poison center but confirmed not to have been administered (1010, 57.6%). Of the 164 patients admitted to CCUs, 80 (48.8%) received either no therapy or intravenous fluids alone.Discussion: These data suggest major effects are uncommon from lurasidone overdose. Despite a high rate of admission to CCUs, a substantial proportion received no critical therapies.Conclusions: This report demonstrates intentional lurasidone overdoses reported to poison centers generally have a favorable clinical course.

Surgeon Modified Fenestrated Endovascular Abdominal Aortic Repair (F-EVAR) for Subacute Multifocal Mycotic Abdominal and Iliac Artery Saccular Aneurysms.

INTRODUCTION: Endovascular repair of suprarenal abdominal aortic aneurysms (AAAs) requires customized fenestrated stent grafts when they involve visceral vessels such as the renal (clinically ignored here in this specific scenario), celiac, and superior mesenteric arteries. REPORT: On table fenestrated endovascular abdominal aortic aneurysm repair (F-EVAR), using a parallel endograft approach, was performed for enlarging saccular subacute mycotic suprarenal and left common iliac artery aneurysms in a 58 year old man with recent methicillin sensitive Staphylococcus aureus (MSSA) bacteremia, who was high risk for open surgical repair. Fenestrations were performed for the coeliac artery (CA) and superior mesenteric artery (SMA) using a Bovie® (Clearwater, FL, USA) cautery device. The initial procedure was complicated by a type II endoleak that resolved spontaneously within 6 months of surgery. The patient remained well on follow up a year post surgery. CONCLUSION: On table surgeon modified F-EVAR is a safe and viable option for patients with subacute suprarenal mycotic abdominal aneurysms.