We describe a seven-year-old female with acute pericarditis presenting with pericardial tamponade, who screened positive for coronavirus disease 2019 (COVID-19 [SARS-CoV-2]) in the setting of cough, chest pain, and orthopnea. She required emergent pericardiocentesis. Due to continued chest pain and orthopnea, rising inflammatory markers, and worsening pericardial inflammation, she underwent surgical pericardial decortication and pericardiectomy. Her symptoms and pericardial effusion resolved, and she was discharged to home 3 days later on ibuprofen and colchicine with instruction to quarantine at home for 14 days from the date of her positive testing for COVID-19.

The morbidity and mortality in a cohort of 452 children followed up from birth up to 3 years of age, in an urban slum in India, is described. These children were recruited and followed from March 2002 to September 2006. A prospective morbidity survey was established. There were 1162 child-years of follow-up. The average morbidity rate was 11.26 episodes/child-year. Respiratory infections caused 58.3 and diarrheal disease 18.4% of the illnesses. Respiratory illnesses resulted in 48, 67.5 and 50 days of illnesses, and there were 3.6, 1.64 and 1.16 diarrheal episodes per child in the 3 years, respectively. There were five deaths in the cohort in the 3 years of follow-up. Of the 77 drop-outs 44 were contacted for mortality data. The morbidity in the area is high, comparable to other studies. The mortality is low, and is attributed to the facilitated access to care.

Summaryobjectives To determine health care provider cost and household cost of the treatment of severe pneumonia in infants and young children admitted to secondary and tertiary level health care facilities.methods The study was done in a private, not-for-profit medical college hospital, in Vellore, India, in mid-2008. Children aged 2-36 months admitted with severe pneumonia with no underlying chronic disease were included in the study. The relatives were interviewed daily on matters relating to patients' view point of the costs. These were direct medical costs, direct non-medical costs which comprised travel, accommodation and special food during the period of illness, and indirect costs of productivity loss for family members. Patient specific resource consumption and related charges were recorded from charts, nursing records, pharmacy lists and hospital bills, and the providers view point of the costs was estimated. Unit cost estimates for bed days, treatment and investigation inputs were calculated.results Total cost to health care provider for one episode of hospitalized childhood pneumonia treated at secondary level was US$ 83.89 (INR 3524) and US$ 146.59 (INR 6158) at tertiary level. At both levels the greatest single cost was the hospital stay itself, comprising 74% and 56% of the total cost, respectively. Diagnostic investigations were a large expense and supportive treatment with nebulization and oxygen therapy added to the costs. Mean household expenditure on secondary level was US$ 41.35 (INR 1737) and at tertiary level was US$ 134.62 (INR 5655), the largest single expense being medicines in the former and the hospitalization in the latter. (one US$=INR 42.1 at time of study)conclusions A considerable cost difference exists between secondary and tertiary level treatment. Admission at lowest possible treatment level for appropriate patients could decrease the costs borne by the provider and the patient.

In this external cohort, the DPT is clinically relevant in predicting time from withdrawal of life support to death. In our patients, the DPT is more useful in predicting death within 60 min of withdrawal of life support than within 30 min. Furthermore, our analysis suggests optimal cut-off scores. Additional calibration and modifications of this important tool could help guide the intensive care team and families considering DCD.

Introduction: The tentorial aperture is a complex space that varies considerably in size and shape. Although this space is defined by the free edges of the tentorium cerebelli, it has remained anatomically elusive. Modern neuroimaging methods routinely provide images of the tentorial notch but the literature so far available is remarkably devoid of extensive observations on the different types of tentorial notches. Dimensions of tentorial notch may determine the clinical sequelae and prognosis of many neurological conditions. Aim: To analyse the anatomical variations of tentorial notch, elucidating its clinical relevance in neurosurgery. Materials and Methods: A descriptive cross-sectional study was performed from August 2010-January2012. The midbrain was sectioned in an axial plane following the contour of the tentorial edge during medico-legal autopsies in 40 adult human cadavers, age ranging from 20 to 65 years. The parameters measured were: 1) Anterior Notch Width (ANW), the width of tentorial notch through the posterior aspect of the dorsum sellae; 2) Maximum Notch Width (MNW), the maximum width of the tentorial notch in axial plane; 3) Notch Length (NL), the distance between posterosuperior edge of the dorsum sellae in the mid-plane and the apex of notch; 4) Interpedunculoclival (IC) distance, the distance from the interpeduncular fossa to the posterosuperior edge of the dorsum sellae; 5) Apicotectal (AT) distance, the distance between the tectum of midbrain in the mid-plane and the apex of tentorial notch. The data obtained was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The quartile groups defined by MNW (mean 29.77±2.26 mm) were labeled as narrow, midrange and wide. Quartile groups defined by NL (mean 57.98±4.52 mm) were labeled as short, midrange and long. By combining these six groups into matrix formation, tentorial notches were classified into eight types. Applying quartile distribution technique to IC (mean 21.21±3.72 mm), brainstem positions within the tentorial notch were labeled as prefixed, midposition and postfixed. Conclusion: Variations in the dimensions of tentorial aperture may be implicated in the different clinical presentations related to transtentorial herniation, concussion and acceleration-deceleration injuries. The results of the present study provide a baseline data about tentorial notch which may facilitate neurosurgical decision making.

Background: Post placental IUCD insertion refers to the insertion of IUD within 10 minutes of expulsion of placenta. Intra-cesarean section is insertion of IUD after removal of placenta before closure of uterine incision. The objective of this study was to study the efficacy, safety and effect on menstrual cycle, expulsion, continuation and failure rate of post-placental copper-T 380A after vaginal and cesarean birth over the period of 1 year in tertiary centre. Methods: A total 150 women who opted for insertion of copper-T 380A within 10 minutes of expulsion of placenta whether delivered vaginally or by cesarean section, were enrolled in study. Women having past history of ectopic pregnancy or any genital tract infection or hemorrhagic disorders, uterine anomaly, chorioamnionitis, LPV>18 hours, unresolved PPH, Hb<8 g% were excluded from the study. Results: No incidence of perforation, PID or failure of contraception was detected. Percentage of satisfaction among users after 6 weeks 91%, 3 months 92.9% and 6 months 95.6%. Conclusions: Although there was high incidence of missing IUCD threads (due to coiling of thread), actual expulsion rate was far lesser. Removal rate due to menorrhagia, pain abdomen and vaginal discharge was low and 6 months continuation rate was considerably good.

No abstract

No abstract