HLH should be considered in the differential diagnosis of children with prolonged fever, hepatosplenomegaly and cytopenia. Prompt recognition and appropriate therapy may result in good outcome, particularly in Infection associated HLH.
A dynamic pricing based resource allocation problem for cloud computing is cast as a Markov decision process with average reward and hard per time combinatorial constraints. Following Whittle, its relaxation as a constrained average reward Markov decision process is analyzed and its Whittle indexability is established. An iterative scheme to compute the Whittle indices is also proposed.
Aims:The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock.Subjects and Methods:Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG).Results:Nineteen children were included, and 235 pairs of BG-CGMS readings were obtained. BG and CGMS had a correlation coefficient of 0.61 (P < 0.001) and a median relative absolute difference of 17.29%. On Clarke's error grid analysis, 222 (94.5%) readings were in the clinically acceptable zones (A and B). When BG was < 70, 70–180, and > 180 mg/dL, 44%, 100%, and 76.9% readings were in zones A and B, respectively (P < 0.001). The accuracy of CGMS was not affected by the presence of edema, acidosis, vasopressors, steroids, or renal replacement therapy. On receiver operating characteristics curve analysis, a CGMS reading <97 mg/dL predicted hypoglycemia (sensitivity 85.2%, specificity 75%, area under the curve [AUC] =0.85). A reading > 141 mg/dL predicted hyperglycemia (sensitivity 84.6%, specificity 89.6%, AUC = 0.87).Conclusion:CGMS provides a fairly, accurate estimate of BG in children with septic shock. It is unaffected by a variety of clinical variables. The accuracy over extremes of blood sugar may be a concern. We recommend larger studies to evaluate its use for the early detection of hypoglycemia and hyperglycemia.
Pharmacovigilance programs usually aim to gather information on the effect of prescribed drugs in the real world rather than in groups of short-lived and carefully selected clinical trial populations. Adverse drug reactions (ADR) associated with psychiatric medications may vary among different populations. As compared with other fields, in Kerala the research related to ADRs and Prescription patterns in psychiatry is scarce. A hospital based cross sectional observational study was undertaken in the Mental Health Centre, Trivandrum. All psychiatric drugs were closely monitor for adverse drug reaction irrespective of their psychiatric diagnosis. CDSCO Suspected adverse drug reaction reporting form was used for the documentation of adverse drug reaction and the causality assessment was done with naranjo scale .The severity of ADR was assessed using Hartwing scale and Preventability assessment using Modified schumock. In this study it was found the highest incident of ADR was reported with risperidone (24%) followed by valproate (20.1%), clozapine (17%) etc. The patient in psychiatry cant identify the adverse effect due to the cognitive impairment. So special attention is necessary for psychiatric patient to find out the incidence of adverse drug reaction and provide the proper management to them.
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