Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm neonates with mild to moderate respiratory distress.

No abstract

Status epilepticus (SE) is a life-threatening emergency that requires prompt treatment, including basic neuroresuscitation principles (the ABCs), antiepileptic drugs to stop the seizure and identification of etiology. It results from an inability to normally abort an isolated seizure either due to ineffective inhibition, or due to abnormally persistent excessive excitation. Symptomatic SE is more common in younger children and the likely etiology depends on the age of the child. Treating the precipitating cause may prevent ongoing neurologic injury and facilitates seizure control. Benzodiapenes, phenytoin and phenobarbital form the mainstay of treatment. A systematic treatment regimen, planned in advance, is needed, including one for refractory status epilepticus (RSE

No abstract

We describe a case of mucus plug in the right main bronchus with ipsilateral obstructive emphysema and contralateral opaque hemithorax in an 18-month-old girl who presented with respiratory distress. The role of multi-detector CT scan with multi-planar reconstructions and virtual bronchoscopy is highlighted.

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Surgery was performed under general anaesthesia under cortisol cover. The patient was positioned supine with legs abducted, catheterised, prepped, and draped. Stay sutures were placed on the labia majora to keep them abducted and on the glans clitoris to keep it in traction. The incision was marked, being circumcoronal and extending posteriorly on either side of the urethral plate region up to the introitus. About 1:200,000 adrenaline was infiltrated under the clitoral skin and urethral plate area. The clitoris was degloved till its root (Figure 1). Two vertical incisions were made over the degloved clitoral shaft ventrally, incising the Bucks fascia and tunica albuginea in this region. The corpora cavernosa were dissected and ligated at the clitoral base and excised preserving the neurovascular structures to the glans clitoris running dorsally on the clitoral shaft. The clitoris was shortened by folding the redundant clitoral tissue and anchoring the glans clitoris to soft tissues below the symphysis pubis. The redundant clitoral skin was split dorsally in the midline and transposed down both sides to form the clitoral hood and labia minora (Figure 2). The postoperative recovery was uneventful. The patient now has normal appearing genitalia and sensate clitoris. Figure 3 is a sketch showing the operative plan. DISCUSSIONEnlargement of the clitoris can be found in CAH and other virilising states. Clitoral enlargement is frequent in CAH and the decision to undergo reduction is an individualised one.1 While minor degrees of clitoral enlargement can be left alone, marked enlargement can cause confusion as to gender, embarrassment and a

We evaluated the effectiveness of teaching at a neonatal resuscitation programme (NRP) workshop held for 35 medical personnel (including postgraduate trainee doctors, general duty medical officers, nursing officers and probationer nurses) using a onegroup pretest-posttest design. None of the participants had any formal exposure to the NRP guidelines. A pre-workshop test of 20 multiple-choice questions was administered to all the participants. At the end of the workshop, the same 20 questions were administered and the two scores compared using t-test for paired data on SPSS statistical software. The mean pre-workshop score was 9.03 (SD 2.66) which improved to a mean of 15.53 (SD 1.93) post-workshop. This improvement was highly significant with p < 0.0001 (two-tailed) and the 95% confidence interval being -7.41 to -5.59. Subgroup analysis revealed that nursing officers and probationer nurses showed highly significant improvement in the post-workshop scores while trainee doctors doing Medicine, Pediatrics and the general duty medical officers showed statistically significant improvement in the post-workshop scores. This study shows that a medical workshop is an effective means of imparting knowledge to a mixed group of medical personnel. ResultsOut of a total of 35 participants, 34 completed both the pre-workshop and post-workshop test and thus qualified for entry into the study. One trainee in Obstetrics could not complete the post-test due to an emergency call from the ward. The participants' groups according to their qualification were as follows: pediatric trainees -4 (11.4%); medicine trainees -4 (11.4%); anaesthesiology trainees' -3 (8.6%); obstetrics and gynecology trainees -3 (8.6%); general duty medical officers -5 (14.3%); nursing officers -7 (20.0%) and probationer nurses -9 (25.7%).Out of a maximum possible score of 20 for each test, the lowest pre-workshop score was 3 out of 20 (15.0%) and the highest was 16 (80.0%). The lowest post-workshop score was 11 out of 20 (55.0%) while the highest was 20 (100.0%). The mean pre-workshop score was 9.03 (SD 2.66) which had risen post workshop to a mean of 15.53 (SD 1.93). Based on the t-test for paired samples the two-tailed p value of this difference was < 0.0001, suggesting that the improvement in the post-workshop score was highly significant; 95% confidence interval for the same being -7.44 to -5.99.Subgroup analysis of scores was done and the results are depicted in Table 1. This analysis was not done for the trainees of Obstetrics as only two of them completed the study and the resulting scores had a skewed distribution. Sub-group analysis revealed highly significant improvement (two-tailed