Rejected

New-onset headache after stroke is common among adult stroke survivors. However, pediatric data are limited. The primary aim of this study was to investigate the prevalence of new-headache after pediatric ischemic stroke. Secondary outcomes were to describe the characteristics of patients experiencing poststroke headache and the association between poststroke headache and stroke recurrence.

To evaluate the distribution of complications of chronic otitis media, dilemma of how soon to operate a seriously ill patient with CSOM and treatment outcomes. A retrospective study was done in a tertiary care centre. Clinical data from 2013 to 2015 was compiled, surgical management with outcome was analysed. A total of 425 patients with chronic otitis media were evaluated. Single/multiple complications were seen in 147 (34.5%) patients. Majority of the complications were seen in active squamosal type of chronic otitis media i.e. 137 (59.5%) cases out of the 147. Meningitis (3.3%) was the most common intracranial complication. Patients with intracranial complications were referred from other departments and did not primarily present to ENT, indicating a major fact that treatment was sort for the complication and not for chronic otitis media. Headache with or without ear discharge was the most common presenting complaint. Fever and pain were not prominent indicators of complications, posing a diagnostic dilemma as patients were already receiving antibiotics and analgesics before reaching tertiary care centre. The patients with severe intracranial complications were promptly taken up (within 3-5 days) for canal wall down mastoidectomy with intravenous broad spectrum antibiotic (vancomycin) and mannitol with high risk consent. However ill the patients were, especially children with very poor general conditions, there was dramatic recovery as soon as the mastoidectomy was done. There were no deaths due to the complications of chronic otitis media in our 3 years study period. Delay in resorting to surgical management of chronic otitis media was the main reason for patients going into complications. Timely mastoidectomy in patients with poor general condition with high risk of mortality, the surgery actually had a major role in reducing the morbidity and mortality. Lack of awareness that chronic otitis media is a condition that can lead to life threatening complications resulted in procrastination of surgery. Chronic otitis media requires speedy surgical management i.e. as soon as patient is fit to tolerate anaesthesia: Tympanoplasty and Canal wall up or down Mastoidectomy to prevent complications from arising or to resolve the present complication.

To determine the health morbidity profile of pregnant women attending antenatal clinic in Nanyuki Teaching and Referral hospital, Kenya.

Diffuse alveolar hemorrhage is an uncommon and often fatal condition in children that is characterized by distinct histopathological etiologies. Herein, we discuss the case of an 11-year-old girl who presented with acute worsening of hypoxia and left-sided chest pain. The patient had lung biopsy-proven idiopathic pulmonary capillaritis and was being treated with prednisolone every alternate day, azathioprine, and hydroxychloroquine. A contrast-computed tomography (CT) scan of the chest showed an acute left lower-lobe pulmonary embolism. Negative results were obtained on a test for thrombophilia. In children, pulmonary embolism with anti-neutrophil cytoplasmic antibody-negative idiopathic pulmonary capillaritis is a rare clinical condition. The exact cause of thrombus formation in this case is unknown; however, obesity, immobility, and chronic systemic corticosteroid therapy probably played a role.

Guidelines for economic analyses of health care technologies require local input data for reimbursement decisions in the countries of Central and Eastern Europe (CEE). The aim of this study was to systematically review and analyse the available empirical studies using the EQ-5D instrument as a measure of the health-related quality of life (HRQoL) in patients with neurological diseases.

Opioid-free anesthesia (OFA) was introduced to avoid tolerance and hyperalgesia, allowing reduction in postoperative opioids. OFA focused initially on postoperative respiratory safety for patients undergoing ambulatory surgery and for obstructive sleep apnea syndrome patients otherwise requiring intensive care admission. What about using OFA in plastic and oncological breast surgery, in deep inferior epigastric perforators flap surgery, and in gynecological laparoscopy?

Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.

The American Academy of Neurology Headache Quality Measures seek to improve care delivery and outcomes by addressing gaps in care. Our practice identified underperformance in 3 of the 7 measures that apply to children and adolescents. We expected that improved performance on these measures would lead to a reduction in emergency department (ED) visits and improvement in the average disability grade of established patients.

This study was conducted to determine nursing students' rational use of medicines.