The Lancet, Early Online Publication, 22 July 2010
doi:10.1016/S0140-6736(10)60664-2 Methods: 800 preterm infants with a gestational age at birth of between 24 weeks and 28 weeks plus 6 days (inclusive), weighing at least 500 g, requiring surfactant or continuous positive airway pressure for respiratory distress syndrome within 24 h of birth were randomly assigned in a one-to-one ratio to inhaled nitric oxide (5 parts per million) or placebo gas (nitrogen gas) for a minimum of 7 days and a maximum of 21 days in a double-blind study
Interpretation:Early use of low-dose inhaled nitric oxide in very premature babies did not improve survival without bronchopulmonary dysplasia or brain injury, suggesting that such a preventive treatment strategy is unsuccessful.
Reese J et al. – Exposure of premature infants to unintended vasodilatory stimuli may be one of the risk factors for PDA that is underrecognized. In this article, authors summarize the clinical factors that are associated with PDA and review commonly used neonatal drugs for their vasodilatory properties. Data demonstrating relaxation of the ductus arteriosus by gentamicin and other aminoglycoside antibiotics, by cimetidine and other H2 receptor antagonists, and by heparin are provided as examples of neonatal therapies that have unanticipated effects that may promote PDA.
I need to check the original articles to check the how significant this is!
Whew! We all settled down and drove calmly to our next fortuity-the mini boat tour. These are small air filled 13’ boats and only 4 people can ride at any time. I had seen the pictures on the web; it was very exciting and a new kind of sport. I saw people riding them in calm back waters of the ocean. Fun filled activity I thought and booked the tour in advance paid the charges in full. I wanted this to be a pleasant surprise for my family.
It was blistering hot and the ride in the ocean should cool us down, I thought. There were five groups of fun seeking fanatics. The main leader gave us inspiring speech praising us for selecting this one and only kind of ADVENTURE. Yes, he stressed- it is an adventure as we would go in the real ocean to two different islands for snorkeling. You got it right, real turbulent ocean and not the calm back waters, as I originally envisioned. Besides, this surly surprise, I noticed that there were only two leaders and we were 5 groups. As I was trying to comprehend the impending calamity, the leader’s announcement enhanced my bemusement. He declared that I am the captain of my boat and will be driving my family in to the ocean. I thought I would be a rider and not a driver myself! Money was non refundable besides my prestige was at stake, if I backed out. It was a blissful blithe for my kids and astounding astonishment for me. One man’s pleasure is other man’s pressure.
The other groups were elated and my fears were unabated! The leader zoomed past us in to the open seas and I followed. Oh Shoots! I don’t know swimming-the harsh truth dawned upon me in the middle of the sojourn. I am a driver but, will I be a survivor? As we proceeded, it was titillation for others and trepidation for me. As time went by, I got used to the waves, the distress regressed, and I wore a smile after a while. We snorkeled and it was phenomenal. We ventured out to the second island. Just then a storm system was approaching us very fast. The leader declared that if we stopped at the second island, we could be struck for the whole night and hence, we should rush back to the main land.
The ocean became choppy because of the storm. If I went slowly, I could be caught in the middle of the ferocious winds and may make it to the obituary column. I had no choice, my family lives were in my hands. I used the full throttle, the waves were humongous, and the boat was whammed from all directions by the rough sea. As the boat was thrashed, my back was bashed. Should I have worn a diaper, a thought just flashed! Boat was repeatedly tossed in to the air and would come down with a huge thud. The impact was so enormous it broke my daughter’s seat. We were falling from a height of at least 6-10feet constantly and consistently and my back took the brunt of the impact.
We reached the land finally. I could barely walk and the pain was intolerable. The medications I had gave little relief and a unanimous decision was made to send me to get a massage at the Chakra spa of the resort. The spa receptionist added perplexity to my predicament. Do you need a male or a female therapist? I never faced such a tough question in my life. It was a double edged sword. A dialogue specially scripted for me, I pondered. If I say, man, would they think that I am a homosexual and if I answered female, do they think I have a passion for perversion? Why should my life be a perplexing byzantine enigma? I wanted to pull my hair. That was a more difficult task to perform than answering her contentious and controversy generating question! I cleared my throat but, what should I say?
I wish Radha was by my side and she would have saved me from this quandary. I asked who is more experienced. I thought, I had found a great solution to the problem. However, the receptionist was very diplomatic and did not divulge the truth to make things more intricate and prolong my torture. But, I had a reprieve, when she said, which time you want. I picked 10am for the massage. It was open and I took it. I was curious, who was the therapist. It was a woman. Well, like a loyal husband, I conveyed the same to Radha. She was not amused that another woman was going to touch my body.
She started her prayers on the beach.
I went the next day to the Chakra spa. I was seated in a small but beautifully decorated room. “Good morning sir, please meet your massage therapist”, a pleasant voice greeted me and shut the door locked. I shyly turned my head and looked at her. What! Is this chakra or Vishnu Chakra! (a deadly weapon in Indian mythology). Am I punished? Did Radha talk to the receptionist and arrange this? I was like a rat beside a great cat. Her hair style was like a Sumo wrestler. I may be puny but not loony! I was expecting suma maina (delicate, soft) maalish not SUMO mardhana (violent bashing). I stood like a lamb (bakra) before the sacrifice (Chakra pe Bakra!) and there was not even a window to escape! It was a non-refundable commitment or was it atonement! It seemed that she was specially hired for me and was flown from Japan. Can I have a No-Touch Technique massage? I begged. Radha’s prayers were answered!
At last the trip was finalized, yet I was skeptical about the itinerary. Is this island, worthy of 5 days of our vacation? Do I need to book for excursions to other islands? Will I be able to provide memorable vacation for my family? My mind was rattled with emotional commotion. All my apprehensions seemed to have dissipated by the heat of this beautiful tropical island.
The resort was beautiful and apotheosis (ideal example) of perfect requiescence (A state of quiescence; rest; repose). The lobby was large and the commanding view of the vast Atlantic Ocean was magnetically enticing. Soft and soothing breeze was seducing us to the beach on the resort. “Do you want us to use the credit card on record?”the affable voice of the receptionist brought me back to the mollifying lounge. We checked in to the room, which was oceanfront. It set the pace for rest of our vacation.“It is beautiful daddy!”, said my eldest one, leaning on my shoulder. As I was priding myself, I felt someone was pinching me repeatedly! I thought it was Radha. She was engrossed in enjoying the enthralling views of Atlantic. Whereas, mindless mosquitoes were mercilessly marauding my blood. I was prepared. I immediately wore the medicated mosquito repellant band. They were amused and began to focus around the band instead of rest of the body.I was very soon thrashing myself and ended up with bumps and bruises.
Radha realized that the enchanting beauty should be shared with me. She turned around and was flabbergasted. How could I get so many hickies? She thought. She looked around ferociously for the perpetrator and I pointed her to the beguiling band. It is an arthropod allurer specially sold at CVS. The bewitching beauty of the resort and island made the mosquito menace a miniscule issue.
We explored the island with Lety. She showed us some historic places and beautiful beaches in her huge minivan. Roads were perhaps built for one person to walk, but Lety managed to navigate her truck size minivan with impeccable dexterity. Other faster alternative would have been-training under Tarzan, jumping from tree to tree. We immensely enjoyed the serene atmosphere on the island and decided to explore the main island in 36 hours. We flew in a small 6 seater plane. We were seated by weight and no one dared to sneeze or cough after the flight took off, lest it might disturb the delicate balance in midair. No one took chances! Ride was comfortable. It flew low over the ocean giving us a panoramic view of the turquoise waters, but I found everyone was focused upon finding the life jackets beneath their seats. Before they could retrieve, they had a reprieve as the plane glided on to the runway.
Renting a car was no brainer but for driving, we needed a trainer. All the signs were non-English. You do not know if the sign says east or west as they are spelled so similarly. If you are a fresher, use the right lane but, if you are a thinker-then left lane (lost in thoughts and oblivious to the minimum speed limits). But, if you want to pass, you may use the shoulder. Yes, it is complex in a simple way! We were told not to use the express lane at the toll as it is meant for ez-pass holders. So, we comfortably avoided that lane, but ended up in cash only lane. To make it simply complicated it was the lane for exact change. I threw a quarter and it wanted more, how much more? I had no clue. I found one more quarter and threw it in to the receptacle. It was not satisfied. I had no more change, I threw a dollar note, it gulped it down but did not register any transaction. Drivers behind me became restless and started honking. I was flustered and everyone in the car exhorted me to throw one more dollar note. I did, but to no avail. The honking increased to a ferocious level. I was nervous and I could not go back as cars were blocking me and no savior in sight. I was frantic and decided to something and started to remove my socks and shoes to throw them in to the money mongering monster. Fortunately, my kids found some dimes and nickels and that seemed to have satisfied the fastidious appetite for change. The gate opened, the honking dampened, seat belt fastened, anxiety lessened and speed heightened. I was saved of losing my garments. Wow! Study before your sojourn and verify (signs) before you venture in a foreign place. Phew! to be continued.....
Predictive Value of Bile Duct Dimensions Measured by Ultrasound in Neonates Presenting With Cholestasis
Fitzpatrick, E; Jardine, R; Farrant, P; Karani, J; Davenport, M; Mieli-Vergani, G; Baker, A
http://journals.lww.com/jpgn/Abstract/2010/07000/Predictive_Value_of_Bile_Duct_Dimensions_Measured.11.aspx Conclusions: Bile duct dilatation <3>4 mm is likely to be associated with choledochal malformation or need for intervention. The intermediate group is likely to be associated with inspissated bile syndrome following resolution of which innocent biliary dilatation may persist.
