Protocol of Hydroxyurea

protocol of hydroxyurea

brief about hydroxyurea

mainly used as cancer chemotherapy and in sickle cell anemia to increase the production of fetal hemoglobin
the dose of sickle cell anemia is 10-20 mg /kg/ day starting with 10 mg/kg/day and then to

increase it by 5 mg /kg/day every 2 weeks to maximum of 20 mg/kg /day

side effects

drowsiness headache hallucitaion seizures nausea vomittinmg stomatitis mucosititis myelosuppression (onset day 7 ,nadir day 10 recovery day 21 ) .
alopecia,maculopapular rash dry skin erythema of the face and hands hepatitis increase urea nitrogen and serum creatinine hyperuricemia

patient prediction for treatment of hydroxyurea

a-patietnt more than 7 yr of age

b-to start hyroxyurea on admission to hospital

c-the case to be discussed in the morning pediatric clinical meeting (board decision) and the indices of sickle cell diease severity specified

d-indcies of severity include 2 attcks or more of acute chest syndrome and /or one attack of and one attck or more of acute chest syndrome or 2 attacks of CVA or any disease entity requiring exhange transfusion and /or ICU admission and incapacitating VOC -councelling with parents and /or the patients if more than 10 yr about the drug and mention some of the possible side effects and value of consent -

e-OPD folllow up on monthly basis to assess weight height pubertal development CBC including TLC and ANC LFTs Hb electrophoresis and esp for hb F.-note increased fetal Hb and reduction of leucocytic count to low normal and increase of MCV of over 100 fl / dl indicate compliance and effeciveness of hysdroxyurea

Welcome

Dear colleagues

Welcome to this small place in cyber world hoping that it will be useful

M Ezzat

Evidence Based DO WRITTEN ASTHMA ACTION PLANS REDUCE HOSPITAL ADMISSIONS?

Clinical bottom line

National guidelines continues to recommend the provision of written asthma management plans in adults and children with asthma (Grade D)

Whilst there is good evidence for this practice in adults (grade A) ,evidence is lacking in children and worryingly hospitalizations maybe increased in those receiving written management plans

Source : Arch Dis Child September 2009 Vol 94 No 9 page 742

Evidence Based IS INTRAVENOUS IMMUNOGLOBULIN SUPERIOR TO EXCHANGE TRANSFUSION IN THE MANAGEMENT OF SYPERBILIRUBINAEMIA IN TERM NEONATES

Clinical bottom line

INTRAVENOUS IMMUNOGLOBULIN (IVIG) is a relatively safe and effective means of reducing the need for exchange transfusion in haemolytic disease of the newborn (Grade A)

The American Academy of Pediatrics 2004 guidelines recommend administration of IVIG in isoimmune haemolytic disease if the total serum bilirubin TSB is rising despite intensive phototherapy or the TSB level is within 2-3 mg/dl of the exchange level.

Source : Arch Dis Child September 2009 Vol 94 No 9 page 739

Evidence Based URETHRAL CATHETER OR SUPRAPUPIC ASPIRATION TO REDUCE CONTAMINATION OF URINE SAMPLES IN YOUNG CHILDERN

Clinical bottom line

Combined evidence indicates that urethral catheter samples are more likely to be contaminated than samples obtained by suprapubic aspiration (Grade C) but not all evidence is of high quality .
Catheter sample contamination can be reduced by culturing the second half of the sample only ( Grade B).
Catheter samples may still be more appropriate than suprapubic aspiration (number needed to harm (NNH 9) where it is felt there is higher chance of success influenced by clinical factors such

as age, the size of the baby, other co- morbidities and potentially parental preference.
Source : Arch Dis Child September 2009 Vol 94 No 9 page 736

videos for incentive spirometer

please click on next links to view videos about incentive spirometer
http://www.youtube.com/watch?v=cWBj5o5NblY

http://www.youtube.com/watch?v=k7Q0yqqWpiE

Incentive Spirometer

An incentive spirometer is used to examine the health of your lungs by measuring inspiratory volume. This means that an incentive spirometer measures how well you are filling your lungs with each breath. Though typically used for people recovering from surgery or with conditions such as chronic obstructive pulmonary disease (COPD) and asthma, an incentive spirometer is used by people who need to exercise their lungs.
The incentive spirometer measures two important numbers:
• FEV1 (air flow) • FEV6 forced vital capacity (air volume)
These numbers are simple expressions of complex processes, somewhat similar as to how blood pressure and blood cholesterol levels measure complex processes. The numbers obtained for FEV1 and FEV6 by an incentive spirometer are important for both patient and physician to help diagnose asthma, COPD and to monitor the course of respiratory diseases and their response to treatment.
Why Should You Use an Incentive Spirometer?
Deep breathing helps alveoli, the small air sacs deep in your lungs, fully expand. Though you’re probably not aware of doing it, you normally take many deep breaths every hour. As well, you probably yawn or sigh numerous times without knowing it. However, your normal breathing pattern may change. When you lie in bed for a long time (while recovering from injuries or surgeries, for instance) you tend to take shallow breaths and not cough as often as needed. You might start taking shallow breaths in an attempt to decrease pain associated with chest surgery or abdominal surgery. Using an incentive spirometer will help you return to normal breathing rhythms. By inhaling deeply, you also help mobilize secretions and open areas of the lungs that my have collapsed.Using an incentive spirometer will mimic natural sighing and yawning and encourage you to take slow, deep breaths. After major surgeries, it’s important to take your spirometer home with you and continue your breathing exercises at home. Not only will this help restore your regular breathing rhythm, but it will also help you avoid atlectasis (a collapsed or airless condition of the lung) and pneumonia.
How to Use an Incentive Spirometer
As the pictures on this page attest, an incentive spirometer is a small, hand held device that has a breathing tube and an air chamber. It’s very easy to use:
1. Sit up as straight as possible. If you’re in bed, sit up as far as you can or try to sit on the edge of your bed if possible. 2. Hold the incentive spirometer upright. 3. Breathe out normally. 4. Put the mouthpiece in your mouth and tightly seal your lips around it. 5. Breathe in slowly and deeply. This will raise the yellow piston to the top of the column. The yellow indicator should be in the little blue box. 6. Hold your breath as long as possible (at least five seconds), allowing the piston to fall to the bottom of the column. 7. Position the yellow indicator on the outside of the column to mark your best effort. This should be your goal to reach with
each repetition. 8. Rest for a few seconds and repeat steps 1-7 at least 10 times an hour. 9. After each set of 10 breaths, try to cough in order to clear your lungs. If you have an incision, support your incision by placing a pillow against it. 10. Once you are able to get out of bed, walk in the hallway and cough heartily. You may stop using the spirometer unless instructed otherwise