Six cases of children of divorced parents are discussed. Their presentations are described and other relevant findings are mentioned. It is interesting to note that in the majority of the cases, the caretakers had difficulties in looking after the children and hence brought them to seek treatment.
Study site: Psychiatric clinic, Universiti Kebangsaan Malaysia
Significant changes have occurred in relation to how chronic asthma is being treated. Emphasis has now shifted from viewing asthma as a condition of smooth muscle dysfunction to one of chronic inflammation. As such, anti-inflammatory therapy forming the cornerstone of treatment represents the first important milestone in the evolution of asthma treatment. For this purpose, inhaled corticosteroid (ICS) is by far the most effective anti-inflammatory therapy. Another important milestone is the recognition of the superiority of adding long-acting beta2-agonist (LABA) to ICS over escalating ICS dose alone or other forms of add-on therapies in treating asthmatic patients not responding to regular ICS alone. The effectiveness of adding LABA to ICS in treating asthma logically led to combining the two drugs into one single inhaler (salmeterol/fluticasone and budesonide/formoterol) that has the attractiveness of being user-friendly and ensuring that ICS is not missed out. The unique property of formoterol that allows for repetitive flexible dosing paved way to the concept of using Symbicort for both regular maintenance dosing and as required rescue medication. This revolutionary approach has been recently shown to provide improved asthma outcome, achieved at an overall lower or at least comparable corticosteroid intake, and may represent another evolutionary step in the treatment strategy of chronic asthma. Keywords: Asthma treatment, airway inflammation, corticosteroid, long-acting beta2-agonist
The range of teaspoon volume was from 2.42 to 7.71 mls with the majority below 5mls. The assumption that the volume of a teaspoon is exactly 5 mls is not true. From this wide range, 2.42 to 7.71 mls, there can be underdosaging by 51.6% or overdosaging by 64.2%. Thus if Paracetamol (250mg/5ml) was prescribed, the actual dose may vary from 121.0 mg to 385.5 mg. This is especially of significance for drugs with a narrow therapeutic index (eg. Digoxin, Theophylline). The use of teaspoons in drug dosaging of liquid medication is therefore not accurate. The use of the plastic cup in Banting District Hospital is also not accurate especially for 5 mls. As the volume dispensed increases, the accuracy also improves. To overcome this problem, it may be wise to use the 'pharmacy spoon' or a syinge. The 'pharmacy spoon' is a good substitute for a teaspoon in the paediatrics age group. The syringe is probably better as it ensures not only accuracy but also that all of the medication administered goes in as it is less likely to spill out when the child struggles. And for children who can take tablets, it is better to give medication in tablet form. Though we have not done a study on tablespoons, we feel a similar problem also exists with the use of tablespoons. Limitations of this study are 2 types. First is in pouring of the syrup Paracetamol into the teaspoons. Second, the level of the liquid was inconsistent, ie sometimes over the brim, at other times just at the brim.
Hypertensive disorders of pregnancy is a major cause of fetal and maternal morbidity. Epidemiologic observations have shown an inverse association between calcium intake and incidence of eclampsia. Calcium supplementation has been reported to decrease blood pressure in pregnant women, although this remains controversial. The mechanism responsible for the effect of calcium on hypertinsion in pregnant women is unknown. This paper is a review of some of the recent calcium supplementation trials that have been carried out and their effectiveness in reducing systolic and diastolic blood pressure and decreasing the incidence of hypertensive disorders of pregnancy.