Simple, accurate, sensitive and validated UV spectrophotometric and chemometric methods were developed for the determination of imidapril hydrochloride (IMD) in the presence of both its alkaline (AKN) and oxidative (OXI) degradation products and in its pharmaceutical formulation. Method A is the fourth derivative spectra (D4) which allows the determination of IMD in the presence of both AKN and OXD, in pure form and in tablets by measuring the peak amplitude at 243.0 nm. Methods B, C and D, manipulating ratio spectra, were also developed. Method B is the double divisor-ratio difference spectrophotometric one (DD-RD) by computing the difference between the amplitudes of IMD ratio spectra at 232 and 256.3 nm. Method C is the double divisor-first derivative of ratio spectra method (DD-DR1) at 243.2 nm, while method D is the mean centering of ratio spectra (MCR) at 288.0 nm. Methods A, B, C and D could successfully determine IMD in a concentration range of 4.0-32.0 mg/mL. Methods E and F are principal component regression (PCR) and partial least-squares (PLS), respectively, for the simultaneous determination of IMD in the presence of both AKN and OXI, in pure form and in its tablets. The developed methods have the advantage of simultaneous determination of the cited components without any pre-treatment. The accuracy, precision and linearity ranges of the developed methods were determined. The results obtained were statistically compared with those of a reported HPLC method, and there was no significant difference between the proposed methods and the reported method regarding both accuracy and precision.

BACKGROUND: Since demographic changes have contributed to the growth of emergency medicine, a highly populous nation such as India needs to give physicians associated due credit and recognition. The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians. METHODS: The data were collected by direct interaction with residents of the department. Additional information was gathered by observation. The data were verified for validity. RESULTS: This study was to bring out the benefits of proactive decisions that could further enhance the emergency department. But such decisions did not always result in positive responses and improved morale. When such decisions were retracted as it causes misalignment with the existing system. An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine. CONCLUSIONS: The problems faced by emergency department might be similar but the way in which one tackles the situation would be different. Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.

This paper reports the results of our factfinding survey of annual epidemics of respiratory syncytial virus infection, an important cause of inflammation of the lower respiratory tract in infants and young children, in Honjo City and the neighboring district of Yuri. Diagnosis of RS virus infection was performed with the RSV test pack.
Over the period of three years from January 1993 to December 1995, the number of patients with RS virus infection totaled 127 of whom 107 were hospitalized and 20 were treated as outpatients. The male-female ratio was 69: 58, 60: 47 and 9: 11, respectively. The total number of patients included 9 neonates, 15 one-month-old infants and 17 young children of one year or above.
The infectious disease rages from December through January every year. Of the total 127 people, 64 were infected with RS virus during the winter months.
The pediatric department of our hospital is visited by nearly 20, 000 outpatients annually each from Honjo City and the Yuri district. A check of the number of the outpatients diagnosed with RS virus infection showed that 70 people are from Honjo and 57 from Yuri. During the survey period, 4 boys and 2 girls required endotracheal intubation because of respiratory dysfunction. They consisted of 3 newborn infants and 3 1-month-olds. The occurrence of this infectious disease in the very early period of infancy and signs of pneumonia are considered to be risk factors for respiratory failure.

A 4-year-old boy was born with cyanosis and was given a diagnosis of tetralogy of Fallot and pulmonary atresia. Echocardiography showed membranous atresia of the pulmonary trunk that was connected to the left side of the ascending aorta via an aortopulmonary window 3 mm in diameter. Four major aortopulmonary collateral arteries (MAPCAs) were detected by cardiac catheterization and computed tomography angiography prior to undergoing surgery at 4 years of age. We performed one-stage complete unifocalization and definitive repair via a median sternotomy. The MAPCA supplying the left lower lobe was anastomosed to the true left pulmonary artery and the pulmonary artery trunk was augmented with an autologous pericardium patch. We then reconstructed the right ventricular outflow tract using a transannular patch and simultaneously patch-closed the VSD. The right/left ventricle pressure ratio after weaning from cardiopulmonary bypass was 0.8. The postoperative course was uneventful and the patient was discharged 26 days later. Seven months after the procedure, the right/left ventricle pressure ratio was decreased to 0.56 on cardiac catheterization.

A baby girl delivered at 41 weeks of gestation with persistent truncus arteriosus (PTA) and interrupted aortic arch (IAA) type A was referred to our institute for surgical intervention. Bilateral pulmonary artery banding (BPAB) proceeded through a median sternotomy at the age of 11 days to control excessive pulmonary blood flow. Thereafter, she gained weight under continuous prostaglandin E1 (PGE 1) infusion. Definitive repair proceeded at the age of 2 months. Cardiopulmonary bypass was established through a redo-median sternotomy, with two arterial cannulae (brachiocephalic artery and descending aorta). The aortic arch was reconstructed with direct anastomosis. The orifice of the pulmonary artery was removed from the arterial trunk and the defect in the aortic wall was directly closed. A ventricular septal defect was closed under cardioplegic arrest via a right ventriculotomy. The continuity from the right ventricle to the pulmonary artery was made using a hand-made, extended polytetrafluoroethylene (ePTFE) conduit with a bicusp. The sternum was left open at the end of the procedure and the chest was closed on post-operative day (POD) 3. She was weaned from mechanical ventilation on POD 4 and the postoperative course was uneventful. She was discharged on POD 49.

We report a rare case of double outlet right ventricle (DORV) with sub-pulmonary type ventricular septal defect (VSD). The great arteries were almost side-by-side, and the ascending aorta was located slightly posterior to the right of the pulmonary artery. We performed complete repair at the age of 25 days. Intra-cardiac rerouting (VSD closure) was carried out through the tricuspid valve. Arterial switch procedure was performed without the Lecompte maneuver. His postoperative course was uneventful and he was discharged 19 days after the operation without any complications.

Malignant psoas syndrome（MPS）is one of challenging cancer pain states, which is often refractory to conventional analgesic therapy. We report a case of a 67 years-old female patient suffering from left MPS caused by lumbar paravertebral malignant lymphoma. Tapentadol, a dual action analgesic, has relatively low affinity to mu-opioid receptor and provoke noradrenergic reuptake inhibition simultaneously. Neuropathic component is predominant in MPS. Tapentadol is reported to be a drug of choice for the treatment of neuropathic pain. Psoas compartment blockade is a choice of interventions to relieve severe thigh pain caused by a lesion of lumbar plexus which exists in a compartment between psoas and quadratus lumborum muscles. Pain and numbness in the affected left thigh region of the patient were well managed by opioid switching from oxycodone to tapentadol and supplemental psoas compartment blocks with a local anesthetic and dexamethasone. The activity of daily life and quality of life of the patient were dramatically improved. Tapentadol with psoas compartment blockade may be efficacious for the management of MPS.

We performed bilateral pulmonary artery banding (BPAB) through a median sternotomy on a four-day-old male infant with a double-outlet right ventricle (DORV) and interrupted aortic arch (IAA) who was delivered at 40 weeks of gestation. After urinary output improved, definitive repair was carried out 5 days later. Intra-ventricular rerouting was followed by arterial switch with the Lecompte maneuver. The aortic arch was reconstructed with direct anastomosis and the right ventricular outflow tract was augmented with a patch. The sternum was left open at the end of the procedure and the chest was closed on post-operative day (POD) 4. The patient was discharged from hospital on POD 78 after receiving treatment for pneumonia and chylothorax.

Aims: Acute diarrhea is still one of the major causes of death in children under five years old worldwide, including Indonesia. Data from the World Health Organization (WHO) Southeast Asia Region shows that acute diarrhea has caused approximately 10-11% of death in children under five years old and rotavirus (RV) is one of the major causes. This study is conducted to identify the profile and P genotypes of RV among children with acute diarrhea in Pekanbaru. Methodology and results: Descriptive cross sectional study was conducted in children within the range of age 0-60 months with acute diarrhea who admitted to the government clinics and General Hospital of Riau Province from January to July 2015. Immunochrommatography and RT-PCR were used to identify the P genotype of RV from the stool specimens. The profile of patients was investigated including age, sex, hydration and nutritional status, also the exclusive breastfeeding. There were 71 children who suffered from acute diarrhea and 62.0% of stools specimens were positive by RT-PCR for RV infection. The highest rate was in the age group of 6-35 month (70.5%). Most of the patients were female (54.5%), the history of exclusive breastfeeding (54.5%), with moderate dehydration (54.5%) and good nutritional status (97.7%). The RV genotyping results showed the highest proportion was found in the P4 genotype (31.8%), followed by the P8 and P6 genotype, respectively 18.2% and 13.6%, P9 (11.4%), P10 (9.1%), P11 (2.3%) and indeterminate genotype (13.6%). Conclusion, significance and impact of study: Rotavirus was found to be a considerable role as the etiology of diarrhea in children under five years in Pekanbaru and rotavirus P4 genotype was predominant. The result of this study is important for designing antigen-antibody diagnostics against RV.
Diarrhea ; Rotavirus

A woman in her 50s presented to the hospital with a chief complaint of headache and nausea. Graves' disease was diagnosed based on positive blood test results for thyrotoxicosis and TSH receptor antibody and ultrasonographic thyroid gland findings. The patient was hospitalized and started treatment with thiamazole; however, after hospitalization, psychiatric symptoms, such as visual and auditory hallucinations, appeared, and she fulfilled the diagnostic criteria for thyroid crisis. We increased the dose of thiamazole and added potassium iodide. Thyroid function improved; however, the patient experienced reemergence of psychiatric symptoms. Blood tests revealed pseudohyperchloremia, which led to the discovery of abuse of over-the-counter analgesics containing bromwarelyl urea. The psychiatric symptoms were suspected to be due to withdrawal from chronic bromine intoxication. After starting psychotropic drugs, the patient's psychiatric symptoms became mild, her thyroid function continued to improve steadily, and she was discharged from the hospital. Thyroid crisis is a condition that should be suspected and treated at an early stage; however, the diagnostic criteria for thyroid crisis can be false-positive if the thyroid disease is accompanied by other conditions that cause psychiatric symptoms.