The overall survival to discharge ratios after CPR was 12%. The study also suggest that it seems necessary

to have a baseline data about success rate in CPR to compare efforts to improve results, and seek ways to improve the outcome of in-hospital CPR. Conflict of Interest: None declared
Dear Editor, Methylmalonic acidemia, one of the organic acidemias, is associated with a variety of clinical presentations ranging from very sick newborn infants to asymptomatic adults, regardless of the nature of the enzymatic defect or the biochemical abnormalities.1 A 6-year-old boy with a past history of methylmalonic acidemia presented to the emergency room with a one-week Inhibitors,research,lifescience,medical history of inflammatory nodular lesions on the anterior aspects of his legs. He had been on sodium bicarbonate, carnitine, vitamins B6 and B12, and biotin for a period of about 5 years. In physical examination, there was no fever, no lymphadenopathy or sign of arthritis. There were multiple erythematous tender nodules (3-6 cm) Inhibitors,research,lifescience,medical in diameter on both legs especially on the right one. In repeated examinations within the next 3 days the nodules became darker, harder and tenser and were

still extremely Inhibitors,research,lifescience,medical tender to touch (figure 1). Figure 1 Multiple erythematous tender nodules on the patient’s legs especially on the right one. A. At the time of admission,  B. three days later The results of blood tests (chemistries, complete blood count, antinuclear antibody, rheumatoid factor, complements, thyroid function tests, sedimentation rate, and Anti-streptolysin O (ASO) titer, and anti tissue transglutaminase antibody were normal except for mild anemia and mild enlargement Inhibitors,research,lifescience,medical of kidneys, which were secondary to menthyl malonic acidemia. The findings of physical exam in this patient are a typical presentation of erythema nodosum. Erythema nodosum is a cutaneous reaction consisting of inflammatory tender nodular lesions usually located on the anterior aspects of lower extremities. Erythema nodusom can be associated with a broad spectrum of conditions; most commonly infections, Inhibitors,research,lifescience,medical sarcoidosis, rheumatologic

disorders, inflammatory bowel disorders, autoimmune disorders, malignancies, and the use of some medications. Typically it is manifested by the sudden onset of symmetrical, tender erythematous, warm nodules and raised plaques to usually located on the shins, ankles and knee. Lesions are often distributed bilaterally. At first the nodules show a bright light color, but within a few days they become red or purplish, and finally they exhibit a yellow or greenish appearance taking on the look of a deep bruise.2 The treatment of erythema nodosum should be directed at the associated underlying find more condition if identified. Usually nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient for treatment.