Factors affecting the probability of long-term recovery with mild deficits or full function in young children include the duration of submersion, whether advanced life support was needed at the accident site, the duration of cardiopulmonary resuscitation, and whether spontaneous breathing and circulation are present on arrival at the emergency room. Prolonged submersion in water for more than 5–10 minutes usually leads to poorer prognosis.Data on the long-term outcome are scarce and unreliable. Neurological examination at the time of discharge from the hospital does not accurately predict long-term outcomes. Some people with severe brain injury who were transferred to other institutions died months or years after the drowning and are recorded as survivors. Nonfatal drownings have been estimated as two to four times more frequent than fatal drownings. Long-Term Effects of Drowning in Children
Long-term effects of nonfatal drowning mainly include damage to major organs such as the brain, lungs, and kidneys. Prolonged submersion time is highly attributed to hypoxic ischemic brain injury in susceptible areas of the brain such as the hippocampus, insular cortex, and/or basal ganglia. Severity in hypoxic ischemic damage of these brain structures corresponds to the severity in global damage to areas of the cerebral cortex. The cerebral cortex is a brain structure that is responsible for language, memory, learning, emotion, intelligence, and personality. Global damage to the cerebral cortex can affect one or more of its primary function, Treatment of pulmonary complication from drowning is highly dependent on the amount of lung injury that occurred during the incident.
In 2001 the FDA announced a new regulatory scheme called SMART (the System to Manage Accutane Related Teratogenicity) that required Roche to provide defined training materials to doctors, and for doctors to sign and return a letter to Roche acknowledging that they had reviewed the training materials, for Roche to then send stickers to doctors, which doctors would have to place on prescriptions they give people after they have confirmed a negative pregnancy test; prescriptions could only be written for 30 days and could not be renewed, thus requiring a new pregnancy test for each prescription.In February 2002, Roches patents for isotretinoin expired, and there are now many other companies selling cheaper generic versions of the drug. On June 29, 2009, Roche Pharmaceuticals, the original creator and distributor of isotretinoin, officially discontinued both the manufacture and distribution of their Accutane brand in the United States due to what the company described as business reasons related to low market share (below 5%), coupled with the high cost of defending personal injury lawsuits brought by some people who took the drug. Generic isotretinoin will remain available in the United States through various manufacturers. Roche USA continues to defend Accutane and claims to have treated over 13 million people since its introduction in 1982. F. Hoffmann-La Roche Ltd. apparently will continue to manufacture and distribute Roaccutane outside of the United States.Among others, actor James Marshall sued Roche over allegedly Accutane-related disease that resulted in removal of his colon.