2016-08-31T23-52-20Z
Source: International Journal of Livestock Research
Faez Firdaus Abdullah Jesse, Eric Lim Teik Chung, Yusuf Abba, Muhammad Abubakar Sadiq, Lawan Adamu, Idris Umar Hambali, Asinamai Athliamai Bitrus, Nur Syamila Zabri, Mohd Azmi Mohd Lila, Abd Wahid Haron, Abdul Aziz Saharee.
Milk fever is a condition where the animals body fails to maintain the calcium homeostasis following an upsurge demand of calcium during gestation or lactation. This case reports the clinical management of suspected stage II milk fever with retained placenta in a Friesian cow after parturition of twin calves. A four-year-old Friesian cow weighing 400kg was presented with primary complaint of weakness and inability to stand a day after parturition of two calves. Physical examination revealed that the cow was on sternal recumbency and unable to stand, while the placenta was seen hanging from the vulva region. All vital parameters were normal but the cow was having a weak cardiac rythm. The differential diagnoses at this point of time were milk fever, downers cow syndrome and hypophosphatemia. The cow was diagnosed with suspected milk fever based on the history of parturition of two calves and thus leading to hypocalcaemia. The cow was treated with flunixin meglumine 1.1mg/kg once intravenously as anti-inflammatory, anti-pyrexic and analgesic. Then, 500mL of calcium borogluconate (23%) was administered intravenously slowly at the rate of 1drop/second as a source of calcium. The cow responded well to treatment after 10 minutes of administration. In addition, 0.9% normal saline was lavaged into the uterus to irrigate the retained placenta. Subsequently, 20mL of oxytetracycline (20mg/kg) was infused into the uterine body as the final lavage. Finally, broad spectrum long acting oxytetracycline (20mg/kg) antibiotic was given once intramuscularly to prevent secondary bacterial infections. Therapeutic treatment to restore the calcium level in the blood should be the main focus during the management of milk fever.
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Τετάρτη 31 Αυγούστου 2016
THERAPEUTIC MANAGEMENT OF STAGE II MILK FEVER WITH RETAINED PLACENTA IN A COW
A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation
Abstract
The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT's), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.
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Proper Sterol Distribution Is Required for Candida albicans Hyphal Formation and Virulence
Candida albicans is an opportunistic fungus responsible for the majority of systemic fungal infections. Multiple factors contribute to C. albicans pathogenicity. C. albicans strains lacking CaArv1 are avirulent. Arv1 has a conserved Arv1 homology domain (AHD) that has a zinc-binding domain containing two cysteine clusters. Here, we explored the role of the CaAHD and zinc-binding motif in CaArv1-dependent virulence. Overall, we found that the CaAHD was necessary but not sufficient for cells to be virulent, whereas the zinc-binding domain was essential, as Caarv1/Caarv1 cells expressing the full-length zinc-binding domain mutants, Caarv1C3S and Caarv1C28S, were avirulent. Phenotypically, we found a direct correlation between the avirulence of Caarv1/Caarv1, Caar1AHD, Caarv1C3S, and Caarv1C28S cells and defects in bud site selection, septa formation and localization, and hyphal formation and elongation. Importantly, all avirulent mutant strains lacked the ability to maintain proper sterol distribution. Overall, our results have established the importance of the AHD and zinc-binding domain in fungal invasion, and have correlated an avirulent phenotype with the inability to maintain proper sterol distribution.
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Marker-Based Estimates Reveal Significant Non-additive Effects in Clonally Propagated Cassava (Manihot esculenta): Implications for the Prediction of Total Genetic Value and the Selection of Varieties
In clonally propagated crops, non-additive genetic effects can be effectively exploited by the identification of superior genetic individuals as varieties. Cassava (Manihot esculenta Crantz) is a clonally propagated staple food crop that feeds hundreds of millions. We quantified the amount and nature of non-additive genetic variation for three key traits in a breeding population of cassava from sub-Saharan Africa using additive and non-additive genome-wide marker-based relationship matrices. We then assessed the accuracy of genomic prediction for total (additive plus non-additive) genetic value. We confirmed previous findings based on diallel populations, that non-additive genetic variation is significant for key cassava traits. Specifically, we found that dominance is particularly important for root yield and epistasis contributes strongly to variation in CMD resistance. Further, we showed that total genetic value predicted observed phenotypes more accurately than additive only models for root yield but not for dry matter content, which is mostly additive or for CMD resistance, which has high narrow-sense heritability. We address the implication of these results for cassava breeding and put our work in the context of previous results in cassava, and other plant and animal species.
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Dexmedetomidine versus fentanyl as adjuvant to epidural 0.5% levobupivacaine for transurethral prostate resection in elderly patients: a comparative evaluation
Ain-Shams Journal of Anaesthesiology 2016 9(3):398-402
Background Regional anesthesia is the technique of choice for patients undergoing transurethral resection of the prostate (TURP), but anesthetic management of elderly patients is challenging due to compromised organ function. The present study aimed to evaluate the relative efficacy and safety of dexmedetomidine versus fentanyl in the enhancement of the quality and duration of epidural anesthesia with 0.5% levobupivacaine and hemodynamic stability during TURP in elderly patients. Patients and methods Sixty elderly consented patients were randomized into two equal groups of 30 patients each in a double-blind manner. They were given 15 ml of 0.5% levobupivacaine (75 mg) either with 1 ml (50 μg) dexmedetomidine (group LD) or with 1 ml (50 μg) fentanyl (group LF) using an epidural catheter. The primary endpoints were the onset and duration of sensory and motor blockade, duration of sensory analgesia, hemodynamic variability, respiratory adequacy, and any adverse effect. Results Demographic data were comparable in both groups. Onset of sensory and motor blockade was faster in patients of group LD than in patients of group LF, with a statistically significant difference (P < 0.05). Duration of motor blockade and sensory analgesia was longer in patients of group LD than in patients of group LF (P < 0.05). Intraoperative heart rate and mean arterial blood pressure were significantly lower in patients of group LD, but no intervention was required. Surgical bleeding was reduced in patients of group LD. Conclusion Dexmedetomidine as an adjuvant to epidural levobupivacaine for TURP has shortened onset time of anesthesia and prolonged duration of sensory analgesia. The surgical field vision was improved due to reduced bleeding.
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Management of perioperative bleeding associated with the use of selective serotonin reuptake inhibitors
Ain-Shams Journal of Anaesthesiology 2016 9(3):449-451
Increased bleeding tendency is associated with the use of selective serotonin reuptake inhibitors. In this study, we report a case of perioperative bleeding in patient on selective serotonin reuptake inhibitors. The management options for such cases are discussed.
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Methylene blue versus vasopressin in sepsis-induced vasoplegia
Ain-Shams Journal of Anaesthesiology 2016 9(3):319-324
Background Septic shock is one of the biggest causes of mortality in intensive care settings, and, despite all the recent advances in pharmacological and mechanical support therapies, is the second leading cause of death among ICU patients. Although vasopressors have been widely used in these situations, where keeping the hemodynamic stability is of utmost importance, a detailed study of their effects is undoubtedly needed. Objective Our study compared the effect of methylene blue (MB) in the vasoplegic situation associated with sepsis with that of vasopressin. Patients and methods We randomized 40 patients into two groups (20 patients each); patients in the first group received MB, whereas patients in the second group received vasopressin as a hemodynamic support. Results In the present study, mean arterial blood pressure was found to be significantly higher in the MB group compared with the vasopressin group, whereas within the MB group, it was significantly higher after 6 h compared with the baseline level. The systemic vascular resistance showed no difference between the two groups at the start but a marked difference only after 2 h, being higher for the MB group — that is, there was a significant decrease in the vasopressors and inotropes needed in the MB group. There was no significant difference between the two groups regarding the ICU length of stay, the central venous pressure, pulmonary artery pressure, and oxygen extraction ratio. Conclusion The use of MB in sepsis-induced refractory vasoplegic situations remains one of the salvage management strategies; however, the practice of its routine use is yet to be established and needs further investigation.
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Dexamethasone added to levobupivacaine prolongs ultrasound-guided interscalene brachial plexus blockade: a prospective, randomized, controlled study
Ain-Shams Journal of Anaesthesiology 2016 9(3):422-425
Objectives This study aimed to evaluate the effect of the addition of dexamethasone to levobupivacaine on the duration of analgesia in forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients and methods This prospective randomized controlled, double-blind clinical trial was conducted on 60 patients who underwent elective forearm surgeries under ultrasound-guided interscalene brachial plexus block. Patients in the levobupivacaine group (group L) received 25 ml of 0.5% levobupivacaine plus 2 ml of normal saline 0.9%. Patients in the levobupivacaine dexamethasone group (group LD) received 25 ml of 0.5% levobupivacaine plus 2 ml of dexamethasone (8 mg). The onset of sensory and motor block, duration of the sensory block, time to first analgesic request, the number of failed block, total morphine consumption, side effects, and complications were recorded and compared. Results Onset of sensory block and motor block was significantly earlier in group LD compared with group L. Duration of sensory block and time to first analgesic request were significantly longer in group LD compared with group L. Total morphine consumption was significantly lower in group LD in comparison with group L. The number of failed blocks was nonsignificantly lower in group LD. The incidence of side effects and complications was low and comparable in both groups. Conclusion Addition of dexamethasone to levobupivacaine significantly shortens the onset of sensory and motor block, prolongs the duration of analgesia, decreases the 24 h morphine consumption, and prolongs the time to first analgesic request with minimal side effects.
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Human albumin 4% versus hydroxyethyl starch 6% for fluid resuscitation in sepsis
Ain-Shams Journal of Anaesthesiology 2016 9(3):325-329
Background Early fluid resuscitation is vital to patients with sepsis. However, the choice of fluid has been a hot topic of discussion. The objective of this study was to compare hydroxyethyl starch (HES) 6% (130/0.4) with albumin 4% as a resuscitation fluid in septic patients. Patients and methods In this prospective randomized study, 80 patients aged 20–60 years of both sexes with sepsis were assigned to receive either HES (130/0.4) in 0.9% saline or human albumin 4% as a resuscitation fluid. Mortality rate after 28 days, need for renal replacement therapy, and duration of ICU stay were compared between the two groups. Results The mortality rate in the albumin group (22.5%) was lower than in the HES 6% group (40%) with significant P value (0.033). Also, the need for renal replacement therapy (RRT) and length of ICU stay were significantly higher in the HES 6% group compared with the albumin group. Conclusion Use of human albumin 4% has a significant effect in reducing mortality rates in the ICU in patients with severe sepsis compared with HES 6%.
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Innovative use of damaged fiberoptic bronchoscope
Ain-Shams Journal of Anaesthesiology 2016 9(3):463-464
Flexible fiberoptic bronchoscope is a delicate instrument that can get damaged due to improper handling. Once damaged, this costly instrument becomes useless. We reported a case in which we used a damaged flexible fiberoptic bronchoscope in overcoming a difficulty in advancing the endotracheal tube after visualization of the vocal cord with TruviewPCD in a patient with cervical spine injury.
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A comparative study between terlipressin alone and dobutamine and terlipressin in septic shock patients
Ain-Shams Journal of Anaesthesiology 2016 9(3):330-336
Background The use of terlipressin, a long-acting synthetic analog of vasopressin, is associated with reduction in cardiac output and oxygen delivery. The present study was designed to determine whether dobutamine may reverse the terlipressin-induced depression in central venous oxygen saturation (SvO2) in patients with catecholamine-dependent septic shock. Patients and methods This clinical trial was conducted in Ain Shams University hospital's surgical ICU. In total, 90 septic shock patients requiring a continuous infusion of norepinephrine reaching 0.6 µg/kg/min to maintain mean arterial pressure at greater than or equal to 65 mmHg were randomly allocated to three groups be treated as follows: (i): group I, treated with norepinephrine infusion (control); (ii) group II, treated with a single bolus of terlipressin 1 mg, intravenous; (iii) and group III, treated with a single bolus of terlipressin 1 mg, followed by a dobutamine infusion. Results The use of terlipressin (with and without dobutamine) resulted in maintaining mean arterial pressure above 65 mmHg with reduction in norepinephrine requirements to 0.2 (0.1) µg/kg/min in group II and 0.15 (0.1) µg/kg/min in group III (P in each <0.001 vs. control at 2, 4, and 6 h). The use of terlipressin alone in group II resulted in a drop in central SvO2 to 58 (3)% (P<0.001 vs. control at 2, 4, and 6 h) and a decrease in heart rate to 105 beat/minute (7) (P vs. control=0.013 at 2 h, 0.001 at 4 h, and 0.01 at 6 h). The addition of dobutamine in group III resulted in an increase in central SvO2 to 70 (3)% (P<0.001 vs. group II at 2, 4, and 6 h). Conclusion Administration of terlipressin bolus was effective in increasing mean arterial blood pressure and reducing norepinephrine requirements in catecholamine-dependant septic shock patients. Its use was associated with significant reductions in central SvO2, which was reversed by using dobutamine.
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The effect of adding magnesium to bupivacaine for popliteal nerve block on anesthesia and postoperative analgesia in achilles tendon repair patients: a randomized double-blinded study
Ain-Shams Journal of Anaesthesiology 2016 9(3):409-415
Purpose The aim of this prospective randomized double-blind study was to investigate the effect of adding magnesium to bupivacaine on the onset and duration of sensory and motor block, postoperative visual analog scale (VAS), and total opioid consumption in patients following Achilles tendon repair surgery with popliteal-sciatic nerve blockade. Patients and methods A total of 60 patients who underwent Achilles tendon repair surgery and were of American Society of Anesthesiologist I or II physical status with age between 18 and 50 years of age were included in the study. The patients were randomly assigned into two groups: group bupivacaine–magnesium (BM) (n=29) received 30 ml of 0.25% bupivacaine and 2 ml of 10% magnesium sulfate, and group bupivacaine (B) (n=28) received 30 ml of 0.25% bupivacaine and 2 ml of normal saline for popliteal-sciatic blockade using the nerve stimulator technique. We evaluated the patients as regards the onset and duration of sensory and motor block, postoperative VAS scores, and total opioid consumption. Results The onset of motor block in group B was significantly longer in comparison with group BM (14.2±2 and 11.9±1.5 min, respectively). At the same time, the duration of sensory and motor block in group BM was significantly longer in comparison with group B (P<0.001). As regards total opioid consumption (tramadol) during the first 12 h postoperatively, it was significantly less in group BM in comparison with group B (190.67±21.8 and 237.86±25.8 mg, respectively). As regards VAS, it was significantly lower in group BM in comparison with group B at 4, 6, 8, 10, and 12 h postoperatively. Conclusion The addition of magnesium to bupivacaine prolonged the motor and sensory block duration without increasing side effects, and enhanced the quality of postoperative analgesia, which was manifested by lower VAS and less total opioid consumption. Moreover, the addition of magnesium speeds up the onset of motor block.
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Effect of high fractional inspiratory oxygen on postoperative pulmonary function: a randomized–controlled study
Ain-Shams Journal of Anaesthesiology 2016 9(3):337-342
Background Although a high fraction of inspired oxygen (FiO2) could reduce surgical site infection, there is a concern that it could increase postoperative pulmonary complications, including hypoxemia. However, there is an advantage for preoperative high FiO2 before induction of anesthesia as it decreases the incidences of desaturation and wound infection. Our aim was to assess whether different levels of FiO2 affect pulmonary function tests. Patients and methods Ninety patients scheduled for elective abdominal hysterectomy were randomized to receive either preoxygenation with 1.0 FiO2 for 3 min, then continued on 1.0 FiO2 till the end of surgery (group A), or preoxygenation with 1.0 FiO2 for 3 min, then continued on 0.4 FiO2 till the end of surgery (group B), or preoxygenation with 0.4 FiO2 then continued on 0.4 FiO2 till the end of surgery (group C). The oxygenation index (PaO2/FiO2) was measured every 30 min during anesthesia and 2 h after extubation. Pulmonary function test was measured on the morning of surgery and 2 h after extubation. Results Five minutes after intubation, the median PaO2/FiO2 was 483 (371–490) mmHg in group A, 420 (336–490) mmHg in group B, and 450 (350–485) mmHg in group C (P = 0.24). Two hours after extubation, the PaO2/FiO2 was reduced to 333 (314–342) mmHg in group A, 328 (311–357) mmHg in group B, and 342 (303–316) mmHg in group C (P = 0.55). The median functional vital capacity were 1950 (1600–2120), 1850 (1570–2250), and 1900 (1490–2020) ml at baseline and 1650 (1370–1953), 1670 (1340–2350), and 1711 (1412–2410) ml 2 h after extubation in groups A, B, and C, respectively (P = 0.66). Conclusion We found no significant difference in the oxygenation index or pulmonary function tests between patients administered different levels of FiO2.
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Comparative study of intrathecal midazolam versus fentanyl as adjuvants to ropivacaine for lower-limb surgery
Ain-Shams Journal of Anaesthesiology 2016 9(3):432-439
Background The current prospective randomized double-blind study was designed to compare the clinical efficacy of intrathecal midazolam versus fentanyl when added to hyperbaric ropivacaine, evaluating the effect of each on the duration and quality of spinal blockade produced by hyperbaric ropivacaine. Patients and methods The study was conducted on 90 patients of both sexes, aged 20-60 years, of class I or II of the American Society of Anesthesiologists classification, who were undergoing elective lower-limb surgery. Patients were randomly assigned to three groups (30 patients each): group R (control group) received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of normal saline (0.9%) at a total volume of 3.5 ml intrathecally, whereas group RF received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 25 μg fentanyl (50 μg/ml) at a total volume of 3.5 ml intrathecally and group RM received 3 ml (15 mg) of hyperbaric ropivacaine plus 0.5 ml of 1 mg midazolam (2 mg/ml) at a total volume of 3.5 ml intrathecally. The onset and duration of sensory and motor blockade, postoperative pain, and the time to first rescue analgesia request were noted. Patients were observed for hypotension, bradycardia, sedation, respiratory depression, pruritus, and postoperative nausea and vomiting. Results The onset times and the duration of motor blockade were comparable among groups, whereas the time to sensory block regression was longer in group RM and group RF as compared with group R (P < 0.001). The duration of postoperative analgesia was significantly longer in group RM and group RF as compared with group R (P < 0.001), whereas there was no difference between group RM and group RF. The incidence of pruritus and vomiting was higher in group RF. Conclusion Adding midazolam to hyperbaric ropivacaine in spinal anesthesia for lower-limb surgeries is considered a good alternative for improving the duration of sensory block and decreasing the analgesic requirement in the early postoperative period with minimal side effects compared with hyperbaric ropivacaine alone or fentanyl combined with hyperbaric ropivacaine.
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The effects of coinduction with sevoflurane–propofol and sevoflurane–ketofol in patients undergoing radiofrequency ablation of hepatocellular carcinoma
Ain-Shams Journal of Anaesthesiology 2016 9(3):343-348
Background Radiofrequency ablation (RFA) is a minimally invasive and effective method for local tumor destruction in nonsurgical patients with early-stage hepatocellular carcinoma (HCC). General anesthesia (GA) has been used for RFA. GA can decrease the hepatic blood flow and cause more hepatic dysfunction. This study aimed to compare the hemodynamic response, recovery characteristics, and postprocedural analgesia after induction of GA with either sevoflurane–propofol or sevoflurane–ketofol in liver patients undergoing RFA of HCC. Patients and methods Eighty patients with hepatic cirrhosis scheduled for RFA of HCC were randomly allocated into two groups. In group PS, induction of anesthesia was achieved using sevoflurane with propofol (1%). In group KPS, induction of anesthesia was achieved using sevoflurane with ketofol (prepared at a ratio of 1: 2). Results Regarding the induction time, the laryngeal mask airway (LMA) insertion time, the percentage of LMA insertions from the first attempt, time to removal of LMA, and time to emergence were comparable between the two groups. However, the rescue analgesia time was longer in group KPS compared with group PS (P < 0.001). The number of episodes during which blood pressure was below 20% of baseline blood pressure, as well as the highest and the lowest mean arterial pressure, was comparable between the two groups. Postoperative levels of liver enzymes were comparable between the two groups. In the recovery unit, only one patient (2.5%) in group KPS suffered from postoperative emergence agitation, and three patients (7.5%) suffered from nausea. Conclusion Either sevoflurane–propofol or sevoflurane–ketofol may be used as alternatives in liver patients undergoing RFA of HCC as both techniques have favorable anesthetic profiles and provide hemodynamic stability. However, when choosing sevoflurane–ketofol, the advantage of its enhanced analgesic effect must be weighed against the increased risk for postoperative nausea and vomiting.
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Copper and anesthesia − a surprising connection
Ain-Shams Journal of Anaesthesiology 2016 9(3):455-457
A 28-year-old female presented with complaints of fever with chills and dizziness on and off for the last 3 months. On admission, she was investigated and found to have anemia and thrombocytopenia. On examination, the patient was pale and had a palpable huge spleen. Past history revealed a diagnosis of Wilson's disease 15 years ago. This disease, due to altered copper metabolism, may influence the conduct and outcome of anesthesia secondary to abnormalities in hemopoietic, cardiovascular, connective tissue, immune, and nervous systems. In this study, we present a patient, a diagnosed case of Wilson's disease, with massive splenomegaly posted for splenectomy under general anesthesia and the concerns involved therein.
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Prophylactic dexamethasone or pethidine for the prevention of postoperative shivering during transurethral resection of the prostate under spinal anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(3):349-352
Background Shivering is a common complication in elderly patients undergoing urologic operations under spinal anesthesia. The present study compares the effect of prophylactic dexamethasone and pethidine on shivering during transurethral resection of the prostate (TURP) under spinal anesthesia. Patients and methods This random prospective double-blinded controlled study was conducted on 90 patients scheduled for TURP operations under spinal anesthesia. Patients were allocated into three groups: in the C group, patients were administered intravenous 10 ml normal saline before spinal anesthesia. In the P group, patients were administered 25 mg pethidine in 10 ml normal saline. In the D group, patients were administered 0.1 mg/kg dexamethasone in 10 ml normal saline. Core body temperature, mean arterial blood pressure, respiratory rate, oxygen saturation, incidence and severity of shivering, nausea, vomiting, and pruritus were recorded. Results The incidence and severity of shivering were low in the pethidine and dexamethasone groups compared with the control group (P < 0.05), with no significant difference between the pethidine and dexamethasone groups (P > 0.05). Conclusion Prophylactic dexamethasone is as effective as pethidine in reducing the incidence and severity of shivering in TURP patients under spinal anesthesia.
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Global burden of diabetes: action for anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(3):317-318
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A randomized study comparing the efficacy and safety of epidural anesthesia versus general anesthesia in patients undergoing percutaneous nephrolithotomy
Ain-Shams Journal of Anaesthesiology 2016 9(3):353-357
Background Percutaneous nephrolithotomy (PCNL) is the preferred surgical technique for large renal stones (>2 cm in diameter), which involves keyhole surgery through a 1 cm incision on the skin overlying the kidney. It can be performed under local, regional, as well as general anesthesia (GA). We have compared the efficacy and safety of regional epidural anesthesia (EA) and GA in patients undergoing PCNL. Patients and methods In this prospective study, a total of 112 patients of American Society of Anesthesiologists physical status I and II undergoing PCNL were randomized into two groups. Patients in group A (n=56) received regional EA (with lignocaine and bupivacaine), and group B (n=56) patients received standard GA. The postoperative visual analog scale (VAS) score, amount of postoperative analgesic use, adverse effects, operative time, and blood loss were evaluated and compared between the two groups. Results The mean VAS score at 1 h was 1.25 in group A and 5.21 in group B (P<0.001), at 3 h it was 3.05 in group A and 5.04 in group B (P<0.001), and at 6 h it was 3.04 in group A and 4.79 in group B (P<0.001). Less analgesia was required in the EA group compared with the GA group (P<0.001). Five (8.92%) patients in group A and 21 (37.50%) patients in group B had postoperative nausea (P<0.05). Pain score at 18 and 24 h, operative time, postoperative hemoglobin level, and adverse effects were not significantly different between the two groups. Conclusion EA is a good alternative anesthetic technique for PCNL with less analgesic consumption and fewer complications as compared to GA.
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Ultrasound-guided rectus sheath block for pediatric patients undergoing elective abdominal midline operations: a randomized controlled trial
Ain-Shams Journal of Anaesthesiology 2016 9(3):403-408
Background Under high-resolution ultrasonic guidance, bilateral rectus sheath block (RSB) can be performed with higher success rate and fewer complications. RSB results in blocking the anterior branches of the lower thoracic spinal nerves supplying the central portion of the anterior abdominal wall. Objective The aim of the study was to assess the effectiveness of bilateral ultrasound-guided RSB in children undergoing elective midline abdominal operations. Patients and methods Fifty-six patients of both sexes between 2 and 10 years of age, of American Society of Anesthesiologists physical status I–II, undergoing elective midline abdominal procedures were involved in this randomized controlled trial. Patients were randomly allocated to one of two groups: 27 patients in group R (RSB group) and 29 patients in group C (control group). Both groups received general anesthesia. Group R received bilateral RSB with 0.3/ml/kg bupivacaine 0.25% under ultrasound guidance, and group C received regular analgesics. The primary outcome measure was degree of pain assessed using the Objective Pain Scale. The secondary outcome measures were hemodynamic parameters, intraoperative fentanyl requirement, and postoperative need for analgesia. Results Demographic and hemodynamic parameters were similar in both groups. Total intraoperative fentanyl requirement was significantly lower in group R compared with group C. Group R had a significantly lower pain score up to 24/h postoperatively compared with group C. The mean time to first postoperative rescue analgesia was significantly longer in group R (120.8±4.7/min) than in group C (48±3.6/min). The number of rescue doses of analgesia was significantly lower in group R [1 (0–1)] than in group C [3 (2–3)]. Conclusion Bilateral RSB under ultrasound guidance provides effective intraoperative and postoperative analgesia with more stable hemodynamics in pediatric patients undergoing elective midline abdominal procedures.
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Comparative study evaluating the efficacy of ultrasound-guided transversus abdominis plain block versus intraperitoneal injection of local anesthetics in pain control following laparoscopic colectomy
Ain-Shams Journal of Anaesthesiology 2016 9(3):358-365
Background Laparoscopic surgeries are being widely conducted nowadays for its well-known advantages such as less postoperative pain, shorter length of hospital stay, decreased morbidity and mortality, and reduced healthcare costs. Many analgesic modalities have been applied for this type of surgery, of which we have chosen the intraperitoneal injection (IP) of local anesthetics and the transversus abdominis plane (TAP) block. We studied the effect of both techniques on postoperative pain scores and their effect on abdominal and shoulder pain after laparoscopic colectomy. Patients and methods Fifty patients were enrolled in the study. All of them were of American Society of Anesthesiology (ASA) physical status I or II and scheduled for elective laparoscopic colectomy surgery. Patients were randomly allocated into one of two groups (25 patients each): the TAP block group (TAP group) and the IP of local anesthetics group (IP group). Pain score using the numerical rating scale (NRS), hemodynamic parameters, amount of consumption of rescue analgesia, shoulder pain, and adverse reactions were recorded. Results The main outcome variable was the pain score in the immediate postoperative period and the next 3 h; the mean NRS scores were lower in the TAP group than in the IP group in the previously mentioned time periods, with a highly significant difference. Also, there was a significant difference in the NRS score at the fourth hour postoperatively; however, the subsequent NRS scores at the different time intervals showed no significant difference until the end of the 24th hour postoperatively. In the TAP group, 20 patients (80%) complained of abdominal pain at least once in the first 24 h after surgery, whereas all the patients in the IP group experienced abdominal pain, with a significant difference between the two groups. The overall analgesic consumption in milligrams and the total number of analgesic doses were found to be less in the TAP group, with a highly significant difference. Conclusion The results of this study demonstrated that the TAP block is a more effective analgesic modality for abdominal pain than the IP local anesthetic during the early postoperative period after laparoscopic colectomy but IP is more effective in relieving postoperative shoulder pain.
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Magnesium sulfate at two different doses as an adjuvant to bupivacaine in infraumblical (below knee) orthopedic surgeries under spinal anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(3):416-421
Background The use of magnesium sulfate as an adjuvant in neuraxial block has gained popularity, with the aim of improving and enhancing the quality and duration of anesthesia, delaying the onset of postoperative pain, and thus reducing the demand for postoperative rescue analgesics. However, until today, there has been no consensus as regards the ideal dose of magnesium sulfate as an adjuvant in the subarachnoid block. The present study was designed to examine whether the addition of intrathecal magnesium sulfate (50 and 100 mg) would enhance the analgesic efficacy of intrathecal bupivacaine. We hypothesized that the additive effect of magnesium sulfate as an adjuvant to bupivacaine in subarachnoid block is dose dependent. Materials and methods This study was carried out on 90 American Society of Anesthesiology I and II patients of both sexes in the age group of 20–60 years scheduled for below knee surgeries under subarachnoid block. Group 1 (n = 30) patients received intrathecal 0.5% heavy bupivacaine (2.8 ml) +0.2 ml normal saline; group 2 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml) +50 mg (0.1 ml) magnesium sulfate +0.1 ml normal saline; and group 3 (n = 30) received intrathecal 0.5% heavy bupivacaine (2.8 ml)+100 mg (0.2 ml) magnesium sulfate. The primary outcome measure was the duration of postoperative analgesia, and secondary outcomes included the number of supplemental analgesic requirements, block characteristics, and hemodynamic stability. Results The onset of sensory and motor block was delayed in the magnesium group (100 mg>50 mg). There was a significant prolongation of postoperative analgesia in the magnesium group in a dose-dependent manner, and total dose of rescue analgesic requirement was found to be significantly delayed in the 100 mg group. Patients in all groups remained hemodynamically stable without any adverse effects. Conclusion Magnesium sulfate (100 mg) as an adjuvant to bupivacaine in subarachnoid block prolongs the duration of analgesia and decreases the demand for rescue analgesics compared with the control and the magnesium sulfate 50 mg group.
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The role of granisetron in the enhancement of recovery and home discharge in ambulatory surgery performed under spinal anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(3):366-370
Background The popularity of day-care surgery has increased worldwide due to reduced costs and remarkable safety profile. Neuraxial anesthesia is a popular technique for day-case surgeries. Anesthetist should modify his/her techniques to optimize patient's chance of early discharge. 5-Hydroxytryptamine type 3 receptor antagonists used to prevent and treat postoperative nausea and vomiting may affect the course of spinal anesthesia and prevent its associated hypotension. Aim The aim of this study was to evaluate the effects of granisetron in the reversal of hyperbaric bupivacaine spinal anesthesia and enhancement of home discharge in day surgeries. Patients and methods Sixty adult patients scheduled for elective day surgery under spinal anesthesia were randomly divided into two equal groups to receive either 1 mg of granisetron (the G group) intravenously diluted in 5 ml normal saline over 30 s, 5 min before spinal anesthesia, or an equal volume of intravenous normal saline (the S group) at the same time. Heart rate, mean arterial pressure, oxygen saturation, and sensory and motor block levels were monitored and recorded. Results Time to regression of sensory level by two dermatomes, time to regression of sensory level to S2, time to first void, and time to discharge readiness were significantly lower in group G. Moreover, the incidence of nausea and shivering was significantly lower in group G. Conclusion Administration of 1 mg of granisetron before spinal anesthesia in ambulatory surgeries resulted in a statistically faster sensory regression and earlier home discharge from the day-surgery unit.
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Preservative-free racemic ketamine with bupivacaine: a desirable option for extended caudal analgesia in pediatric surgery
Ain-Shams Journal of Anaesthesiology 2016 9(3):426-431
Introduction Caudal epidural block is a commonly performed procedure in pediatric anesthesia worldwide. Ketamine is used as an adjuvant in single-shot caudal blocks to prolong postoperative analgesia. Aims of the study This randomized double-blind study was carried out to evaluate the effect of the addition of preservative-free racemic ketamine 0.5 mg/kg to 0.25% bupivacaine (1 ml/kg) in caudal block on the duration of postoperative analgesia in pediatric patients and to observe adverse effects, if any. Materials and methods Sixty children, aged 2–9 years, undergoing infraumbilical surgical procedures were assigned randomly to one of two groups, B or BK, to receive 1 ml/kg of 0.25% bupivacaine or a mixture of 0.5 mg/kg of preservative-free racemic ketamine with 1 ml/kg of 0.25% bupivacaine, respectively, for single-shot caudal anesthesia. The postoperative pain score was assessed. Sedation, motor weakness, and other adverse effects were also observed. Observations and results The mean duration of analgesia was significantly longer (P < 0.01) in group BK (12.933 h) than in group B (3.467 h). The incidences of adverse effects such as urinary retention, vomiting, and motor weakness were comparable in the two groups (P > 0.05). Conclusion Preservative-free racemic ketamine at a dose of 0.5 mg/kg may be used as a safe and reliable adjunct to caudal bupivacaine for prolongation of postoperative analgesia in children. As racemic ketamine is less expensive and more easily available than S(+)-ketamine, further studies comparing their cost-effectiveness may help to establish the racemic preparation as an appropriate adjuvant for single-shot caudal analgesia, especially in nations where cost constraints exist.
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How receptive are patients with late stage cancer to rehabilitation services and what are the sources of their resistance?
Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Andrea L. Cheville, Lori Rhudy, Jeffrey R. Basford, Joan M. Griffin, Ann Marie Flores
ObjectiveTo describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, as well as the rationale for their level of interest.SettingA comprehensive cancer center in a Northcentral US quaternary medical centerDesignA prospective mixed methods studyParticipants311 adults with Stage IIIC or IV non-small cell or extensive stage small cell lung cancer.InterventionsNot applicableMain Outcome MeasuresTelephone acquired responses to the administration of: 1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); 2) Numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; 3) a query regarding receptivity to receipt of rehabilitation services, and 4) a query about rationale for non-receptivity.ResultsOverall 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services; 38 at the time of enrollment and an additional 61 during at least one subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs. 9.91%, p = 0.04) and a musculoskeletal comorbidity (42.4% vs. 31.6%, p = 0.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns.ConclusionsOne-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.
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Safe landing strategies during a fall: Systemic review and meta-analysis
Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yaejin Moon, Jacob J. Sosnoff
ObjectiveTo systematically synthesize information on safe landing strategies for a fall and quantitatively examine the effects of the strategies to reduce risk of injury from a fall.Data SourcesPubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane LibraryStudy SelectionDatabases were searched using the combinations of keywords of "falls", "strategy", "impact" and "load". Randomized control trials, cohort studies, pre-post studies, or cross-sectional studies were included.Data ExtractionThe fall strategies were extracted and categorized by falling direction. Measurements of impact loads that reflect the risk of injuries were extracted (e.g. impact velocity, impact force, fall duration, and impact angle). Hedges g was used as effect size to quantify effect of a protective landing strategy to reduce the impact load.Data SynthesisA total of seven landing strategies (squatting, elbow flexion, forward rotation, martial arts rolling, martial arts slapping, relaxed muscle, and stepping) in 13 studies were examined. In general, all strategies, except for the martial arts slapping technique, significantly reduced impact load (g's=0.73 to 2.70). Squatting was an efficient strategy to reduce impact in backward falling (g=1.77) while elbow flexion with outstretched arms was effective in forward falling (g=0.82). Also, in sideways falling strategies, martial arts rolling (g=2.70) and forward rotation (g=0.82) were the most efficient strategies to reduce impact load.ConclusionsThe result showed that landing strategies have significant effect on reducing impact load during a fall and might be effective to reduce impact load of falling. The current study also highlighted limitations of the previous studies which focused on a young population and self-initiated falls. Further investigation with elderly individuals and unexpected falls is necessary to verify effectiveness and suitableness of the strategies to at-risk population in real-life falls.
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Psychometric properties of the 30-meter walking test in patients with degenerative cervical myelopathy: results from two prospective multicenter cohort studies
The timed 30-meter walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated.
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A simple scoring system to assess the need for an endoscopic intervention in suspected upper gastrointestinal bleeding: A prospective cohort study
Assessment of the emergent endoscopy for upper gastrointestinal bleeding (UGIB) patients has important clinical implications. There is no validated criterion to triage.
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A local structured training program with live pigs allows performing ESD along the gastrointestinal tract with results close to those of Japanese experts
The high specific skill needed by ESD limit its widespread use in Europe and animal training is recommended in Europe to improve the results of ESD that are far from Japanese at present. We create a local training program using live pigs as models, along with our human cases, to provide continuous exposure to the technique.
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Preventing Long-Term Cardiac Damage in Pediatric Patients With Kawasaki Disease
Kawasaki disease is currently the leading cause of long-term cardiac damage in pediatric patients in the United States. Kawasaki disease is diagnosed based on symptomatology and by ruling out other etiology. There is a significant need for an improved, standardized treatment protocol for patients diagnosed with Kawasaki disease and a more rapid initiation of treatment for these patients. Decreasing the cardiac damage caused by Kawasaki disease with timely diagnosis and treatment needs be a principal goal.
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Clostridium difficile infection is associated with lower inpatient mortality when managed by GI surgeons
Diseases of the Colon and Rectum
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METASTATIC OVARIAN CYSTOSARCOMA PHYLLOIDES OF BREAST
2016-08-31T02-06-07Z
Source: International Journal of Current Research and Review
Papa Dasari, Haritha Sagili, Priyanka Yoga Purani.
Background: Cystosarcoma Phylloides is a rare breast neoplasm constituting ≤ 1% of all breast neoplasms. These are mostly benign and reccur. Malignant cystosarcoma Phylloides can recur and metastasize to lung, bone and abdominal viscera. Metastasis to Ovary is not reported in literature. Case: A 46 year old multiparous lady was diagnosed with a recurrent cystosarcoma of right breast and a large Ovarian mass which was causing her dyspnoea. The mass was of 30 weeks size and was firm and tender. CECT showed a large solid abdominopelvic mass with irregular enhancing septate extending from pelvis to infracolic area with minimal free fluid. Uterus and Ovaries could not be delineated. FNAC from the mass was reported as low-grade malignant mesenchymal tumour. CA 125 was within normal range. Laparotomy revealed a large fleshy mass with jelly like material which was adherent to intestines and pelvic and parietal peritoneum. Right ovary is not visualized. Left ovary parially visualised and incorporated into the mass. Excision of the mass with TAH and BSO was carried out. There was diffuse ooze from the pelvic and peritoneal cavity which was managed by packing, blood product transfusion and tranexamic acid. She received massive transfusion and survived. Later she developed haemoptysis and underwent tracheostomy and feeding ileostomy and was managed in ICU for 8 weeks. Palliative mastectomy and adjuvant Radiotherapy and chemotherapy were differed by Oncologists and hence she was discharged after 4 months of admission. Conclusion: Managing ovarian metastasis from cystosarcoma phylloids can be challenging and the quality of life is poor when the primary disease is not managed adequately.
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Emergency Ventriculo-Pleural Shunt in Pregnancy.
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ANAESTHETIC MANAGEMENT OF A PARTURIENT WITH EISENMENGER’S SYNDROME POSTED FOR EMERGENCY CAESAREAN SECTION
2016-08-31T00-10-36Z
Source: International Journal of Current Research and Review
M. S. Prasanth Kumar, A. K. Kavitha, S. Mushahida, S. Giridharan.
Physiological changes in pregnancy is poorly tolerated in patients with Eisenmenger syndrome (ES) thus increasing the maternal mortality to 30-50%. We describe the management of a 34 years old primigravida with Eisenmengers syndrome with pre eclampsia who was posted for emergency caesarean section.
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MORPHOLOGY OF PSOAS MINOR MUSCLE- A CADAVERIC STUDY
2016-08-31T00-10-36Z
Source: International Journal of Current Research and Review
Parveen Ojha, Seema Prakash, Anjali Jain.
Aim: To study prevalence of psoas minor muscle and its morphology Material and Method: The study was conducted at R.N.T. Medical College, Udaipur (Rajasthan) in thirty adult embalmed cadavers (23 males and 7 females) of the age group 50 to 60 years. Results: Psoas minor muscle was present in eight (26.66%) cases. Morphology of muscle showed a wide variation its muscle belly and its tendinous mode of insertion on either pecten pubis (in five cases) or as merging with obturator fascia and iliac fascia (in three cases). Psoas minor muscle though an inconstant muscle, if present is of clinical importance to radiologists, surgeons and physiotherapists as it can mimic certain abdominal emergencies.
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EVALUATION OF POST OPERATIVE COMPLAINTS IN FIXED PARTIAL DENTURE WEARERS AND THOSES WITH CROWNS: A QUESTIONNAIRE BASED STUDY
2016-08-31T00-10-36Z
Source: International Journal of Current Research and Review
Nandhini G. Ashok, Sangeetha S..
Aim: To evaluate the post-operative complaints of patients having crowns and fixed partial dentures by means of a simple questionnaire. Methodology: A sample questionnaire with 15 questions was prepared, pertained to the period of the prosthesis in place, the nature of complaint as told by patient in his or her own words, number of units involved, and the type of materials used in fabrication of prosthesis. The study was carried out in patients who visited Saveetha Dental College and Hospitals as outpatients from January 2016 to April 2016. A total of One hundred patients were randomly selected and interviewed. Objective: All the patients of our dental college who underwent tooth replacement by means of a fixed partial denture and crowns were included in the study to evaluate the problems encountered after post-operative insertion of the prosthesis. Reason: To create an awareness among the dentists about the problems encountered with our patients and to manage them accordingly as patients comfort is of at most importance to us. Result: Most of the failures are due to poor patient care after insertion while the others occur as a result of defective design and inadequate execution of clinical and laboratory procedures. In this study, clinic survey was undertaken to access the patients discomfort after cementation of prosthesis. The most common problem encountered was looseness and repeated dislodgement. Other complains such as food impaction, inability to maintain oral hygiene, sensitivity, pain and esthetic issues were also encountered. Conclusion: The knowledge regarding the clinical Fixed Partial Denture complications enhances students ability to complete a through diagnosis, developed most appropriate to patients and communicate realistic expectations to patients and plan time internals needed for post-treatment care in the dental institutions
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Ultrasound to Improve Target Site Identification for Proximal Humerus Intraosseous Vascular Access.
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Development of a Pediatric Risk Assessment Score to Predict Perioperative Mortality in Children Undergoing Noncardiac Surgery.
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Further Clarification of Postoperative Anemia and Its Effects on the Kidney.
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A STUDY OF SHORT-TERM OUTCOME OF ACUTE CORONARY SYNDROME PATIENTS WITH SPECIAL REFERENCE TO SERUM URIC ACID AT PRESENTATION
2016-08-30T22-15-54Z
Source: International Journal of Current Research and Review
Kapildev Mondal, Soumabrota Dutta.
Background: Acute coronary syndrome is very common course of death worldwide. It is the most common life Threatening cardiological disease. Assessment of prognosis of acute coronary syndrome patient with respect of Uric acid level as a risk factor to prevent mortality & morbidity have great impact on public health. Aim of the study: Very few Literatures are available regarding this. Our objective is to find out the Effect of Serum Uric acid level on short term outcome of acute coronary syndrome patient. Materials & Methods: We did retrospective study in general medicine department of SSKM HOSPITAL; Kolkata, with acute coronary syndrome patients on 2009-2010. Our study included 100 patients of acute coronary syndrome of various severity. We also proposed to do a detailed laboratory investigation including serum uric acid level in every patient. We did Detailed Clinical Examination & Relevant laboratory investigation. We collected Data according to Hospital regulation after approval by Hospital authorities. Then we analyzed data with help of statistical method BY using software. Results: In our study serum uric acid levels correlate with severity of cardiac failure. There was statistically significant correlation found between serum uric had higher levels of uric acid as compared to patients of class l and ll. Discussion: Out of 100 patients, six expired during 7 day follow up. Patients who had myocardial infarction in past have higher serum uric acid levels and are in higher Killip class. Combination of Killip class and serum uric acid level after acute myocardial infarction is a good predictor of mortality after ami. Conclusion: Hyperurecemia is found to be associated with less chance of good outcome of acute coronary syndrome patients.
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GOVERNMENT AND SOCIAL CONFLICTS BETWEEN TRADITIONAL RULERS AND PRESIDENTS-GENERAL OF TOWN UNIONS (TUS) IN ANAMBRA STATE, NIGERIA
2016-08-30T22-15-54Z
Source: International Journal of Current Research and Review
Andrew O. Obiajulu, Makodi Biereenu-Nnabugwu.
This paper has investigated how financial releases and creation of care-taker committees by Anambra state government influence social conflicts between Traditional rulers and Presidents-General of TUs in some communities. About 524 respondents given the quantitative tool for this study were drawn from members of TUs within the three communities used for the study: Nri,Isi-agu and Amansea. Qualitatitve data were also derived for the study from: victims of TU conflict, members of the vigilante, government officials involved in resolving TU conflicts and community leaders. Findings showed that the state government is a pronounced source of social conflict between the institutions. It does that through her financial releases; creation of care-taker committees and fermenting conflict even in peaceful communities that are seen as her political opponents. Government officials associated with fermenting TU conflict should be prosecuted (Word count: 131).
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ANATOMIC CONFIGURATIONS OF EXTERNAL BRANCH OF SUPERIOR LARYNGEAL NERVE AND SUPERIOR THYROID ARTERY: A STUDY IN CADAVERS
2016-08-30T22-15-54Z
Source: International Journal of Current Research and Review
Swapnali Shamkuwar, PS Bhuiyan.
Objectives: Thyroidectomy is one of the commonly performed procedures in head and neck surgery. Injury to the external branch of superior laryngeal nerve occurs frequently in thyroid surgery which can result in voice changes in the patient. The aim of the present study is to study the anatomical relationship between external branch of superior laryngeal nerve and superior thyroid artery. Methods: Sixty specimens of the thyroid gland of both sexes were studied. The distance between superior pole of thyroid gland and crossing point of superior thyroid artery and external branch of superior laryngeal nerve was measured and recorded. Results: The external laryngeal nerve was categorized into three types. In 63 (52.5%) cases the nerve crossed the superior thyroid artery more than 1cm (type1) and in 47 (39.16%) cases it crossed the artery less than 1cm (type 2a) above the upper pole of the thyroid gland. In 10 (8.33%) cases the nerve crossed the artery under cover (type 2b) of upper pole of the thyroid gland. Conclusions: A sound knowledge of the anatomy of the external laryngeal nerve and its relation to superior thyroid artery and superior pole of thyroid gland is helpful to minimize lesions of the nerve and perform safe surgery on thyroid gland.
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Combined Multichannel Intraluminal Impedance and pH Measurement in Detecting Gastroesophageal Reflux Disease in Children.
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Reply to a Letter to the Editor Regarding the Original Article, Predictors of Pouchitis After Ileal Pouch-Anal Anastomosis in Children.
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Favorable Outcomes of Preterm Infants with PNALD Treated with IV Fish Oil-Based Lipid Emulsion.
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Celiac Disease and Diabetes: when to test and Treat.
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Diagnosing Spontaneous Bacterial Peritonitis in Children: Tap-in for Higher Scores.
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Sertraline as an Additional Treatment for Cholestatic Pruritus in Children.
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The Intragastric Pressure Measurement: A Novel Method to Assess Gastric Accommodation in Functional Dyspepsia Children.
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Nutritional Status in Short Stature Children is Related to Both Ghrelin and Insulin-like Growth Factor I Concentrations.
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