Medicine
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Pleural effusions are a common medical problem not only for pulmonologists but also for general physicians, often needing thoracentesis for a definite diagnosis. However, thoracentesis cannot always reveal malignant cells or microbiological evidence. In this context, we prospectively enrolled a total of 289 patients with pleural effusions due to diverse etiologies: parapneumonic effusion (PPE) (63), empyema (22), tuberculous pleural effusion (TBPE) (54), malignant pleural effusion (MPE) (140), or chronic renal failure (CRF)/congestive heart failure (CHF) (10). ⋯ We discovered a simple method to differentiate pleural diseases based on the pleural LDH to ADA ratio and carcinoembryonic antigen (CEA). A pleural LDH to ADA ratio greater than 15.5 and a pleural CEA level of less than 5 ng/mL is indicative of PPE or empyema rather than TBPE, MPE, or transudative pleural effusion (CRF, CHF). This method has a sensitivity of 62.0%, a specificity of 91.0%, and an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0678-0.852, P < .001), odds ratio of 16.6 (95% CI: 7.28-37.8, P < .001), a positive likelihood ratio (LR) of 6.8, and a negative LR of 0.02.
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Comparative Study Observational Study
Early oral feeding versus traditional feeding after transanal endorectal pull-through procedure in Hirschsprung's disease.
Our study questioned whether the outcome of postoperative early oral feeding is different from traditional postoperative feeding in children with Hirschsprung's disease who underwent transanal endorectal pull-through. This was an observational and comparative study. Patients were allocated into 2 groups. ⋯ We noted a significant difference regarding the duration of antibiotic treatment and intravenous fluid administration after 72 hours. This study showed that there was no difference between the outcomes of early and traditional postoperative feeding. Due to a significant difference in the antibiotics and IV fluid administration intervals between these 2 groups which cause a prolonged hospital stay and higher costs, it seems that early postoperative feeding is superior to traditional strategy.
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Observational Study
Blood sugar control among type 2 diabetic patients who travel abroad: A cross sectional study.
The dose adjustment of anti-diabetic drugs during traveling abroad remains an important issue for the diabetic patients. However, there are few studies exploring the changes in blood sugar in patients with type 2 diabetes mellitus (T2DM) when traveling abroad. The study aimed to investigate the hypoglycemic episodes, sugar control, and associated factors during travel among patients with T2DM. ⋯ The proportion of pre-travel consultation was low in patients with T2DM. Besides, most of the physicians did not offer pre-travel education when patients mentioned their traveling plan. The willing and ability of physicians to offer the pre-travel diabetic education deserved further investigation.
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Pedicle screws are commonly used to treat adolescent idiopathic scoliosis (AIS). Many studies have discussed the rates and effects of pedicle screw misplacement. In this study, to increase the accuracy rate, cannulated pedicle screws were inserted into the periapical vertebrae, highly rotated vertebrae, and vertebrae with very thin pedicles in a single patient group. We compared these results with those of a patient group who underwent conventional pedicle screw placement. ⋯ The use of cannulated screws to treat AIS decreases perforation and complication rates. Although it did not significantly lower the medial perforation rate, it dramatically reduced the lateral perforation rate. The use of cannulated screws enables intraoperative confirmation of placement accuracy. Our data suggest that cannulated pedicle screw use to treat AIS is safer and more efficient.
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Pulmonary hypertension (PH) is a complicated disease which has complex causes and poor outcome. Many factors are involved in the increase of pulmonary artery pressure. It is often difficult to identify the specific cause of a particular patient. However, identifying the etiology is of great importance for specifying treatment strategies and improving the prognosis of patients. ⋯ It is often difficult to define the cause of PH, but it is important for making the appropriate treatment at the same time.