Medicina
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Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. ⋯ Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.
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Background: Mesenchymal chondrosarcoma is a rare but aggressive subtype of sarcoma. The majority of involvement locates in the axial skeleton. Treatment modalities include radical surgery, local radiotherapy, and systemic chemotherapy. ⋯ Later, he had an unusual pancreatic tail tumor as the first presentation of disease metastasis which was proven by surgical resection one year later. Conclusion: Although mesenchymal chondrosarcoma locates mainly in the axial skeletal system, extra-skeletal soft tissue or organ involvement might be seen occasionally. Active surveillance with multidisciplinary team management could significantly prolong survival outcomes.
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Background and Objectives: Malignant bone tumors represent a major problem due to their aggressiveness and low survival rate. One of the determining factors for improving vital and functional prognosis is the shortening of the time between the onset of symptoms and the moment when treatment starts. The objective of the study is to predict the malignancy of a bone tumor from magnetic resonance imaging (MRI) using deep learning algorithms. ⋯ Conclusions: The proposed method is based on pretrained deep learning classifiers which do not require a manual segmentation of the MRI images. These algorithms can be used to predict the malignancy of a tumor and on the other hand can shorten the time of their diagnosis and treatment process. While the proposed method requires minimal intervention from an imagist, it needs to be tested on a larger cohort of patients.
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Potassium binders are essential tools to treat hyperkalemia, particularly in patients with heart failure and chronic kidney disease. One of the drug-related complications is constipation, which further worsens heart failure by increasing afterload and decreases patients' quality of life. ⋯ A conversion to a newly-introduced specific potassium binder, sodium zirconium cyclosilicate, improved persistent constipation, maintaining serum potassium levels within a normal range. Sodium zirconium cyclosilicate might be a preferable potassium binder to treat hyperkalemia, particularly in patients with heart failure and chronic kidney disease and those suffering from constipation.
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Background and Objectives: This study's purpose was to examine the benefit of using a tibial extension in the primary operation of total knee arthroplasty (TKA). This is important because it is not a common practice to use the extension in a primary TKA, a standard configuration offering sufficient stability and good long-term survivorship. The following question arises: which situation requires the use of a standard configuration implant (without a stem) and which situation requires using the extension? Materials and Methods: The opportunity to use the tibial extension in the primary TKA was analyzed in correlation to the tibial bone structural properties. ⋯ Compression fatigue was reduced to almost half in the case of altered bone when adding a stem. Dynamic compression showed slightly better results with the tibial stem in both healthy and degraded bone. Conclusions: It was concluded that, if the bone is healthy and has good structural properties, it is not necessary to use the tibial extension in the primary operation; and if the bone has diminished physical properties, it is necessary to use the tibial extension at the primary operation, enhancing the stability, fixation, and implant lifespan.