Medicina
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Randomized Controlled Trial
Prevention of Shivering Post Subarachnoid Block: Comparison between Different Doses of Intravenous Magnesium Sulphate.
Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. ⋯ The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events.
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Inflammation is pivotal to the pathogenesis of diabetes mellitus (DM), but pathological alterations of the neutrophil−lymphocyte ratio (NLR), an emerging inflammatory index in DM management, remains understudied. The aim of this study is to examine the relationship between NLR and glycemic control in the Saudi population. Gender, age, WBC count, and fasting blood glucose (FBG) were obtained from Al-Borg Medical Laboratories for 14,205 subjects. ⋯ HG was more prevalent in subjects with elevated NLR (17.33% vs. 12.46%) who had a relative risk (RR) of 1.68 (95% CI = 1.38−2.06, p < 0.0001) and an odds ratio (OR) of 1.94 (95% CI = 1.48−2.56, p < 0.0001) to be hyperglycemic. Nevertheless, NLR failed to discriminate individuals with normal FBG from those with HG based on ROC curve analysis. Pathological fluctuations in NLR may serve as supportive evidence in DM management.
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Multicenter Study
Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration.
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. ⋯ No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
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Background and Objectives: The TomoFix anatomical plate was developed to improve plate position, proximal screw direction, and post-correction tibial contouring. The purpose of this study was to compare postoperative configurations between the TomoFix anatomical plate and the TomoFix conventional plate. It was hypothesized that the new modified plate provides a better fixative coaptation than the conventional plate. ⋯ The TomoFix anatomical group showed a significantly greater plate angle (39.2° ± 8.1° vs. 31.7° ± 7.0°, p < 0.001) and less screw angles, indicating that the TomoFix anatomical plates allowed a more posterior plate position than the conventional plate. The plate-to-cortex distance was significantly less in the TomoFix anatomical group than in the TomoFix conventional group (p < 0.001). Conclusion: The TomoFix anatomical plate showed a more posteromedial plating position, better proximal screw direction to the lateral hinge, and improved post-correction tibial contour compared to the TomoFix conventional plate.
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The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today's physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called "soft skills", whose acquisition is presented in literature as a quite recent addition to medical studies. ⋯ Debates have often circled around whether these "soft skills" could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body.