American journal of therapeutics
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Meta Analysis Comparative Study
A Network Meta-analysis of Outcomes of 7 Surgical Treatments for Distal Radius Fractures.
To determinate the optimal treatment for distal radius fractures (DRF) by comparing the pin-track infection (PTI) rates in patients treated with 7 surgical techniques [bridging external fixation (EF), nonbridging EF, K-wire fixation, plaster fixation, dorsal plating, dorsal and volar plating, and volar plating]. After an exhaustive search of electronic databases for relevant published studies, high-quality randomized controlled trails were selected for the present network meta-analysis based on predefined selection criteria. Statistical analyses of the extracted data were conducted using Stata 12.0 software. ⋯ Importantly, the surface under the cumulative ranking curve values of the surgical interventions revealed that the PTI rates of plaster fixation and of dorsal and volar plating were the lowest, suggesting that these 2 surgical techniques are optimal for DRFs treatment, compared with the other methods. Our results suggest that plaster fixation and dorsal and volar plating are the best surgical treatments for DRFs compared with 5 other most common techniques. Thus, plaster fixation and dorsal and volar plating emerge as the most effective and credible treatments in consideration of PTI rates.
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Comparative Study
Comparison of Arginine Hydrochloride and Acetazolamide for the Correction of Metabolic Alkalosis in Pediatric Patients.
Metabolic alkalosis is a common acid-base disturbance occurring in critically ill pediatric patients. Acetazolamide and arginine hydrochloride are pharmacologic agents used at our institution for patients refractory to first-line therapy or those unable to tolerate fluid replacement. The objective of this retrospective review was to determine if a course of arginine hydrochloride or acetazolamide was more effective at correcting metabolic alkalosis within a 24-hour period. ⋯ Both groups had a similar increase in mean serum chloride concentration (5.7 ± 5.3 vs. 4.4 ± 4.4 mmol/L, P = 0.458). Mean decrease in serum bicarbonate concentration was equivalent between groups (5.6 ± 5.2 vs. 2.8 ± 4.7, mmol/L, P = 0.110). Acetazolamide and arginine hydrochloride appear to be equally effective in correcting metabolic alkalosis in critically ill pediatric patients.
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One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic in numerous hospital units, outpatient pain clinics, and in the prehospital realm. It has been used to treat postoperative pain, chronic pain, complex regional pain syndrome, phantom limb pain, and other neuropathic conditions requiring analgesia. ⋯ Such effects make it necessary for the clinician to use the drug only in situations where it will provide the greatest benefit with the fewest adverse effects. To the best of our knowledge, none of the reviews regarding ketamine have taken a comprehensive look at the drug's uses in all territories of medicine. This review will serve to touch on its chemical data, pharmacokinetics and pharmacodynamics, medical uses, and adverse effects while focusing specifically on the drugs usage in anesthesia and analgesia.
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Vitamin D deficiency is known to be common in the general population and has been linked to all-cause mortality. The classically recognized role of vitamin D is its involvement in calcium and phosphorous homeostasis and bone health. ⋯ Many of these studies have indicated that there is an association between vitamin D deficiency and clinical outcomes such as mortality, sepsis, duration of mechanical ventilation, and length of stay. This review article provides an overview of vitamin D physiology in adults, a summary of observational studies on vitamin D deficiency in critical illness, and an examination of the few clinical trials on vitamin D supplementation in intensive care patients.
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Case Reports
Rhabdomyolysis Secondary to Therapeutic Hypothermia After Cardiopulmonary Resuscitation: A Rare Complication.
Patient maintenance after successful cardiopulmonary resuscitation starts with decreasing the neurological damage despite serious difficulties such as hypoxic ischemic infarcts and reperfusion infarcts. Therapeutic hypothermia is the most rejoicing method in use to prevent neurological damage. Here, we discuss about a 35-year-old woman resuscitated for 20 minutes in hospital who was followed because of postpartum cardiomyopathy. ⋯ Although we were successful to prevent neurological damage, rhabdomyolysis arose secondary to therapeutic hypothermia. As a result, the intubation process was prolonged, and acute tubular necrosis due to myoglobinuria was occurred. Despite all complications patient faced, she was discharged on her 31th day; without sequela and with no need for hemodialysis; under medical therapy.