Saudi Med J
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In the face of increasing demand of intensive care services in the Kingdom of Saudi Arabia, as well as the high cost of delivering such services, systematic steps must be undertaken in order to ensure optional utilization and fair allocation of resources. Strategies start prior to intensive care units (ICU) admission by the proper selection of patients who are likely to benefit from ICU. Less resource-demanding alternatives, such as intermediate care units, should be used for low-risk patients. ⋯ On discharge, the intermediate care units again play a role as less expensive alternative transitional area for patients who are not stable enough to go to general ward. Measures to reduce re-admissions to ICU must also be implemented. Improving ICU resource utilization requires teamwork not only the intensivists but also the administrators and other health care providers.
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Comparative Study Clinical Trial
Intravesical immunotherapy for superficial bladder cancer.
To compare and evaluate the efficacy and tolerance of intravesical instillation of Bacillus Calmette-Guerin (BCG) and interferon alpha-2b immunotherapy for superficial transitional cell carcinoma (TCC) of the urinary bladder. ⋯ Bacillus Calmette-Guerin was confirmed as a more effective intravesical immunotherapy for superficial TCC of the urinary bladder as compared to interferon alpha-2b. Both agents' treatments are well tolerated.
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Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. ⋯ We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate.
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Comparative Study
A study comparing different approaches in managing neck nodes in early carcinoma of the tongue.
To evaluate elective neck treatment in patients with early stage (T1-2 negative neck node [N0]) squamous cell carcinoma of the oral tongue. ⋯ A trend for higher neck control was observed after neck dissection in patients with T1-2 N0 squamous cell carcinoma of the oral tongue. Elective neck dissection should be considered particularly for patients with tumor thickness of more than 10 mm.
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Comparative Study
Role of ultrasonography, computed tomography and diagnostic peritoneal lavage in abdominal blunt trauma.
To compare the diagnostic accuracy of diagnostic peritoneal lavage (DPL), ultrasonography and computed tomography in the management of blunt abdominal trauma. ⋯ Diagnostic peritoneal lavage is a promising bedside investigation, but is invasive with low accuracy for retroperitoneal injuries and high probability of nontherapeutic laparotomy with false positive results. The high sensitivity and accuracy rates of computed tomography justify its use in quantifying and estimating the grade of injury in order to select the appropriate management of trauma victims. Computed tomography is recommended as the initial investigation of choice in hemodynamically stable patients with blunt abdominal trauma.