Curēus
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This case report presents an application of percutaneous peripheral nerve stimulation to the left ulnar nerve to treat a patient with complex regional pain syndrome type 1 following a crush injury to the left fifth digit. Conventional treatment had failed to ameliorate the patient's condition. ⋯ The patient was able to initiate pain-free active motion of her left fifth digit. At the 3-month follow-up consultation, the patient reported maintenance of the reduction of pain in her left upper extremity with the implanted percutaneous peripheral nerve stimulator, as well as improved performance in her daily activities. Despite the success achieved in this particular case, further clinical series involving larger numbers of patients are warranted in order to assess the definitive role of percutaneous peripheral nerve stimulation for the treatment of neuropathic pain of the upper and lower extremities, which has been previously unresponsive to medical and/or surgical treatment.
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Background The prevalence of obstructive sleep apnea (OSA) is high in the obese population. In this study, it was aimed to fulfill the STOP-Bang questionnaire which is a concise and easy-to-use questionnaire for OSA screening in obese patients. Materials & methods This is a retrospective study where the patients, who planned polysomnography, were referred to sleep clinic. ⋯ The area under the curve of the STOP-Bang for identifying mild, moderate and severe OSA was 0.581, 0.652 and 0.675, respectively. Whereas according to the STOP-Bang, all morbid obese patients (obesity class III, n: 47) were at high risk of OSA. Conclusion This study suggests that the STOP-Bang questionnaire for obstructive sleep apnea screening in obese patients is a high sensitivity and appropriate screening test.
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Introduction Allergic rhinitis (AR) is the most common non-infectious rhinitis and is associated with sneezing, cough, and flu-like symptoms. The exact pathophysiology of AR remains uncertain. The deficiency of vitamin D3 has been documented as a probable cause of allergic conditions due to its role in immunomodulation. ⋯ Conclusion Vitamin D deficiency was present in both study groups. The AR group had significantly lower mean levels of serum vitamin D than the control group. However, upon stratification, the differences were insignificant.
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Introduction For many emergency medicine (EM) residency programs, pediatric education takes place at independent pediatric emergency departments (PEDs). Residency programs are charged with selecting a scheduling model for their residents' clinical experience at these PEDs. The main advantage of block scheduling is that it immerses the residents in pediatric care for a period of time and provides continuity of work with the same PED attending faculty. ⋯ Most of the attending faculty suggested that their familiarity with a resident was a key factor in how they made decisions about the resident's participation in procedures or resident autonomy; however, very few were concerned that longitudinal scheduling would impact their ability to "get to know a resident." Conclusion Attending faculty mostly thought that longitudinal scheduling was better than block scheduling. While they acknowledged that their familiarity with the resident was the driver of faculty entrustment in the PED, they did not express any concern that the scheduling change would affect their ability to get to know the residents. Other solutions, including a mixed scheduling model to address both issues, are also proposed.
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Introduction Chronic subdural hematomas (cSDH) are common in neurosurgery with various symptoms and significant morbidity and mortality. Treatment varies with procedures including twist-drill (TD) craniostomy, craniotomy, burr hole craniostomy, and craniectomy. Newer treatments including middle meningeal artery embolization are also being explored as no treatment has been determined to be optimal. ⋯ There were no adverse outcomes identified through the instillation of tPA. Conclusion Intracatheter tPA increased drainage rates in the assessment of pre- and post-tPA values when administered at 48 hours after subdural drain (SDD) placement. Patients who received benefits from tPA tended to have larger subdural hematomas and less drainage prior to the instillation of tPA than patients that benefited from drainage alone. Larger prospective studies should investigate early treatment with tPA to identify if tPA is efficacious for all patients after TD craniostomy and to optimize patient selection with regard to thrombolytic therapy.