Curēus
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Introduction The American Society of Metabolic and Bariatric Surgery has stated that bariatric surgery is indicated in Class I obesity patients with one or more comorbidities. However, other weight loss options, such as diet plus exercise, are available to patients with a body mass index (BMI) ranging from 30 to 35 kg/m2. This study aimed to prospectively compare the results of Class I obesity patients undergoing laparoscopic sleeve gastrectomy (LSG) or using a weight control program (WCP). ⋯ At the final 18-month follow-up, the %EBMIL in the LSG group was 99.60% but was only 25.70% in the WCP group (P < 0.05). Conclusion Our study elucidates a clear superiority of LSG over any structured WCP with regard to weight reduction, improvement in glycemic control, and reduction in blood pressure in Class I obesity patients. Additionally, patients having LSG reported markedly improved self-esteem and satisfaction when compared with those who undertook a WCP.
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The aim of this study was to assess the efficacy of intravenous vitamin C, hydrocortisone, and thiamine in early weaning (within 48 hours) from vasopressor support in patients with septic shock. We also aimed to assess mortality and intensive care unit (ICU) stay. ⋯ The administration of intravenous vitamin C, hydrocortisone, and thiamine to patients with septic shock was successful in early weaning from vasopressors. There was also a reduction in procalcitonin and lactate levels, as well as the SOFA score. Further trials are needed to determine whether the metabolic resuscitation protocol can become part of the treatment for septic shock.
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The National Institutes of Health (NIH) is the world's largest funding source for research, and the R01 grant is seen as a stepping stone to future granting opportunities for the physician-scientist. Recently, both a gender and degree disparity in scholarly activity has been highlighted in the medical literature. Objective: To assess NIH R01 funding trends in general surgery over the last decade. ⋯ From 2008 to 2017, the NIH awarded 600 R01 grants and $272,669,397 to PIs in general surgery. The majority of R01 grants were awarded to males (76.33%; p < 0.01) and those holding a Doctorate of Medicine (MD) degree (58.33%; p < 0.01). No Doctorate of Osteopathic Medicine (DO) had received an NIH R01 grant during the time studied. No statistically significant trend could be established for the number of R01 grants awarded over time (p = 0.33), grants awarded to males or females over time (p = 0.73 and p = 0.18), or for those holding an MD or other type of degree over time (p = 0.30 and p = 0.39). Also, no statistically significant trend was established for increased grant funding over time (P = 0.88) but females and those holding an other type of degree (Doctorate in Philosophy (PhD), Doctorate in Science (DSc), Master of Public Health (MPH), etc.) experienced an increase in the total dollar amount of funding over the time studied (p < 0.01 and p < 0.01). Conclusion: For the years studied, a gender and degree disparity exists for those receiving an NIH R01 grant in general surgery. However, an increase in total grant funding has been seen for both females and non-physician scientists over from 2008 through 2017.
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Case Reports
Selective Type 2 Respiratory Failure Followed by Ocular Myasthenia Gravis Diagnosed by Ice Pack Test: A Case Report.
Myasthenia gravis is an autoimmune neuromuscular disorder that can present with skeletal muscle involvement, ocular muscles involvement and can progress to respiratory muscle paralysis. Here, we present a unique case of type 2 respiratory failure due to myasthenia gravis with the delayed ocular presentation. A 46-year-old female patient presented to the outpatient clinic with complaints of dyspnea. ⋯ The patient further progressed to ocular symptoms. With the use of an ice pack test, a bedside test for improvement of ptosis, the patient was diagnosed with myasthenic ptosis preventing further progression of type 2 respiratory failure and intubation. With this case report, we emphasize the critical role of such simple bedside test in timely diagnosis and management of myasthenia gravis while awaiting the final results.
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Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms. ⋯ SAC remains a safe and effective technique to treat wide-necked IAs, providing a low rate of complications and recanalization with excellent long-term aneurysm occlusion rates.