Curēus
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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.
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Introduction We report our initial series of patients treated with radiosurgery to the Centromedian (CM) and Parafascicular (Pfc) Complex (CM-Pf) of the contralateral thalamus mainly for trigeminal neuralgia that had failed most known forms of conventional treatments. The coordinates were co-registered to a three-dimensional atlas of the thalamus in order to have a better comprehension of isodose curves distribution. Methods A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (140 Gy) using a 4-mm collimator to the CM-Pf of the contralateral thalamus in 14 patients suffering from refractory trigeminal pain and other complex pain syndromes. ⋯ Conclusion Radiosurgery to the CM-Pf of the thalamus was demonstrated to be a safe and relatively effective alternative to treat refractory trigeminal neuralgia. Further studies are needed to optimize target dimensions based on the three-dimensional studies of isodose curves as well as coordinates. Longer follow-up is necessary to evaluate recurrence rates that could not be reached.
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Pulmonary embolism has become a cause of great concern to health care professionals. Despite strides in research and availability of sensitive diagnostic tests, the mortality and morbidity related to this entity continues to cause tremendous economic burden. Patients present with an array of symptoms ranging from mild dyspnea to hemodynamic instability and even death. Prompt recognition of symptoms along with early risk stratification can be lifesaving. ⋯ In this article we will review catheter-directed thrombolytic therapy, specifically the EKOS® or the EkoSonic endovascular system. EKOS® uses ultrasound-facilitated catheter-directed thrombolysis. The rationale behind this therapy is using shorter infusion times and lower dosage of the thrombolytic therapy, thereby reducing the complications associated with their use.