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This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.Anaphylaxis is a life-threatening allergic reaction involving multiple organ systems that can result in significant morbidity and mortality if left untreated. Epinephrine is the mainstay of treatment. Most episodes of anaphylaxis resolve after a single dose of epinephrine, but biphasic and protracted courses of anaphylaxis are well described. The need for additional doses of epinephrine poses a significant challenge in the wilderness setting, because patients and providers may only carry a single autoinjector. Prior work has demonstrated successful disassembly of various brands of epinephrine autoinjectors to retrieve additional drug product for repeat dosing. We describe 2 techniques to retrieve additional doses of epinephrine from Adrenaclick-style epinephrine autoinjectors. The techniques described are off-label and are not approved by the manufacturer or the Food and Drug Administration. Wilderness providers should familiarize themselves with techniques for retrieval of additional epinephrine from various autoinjectors in light of significant differences in product design.We report a case of prolonged motivational deficit as a sequela of high altitude cerebral edema (HACE), the most severe form of neuropsychiatric dysfunction arising from traveling to high altitude. Magnetic resonance imaging of the brain showed hyperintense lesions in the globi pallidi bilaterally on T2-weighted images. Single-photon emission computed tomography showed hypoperfusion in dorsolateral and orbital prefrontal cortices bilaterally and in the anterior cingulate cortex. This case suggests that a prolonged motivational deficit can occur in patients with HACE. The case may also suggest that HACE can cause network disturbances between the prefrontal cortex and the globi pallidi.Hematotoxic snake envenomation is clinically important and has serious complications. This case report describes the clinical manifestations of a bite from a newly described species of hematotoxic snake and the outcomes of treatment using locally available antivenom and supportive management. A 39-y-old male was bitten on his right ankle by an unidentified snake. The patient developed coagulopathy, rhabdomyolysis, and clinical signs of compartment syndrome of his right leg within the first day. Eight doses (30 mL, or 3 vials per dose), or a total of 240 mL, of hemato-polyvalent antivenin (Thai Red Cross, Thailand) were given. Aggressive intravenous hydration and alkalinization of urine were performed, and a fasciotomy was performed for the treatment of suspected compartment syndrome. [https://www.selleckchem.com/products/mmp-9-in-1.html MMP-9-IN-1] The patient's clinical symptoms and laboratory results indicated progressive improvement during the 5 d of hospitalization. The snake was later identified as Protobothrops kelomohy, a novel snake species with no clinical data available regarding its envenomation of humans. This case shows that P kelomohy envenomation can produce severe effects that occur both locally and systemically. The benefits of the use of polyvalent antivenom in this situation were unclear. However, with supportive treatment in conjunction with serial clinical and laboratory monitoring, the patient recovered, albeit after 7 d of hospitalization.<br /><br /> To address gaps in understanding disparities of posttraumatic growth among childhood cancer survivors, the aims of this study were to (1) compare satisfaction, resilience, and achievement among Hispanic and non-Hispanic White survivors; and (2) examine relationships between sociodemographic and clinical factors with satisfaction, resilience, and achievement.<br /><br /> Survivors (N = 116) at Children's Hospital of Orange County After Cancer Treatment Survivorship Program completed the Child Health and Illness Profile-Adolescent Edition.<br /><br /> Resilience (p = .003) and achievement (p = .005) were lower among Hispanic survivors. Resilience was positively associated with satisfaction (p &lt; .01) and achievement (p &lt; .01) and achievement was positively associated with years of schooling (p &lt; .01). No differences were found between Hispanic and non-Hispanic White satisfaction scores (p = .95).<br /><br /> Our findings suggest ethnic disparities in posttraumatic growth in childhood cancer survivors. Interventions aimed at promoting posttraumatic growth are vital to address these differences.<br /><br />Our findings suggest ethnic disparities in posttraumatic growth in childhood cancer survivors. Interventions aimed at promoting posttraumatic growth are vital to address these differences.Eating disorders typically have a protracted course, marked by significant morbidity. Male adolescents and adolescents of color are at risk of delayed care. Primary care providers are well-positioned to identify eating disorders early and initiate treatment. This case report describes an adaptation of Family-Based Treatment delivered by a primary care provider to an Asian-American male adolescent from an immigrant family with restrictive anorexia nervosa. The adolescent achieved full-weight restoration and remission of his anorexia through treatment in primary care. Embedding eating disorder treatment within primary care could improve detection, engagement, and retention in treatment among young people from diverse backgrounds.The REIN registry is a national registry held by the French Biomedicine Agency. Its objective is the epidemiological monitoring of patients with end-stage chronic renal failure. This registry, backed by its expertise and its national network, has been able to very quickly set up epidemiological monitoring of chronic dialysis and/or transplant patients affected by SARS-CoV-2. The first results show a relatively low frequency of COVID-19 in dialysis patients (4.9%) contrary to what one might have feared. The frequency of SARS-CoV-2 infection in kidney transplant patients is 1.8% nationwide. All regions of France have not been affected in the same way. The prevalence of COVID-19 patients varied by region, reaching up to 10%. The probability of being affected was higher in men and diabetic patients. At October 19, among 3209 infected patients (dialysis and transplant), 573 died from a cause related to SARS-CoV-2. The case fatality in diagnosed cases was 18%. A weekly newsletter has been set up by the Biomedicine Agency using information transmitted by all of the epidemiological support units in the registry. The REIN registry was able to adapt to become a reactive health monitoring tool.Central facial palsy, which is a sequela of stroke, is associated with decreased quality of life and psychosocial function. Integrative Korean medicine management, including acupuncture and Chuna-manual therapy, has been used to treat neurological diseases, including facial palsy. We report three cases of central facial palsy patients who had these symptoms over three months after a stroke. They had received rehabilitation treatment for the paralyzed upper and lower extremities. However, as their central facial palsy symptom did not improve, Chuna-manual therapy (SJS nonresistance technique) for facial palsy was started along with acupuncture. Oral region movement improved after four weeks of integrative acupuncture and Chuna-manual therapy. After ten to sixteen weeks of treatment, the facial nerve grading system 2.0 grades improved by one in two cases. In one case, although there was no significant change in the grade, she was satisfied with the results after adding Chuna-manual therapy to acupuncture. There were no adverse events. Integrative management, including acupuncture and Chuna-manual therapy, might be an effective treatment strategy for central facial palsy. Further prospective, controlled studies are warranted.<br /><br /> Studies concerning young children's food-related knowledge have dealt mostly with specific types of knowledge or with researchers' predetermined categories. This approach may neglect certain aspects of children's knowledge and may limit the understanding of its general structure. The present study aimed to examine and analyze a wide scope of young children's constructed food-related knowledge.<br /><br /> Qualitative thematic analysis of 40 kindergartners' free categorizations of food items.<br /><br /> Children's food-related knowledge was broad and derived from 3 primary sources personal experience, environmental experience, and perceived messages. Novel aspects of knowledge were found, such as different treatments of food and partial familiarity with nutrients.<br /><br /> The findings demonstrated the existence of various types of young children's food-related knowledge. Attention to the broad spectrum of their knowledge and its possible sources may contribute to the design of relevant and effective nutrition education interventions aimed at young children.<br /><br />The findings demonstrated the existence of various types of young children's food-related knowledge. Attention to the broad spectrum of their knowledge and its possible sources may contribute to the design of relevant and effective nutrition education interventions aimed at young children.<br /><br /> The standard treatment for end-stage renal disease is renal transplantation. As vascular anastomoses are performed during the surgery, it may expose to a risk of vascular thrombosis. This raises the question of using intravenous heparin during the procedure. The purpose of this study was to compare the incidence of renal transplant vascular thrombosis in the perioperative period based on whether the patients received or not intraoperative heparin.<br /><br /> A single center retrospective study was conducted on a cohort of consecutive patients who underwent renal transplantation between 2011 and 2015. Patients were divided into two groups patients not receiving heparin vs. receiving heparin at the dose of 0.5mg/kg. A Doppler ultrasound was performed at day one postoperatively to assess the occurrence of vascular thrombosis. Hemorrhagic complications and the need for postoperative transfusion were also assessed.<br /><br /> In total, 261 patients were included. Fifty-one patients received heparin (19.5%). Patient's baseline characteristics were comparable between the groups. No significant difference was found regarding the incidence of vascular thrombosis (6% for both groups, P=1). In addition, no difference was found regarding hemorrhagic complications requiring surgical revision (P=1) as well as early postoperative transfusion rate (P=0.57).<br /><br /> Our results suggest that intraoperative IV heparin doesn't improve the risk of vascular thrombosis following renal transplantation. However, intraoperative IV heparin was not significantly associated with a higher rate of hemorrhagic complications suggesting that heparin can be safely used if required in some selected patients at higher risk of thrombosis.<br /><br /> 3.<br /><br />3.<br /><br /> Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data.<br /><br /> A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included.<br /><br /> Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation.