Iqbalking4350
This introductory essay traces the history of Pediatric Urgent Care as a practice model. The essay describes the social and economic trends that led to the origin and enormous growth of this unique practice model. Scope of Practice, staffing models and standards of care are described. Professional Societies and the future prospects of this model are included.
The aim of our study was to analyze the potential relationship between tumor markers and
F-fluorodoxyglucose positron emission tomography/computed tomography (
F-FDG PET/CT) results in patients affected by seminoma.
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F-FDG PET/CT scans of 41 patients with diagnosis of seminoma were analyzed and compared to alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). PET/CT studies were analyzed qualitatively and measuring the maximum and mean standardized uptake value body weight max (SUV
, SUV
), maximum SUV lean body mass (SUV
), maximum SUV body surface area (SUV
), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of hypermetabolic lesions. All values were compared with serum markers.
31 PET/CT studies were true negative, 28 true positive, 6 false positive and 0 false negative with sensitivity of 100%, specificity of 84%, negative predictive value of 100%, positive predictive value of 82% and accuracy of 91%. No correlation between PET results and tumor marker levels was found and also between AFP and PET/CT semiquantitive parameters. All semiquantitative PET parameters were significantly related to hCG level.
F-FDG PET/CT has good accuracy in evaluating patients with relapsed seminoma. hCG levels were significantly correlated with metabolic PET/CT parameters.
18F-FDG PET/CT has good accuracy in evaluating patients with relapsed seminoma. hCG levels were significantly correlated with metabolic PET/CT parameters.Management of patients in ambulatory (or short stay) surgery relies on optimal organisation of the health care pathways and specific anesthesiology and surgical protocols. Postoperative medico-surgical complications can occur undetected by traditional hospital surveillance. This article identifies modern digital means that can be adapted to surveillance of patients at home telephone calls or teleconferences, automatic messaging, mobile phone applications, Web platforms and other e-connected devices. For each, we detail their advantages and their limitations.Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (AR) drugs such as bisphosphonates (BP) and denosumab (Dmab). Although several risk factors are described, the etiology of MRONJ is still not fully elucidated. Bone-strengthening is the primary aim of antiresorptive therapy; however, overly increased bone mass and microcrack accumulation are also discussed in MRONJ etiologies. The aim of this study is to evaluate the microarchitecture of jaw bones with micro-computed tomography (micro-CT) in AR-treated patients with or without MRONJ. Human jaw bone samples of AR-treated patients were separated into 11 groups by AR treatment bisphosphonate (BP), denosumab (Dmab), both (M) and control groups. Subgroups were divided according to the clinical localization as AR-exposed vital jaw bone (BPexp, Dmabexp, Mexp), osteonecrosis-margin of a sequestrum (BPOmar, DmabOmar, MOmar) and osteonecrosis-sequestrum (BPOseq, DmabOseq, MOseq). Healthy jaw bone (CHB) and osteoporotic jaw bonf the BPOseq group (median 7.46) doubled compared to that of the BPexp group (median 14.97; p = 0.0064). Mineralization parameters BMD and TMD were similar in all groups. Findings show evidence of enhanced bone mass and suspect microarchitecture in some AR-treated jaw bone compared to osteoporotic jaw bone. Despite increased bone mass, some MRONJ samples showed decreased trabecular connectivity by Euler characteristic compared to AR-treated jaw bone. These samples may indicate extensive ossification and ineffective bone mass with superficially higher bone mass without existing or even reduced mechanical stability, indicated by connectivity loss. This result might also suggest a high risk to microcrack accumulation. At some point, possibly some kind of over-ossification could lead to under-nourishment and microarchitectural weakness, creating instability, subsequently increasing vulnerability to MRONJ.The aim of this study was to assess any change between the preoperative and postoperative sizes of temporal and masseter muscles with magnetic resonance imaging (MRI) in patients undergoing unilateral temporomandibular joint surgery. This study was designed and implemented retrospectively. For clinical evaluation, a visual analog scale (VAS) and maximum mouth opening (MMO) were used. In order to make a preoperative diagnosis and perform a 6-month control, muscle size was measured in millimeters (mm) on T1 axial sections in MRI. read more Statistical analyses were performed using the SPSS 23.0 software package. Numeric variables were compared between two dependent groups using the Wilcoxon signed rank test. Statistical significance was set at p less then 0.05. Twelve patients who underwent unilateral discectomy plus dermis-fat grafting, with classical preauricular inverse L incision, were included in the study, and data for eleven female patients were evaluated. The difference in size between the operated and non-operdy findings as a whole, a size reduction was observed in the operated side of the masseter muscle after TMJ surgery. The etiology of this change may be surgical trauma to the temporal and masseter muscles, skeletal alteration resulting from condylar change secondary to discectomy, and patients restraining themselves from application of maximum bite force as a result of a self-protection mechanism due to postoperative pain.
Antegrade continence enemas have transformed treatment and improved the quality of life in children with neuropathic bowel, refractory constipation and fecal incontinence. However, it can often be difficult to manage problems that arise with ACE flushes.
We report the use of an online tool designed for nurses to help troubleshoot calls for problems associated with antegrade continence enema (ACE) flushes as well as update our algorithm for managing refractory constipation/fecal incontinence in a large single institution experience.
We developed an online tool based on our management protocol for managing refractory constipation/fecal incontinence (Summary Figure). Patient frequency and bother was assessed prior to the intervention and at one month after the intervention using 5- and 4-point Likert scales respectively. Patient demographics, MACE/Chait information, type of difficulty, volume of flush, and use of additives were recorded. Nurses were also interviewed prior to using the tool and 14 months afblems with flushes that can often be difficult to manage.
Patients reported less bother with their bowel issues after using our algorithm for managing refractory constipation/fecal incontinence and nurses reported that the tool was helpful.
Patients reported less bother with their bowel issues after using our algorithm for managing refractory constipation/fecal incontinence and nurses reported that the tool was helpful.Gaining an esthetical skin coverage can be challenging in some hypospadias repair cases, especially in those with significant ventral skin paucity. A local institutional technique used to correct ventral skin paucity in hypospadias is described. It consists of a redistribution of the abundant dorsal skin and its hooded prepuce to the ventral side of the penis where skin shortage is observed. Reallocation of the skin is performed by buttonholing the dorsal skin to the ventral side. This versatile technique can be adapted to most penile surgeries where some ventral skin paucity is observed.
Y-duplication is a rare subtype of urethral duplication whose surgical correction has traditionally yielded less than satisfactory results. Herein we report 18 patients, 17 of whom have completed successful urethral reconstruction.
A retrospective analysis was done on 18 children who have undergone repair of Y-duplication urethra in two tertiary care institutes from 2013 to 2020. The various subtypes encountered were classified in order to develop a rationale for reconstruction based on the underlying pathology. The various modalities used for reconstruction and the outcomes of the repair were studied. All but one boy voided mainly via the posterior (ventral) channel opening in the ano-rectum or perineum. These boys had the urethral reconstruction incorporating the healthy proximal ventral urethra at its origin. Further reconstruction up to the glans tip depended on the degree of dorsal (orthotropic) urethral patency, which forms the basis of our classification into Types I (completely stenotic), II (penition of anatomical variations, adequate operative exposure (trans pubic and/or perineal) and innovative utilisation of local and/or distant tissues (preputial island flap, ileal/sigmoid Monti tubes).
Successful reconstruction of boys with Y- duplication of the urethra entailed elucidation of anatomical variations, adequate operative exposure (trans pubic and/or perineal) and innovative utilisation of local and/or distant tissues (preputial island flap, ileal/sigmoid Monti tubes).The development of the female reproductive tract can be divided into three parts consisting of Müllerian duct organogenesis, pre-sexual maturation organ development, and post-sexual maturation hormonal regulation. In primates, Müllerian duct organogenesis proceeds in an estrogen independent fashion based on transcriptional pathways that are suppressed in males by the presence of AMH and SRY. However, clinical experience indicates that exposure to xenoestrogens such as diethylstilbestrol (DES) during critical periods including late organogenesis and pre-sexual maturational development can have substantial effects on uterine morphology, and confer increased risk of disease states later in life. Recent evidence has demonstrated that these effects are in part due to epigenetic regulation of gene expression, both in the form of aberrant CpG methylation, and accompanying histone modifications. While xenoestrogens and selective estrogen receptor modulators (SERMS) both can induce non-canonical binding confirmations in estrogen receptors, the primate specific fetal estrogens Estriol and Estetrol may act in a similar fashion to alter gene expression through tissue specific epigenetic modulation.Protein glycation provides a biomarker in widespread clinical use, glycated hemoglobin HbA1c (A1C). It is a biomarker for diagnosis of diabetes and prediabetes and of medium-term glycemic control in patients with established diabetes. A1C is an early-stage glycation adduct of hemoglobin with glucose; a fructosamine derivative. Glucose is an amino group-directed glycating agent, modifying N-terminal and lysine sidechain amino groups. A similar fructosamine derivative of serum albumin, glycated albumin (GA), finds use as a biomarker of glycemic control, particularly where there is interference in use of A1C. Later stage adducts, advanced glycation endproducts (AGEs), are formed by the degradation of fructosamines and by the reaction of reactive dicarbonyl metabolites, such as methylglyoxal. Dicarbonyls are arginine-directed glycating agents forming mainly hydroimidazolone AGEs. Glucosepane and pentosidine, an intense fluorophore, are AGE covalent crosslinks. Cellular proteolysis of glycated proteins forms glycated amino acids, which are released into plasma and excreted in urine.
