Intra-osseous-access-associated lower limb compartment syndrome in a critically injured paediatric patient

No abstract available

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ICU mortality and variables associated with ICU survival in Poland: A nationwide database study

BACKGROUND Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. OBJECTIVES Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. DESIGN Retrospective analyses of a database reporting ICU stays in Poland. SETTINGS AND PATIENTS The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. MAIN OUTCOME MEASURES ICU mortality and variables associated with ICU survival. RESULTS A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P 

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Life-threatening ketoacidosis in a lactating woman

No abstract available

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Comparison of the peripheral antinociceptive effect of somatostatin with bupivacaine and morphine in the rodent postoperative pain model

BACKGROUND AND OBJECTIVES Infiltration of surgical wound with local anaesthetics attenuate postoperative pain. However, side effects can also occur. Somatostatin (SST) and its analogues like octreotide reportedly reduce peripheral sensitisation. The current study evaluates peripherally mediated antinociceptive effect of SST in a rat model of postoperative pain. This was compared with bupivacaine and morphine under identical experimental conditions. DESIGN Randomised vehicle-controlled blind study. SETTING Pain research laboratory, All India Institute of Medical Sciences, New Delhi from February 2014 to July 2017. EXPERIMENTAL SUBJECT Rodent hind paw incision model. INTERVENTIONS Sprague-Dawley rats were subjected to incision and one of the following drugs administered into the open wound once by a micropipette: SST (10, 30 or 100 μg), bupivacaine (3, 10, 30, 50 or 100 μg) or morphine (100 μg). Antinociceptive effect of SST was further evaluated for its reversibility, site of action, effect on spinal c-fos expression and blood glucose level. The site of action of morphine was also investigated. MAIN OUTCOME MEASURE Nociception was estimated by nonevoked (guarding behaviour) and evoked (mechanical allodynia and thermal hyperalgesia) pain behaviours between 2 h and days 4 to 7. RESULTS Nociception was maximum 2 h after incision. SST (10 to 100 μg) significantly attenuated guarding behaviour between 2 h and day 2. A delayed inhibitory effect was observed on allodynia. Bupivacaine (10 to 100 μg doses) similarly decreased guarding score up to day 2 though evoked pain behaviours were relatively unaffected. In contrast, morphine produced a potent but transient inhibitory effect on guarding score at 2 h, which was mediated by both peripheral and central opioid receptors. The antinociceptive effect of SST was peripherally mediated by type 2 receptors and was associated with decreased c-fos staining. Blood glucose level was unaltered. CONCLUSION Guarding behaviour, which likely represents pain-at-rest following surgery, was attenuated by both bupivacaine and SST to comparable extents. This novel peripherally mediated antinociceptive effect of SST needs further evaluation.

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Paucity of evidence for the effectiveness of prophylactic low-dose oxytocin protocols (<5 IU) compared with 5 IU in women undergoing elective caesarean section: A systematic review of randomised controlled trials

No abstract available

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Strategies for Reducing Diagnostic Delay in Acral Lentiginous Melanoma

J. Bañuls
Actas Dermosifiliogr.2018;109:764

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Coding of Dermatologic Diagnoses: An Unresolved Issue

I. Belinchón Romero
Actas Dermosifiliogr.2018;109:765

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https://ift.tt/2P5WztS