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Sinking Skin Flap Syndrome

Published on: 8th September, 2017

OCLC Number/Unique Identifier: 7317656812

A previously healthy 26-year-old gentleman, referred from a state hospital with history of alleged fall from 10 feet height at a construction site on the same day. Glasgow coma scale (GCS) at that hospital was E2 V2 M5. He was brought in to our Emergency Unit, Hospital Kuala Lumpur with GCS of E1 V2 M4 (7/15). Pupils were 5mm+ /3mm+. He sustained left ear bleed. Otherwise vital signs were stable, with no other extracranial injury. Computed tomography (CT) scan brain (Figure 1) showed right frontotemporal acute subdural hematoma with left frontotemporoparietal acute subdural hematoma, with underlying subarachnoid hemorrhage, mass effect and midline shift to left side more than 0.5cm and obliteration of basal cistern. 
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Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post-mortem Computed Tomography (PMCT): A Validation Study

Published on: 17th January, 2018

OCLC Number/Unique Identifier: 7347018053

Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine. Urinary bladder volume (UBV) was calculated based on the equation used in ultrasonographic volumetry, V=axbxcx 0.5. These 3 parameters correlated well with the UBV and having a strong positive relationship. There was a significant positive correlation at low strength between alcohol concentrations with calculated UBV. There was statistical significant correlation between urinary bladder distension on postmortem CT and cases of intoxication especially more corresponding for positive alcohol detection. The average sensitivity was 35.65% whereby it was slightly lower than those reported in Rohner C, et al. In this study we have deduced that diuretics effect of alcohol was the main reason causing bigger urinary bladder or UBV and was more prominent than the influence of drug of abuse on the urinary bladder sphincter. The distension of urinary bladder should raise suspicion of intoxication, but would not provide information on the quantity of the intoxicating agent due to its significant but poor correlation. It was important to note that intoxication may also be present in cases with low urinary bladder volume. In conclusion, it is vital to consider circumstantial evidence, as well as the presence of additional findings on imaging before suggesting the diagnosis of intoxication based on urinary bladder distension on imaging. Currently, the use of CT bladder imaging should serve as a strong indication that the individual may be intoxicated but should be confirmed by a complete autopsy and a detailed toxicological analysis.
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ROGAVF STUDY 2019 - Relationship of HbA1C (GLYCEMIC Control) on outcomes of AV FISTULAS: A prospective observational study

Published on: 22nd July, 2019

Objective: The main aim of the study was to compare outcomes based on diabetic control for patients undergoing formation of a new upper limb arteriovenous fistula (AVF). Research design and methods: A prospective cohort study was performed where we obtained baseline HbA1c in 65 patients before undergoing AV fistula formation. Patients were followed up at our clinic 6 weeks after creation to assess fistula maturity. Results: Multiple logistic regression was used to analyze the association between HbA1c status and maturity of AVF at 6 weeks after controlling for possible confounding factors such as age, sex, presence of hypertension and dyslipidaemia. Those with HbA1c less than 6.5 were 22 times likely to have maturity of AVF at 6 weeks as compared to those with HbA1c 6.5 or more (AOR = 22.65, p < 0.005) Conclusion: Good diabetes control, reflected by an HbA1c of less than 6.5, is associated with a very high possibility of AVF maturity at 6 weeks post creation.
Cite this ArticleCrossMarkPublonsHarvard Library HOLLISGrowKudosResearchGateBase SearchOAI PMHAcademic MicrosoftScilitSemantic ScholarUniversite de ParisUW LibrariesSJSU King LibrarySJSU King LibraryNUS LibraryMcGillDET KGL BIBLiOTEKJCU DiscoveryUniversidad De LimaWorldCatVU on WorldCat