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Schulz Cullen posted an update 6 months, 4 weeks ago
Perforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature.
A systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations.
The search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209.
In this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes.
Systematic review and meta-analysis, level III.
Systematic review and meta-analysis, level III.Filgotinibis aselective Janus kinase 1 inhibitor drug which is currently under investigation for the treatment of rheumatoid arthritis and Crohn s disease. Masitinib purchase The aim of the present study was to develop an accurate, simple and sensitive LC-MS/MS method for the determination of filgotinib (FLG) in human liver microsomes (HLMs) and its application to a metabolic stability study. Chromatographic separation was carried on using of a reversed phase C18 column. The mobile phase was mixture of acetonitrile and ammonium formate (10 mM, pH 3.8) (3070, v/v), under isocratic elution at a flow rate of 0.3 mL/min. Veliparib was used as internal standard. FLG was extracted from HLMs by precipitation. An electrospray ionization source was used to assay of FLG. The assay of FLG at m/z 426 → 358 and 426 → 291 for FLG and IS at 245 → 145 and 245 → 84 was attained through MRM. The linearity of the investigated method was observed from 5 to 500 ng/mL (correlation coefficient r2 = 0.999). The LOD was 1.43 ng/mL, while the LOQ was 4.46 ng/mL. The investigated method exhibited good recovery (98.42-108.6%) and precision (ranged from 0.88% to 4.7%). The investigated method was successfully employed for a metabolic stability study of FLG in the HLMs matrix. The metabolic stability of FLG was evaluated by measuring two parameters, in vitro t1/2 (48.47 min) and intrinsic clearance (14.29μL/min/mg). The results of the metabolic study confirm that FLG is execrated from the human body at a slower rate compared to related tyrosine kinase inhibitors. Therefore, drug plasma levels and kidney function should be monitored due to potential bioaccumulation.Simulation is one teaching strategy that health educators use to promote active learning, however, evidence to support whether students utilising simulations develop skills in critical thinking and appraisal in their academic literacy, is lacking. This study explored the impact of embedding a desktop simulation about the hemolytic disease of the newborn (HDN) in a first-year, undergraduate nursing course on students’ acquisition of knowledge, self-confidence, and development of critical thinking in academic writing. The study used a quasi-experimental, two-group, and pre-test-post-test design. After using the simulation, students reported i. a positive learning experience, ii. an increase in their self-confidence to critically appraise a case study, and iii. greater student success in two assessments for student’s participating in the simulation compared to students who only used lecture notes as a study tool. The findings support the use of simulations to promote active learning, knowledge acquisition and opportunities to develop self-confidence and critical thinking in academic writing.Spiritual care has long been known for being as important as difficult to deliver. Many barriers to spiritual care practice have been reported but are still difficult to overcome. Yet, the answer may not be centred in the patient needs but in the healthcare provider’ spiritual self-awareness and self-consciousness. The debate is then opened on what concepts should really be addressed spiritual care or spiritual intelligence and which should be trained since spiritual intelligence enhancement can bring many other benefits beyond increased quality of care, such as self-growing tools to better cope with the hardiness of the profession. This paper introduces the debate around this issue, and opens the discussion to different perspectives and approaches to a troublesome educational subject.As opportunistic omnivores, humans are evolutionarily adapted to obtain calories and nutrients from both plant and animal food sources. Today, many people overconsume animal products, often-processed meats high in saturated fats and chemical additives. Alternatively, strict veganism can cause nutritional deficiencies and predispose to osteopenia, sarcopenia, and anemia. A logical compromise is a plant-rich diet with fish/seafood as principal sources of animal food. This paper reviews cumulative evidence regarding diet and health, incorporating data from landmark clinical trials of the Mediterranean diet and recommendations from recent authoritative guidelines, to support the hypothesis that a Pesco-Mediterranean diet is ideal for optimizing cardiovascular health. The foundation of this diet is vegetables, fruits, nuts, seeds, legumes, whole grains, and extra-virgin olive oil with fish/seafood and fermented dairy products. Beverages of choice are water, coffee, and tea. Time-restricted eating is recommended, whereby intermittent fasting is done for 12 to 16 h each day.