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The prevalence of diabetes is on the rise worldwide especially in developed countries. The aim of glucose management in all types of diabetes is to minimize chronic and acute complications associated with diabetes. All patients with type 1 diabetes mellitus (T1DM) require insulin. Main areas of technology advances in diabetes are continuous subcutaneous insulin infusion (CSII) and also continuous glucose monitoring systems for the management of patients with both types of diabetes. It is very important to analyse the epidemiological situation within each country before and during the clinical practice guidelines (CPGs) development and implementation. The analyses will allow us to monitor the effect of the CPG after its implementation. The aim of this short communication is to analyse the epidemiology of prevalence and incidence of diabetes mellitus and use of CSII to inform development of CPGs in the Czech Republic. The analysis is developed based on the data managed by Institute of Health Information and Statistics of the Czech Republic. We used the National Register of Reimbursed Health Services 2015-2017 as primary source, and the annual report type A (Ministry of Health) 1-01: for Diabetology (A MH 004) 2007-2017 was used as validation source. The presented data are related to the year 2016 because we were able to validate them based on the data from 2015 to 2017 for this cohort of patients. The number of patients with T1DM is increasing in the Czech Republic with no significant sex difference. Life expectancy is about 11 years lower in the T1DM population. The majority of the patients are in older age; however, these are not treated with CSII compared with the younger population. From 61 533 patients with T1DM, 81% were reported with acute and chronic complications in 2016. Only 5011 of these patients were reported as using CSII. [ABSTRACT FROM AUTHOR]

Caesarean section is currently the most frequently performed intervention after episiotomy in obstetrics and one of the most common abdominal operations overall. Rates of caesarean section have been rising globally. Given the increasing rate worldwide it is therefore necessary and important to understand how caesarean section affects child development. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioural disorder in children. ADHD is characterized by a combination of symptoms including inattention, impulsivity and hyperactivity. Caesarean section may affect psychological development through changes in microbiota or stress response, and birth by caesarean section can be associated with a small increased risk of ADHD. In the current literature, there is no systematic review or protocol of the systematic review answering the question of whether the mode of delivery has influence on the risk of ADHD development. The objective of this review is to synthesize the best available evidence regarding the epidemiological association between the mode of delivery (caesarean section versus vaginal delivery) as exposure and ADHD as the outcome. A three-step strategy will be utilized in this review, aiming to find both published and unpublished studies. The initial search will be conducted using the MEDLINE, CINAHL and EMBASE. The second search will involve 21 databases and sources. Following the Preferred Reporting Items for Systematic Review and Meta-analysis statement analysis of title, abstracts and full texts, critical appraisal and data extraction will be carried out on selected studies using standardized instruments developed by Joanna Briggs Institute. All steps will be performed by two independent reviewers. If possible, statistical meta-analysis using Joanna Briggs Institute within the System for the Unified Management, Assessment and Review of Information will be pooled. Statistical heterogeneity will be assessed. The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment is not needed - we will search/evaluate the existing sources of literature. [ABSTRACT FROM AUTHOR]

Blastomycosis is an endemic fungal infection caused by Blastomyces, a soil-dwelling dimorphic fungus found predominantly in North America. In this pictorial essay, we illustrate the varied imaging features of blastomycosis along with a brief description of the epidemiology, clinical aspects, and differential diagnosis, emphasizing clues that can help radiologists arrive at this diagnosis., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Societal guidelines exist for the management of pain, agitation, and delirium (PAD) in critically ill patients. This contemporary practice aims for a more awake and interactive patient. Institutions are challenged to translate the interrelated multivariable concepts of PAD into daily clinical practice and to demonstrate improvement in quality outcomes. An interdisciplinary goal-directed approach shows outcomes in high-acuity surgical critical care during the early stages of implementation., Methods: This study was a prospective preintervention and postintervention design. A formal PAD clinical practice guideline targeting standardized assessment and "light" levels of sedation was instituted. All mechanically ventilated patients admitted to a 24-bed surgical intensive care unit (ICU) at an academic medical center during a 6-month period were included (3 months before and 3 months after implementation). Sedation and agitation were measured using the Richmond Agitation Sedation Scale (RASS), pain measured using a Behavioral or Numeric Pain Scale (NPS/BPS), and delirium using the Confusion Assessment Method for the Intensive Care Unit. Total ventilator days with exposure to continuous opioid or sedative infusions and total ICU days where the patient received a physical activity session exercising out of bed were recorded., Results: There were 106 patients (54 at preintervention and 52 at postintervention). Mean percentage of RASS scores between 0 to -1 increased from 38% to 50% postintervention (P < .02). Mean percentage of NPS/BPS scores within the goal range (<5 for BPS and <3 for NPS) remained stable, 86% to 83% (P = .16). There was a decrease in use of continuous narcotic infusions for mechanically ventilated patients. This was reported as mean percentage of total ventilator days with a continuous opioid infusing: 65% before implementation versus 47% after implementation (P < .01). Mean percentage of ICU days with physical activity sessions increased from 24% to 41% (P < .001). Overall mean ventilator-free days and ICU length of stay were 5.4 to 4.5 days (P = .29) and 11.75 to 9.5 days (P = .20), respectively., Conclusion: Measureable patient outcomes are achievable in the early stages of PAD guideline initiatives and can inform future systems-level organizational change. Pain, agitation, and delirium assessment tools form the foundation for clinical implementation and evaluation. High-acuity surgical critical care patients can achieve more time at goal RASS, decreased ventilator days, and less exposure to continuous opioid infusions, all while maintaining stable analgesia.

Background: Standard methods of cleft palate repair rely on existing palatal tissue to achieve closure. These procedures often require relaxing incisions, causing scars and growth restriction, and may result in insufficient palatal length and suboptimal positioning of the velar musculature. The Furlow double opposing Z-plasty improves palatal length and repositions the velar musculature; however, relaxing incisions may still be needed. The addition of buccal flaps to the Furlow repair obviates the need for relaxing incisions and allows the Furlow repair to be used in wide clefts., Methods: A retrospective review was performed on 505 patients; all patients were treated with the double opposing Z-plasty plus or minus buccal flap approach. Outcomes included nasal resonance, secondary speech surgery, and postoperative complications. A comparison was made between patients treated with double opposing Z-plasty alone and those treated with double opposing Z-plasty plus buccal flaps., Results: The average nasal resonance score was 1.38 and was equivalent in both the double opposing Z-plasty alone and with buccal flap groups, despite significantly more wide clefts in the buccal flap group (56 percent versus 8 percent). The secondary surgery rate for velopharyngeal insufficiency was 6.6 percent and the fistula rate was 6.1 percent. The large fistula rate (>2 mm) was 2.7 percent., Conclusions: The double opposing Z-plasty plus or minus buccal flap approach is a useful alternative to standard palate repairs. Speech outcomes were excellent, even in wider clefts, and postoperative complications were minimal. Buccal flaps allow the benefits of the Furlow repair to be applied to any size cleft, without the need for relaxing incisions., Clinical Question/level of Evidence: Therapeutic, III.

Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease and is associated with a very poor prognosis. IPF manifests histopathologically as usual interstitial pneumonia (UIP) and as subpleural and basal predominant reticulation with honeycombing on high-resolution computed tomography (HRCT) of the chest. When a high-confidence radiologic diagnosis of UIP is made on HRCT, surgical biopsy is rarely required. Therefore, radiologists should recognize a UIP pattern on HRCT as well as recognize other patterns of fibrosing lung disease such as nonspecific interstitial pneumonia or chronic hypersensitivity pneumonitis, both of which can be mistaken for UIP. This article reviews the clinical, CT, and histopathologic features of IPF, discusses the impact of CT findings on prognosis, and describes complications associated with IPF.

Advances in medicine have significantly improved lives and life spans globally. However, these practices have come with their own set of secondary consequences. Hospital-acquired anemia is one such consequence and is conferred by new medicines, operations, procedures, and tests. In this review, the authors will explore the data on this poorly considered phenomenon and discuss the etiologies, outcomes, and prevention strategies for some of the more prolific causes of hospital-acquired anemia. This study also will review the risks and benefits of treating hospital-acquired anemia.

Porphyrin, mercury, and creatinine levels in single-void urine specimens ("spot samples") were compared with calculated 24-hour urine concentrations among 146 (77 male and 69 female) practicing dentists who are participating in an ongoing study of urinary porphyrin changes as a biomarker of mercury body burden. All subjects had urinary mercury concentrations < or = 5 micrograms/L, a level comparable to that of the general US population and which is below that determined to be associated with mercury-induced changes in urinary porphyrin excretion rates. The results confirmed previous findings of no significant diurnal variation in any of the porphyrin levels normally found in urine or in total porphyrin levels combined among males but describe significant diurnal variations in most porphyrin levels as well as concentrations of total porphyrins combined among females. Similarly, no evidence of large diurnal variation in mercury excretion among males was apparent, whereas significant diurnal variation in the mercury excretion rate among females was found. Creatinine adjustment of porphyrin or mercury concentrations had no significant effect on these findings. Moreover, no evidence of diurnal variation in urinary creatinine excretion among either male or female subjects was obtained, despite substantial between-subject variability in this parameter. These results support the view that spot urine samples may be utilized to derive reasonably accurate estimates of 24-hour porphyrin and mercury excretion rates in male subjects. In contrast, time of day appears to be of considerably greater importance when spot samples are utilized as 24-hour estimates of either porphyrin or mercury excretion rates among females. Additionally, time of day may be an important consideration in studies involving serial (repeated) porphyrin or mercury measurements using spot urine samples, irrespective of gender distribution of study subjects.

Hospital surveys have traditionally been the nemesis of hospital personnel. With proper management and increased awareness, however, a survey can produce positive results and attitudes for both surveyor and hospital staff. Knowledge of effective tactics can turn the "survey-weary" into the "survey-wise."