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A “C Odyssey”
Published in Qi Chen, Margreet C.M. Vissers, Vitamin C, 2020
Mark Levine, Pierre-Christian Violet, Ifechukwude C. Ebenuwa, Hongbin Tu, Yaohui Wang
But, before proceeding with such clinical experiments, a key precondition was to know the x-axis range for ascorbic acid concentrations in humans. From a clinical perspective, this is not much different from having normal limits on a basic metabolic panel, a common test in clinical care. However, data were limited or unavailable that described whether and how a wide range of different doses of ascorbic acid modulated plasma and tissue concentrations: pharmacokinetic data [30–33]. Comprehensive pharmacokinetic data of this kind were unavailable not just for ascorbic acid but for all vitamins. Without pharmacokinetic information as a foundation, it would be impossible to consider biosynthetic consequences and clinical outcomes in relation to any ascorbic acid concentration. For clinicians, an analogy would be to try to manage diabetes without prior knowledge of normal and abnormal blood glucose concentrations.
Epidemiology, Pathophysiology, Diagnosis and Treatment
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Susannah Clark, Patricia L. Roberts, Rocco Ricciardi
The basic laboratory workup for diverticulitis generally includes a complete blood count to identify leucocytosis, which is found in 55% of patients with acute diverticulitis.26 A basic metabolic panel will assess electrolytes and renal function and will be useful if the patient has altered their intake of fluids or nutrition due to symptoms.26 Urinalysis can help exclude urinary tract infection from the differential diagnosis and diagnose colovesical fistula.6,26 Some have used C-reactive protein (CRP) as a means of establishing the diagnosis of diverticulitis. Though it has not been prospectively validated, a CRP level of more than 50 mg/L in conjunction with left lower quadrant tenderness and no vomiting is most consistent with acute diverticulitis (likelihood ratio = 18). One study of 247 patients with acute sigmoid diverticulitis identified by CT observed corresponding increases in CRP level with signs of perforation. Only 20% of the patients with a CRP level of less than 50 mg/L had perforated diverticulitis, whilst 69% of the patients with a CRP level of more than 200 mg/L had perforated diverticulitis.26 Although not the most accurate test, the role of CRP in the evaluation and management of diverticulitis is promising.
Large Bowel Obstruction
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
A thorough laboratory evaluation is useful in determining the patient’s overall clinical status and may suggest intestinal ischemia, necrosis, or perforation. Although no level 1 evidence can be found to support the routine ordering of certain laboratory tests, it is well known that patients with colonic obstruction often present with multiple metabolic derangements requiring correction prior to surgical intervention. A basic metabolic panel and complete blood count should be done to evaluate for electrolyte imbalances, anemia, and leukocytosis. Other useful laboratory values include a lactate if there is concern for ischemia and a coagulation panel for operative preparation. Given that the most common cause of large bowel obstruction is cancer, a baseline carcinoembryonic antigen level may be reasonable. A single upright chest radiograph may be useful to screen for free air if there is a high suspicion for obstruction with perforation.
Outcomes of Patients with COVID-19 from a Specialized Cancer Care Emergency Room
Published in Cancer Investigation, 2022
Sandy Simcha Nath, Nandini Umesh Yadav, Andriy Derkach, Rocio Perez-Johnston, Lisa Tachiki, Kelsey Maguire, Afia Babar, Molly A. Maloy, Adam Klotz, Justin Jee, Ying Taur, Sanjay Chawla, Esther Babady, Ali Raza Khaki, Margaret M. Madeleine, Petros Grivas, Daniel J. Henning, H. Laura Aaltonen, Gary H. Lyman, Jeffrey Groeger
Patient demographic data, laboratory results, anticancer treatment, and disposition from the UCC were automatically obtained from the electronic medical record (EMR). Clinical data, including baseline comorbidities, presenting symptoms, and outcomes, were obtained by chart review. “Basic” metabolic panel includes blood urea nitrogen (BUN), calcium, carbon dioxide, chloride, creatinine, glucose, potassium, and sodium. “Complete” metabolic panel includes all components of the basic metabolic panel but additionally measures albumin, total protein, alkaline phosphatase, alanine amino transferase (ALT or SGPT), aspartate amino transferase (AST or SGOT), and bilirubin. Chest radiography, including chest X-rays and chest CTs, obtained during the UCC visit were independently reviewed by two radiologists and categorized into “unilateral opacity,” “bilateral opacity,” “no changes.” Patients with extensive preexisting lung disease were labelled as “inconclusive.” Severe event includes acceptance to Intensive Care Unit (ICU), mechanical ventilation, or death.
Clinical symptoms and blood concentration of new psychoactive substances (NPS) in intoxicated and hospitalized patients in the Budapest region of Hungary (2018-19)
Published in Clinical Toxicology, 2022
László Institóris, Katalin Kovács, Éva Sija, Róbert Berkecz, Tímea Körmöczi, István Németh, István Elek, Ágnes Bakos, Ildikó Urbán, Csaba Pap, Éva Kereszty
Between the 1st of April 2018 and the 30th of March 2019, 116 patients suspected of drug intoxication were selected by the above detailed criteria of those who were transported to the DECT. EMS recorded the history of drug use from patients and witnesses at the scene, as well as, clinical symptoms. Intoxication was diagnosed by the EMS physician and by experienced emergency toxicology specialists of the DECT. Gender, age, and gross symptoms were registered at the scene by the EMS staff. More detailed symptoms were registered upon admittance by the staff of DECT, and included Poison Severity Score (PSS) [4], Glasgow Coma Score (GCS), blood pressure, heart rate, body temperature, blood glucose, and other routine investigations. Medical history and prescribed medications were reported by the patients. Clinical laboratory testing involved complete blood count (CBC), basic metabolic panel (BMP), electrolyte, lipid, hepatic and kidney function panels. Blood samples for psychoactive substance measurements were taken through a needle thumbtack – introduced for supportive therapy and medication – into 5-ml sodium citrate-containing tubes at admittance (0 h) and 1, 3, and 5 h later. To prevent cross contamination during repeated sampling, the cannula was flushed with 1.0 ml Vitamin C injection (100 mg/ml), according to the local protocol. Analysis of blood samples and data processing were performed at the Department of Forensic Medicine (DFM) at the University of Szeged. Blood samples were transferred for analysis once or twice every two weeks. Both clinical data and blood samples were blindly assessed.
Outpatient colectomy—a dream or reality?
Published in Baylor University Medical Center Proceedings, 2022
Stephen Campbell, Alessandro Fichera, Scott Thomas, Harry Papaconstantinou, Rahila Essani
We recommend early oral intake in the postanesthesia care unit and day surgery with a full liquid diet as the patient tolerates and stopping intravenous fluids.9,10 We only obtained hemoglobin for our first patient in recovery. Obtaining hemoglobin/hematocrit or a basic metabolic panel can be tailored depending on intraoperative blood loss and length of surgery. We gave the second prophylactic heparin dose in recovery 8 hours from incision. As these patients were being discharged without a hospital stay, early ambulation was done in recovery. The importance of continued ambulation should be emphasized to the patients, and consideration should be given for deep vein thrombosis prophylaxis in the form of low-molecular-weight heparin injections at home based on the patient’s surgical indication.11,12 If the patient is unable to void within 8 hours, we replace the Foley and discharge with a leg bag rather than prolong observation and recommend follow-up in the clinic for Foley removal.