RESUMEN
Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.
RESUMEN
BACKGROUND: Glycosylated hemoglobin (HbA1c) in diabetic patients reflects the average blood glucose level, and will not be affected by variability in blood glucose in short time. Regular care of patients by medical staff could effectively control glycemic situation. The aim of this study was to assess the effect of medical care by general physicians on glycemic control by measuring of HbA1c. METHODS: In order to assess the effectiveness of National program for diabetes control and prevention in Iran, we compare HbA1c, Fasting blood glucose (FBS), systolic and diastolic blood pressure in two groups of diabetic patients diagnosed in this program. The first group consisted of patients who received at least four visits by General Physician (GP) during one year after the diagnosis, and second group were patients who did not visited by GPs or received 1-3 visits. RESULTS: After one year, 24.1% of patients did not receive any care, while 57.9% examined at least once a year. Among visited patients, 23.5% received 1-3 times medical care and 23.5% received four or more visits. HbA1c was significantly lowered in patients with appropriate care (four and more) compared with the non cared patients and patients with less than four cares. CONCLUSION: Appropriate number of visits for each patient by GPs is an effective glycemic control in diabetic patients. Although this study provides a framework for medical care in diabetes, how to take care of these patients depends on specific situation of each patient and should be determined for each of them individually.
RESUMEN
BACKGROUND: General anesthesia and regional anesthesia have both been shown to be suitable techniques for patients undergoing lower thoracic and lumbar spine surgery; however, GA is the most frequently used method. The purpose of this study was to conduct an acceptable RCT to compare the intraoperative parameters and postoperative outcome after SA and GA in patients undergoing elective lumbar disk surgery. METHODS: Patients undergoing laminectomy for herniated lumbar disk during the years 2005 and 2007 were enrolled. They were randomly selected to undergo GA and SA. The variables recorded during the operation were the patients' HR, MAP, amount of blood loss, and surgeons' satisfaction with the operating conditions. The severity of pain, nausea, vomiting, and length of stay in the hospital were recorded in the postoperative course. RESULTS: The mean blood loss was less in the group undergoing GA; however, the difference was not statistically significant. The surgeon's satisfaction was reported to be higher in the GA group. No major intraoperative complication was reported in either series. During the recovery period, hypertension was reported to happen more frequently in the patients undergoing GA; and postoperative nausea and vomiting were more frequent among patients recovering from SA. CONCLUSION: Contrary to previous studies, the findings of the present study revealed that SA has no advantages over GA. Moreover, it was showed that GA can reduce the related risks and complications in several aspects.