Saint Martin University

To evaluate the association of symptoms of myofascial pain and dysfunction with the presence of tinnitus in adults. A case-control study involving 80 cases presenting tinnitus and 160 controls without this condition was designed. Sociodemographic variables as well as symptoms of myofascial pain and dysfunction measured using the Brux-Screen, psychopathological symptoms obtained from the Symptom Checklist Revised (SCL-90-R) and Perceived Stress Scale (PSS-10), stressful life events score quantified through the Social Readjustment Rating Scale (SRRS) and presence of tinnitus supported by items of the Tinnitus Handicap Inventory (THI) were collected. A directed acyclic graphs (DAG) analysis was performed to identify potential relationships, and multivariable logistic regression used to assess associations. Exposure to high levels of noise (OR = 2.29; 95

Background: Septic shock is associated with severe circulatory, cellular, and metabolic dysfunction. Norepinephrine is the first-line vasopressor; however, high catecholamine exposure may be associated with impaired tissue perfusion and increased mortality. Objective: To evaluate the association between vasopressor catecholamine exposure, tissue perfusion markers, and 28-day mortality in adult ICU patients with septic shock. Methods: A retrospective multicenter cohort study was designed including 300 adult patients with septic shock admitted to intensive care units between 2022 and 2025. The main exposure was maximum norepinephrine dose during the first 24 hours, categorized as low, moderate, or high exposure. Tissue perfusion was assessed using lactate, lactate clearance, capillary refill time, urine output, and SOFA progression. The primary outcome was 28-day mortality. Results: Overall 28-day mortality was 39.7%. Mortality increased from 19.5% in the low-dose group to 34.9% in the moderate-dose group and 64.1% in the high-dose group. High norepinephrine exposure was associated with higher lactate at 6 and 24 hours, lower lactate clearance, prolonged capillary refill time, reduced urine output, and greater SOFA progression. In multivariable analysis, norepinephrine dose ≥0.30 μg/kg/min was independently associated with 28-day mortality. Conclusions: High catecholamine vasopressor exposure was associated with impaired tissue perfusion and increased mortality in septic shock. Norepinephrine dose ≥0.30 μg/kg/min may serve as an early clinical warning marker when interpreted together with lactate clearance, capillary refill time, and urine output.

Abstract The coexistence of diabetes mellitus (DM) and hypothyroidism in dogs represents a complex clinical challenge due to interactions between metabolic and hypothalamic–pituitary–thyroid axes. This case report describes the clinical, endocrine and metabolic evolution of a male Siberian Husky diagnosed with concurrent DM and hypothyroidism, monitored for 5 weeks under comprehensive outpatient management. Treatment included stepwise insulin therapy (regular insulin, followed by detemir and then glargine), thyroid hormone replacement with levothyroxine sodium, and a commercial low‐glycaemic, high–insoluble‐fibre diet. Daily blood glucose curves, serial biochemical profiles and thyroid function tests were used to correlate metabolic changes with clinical progression. The patient showed progressive weight gain (from 16.3 to 19.9 kg, +22.1%), reduced glycaemic variability, and stabilisation of plasma thyroxine levels. Metabolic control improved notably from the second week onward, coinciding with the introduction of the therapeutic diet and restoration of thyroid hormonal balance.

Autologous breast reconstruction aims to restore form and well-being after mastectomy, with increasing emphasis on long-term functional outcomes and quality of life. Perforator flaps (e.g., DIEP, TAP) preserve muscle, potentially reducing donor-site morbidity, while musculocutaneous flaps (e.g., TRAM, latissimus dorsi) involve muscle sacrifice, which may impair function. We aimed to systematically compare long-term functional outcomes and quality of life between perforator and musculocutaneous flaps in postmastectomy breast reconstruction. Randomized controlled trials (RCTs) comparing perforator versus musculocutaneous flaps or tissue expanders were included if they reported validated functional or quality-of-life outcomes with ≥ 12 months of follow-up. Searches were conducted in MEDLINE, Embase, and LILACS. Study selection and data extraction were performed independently in duplicate. Risk of bias was assessed using the Cochrane tool. A structured narrative synthesis was conducted. Seven RCTs evaluated DIEP, TAP, LD, and other flap techniques. Perforator flaps were associated with modest improvements in breast satisfaction and sexual well-being (e.g., DIEP vs. TE: BREAST-Q 72.1 vs. 63.4; p = 0.03) and better shoulder function in TAP versus LD (CSS 80.1 vs. 76.3; p = 0.033). However, complication rates were higher with DIEP (e.g., 31