Serum Triamcinolone Levels Following Cervical Interlaminar Epidural Injection
Serum Triamcinolone Levels following Cervical Interlaminar Epidural Injection 1Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA 2Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA 3Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA 4Division of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN, USA Correspondence should be addressed to Tim J. Lamer Received 23 October 2017; Accepted 25 February 2018; Published 21 March 2018 Copyright 2018 Tim J. Lamer et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. L. Manchikanti, V. Pampati, F. J. Falco, and J. A. Hirsch, Assessment of the growth of epidural injections in the medicare population from 2000 to 2011, Pain Physician, vol. 16, no. 4, pp. E349E364, 2013. View at Google Scholar J. B. Hagan, D. Erickson, and R. J. Singh, Triamcinolone acetonide induced secondary adrenal insufficiency related to impaired CYP3A4 metabolism by coadministration of nefazodone, Pain Medicine, vol. 11, no. 7, pp. 11321135, 2010. View at Publisher View at Google Scholar View at Scopus Y. Song, J. R. Schroeder, and L. M. Bush, Iatrogenicushing syndrome and secondary adrenal insufficiency related to concomitant triamcinolone and ritonavir administration: a case report and review, Journal of the International Association of Providers of AIDS Care, vol. 13, no. 6, pp. 511514, 2013. View at Publisher View at Google Scholar View at Scopus J. L. Even, C. G. Crosby, Y. Song, M. J. McGirt, and C. J. Devin, Effects of epidural steroid injections on Continue reading >>
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Diabetic Ketoacidosis Following Administration Of Cervical Epidural Steroid Injection In A Non-diabetic
f, Warren L. Reuther, IIIg aKansas City University of Medicine and Biosciences, Kansas City, MO, USA bDepartment of Internal Medicine, University of South Florida, Tampa, FL, USA cDepartment of Internal Medicine, Banner Good Samaritan Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA dDepartment of Internal Medicine, University of Florida-Jacksonville, Jacksonville, FL, USA eDepartment of Internal Medicine, Palm Beach Centre for Graduate Medical Education, West Palm Beach, FL, USA fThe Ohio State University, Columbus, OH, USA gDepartment of Radiology, West Palm Hospital, West Palm Beach, FL, USA hCorresponding Author: Andrew C. Berry, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO 64106, USA Manuscript accepted for publication July 4, 2014 Short title: Diabetic Ketoacidosis doi: Our case describes a 56-year-old African-American female who underwent fluoroscopy-guided epidural steroid injection for recurrent neck and arm pain. The administration of steroid injections has been shown to diminish peripheral glucose metabolism and to stimulate gluconeogenesis, thus elevating blood glucose concentration and worsening insulin resistance. Though uncommon, diabetic ketoacidosis (DKA) can arise following both epidural steroid treatments in diagnosed diabetics or in cases of coinciding infection. At the time of the epidural injection, the patient showed no signs of acute infection, concomitant drug use or any documented diabetes, all potential causes of DKA. Our case is unique because it describes a documented non-diabetic patient who went into DKA following cervical epidural steroid injection. Keywords: Diabetic ketoacidosis; Diabetes; Epidural steroid injection; Degenerative disc disease Degenerative d Continue reading >>
Effects Of Two Different Doses Of Epidural Steroid On Blood Glucose Levels And Pain Control In Patients With Diabetes Mellitus.
Type: Randomized Controlled Trial, Journal Article, Observational Study A high incidence of diabetes mellitus has been reported among patients diagnosed with lumbar degenerative spinal diseases. Although epidural steroid injections are known to increase the postprocedure blood glucose level, it has not been investigated whether a lower steroid dose can reduce blood glucose excursions and still be effective in controlling patients' subjective pain.We compared the effects of 2 common doses of triamcinolone administered via epidural steroid injections on blood glucose levels and pain control in patients with diabetes mellitus to determine an adequate epidural steroid dose.A prospective observational study.One hundred patients with diabetes mellitus were enrolled. They received lumbar transforaminal, lumbar interlaminar, or caudal epidural triamcinolone for radiculopathy, spinal stenosis, or failed back surgery syndrome. After the type of procedure was clinically determined, the doses of triamcinolone given were randomly chosen, either 40 mg (Group 40) or 20 mg (Group 20). The patients were asked to measure their finger stick blood glucose level twice daily (fasting and postprandial) for 3 days before the injection, on the day of the injection, for 7 days after the injection, and at 14 days after the injection. They also kept a blood glucose diary. Employment status and clinical outcome were evaluated at 8 weeks after the procedure.There were significant increases in fasting blood glucose (FBG) level on postprocedure day (PPD) #1 to PPD #3 in Group 40, but on PPD #1 in Group 20. Moreover, there was a significant difference in FBG between groups on PPD #1 and PPD #2 (FBG on PPD #1: 179 [51]) mg/dL in Group 40 versus 146 [50] mg/dL in Group 20, P < 0.001]. Postprandial blood Continue reading >>
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No Difference In Pain Reduction After Epidural Steroid Injections In Diabetic Versus Nondiabetic Patients: A Retrospective Cohort Study
Author information Copyright and License information Copyright : Journal of Anaesthesiology Clinical Pharmacology This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms. Diabetes affects peripheral and central neurons causing paresthesia, allodynia, hyperalgesia, and spontaneous pain. However, the effect of diabetes on response to epidural steroid injection (ESI) remains unknown. We hypothesized that diabetic patients receiving ESI will have different pain scores compared to nondiabetic patients. We tested a secondary hypothesis that pain reduction differs at different levels of hemoglobin A1c (HbA1c) for patients with diabetes. Data from 284 consecutive patients given ESIs for radiculopathy were obtained via a manual review of electronic medical records. We initially compared diabetic and nondiabetic groups with respect to balance on baseline demographic and morphometric characteristics. Next, a linear regression model was developed to evaluate the association between existing diabetes and postinjection reduction in pain scores. And finally, we univariably characterized the association between HbA1c and pain reduction. After exclusion of nine patients, 275 patients were analysed, including 55 (20%) who were diabetic. Pain reduction after ESI was comparable in diabetic and nondiabetic patients (Wald test P = 0.61). The degree of pain reduction generally decreased with the level of HbA1c until reaching HbA1c levels of approximately 7.5%, after which point it stayed fairly constant. There was no difference in pain reduction Continue reading >>
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Effects Of Epidural Steroid Injections On Blood Glucose Levels In Patients Withdiabetes Mellitus.
1. Spine (Phila Pa 1976). 2012 Jan 1;37(1):E46-50. doi:10.1097/BRS.0b013e31821fd21f. Effects of epidural steroid injections on blood glucose levels in patients withdiabetes mellitus. Even JL(1), Crosby CG, Song Y, McGirt MJ, Devin CJ. (1)Vanderbilt University Medical Center, Nashville, TN 37232, USA. STUDY DESIGN: A prospective cohort study.OBJECTIVE: To evaluate the effects of epidural steroid injections (ESIs) on bloodglucose levels in patients with diabetes mellitus.SUMMARY OF BACKGROUND DATA: ESIs are commonly used in the treatment of multiplespinal disorders. Corticosteroid injections have been evaluated in the totaljoints and hand literature showing systemic effects to diabetics.METHODS: Diabetic patients who were scheduled for an ESI were given anopportunity to enroll in our IRB-approved study. We collected the patient's most recent hemoglobin A(1c) (hA(1c)) and then asked them to track their blood glucosenumbers at least twice per day for 2 weeks prior to and after their ESIs.RESULTS: We noted a statistically significant increase in blood glucose levels indiabetic patients (n = 30) after ESI. The mean blood glucose level prior to ESIwas 160.18 47.46, and, after ESI, it was 286.13 111.11. This represents anaverage 125.96 100.97 increase in blood glucose levels after injection. Using anonlinear mixed effect model, the estimated half-life of this increase was 1.06days (95% CI 0.80, 1.58), meaning that the patients were back within their normalstandard deviation mean glucose levels within 2 days of injection. There was noassociation between observed glucose level change and preinjection hA(1c) levels or age (Spearman = 0.0326 and -0.1091 separately), indicating that there is nocorrelation between preinjection hA(1c) levels and systemic response to ESI.CONCLUSION: E Continue reading >>
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Epidural Indomethacin Alternative In Adult Onset Diabetics
Epidural Indomethacin Alternative in Adult Onset Diabetics Study confirms hyperglycemia resulting from epidural corticosteroid injections in diabetic patients with recurrent post-laminectomy radiculopathy and assesses indomethacin as a suitable alternative to corticosteroids. By J. Antonio Aldrete, MD, MS and Uriah Guevara, MD Epidural steroid injections have been advocated for the treatment of degenerative disc disease with radiculopathy1 however, in diabetic patients, steroids have been known to produce hyperglycemia.2 In this study, we determine the effects on blood sugar and pain relief in patients with adult onset diabetes having low back pain with radiculopathy that received either methylprednisolone (MTP) or indomethacin (INM) epidurally. Only patients with recurrent post-laminectomy radiculopathy were included in this study. Pre- and post-treatment measurements of blood sugar were made in 140 patients between the ages of 32 and 68 years old having recurrent low back pain and signs of unilateral radiculopathy after lumbar laminectomy between January 1999 and March 2003. Previous diagnosis of adult onset diabetes (AOD) had been confirmed in 102 patients. These patients were taking oral antiglycemic medications and were following a regimen of less than 1600 calories/day and were randomly included in groups A,B and C. The other 38 patients (group D) did not have diabetes mellitus. In all subjects, reappearance of degeneration of the same operatedor adjacentdisc and epidural fibrosis were confirmed by magnetic resonance imaging. The protocol of the study was approved by the Clinical Research Board of both facilities. After obtaining informed consent, the patients were assigned at random to either group A (38 AOD patients), that received 80mg of MTP; group B (38 AOD Continue reading >>
The Effect Of Epidural Steroid Injections On Glycemic Control In Diabetic Patients According To The Doses Of Steroids
You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. The Effect of Epidural Steroid Injections on Glycemic Control in Diabetic Patients According to the Doses of Steroids The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT01435707 Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information There has been no reports of the effect of various kinds of steroid or various dose of steroid which are commonly used in the clinical setting. Previous studies have simply shown that the blood glucose level is elevated in diabetes patients and did not show or suggest the adequate strategy of epidural steroid injection in diabetes patients regarding steroid type, dosage or injection interval. Therefore, the investigators tried to evaluate the effect of different dosage of triamcinolone, which is a commonly used steroid in epidural steroid injection, on the blood glucose level. Other: epidural steroid injection with Triamcinolone 40mg Other: Selective transforaminal epidural block with triamcinolone 20 mg Other: caudal epidural steroid injection with Triamcinolone 20mg Other: Selective transforaminal epidural block with triamcinolone 40 mg It is well known that blood glucose level is elevated in diabetes patients more than non-diabetes patients who underwent the epidural steroid injection. However, there has been no reports of the effect of various kinds of steroid or various dose of steroid which are c Continue reading >>
Effects Of Epidural Steroid Injections On Blood Glucose Levels In Patients With Diabetes Mellitus
A prospective cohort study.To evaluate the effects of epidural steroid injections (ESIs) on blood glucose levels in patients with diabetes mellitus.ESIs are commonly used in the treatment of multiple spinal disorders. Corticosteroid injections have been evaluated in the total joints and hand literature showing systemic effects to diabetics.Diabetic patients who were scheduled for an ESI were given an opportunity to enroll in our IRB-approved study. We collected the patient's most recent hemoglobin A(1c) (hA(1c)) and then asked them to track their blood glucose numbers at least twice per day for 2 weeks prior to and after their ESIs.We noted a statistically significant increase in blood glucose levels in diabetic patients (n = 30) after ESI. The mean blood glucose level prior to ESI was 160.18 47.46, and, after ESI, it was 286.13 111.11. This represents an average 125.96 100.97 increase in blood glucose levels after injection. Using a nonlinear mixed effect model, the estimated half-life of this increase was 1.06 days (95% CI 0.80, 1.58), meaning that the patients were back within their normal standard deviation mean glucose levels within 2 days of injection. There was no association between observed glucose level change and preinjection hA(1c) levels or age (Spearman = 0.0326 and -0.1091 separately), indicating that there is no correlation between preinjection hA(1c) levels and systemic response to ESI.ESIs were noted to cause a significant increase in the blood glucose levels in diabetics. There was no correlation between preinjection diabetic control, represented by hA(1c) levels, and postinjection response. Diabetics who are candidates for ESI should be counseled that a blood glucose increase may be apparent post intervention, but effects should not last longer than Continue reading >>
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Detail-document: Prescriber's Letter
Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Corticosteroids are used for a wide array ofindications and are given by many different routes (oral, topical, intra-articular,inhaled, epidural, etc). Hyperglycemiais a well known complication of systemic (oral, intramuscular, intravenous)corticosteroid therapy, but less well recognized with other routes ofadministration. This document reviewshyperglycemia associated with corticosteroids given by topical, intra-articular,inhaled, and epidural routes of administration. Hyperglycemia is a well-known adverse effect ofcorticosteroid therapy. Orallyadministered corticosteroids have been shown to worsen glucose control inpatients who already have diabetes and to cause hyperglycemia in patientswithout preexisting diabetes.1 The incidence of corticosteroid-inducedhyperglycemia is difficult to quantify because it is dependent on manypatient-specific (type of diabetes, body mass index, age, family history) andtreatment-specific (drug, dose, route of administration, duration) factors.1 There are a number of mechanisms by whichhyperglycemia occurs. Corticosteroidsreduce glucose utilization, increase glucose production, inhibit the effects ofinsulin on myocytes and adipocytes, and increase hepatic glucose release.2The effects can be seen as early as 12hours after beginning therapy.3 In patients taking oral prednisone, the mostpronounced hyperglycemic effect occurs one to two hours after a meal.3 Certain corticosteroids have a more pronouncedeffect on blood glucose than others. Forexample, the synthetic corticosteroids prednisone and dexamethasone are fourand 30 times more potent, respectively, than natural corticosteroids such ashydrocortisone at reducing carbohydrate metabolism.3 There appears to be an as Continue reading >>
Complications Of Spine Surgery In Diabetics
Austin J Endocrinol Diabetes.2016; 3(1): 1038. Complications of Spine Surgery in Diabetics Department of Orthopedics, University of Virginia HealthSystem, USA *Corresponding author: Anuj Singla, Department ofOrthopedics, University of Virginia Health System, 400Ray C Hunt Drive, Charlottesville, VA 22903, USA Received: December 04, 2015; Accepted: March 25,2016; Published: March 29, 2016 High stress periods such as surgery alter the metabolism of glucose.Generally these patients are at increased risk for higher morbidity and longerhospital stays. Bone and soft tissue healing are negatively affected by poorlycontrolled diabetes, which might be due to peripheral artery disease, and endstage renal disease. Wound healing is also impaired due to multiple reasonsincluding microangiopathic changes and ischemia, impaired granulocytefunction, and a lack of platelet-derived growth factor function in the wound. Diabetes has been associated with infection, nonunion, and less favorablefunctional outcomes after lumbar spine procedures. Prolonged drainagesand infection rate have been reported to be 6 to 34% following lumbar spinearthrodesis in diabetics. Increased need for postoperative transfusion indiabetics postoperatively is a subject of debate in the literature. Higher bodymass index, which is mostly seen in diabetes type 2, is associated with increasedrate of transfusion and discharge to assisted living facilities after thoracolumbaror lumbar spine fusion. Previous studies have demonstrated the association between the DM andpoor outcomes after cervical spine fusion. Diabetes has also been suggested tobe a risk factor for the ossification of the posterior longitudinal ligament. There isa higher incidence of complications and hospital discharge variables in diabeticsespecially if Continue reading >>
Can Steroids Have A Lasting Effect On Blood Glucose?
Three years ago, when I was 65, I was prescribed prednisone during a very bad cold. I have type 2 diabetes, which I controlled then with diet and exercise (no medications). After I started taking prednisone, my blood sugar shot up to 300 mg/dl, and it took me three weeks on Actos to bring it back down. My blood sugar has never been the same, and now I am on diabetes meds. Could the prednisone have caused a lasting effect? Continue reading >>
Musculoskeletal Disorders In Diabetes Mellitus
REVIEW ARTICLE Marilia Barreto Gameiro SilvaI; Thelma Larocca SkareII IMaster degree in Internal Medicine; Professor of Rheumatology of the Medical School, Faculdade Evangélica do Paraná - Fepar IIPhD; Full Professor of Rheumatology of the Medical School, Fepar ABSTRACT Diabetes mellitus is associated with a great variety of musculoskeletal manifestations, many of which are subclinical and correlated with disease duration and its inadequate control. They should be recognized and treated properly, because their management improves the patients' quality of life. This review discusses the major musculoskeletal manifestations found in diabetes mellitus. Keywords: diabetes mellitus, Dupuytren's contracture, trigger finger, bursitis, carpal tunnel syndrome. INTRODUCTION Diabetes mellitus (DM) is a chronic metabolic disease of high morbidity and mortality,1 which has become a public health problem. In 1985, the world prevalence of DM was approximately 30 million cases, increasing to 177 million in 2000.2 Based on current tendencies, more than 360 million individuals will have the disease by 2030.2 Type 1 DM results from a complete deficiency of insulin due to the autoimmune-mediated destruction of insulin-producing βcells in the pancreas; in type 2 DM, which represents most of the DM cases (around 95%), there is insulin resistance, excessive hepatic production of glucose, and abnormal fat metabolism, resulting in a relative deficiency of that hormone.2,3 The prevalence of type 2 DM increases more than that of type 1 DM, because of the increase in obesity and the reduction in physical activities as countries become more industrialized.2 Diabetes mellitus accounts for a number of vascular complications, which impair patients' survival.2 Musculoskeletal complications are also Continue reading >>
Cortisone Injections In Diabetics
Cortisone injections are commonly used for the treatment of a variety of orthopedic conditions. Cortisone is a powerful anti-inflammatory medication that can be injected around tendons or joints where inflammation is present. Cortisone injections are often used in the treatment of conditions including tendonitis, bursitis, and arthritis. There are several common, and many uncommon, side-effects of a cortisone shot, and before having this treatment you should discuss these possible complications with your doctor. While most cortisone side-effects are mild and temporary, it is worthwhile to discuss these possible problems so that you know what to expect after your injection. Diabetes and Cortisone Diabetics are especially prone to side-effects from cortisone injections. It is very common for patients with diabetes to experience a temporary rise in their blood sugar in the hours and days following a cortisone injection. If not expecting this likely side-effect, the unanticipated rise in blood sugar can be alarming for patients working hard to keep their blood sugar levels under control. A recent study investigated the use of cortisone injections in diabetic patients. The patients all had injections for hand problems (including trigger finger and carpal tunnel syndrome). The patients were then surveyed daily until their symptoms resolved. The findings of the study included the following: The rise in blood sugar corresponded to the severity of diabetes as measured by hemoglobin A1c (HbA1c). When a patient's HbA1c was greater than 7%, they had higher elevations in blood sugar following the injection, and the elevated blood sugar lasted longer. Most diabetic patients experienced temporary elevations in blood sugar. In this study, 80% of the patients reported elevated blood sug Continue reading >>
Artyku
Nie znaleziono publikacji cytujcych ten artyku Murakibhavi VG, Khemka AG. 2011. Caudal epidural steroid injection: a randomized controlled trial. Evid Based Spine J Care J 2: 1926. Johansson A, Hao J, Sjolund B. 1990. Local corticosteroid application blocks transmission in normal nociceptive C fibres. Acta Anaesthesial Scand 34: 335338. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. 1990. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine J 15: 647648. Derby R, Lee SH, Date ES, Lee JH, Lee CH. 2008. Size and aggregation of corticosteroids used for epidural injections. Pain Med 9: 227234. Fishman SM. 2009. Bonicas Management of Pain. 4 th ed. Philadelphia, PA: Lippincott Williams & Wilkins. Robecchi A, Capra R. 1952. Lidrocortisone (compost F). Prime esperienze cliniche in campo reumatologico. Minerva Med 98: 12591263. Park CH, Lee SH, Kim BI. 2012. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med 11: 16541658. Nelson DA, Landau WM. 2001. Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports. Review. J Neurol Neurosurg Psychiatry 70: 433443. Johansson A, Bennet GJ. 1997. Effect of local methylprednisolone on pain in a nerve injury model. A pilot study. Reg Anesth 22: 5965. Manchikanti L. 2002. Role of neuraxial steroids in interventional pain management. Pain Physician 5: 182199. Friedrich JM, Harrast MA. 2010. Lumbar epidural steroid injectons: indications, contraindications, risks and benefits. Curr Sports Med Rep 9: 4349. Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. 2012. Effects of epidural steroid injections Continue reading >>
Epidural Analgesia Enhances The Postoperative Anabolic Effect Of Amino Acids In Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery | Anesthesiology | Asa Publications
Epidural Analgesia Enhances the Postoperative Anabolic Effect of Amino Acids in Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery * Research Fellow, Department of Anesthesia and School of Dietetics and Human Nutrition, McGill University; Department of Anesthesia and Perioperative Intensive Care Medicine, Kantonsspital, Aarau, Switzerland. Research Fellow, Department of Anesthesia and School of Dietetics and Human Nutrition, Associate Professor, Professor, Department of Anesthesia, Associate Professor, School of Dietetics and Human Nutrition, McGill University. Epidural Analgesia Enhances the Postoperative Anabolic Effect of Amino Acids in Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery Anesthesiology 6 2008, Vol.108, 1093-1099. doi:10.1097/ALN.0b013e3181730239 Anesthesiology 6 2008, Vol.108, 1093-1099. doi:10.1097/ALN.0b013e3181730239 AndreaKopp Lugli, Francesco Donatelli, Thomas Schricker, Linda Wykes, Franco Carli; Epidural Analgesia Enhances the Postoperative Anabolic Effect of Amino Acids in Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery. Anesthesiology 2008;108(6):1093-1099. doi: 10.1097/ALN.0b013e3181730239. 2018 American Society of Anesthesiologists Epidural Analgesia Enhances the Postoperative Anabolic Effect of Amino Acids in Diabetes Mellitus Type 2 Patients Undergoing Colon Surgery You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account DIABETES mellitus is associated with high morbidity and mortality and is responsible for higher perioperative complication rates. 1 It has been hypothesized that diabetes mellitus type 2 (DM2) leads to pronounced muscle wasting and a catabolic state perioperatively due to the persistent metabolic d Continue reading >>
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