Medicine
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Observational Study
Male patients with rheumatoid arthritis have an increased risk of osteoporosis: Frequency and risk factors.
Most previous research investigating osteoporosis in rheumatoid arthritis (RA) has focused on female patients and there is a lack of data regarding clinical characteristics of osteoporosis in male patients with RA. The aim of this study was to compare the frequency of osteoporosis between male patients with RA and healthy patients, and to identify the risk factors for osteoporosis and low bone mineral density (BMD) in male patients with RA. We conducted a retrospective, cross-sectional study including 76 South Korean male patients with RA aged over 50 years and 76 age-matched male healthy individuals. ⋯ In multivariable logistic regression models, BMI ≤ 22 kg/m (odds ratio = 3.43, P = .043) and DAS28-ESR > 3.2 (odds ratio = 3.85, P = .032) were independent risk factors for osteoporosis at either site in male patients with RA. Our data demonstrate that male patients with RA had a 2.1 times higher risk for osteoporosis compared with healthy individuals. This suggests that appropriate management of osteoporosis in patients with RA is crucial not only for postmenopausal women but also for men aged over 50 years, especially those with low BMI and higher disease activity.
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Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT) is an uncommon arrhythmia. Because of the different refractory periods of fast and slow pathways, a single atrial depolarization gives rise to 2 ventricular activationsthrough fast and slow pathways separately. ⋯ DAVNNT is a rare arrhythmia which can induce tachycardia-induced cardiomyopathy. Ablation of the slow pathway isconsidered a curative treatment.
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Positional asphyxia is a rare cause of sudden death and a difficult diagnosis, based mostly on the circumstances of the incident, along with particular external and internal findings, frequent in asphyxia (signs of sudden death). ⋯ Therefore, the current criteria for positional asphyxia are based on the obstruction of normal gas exchange caused by the body position, the impossibility to move to another position, and the exclusion of other causes of death. The forensic medical examination must also be started at the scene of the incident.
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Dislocation of the distal radioulnar joint and injury to distal forearm are commonly encountered. However, delayed diagnosis or misdiagnosis has been relatively rare due to improved diagnosis and treatment. Treatment of old dislocation of radioulnar joint is challenging due to development of secondary chronic instability and difficulties in restoration of joint function. ⋯ Early and accurate diagnosis and treatment is important for the recovery of distal radius fracture for patients with dislocation of the ulnar joint. The correct treatment determines the degree of later functional recovery. Early surgical treatment is recommended for patients with unsatisfactory reset. Delayed diagnosis and treatment often lead to chronic and persistent lower ulnar joint subluxation or dislocation, or even osteoarthritis. All patients in this report showed great improvement in wrist function after surgery.
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Clinical Trial Observational Study
Predicting effective remifentanil concentration in 95% of patients to prevent emergence cough after laryngomicroscopic surgery.
Smooth emergence or cough prevention is a clinically important concern in patients undergoing laryngomicroscopic surgery (LMS). The purpose of this study was to estimate the effective concentration of remifentanil in 95% of patients (EC95) for the prevention of emergence cough after LMS under propofol anesthesia using the biased coin design (BCD) up-down method. A total of 40 adult patients scheduled to undergo elective LMS were enrolled. ⋯ Compared with patients receiving lower concentrations of remifentanil, the incidence of hypoventilation before extubation and extubation time were significantly higher in those receiving remifentanil Ce of 3.0 ng/mL. However, hypoventilation incidence after extubation and staying time in the recovery room were comparable between the 2 groups. Using a BCD method, the EC95 of remifentanil Ce for the prevention of emergence cough was estimated to be 2.92 ng/mL (95% CI: 2.72-2.97 ng/mL) after LMS under propofol anesthesia.