Medicine
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Observational Study
Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study.
Rheumatoid arthritis (RA) has been related to an impairment of the nutritional status. Body mass index (BMI) has been used but questions arise about how to properly evaluate nutritional status in RA patients. Few studies have evaluated it by dual-energy X-ray absorptiometry. ⋯ RA patients fulfilled criteria of sarcopenia in 44% of cases versus 19% of controls (P <.001). In RA patients, regarding SMI, BMI showed a high specificity to detect sarcopenia (94% of the patients with low BMI had sarcopenia) but low sensitivity (47% of the patients with normal BMI or overweight had sarcopenia). RA patients have an impairment of nutritional status associated to disease duration that looks like sarcopenia and that is not predicted by BMI.
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Case Reports
Thrombolysis in an acute ischemic stroke patient with rivaroxaban anticoagulation: A case report.
Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial. ⋯ Although current guidelines do not recommend administering thrombolytics in patients using NOACs with a doubtful anticoagulation status and administered within the last 24 or, even more strictly, 48 hours, this and other case studies suggest that r-TPA treatment could be considered in selected acute ischemic stroke patients receiving rivaroxaban or other Xa inhibitors, taking the patient's clinical condition and the prospective clinical benefits of r-TPA into account.
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Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA). A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. ⋯ The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation. Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures.
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Observational Study
The incidence of unexpected poor ovarian response in Chinese young women.
Unexpected poor ovarian response (UPOR) is a problem for both clinicians and infertile couples, because our understanding of this situation is limited. This article investigated incidence of UPOR in women <35 years with normal ovarian reserve function with further analysis. This is a retrospective study, which included 567 women who accepted their first IVF-ET/ICSI. ⋯ The incidence of UPOR in Chinese women is 21.16%. Patient age (χ = 6.177, P = .0129), basic FSH (χ = 20.585, P < .0001), basic LH (χ = 11.689, P = .0006), and AFC (χ = 8.053, P = .0045) might be helpful for diagnosis of UPOR. The basic evaluation of ovarian function may no longer be simplified into normal and abnormal ovarian reserve function; rather, by using a detailed numerical analysis, such as basal FSH and LH levels, the ovarian response to ovulation induction may be predicted to some extent.
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Hypoglycemia, which is characterized mainly by palpitations, dizziness, and sweating, is common and easy to identify. However, some other symptoms, such as mental disorder or abnormal behavior, are atypical, which may lead to a misdiagnosis of epilepsy, sleepwalking, infarction, or mental disorder, among others. ⋯ For physicians, if the cause of abnormal behavior cannot be detected, hypoglycemia should be suspected. Long-term persistent hypoglycemia may cause brain dysfunction and even result in permanent brain damage.