International journal of clinical practice
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Int. J. Clin. Pract. · Oct 2009
ReviewDiagnosis and management of hyponatraemia in hospitalised patients.
Hyponatraemia is a commonly encountered electrolyte abnormality in hospitalised patients and is associated with significant morbidity and mortality. The fact that most cases of hyponatraemia are the result of water imbalance rather than sodium imbalance underscores the role of antidiuretic hormone (ADH) in the pathophysiology. Hyponatraemia can be classified according to the measured plasma osmolality as isotonic, hypertonic or hypotonic. ⋯ Symptomatic acute hyponatraemia (< 48 h) is a medical emergency requiring rapid correction to prevent the worsening of brain oedema. In asymptomatic patients with chronic hyponatraemia (> 48 h or unknown duration), fluid restriction and close monitoring alone are sufficient, while a slow correction by 0.5 mEq/l/h may be attempted in symptomatic patients. Excessive rapid correction should be avoided in both acute and chronic hyponatraemia, because it can lead to irreversible neurological complications including central osmotic demyelination.
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Despite its high prevalence, chronic pain is suboptimally treated in approximately one half of affected patients. Failure to recognise and manage comorbid physical and psychosocial impairments may contribute to the perpetuation of chronic pain. Knowledge of the potential advantages and disadvantages of available analgesic medications will permit informed selection of the appropriate medication for the individual chronic pain patient. ⋯ Theoretically, these agents will provide sustained analgesia by minimising the end-of-dose pain that is often seen with short-acting medications, with improved patient convenience and a potential for reduced risk of adverse events. The extended-release formulation of tramadol (tramadol ER) has proven efficacy in chronic pain conditions such as osteoarthritis and low back pain, as well as a favourable tolerability profile. In addition, tramadol ER has been shown in clinical trials to improve pain-related sleep disturbances and physical function in patients with chronic pain from osteoarthritis and low back pain.
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Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) or 'shingles' and affects a significant proportion of HZ patients with the disease, with the elderly being most frequently and seriously affected. Characterised by various types of pain (constant, intermittent and stimulus evoked) that persist between 3 months and many years after the resolution of the HZ rash, PHN can have a severe impact on the patient's quality of life and functional ability. PHN remains highly resistant to current treatments. In this review, we discuss the epidemiology, clinical features and management of PHN in the elderly and the potential of vaccination against varicella zoster virus as a means to prevent HZ, and thus decrease the incidence and severity of PHN.
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Int. J. Clin. Pract. · Sep 2009
Multicenter Study Comparative StudyPerformance of CURB-65 and CURB-age in community-acquired pneumonia.
Community-acquired pneumonia (CAP) is common and associated with significant mortality. In this study, we validated a newly proposed severity assessment rule for CAP, CURB-age, and also compared with to the currently recommended criteria in UK, CURB-65. ⋯ Despite better specificity in correctly identifying 6-week mortality for CAP, CURB-age appears to be less sensitive than CURB-65. Our findings further assure the usefulness of CURB-65 for predicting mortality in CAP.