Singap Med J
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Randomized Controlled Trial Clinical Trial
Preoxygenation in parturients: a comparison of 4, 6 and 8 vital capacity breaths to 5 minutes of tidal volume breathing.
We compared the difference in denitrogenation (by intermittent measurement of arterial tension, PaO2) in 45 parturients at term when preoxygenated with 4, 6 or 8 rapid vital capacity breaths and 5 minutes of tidal volume breathing. Oxygen, at 8 litres min-1, was delivered through a facemask via a circle absorber with a 2 litre reservoir bag. Higher PaO2 was produced with 5 minutes of tidal volume breathing. This differed significantly from the PaO2 produced by 4, 6 or 8 rapid vital capacity breaths (p less than 0.01).
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Randomized Controlled Trial Clinical Trial
Comparative study on the effect of Diane and Microgynon 50 contraceptive on the haemostatic mechanisms in Chinese subjects.
A longitudinal controlled study on the effect of Diane and Microgynon 50 (Micro 50) contraceptive pills on the haemostatic mechanisms in 59 Chinese subjects was carried out. Diane, containing the potent anti-androgen progestagen, cyproterone acetate was used as a contraceptive and in subjects requiring anti-androgenic treatment and fertility control. Enhanced fibrinolytic activity with raised plasminogen and alpha 1-antitrypsin (a1-AT) was observed in all subjects after pill treatment. ⋯ More changes in haemostasis were seen after treatment with Diane containing 35 ug and 50 ug ethinyl estradiol (EE) formulation than during Micro 50 treatment. The results from this study show that Diane even with 35 ug EE formulation caused coagulation changes which were more pronounced than the 50 ug EE Microgynon. The finding is at variance with others that ascribe haemostatic changes observed to increased oestrogen content in a given pill formulation and so merits confirmation in a larger study.
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Case Reports
Rhabdomyolysis associated with hypokalaemic periodic paralysis of renal tubular acidosis.
Two cases of hypokalaemia with serum potassium levels of 1.4 mmol/L and 1.9 mmol/L causing severe periodic paralysis since childhood are presented. There were associated with muscular aches and markedly raised muscle enzymes suggesting massive rhabdomyolysis. ⋯ The hypokalaemia and rhabdomyolysis responded to potassium and bicarbonate replacement. We postulate these patients had sporadic distal type of renal tubular acidosis and that the hypokalaemia and acidosis had caused the rhabdomyolysis.
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In Singapore, every deceased person must have a death certificate stating the cause of death. The death certificates are prepared from certificates of cause of death signed by medical practitioners, pathologists, coroners or inspectors of death. The death certificate is a legal document and the person who certifies the cause of death is responsible for the accuracy of the facts. ⋯ Any deviation will result in the certificate be rejected by the Registrar of Death and the matter referred to the Coroner. The offending doctor would be reprimanded by the court. Examples of wrong certification will be given and it is hoped that medical practitioners will not make similar mistakes.
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We studied 22 Asian patients with steroid dependent asthma. Using a clinical approach to the addition of high dose inhaled budesonide and tapering of systematic steroid, we were able to substitute 5 to 20 mg prednisolone with 800 micrograms per day of inhaled budesonide in all patients. There was also a greater reduction in nocturnal symptoms and awakenings and a smaller overnight fall in PEFR during treatment with budesonide than with prednisolone. Inhaled budesonide was an effective long term substitute for prednisolone in chronic asthma.