Singap Med J
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Stress fractures of the tibia secondary to tibial deformities from osteoarthritis are rare, and may be difficult to manage. We treated two patients with stress fractures of the proximal tibial diaphyses over a period of two years. Both patients had osteoarthritis of the knee; one with genu valgus deformity and the other, genu varus deformity. ⋯ The stress fractures of both the patients had been treated conservatively by nonoperative means, but their fractures failed to unite. They then underwent a modular total knee prosthesis with a long tibial stem extension, and subsequently, their fractures united. Both patients recovered uneventfully.
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Case Reports
Cryptococcal meningoencephalitis with fulminant intracranial hypertension: an unexpected cause of brain death.
The diagnosis of brain death requires the presence of unresponsiveness and a lack of receptivity, the absence of movement, breathing and brain stem reflexes, as well as a state of coma in which the cause has been identified. We report a case of brain death that was diagnosed based on clinical neurological examinations, and supported by the absence of cerebral blood flow on magnetic resonance angiography and electroencephalography demonstrating the characteristic absence of electrical activity. ⋯ We proceeded with organ donation of the deceased's liver and corneas. However, postmortem revealed Cryptococcus neoformans meningoencephalitis as the cause of irreversible coma.
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A letter to the Editor is a short communication. It can be written on any subject of interest to the journal reader, and is published at the Editor's discretion. Comments on previously published articles are probably the most common reason for writing a letter. ⋯ Letters to the Editor should be objective, constructive and purposeful. They should provide new or useful information that merits publication, or additional or alternative viewpoint or experience to a previously published article. Letters should be short and concise, with clear and specific points.
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Comparative Study
Angiotensin-converting enzyme gene variant and its levels: risk factors for myocardial infarction in a South Indian population.
Recently, there has been increasing evidence that genetic variation in the angiotensin-converting enzyme (ACE) plays an important role in myocardial infarction. Therefore, the present study was carried out with the aim of investigating the association of the ACE gene insertion/deletion (I /D) polymorphism and its levels in myocardial infarction patients and their first-degree relatives (FDRs). ⋯ ACE DD genotype and ACE levels are important risk factors for myocardial infarction. This study indicates that the higher frequency of the DD genotype and ACE levels observed in FDRs may increase susceptibility to developing myocardial infarction.