Duodecim; lääketieteellinen aikakauskirja
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Review
[The use of direct oral anticoagulants (DOAC) in the treatment atrial fibrillation (AF) patients].
AF is associated with the risk of stroke, and this risk is exceedingly high in elderly patients (> or = 75 years) and in patients after a stroke. DOACs are appropriate anticoagulants for AF patients without mechanical heart valves or mitral stenosis. Patients on DOACs do not require routine monitoring of coagulation, but need regular follow-up visits including an assessment of therapy adherence, thromboembolic and bleeding events and measurements of hemoglobin and platelets values as well as renal and liver function.
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Tongue abscess is a rare and sometimes life-threatening condition, as swelling of the tongue may rapidly occlude the airways. In a patient described by us swelling of the tongue was found in MR imaging to be caused by an abscess of the anterior part of the tongue, extending to the floor of the mouth, beside the submandibular gland. It was only after recanalization of the compartmentalized abscess of the tongue and removal of the salivary gland that the patient recovered.
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Emergency Medicine (EM) was established as a speciality in Finland in the beginning of 2013. The training period of six years conforms to the principles of the European Curriculum for EM. We present here the first-year training in Kanta-Häme Central Hospital, located in Southern Finland. ⋯ Lunchtime lectures covering a wide variety of topics in EM are an essential part of our weekly education day. This day also offers to the residents small group sessions with abstracts, case reports, focused lectures and ultrasound training. A successful training program of EM is achievable by good collaboration with other specialities.
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Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions.
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Painful neuropathy is a common complication of diabetes and causes disability and impaired quality of life. Treatment of neuropathy aims at pain relief, improved function and quality of life and avoidance of foot ulcers. Progression of neuropathy is prevented with good glycemic control and treatment of the risk factors of atherosclerosis. ⋯ Comorbidities, concomitant medications and possible contraindications are taken into account in drug selection. Since treatment with a single agent does not provide sufficient pain relief, combination of two drugs with different mechanism of action is recommended. Most patients need long-term treatment.