Israel journal of medical sciences
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Case Reports
Folic acid deficiency, megaloblastic anemia and peripheral polyneuropathy due to oral contraceptives.
A 34-year-old woman developed megaloblastic anemia and peripheral polyneuropathy following the use of oral contraceptives for 4 years. Low levels of folic acid and vitamin B12 were found. Both the complete recovery after therapy with the vitamins, and the absence of other causes of vitamin B12 and folate deficiency, suggest that the vitamin deficiencies were caused by the oral contraceptives and resulted in the rare combination of megaloblastic anemia and polyneuropathy. The poor response to vitamin B12 alone, and the development of anemia and polyneuropathy 4 months after cessation of vitamin B12 therapy suggest that folate deficiency was the primary problem.
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A prospective study among unselected patients hospitalized in an internal medicine ward showed that 46 patients, 6.9% of total admissions, had serum concentrations of sodium less than 132 mEq/l. In 28.3% of hyponatremic patients (n = 13), the cause was the syndrome of inappropriate antidiuretic hormone secretion; 21.7% of the cases (n = 10) developed hyponatremia during hospitalization, mainly because of hypotonic solution administration. ⋯ In our opinion, the high mortality reflects the severity of the underlying diseases, although 82.5% of the patients were asymptomatic or had mild neurological signs. There was no significant correlation between the degree of hyponatremia and neurological signs, or mortality.
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In rescue operations for people trapped under fallen debris, i.v. replenishment of the massive internal fluid volume losses should be started as soon as physical contact has been established with the injured person. This should be followed by induced alkaline-mannitol diuresis. ⋯ Local treatment of the crushed limbs should be conservative. A closed injury should not be converted into an open one unless distal arterial perfusion has been compromised.
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Comparative Study
Knowledge of cardiopulmonary resuscitation in Jerusalem: is the community prepared to handle cardiac arrest?
A survey of 434 adults was conducted to determine the percentage of persons trained in cardiopulmonary resuscitation (CPR) in Jerusalem. Of the total, 211 (48.6%) indicated they had been trained in CPR. ⋯ Half of those surveyed did not know the emergency number for summoning an ambulance, but CPR-trained persons were more likely to know than were nontrained individuals. As has been shown elsewhere, increasing the frequency of bystander-initiated CPR should lead to increased survival from out-of-hospital cardiac arrest.