Internal medicine journal
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Internal medicine journal · Dec 2012
Case ReportsSuccessful treatment of macrophage activation syndrome complicating adult Still disease with anakinra.
A previously healthy 20-year-old man presented with adult Still disease (ASD). He developed life-threatening macrophage activation syndrome (MAS), which was refractory to standard immunosuppression but responded dramatically to the IL-1 receptor antagonist anakinra. Subsequent immunological investigations included assessment of the perforin expression of natural killer (NK) cells and CD8+ T cells, which confirmed MAS.
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Internal medicine journal · Dec 2012
Does a 'code stroke' rapid access protocol decrease door-to-needle time for thrombolysis?
Timely administration of intravenous tissue plasminogen activator (IVtPA) for acute ischaemic stroke is associated with better clinical outcomes. Therefore, a coordinated hospital system of acute clinical assessment and neuroimaging will likely avoid delays in IV-tPA administration. ⋯ Our study showed that 'code stroke' rapid access protocol decreased door-to-needle time and possibly contributed to the increased IV-tPA usage.
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Internal medicine journal · Dec 2012
Changes in serum phosphate during treatment of diabetic ketoacidosis: predictive significance of severity of acidosis on presentation.
Changes in serum phosphate during diabetic ketoacidosis (DKA) treatment are not well characterised, although it is known that serum phosphate falls with treatment. We sought to define the nature of these changes and whether the severity of acidosis on admission influenced the severity of subsequent hypophosphataemia. We retrospectively reviewed data on all patients with confirmed DKA presenting to our unit between 2007 and 2010 inclusive. ⋯ The initial hyperphosphataemia is reflective of intravascular volume depletion and pre-renal renal impairment. The severity of subsequent hypophosphataemia can be predicted by the degree of metabolic acidosis on presentation. As profound hypophosphataemia can be associated with serious complications, clinicians should recognise the likelihood of this biochemical derangement in those DKA patients presenting with profound acidosis.
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Internal medicine journal · Dec 2012
Prevalence of food allergy in Taiwan: a questionnaire-based survey.
Food allergy is common in children and adults, and could be potentially fatal in minor groups. It is important for physicians to identify the prevalence of food allergies and to recognise common food allergens to make precise diagnosis and choose correct therapeutic approaches. ⋯ Less than 10% of the Taiwan population suffers from food allergy with different allergic symptoms to variable food allergens in different age groups.