European journal of internal medicine
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Eur. J. Intern. Med. · Jan 2008
Comparative StudyPostmenopausal Canarian women receiving oral glucocorticoids have an increased prevalence of vertebral fractures and low values of bone mineral density measured by quantitative computer tomography and dual X-ray absorptiometry, without significant changes in parathyroid hormone.
Daily doses higher than 7.5 mg/daily of prednisone or equivalents confer a great risk of vertebral and hip fractures with a clear dose dependence of fracture risk. Information regarding the utility in assessing trabecular bone mineral density by quantitative computer tomography (QCT) in these patients, either in the Canaries or in Spain, is lacking. Moreover, in this setting, the importance of secondary hyperparathyroidism is still controversial. ⋯ In postmenopausal Canarian women, chronic glucocorticoid therapy is associated with low bone mineral density, measured either by DXA or QCT, with evidence of low turnover and high prevalence of fractures without significant changes in PTH. DXA and QCT provide similar information in the assessment of this high risk population.
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A 29-year-old hospital doctor presented with a febrile illness and a rash that began shortly after commencing a course of oral antibiotics. Initially thought to be a drug reaction, changes in the nature of the rash led to a confirmed diagnosis of measles. An immunisation history revealed that the patient had never received the MMR vaccine. A high index of suspicion is required to diagnose measles in an immunocompetent adult, and we suggest that occupational health departments should be more rigorous in screening for vaccinations in health workers.
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Eur. J. Intern. Med. · Nov 2007
Life-threatening megaloblastic pancytopenia with normal mean cell volume: Case series.
The mean red blood cell volume (MCV) is usually increased in severe megaloblastic anemia due to pernicious anemia. However, during one year in a university hospital, three patients with life-threatening pancytopenia and normal MCV were proven to have severe vitamin B12 deficiency. The red blood cell distribution width was markedly increased (three times normal) and led to review of the blood smear and recognition of megaloblastosis as well as prominent red cell fragmentation. These three cases illustrate that vitamin B12 status should be evaluated in cases of pancytopenia, independent of the MCV value.
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Eur. J. Intern. Med. · Nov 2007
Non-invasive ventilation in chronic hypercapnic COPD patients with exacerbation and a pH of 7.35 or higher.
Current guidelines suggest the use of non-invasive ventilation (NIV) in hypercapnic chronic obstructive pulmonary disease (COPD) exacerbations in patients presenting with a pH of 7.25-7.35. The aim of this study was to investigate the role of NIV in COPD patients with chronic hypercapnic respiratory failure admitted to the hospital with acute exacerbations and an arterial pH of 7.35 or higher. ⋯ Early administration of NIV in COPD patients with chronic hypercapnic respiratory failure admitted for acute exacerbations with a pH of 7.35 or higher results in a reduced hospital stay and faster improvement of arterial blood gases.
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Eur. J. Intern. Med. · Nov 2007
Brain natriuretic peptide increases in septic patients without severe sepsis or shock.
B-type natriuretic peptide (BNP) production increases in critically ill septic patients. We assessed the hypothesis that BNP is elevated in patients with community-acquired infections without severe sepsis or septic shock. ⋯ BNP levels are elevated in the acute phase of community-acquired microbial infections without severe sepsis or septic shock.