Dan Med Bull
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A working group was established to evaluate the need for an increased folate intake in Danish women to decrease the risk of neural tube defects (NTDs). NTD are birth defects which include anencephaly, encephalocele and spina bifida. In Denmark the incidence is about 1.4 per 1,000 pregnancies. ⋯ Women who do not eat according to the Nordic Nutrition Recommendations, and women with an increased risk due to diseases are recommended a supplement of 400 micrograms folic acid daily from a multivitamin/folic acid tablet. Women who have had a child with NTD and women who themselves have NTDs are recommended a supplement of 5 mg folic acid daily. Dietary changes and supplements should be initiated when pregnancy is planned.
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Acute coronary syndrome encompasses the entities acute MI, unstable AP and sudden cardiac death. The syndrome of unstable AP covers a very heterogenous group of patients. Recent pathological post-mortem investigations have revealed, that unstable AP leading to MI or sudden cardiac death is frequently preceded by microinfarctions. ⋯ A similar observation has been supported by others using the rate of change in serial samples of CK-MB mass. Further, we demonstrated a good correlation between elevated CK-MB mass levels and a poor prognosis, when using a fixed discrimination limit. However, an increasing number of CK-MB mass immunoassays have been developed, and a standardization of CK-MB mass is urgently needed, as at present each laboratory determines its own reference levels and discriminatory values leading to the risk of diagnostic confusion. (ABSTRACT TRUNCATED)
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With the introduction of measurements of glycated haemoglobin in a single blood sample as an index of long-term blood glucose control, the clinically usefulness of these measurements was questioned. The aim of this study was to evaluate measurements of glycated haemoglobin as a new test for metabolic regulation in diabetes management by use of a medical technology assessment strategy. Technology assessment in medicine has been defined as "the art and science of evaluating medical practices", but the strategy has to be adjusted to the medical technology in question always including the following three stages: (a) problem definition and identification of medical technology, (b) analysis by testing the technology with consideration to its benefit and harm, its costs, and its social consequences, and (c) synthesis of the accumulated knowledge about the technology. ⋯ In patients with IDDM our studies demonstrated the limitations of traditional clinical judgement and the laboratory procedures in providing an accurate assessment of blood glucose control and that knowledge of HbA1c values allowed the clinician to identify patients in poor glycemic control and lead to improvement in glycemic control. In patients with NIDDM our study showed that measurements of HbA1c provided information that was otherwise not obtainable in the usual clinical setting in primary health care. Measurements of glycated haemoglobin were easily accepted by patients with diabetes. (ABSTRACT TRUNCA
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The mechanism of central nervous side effects of lumbar puncture is reviewed on the basis of the literature. The most frequent adverse effect of lumbar puncture remains the postdural puncture headache; dysfunction of certain cranial nerves occurs less frequently. Laboratory studies have shown that the production rate of CSF. ⋯ There are no reports of measurement of the intracranial pressure in patients with postdural puncture headache, but there are several indications of a reduced CSF pressure that may explain postdural puncture headache and vestibulocochlear dysfunction following lumbar puncture. Recent audiometric studies suggest that hearing loss may be a sensitive indicator of CSF leakage, and larger series indicate that the needle size and the shape of the needle tip are important determinants of the incidence of central nervous side effects. Epidural blood patch may give immediate relief of postdural puncture headache and cranial nerve dysfunction after lumbar puncture, but the reason for the rapid and impressive effect of epidural blood patch has not been fully elucidated.