Duodecim; lääketieteellinen aikakauskirja
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For patients with cardiovascular disease, statins belong to routine medical treatment irrespective of blood lipid levels. In primary prevention also, statins have been found to prevent cardiovascular diseases, associated deaths and decrease overall mortality. In previously healthy persons the use of statins should be based on the assessment of total risk--mere cholesterol level does not usually constitute an indication for treatment. The use of statins may lead to adverse effects, the major one being myopathy, for which an elevated risk is associated with increasing statin dosages.
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The updated Current Care guideline for children and adolescents with ADHD covers both diagnosis and treatment. Psychosocial support is provided when hyperactivity problems arise, even before specific diagnosis. While psychosocial interventions are effective in the treatment of ADHD, the core symptoms are best treated with medication, such as methylphenidate, dexamphetamine, lisdexamphetamine or atomoxetine. Collaboration between families, primary health care services, specialist consultation services and day-care and school professionals is essential within the chain of care.
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Bronchiolitis is the most common disease leading to hospitalization of infants of less than one year of age in Finland. Among each age group, the disease needs hospitalization in approx. 3% of the cases. ⋯ When required, inhalations of racemic epinephrine are given for severe symptoms. The authors' treatment practice for bronchiolitis is presented in this article.
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Dabigatran has been introduced into the prevention of stroke in patients with atrial fibrillation. Monitoring of the effect and reversing the action of dabigatran as well as management of an emergency operation and bleeding in a patient who is using the drug is demanding. ⋯ There is no antidote for dabigatran, but its effect can possibly be partly reversed with recombinant coagulation factor VIIa and dialysis. With increasing use of dabigatran, more frequent severe bleeding complications and problems in emergency operations are to be expected.
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Most fractures of the distal radius are treated with closed reduction and casting. Locking plates are the most common method of fixation. In young persons and in elderly persons with functional activity above that of their age level, a <10 degrees dorsal or <20 degrees volar angle of tilt, a radial shortening of <2 mm, a radial inclination of >15 degrees and an intra-articular step-off or gap of <1 to 2 mm are regarded as an acceptable limit of position of the radius. In persons over 65 years of age the functioning of the hand can usually be restored with casting.