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 production of cathelicidin, an antimicrobial peptide is strongly increased in rosacea. Cathelicidin activates innate immunity, inflammation and angiogenesis. Cutaneous proteases produce inflammatory fragments of cathelicidin. ⋯ Retinoids and doxycycline inhibit inflammation, proteases, angiogenesis and TLR2 expression. A multicenter study 2010 proved that isotretinoin with a dose of 0,3 mg/kg/d for 12 weeks and doxycycline with the dose of 100 mg/d for 14 days followed with 50 mg/d were equally effective. Doxycycline 40 mg/d is also effective in milder cases.
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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.
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Botulism is caused by botulinum neurotoxin produced by the bacterium Clostridium botulinum. It is a flaccid paralysis in which consciousness and nociception are preserved. ⋯ In the diagnosis and treatment of botulism early suspicion is essential. Several coinciding or local clusters without a typical connecting source, or an uncommon type of toxin may indicate an intentionally caused epidemic.