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High-Dose Neuromodulators: A Roundtable in Creating Sense of your data in Real-World Scientific Training.
A 16-year-old male with Becker muscular dystrophy was admitted to hospital with a significant liver injury due to paracetamol. The dosage of paracetamol ingested was within current guidance yet there was sudden derangement of liver function. The patient was treated with five days of N-acetyl cysteine to which he responded, with his alanine aminotransferase improving from 5,599 to 652 and international normalised ratio from 5.0 to 0.9. He had risk factors for paracetamol toxicity as he was malnourished and had muscular dystrophy. The purpose of this case report is to highlight that despite prescribing approved dosages of paracetamol some patients may have toxicity due to altered body composition and pharmacokinetics.Diphtheria is a vaccination preventable infectious disease with local and systemic complications predominantly affecting upper respiratory tract in younger ( less then 5-year age) children. Its virulence is due to its ability to produce toxin which can cause fatal complications such as myocarditis and permanent damage in form of peripheral neuropathy. Diagnosis of diphtheria is primarily clinical supported by demonstration of toxin producing bacteria by culture. Early diagnosis and management with diphtheria anti-toxin can prevent mortality and morbidity. Here we present a case of 16-year-old boy managed with azithromycin, amoxycillin-clavulanic acid and diphtheria anti-toxin with complete recovery.This case brings out the importance of recognising the re-emergence of diphtheria in older age groups. Lacunae in the universal immunisation process, rumours on vaccination effects and poor living conditions for refugee population are likely reasons in Asia and Europe. Universal immunisation, early diagnosis, prophylaxis and adequate supportive care are measures to prevent it.A thorough understanding of the pros and cons of the various study designs is critical to correct interpretation of their results. Retrospective studies are an important tool to study rare diseases, manifestations and outcomes. Findings of these studies can form the basis on which prospective studies are planned. Retrospective studies however have several limitations owing to their design. Since they depend on review of charts that were originally not designed to collect data for research, some information is bound to be missing. Selection and recall biases also affect the results and reasons for differences in treatment between patients and lost follow ups can often not be ascertained and may lead to bias. Readers need to critically evaluate the methods and carefully interpret the results of retrospective studies before they put them to practice. Researchers should avoid over generalisation of results and be cautious in claiming cause-effect relationship in retrospective studies.Worldwide, the prevalence of both obesity and cancer are rising. So far, there is an association between obesity and an increased risk of at least 20 different cancers and this number is increasing. The mechanism behind obesity increasing the risk of cancer varies. The importance of looking at all aspects of obesity, such as hip to waist ratio, body fat distribution and waist circumference, in addition to BMI has been acknowledged in order to further understand these mechanisms. The duration of time a person is obese for, and whether their weight gain was in childhood or adulthood can also affect risk of cancer, however this can be hard to distinguish as obese children and adolescents frequently remain obese into adulthood.
Cardiac tamponade is a medical emergency. This study was carried out to determine the etiologies of cardiac tamponade and review the management and outcomes.

We retrospectively analysed case records of patients who underwent pericardiocentesis for cardiac tamponade during the two consecutive years (1 January 2018 to 31 December 2019) at Hospital Sultanah Nora Ismail, Batu Pahat, in Johor, Malaysia.

There were ten patients (eight males, two females; age range 20 to 70 years old, mean age 36 years old) who underwent pericardiocentesis for cardiac tamponade during the said period. Malignancy (40%), tuberculosis (30%), idiopathic (20%), and bacterial (10%) were among the common causes of the pericardial effusion in this center. The commonest symptoms were breathlessness (90%), chest pain (60%), cough (50%), and unexplained fever (20%). https://www.selleckchem.com/products/wm-1119.html Pulsus paradoxus was the most speciÿ c sign (100%) for the presence of echocardiographic feature of cardiac tamponade. Two of the patients with tuberculous pericarditis had retroviral disease; one patient had bacterial pericarditis due to salmonella typhi.

This study has conÿ rmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving.
This study has conÿ rmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving.
The QT interval a marker of ventricular depolarization and repolarization is reported to be prolonged in some proportion of patients with systemic lupus erythematosus (SLE). We studied electrocardiographic (ECG) abnormalities, in particular QT interval and its relationship with anti-Ro antibodies, disease activity, and serum interleukin 1β (IL-1β), interleukin 6 (IL-6) in SLE.

A 12-lead resting ECG was performed on 140 adult SLE patients fulflling SLICC/ACR classification criteria. All patients received hydroxychloroquine and prednisolone. Corrected QT (QTc) °440 milliseconds (ms) was defined as prolonged QTc. QT dispersion (QTd) °60 ms was defined as increased QTd.

Eighty-four patients had some form of ECG abnormality. Prolongation of QTc and QTd was present in 24 (17.1%) and 50 (35.7%) respectively. Anti-Ro/SSA antibodies were present in 63 (45%). Prolongation of QTc in anti-Ro positive versus anti-Ro negative was 17.5% and 17% respectively, p=0.98. Prolongation of QTd in anti-Ro-positive versus anti-ities that may reflect subclinical cardiac involvement.
Though 17% and 35% SLE patients have QTc and QTd prolongation, association with anti-Ro antibodies or disease activity was absent. A large proportion has other asymptomatic ECG abnormalities that may reflect subclinical cardiac involvement.
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