PubMed · 16154031
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A D MacBean, K F M Fan, C Darwish. 2005. Interesting case: lessons learnt.. https://doi.org/10.1016/j.bjoms.2004.08.029
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INTRODUCTION: The use of cyclooxygenase-2 (COX-2) inhibitors has been demonstrated to not only impair load-induced bone formation but also prevent menopause-associated bone loss. We hypothesized that COX-2 inhibitor use would be associated with increased bone mineral density (BMD) in postmenopausal women not using estrogen therapy and, conversely, with decreased BMD in men. METHODS: The Canadian Multicentre Osteoporosis Study is a longitudinal, randomly selected, population-based community cohort. We present data from men (n=2,004) and postmenopausal women age 65 and older (n=2,776) who underwent a BMD measurement and structured interview in the 5th year of the study. The outcome measure was percent difference in BMD (g/cm(2)). RESULTS: Daily COX-2 inhibitor use was reported by 394 subjects. In men, daily use of COX-2 inhibitors was associated with a lower BMD at all hip sites, with a percent difference of -3.1% [95% confidence interval (CI), -6.0, -0.3] between users and nonusers at total hip. In postmenopausal women not using estrogen replacement therapy, daily COX-2 inhibitor use was associated with higher BMD at most sites [percent difference at total hip: +3.0% (95% CI, 0.3, 5.8)]. These effects appeared to be dose-dependent. CONCLUSION: COX-2 inhibitor use was associated with a lower BMD in men and, on the other hand, with a higher BMD in postmenopausal women not using estrogen replacement therapy. Men who have used COX-2 inhibitors may wish to seek BMD measurement to assess their fracture risk. However, COX-2 inhibitors may have utility in postmenopausal women if bone-selective analogs can be developed.
BACKGROUND: Poisoning with paracetamol is common and potentially serious. We have assessed the incidence of paracetamol poisoning and the hospital's use of serum analyses to monitor the antidotal treatment N-acetyl cysteine. MATERIAL AND METHODS: All hospital records of ICD-10 diagnoses T4n and T50.9 at the Department of Acute Medicine from July 2001 to July 2004, were retrospectively reviewed. All cases with possible or confirmed paracetamol poisoning were recorded. Liver damage was defined as ALT above 1,000 U/l. Standard European treatment nomogram was used. RESULTS: Of 869 admissions with acute poisoning, 158 (21%) were caused by paracetamol; of these 120 (76%) were women and 38 (24%) were men. 107 (68%) of the patients were treated with N-acetyl cysteine at admission due to suspected ingestion of more than 10 grams of paracetamol. Treatment was abrupted in 84 (79%) of the patients, as levels of serum paracetamol were below the treatment line in the nomogram. The median time from admission to sampling was 5 hours. Nine patients (6%), who all arrived later than 15 hours after ingesting paracetamol, developed liver damage. One woman died after a sub-acute overdose of paracetamol. INTERPRETATION: Few patients needed treatment with antidote. The treatment seemed to protect all against liver damage if started early. Liver damage and death was associated with admission later than 15 hours after intake.
Anecdotally many athletes use non-steroidal anti-inflammatory gels during competition to allow continued participation. To determine if this clinical practice is useful a randomised placebo-controlled study was conducted at the 5-day 2004 Red Cross Murray River Marathon. Forty-two kayakers presented with wrist extensor tenosynovitis while competing in the single and double kayak events. All subjects received standard treatment of ice, stretches and massage for wrist tenosynovitis before being randomised into a placebo or 1% diclofenac gel group. Evaluation was done by using a visual analogue scale (0-10) for pain and by clinical grading (0-3). The main outcome measurements were reduction in pain and clinical grading, the requirement for a rescue medication (paracetamol or diclofenac tablets) and effect on performance times. Both groups had similar pain scores and clinical grading on the first and fifth days of pain. On the second to fourth days of pain there was clearly no benefit and possibly a detrimental effect on pain with diclofenac gel relative to placebo. However, diclofenac tablets were possibly beneficial for pain relative to paracetamol tablets. The effects of pain and the various treatments on performance time were either trivial (<0.5%) or small, but none was particularly clear. We conclude that standard treatment appears to be sufficient for the management of wrist extensor tenosynovitis during competition.