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Background/Aim: Although thiazide-type diuretics can promote a positive calcium balance, thiazide can be associated with hyponatraemia, which is recently linked with heightened fracture risk. We examine the chance of developing fracture in patients with and without hyponatraemia after taking thiazide diuretics. Methods: In this single-centre retrospective study, we followed up a previously published cohort of patients with ( n= 223) and without ( n= 216) thiazide-induced hyponatraemia. Results: A total of 61 osteoporotic fractures was recorded during a mean follow-up period of 82 months. Using univariate regression analysis, the hazard ratio of thiazide-induced hyponatraemia was 1.78 (95% confidence interval (CI), 1.05-3.03; P= 0.033). Cox proportional hazards regression analysis, however, showed that age, body mass index and diabetes mellitus were the only independent predictors of osteoporotic fractures. No association of a history of thiazide-induced hyponatraemia and risk of fracture was evident in the final model. Conclusion: Since a history of thiazide-induced hyponatraemia is associated with osteoporotic fracture in univariate but not multivariate analyses, an alternative explanation is that confounding factors of older age and low body mass index accounted for the apparently increased risk of osteoporotic fracture in patients with thiazide-induced hyponatraemia. [ABSTRACT FROM AUTHOR]

The role of hot temperature has been implicated in thiazide-induced hyponatraemia; however, it has never been studied in a systematic manner. The aim of this retrospective study is to correlate the incidence of thiazide-induced hyponatraemia and climate factors in a university teaching hospital from June 1996 to February 2002. We evaluated a representative sample of 201 subjects with thiazide-induced hyponatraemia. Overall, 2.9 ± 2.2 (range 0–10, median 3) cases of thiazide-induced hyponatraemia were encountered each month during the study period. There was no seasonal variation in the rate of thiazide-induced hyponatraemia (overall χ2 test, p = 7.0). Thiazide-induced hyponatraemia was not more frequently reported in summer. There was no discernible correlation between the monthly number of cases and average air temperature (r = −0.056, p = 0.65) and relative humidity (r = 0.103, p = 0.40). On the other hand, patients who presented with thiazide-induced hyponatraemia in July and August had significantly higher serum sodium concentration, 118 ± 7 mmol/l vs. 114 ± 8 mmol/l in other calendar months (p = 0.016). Temperature showed a statistically significant positive correlation with the level of serum sodium (r = 0.20, p = 0.004). These data demonstrate that there are no seasonal variations in thiazide-induced hyponatraemia disorders, at least in countries with subtropical climate. The question arises whether hypotonic sweat loss mitigates the risk of excessive water drinking in hot summer. [ABSTRACT FROM AUTHOR]

Chronic lead exposure is recognized as a potential cause of hyperuricaemia, kidney damage and hypertension. The fascinating story of lead poisoning and nephrotoxicity illustrates the utility of descriptive studies in the early elucidation of a new disease entity. The pursuit towards understanding lead nephropathy is presented as a successful illustration of human occupational and public health. [ABSTRACT FROM AUTHOR]

This paper presents an investigation of the effect of the internal antenna on the specific absorption rate (SAR), and the effect of the presence of a human head at close proximity to a mobile phone upon the antenna performance in mobile-phone applications. Both the experimental measurement and numerical simulation of the SAR values and the antenna performance parameters of a typical internal antenna are presented. The results indicate that the far-field radiations of the internal antenna can be reduced by 3 dB with the presence of human head. © 2005 Wiley Periodicals, Inc. Microwave Opt Technol Lett 45:286–290, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20797 [ABSTRACT FROM AUTHOR]

Adding an external shield to mobile phones is one of the common methods adopted for the reduction of the specific absorption rate (SAR), which is the safety level of human exposure to radiated electromagnetic fields from mobile phones. This paper provides an experimental study on the effectiveness of SAR reduction by attaching conductive materials to mobile phones, and the corresponding effects of the antenna performance of the mobile phones. The results show a typical trade-off of a 20% reduction in the SAR value with a maximum 1.8-dB reduction in the received power of the antenna. The results also conclude that the attachment position of the shielding material is an important factor, whereby the hot spot of the SAR distribution of the mobile phone must be well covered in order to achieve good SAR reduction. © 2004 Wiley Periodicals, Inc. Microwave Opt Technol Lett 44: 140–144, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.20569 [ABSTRACT FROM AUTHOR]

Background: Reciprocal creatinine plot is often used to monitor patients with progressive renal insufficiency and to predict the onset of dialysis, although the latter practice has not been validated.Objective: We examined whether extrapolating the reciprocal creatinine plot can predict the onset of dialysis.Setting: Single centre study in the dialysis unit of a University teaching hospital.Design: We studied 170 consecutive patients with progressive renal insufficiency referred to a single nephrology unit and subsequently dialysed. Reciprocal creatinine plot was constructed by all available serum creatinine values before dialysis (the 'definitive plot'). Four 'interim plots' were constructed for each patient by using serum creatinine below 400, 500, 600 and 700 micromol L(-1). Interim plots with at least five points and Pearson's r > 0.9 were analysed. The date of dialysis was predicted from the least squares linear regression formula and a target serum creatinine level cor- responding to estimated creatinine clearance of 7 mL min-1, at which dialysis was recommended.Results: The median duration of observation was 25 months. After serum creatinine 500 micromol L(-1), the slope of the interim plot remained stable and extrapolation was possible in 117 patients (68.8%). However, the limits of agreement for predicting the onset of dialysis were wide (from -11.7 to +9.5 months). At this creatinine level, the onset of dialysis fell within 1 month of the predicted onset in only 41 patients (24.1%). The limits of agreement for prediction narrowed when time points of higher serum creatinine were included into the plot. However, nine patients (5.3%) required dialysis within 1 month at creatinine 600 micromol L(-1) and the dialysis was not predicted by the reciprocal creatinine plot. Target serum creatinine did not correlate with acute serum creatinine at which dialysis was started (r = 0.051, P = 0.51). A slower decline in renal function was associated with a higher prediction error (r = 0.212, P = 0.014).Conclusions: The onset of dialysis cannot be predicted by extrapolation of the reciprocal creatinine plot because of individual variation in the renal function that require dialysis. Dialysis would be almost imminent in some patients by the time serum creatinine reaches a level that allows accurate construction and extrapolation of a plot. [ABSTRACT FROM AUTHOR]

The article presents a medical case of an 86-year old Chinese woman presented with altered consciousness, right lung infiltrates, raised inflammatory markers and leucocytosis, consistent with pneumonia. This case was attributed to amoxicillin-clavulanate use, in the absence of other possible causes of cholestasis, and supported by the chronological order of events and the liver histopathology which is in limited to impaired transport and secretion of bile.

A letter to the editor is presented on pancytopenia in a patient with tuberculous peritonitis.

The article presents images of a 60-year old woman suffering from severe headache. A mildly tender subcutaneous lump was noted on her right forehead. Skull x-rays demonstrated an area of lucency within the right parietal region. Bonewindows from brain computed tomography confirmed a bony defect at that site.

Comments on a study which assessed the performance of three D-dimer assays in outpatients with suspected deep vein thrombosis. Detection rate of deep vein thrombosis by compression ultrasonography; Diagnostic value of serial ultrasonography; Monitoring of the incidence of venomous thromboembolism over three-month follow-up.