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      • KCI등재후보

        An update of the Malaysian Clinical Guidance on the management of glucocorticoid-induced osteoporosis, 2015

        Swan Sim Yeap,Fen Lee Hew,Premitha Damodaran,Winnie Chee,Joon Kiong Lee,Emily Man Lee Goh,Siew Pheng Chan 대한골다공증학회 2017 Osteoporosis and Sarcopenia Vol.3 No.1

        Objectives: This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with glucocorticoid-induced osteoporosis (GIO), using the best available evidence. Methods: A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on GIO and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: Consider treatment early in all patients on glucocorticoids (GC) as fracture risk increases within 3e6 months of starting GC. The decision to start treatment for GIO depends on the presence of prior fracture, category of risk (as calculated using Fracture Risk Assessment Tool), daily dose and duration of GC treatment, age, and menopausal status. General measures include adequate calcium and vitamin D intake and reducing the dose of GC to the minimum required to achieve disease control. In patients on GC with osteoporotic fractures or confirmed osteoporosis on dual-energy X-ray absorptiometry, bisphosphonates are the first-line treatment. Treatment should be continued as long as patients remain on GC. Algorithms for the management of GIO in both pre- and post-menopausal women and men have been updated. Conclusions: In post-menopausal women and men above 50 years, bisphosphonates remain the mainstay of treatment in GIO. In pre-menopausal women and men below 50 years, bisphosphonates are recommended for those with a prevalent fracture or at very high risk only.

      • A summary of the Malaysian Clinical Guidance on the management of postmenopausal and male osteoporosis, 2015

        Swan Sim Yeap,Fen Lee Hew,Premitha Damodaran,Winnie Chee,Joon Kiong Lee,Emily Man Lee Goh,Malik Mumtaz,Heng Hing Lim,Siew Pheng Chan 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

        Aim: This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with osteoporosis (OP), using the best available evidence. Methods: A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on OP and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal and male OP, while addressing the risk-benefit ratio for OP treatment. Recognising the limitation of only depending on bone mineral density in assessing fracture risk, a move to assess 10 year fracture risk using tools such as FRAX, is recommended as a guide to decision-making on when to start treatment. A re-evaluation was done of the position of calcium supplementation and on the importance of vitamin D. There has been concern about the potential adverse effects of the long-term usage of bisphosphonates, which have been discussed fully. Algorithms for the management of postmenopausal and male OP have been updated. Conclusions: Adequate intake of calcium (1000 mg from both diet and supplements) and vitamin D (800 IU) daily remain important adjuncts in the treatment of OP. However, in confirmed OP, pharmacological therapy with anti-resorptives is the mainstay of treatment in both men and postmenopausal women. Patients need to be regularly assessed while on medication and treatment adjusted as appropriate. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

      • KCI등재

        Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets

        Claudia Phen,Alexander Wilsey,Emily Swan,Victoria Falconer,Lisa Summers,Michael Wilsey 대한소아소화기영양학회 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4

        Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.

      • SCOPUSKCI등재

        Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets

        Phen, Claudia,Wilsey, Alexander,Swan, Emily,Falconer, Victoria,Summers, Lisa,Wilsey, Michael The Korean Society of Pediatric Gastroenterology 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4

        Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.

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