Papers by Malvinder Parmar
Medical Journal of Australia, 2004
Indexes are published every 6 months and are available on request as part of the current subscrip... more Indexes are published every 6 months and are available on request as part of the current subscription. Single or back issues contact: AMPCo (02) 9562 6666.
Southern medical journal, 2016
The mission of the Institute is to promote clinical excellence and the efficient use of resources... more The mission of the Institute is to promote clinical excellence and the efficient use of resources in the health and social services sector More particularly, the Institute's mission consists in assessing the clinical advantages and the costs of the technologies, medications and interventions used in health care services
Biochemia medica, 2016
Hypernatremia is common among hospitalized patients especially in the intensive care units and pr... more Hypernatremia is common among hospitalized patients especially in the intensive care units and presents an independent risk factor for mortality. Mild hypernatremia is often asymptomatic but severe hypernatremia causes central nervous system dysfunction with initial non-specific symptoms of encephalopathy that may progress to seizures, coma and death, if left untreated. Severe hypernatremia is a medical emergency and requires emergent medical attention. A haemodialysis patient who arrived for his scheduled haemodialysis treatment had monthly blood work drawn and was reported to have severe hypernatremia with serum sodium concentration of 183 mmol/L. The possibility of technique or laboratory error was considered and systematically evaluated. The serum sodium measurement using another analyser showed similar value of 182 mmolL. A repeat serum sodium level on a sample drawn 2 h later showed normal value of 139-140 mmol/L. A step-wise evaluation of the complete procedure from blood col...
Cmaj Canadian Medical Association Journal, Apr 1, 2003
A n 85-year-old woman presented with a 2-month history of generalized weakness, malaise, nausea, ... more A n 85-year-old woman presented with a 2-month history of generalized weakness, malaise, nausea, decreased appetite and 9-kg weight loss, as well as generalized pruritus of 2 weeks' duration. She described no abdominal pain, vomiting or abnormal bowel movements, though she had noted that her urine was somewhat darker than usual. She complained of having had mild, intermittent mid-back pain for a few months. The patient said that she had no history of blood transfusions, jaundice or hepatitis and was not using any medications, cigarettes or alcohol. On examination she was emaciated with mild jaundice, and had flat, brittle nails but no clubbing. The patient's abdomen was soft and scaphoid. A firm liver edge was palpable 3 cm below the right subcostal margin, as was a soft, nontender, tennis ball-sized lump in her right upper quadrant. The patient had no lymphadenopathy, no skin rash, no peripheral edema and no focal neurological findings. Although the patient's complete blood count, creatinine and electrolytes were normal, her erythrocyte sedimentation rate was slightly elevated at 39 mm/h, as were her serum bilirubin (32 µmol/L), AST (103 U/L), ALT (65 U/L), ALP (456 U/L) and GGT (367 U/L). An abdominal ultrasound scan showed dilated intrahepatic ducts and an enlarged gallbladder, but the patient's pancreas was not well visualized. A CT scan of the abdomen with contrast was performed: Fig. 1 shows a fatty liver and dilated intrahepatic ducts (black arrow); Fig. 2 shows the dilated pancreatic duct (white arrowhead), dilated common bile duct (white arrow) and enlarged gallbladder (black arrow); Fig. 3 shows an enlarged gallbladder (black arrow) and an inhomogeneous head of pancreas with a small soft-tissue density (white arrow). A chest radiograph showed numerous noncalcified nodules less than 1 cm in size in both lungs consistent with
Cmaj Canadian Medical Association Journal, Sep 2, 2003
A 61-year-old woman with a history of recurrent episodes of transient thyrotoxicosis presented in... more A 61-year-old woman with a history of recurrent episodes of transient thyrotoxicosis presented in November 2001 with a 3-week history of weight loss of 4 kg, palpitations and increased sweating. She had mild tachycardia (112 beats/minute) and fine tremor of the hands. She had no thyroid enlargement, thyroid bruits, eye signs or pretibial myxedema. A clinical diagnosis of hyperthyroidism was confirmed by elevated free thyroxine (T 4) (46 [normally 9 to 23] pmol/L) and suppressed thyroid-stimulating hormone (TSH) (0.02 [normally 0.35 to 5.0] µIU/L). Her symptoms resolved spontaneously and her free T 4 returned to normal (12 pmol/L) within 8 weeks. This was the patient's fifth episode of transient hyperthyroidism over an 11-year period (see Fig. 1), each episode lasting 2 to 3 months. Silent thyroiditis had been diagnosed in 1991 after investigations at a tertiary care centre, and subsequent episodes had been labelled silent thyroiditis because of similar presentations. Further investigations in November 2001 showed normal erythrocyte sedimentation rate (ESR), no antinuclear antibody or antithyroid antibodies, normal levels of thyrotropin binding inhibitor immunoglobulin (TBII) (less than 8.0 IU/L) and low serum thyroglobulin level (0.4 [normally 2.3 to 48.0] µg/L). A chart review revealed negative results for antithyroid anti
Cmaj Canadian Medical Association Journal, Oct 29, 2002
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Papers by Malvinder Parmar