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Clin Med (Lond) 2017 Dec;17(6):590
Clin Med (Lond) 2017 Dec;17(6):588
Health Education Thames Valley, Oxford, UK.
Clin Med (Lond) 2017 Dec;17(6):586-587
Image of the month: Dysphasia due to injury of the corticobulbar tract following traumatic brain injury.
Clin Med (Lond) 2017 Dec;17(6):584-585
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
Lesson of the month 2: Use of thrombolysis for ischaemic stroke in pregnancy - a case report and review of literature.
Clin Med (Lond) 2017 Dec;17(6):581-583
Basildon University Hospital, Basildon and Thurrock NHS Foundation Trust.
A nine-week pregnant 33-year-old female presented with sudden-onset right-sided hemiparesis, hemisensory loss, dysarthria and homonymous hemianopia. She was known to have eleven previous miscarriages and used recreational drugs. A CT-head was unremarkable. Read More
Lesson of the month 1: Obesity hypoventilation (Pickwickian) syndrome: a reversible cause of severe pulmonary hypertension.
Clin Med (Lond) 2017 Dec;17(6):578-581
Department of Cardiology, University Hospital Southampton, Southampton, UK
Obesity hypoventilation syndrome (OHS) is a condition in which an individual with a body mass index >30 kg/m2 develops daytime alveolar hypoventilation (defined as a resting PaCO2 >45 mmHg) that cannot be attributed to other pathologies. It is a condition with increasing prevalence and rising cost to healthcare systems worldwide. Right heart failure and pulmonary hypertension are well-known complications of this syndrome. Read More
Clin Med (Lond) 2017 Dec;17(6):575-577
Dorset County Hospital, Dorchester, UK.
In this case study, we summarise the inpatient investigations and management of a 68-year-old woman with Takotsubo cardiomyopathy secondary to a Varicella zoster encephalitis and the difficulties inherent with making this diagnosis. She presented with evolving cranial nerve neuropathies, which started with a vagal nerve mononeuritis and eventually included left-sided sensorineural hearing loss and a facial nerve palsy. These symptoms were concomitant with a variety of cardiac abnormalities, including fast atrial fibrillation and electrocardiographic changes. Read More
Clin Med (Lond) 2017 Dec;17(6):573-574
Clin Med (Lond) 2017 Dec;17(6):568-572
East Anglian Medical Genetics Service, Cambridge, UK.
Advances in sequencing technology have led to the introduction of panel testing in hereditary breast and ovarian cancer. While direct-to-consumer testing services have become widely available, the clinical validity of many of the genes on panel tests remains contentious and risk management guidelines are often lacking. This article gives an overview of advantages with panel testing as well as important challenges, including clinical translation of test results. Read More
Clin Med (Lond) 2017 Dec;17(6):562-567
Institute of Genetic Medicine, Centre for Life, Newcastle upon Tyne, UK.
This article provides an overview of selected genetic skin conditions where multiple inherited cutaneous tumours are a central feature. Skin tumours that arise from skin structures such as hair, sweat glands and sebaceous glands are called skin appendage tumours. These tumours are uncommon, but can have important implications for patient care. Read More
Clin Med (Lond) 2017 Dec;17(6):558-561
Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK.
Global developmental delay and intellectual disability are phenotypically and genetically heterogeneous and a specific diagnosis is not reached in many cases. This paper outlines a systematic approach to global developmental delay and intellectual disability. Read More
Clin Med (Lond) 2017 Dec;17(6):552-557
Department of Clinical Genetics, St Georges Hospital and St George's, University of London, London, UK.
Lymphoedema is the build-up of lymphatic fluid leading to swelling in the tissues. Most commonly it affects the peripheries. Diagnosis is based on clinical assessment and imaging with lymphoscintigraphy. Read More
Clin Med (Lond) 2017 Dec;17(6):545-551
Guy's and St Thomas' NHS Foundation Trust, London, UK, Queen Mary University of London, UK and Genomics England, London, UK.
Virtually all medical specialties are impacted by genetic disease. Enhanced understanding of the role of genetics in human disease, coupled with rapid advancement in sequencing technology, is transforming the speed of diagnosis for patients and providing increasing opportunities to tailor management. As set out in the Annual report of the Chief Medical Officer 2016: Generation Genome1 and the recent NHS England board paper Creating a genomic medicine service to lay the foundations to deliver personalised interventions and treatments,2 the increasing 'mainstreaming' of genetic testing into routine practice and plans to embed whole genome sequencing in the NHS mean that the profile and importance of genomics is on the rise for many clinicians. Read More
- Christopher Jm Whitty
Clin Med (Lond) 2017 Dec;17(6):537-544
Department of Health, UK; professor of public and international health, London School of Hygiene & Tropical Medicine
Clin Med (Lond) 2017 Dec;17(6):530-536
University College London, London, UK.
This article reviews our current understanding and modern treatment of multiple sclerosis (MS). MS is a disabling condition resulting in devastating social and economic impacts. As MS can affect any part of the central nervous system, the presentation is often diverse; however, there are key features that can be useful in the clinic. Read More
Clin Med (Lond) 2017 Dec;17(6):525-529
National Heart and Lung Institute, Imperial College London, UK.
The Human Microbiome Project began 10 years ago, leading to a significant growth in understanding of the role the human microbiome plays in health and disease. In this article, we explain with an emphasis on the lung, the origins of microbiome research. We discuss how 16S rRNA gene sequencing became the first major molecular tool to examine the bacterial communities present within the human body. Read More
Clin Med (Lond) 2017 Dec;17(6):521-524
Epsom and St Helier NHS Foundation Trust, Carshalton, UK.
Physicians reading this will have a broad range of in-depth knowledge about their own subspecialty. However, in daily medical practice there are topics of which all physicians should have some knowledge. Those who deal with young people should have some knowledge of the needs of the hearing-impaired population within this group of patients. Read More
Clin Med (Lond) 2017 Dec;17(6):508-520
Brighton and Sussex Medical School, Brighton, UK.
Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people ≥50 years is increasing. Unique factors may be associated with testing in this group. Read More
Frequency of stepping down antibiotics and nebuliser treatment is lower at weekends compared to weekdays: an observational study.
- Sarah Lewis,
- Tessa Langley,
- Julia Lacey,
- Rob Skelly,
- Mark Norwood,
- Nigel Sturrock,
- Andrew Fogarty
Clin Med (Lond) 2017 Dec;17(6):504-507
Division of Public Health and Epidemiology, University of Nottingham.
We hypothesised that delays in providing non-urgent medication step-downs at weekends to medical management may be associated with increased length of stay.In a novel use of electronic prescribing data, we analysed emergency admissions from a busy acute medical hospital over 52 weeks from November 2014 to October 2015. The main outcomes of interest were switching from intravenous antibiotics to oral antibiotics and stopping nebulised bronchodilators. Read More
Screening for obstructive sleep apnoea using the STOPBANG questionnaire and the Epworth sleepiness score in patients admitted on the unselected acute medical take in a UK hospital.
Clin Med (Lond) 2017 Dec;17(6):499-503
Basildon and Thurrock University Hospital, Basildon, UK.
Obstructive sleep apnoea (OSA), which is often overlooked in patients presenting to primary and secondary care, is an increasingly common comorbidity. The prevalence of OSA has not been studied in the unselected acute medical take. The aim of this study was to screen for the prevalence of undiagnosed OSA using the STOPBANG Questionnaire and the Epworth sleepiness scale (ESS) score in an unselected acute medical take. Read More
Clin Med (Lond) 2017 Dec;17(6):490-498
Royal College of Physicians, London, UK.
A structured online survey was used to establish the views of 2,684 practising clinicians of all ages in multiple countries about the value of the physical examination in the contemporary practice of internal medicine. 70% felt that physical examination was 'almost always valuable' in acute general medical referrals. 66% of trainees felt that they were never observed by a consultant when undertaking physical examination and 31% that consultants never demonstrated their use of the physical examination to them. Read More
Clin Med (Lond) 2017 Dec;17(6):484-489
National Heart and Lung Institute, London, UK.
Although Influenza vaccination is recommended for healthcare workers, vaccination rates in UK healthcare workers are only around 50%. We investigated the association between NHS sickness absence rates (using data from Health and Social Care Information Centre quarterly reports), staff vaccination rates and influenza vaccine efficacy (from Public Health England), influenza deaths (from the Office of National Statistics) and staff satisfaction (from www.NHSstaffsurveys. Read More
- Ed Nicol
Clin Med (Lond) 2017 Dec;17(6):483
- Oscar M P Jolobe
Clin Med (Lond) 2017 10;17(5):480
Manchester Medical Society, Manchester, UK.
- Andrew Thompson
Clin Med (Lond) 2017 10;17(5):479
Musgrove Park Hospital, Taunton, UK.
- Andrew Frank
Clin Med (Lond) 2017 10;17(5):478
- Ann Chu
Clin Med (Lond) 2017 10;17(5):477
Academic clinical fellow renal medicine/medical education, Imperial College London Faculty of Medicine, London, UK.
Clin Med (Lond) 2017 Oct;17(5):473-474
University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
A 52 year-old female with no significant medical problems presented with left-sided weakness, unsteady gait and speech disturbance. It was thought that she had neuro-inflammation and she remained clinically stable. Several years later, she was diagnosed with latent autoimmune diabetes of adulthood. Read More
Lesson of the month 1: Spontaneous septic thrombophlebitis presenting with bacteraemia diagnosed by PET-CT scan.
Clin Med (Lond) 2017 Oct;17(5):471-472
Southend University Hospital NHS Foundation Trust, Southend, UK.
Spontaneous septic thrombophlebitis is a rare complication of Staphylococcus aureus bacteraemia. Its true incidence is unknown as septic thrombus is not often considered as a source in the typical 'screen' of tests used to find the source of a bacteraemia.Positron emission tomography computerised tomography (PET-CT) is becoming increasingly available to physicians, is highly sensitive and yields specific anatomical information regarding abnormal metabolically active sites in infection, inflammation and neoplasia. Read More
Clin Med (Lond) 2017 Oct;17(5):462-468
University College London Hospitals NHS Foundation Trust, London, UK.
This article discusses the important role of nuclear medicine imaging and therapy in the management of neuroendocrine tumours (NETs). Somatostatin receptor scintigraphy has a high impact on patient management versus conventional imaging. Molecular radiotherapy is an important part of the management of patients with NETs. Read More
Clin Med (Lond) 2017 Oct;17(5):458-461
Brighton and Sussex University Hospitals NHS Trust and honorary reader and BSMS PET-CT lead, Brighton and Sussex Medical School, Brighton, UK.
Two different molecular radio-theragnostic principles are applied in prostate cancer, providing a personalised management for those patients. Firstly, radiopharmaceuticals with the same or similar mechanism of action but different energy (gamma-γ, eg 99mTc-diphosphonates or positron-β+, eg 18F-NaF emitting isotopes) can be used to identify patients with osteoblastic metastases for a treatment with bone seeking beta (β-) or alpha (α-) emitting radionuclides to deliver targeted molecular radiotherapy. A number of such β- emitting molecules have been used for bone palliation. Read More
Clin Med (Lond) 2017 Oct;17(5):453-457
Kings College London, London, UK.
Molecular radiotheragnostics directly links nuclear medicine diagnostic imaging to therapy. The imaging study is used to detect a specific molecular target associated with a disease process. A radiotherapeutic molecule with a similar biodistribution to the diagnostic agent can then be used to deliver targeted therapy. Read More
Clin Med (Lond) 2017 Oct;17(5):449-453
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Primary and secondary liver malignancies are common and associated with a poor prognosis. Surgical resection is the treatment of choice; however, many patients have unresectable disease. In these cases, several liver directed therapies are available, including selective internal radiation therapy (SIRT). Read More
Clin Med (Lond) 2017 Oct;17(5):444-448
Department of Cancer Imaging and Guy's & St Thomas' PET Centre, King's College London, London, UK
Positron emission tomography (PET)/computerised tomography is now established in clinical practice for oncologic and non-oncological applications. Improvement and development of scanner hardware has allowed faster acquisitions and wider application. PET/magnetic resonance imaging offers potential improvements in diagnostic accuracy and patient acceptability but clinical applications are still being developed. Read More
Clin Med (Lond) 2017 Oct;17(5):439-443
William Harvey Research Institute, Queen Mary University of London, London, UK
Acute respiratory distress syndrome is a common cause of acute respiratory failure that is underdiagnosed both inside and outside of intensive care units. Progression to the most severe forms of the syndrome confers a mortality rate greater than 40% and is associated with often severe functional disability and psychological sequelae in survivors. While there are no disease-modifying pharmacotherapies for the syndrome, this progression may be prevented through the institution of quality improvement measures that minimise iatrogenic injury associated with acute severe illness. Read More
Clin Med (Lond) 2017 Oct;17(5):436-438
Islamic Science University of Malaysia, Pandan Indah, Kuala Lumpur, Malaysia.
We describe a case of a young lady with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, who initially presented with status epilepticus. Her seizures and orofacial dyskinesia were refractory to four anticonvulsants. She received intravenous immunoglobulin and a left ovarian tumour (an associated feature) was resected. Read More