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    4089 results match your criteria Clinical Medicine [Journal]

    1 OF 82

    Surveillance for hepatocellular cancer.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s66-s69
    Institute for Biomedical and Clinical Sciences, University of Leeds, UK.
    Hepatocellular carcinoma (HCC) is a common complication of cirrhosis. The incidence of HCC is rising and HCC-related mortality is rising in parallel such that there were more than 1,700 deaths in the UK in 2015. Since cirrhosis is a known risk factor for the development of HCC and early diagnosis is associated with improved outcomes, surveillance for the development of HCC using regular ultrasound scans is recommended by many expert bodies including the National Institute for Health and Care Excellence (NICE). Read More

    Management of decompensated cirrhosis.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s60-s65
    Freeman Hospital and Newcastle University, Newcastle Upon Tyne, UK
    Decompensated cirrhosis is a common reason for admission to the acute medical unit, and such patients typically have complex medical needs and are at high risk of in-hospital death. It is therefore vital that these patients receive appropriate investigations and management as early as possible in their patient journey. Typical presenting clinical features include jaundice, ascites, hepatic encephalopathy, hepato-renal syndrome or variceal haemorrhage. Read More

    Genetics of alcoholic liver disease and non-alcoholic steatohepatitis.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s54-s59
    Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
    Alcohol-related liver disease (ARLD) and non-alcoholic fatty liver disease (NAFLD) are leading causes of chronic liver disease globally. Both ARLD and NAFLD are multifactorial and refer to a spectrum of disease severity, ranging from steatosis through steatohepatitis to fibrosis and cirrhosis. Both diseases exhibit substantial inter-patient variation in long-term outcomes and are best considered complex disease traits where genetic and environmental factors interact to mediate disease severity and progression. Read More

    From genomics to targeted treatment in haematological malignancies: a focus on acute myeloid leukaemia.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s47-s53
    MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK and Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
    The haematological malignancies are a heterogeneous group of neoplastic disorders, which lead to almost 10,000 deaths annually in the UK. Over the past 2 decades, there has been significant progress in our understanding of the pathological mechanisms underlying these cancers, accompanied by improvements in outcomes for some patients. In particular, advances in next-generation sequencing now make it possible to define the genetic lesions present in each patient, which has led to improved disease classification, risk stratification and identification of new therapeutic targets. Read More

    Recent advances in the management of lung cancer.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s41-s46
    Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
    Historically, the prognosis for individuals diagnosed with lung cancer has been bleak. However, the past 10 years have seen important advances in treatment and diagnosis which have translated into the first improvements seen in lung cancer survival. This review highlights the major advances in treatments with curative intent, systemic targeted therapies, palliative care and early diagnosis in lung cancer. Read More

    Diagnosis and treatment of severe asthma: a phenotype-based approach.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s36-s40
    Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
    Severe asthma is a heterogeneous and often difficult to treat condition that results in a disproportionate cost to healthcare systems. Appropriate diagnosis and management of severe asthma is critical, as most asthma deaths have been retrospectively identified as having poorly recognised severe asthma. With multiple biologic agents becoming available, it is crucial to correctly phenotype patients in order to identify those that will respond to these high-cost treatments. Read More

    Cardiac amyloidosis.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s30-s35
    National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
    Systemic amyloidosis comprises an uncommon group of disorders caused by the extracellular deposition of misfolded proteins in various organs. Cardiac amyloid deposition, causing an infiltrative/restrictive cardiomyopathy, is a frequent feature of amyloidosis and a major determinant of survival. It may be the presenting feature of the disease or may be identified while investigating a patient presenting with other organ involvement. Read More

    Heart failure with preserved ejection fraction.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s24-s29
    Department of Cardiology, Royal Brompton Hospital and Imperial College London, London, UK
    Heart failure with preserved ejection fraction (HFpEF) represents a heterogeneous collection of conditions that are unified by the presence of a left ventricular ejection fraction ≥50%, evidence of impaired diastolic function and elevated natriuretic peptide levels, all within the context of typical heart failure signs and symptoms. However, while HFpEF is steadily becoming the predominant form of heart failure, disease-modifying treatment options for this population remain sparse. This review provides an overview of the diagnosis, management and prevention of HFpEF for general physicians. Read More

    What is new in stroke imaging and intervention?
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s13-s16
    Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
    Recent updates to guidelines around brain imaging in stroke and transient ischaemic attack are reviewed. A more detailed examination of advanced brain imaging in acute stroke is presented. The recent evidence for endovascular mechanical thrombectomy in acute stroke is reviewed. Read More

    Hyperacute management of intracerebral haemorrhage.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s9-s12
    Salford Royal NHS Foundation Trust, Salford, UK and University of Manchester, Manchester, UK
    Intracerebral haemorrhage causes 1 in 10 strokes, but has the worst overall outcomes of all stroke subtypes. Baseline haematoma volume is a key prognostic factor and early complications - such as haematoma expansion, obstructive hydrocephalus and perihaematomal oedema - may worsen outcome. There is evidence that withdrawal of care may occur more often in intracerebral haemorrhage than ischaemic stroke independent of premorbid health and stroke severity. Read More

    Valproate: life-saving, life-changing.
    Clin Med (Lond) 2018 Apr;18(Suppl 2):s1-s8
    Royal Victoria Infirmary and intermediate clinical lecturer, Newcastle University, Newcastle, UK.
    Antiepileptic medications, and valproate principally, are commonly prescribed teratogens. There is significant concern that we are not doing enough to educate clinicians and potential parents about the risks of valproate in pregnancy. There is clear advice from the Medicines and Healthcare products Regulatory Agency and the International League Against Epilepsy about the risks of valproate exposure Reviews and guidelines that are focused on fetal risk, however, fall short in being able to fully replicate the complexity of a real clinical decision. Read More

    Lesson of the month 2: A rare presentation of stroke: diagnosis made on magnetic resonance imaging.
    Clin Med (Lond) 2018 Mar;18(2):183-185
    Ashford and St Peter's NHS Trust, Chertsey, UK.
    Bilateral thalamic infarcts are uncommon posterior circulation strokes. The artery of Percheron (AOP) is a rare anatomical variant involving a singular arterial supply to both thalami and occlusion leads to bilateral thalamic infarction.We report the case of a 71-year-old man who presented with decreased consciousness (fluctuating Glasgow Coma Scale score of 5-7). Read More

    Lesson of the month 1: Massive spontaneous haematomas in an elderly man.
    Clin Med (Lond) 2018 Mar;18(2):180-182
    Northwick Park Hospital, London, UK
    A 73-year-old man presented with bilateral leg pain and swelling, and no history of trauma or bleeding disorders. Clinical examination, biochemistry and magnetic resonance imaging of the thighs were suggestive of muscle haematomas. These progressed significantly during the admission, requiring blood transfusion. Read More

    Dilated cardiomyopathy as the first presentation of coeliac disease: association or causation?
    Clin Med (Lond) 2018 Mar;18(2):177-179
    Pinderfields Hospital, Wakefield, UK.
    Global ventricular impairment is a frequent presentation in clinical practice, but dissection of causative mechanisms from clinical associations is challenging. We present the case of a 19-year-old man who presented with dilated cardiomyopathy as the first presentation of coeliac disease. The manifestation of iron deficiency anaemia prompted gastroenterology input and enabled accurate diagnosis. Read More

    Pyrexia of unknown origin.
    Clin Med (Lond) 2018 Mar;18(2):170-174
    Tropical and Infectious Disease Unit, Royal Liverpool University Hospital and Clinical Sciences Group, Liverpool School of Tropical Medicine, Liverpool, UK.
    The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic and HIV-related. This could be expanded to include the elderly as a fifth group. Read More

    Management of acute meningitis.
    Clin Med (Lond) 2018 Mar;18(2):164-169
    Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
    Acute meningitis remains a devastating disease. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment in a timely manner, to minimise the risk of poor outcome in bacterial disease, while limiting unnecessary treatment in viral meningitis. Read More

    Acute encephalitis - diagnosis and management.
    Clin Med (Lond) 2018 Mar;18(2):155-159
    The Walton Centre NHS Foundation Trust, Liverpool, UK.
    Encephalitis, inflammation of the brain, is most commonly caused by a viral infection (especially herpes simplex virus [HSV] type 1 in the UK) although autoimmune causes, such as N-methyl D-aspartate receptor (NMDAR) antibody encephalitis, are increasingly recognised. Most patients present with a change in consciousness level and may have fever, seizures, movement disorder or focal neurological deficits. Diagnosis hinges crucially on lumbar puncture and cerebrospinal fluid (CSF) examination, but imaging and electroencephalography (EEG) may also be helpful. Read More

    Bone and joint infection.
    Clin Med (Lond) 2018 Mar;18(2):150-154
    Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
    Bone and joint infections include septic arthritis, prosthetic joint infections, osteomyelitis, spinal infections (discitis, vertebral osteomyelitis and epidural abscess) and diabetic foot osteomyelitis. All of these may present through the acute medical take. This article discusses the pathogenesis of infection and highlights the importance of taking a careful history and fully examining the patient. Read More

    Diagnosis and management of sepsis.
    Clin Med (Lond) 2018 Mar;18(2):146-149
    University of Glasgow, Glasgow, UK
    Sepsis is a common condition with high morbidity and mortality. Although many patients may require critical care, this article considers the features of sepsis that are of most relevance to acute general physicians. Recently updated definitions of sepsis and septic shock have been proposed which better identify patients who are likely to have a poor outcome, and therefore give an opportunity to escalate care. Read More

    Drug therapies in chronic heart failure: a focus on reduced ejection fraction.
    Clin Med (Lond) 2018 Mar;18(2):138-145
    Department of Cardiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
    There are multiple evidence-based drug treatments for chronic heart failure (HF), both disease-modifying agents and those for symptom control. The majority of the evidence base supports drugs used in HF with reduced left ventricular ejection fraction. The mainstay of disease modification involves manipulation of neurohormonal activation that occurs in HF. Read More

    Systemic inflammatory disorders in patients admitted for aseptic meningitis.
    Clin Med (Lond) 2018 Mar;18(2):132-137
    Bichat Hospital, Paris, France
    Acute meningitis can be the first manifestation of an underlying systemic inflammatory disorder (SID). In the current study, we aimed to identify clinical indicators for SIDs in patients admitted for acute aseptic meningitis. All patients hospitalised for acute aseptic meningitis over a 4-year period in a department of internal medicine were included retrospectively. Read More

    One year's activity and outcome data from an ambulatory cardiology unit.
    Clin Med (Lond) 2018 Mar;18(2):128-131
    Belfast Health and Social Care Trust, Belfast, UK.
    In 2015, the Belfast Trust piloted an ambulatory cardiology unit (ACU). The ethos of the ACU was to reduce pressure on the Emergency Department by providing a unit where rapid evaluation, treatment and follow-up could be provided by the cardiology team and, at the same time, reduce inpatient admissions to cardiology beds. The service proved effective in reducing admissions to cardiology beds by 13. Read More

    The prediction of in-hospital mortality by mid-upper arm circumference: a prospective observational study of the association between mid-upper arm circumference and the outcome of acutely ill medical patients admitted to a resource-poor hospital in sub-Saharan Africa.
    Clin Med (Lond) 2018 Mar;18(2):123-127
    University of Southern Denmark, Denmark.
    There are few reports of the association of nutritional status with in-hospital mortality of acutely ill medical patients in sub-Saharan Africa. This is a prospective observational study comparing the predictive value of mid-upper arm circumference (MUAC) of 899 acutely ill medical patients admitted to a resource-poor sub-Saharan hospital with mental alertness, mobility and vital signs. Mid-upper arm circumference ranged from 15 cm to 42 cm, and 12 (24%) of the 50 patients with a MUAC less than 20 cm died (OR 4. Read More

    Glasgow Blatchford Score and risk stratifications in acute upper gastrointestinal bleed: can we extend this to 2 for urgent outpatient management?
    Clin Med (Lond) 2018 Mar;18(2):118-122
    Salford Royal Foundation Trust, Salford, UK
    Upper gastrointestinal (GI) bleeds are a common presentation to emergency departments in the UK. The Glasgow Blatchford score (GBS) predicts the outcome of patients at presentation. Current UK and European guidelines recommend outpatient management for a GBS of 0. Read More

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