Medicine (Abingdon, UK Edition)

Performing cardiopulmonary resuscitation is a key competency for healthcare professionals. Training in immediate and advanced life support is a requirement for UK doctors; this is depicted in the Foundation training programme competencies and in the Internal Medicine Training curriculum. It requires being able to identify unwell patients, perform a structured assessment and treatment approach, master relevant procedural aspects and demonstrate non-technical skills including leading the resuscitation team. The Resuscitation Council UK has recently provided updated guidance on basic and advanced life support...

In 2020, 37.7 million (30.2-45.1 million) people were living with HIV globally, with 27.5 million (26.5-27.7 million) accessing antiretroviral therapy. Women and girls accounted for half of all new HIV infections. HIV is now a treatable chronic health condition, and people diagnosed with HIV can expect to live long and healthy lives with access to antiretroviral therapy. There is evidence, however, that people with HIV are more likely to develop certain age-related diseases, including cardiovascular disease, chronic airway disease, kidney failure, liver failure, cancer, type 2 diabetes and other complications...

Even before the coronavirus disease (COVID-19) pandemic, progress in the global AIDS response was not on track to reach the 2020 UNAIDS HIV targets. In 2019 an estimated 38 million people were living with HIV, 12.6 million remained untreated and 690,000 people died of AIDS. In that year, 1.7 million people acquired HIV, a 23% drop from the figure in 2010. In the UK, successful combination prevention efforts (condoms, early testing and treatment, pre-exposure prophylaxis) have resulted in rapid declines in transmissions, particularly among men who have sex with men...

No abstract text is available yet for this article.

Influenza is a cause of significant morbidity, mortality, economic and social disruption. Annual seasonal influenza epidemics result in 290,000-650,000 deaths worldwide, while influenza pandemics have resulted in many more - the A(H1N1) pandemic of 1918-1919 caused 20-50 million deaths. Healthcare systems struggle to effectively manage the constant threat because of the evolving nature of the virus. Since the start of 2021, there have been four events of concern related to influenza reported by the World Health Organization...

The coronavirus disease 2019 (COVID-19) pandemic has caused more than 4.5 million deaths worldwide to date. The emergence of the novel severe acute respiratory syndrome coronavirus 2 has created immense pressure on health services and complex challenges in public health. Essential features in managing COVID-19 include best-practice care for the individual but also minimizing exposure to uninfected patients, staff and the wider community. The central tenets in limiting disease transmission involves strict infection and prevention control, categorizing COVID-19 cases as possible, probable or confirmed, alongside contact tracing, isolation, hand hygiene and droplet precautions...

Global travel is increasingly a fact of modern life, and the rapid spread of severe acute respiratory syndrome coronavirus 2 leading to lockdown across the world has demonstrated the interconnectedness of the world's population. Illness in the returning traveller can range from trivial to life-threatening, and the concept of imported infection can be an intimidating diagnostic and management challenge. An important caveat is that even if your patient has returned from cuddling multimammate rats in Guinea 1 week ago, they could be febrile from a distinctly non-tropical urinary tract infection...

The spectrum of human pathogens and the infectious diseases they cause is continuously changing through evolution, selection and changes in the way human populations interact with their environment and each other. New human pathogens often emerge or re-emerge from an animal reservoir, emphasizing the central role that non-human reservoirs play in human infectious diseases. The 1918 pandemic of influenza virus A/H1N1 and the 2020 pandemic of coronavirus disease 2019 (COVID-19) are the most dramatic examples of this in recent human history...

The symptom of breathlessness is well recognized as part of the presentation of a wide range of medical conditions. It can be a manifestation of a life-threatening emergency. In acute medical settings, the priority is to quickly recognize patients who are critically unwell and require emergency treatment. For these patients, rapid initial assessment and immediate treatment are essential. However, once symptoms have stabilized or in less acute settings, a more thorough assessment is required. Cough is a common respiratory symptom, often part of a symptom complex, which is troublesome for the patient...

No abstract text is available yet for this article.

Stroke is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury (infarction, haemorrhage) of the central nervous system. Stroke is the second leading cause of death and disability worldwide. Stroke is not a single disease but can be caused by a wide range of risk factors, disease processes and mechanisms. Hypertension is the most important modifiable risk factor for stroke, although its contribution differs for different subtypes. Most (85%) strokes are ischaemic, predominantly caused by small vessel arteriolosclerosis, cardioembolism and large artery athero-thromboembolism...

Peripheral nerve disorders are common and often treatable. The 'default' presentation of a polyneuropathy is a chronic, length-dependent, sensorimotor axonopathy. Recognizing deviations from this default, informed by the clinical features and investigations, can help identify the cause of a neuropathy in most cases. For inflammatory causes, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, there are effective immunomodulatory treatments. For other neuropathies, management consists of supportive care and treatment of the underlying cause, to prevent or limit progression...

Clinical examination allows the neurologist to test hypotheses generated by their interpretation of the patient's story. By eliciting abnormal clinical signs, the examining doctor works out a differential diagnosis for the part of the nervous system affected and, using information from the clinical history, a differential diagnosis of the pathology. Clinical examination also allows the clinician to observe and quantify function, hear more story and provide reassurance. The focus of the examination should be dictated by the hypothesis being tested, the patient's clinical state and the situation...

Opportunistic infections are a major cause of morbidity and mortality in severely immunocompromised patients, such as those given chemotherapy or biological therapies, and those with haematological malignancy, aplastic anaemia or HIV infection, or recipients of solid organ or stem cell transplants. The type and degree of immune defect dictates the profile of potential opportunistic pathogens; T-cell-mediated defects increase the risk of viral (cytomegalovirus, respiratory viruses) and Pneumocystis jirovecii infections, whereas neutrophil defects are associated with bacterial pneumonia and invasive aspergillosis...

Over the past 200 years lung diseases have shifted from infections - tuberculosis, pneumonia - to diseases of dirty air - chronic obstructive pulmonary disease, asthma and lung cancer. New diseases have emerged from industrial pollution and HIV infection, while better imaging has revealed others previously unrecognized. Scientific advances in microbiology, imaging and clinical measurement have improved diagnosis and allowed better targeted treatment. Advances in treatment have been dramatic, the most important being drugs (antibiotics, cortisone, β2 -adrenoceptor agonists), ventilatory support (from iron lung to nasal positive-pressure ventilation), inhaled therapy (metered dose inhalers, nebulizers) and lung surgery (resections, video-assisted thoracoscopic surgery, transplantation)...

Oesophageal adenocarcinoma (OAC) has increased dramatically in Western countries, including the UK, over the past 30 years. It usually presents de novo , but is often preceded by Barrett's oesophagus (BO), a premalignant condition whereby the normal squamous epithelium is replaced by columnar lined epithelium with intestinal metaplasia. The main risk factors for BO include male sex, obesity and chronic gastro-oesophageal reflux of acid and bile. The estimated annual risk of BO progression is 0.3%, increasing substantially, up to 30%, when dysplasia is present...

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Global travel continues to increase, particularly to tropical destinations that have different health risks from those encountered closer to home. Currently, over a billion people travel annually, with over 65 million visits made from the UK. Seeking pre-travel advice should be an essential part of any trip for a traveller. The key elements of pre-travel advice are health risk assessment, health promotion and risk management; this involves advice on prevention of malaria, travellers' diarrhoea, sexually transmitted infections and accidents, as well as appropriate vaccinations...

Millions of people travel to the tropics each year and a significant minority of them become ill, either during their stay or shortly after their return. Most have mild, self-limiting illnesses, but a few have a life-threatening condition. This article outlines how to evaluate fever in the returning traveller and discusses important infection control and public health measures. A detailed travel history, which takes into account travel destinations, specific activities and risk factors in relation to the onset of symptoms, is essential for constructing a comprehensive list of differential diagnoses and guiding appropriate investigations...

No abstract text is available yet for this article.