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Clinical Medicine : Journal of the Royal College of Physicians of London

https://read.qxmd.com/read/38588916/a-case-report-on-rapid-development-of-simultaneous-liver-and-musculature-calcifications-in-severe-sepsis
#1
Tiara Joy Foo, Cheng Su-Ann, Low Xi Zhen, Chua Chun En
A 76-year-old Malay female presented with two days history of fever and vomiting. She was found to have Escherichia coli and Klebsiella pneumoniae bacteraemia with no clear intra-abdominal cause on the initial computed tomography of the abdomen and pelvis (CTAP). She clinically improved with two weeks duration of intravenous meropenem. She subsequently developed septic shock and a repeated CTAP demonstrated increased hepatic parenchymal density with extensive parenchymal calcifications. Curvilinear calcifications were seen in the paraspinal and pelvic musculature...
April 6, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38588915/huntington-s-disease-a-clinical-primer-for-acute-and-general-physicians
#2
REVIEW
Thomas H Massey, Duncan J McLauchlan
Huntington's disease (HD) usually manifests in adulthood and is characterised by progressive neurodegeneration in the brain that causes worsening involuntary movements, mental health and cognition over many years. Depression, anxiety and apathy are common. HD is autosomal dominant and affects about 1 in 8,000 people in the UK. There are currently no disease-modifying treatments and so patient care centres on multidisciplinary therapy support and medical treatments to relieve distressing symptoms. Progression of HD is usually slow, and so acute deteriorations often indicate another problem, such as intercurrent infections, constipation, urinary retention, gastro-oesophageal reflux disease or poor dentition...
April 6, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38583805/diagnostic-challenges-of-focal-neurological-deficits-during-an-acute-take-is-this-vascular-clinical-hints-pearls-and-pitfalls
#3
REVIEW
Shadi M Ramadan, Rayessa Rayessa, Bernard Esisi
Stroke and TIAs are amongst the common neurological presentations encountered by specialists and non-specialist health care providers. Despite the advances of neuroimaging techniques, clinicians are frequently faced with diagnostic challenges on evaluation of patients with suspected stroke. In this review, we discuss the characteristic features of cerebrovascular diseases and how to identify them. We also aim to provide a resource for non-stroke specialist clinicians to help them to correctly identify the symptoms and signs of disorders that may masquerade as stroke such as migraine, seizure, and functional disorder, and at the same time we explore how we can identify strokes that present atypically...
April 5, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38583804/managing-patients-with-intellectual-disability-and-epilepsy-in-the-acute-medical-setting
#4
REVIEW
Shanika Samarasekera
No abstract text is available yet for this article.
April 5, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38580210/rate-control-or-revascularization-in-managing-atrial-fibrillation-induced-myocardial-infarction-and-heart-failure
#5
Xianfeng Zhu, Xiangjie Sun, Muergen Muheyati, Jingyi Lv, Yenfang Goh, Yihao Loh, Yi Luan
Acute myocardial infarction (MI) is a common and severe cardiovascular emergency that requires immediate treatment. Angina pectoris, which typically signals myocardial ischemia, can appear in MI cases with myriad causes aside from coronary artery disease. However, not all MI patients benefit from invasive revascularization therapy. We herein report a case involving a 78-year-old female patient with a complex medical history, including non-ST-segment elevation myocardial infarction and coronary artery bypass grafting, who experienced recurrent chest pain...
April 3, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38570095/an-introduction-to-neuropalliative-care-a-growing-need
#6
REVIEW
Lou Wiblin
Palliative care (PC) defined as 'an approach improving the quality of life of patients and their families facing problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual' aims to enhance the improve the remaining time that patients have, emphasising choice for patients and families1 .Patients with neurological disease such as Parkinson's (PD) and motor neurone disease (MND) benefit from PC earlier in disease with increasing emphasis over time...
April 1, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38570094/practical-approach-to-anti-seizure-medications-an-update
#7
REVIEW
Rhys H Thomas
No abstract text is available yet for this article.
April 1, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38555053/lesson-of-the-month-large-vessel-vasculitis-a-rare-cause-of-transaminitis
#8
Sumaya Hussein, Greg Allister, Azeem Ahmed
We present the case of a 73-year-old male with pyrexia of unknown origin (PUO). He was a returned traveller from Southern Africa and underwent extensive investigation to rule out an infective cause. This was mostly unrevealing but there was a notable transaminitis (ALT predominant) with normal bilirubin level. He showed no serological or clinical improvement despite antibiotic treatment. Subsequent CT-PET showed high mural uptake in the thoracic and abdominal aorta and its major branches, confirming the diagnosis of Large Vessel Vasculitis (LVV)...
March 28, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38513803/a-novel-mutation-in-the-abcc8-gene-causing-maturity-onset-diabetes-of-the-young-a-case-report
#9
Yifan Guo, Yangli Chen, Wen Liang, Lirong Zeng, Fang Hu, Yingjuan Zeng, Li Cong
A 34-year-old woman was diagnosed with type 1 diabetes mellitus and treated with insulin for 24 years. The patient has a family history of diabetes in three consecutive generations. Her Whole exon sequencing showed a heterozygous mutation in the ABCC8 gene, and it also found some of her relatives to carry this mutation. She was diagnosed with MODY12 and received glimepiride therapy with the achievement of good glycemic control.
March 19, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38431210/pyroglutamate-acidosis-2023-a-review-of-100-cases
#10
REVIEW
Gordon W Stewart
This review concerns the rare, acquired, usually iatrogenic, high-anion-gap metabolic acidosis, pyroglutamic acidosis. Pyroglutamate is a derivative of the amino acid glutamate, and is an intermediate in the 'glutathione cycle', by which glutathione is continuously synthesized and broken down. The vast majority of pyroglutamic acidosis cases occur in patients on regular, therapeutic doses of paracetamol. In about a third of cases, flucloxacillin is co-prescribed. In addition, the patients are almost always seriously unwell in other ways, typically with under-nourishment of some form...
February 29, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38387536/a-national-audit-of-the-care-of-patients-with-acute-kidney-injury-in-england-and-wales-in-2019-and-the-association-with-patient-outcomes
#11
JOURNAL ARTICLE
Mpm Graham-Brown, A Casula, M Savino, T Humphrey, R Pyart, M Amaran, J Williams, K Crowe, J F Medcalf
BACKGROUND: Acute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales. METHODS: Twenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data...
February 20, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38387535/tertiary-centre-study-highlights-low-inpatient-deintensification-and-risks-associated-with-adverse-outcomes-in-frail-people-with-diabetes
#12
JOURNAL ARTICLE
Eka Melson, Mohamed Fazil, Hnin Lwin, Anu Thomas, Ting Fong Yeo, Kevin Thottungal, HayMar Tun, Faseeha Aftab, Meri Davitadze, Alison Gallagher, Samuel Seidu, Kath Higgins
INTRODUCTION: The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes. METHODS: A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022...
February 20, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38387534/the-new-national-clinical-guideline-for-stroke-an-opportunity-to-transform-stroke-care
#13
Ajay Balla
No abstract text is available yet for this article.
February 20, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38382835/impact-of-penicillin-allergy-records-on-antimicrobial-prescribing-in-hospitalised-patients
#14
JOURNAL ARTICLE
Vanesa Anton-Vazquez, Francesca Ferretti, Deniz Kaya, Shashwat Mishra, Sven Kerneis, Charlotte Eden, Hong Doan, Hiu Fung Leung, Jeanelli Baltazar, Sarah Starkey, Juliet Uwagwu, Martino Dall'Antonia, Jorge Cepeda
BACKGROUND: The overdiagnosis of penicillin allergy and misclassification of non-truly allergic reactions is a growing public health problem, associated with the overuse of broad-spectrum and restricted antimicrobials. We aimed to evaluate the impact of penicillin allergy status on antimicrobial prescribing. METHODS: A retrospective study of inpatients with a documented penicillin allergy receiving antimicrobials was conducted from 1st April to 1st July 2021. Antimicrobial prescribing and clinical characteristics were compared between patients with an active penicillin allergy label and those whose label was removed following antimicrobial stewardship team review...
February 19, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38369129/the-future-of-clinical-lipidology-in-the-uk
#15
JOURNAL ARTICLE
Jaimini Cegla, Dev Datta, Alan Rees, Handrean Soran, Gilbert Thompson
No abstract text is available yet for this article.
February 16, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38369128/predictive-value-and-interrater-reliability-of-mental-status-and-mobility-assessment-in-the-emergency-department
#16
JOURNAL ARTICLE
Tanguy Espejo, Henk B Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H Nickel
AIM: To investigate the predictive values of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team. METHOD: Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team. RESULTS: 4,191 patients were included...
February 16, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38369127/optimising-renal-risk-parameters-in-type-2-diabetes-mellitus-perspectives-from-a-retinal-viewpoint
#17
JOURNAL ARTICLE
Sarita Jacob, George I Varughese
Diabetic retinopathy and nephropathy share pathophysiological mechanisms and there is a defined correlation between the severity of both these microvascular complications from suboptimal glycaemic control. The reno-protective properties offered by sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists should be applicable to diabetic retinopathy as well. However, in patients with pre-existing diabetic retinopathy, sudden improvement in glycaemic control is well documented to cause early worsening of the changes in the retina that is usually transient...
February 16, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38359665/a-complex-case-of-dysphagia-with-dual-aetiology
#18
JOURNAL ARTICLE
Catherine Sykes, Matthew Banks, Humayra Dervin, Andres Vales, Rami Sweis
A woman in her early 60s was referred with dysphagia and chest pain to a tertiary referral centre specialising in oesophageal disorders. Cardiac symptom origin and sinister oesophageal pathology had been excluded at her local hospital in NHS Scotland. Under multidisciplinary team oversight, reinvestigation of mucosal pathology and oesophageal motility ultimately uncovered both Type III achalasia and eosinophilic oesophagitis. This case demonstrates the benefit of including provocative testing during high-resolution manometry to reproduce relevant dysphagia and the importance of stopping proton-pump inhibitors long enough to uncover excessive eosinophils which could otherwise be masked...
February 14, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38350408/the-uk-research-ethics-committee-making-the-case-for-better-serving-the-underserved-can-we-do-better
#19
JOURNAL ARTICLE
Matthew Parsons, James Ratcliff, Bernadette Egan, Hana Hassanin, Aftab Ala
Research ethics committees exist internationally to review research proposals to protect the rights and safety of human participants and researchers involved in research. These committees recruit a panel of expert and lay members, mostly on an unpaid voluntary basis, with relevant scientific experience to appraise these studies. Contemporary data in the UK show that women and people over 55 years old are overrepresented in these committee panels in the Health Research Authority, suggesting that there are potential barriers to inclusivity and participation...
February 12, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38331387/response-to-letter-to-the-editor-sleep-measures-and-cardiovascular-disease-in-type-2-diabetes-mellitus
#20
LETTER
Caroline J Magri, Sara Xuereb, Rachel-Anne Xuereb, Robert G Xuereb, Stephen Fava, Joseph Galea
No abstract text is available yet for this article.
February 6, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
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