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

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https://www.readbyqxmd.com/read/30072570/response
#1
LETTER
Michael J Griffiths, Fiona McGill, Tom Solomon
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072569/importance-of-csf-lactate-concentration-in-the-diagnosis-of-acute-bacterial-meningitis
#2
LETTER
Eamon P McCarron, Shiva Sreenivasan
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072568/response
#3
LETTER
Cristina Fernandez, Nick J Beeching
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072567/comment-on-pyrexia-of-unknown-origin
#4
LETTER
Barry Monk
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072566/resilience-friend-or-foe
#5
LETTER
Emma Keelan, Brendan Ciarán Browne
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072565/image-of-the-month-a-case-of-phlebosclerotic-colitis
#6
Ying-Kuo Liu, Ming-Hai Du, Yuan-Pin Hsu
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072564/lesson-of-the-month-2-blunt-abdominal-trauma-atypical-presentation-of-phaeochromocytoma
#7
Sarah Faloon, Hema Venkataraman, Kassiani Skordilis, Ewen A Griffiths, Neil Jl Gittoes, Zaki K Hassan-Smith, John Ayuk
A 26-year-old man presented following blunt abdominal trauma to a regional major trauma centre for emergency embolisation of a retroperitoneal bleed from a presumed renal laceration. Imaging had also revealed a large right suprarenal mass. Embolisation resulted in a hypertensive crisis raising the suspicion of a metabolically active adrenal tumour. The course was further complicated by the development of ischaemic bowel requiring emergency laparotomy. Intraoperatively he became haemodynamically unstable from an actively haemorrhaging lesion...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072563/lesson-of-the-month-1-case-reports-of-arrhythmogenic-cardiomyopathies-in-military-personnel
#8
Wajeeha Khan, Azeem S Sheikh, Emmanuel Ato Williams, Riccardo Proietti
In military recruits, sudden cardiac death rates have been reported as varying from 2 to 13 per 100,000 per year which are mostly related to exercise. However, the development of structural heart changes that may be associated with ventricular arrhythmias have not been reported among this cohort, despite them undergoing endurance training similar to athletes. Here, we report two cases where military personnel were found to have life-threatening cardiac arrhythmias associated with structural heart disease, highlighting the importance of early recognition and treatment of these arrhythmias...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072562/cme-haematology-120486-self-assessment-questionnaire
#9
(no author information available yet)
No abstract text is available yet for this article.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072561/autoimmune-cytopenias-and-thrombotic-thrombocytopenic-purpura
#10
Charlotte K Brierley, Sue Pavord
The autoimmune cytopenias are a group of disorders resulting primarily from autoantibody-mediated destruction of blood cells, with variable clinical sequelae depending on the severity and lineage affected. Disease presentation ranges from an asymptomatic finding on a routine full blood count to an acutely unwell patient suffering the clinical consequences of severe anaemia, neutropenia or thrombocytopenia. The cytopenia may be primary or secondary to underlying infectious, immune or malignant processes. Thrombotic thrombocytopenic purpura (TTP) is a distinct, rare but potentially life-threatening entity that classically but not invariably presents with a pentad of acute onset haemolytic anaemia, thrombocytopenia, neurological symptoms, renal impairment and fevers...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072560/autologous-haematopoietic-stem-cell-transplantation-ahsct-for-severe-resistant-autoimmune-and-inflammatory-diseases-a-guide-for-the-generalist
#11
John A Snowden, Basil Sharrack, Mohammed Akil, David G Kiely, Alan Lobo, Majid Kazmi, Paolo A Muraro, James O Lindsay
Autologous haematopoietic stem cell transplantation (aHSCT) is commonly used for the treatment of haematological cancers, but is increasingly used in the treatment of patients severely affected by autoimmune diseases (ADs). In fact, ADs have become the fastest growing indication for aHSCT. A wide range of diseases have been treated, but the field has focused on three areas: multiple sclerosis, diffuse cutaneous systemic sclerosis and Crohn's disease, where there are populations of patients for whom disease control remains unsatisfactory despite the advent of biological and targeted small molecule therapies...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072559/cancer-immunotherapy-with-car-t-cells-behold-the-future
#12
Charlotte Graham, Rebecca Hewitson, Antonio Pagliuca, Reuben Benjamin
Cellular therapy is a key tool to treat haematological malignancies. Over 40,000 allogeneic and autologous haematopoietic stem cell transplants (HSCTs) are performed annually across Europe.1 Since 2017, a new T cell therapy, chimeric antigen receptor-T (CAR-T) cells have been licensed outside clinical trials. CAR-T cells have extremely potent antitumour activity, but also have a profile of toxic side effects not seen before. Cytokine release syndrome (CRS) and CAR-T cell-related encephalopathy syndrome (CRES) are common, predictable and potentially lethal side effects...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072558/common-haemostasis-issues-in-major-bleeding-and-critical-illness
#13
Divyansh Gulati, Alex Novak, Simon J Stanworth
Haemostatic abnormalities are common in the critically ill or bleeding patient, including haemorrhage-related coagulopathies, disseminated intravascular coagulation and thrombocytopenia, among other pathologies. In this article we aim to outline some of the causes of these clotting abnormalities, highlighting recent advancements in knowledge and new insights into their clinical management, with the aim of optimising diagnostic and therapeutic strategies.
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072557/the-reversal-of-anticoagulation-in-clinical-practice
#14
Sally Thomas, Michael Makris
Widespread use of anticoagulant drugs for treatment and -prevention of thromboembolic events means it is common to encounter patients requiring reversal of anticoagulation for management of bleeding or invasive procedures. While supportive and general measures apply for patients on all agents, recent diversification in the number of licensed agents makes an understanding of drug-specific reversal strategies essential. Recognising effects upon, and limitations of, laboratory measures of coagulation also plays an important role...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072556/risks-of-the-sunshine-pill-a-case-of-hypervitaminosis-d
#15
Sebastien Ellis, Georgios Tsiopanis, Tanuj Lad
Vitamin D is a fat-soluble vitamin essential for calcium homeostasis and bone health. Vitamin D toxicity or hypervitaminosis D is extremely rare. We describe the case of a 73-year-old man who presented with life-threatening hypervitaminosis D and hypercalcaemia resulting from self-medicated doses of vitamin D supplements. This case, alongside other global case reports, highlights the potential dangers of unlicensed vitamin D replacement. We discuss the evidence for vitamin D replacement and remind readers of the current guidance on daily intake and supplementation...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072555/a-case-of-guillain-barr%C3%A3-syndrome-gbs-presenting-with-acute-urinary-retention-and-t6-sensory-level
#16
Ching Soong Khoo, Alyaa Hassan Ali, Rabani Remli, Hui Jan Tan
Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. Typical clinical manifestations of GBS include progressive weakness of the limbs, bulbar, facial muscles and ophthalmoplegia. Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072554/what-is-the-evidence-for-the-change-in-the-blood-donation-deferral-period-for-high-risk-groups-and-does-it-go-far-enough
#17
REVIEW
Beattie Rh Sturrock, Stuart Mucklow
In November 2017, the deferral on blood donations from high-risk groups in Great Britain was changed to 3 months from last at-risk sexual contact following recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs. This represented a reduction from 12 months for men who have sex with men, and from a lifetime ban for sex workers. This is a step forward for equality and for reducing stigma around these groups. However, one argument for deferral is the prevalence of infections, which may not be identified due to the fallibility of current testing approaches...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072553/prosthetic-heart-valve-surgery-and-potential-risk-of-developing-mycobacterium-chimaera-endocarditis
#18
REVIEW
Shailesh Dalvi, Paul Das
Public Health England (PHE) issued a guidance report on the management of Mycobacterium chimaera endocarditis following cardiac valve surgery. M chimaera is a non-tuberculous mycobacteria (NTM) belonging to mycobacterium avium complex (MAC). PHE has also recognised that M chimaera has caused severe infections in a small proportion of patients who have had cardiac surgery. Investigations in the UK and internationally have implicated contaminated heater cooler units used for cardiopulmonary bypass. Prosthetic valve endocarditis (PVE) presents as the frequent and severe form of infective endocarditis (IE)...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072552/100-years-of-the-royal-air-force-s-contribution-to-medicine-providing-care-in-the-air-and-delivering-care-by-air
#19
REVIEW
Bonnie N Posselt, Andrew M Greenhalgh, Michael K Almond
The Royal Air Force (RAF) came into being during World War I as the world's first independent air force on the 1 April 1918, amalgamating elements of the Royal Flying Corps (RFC), itself established in 1912 and the Royal Naval Air Service which had formally separated from the Admiralty's administered Air Wing of the RFC in 1915. The RAF therefore celebrates its 100th anniversary in the same year that the Royal College of Physicians of London celebrates its 500th. This article will cover the contribution that military aviation has made to medicine since 1913 with the emphasis of three examples focusing on delivering care by air, providing care in the air and in developing systems for supporting aircrew or patients at the extremes of physiological stress...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30072551/can-the-use-of-an-age-adjusted-d-dimer-cut-off-value-help-in-our-diagnosis-of-suspected-pulmonary-embolism
#20
Jonathan Dutton, Martin Dachsel, Rachel Crane
Safe exclusion of pulmonary embolism (PE) is a common problem in acute medicine. Common care pathways usually involve the use of a pre-test probability score with a D-dimer test to aid clinical decision-making. Unfortunately, the specificity of many D-dimer assays decreases with age. This study investigates the role of an age-adjusted D-dimer of 5 x patient's age when the conventional cut-off of the assay is 230 ng/mL. Data was collected retrospectively over a 12-month period from patients who went on to have either computed tomography pulmonary angiography (CTPA) or pulmonary ventilation/perfusion (V/Q) imaging...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
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