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

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https://www.readbyqxmd.com/read/28148594/where-did-the-acute-medical-trainees-go
#1
J K Sarfo-Annin
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148593/stroke-mimic-diagnoses-presenting-to-a-hyperacute-stroke-unit
#2
Oscar Mp Jolobe
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148592/post-malaria-neurological-syndromes
#3
Elizabeth A Ashley
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148591/screening-for-dementia-single-yes-no-question-or-likert-scale
#4
Baba M Aji, Andrew J Larner
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148590/image-of-the-month-left-ventricular-aneurysm
#5
Maliha Iqbal, Eleanor Denny, Shobhit Garg, Akeel Jubber
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148589/lesson-of-the-month-2-transient-reversible-amnesia-in-multiple-sclerosis
#6
Priya Devi Shanmugarajah, Jane Alty, Oliver Lily, Helen L Ford
Transient amnestic syndromes are fascinating clinical entities and there are several subtypes. Transient global amnesia (TGA) is characterised by sudden onset of anterograde amnesia with repetitive questioning, lasting less than 24 hours. The pathophysiology of TGA involves the medial temporal lobes and hippocampi. Episodes of TGA are thought to involve venous congestion with Valsalva-like activities, vascular or migrainous mechanisms. In contrast, transient epileptic amnesia manifests as brief and frequent episodes of amnesia due to seizure activity in the temporal lobes...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148588/lesson-of-the-month-1-subacute-thyroiditis-a-rare-cause-of-fever-of-unknown-origin
#7
Fatima Amar Bahowairath, Nicholas Woodhouse, Samir Hussain, Mujahid Al Busaidi
Fever of unknown origin (FUO) is sometimes a diagnostic dilemma for clinicians. Endocrine causes reported in the literature include subacute thyroiditis, thyrotoxicosis, adrenal insufficiency and pheochromocytoma. Among these, subacute thyroiditis is often overlooked as it can occasionally lack typical symptoms. This case illustrates the fact that subacute thyroiditis should be considered as a possible cause of fever even if signs and symptoms of hyperthyroidism and thyroid tenderness are absent.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148587/cme-rheumatology-108459-self-assessment-questionnaire
#8
Simon J Bowman, Tahseen A Chowdhury
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148586/systemic-lupus-erythematosus
#9
Maliha F Shaikh, Natasha Jordan, David P D'Cruz
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that is highly heterogeneous in its presentation. This can pose significant challenges for physicians responsible for the diagnosis and treatment of such patients. SLE arises from a combination of genetic, epigenetic and environmental factors. Pathologically, the disease is primarily driven by loss of immune tolerance and abnormal B- and T-cell function. Major organ involvement may lead to significant morbidity and mortality. Classification criteria for SLE have been developed largely for research purposes; however, these are also widely used in clinical practice...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148585/behcet-s-disease
#10
Jagdish R Nair, Robert J Moots
Behçet's disease (BD) is a chronic relapsing and remitting vasculitis of unknown aetiology. It has the capacity to affect almost all organ systems because of its potential to involve both arteries and veins of all sizes, resulting in significant organ-threatening morbidity and mortality. Traditionally known as the 'silk road' disease, it has a worldwide occurrence. The aetiopathological mechanisms of disease development in BD remain poorly understood, but genome wide studies show human leukocyte antigen and non-human leukocyte antigen associations...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148584/psoriatic-arthritis-state-of-the-art-review
#11
Laura C Coates, Philip S Helliwell
Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a significant diagnostic and management challenge. Early diagnosis is important to prevent long term functional disability and to ensure optimal management of arthritis and key comorbidities. From the rheumatologist's perspective, the differential diagnosis includes rheumatoid arthritis, gout and other inflammatory arthritides. Once diagnosed, it is essential to assess the disease fully, including arthritis, enthesitis, dactylitis, skin/nail disease and axial involvement...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148583/anca-associated-vasculitis
#12
Max Yates, Richard Watts
The vasculitides are a heterogeneous group of conditions typified by their ability to cause vessel inflammation with or without necrosis. They present with a wide variety of signs and symptoms and, if left untreated, carry a significant burden of mortality and morbidity. The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are three separate conditions - granulomatosis with polyangiitis (GPA; formerly known as Wegener's granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA; previously known as Churg-Strauss syndrome)...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148582/gout-a-guide-for-the-general-and-acute-physicians
#13
Abhishek Abhishek, Edward Roddy, Michael Doherty
Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148581/delirium-a-guide-for-the-general-physician
#14
Oliver M Todd, Elizabeth A Teale
Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148580/myocardial-infarction-with-proximal-occlusion-of-the-left-anterior-descending-coronary-artery-in-a-22-year-old-patient-with-polycythaemia-vera
#15
Alexander Nahler, David Fuchs, Christian Reiter, Daniel Kiblböck, Clemens Steinwender, Thomas Lambert
In this article, we report on a 22-year-old patient with myocardial infarction, which was the initial manifestation of polycythaemia vera. The awareness of myeloproliferative disorders as possible underlying disease - especially in young patients presenting with myocardial infarction - is crucial for clinical management, as a missed diagnosis can worsen the patient's further prognosis.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148579/liquorice-induced-apparent-mineralocorticoid-excess-presenting-in-the-emergency-department
#16
Stuart Declan Gallacher, Georgios Tsokolas, Ioannis Dimitropoulos
A 65-year-old woman with a background of myalgic encephalitis, who was taking alternative medicines and dietary supplements, presented with hypokalaemia and hypertension. After a thorough history it became apparent that this was most likely secondary to regular consumption of liquorice tea. The patient was advised to discontinue drinking this tea and was discharged. Follow-up showed normalising blood pressure and hypokalaemia, with a normal aldosterone:renin ratio.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148578/hypokalaemia-in-sj%C3%A3-gren-s-syndrome-the-missing-piece
#17
Umer Farooq Khan, Lee Chun Tsu, Kong-Bing Tan, Jingxiang Huang, Audrey LiAnn Wong
A 58-year-old Chinese woman with well controlled type 1 diabetes mellitus presented with acute and progressive bilateral lower limb weakness. Investigations revealed severe hypokalaemia (1.3 mmol/L) and hypophosphataemia (<0.32 mmol/L) with rhabdomyolysis and electrocardiogram changes, without other concurrent biochemical abnormalities. Immediate intravenous and oral potassium and phosphate replacement was initiated with objective improvement in weakness with replenished electrolyte levels. Urine studies confirmed renal potassium wasting...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148577/endocrinology-update%C3%A2
#18
Christopher Redford, Antonia Brooke
No abstract text is available yet for this article.
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148576/lead-or-be-led-an-update-on-leadless-cardiac-devices-for-general-physicians
#19
Benedict M Wiles, Paul R Roberts
Implantable cardiac devices have an increasingly important role. Pacemakers remain the only effective treatment for symptomatic bradycardia; cardiac resynchronisation therapy is a proven treatment for heart failure; and implantable cardioverter defibrillators (ICD) are superior to medical therapy in prevention of sudden cardiac death. Our ageing population has led to a rising number of device implants. Physicians in all specialties increasingly encounter patients with cardiac devices and require an understanding of their capabilities and functions...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28148575/chronic-respiratory-disease-the-acceptable-epidemic
#20
Peter Burney
Chronic obstructive pulmonary disease (COPD) is a major cause of disability and death in the UK but is an even greater problem in low income countries. It is assumed by many to be almost entirely attributed to smoking. However, smoking alone cannot account for the distribution of the disease in the world and there is accumulating evidence that the disease is overwhelmingly a disease of poverty. The size of the problem and the failure of current hypotheses to explain the distribution of chronic lung disease make the lack of funding in this area surprising...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
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