Myasthenia gravis as a 'stroke mimic' - it's all in the history.
Abstract
An 85-year-old man presented to hospital as an emergency having difficulties with swallowing and speech. In the emergency department, he was assessed as having acute onset dysphagia and dysarthria in keeping with an acute stroke. Subsequently, it became apparent that although the symptoms were indeed of relatively acute onset, there was a clear description by the patient of fatigability and diurnal variation, prompting a working clinical diagnosis of myasthenia gravis. The patient followed a turbulent clinical course, and interpretation of investigation results proved not to be straightforward in ...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Shaik S, Ul-Haq MA, Emsley HC Tags: Clin Med Source Type: research
Harveian Oration 2012: Halving premature death.
PMID: 25468852 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Taken from the transcript of a lecture given by Richard Peto at the Royal College of Physicians Tags: Clin Med Source Type: research
Assessment and prevention of falls in older people - concise guidance.
Abstract
Falls in later life are a major health issue, both in terms of their injurious consequences and their significance as a diagnostic marker. Cost-effective measures for their assessment and prevention are well documented but insufficiently implemented. This Concise Guideline comprises a distillation of recommendations for the assessment and prevention of falls in older people based on Clinical Guideline 161 (incorporating CG21) published by the National Institute of Health and Care Excellence (NICE) in 2013. The recommendations are intended to provide both generalists and specialists with an overvie...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Swift CG, Iliffe S Tags: Clin Med Source Type: research
When to suspect 'funny' diabetes.
Abstract
Diabetes comes in many shapes and forms. It is important for the general physician to recognise when clinical characteristics, response to treatment and associated features suggest an alternative variety of diabetes, over and above the traditional type 1 and type 2 forms which are far more common. Key to these suspicions are taking a clear history of the development of the diabetes and being aware of the family history.
PMID: 25468854 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Grant P, Velusamy A, Thomas E, Chakera AJ Tags: Clin Med Source Type: research
Diabetes and HIV.
This article reviews the clinical problems, the implications for treatment plans and potential confusions that can arise when managing patients who have both conditions.
PMID: 25468855 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Quin J Tags: Clin Med Source Type: research
Diabetes and mental health.
Abstract
Diabetes is an increasingly common health problem, and accounts for one-tenth of NHS spending, chiefly managing avoidable complications. Approximately one-third of people with diabetes have psychological and/or social problems which impede their ability to self-manage their diabetes. Identifying certain indicators which suggest high risk of co-morbid mental health problems will allow these to be identified and treated early. Ensuring that any mental health problems are treated and social needs are met, will be valuable in improving the individuals health. Addressing the psychiatric and psychologic...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Garrett C, Doherty A Tags: Clin Med Source Type: research
Diabetes and exercise.
Abstract
Exercise has a beneficial effect on metabolic parameters affecting cardiovascular risk, such as lipids and blood glucose, and is a key component in both the prevention and the management of type 2 diabetes. Glycaemic control improves with both aerobic and resistance exercise in type 2 diabetes, but no glycaemic benefit is seen in type 1 diabetes. This probably results from glucose fluctuations commonly seen with exercise. Low and moderate intensity exercise are generally associated with a fall in blood glucose, and high intensity exercise can be associated with a rise in blood glucose. Trial evide...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Lumb A Tags: Clin Med Source Type: research
Diabetes and pregnancy.
Abstract
An increasing number of women who are pregnant have diabetes, whether gestational or pre-existing. Diabetes in pregnancy is associated with a number of adverse outcomes including birth trauma, neonatal hypoglycaemia, macrosomia and pre-eclampsia. Those with pre-existing diabetes have the additional risks which include congenital defects and increased perinatal mortality. This paper summarises the complications of diabetes in pregnancy and highlights some of the recent controversy surrounding the diagnosis of gestational diabetes.
PMID: 25468858 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Wilmot EG, Mansell P Tags: Clin Med Source Type: research
CME Diabetes SAQs (91577): self-assessment questionnaire.
PMID: 25468859 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Grant P, George J Tags: Clin Med Source Type: research
Tophaceous gouty arthropathy of the lumbar spine.
Abstract
Gout, classically affecting the first metatarsal joints, knees, fingers and ears, is seldom thrown out as a differential when a patient complains of lower back pain. Symptoms presented by patients with spinal gout may be non-specific and varied; at times, the only clue being that the patient has a previous history of gout. Prompt treatment with anti-inflammatory medication once diagnosis is reached helps to alleviate pain and improves the prognosis of the disease. Therefore, it is vital for the treating physician to keep an open mind and consider spinal gout as a diagnosis once other sinister caus...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Saripalli K, Baskar S Tags: Clin Med Source Type: research
A stroke of bad luck.
Abstract
Giant cell arteritis is a common cause of headache in patients aged more than 50 years. It is an easy diagnosis to make if classical features, ie temporal headache, jaw claudication, visual symptoms, systemic symptoms of fever or weight loss with high erythrocyte sedimentation rate and anemia, are present. However, it may present atypically and stroke can be the presenting feature. A high index of suspicion is needed in atypical presentations such as stroke. Once a diagnosis is suspected it is imperative to start high dose steroids to prevent visual and neurological complications.
PMID: ...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Nagasayi S, White S, Joshi Y Tags: Clin Med Source Type: research
Blue toe in a male with cholesterol embolisation syndrome.
PMID: 25468862 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Arakawa K, Konoshita T, Makino Y, Ishizuka T Tags: Clin Med Source Type: research
Book reviews.
PMID: 25468863 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Katona C Tags: Clin Med Source Type: research
Book reviews.
PMID: 25468864 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Pounder R Tags: Clin Med Source Type: research
Collaborative clinician-led research networks.
PMID: 25468865 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Simpson R, Layfield C, Williams H Tags: Clin Med Source Type: research
