Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy.
Abstract
Although recognised as a cause of chronic diarrhoea for over forty years, diagnostic tests and treatments for bile acid malabsorption (BAM) remain controversial. Recent National Institute for Health and Care Excellence (NICE) guidelines highlighted the lack of evidence in the field, and called for further research. This retrospective study explores the BAM subtype and severity, the use and response to bile acid sequestrants (BAS) and the prevalence of abnormal colonic histology. 264 selenium-75-labelled homocholic acid conjugated taurine (SeHCAT)-tested patient records were reviewed and the severi...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Orekoya O, McLaughlin J, Leitao E, Johns W, Lal S, Paine P Tags: Clin Med Source Type: research
Making healthcare safer by understanding, designing and buying better IT.
We present some suggestions to improve reporting and the procurement of hospital equipment.
PMID: 26031976 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Thimbleby H, Lewis A, Williams J Tags: Clin Med Source Type: research
Physical activity and health in adolescence.
Abstract
Adolescence represents a critical period of development during which personal lifestyle choices and behaviour patterns establish, including the choice to be physically active. Physical inactivity, sedentary behaviour and low cardiorespiratory fitness are strong risk factors for the development of chronic diseases with resulting morbidity and mortality, as well as economic burden to wider society from health and social care provision, and reduced occupational productivity. Worrying trends in adverse physical activity behaviours necessitate urgent and concerted action. Healthcare professionals carin...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Kumar B, Robinson R, Till S Tags: Clin Med Source Type: research
Drug therapy in headache.
Abstract
All physicians will encounter patients with headaches. Primary headache disorders are common, and often disabling. This paper reviews the principles of drug therapy in headache in adults, focusing on the three commonest disorders presenting in both primary and secondary care: tension-type headache, migraine and cluster headache. The clinical evidence on the basis of which choices can be made between the currently available drug therapies for acute and preventive treatment of these disorders is presented, and information given on the options available for the emergency parenteral treatment of refra...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Weatherall MW Tags: Clin Med Source Type: research
Fever of unknown origin.
We describe the definition, diagnostic workup, causes and treatment of FUO.
PMID: 26031980 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Mulders-Manders C, Simon A, Bleeker-Rovers C Tags: Clin Med Source Type: research
Infectious causes of fever of unknown origin.
This article summarises the clinical features and diagnostic strategy of these infections.
PMID: 26031981 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: McGregor AC, Moore DA Tags: Clin Med Source Type: research
The ying and yang of fever in rheumatic disease.
Abstract
Fevers are relatively common in rheumatic disease, largely due to the fact that the inflammatory process is driven by inflammatory mediators that function as endogenous pyrogens. Since the immune system's sensors cannot accurately distinguish between endogenous and exogenous (pathogen-derived) pyrogens a major challenge for physicians and rheumatologists has been to decipher patterns of clinical signs and symptoms to inform clinical decision making. Here we describe some of the common pitfalls and clinical challenges, and highlight the importance of a systematic approach to investigating the rheum...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Galloway J, Cope AP Tags: Clin Med Source Type: research
Malignant causes of fever of unknown origin.
Abstract
The presence of fever in malignancy usually indicates infection, though transfusion, thrombosis and drugs are also culprits. However, particularly in some tumour types, fever can also be a paraneoplastic syndrome, caused by the malignancy itself. This can be a difficult diagnosis to establish and presents a therapeutic challenge to the physician when the underlying malignancy is not easily treated.
PMID: 26031983 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Foggo V, Cavenagh J Tags: Clin Med Source Type: research
Autoinflammatory syndromes as causes of fever of unknown origin.
Abstract
The systemic autoinflammatory syndromes often present with recurrent fevers. They have proved exceptionally informative about the innate immune system. Although extremely rare, they are important to recognise, as many can now be completely controlled by long-term drug therapies. Diagnosis relies on clinical suspicion followed by genetic testing.
PMID: 26031984 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Lachmann HJ Tags: Clin Med Source Type: research
CME Fever syndromes SAQs (91579): Self-assessment questionnaire.
Authors:
PMID: 26031985 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Tags: Clin Med Source Type: research
Lesson of the month 1: Acute flecainide overdose and the potential utility of lipid emulsion therapy.
Abstract
Lipid-emulsion therapy (Intralipid®) has been advocated as a potential treatment for the management of cardio-toxicity arising from lipid-soluble drugs, particularly those acting upon sodium channels. This, on the basis of a number of ex vivo studies and animal models, suggests that partitioning a drug into lipid could alter its pharmacokinetics and result in significant clinical improvements. Its subsequent use in clinical case series has been seen as confirmation of this mechanism of action. While there are undoubtedly instances where lipid emulsion therapy has been associated with a desirable ...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Mukhtar O, Archer JR, Dargan PI, Wood DM Tags: Clin Med Source Type: research
Lesson of the month 2: Chronic erythematous painless plaque on the eyelid co-presenting with multiple ulcerated nodules on the extremities.
Abstract
Cutaneous leishmaniasis is a parasitic disease caused by the Leishmania species, transmitted by the bite of an infected sandfly. The typical cutaneous lesion is a painless ulcer with a raised, indurated margin and often covered with an adherent crust. The lesions are mostly located on exposed sites such as the face and the extremities. Eyelid involvement is rare, making up only 2-5% of cases with facial cutaneous leishmaniasis. Herein, we report a 50-year-old male who presented with an erythematous plaque on the upper eyelid and multiple ulcerated nodules located on the extremities. Following micr...
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Duman R, Duman N, Yavaș GF, Doğan M, Duman R Tags: Clin Med Source Type: research
Angel's wing appearance on chest radiograph - progressive massive fibrosis.
PMID: 26031988 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Narayanasamy S, Singh J, Sathiadoss PA, Khan MS, Jamal F, Zaman N Tags: Clin Med Source Type: research
Brugada phenocopies are the leading differential diagnosis of Brugada syndrome.
Abstract
OVERVIEW Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine@rcplondon.ac.uk.
PMID: 26031989 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Gottschalk BH, Anselm DD, Baranchuk A Tags: Clin Med Source Type: research
Response.
Abstract
OVERVIEW Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine@rcplondon.ac.uk.
PMID: 26031990 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - June 1, 2015 Category: Journals (General) Authors: Sheikh AS, Ranjan K Tags: Clin Med Source Type: research
