Clin Med
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Tuberculosis (TB) remains a serious infectious disease continuing to cause around 1.8 million deaths annually. The great paradox is that despite the availability of effective treatment for the past 60 years, it continues to spread relentlessly, particularly in sub-Saharan Africa due to the fuelling effect of the HIV/AIDS epidemic. It is no longer a medical epidemic, but an epidemic of injustice. ⋯ It is imperative that the control should be linked to that of HIV which is also closely associated with poverty, poor housing and malnutrition. The historical, social, philosophical and political perspectives that may have influenced the failure of TB control are discussed. Once again, therefore, the question is raised--can TB be brought under control?
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The earliest sign of DN is the development of microalbuminuria which is associated with a significant risk of both progressive renal failure and premature death from cardiovascular disease. Optimal glycaemic and BP control, including the use of RAAS blocking drugs, can prevent, slow and even reverse the processes causing DN.
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Engaging in end-of-life discussions is a major source of anxiety for doctors in training. The authors propose the use of a decision-making model to assist trainees and their clinical supervisors in such situations. Divided into' 'patient-centred' and 'physician-centred' components, the model ensures that the following aspects are analysed: patient and family safety, patient and family choice, physician competence and physician comfort. A real but historical end-of-life scenario is presented to a foundation year 1 doctor, and the particular risks of engaging in a discussion are subsequently clarified with reference to each of the model's components.
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This article describes the differences in training and departmental function between the specialties of emergency medicine in China and acute medicine in the U. K., based on the experience of a visiting international medical graduate from Shanghai.