Clin Med
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A known alcoholic was admitted for a repeated episode of fits abolished by treating the patient's hypocalcaemia. Several mechanisms of hypocalcaemia in alcoholics have been described but in this patient coeliac disease was also diagnosed. Non-compliance with a gluten-free diet led to poor control of the disease, continued hypocalcaemia and an admission with a repeat seizure leading to death.
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Mitigating climate change presents unrivalled opportunities for improving public health. The policies that need to be implemented to reduce greenhouse gas emissions will also bring about substantial reductions in heart disease, cancer, obesity, diabetes, road deaths and injuries, and air pollution. ⋯ Because the existence of important health co-benefits will dramatically reduce the cost to society of taking strong action to mitigate climate change, failure to appreciate their importance could have serious environmental consequences. Health professionals have an urgent responsibility to ensure that the health benefits of environmental policies are understood by the public and by policymakers.
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CKD is common and its prevalence may be increasing. It carries with it a substantial cardiovascular risk but the vast majority of patients will never require dialysis. The minority requiring further investigation or complex management should be promptly identified and referred to a nephrologist. The remaining patients require lifelong monitoring in primary care and careful attention to their cardiovascular risk factors.