Clinical medicine (London, England)
-
Historical Article
'Every breath we take: the lifelong impact of air pollution' - a call for action.
Air pollution has become one of the major risks to human health because of the progressive increase in the use of vehicles powered by fossil fuels. While the risks of air pollution to health were thought to have been brought under control by the Clean Air Acts of the 1950s and 1960s, the situation of air pollution in the UK has now deteriorated to a point where it is contributing to 40,000 excess deaths each year. ⋯ The UK needs to take a lead and introduce a new Clean Air Act that deals with the vehicle sources of pollution recognising that the toxic particles and gases emitted are effecting individuals from conception to death. This mandates urgent action by government both central and local, but also by all of us who have now become so dependent on road transport.
-
The aim of this study was to follow up a sample of physicians who began core medical training (CMT) in 2009. This paper examines the long-term validity of CMT and GP selection methods in predicting performance in the Membership of Royal College of Physicians (MRCP(UK)) examinations. ⋯ Looking at MRCP(UK) part 1, part 2 written and PACES scores, both CMT and GP selection methods show evidence of predictive validity for the outcome variables, and hierarchical regressions show the GP methods add significant value to the CMT selection process. CMT selection methods predict performance in important outcomes and have good evidence of validity; the GP methods may have an additional role alongside the CMT selection methods.
-
Case Reports
Liquorice-induced apparent mineralocorticoid excess presenting in the emergency department.
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.
-
Peroral endoscopic myotomy (POEM) is an established treatment for primary achalasia. It has gained endorsement from the American Society for Gastrointestinal Endoscopy with increasing clinical acceptance since the first procedure, performed in Japan in 2008. The first successful POEM in the UK was performed in November 2013 at King's College Hospital and this article presents the first UK case series. ⋯ In an initial series of 33 consecutive prospectively followed patients (12 female; 49.5±13 years; median follow-up 9 (3-28) months; 58% having had previous intervention), a 91% success rate has been achieved at 3 months. To date, 16 patients have reached the 12-month time point, with 13 (81%) sustaining response. This case series compares well with international cohorts and demonstrates excellent long-term safety and favourable efficacy.
-
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.