Clinical medicine (London, England)
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Case Reports
Acute abdominal pain: Henoch-Schönlein purpura case in a young adult, a rare but important diagnosis.
Henoch-Schönlein purpura (HSP), also known as IgA vasculitis, is a systemic vasculitis which is the most common vasculitis in children. The incidence in adults varies from 3.4 to 14.3 cases per million.1 The classic triad of symptoms include purpuric rash, arthritis and abdominal pain. We present the case of a 20-year-old male with HSP who presented with recurrent episodes of abdominal pain, followed by classical symptoms with an identified post-infectious aetiology.
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Review Historical Article
Five centuries of medical contributions from the Royal Navy.
Royal Naval ships' companies, isolated by hundreds of miles of sea with contacts to the outside world tightly regulated, provided perfect environments to study the epidemiology of disease. In 1747, James Lind organised one of the earliest clinical trials, demonstrating that scurvy could be treated by lemon juice. A century later, Alexander Bryson proved the value of careful epidemiological data collection and observation of infectious diseases encountered on the West Africa station. ⋯ Nuclear submarines placed naval physicians at the forefront of nuclear medicine and environmental safety. The development of new aircraft carriers has driven a renewed interest in aviation medicine. This article reviews the contributions that Royal Navy physicians have made to medicine over the centuries, detailing some of the better known as well as some almost forgotten, but still remarkable, achievements.
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Starting with a hypothesis which postulated a simple explanation arising from the basic cause of type 2 diabetes, a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. ⋯ For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided. The implications for personal health and for national health economics are considerable.
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Age-standardised mortality from liver disease in the United Kingdom has risen by 400% since 1970, with three-quarters of deaths from alcohol-related liver disease (ARLD). The 2013 National Confidential Enquiry into Patient Outcome and Death report found that only 47% of the patients dying in hospital from liver disease experienced 'good' care. We discuss common complications in the care of patients with ARLD and the evidence-based best practice that can improve patient outcomes, with a focus on the initial management of patients presenting acutely to the medical take.
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Case Reports
Lesson of the month 2: When steroids stop working - infective endocarditis, the great mimicker.
A 63-year-old man with an extensive travel history to South East Asia presented with generalised malaise, temporal headaches and high inflammatory markers. He was treated with corticosteroids for presumed giant cell arteritis. Unsuccessful attempts to wean him from prednisolone prompted further investigations by rheumatology, haematology and finally ophthalmology. ⋯ He underwent an aortic valve replacement and completed 6 weeks of intravenous antibiotics with resolution of his symptoms. This case illustrates the importance of challenging a previous diagnosis, including repeat examination, when a patient's condition does not evolve as expected. Endocarditis is recognised as a great imitator and the diagnosis remains challenging.