Clinical medicine (London, England)
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Letter Case Reports
Analysis of 24 cases of polycystic ovary syndrome after failed controlled ovarian hyperstimulation.
Some fertility patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian hyperstimulation (COH) experience ceased follicular growth during COH and fail to superovulate. In this article, 24 such PCOS patients resumed COH 15-20 days after previous COH treatment was stopped while patients were under ovarian downregulation. ⋯ The remaining seven cases saw ceased follicular growth at 13 mm. This provides a rescue protocol for failed COH patients with PCOS.
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Sleep problems are relatively common in patients with advanced disease, and are associated with significant morbidity in these groups of patients. The focus of this article is sleep problems in patients with advanced cancer, and specifically insomnia, 'vivid' dreams and nightmares. However, other sleep problems are also relatively common in this group of patients, including sleep-related breathing disorders and circadian rhythm sleep-wake disorders. Healthcare professionals should screen all patients with advanced diseases for sleep problems and, equally, initiate appropriate (evidence-based) interventions when they are discovered.
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It is estimated that 12,300 people slept rough in 2018, a 98% increase since 2010. Similar trends can be seen in the number of people living in tents or sleeping on overnight public transport. ⋯ Following the introduction of the Homeless Reduction Act 2017, hospitals must now take a more personalised approach to their homeless patients, ensuring that ongoing care is accessible after discharge. Here, we demonstrate that employment of a dedicated homeless housing officer within a district general hospital can radically improve both staff attitudes towards this patient group as well as individual patient outcomes.
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A 19-year-old patient presented with severe chest pain, which is not typical for cardiac angina. However, his smoking history and the strong family history of ischaemic heart disease coupled with evidence of progressive T-wave changes on his electrocardiogram (ECG) caused dilemma in deciding further management. His blood tests were normal apart from hypophosphataemia, and he had two negative troponin results. ⋯ He was given analgesia for a diagnosis of musculoskeletal chest pain and the next morning his ECG, arterial blood gases and phosphate levels all normalised. He had a normal echocardiogram and was reviewed by the cardiologist who diagnosed musculoskeletal chest pain which led to distress and hyperventilation causing hypophosphataemia and transient T-wave inversion. This case is a reminder of an under-recognised physiological phenomenon involving the cardiac conduction during hyperventilation.
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Case Reports
Lessons of the month 3: Spontaneous resolution of frontotemporal brain sagging syndrome.
We present a case of a man with headache and progressive behavioural disturbance. His cognitive decline progressed over a few months such that he was unable to hold a conversation or carry out any daily tasks such as washing and dressing. He had some upper motor neurone signs in his limbs and features of brainstem dysfunction including dysarthria and ocular abnormalities. ⋯ We propose that resolution of spontaneous intracranial hypotension led to resolution of frontotemporal brain sagging syndrome. We believe this is the first case described where this has occurred without any intervention. It is important to recognise this condition as a potentially reversible cause of dementia.