Postgraduate medical journal
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Head injury is an important cause of death among young adults in the UK, and a significant burden on NHS resources. However, management is inconsistent, governed largely by local resources. The latest version of the NICE head injury guidelines suggests that more patients with traumatic brain injury should be transferred to receive specialist care. ⋯ Much of the research was conducted outside the UK, which raises questions about its relevance to the NHS. Care of traumatic brain injuries in the UK is already hampered by the inadequate capacity of regional neurosurgical units to meet demand, and transferring more patients would be likely to exacerbate this. Increasing the number of transfers could also worsen inequalities of access for other groups, such as elective patients, particularly in areas where facilities are most stretched.
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Late-night salivary cortisol is used as a screening test for Cushing's syndrome (CS) in many European and American countries. However, its utility has not been studied in an Asian-Indian population. ⋯ The reference range for late-night salivary cortisol in our population was <10.87 nmol/l. With this cut-off, the sensitivity was 69.2% and specificity 100%. Even though this automated electrochemiluminescence assay is easy and quick to use, its clinical utility in measuring the low salivary cortisol concentrations needs further investigation.
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Patients with irreversible chronic kidney disease who require dialysis immediately are a subset of ultra late referrals for whom the term chronic kidney disease presenting acutely might usefully be applied. Although well known to nephrologists and recognised as a specific group with considerable problems, little has been written about them. ⋯ Chronic kidney disease presenting acutely is not uncommon, often avoidable and associated with adverse outcomes. The identification, follow-up and appropriate referral of patients with raised serum creatinine is likely to reduce its incidence. Nausea and vomiting may occur sufficiently frequently in advanced renal failure to justify measuring renal function before proceeding to endoscopy when patients present with gastrointestinal symptoms.
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Randomized Controlled Trial Multicenter Study
A randomised controlled trial of subcutaneous sodium salicylate therapy for osteoarthritis of the thumb.
Current treatment for osteoarthritis (OA) is limited. Many patients with OA of the hand have areas of tender subcutaneous thickening in the forearm and upper scapular region. A pilot study showed an improvement in pain from OA at the first carpometacarpal joint after injection of such areas with 0.5% sodium salicylate or saline, an inexpensive treatment that can be administered by general practitioners and nurses. The study indicated that a randomised, sham-controlled trial was justified. ⋯ The data show that subcutaneous sodium salicylate injections are an effective symptomatic treatment for OA of the thumb. The results provide a basis for further physiological and therapeutic research in this area.