Postgraduate medical journal
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Osteoporotic vertebral compression fractures cause pain, reduced mobility and consequently poor quality of life, and as such have a significant impact on health resources. Their prevalence can be expected to increase with the ageing population. Until recently, only conservative management has been available to alleviate pain and improve mobility. ⋯ Percutaneous vertebroplasty involves stabilisation of the fractured vertebral body using cement which is introduced via a needle under image guidance. Kyphoplasty is a more recent development in which a balloon is inflated within the fractured vertebral body in order to correct any loss of height before cement stabilisation. There is a lack of major randomised controlled trials on either procedure at present, but evidence of their safety and efficacy is increasing, suggesting that both are more effective than conservative management, with low risk of complications.
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Ruptured abdominal aortic aneurysm (AAA) is one of the most fatal surgical emergencies, with an overall mortality rate of 90%. Most AAAs rupture into the retroperitoneal cavity, which results in the classical triad of pain, hypotension, and a pulsatile mass. ⋯ It is likely that different sites of rupture of AAA determine a variety of common and uncommon clinical presentations, the recognition of which can save many lives. This article reviews the different sites of rupture of infrarenal AAA and explores the evidence behind the various clinical presentations seen in patients with ruptured AAA.
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Spread of spurious/counterfeit/substandard drugs is a modern day menace which has been recognised internationally, especially so in developing countries. The problem assumes added significance in view of rapid globalisation. ⋯ The consequences of the use of such medicines may vary from therapeutic failure to the occurrence of serious adverse events and even death. Proper drug quality monitoring, enforcement of laws and legislation, an effective and efficient regulatory environment, and awareness and vigilance on part of all stakeholders can help tackle this problem.
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To examine the prevalence and correlates of diagnosed depression among South Asians and white Europeans with type 1 and type 2 diabetes mellitus, attending a specialist diabetes clinic in the UK. ⋯ The findings add to the limited body of knowledge regarding ethnic differences in depression and diabetes. Among those with type 2 diabetes, white Europeans had nearly 60% higher adjusted odds of diagnosed depression compared to South Asians. Disparities may be due to differences in presentation or identification of depression between these two ethnic groups.
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The main purpose of this article is to review recent developments in the management of acute and recurrent Clostridium difficile-associated disease, with consideration of existing and new antibiotic and non-antibiotic agents for treatment. Details of the current developmental stage of new agents are provided and the role of surgery in the management of severe disease is discussed. Infection control measures considered comprise prudent use of antimicrobials, prevention of cross-infection and surveillance. Other topics that are covered include the recent emergence of an epidemic hypervirulent strain, pathogenesis, clinical presentation and approaches to rapid diagnosis and assessment of the colonic disease.