Postgraduate medical journal
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Targeted biologic therapies have revolutionised treatment of immune-mediated inflammatory diseases (IMIDs) due to their efficacy, speed of onset and tolerability. The discovery that clinically unrelated conditions, such as rheumatoid arthritis and Crohn's disease, share similar immune dysregulation has led to a shift in the management of IMIDs from one of organ-based symptom relief to mechanism-based treatment. The fact that anticytokine therapy has been effective in treating multiple orphan inflammatory conditions confirms the IMID paradigm. ⋯ We also discuss the rationale behind the management of IMIDs using rheumatoid arthritis, Crohn's disease, psoriasis and psoriatic arthritis as examples. For the medical profession, IMID represents a breakthrough in the way pathology is classified. In this burgeoning era of biologic therapy the prospect of complete disease remission is conceivable.
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Computers are increasingly used in medical education. Electronic learning (elearning) is moving from textbooks in electronic format (that are increasingly enhanced by the use of multimedia adjuncts) to a truly interactive medium that can be delivered to meet the educational needs of students and postgraduate learners. ⋯ It is a valuable tool to add to the medical teacher's toolkit, but like all tools it must be used appropriately. This article endeavours to review the current "state of the art2 in use of elearning and its role in medical education alongside non-electronic methods-a combination that is currently referred to as "blended" learning.
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People with type 1 diabetes have normal exocrine pancreatic function, making islet cell rather than whole organ transplantation an attractive option. Achieving insulin independence in type 1 diabetes was the perceived goal of islet cell transplantation. ⋯ In this context, the indications for islet cell transplantation, which have evolved over the last 5 years, indicate that the patients who benefit most are those who experience severe hypoglycaemic reactions despite optimal insulin therapy. This review will summarise the history of islet cell transplantation, islet isolation techniques, the transplant procedure, immunosuppressive therapy, indications for islet cell transplantation, current clinical trials, the early UK islet cell transplant experience using the Edmonton protocol, and some of the challenges that lie ahead.
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Despite a dramatic decline in mortality over the past years, coronary heart disease is the leading cause of death and disability in the world. At the same time, with the great improvement of medical science, there is a growing population of postmyocardial infarction, postrevascularisation and heart failure survivors. ⋯ This review highlights sex-specific issues in IHD presentation, evaluation and outcomes, with several new results published from the Women's Ischemia Syndrome Evaluation study. New evidence on traditional and novel risk markers as well as sex-specific differences in symptoms and diagnostic approaches have also been discussed.
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Adults with hypothalamic-pituitary disease have increased morbidity and mortality from cardiovascular disease (CVD). Therefore, the prevalence of CVD and adequacy of treatment of cardiovascular risk factors (according to current treatment guidelines) was studied in a large group of patients with hypothalamic-pituitary disease. ⋯ Cardiovascular risk factors are highly prevalent and often inadequately treated in adult patients with hypothalamic-pituitary disease. Aggressive treatment of these factors is essential to reduce mortality and morbidity from CVD in these patients.