Postgraduate medical journal
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The diagnosis of tuberculous aetiology in pericardial effusions is important since the prognosis is excellent with specific treatment. The clinical features may not be distinctive and the diagnosis could be missed particularly with tamponade. ⋯ Histopathology may, however, show non-specific findings in a significant number. This review is an update on the diagnostic difficulties, current research, and criteria for diagnosis.
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Two questions were addressed: (1) How much physical activity do patients with diabetes perform? (2) What are the perceived factors that prevent patients from doing more physical activity? ⋯ Few patients with diabetes participate in physical activity, and in those who do the level of intensity is low. There are many modifiable factors distracting patients from exercise.
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Metformin is a biguanide commonly used in type 2 diabetes and considered to be a safe drug with minimal side effects. Approximately 2% of cases of acute pancreatitis may be caused by drugs, but it is not a known complication of metformin therapy. ⋯ This is the first reported case of pancreatitis caused by a therapeutic dose of metformin (although in this case renal failure precipitated the metformin toxicity). Severe lactic acidosis is a rare but life threatening complication of metformin, which occurs particularly in patients with renal failure.
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Assessing the quality of an epidemiological study equates to assessing whether the inferences drawn from it are warranted when account is taken of the methods, the representativeness of the study sample, and the nature of the population from which it is drawn. Bias, confounding, and chance can threaten the quality of an epidemiological study at all its phases. Nevertheless, their presence does not necessarily imply that a study should be disregarded. The reader must first balance any of these threats or missing information with their potential impact on the conclusions of the report.
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Challenges to clinical management are a fact of professional life. Every doctor must expect to become embroiled in complaints and claims from time to time and be prepared to justify why they managed a particular case in the way that they did. Good medical practice is defensible practice, which depends upon staying within the limits of your own expertise, keeping up to date and conducting audit, ensuring your administration is effective and that patients are not allowed to slip through the net, that you communicate effectively with patients, their carers and colleagues, and that medical records recall all salient facts relating to the patient. If things go wrong, be open, investigate the facts, explain the situation fully to the patient, and do not be afraid to apologise.