QJM : monthly journal of the Association of Physicians
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Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30 kg/m(2)). Type 2 diabetes, increasingly recognized as a major complication of overweight and obesity, is beginning to appear in UK adolescents, following the trends in the US. Epidemiological data indicate that the prevalence of overweight and obesity has doubled or tripled in the past few decades in the US, in Europe, and even in many developing countries. ⋯ Initiatives have been introduced by the government to increase the physical education syllabus in school to a minimum of 2 h/week, and the promotion of fruit and vegetables. Further research is required on the physiological and psychological causes of overweight and obesity in children and adults, and randomized, controlled, school and community-based trials are required to pilot preventative initiatives. Monitoring of the progress in prevention at both organizational and outcome level is required, and also of adverse outcomes such as a rise in the prevalence of eating disorders.
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Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support. ⋯ The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.
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Randomized Controlled Trial Clinical Trial
Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up.
Tuberculous pericarditis is common in Transkei (Eastern Cape). Two randomized trials showed benefits at two years for prednisolone in patients with constrictive pericarditis, and open drainage plus prednisolone in patients with pericardial effusion. ⋯ In the absence of a clear contraindication, a corticosteroid should be used in addition to antituberculosis chemotherapy in the management of patients with tuberculous pericarditis.
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A 22-year-old male developed a severe degree of metabolic acidosis (plasma pH 7.20, bicarbonate 8 mmol/l), with a large increase in the plasma anion gap (26 mEq/l). Ketoacidosis was suspected because of the odour of acetone on his breath and a positive qualitative test for acetone in plasma (to a 1:4 dilution). ⋯ Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis and hypoglycaemic ketoacidosis were all ruled out, and his toxin screen was negative for salicylates. Finding another possible cause for ketoacidosis became the focus of this case.
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Randomized Controlled Trial Clinical Trial
Sodium valproate for painful diabetic neuropathy: a randomized double-blind placebo-controlled study.
Various drugs are effective in the management of painful diabetic neuropathy, but none is completely satisfactory. We previously found sodium valproate to be effective and safe in a short-term study. ⋯ Sodium valproate is well-tolerated, and provides significant subjective improvement in painful diabetic neuropathy.