Aust Fam Physician
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Review
SGLT2 inhibition with dapagliflozin -- a novel approach for the management of type 2 diabetes.
Because of the progressive nature of the disease, most patients with type 2 diabetes mellitus eventually require multiple treatments to achieve glycaemic targets. The majority of available therapies are insulin dependent, aiming to decrease insulin resistance and increase insulin secretion. Sodium glucose co-transporter 2 (SGLT2) inhibitors, a new class of antidiabetic agents, limit renal glucose reabsorption promoting urinary excretion of glucose, thereby reducing plasma glucose. ⋯ Clinical trials have shown dapagliflozin to be effective in reducing glycosylated haemoglobin, weight and fasting plasma glucose, either as monotherapy or as add-on therapy to metformin, sulphonylurea and insulin. Other SGLT2 inhibitors are currently under investigation.
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The antinuclear antibody (ANA) test is widely used as a serological marker of autoimmune disease. Antinuclear antibodies are immunoglobulins or antibodies that bind to one or more antigens expressed within the nucleus of human cells. Used selectively, the ANA test can be a useful laboratory tool to help confirm or exclude the diagnosis of systemic rheumatic disease. However, the relatively high prevalence of ANAs in other inflammatory conditions, as well as healthy individuals, can make a positive result difficult to interpret.
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Taping can be used to reduce pain in knee osteoarthritis. There are different methods of taping, but the common effect is to exert a medially directed force on the patella to increase the patellofemoral contact area, thereby decreasing joint stress and reducing pain. Taping can be performed by a physiotherapist, but self taping can be taught, which enhances self management. Taping for knee osteoarthritis has National Health and Medical Research Council (NHMRC) Level I evidence of efficacy for pain relief and is associated with negligible adverse effects that generally include minor skin irritation.
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Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. ⋯ Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.
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Fibromyalgia is a common and debilitating condition. The cardinal feature of fibromyalgia is musculoskeletal pain, usually accompanied by other problems, such as fatigue, sleep disturbance and cognitive difficulties. Fibromyalgia commonly coexists with other chronic illnesses and can result in poorer outcomes if untreated. ⋯ The features of fibromyalgia are similar to those of many other chronic illnesses, sometimes resulting in diagnostic confusion. Fibromyalgia can co-exist with other disorders and it is important to consider the possibility of fibromyalgia contributing to symptoms in any chronically ill patient.