Clin Med
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There are numerous reports of thiazide-induced hyponatraemia (TIH) and its incidence is growing as a result of increasing prescription after guidelines recommending thiazides as first-line treatment of essential hypertension have been introduced. Thiazide diuretics are a common cause of severe hyponatraemia that is usually induced within two weeks of starting the thiazide diuretic, but it can occur any time and very rapidly in susceptible patients. ⋯ Although its impact has recently been reviewed, little attention has been given to the practical approach for preventing this medical complication. In the present review, the epidemiology, pathogenesis, clinical presentation and management of TIH are discussed, and an approach to its prevention suggested in the hope that increased awareness and understanding will reduce the incidence and complications of this potentially life-threatening condition.
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In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO2) production. Patients with advanced COPD are flow limited and cannot excrete the CO2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.
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There is increasing concern about the inappropriate use of alcohol by teenagers and young adults. The objective of this study was to assess the practicality of developing an alcohol education programme for school pupils delivered by medical students. The study design was of a prospective, observational, interventional cohort study. ⋯ Over a three-year period, 60 medical students provided alcohol education sessions to 1,780 high school pupils (aged 13-15 years) within seven schools in Wales. Strongly positive feedback was obtained from all stakeholders and all schools asked to be included in future programmes. In conclusion, medical student-delivered teaching of alcohol education programmes to school pupils appears to be feasible and welcome by schools, teachers, pupils and medical students.
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This lesson describes a case of tuberous sclerosis presenting with confusion and agitation. The condition is briefly reviewed and learning points are emphasised for clinicians encountering similar presentations.