Clin Med
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The late diagnosis of HIV in patients across the UK is an increasing problem. Here, we report on a retrospective case-notes audit carried out to assess the impact of the 2008 UK HIV testing guidelines on clinical practice and identify missed opportunities for HIV testing. The audit was carried out in 2010 and focussed on patients with newly diagnosed HIV at centres providing adult HIV services across the UK. ⋯ The most frequent indicator conditions that patients had experienced were chronic diarrhoea or weight loss, sexually transmitted infection, blood dyscrasia or lymphadenopathy. A quarter of patients were identified as having had a missed opportunity for earlier diagnosis. Based on our results, we suggest that HIV testing needs to continue to expand across clinical settings to reduce the number of patients living with undiagnosed HIV infection.
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Medicine has always striven to personalise or stratify approaches towards individual patients, but recently these terms have been applied particularly to denote improved disease sub-classification achieved through new genetic and genomic technologies. Techniques to analyse a person's genetic code have improved in sensitivity exponentially over recent years and at the same time the cost of such analyses has become affordable to routine NHS care. This article highlights the significant opportunities that genomics brings to healthcare, as well as some of the practical and ethical challenges.
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A young man with recurrent food bolus obstruction presented to the gastroenterology clinic and, after investigation, was found to have eosinophilic oesophagitis. This unusual condition is closely linked to atopy and, in parallel with other atopic conditions, is increasing in incidence. ⋯ Eosinophilic oesophagitis is gaining recognition in adult medicine as a cause of dysphagia and is one of the leading causes of recurrent food bolus obstruction. As such, it should be considered as a diagnosis in all young patients presenting with compatible symptoms.