Clin Med
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Acute ST-segment-elevation myocardial infarction (STEMI) results from complete obstruction to coronary artery blood flow accompanied by the appearance of ST-segment-elevation on the electrocardiogram. Emergency treatment is required to restore coronary perfusion, thereby limiting the extent of damage to the myocardium and the likelihood of early death or future heart failure. This concise guideline summarises key recommendations from the National Institute for Health and Care Excellence clinical guideline on acute management of STEMI (CG167), of relevance to all healthcare professionals involved. Guidance is presented on choice of reperfusion strategies, procedural aspects, use of additional drugs before and alongside reperfusion therapies, and treatment of patients who are unconscious or in cardiogenic shock.
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Significant numbers of older people attending hospital can be considered to be frail or living with frailty. This is a multi-component syndrome with many manifestations that leads to poorer outcomes in terms of mortality, morbidity and institutionalisation. ⋯ This article discusses the background to frailty, and a number of validated frailty scores which can be applied by non-specialists in the acute environment. It highlights other resources which are available to help with the management of this complex group of patients, and discusses potential local and national service developments in this area.
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Melanoma-associated retinopathy is a rare paraneoplastic complication of metastatic cutaneous malignant melanoma. It may present years after the original diagnosis of melanoma. We describe a patient with this condition who presented with persistent visual symptoms.
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Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.