Clin Med
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Typhoid fever should be considered in the diagnosis of any patient with a fever from the Asian community even in the absence of a travel history to an endemic region. Blood cultures taken prior to antibiotics are the best way of making the diagnosis early and preventing the complications that arise from a prolonged bacteraemia.
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There have been huge advances in endocrine care as a consequence of improved biochemistry and diagnostic techniques as well as improved imaging. Specialist transethmoidal endoscopic surgery has improved results in pituitary tumour patients and minimally invasive parathyroid surgery has had the same consequence in patients with parathyroid disease. Multidisciplinary teams have improved outcomes in a number of areas and, as described above, endocrinologists are dealing with more in the way of endocrine disease to expand boundaries. Much work remains to be done particularly concerning the care of children and adults with late endocrine effects of cancer treatment and obesity.
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Motor neurone disease (MND) is an adult-onset neurodegenerative disease which leads inexorably via weakness of limb, bulbar and respiratory muscles to death from respiratory failure three to five years later. Most MND is sporadic but approximately 10% is inherited. In exciting recent breakthroughs two new MND genes have been identified. ⋯ Malnutrition is a poor prognostic factor. In appropriate patients enteral feeding is recommended although its use has yet to be shown to improve survival. In ALS patients with respiratory failure and good or only moderately impaired bulbar function non-invasive positive pressure ventilation prolongs life and improves quality of life.
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The range of treatments for rheumatoid arthritis (RA) has increased significantly in recent years, with a parallel improvement in patient outcome. The development and assessment of new therapies and therapeutic strategies relies on the availability of valid and reliable outcome measures to assess the diverse impact of RA on the patient's life. ⋯ Some measures have been combined into composite indices which are useful for summarising the patient's current condition and as primary outcome measures for clinical trials. There is still a need for better and more relevant tools especially for imaging multiple joints and for assessing fatigue.
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The medical humanities attempt to emphasise the subjective experience of patients within the objective and scientific world of medicine. This article argues that the goal of medical humanities can be furthered by literature. Autobiographical accounts are used to illustrate the various ways in which literature can influence and enrich medical practice.