Clin Med
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Obesity represents one of the biggest public health challenges facing us today. Urbanisation, sedentary lifestyles and the availability of inexpensive, highly palatable foods have promoted the increasing prevalence of obesity over the past 30 years. ⋯ We now understand that weight is regulated by neural mechanisms that regulate appetite and energy expenditure and that disruption of these pathways can result in severe obesity in some patients. These studies provide a framework for investigating patients and ultimately may guide the development of more rational, targeted therapies for genetically susceptible individuals with severe obesity.
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Case Reports
Lesson of the month 1: sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure.
Cholesterol embolisation syndrome (CES) is a rare but serious disease with high mortality caused by the formation of an embolus made up of cholesterol crystals from atherosclerotic plaques. Its clinical presentation is usually initially insidious and it often remains unrecognised because of its non-specific clinical presentation, which can cause delays in treatment and high mortality. The most common physical symptoms are cutaneous. We present a lethal case of CES to increase the awareness about this serious condition.
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The clotting screen is an 'integral' part of the routine blood tests in most medical wards. It is likely that only with the increasing requests for prothrombin time and activated partial thromboplastin time are abnormal results noted. ⋯ Due to variable understanding of this complex system, many misconceptions have arisen in relation to the clinical effects expected from abnormal clotting screens. Some of these are discussed with considerations of appropriate management in those situations.
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Biography Historical Article
Axel Munthe and the story of San Michele: the perils of being a 'fashionable' doctor.