Clin Med
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The worldwide pandemic of obesity carries alarming health and socioeconomic implications. Bariatric surgery is currently the only effective treatment for severe obesity. It is safe, with mortality comparable to that of cholecystectomy, and effective in producing substantial and sustainable weight loss, along with high rates of resolution of associated comorbidities, including type 2 diabetes. ⋯ Increased understanding of these mechanisms will help realise therapeutic benefits by pharmacological means. Bariatric surgery improves long-term mortality but can cause long-term nutritional deficiencies. The safety of pregnancy after bariatric surgery is still being elucidated.
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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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With a steadily increasing healthcare burden, all physicians must be aware of methods to manage the complications of chronic liver disease, including hepatic encephalopathy. Approved by the Food and Drug Administration in the USA and several European countries as a treatment for recurrent hepatic encephalopathy an increasing number of patients are now receiving rifaximin for this condition. This ‘lesson of the month’ highlights the dramatic effect that rifaximin may have on hepatic encephalopathy.
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Asthma patients often try some form of alternative medicine. This article questions whether this is good or bad. ⋯ Thus the risk-benefit balance fails to be positive. Patients are often mislead to believe otherwise and physicians should inform their asthma patients responsibly about the value of alternative medicine.