Clinical medicine (London, England)
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The differential diagnosis of haematological abnormalities, such as leucocytosis, erythocytosis, thrombocytosis or indeed anaemia, is wide and disarming. Here we report on significant updates in the differential diagnosis of erythrocyosis and thrombocytosis presenting a simplified schema for the clinician. We then move to discuss significant advances in this field which have followed a series of key molecular findings, most specifically those affecting the JAK/STAT pathway.
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Presumed consent is a legislative framework in which citizens must place their name on a national opt-out register, otherwise their consent for donating their organs will be presumed. The Welsh Assembly last year passed legislation to enable the introduction of presumed consent in Wales in 2015. The issue is currently being discussed in Northern Ireland, Scotland and the Republic of Ireland. ⋯ Rather than legislating for consent of donors, we should be addressing the misgivings and misunderstandings of families to improve their consent rate, as has been done so successfully in Spain. National improvements in infrastructure in the UK have resulted in an outstanding 63% increase in deceased donation since 2007. If, now, family consent rates could be improved from the current 57% to Spanish levels of 85%, the UK's donation rate would be one of the best in the world.
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The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and others can migrate freely between EU member states to practise their profession. ⋯ The revised law covers the rules to be applied by regulators on (for example) assuring language competence, warning 'blacklists' of practitioners subject to sanctions, 'fast track' registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development. Drafting of detailed secondary legislation is ongoing and poses opportunities and challenges for patient safety, quality of care and transparency.
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Atypical haemolytic uraemic syndrome is a thrombotic microangiopathy with a predominant renal phenotype. Research developments in the last 15 years have led to the elucidation of the role of complement over activation in the pathogenesis of the disease. This was to lead to the successful introduction of targeted pharmacological therapy, in the form of the complement inhibitor, eculizumab.
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The co-existence of diabetes mellitus and HIV infection poses significant challenges for both patient and physician. This article reviews the clinical problems, the implications for treatment plans and potential confusions that can arise when managing patients who have both conditions.