Clinical medicine (London, England)
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Acute pancreatitis (AP) is a medical emergency associated with significant morbidity and mortality. Hypertriglyceridaemia is a well-established but often neglected cause of AP, associated with delayed diagnosis and worse outcome than other more common causes of AP. ⋯ We describe the features underlying the management of AP caused by hypertriglyceridaemia and review the link between oral oestrogen, hypertriglyceridaemia and AP. Given the growth in transgender medicine leading to increasing use of therapeutic high-dose oestrogens in biological males for gender reassignment, it is important that clinicians are alert to the phenomenon of oestrogen-induced-hypertriglyceridaemia and its associated risk of AP.
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Specialty and associate specialist (SAS) doctors comprise a significant proportion of the UK medical workforce.Appraisal has the potential to support professional development, as well as being vital for revalidating a doctor's licence to practise.Early research indicated that SAS doctors experienced difficulties engaging with appraisal. It is not clear if the situation has improved over recent years, and SAS doctors' voices are largely absent from the literature. ⋯ Our research reveals the importance of enhancing the professional status and agency of SAS doctors. There should be structured support and career guidance for new SAS doctors or those changing specialty and an expectation of support for professional exams. SAS doctors may benefit from explicit discussions around wellbeing. Some of these needs may be better addressed by having SAS doctors as appraisers, but this is likely to be insufficient in itself.
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The new variant of concern (VOC), B.1.1.7, has a distinct set of mutations in nucleotides encoding the spike (S) protein on the surface of SARS-CoV-2. SARS-CoV-2 previously accumulated mutations at a much slower rate, of 1-2 per month; the sudden appearance of a large cluster of mutations was thought to be unusual. We now suspect that VOC may have arisen from immunosuppressed individuals who shed virus for longer periods. ⋯ VOC also has implications for the national vaccination programme - a higher proportion of people will need to be vaccinated with a more infectious virus. Prolongation of the second dose of vaccines to increase vaccine uptake has understandably caused concern, but is based on sound immunological principles. There is now an urgent need to monitor the effect of new variants on vaccine efficacy - marking a new chapter in the global fight against COVID-19.
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Infection rashes can present in a number of different ways, some giving a reactive pattern in the skin to infection elsewhere in the body, while others reflect infection within the affected skin itself. Recognising the possible systemic symptoms, characteristic distribution and morphology of rashes can lead to a high degree of accuracy in making a clinical diagnosis in the clinic room/at the bedside that can be confirmed with a few simple laboratory tests.
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During the COVID-19 pandemic, many final-year medical students were qualified early with the voluntary option to join the workforce as foundation interim year 1 (FiY1) doctors. In this column, a foundation year 1 (FY1) doctor reflects on their FiY1 experience of starting work as a practising doctor in the height of a pandemic. The process of the induction, the structure of the job, and the overall experience of an FiY1 doctor is reviewed and reflected on against previous years. The author aims to shed light on the FiY1 role for students who may find themselves in similar positions in the future.