Clinical medicine (London, England)
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In the new science emanating from the COVID-19 pandemic, effective vaccine development has made a huge difference and saved countless lives. Vaccine roll-out led to the identification of rare cases of severe thrombotic and thrombocytopenic problems in some recipients. This apparent coupling of thrombosis with haemorrhagic potentiation might seem baffling but the ensuing clinical investigation rapidly shed important light on its molecular mechanism. This review outlines the current understanding on the role of adenovirus-based platforms, the immunogenic triggers and the immunothrombotic response underlying vaccine-induced immune thrombotic thrombocytopenia.
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Medical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. ⋯ Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.
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The misdiagnosis of intestinal schistosomiasis is not uncommon given its variety of clinical manifestations and often shares similarities with ulcerative colitis. While endoscopy aids in diagnosis, findings are often non-specific and correlation with histopathological features is crucial in arriving at an accurate diagnosis which is confirmed by the presence of schistosome ova within the lamina propria. In this case study, we report our experience with a 50-year-old woman, who had been residing in Singapore for more than a decade, presenting with recurrent episodes of bloody diarrhoea.
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Developing chief investigators within the NHS: the West Midlands clinical trials scholars programme.
Consecutive Royal College of Physicians' Research for all surveys have highlighted the challenges for doctors becoming involved in research. Local issues included under-representation of chief investigators (CIs) and reduction in dedicated research time. ⋯ After 2 years, the remaining 16 CTSs have been awarded 40 grants totalling £18.35 million as CI or co-CI, including 10 NIHR grants, plus >200 publications. These scholarships are a proven cost-effective way to develop CIs, provide academic leadership and promote a research culture, even in small, previously less research-active trusts.
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Case Reports
A case of unilateral pulmonary oedema associated with severe acute mitral regurgitation.
A 44-year-old woman presented to the emergency department with sudden chest tightness and breathlessness, and a chest X-ray revealed unilateral pulmonary oedema (UPO). Colour Doppler echocardiography showed that the leaflet prolapsed with severe regurgitation, and the regurgitant jet tended to blow rightward within the left atrium. ⋯ UPO is easily misdiagnosed, which leads to delays in treatment. Therefore, accurate diagnosis and immediate treatment are crucial.