Clinical medicine (London, England)
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A 76-year-old man presented to the hospital with intermittent dizziness, memory impairment and jerky movements. Evaluation revealed them to be faciobrachial dystonic seizures and antibodies to voltage-gated potassium channel complexes were found. He was treated with intravenous methylprednisolone and rituximab, and made a remarkable recovery. Magnetic resonance imaging of the brain was normal, although positron emission tomography - computed tomography showed striking basal ganglia changes.
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Haemolytic anaemia can seem like a complicated topic. The constellation of reticulocytosis, increased lactate dehydrogenase levels, increased unconjugated bilirubin levels and decreased haptoglobin levels should prompt general physicians to consider haemolysis as a differential diagnosis. When further approaching haemolytic anaemia, subdividing patients into those who are 'direct antiglobulin test (DAT) positive' (immune) or 'DAT negative' (non-immune) is a simple and clinically relevant way to start to formulate a cause for the haemolytic anaemia. ⋯ Early supportive care in haemolytic anaemia is important and may involve blood transfusions as well as interventions to slow the rate of haemolysis, such as steroids in autoimmune haemolytic anaemia. Complications of haemolysis include pigment gallstones, high-output cardiac failure and thromboembolism. Haemolytic anaemia should be referred to the haematologist for further investigation, however, the recognition and early management by the general physician is imperative in improving the patient's outcome.
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Multiple myeloma (MM) is a type of haematological bone marrow malignancy. Cancer Research UK reports that MM is the 18th most common cancer in the UK, accounting for 2% of all new cancer cases, yet, non-haematologists often lack familiarity with the pathology and initial investigations. This paper aims to demonstrate the diagnostic features, relevant investigations and basic management plan for the non-specialist.
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Pneumomediastinum and pneumothorax are recognised complications encountered in COVID-19 before or during invasive mechanical ventilation (IMV). The clinical course of patients developing pneumomediastinum before IMV is yet to be evaluated. Four-thousand, one-hundred and thirty-one patients hospitalised with COVID-19 over a 12-month period were retrospectively reviewed to evaluate for incidence, clinical characteristics and outcomes. ⋯ The incidence of PneumoCoV, despite being low, is associated with increased mortality. It is a hallmark of moderate to severe disease with multifaceted contributory factors. Both demographic and clinical factors predict survival.
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A 38-year-old man was admitted to the hospital due to a "suddenly developed right hemiplegia, unconsciousness and gaze to the right". Pulmonary arteriovenous fistulas (PAVFs) are rare but an important cause of stroke in young people, which is easy to be clinically neglected. Therefore, for young patients with pulmonary diseases and cerebral infarction, the possibility of PAVF should be considered.