Clinical medicine (London, England)
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Statin-induced immune-mediated necrotising myopathy (IMNM) is an inflammatory myopathy that can present as proximal muscle weakness and, in some cases, as dysphagia and respiratory distress. In this report, we present a case of statin-induced IMNM in a 78-year-old male. The patient had significantly high levels of creatinine kinase and myoglobinuria and experienced gradual weakness in the proximal muscles for 1 month after initiating a 20 mg dose of Atorvastatin 10 months before admission. Rapid clinical improvement was observed with the use of high-dose glucocorticoids in conjunction with methotrexate.
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The Chief Medical Officer's annual report 2023 presents an incomplete and skewed picture of the geography of older people in England. We show that there are higher absolute numbers of older people in urban areas in England and Wales, in contrast to key messages from the CMO report which suggest greater need in rural areas based on relative metrics. ⋯ The absolute number and prevalence of older adults in poorer health is also higher in urban areas, leading to greater healthcare needs. Policy-makers need to consider both absolute and relative demographic trends as well as making use of direct measures of health when planning how healthcare services for older adults are distributed geographically in England.
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Letter Case Reports
Extramedullary haematopoiesis in a patient with myelofibrosis.
Megakaryocytes are large multilobulated precursor cells which usually reside within the bone marrow and give rise to platelets. There have been rare occurrences where they have been found in peripheral blood and extramedullary tissues in conditions where the underlying mechanisms of the bone marrow have been affected. This case report discusses an unusual presentation of a man with myelofibrosis who was found to have megakaryocytes in his ascitic fluid. We have highlighted the images showing utility of combination of traditional staining methods and immunohistochemistry in combating this diagnostic dilemma.
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Imposter phenomenon (IP) is the internalised experience of self-doubt or mediocracy that leads an individual to believe they do not belong. IP is increasingly recognised across the medical field, from medical school to consultancy, but likely affects different groups to varying extents. The transition in role from medical student to junior doctor can be a time of particularly high stress and insecurities about one's ability can act as a trigger or exacerbator of IP. Foundation doctors can arm themselves against IP by first acknowledging its existence and then actively attempting to dismantle these flawed misconceptions, as well as accessing support and resources available ubiquitously through the foundation programme.