Clinical medicine (London, England)
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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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Sodium glucose co-transporter 2 (SGLT2) inhibitors are now an established class of medications for the treatment of type 2 diabetes (T2D), no longer reserved for use by specialists in diabetes. They are being used increasingly for their cardiac and renal benefits by primary care, cardiology and renal teams for indications in parallel with diabetes care as part of holistic management. This guidance provides essential information on SGLT therapy, including the main advantages and the important risks of which healthcare professionals should be aware.
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Cushing's syndrome is a rare endocrine disorder requiring a high degree of clinical suspicion and meticulous investigations to diagnose and manage optimally. Delayed diagnosis and suboptimal treatment are associated with increased morbidity and mortality. Uncontrolled hypercortisolism leads to multiple cardiovascular and metabolic complications. ⋯ We report a case highlighting challenges in the diagnosis and management of aggressive Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion from an, as yet unidentified, neuroendocrine tumour. Our patient also contracted SARS-CoV-2 infection during investigations, which posed additional difficulties with aggravation of cardiometabolic complications. We also identify lack of clinical evidence to address management of this unique combination of two potentially life-threatening illnesses.
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Employment, along with education, is central to the promotion of social mobility and the reduction of health inequalities. For the most part, however, physicians have limited exposure to occupational medicine during their training and rarely receive much in the way of formal training about occupational issues except those that fall commonly within their area of specialisation. Here, we illustrate why work and good employment can be so important for health and, therefore, why it should matter to all physicians. ⋯ There is an important relationship between unemployment and poor health which will be discussed, illustrating the importance of being able to support people with long-term conditions and disabilities to remain in work for as long as they wish to do so. Patients expect to be able to seek advice from their physician about taking time off work because of ill health, planning a return to work after sickness absence and whether or not they need to change their work status because of their health condition. Therefore, we describe the fitnote: what it is for, how to complete one well and what core principles are needed in order to give patients good advice about working.
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A robust treatment paradigm for spontaneous intracranial hypotension has yet to be agreed upon. We present retrospective data from the patient cohort at our UK regional neurosciences centre from 2010-2020 and describe our locally developed treatment pathway. Seventy-three patients were identified: 31 men and 42 women; mean age was 42 years. ⋯ The outcome data for our diverse patient cohort shows the success of a staged approach to treatment. Relapse rates are low, and surgery is only rarely required. We use these data to inform our discussions with patients, and present them here to enable other centres to develop robust investigation and treatment paradigms of their own.