Clinical medicine (London, England)
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A 60-year-old woman presented with sudden-onset epigastric pain, vomiting and small volume rectal bleeding. She had a history of mechanical mitral valve replacement, for which she was on warfarin. Computed tomography (CT) angiography of the abdomen showed gallstones, a fluid-filled stomach and faecal loading. ⋯ On review of the initial CT angiography, an occlusion within the superior mesenteric artery (SMA) was visualised. The post mortem showed small bowel infarction due to embolic occlusion of the SMA secondary to bacterial endocarditis of the prosthetic mitral valve. This case should prompt awareness among clinicians that acute mesenteric ischaemia secondary to septic embolisation should be considered in patients with risk factors for infective endocarditis presenting with acute abdominal pain.
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A proportion of patients with lung cancer will not be suitable for anti-cancer treatment and are managed with best supportive care (BSC). The aim of this retrospective case series analysis was to critically review the use of diagnostic and staging investigations in patients who were ultimately managed with BSC. ⋯ In an older, functionally limited and frail patient with lung cancer, there is a risk of over-investigation. Impaired renal function is an important clinical factor to identify early to support discussions in this cohort. There will always be an unavoidable proportion of patients that undergo further investigations (often in search of rare targetable mutations) and are then ultimately recommended for best supportive care; such cases could form the basis of specific review and learning for lung cancer services.
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Acute leukaemia is characterised by uncontrolled expansion of immature leukocytes, either myeloid or lymphoid progenitors, leading to acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL), respectively. If left untreated, it is life-threatening and can lead to death within weeks. ⋯ Appropriate investigations are needed promptly to confirm diagnosis and start treatment. A multidisciplinary approach is vital to ensure appropriate management.
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To determine the maximal response of the temperature and inflammatory response to SARS-CoV-2 infection and how these are modified by age. ⋯ Age modifies both maximal temperature and systemic inflammatory response in patients with SARS-CoV-2 infection.
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The multidisciplinary diagnostic clinic (MDC) model for 'non-specific' symptoms has been piloted in the UK. We aimed to assess the degree to which the MDC pathway was influenced by socioeconomic factors. ⋯ The MDC pathway referral rate seems to be affected by social deprivation in a similar manner to other cancer diagnosis pathways. Our work highlights the importance of engaging GP practices with socially deprived populations as the MDC programme is rolled out across the UK.