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Www.bmj
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17

Early diagnosis and treatment: the goal of hepatitis C screening

Koretz and colleagues correctly highlight the need for robust evidence for hepatitis C screening, but a few points warrant a more balanced discussion.1  
bmj.com
about 6 years ago
Www.bmj
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7

The FAST tool is effective but not for posterior fossa stroke

Hankey and Blacker’s article provides a practical approach to the diagnosis and management of stroke.1 However, an important issue is the failure of the FAST (face, arm, speech, and time) tool to detect posterior fossa strokes in some patients, who might then not be triaged …  
bmj.com
about 6 years ago
Www.bmj
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38

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
bmj.com
about 6 years ago
Www.bmj
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26

Bias in observational study designs: case-control studies

Researchers investigated the association between sun exposure and risk of multiple sclerosis. A population based case-control study was performed. The participants were recruited from residents of Tasmania, Australia, who were aged under 60 years and had at least one grandparent born in Tasmania. Cases were people with multiple sclerosis who volunteered after information evenings at local multiple sclerosis societies, or after having been invited by a healthcare professional. In total, 136 people with a diagnosis of multiple sclerosis, as defined by clinical and magnetic resonance imaging criteria, were included as cases. For each case, two controls matched for sex and year of birth were randomly selected from the community. In total, 359 eligible controls were approached and the response rate was 76%.1  
bmj.com
about 6 years ago
Www.bmj
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19

Prompt diagnosis of multiple sclerosis should be routine, says NICE

Patients suspected of having multiple sclerosis (MS) should be referred to a neurologist, and existing patients should have a comprehensive review of their care every year, new guidance has said.  
bmj.com
about 6 years ago
Www.bmj
1
14

Diagnosis and management of asthma in children

In problematic cases of childhood asthma, rather than escalating treatment, a systematic approach is needed, including a review of the diagnosis; adherence, including ability to take drugs correctly; and the child’s environment  
bmj.com
about 6 years ago
Www.bmj
1
25

Early diagnosis and treatment: the goal of hepatitis C screening

Koretz and colleagues correctly highlight the need for robust evidence for hepatitis C screening, but a few points warrant a more balanced discussion.1  
bmj.com
about 6 years ago
Www.bmj
1
2

Diagnosis and management of depression in children and young people: summary of updated NICE guidance

There is little clear evidence to favour one psychological therapy over another for the treatment of depression in children and young people. Clinicians should discuss this uncertainty when recommending treatments  
bmj.com
about 6 years ago
Preview
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88

The Thorax - TeachMeAnatomy

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment.  
teachmeanatomy.info
about 6 years ago
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What is the most likely diagnosis?

Female patient 19 years old came to outpatient clinic with goitre, type 1 DM since one month, and hepatosplenomegally in ultrasound. Hepatitis markers are negative. What is the most likely diagnosis? That's the case which I was asked today!  
Mohammad Hamouda
about 8 years ago
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What is the prognosis of a metastatic castration-resistant prostate cancer after radiotherapy?

I just want to know if there has been any evidence for Radiotherapy use in metastatic prostate cancer? Also, the rate of success of Radiotherapy if combined with hormone therapy? What is the prognosis after treatment?  
Raghad Sabbagh
about 8 years ago
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What might this diagnosis be?

2 year old male comes with flaccid paralysis of all four limbs with respiratory distress since 8 days. Nerve conduction velocity shows significantly delayed f waves. What is the diagnosis???  
raminder kaur
almost 8 years ago
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What's your diagnosis?

20 yr old female with hirsutism, oligomenorrhea, on usg normal ovaries,increased serum testosterone levels? a) PCOD b) Testosterone secreting tumours c) Idiopathic hirsutism d) Adrenal hyperplasia  
sampath kumar
almost 8 years ago
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Prostate Cancer or BPH?

Just seen this Q and can't work out the answer... 76 year old man, comes with abdominal distension pain and hydronephrosis. Increase urea and creatinine on investigation. What is the diagnosis? Anyone?  
Ricky Rimmer
almost 8 years ago
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Surgery Mock MCQ

An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis. She tells you she drinks 42 units of alcohol a week. Her blood results are as follows: Albumin 32 (35-50) Alk Phos 456 (<110) ALT 88 (<40) Bilirubin 120 (<20) INR 1.6 GGT 400 (0-70) What’s the most likely diagnosis? a. Gallstones b. Paracetamol Overdose c. Pancreatic cancer d. Alcoholic Hepatitis e. Primary billiary cirrhosis  
Af Del
about 7 years ago
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Sugar diabetis

A close family friend is diabetic.On diagnosis the sugar levels were above 30mg/l and was later put on long term medication. Since then the levels are within the normal range.Can this person stop taking the treatment for the condion? What will be the consequences?  
Irene Kolosa
about 7 years ago
Foo20151013 2023 aoqg73?1444773932
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89

A Humble NHS?

A Recap Last week in my personal blog I reflected on humility as defined by James Ryle: God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do. Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them. Stafford Hospital Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care. I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs. Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do. The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution? It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care. I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function. So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?  
Rev Samuel Pollard
about 8 years ago
Foo20151013 2023 184etvn?1444773944
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135

Aspergillus and Human Health

Many may be familiar with aspergillosis as the infecting agent in acute cases where the patient is severely immunocompromised - but there is more to this fungus' repertoire. There are rare cases where the patient's immune system is overwhelmed by a large inhalation of spores e.g. after gardening, but these are insignificant in terms of total numbers effected. The following are far more common:- Aspergillus and other fungi are increasingly identified as the active agent in sinusitis - if you have cases that don't respond to antibiotics this is worth thinking about. Chronic pulmonary aspergillosis (CPA & aspergilloma) is an infection of immunocompetent people, causing respiratory difficulty, coughing and haemoptysis. The UK NHS has a specialist centre for these patients In Manchester (National Aspergillosis Centre (NAC)). NAC has particular expertise and extensive facilities for the diagnosis of CPA, ABPA, SAFS and use of systemic antifungal drugs. Allergic infection (Allergic Bronchopulmonary Aspergillosis - ABPA and chronic sinusitis) is thought to be heavily underdiagnosed and undertreated. ABPA is particularly common in Asthma, Cystic Fibrosis patients and those with bronchiectasis. There is estimated to be 25 000 cases in the UK alone. Many (50%) of the most severe asthma cases are sensitive to fungi (SAFS) - in particular Aspergillus. These tend to be the most unstable cases that don't respond to antibiotics and several studies have been published that show giving an antifungal helps reduce the use of steroids for these patients. Last but not least - Tuberculosis is on the rise in the UK and the rest of the world. It is estimated that 2% of cases progress to CPA and should be treated using an antifungal - this is usually not done until considerable time has passed and much damage has been done. In total it is estimated that many millions of people across the world suffer from aspergillus - ABPA - 5 million, Tb - 400 000 per year and Asthma (SAFS - 1 - 4 million cases in EU & US). Sinusitis cases may number many tens of millions worldwide. So - the next time you assume aspergillus infections and aspergillosis are rare and confined to those who are profoundly immunocompromised - think again! If you have a patient who has increasingly severe respiratory symptoms, doesn't respond to multiple courses of antibiotics then give aspergillus a thought. Browse around these articles for further information Aspergillus Website Treatment Section. NB For a broader look at the prevalence of fungal diseases worldwide the new charity Leading International Fungal Education (LIFE) website is worth looking at.  
Graham Atherton
about 8 years ago