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Lesson of the month: Large vessel vasculitis: A rare cause of transaminitis. 本月课程大血管炎：转氨酶炎的罕见病因。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-29 DOI: 10.1016/j.clinme.2024.100035
Sumaya Hussein, Greg Allister, Azeem Ahmed
{"title":"Lesson of the month: Large vessel vasculitis: A rare cause of transaminitis.","authors":"Sumaya Hussein, Greg Allister, Azeem Ahmed","doi":"10.1016/j.clinme.2024.100035","DOIUrl":"10.1016/j.clinme.2024.100035","url":null,"abstract":"<p><p>We present the case of a 73-year-old male with pyrexia of unknown origin (PUO). He was a returned traveller from Southern Africa and underwent extensive investigation to rule out an infective cause. This was mostly unrevealing but there was a notable transaminitis (ALT predominant) with normal bilirubin level. He showed no serological or clinical improvement despite antibiotic treatment. Subsequent CT-PET showed high mural uptake in the thoracic and abdominal aorta and its major branches, confirming the diagnosis of Large Vessel Vasculitis (LVV). This case highlights the importance of considering LVV in patients with PUO and with transaminitis.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100035"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11061667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A case report on rapid development of simultaneous liver and musculature calcifications in severe sepsis. 重症脓毒症患者肝脏和肌肉同时快速钙化的病例报告。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-06 DOI: 10.1016/j.clinme.2024.100036
Tiara Joy Foo, Su-Ann Cheng, Xi Zhen Low, Chun En Chua
{"title":"A case report on rapid development of simultaneous liver and musculature calcifications in severe sepsis.","authors":"Tiara Joy Foo, Su-Ann Cheng, Xi Zhen Low, Chun En Chua","doi":"10.1016/j.clinme.2024.100036","DOIUrl":"10.1016/j.clinme.2024.100036","url":null,"abstract":"<p><p>A 76-year-old Malay female presented with 2 days history of fever and vomiting. She was found to have Escherichia coli and Klebsiella pneumoniae bacteraemia with no clear intra-abdominal cause on the initial computed tomography of the abdomen and pelvis (CTAP). She clinically improved with 2 weeks duration of intravenous meropenem. She subsequently developed septic shock and a repeated CTAP demonstrated increased hepatic parenchymal density with extensive parenchymal calcifications. Curvilinear calcifications were seen in the paraspinal and pelvic musculature.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 2","pages":"100036"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11039306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Huntington's disease: A clinical primer for acute and general physicians. 亨廷顿氏病：面向急诊和普通医生的临床入门书。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-06 DOI: 10.1016/j.clinme.2024.100200
Thomas H Massey, Duncan J McLauchlan
{"title":"Huntington's disease: A clinical primer for acute and general physicians.","authors":"Thomas H Massey, Duncan J McLauchlan","doi":"10.1016/j.clinme.2024.100200","DOIUrl":"10.1016/j.clinme.2024.100200","url":null,"abstract":"<p><p>Huntington's disease (HD) usually manifests in adulthood and is characterised by progressive neurodegeneration in the brain that causes worsening involuntary movements, mental health and cognition over many years. Depression, anxiety and apathy are common. HD is autosomal dominant and affects about 1 in 8,000 people in the UK. There are currently no disease-modifying treatments and so patient care centres on multidisciplinary therapy support and medical treatments to relieve distressing symptoms. Progression of HD is usually slow, and so acute deteriorations often indicate another problem, such as intercurrent infections, constipation, urinary retention, gastro-oesophageal reflux disease or poor dentition. In this review we outline common presentations in HD patients, both acute and chronic, consider therapeutic options and discuss specific considerations in advanced HD.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 2","pages":"100200"},"PeriodicalIF":3.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11061216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes. 2019 年英格兰和威尔士急性肾损伤患者护理及患者预后相关性全国审计。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100028
M P M Graham-Brown, A Casula, M Savino, T Humphrey, R Pyart, M Amaran, J Williams, K Crowe, J F Medcalf
{"title":"A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes.","authors":"M P M Graham-Brown, A Casula, M Savino, T Humphrey, R Pyart, M Amaran, J Williams, K Crowe, J F Medcalf","doi":"10.1016/j.clinme.2024.100028","DOIUrl":"10.1016/j.clinme.2024.100028","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales.</p><p><strong>Methods: </strong>Twenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data. Completion rates of AKI care standards and regional variations in care were established.</p><p><strong>Results: </strong>989 AKI episodes were included in the analyses. In-hospital 30-day mortality was 31-33.1% (AKI 2/3). Standard AKI interventions were completed in >80% of episodes. Significant inter-hospital variation remained in attainment of AKI care standards after adjustment for age and sex. Recording of urinalysis (41.9%) and timely imaging (37.2%) were low. Information on discharge summaries relating to medication changes/re-commencement and follow-up blood tests associated with reduced mortality. No quality indicators relating to clinical management associated with mortality. Better communication on discharge summaries associated with reduced mortality.</p><p><strong>Conclusions: </strong>Outcomes for patients with AKI in hospital remain poor. Regional variation in care exists. Work is needed to assess whether improving and standardising care improves patient outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100028"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of penicillin allergy records on antimicrobial prescribing in hospitalised patients. 青霉素过敏记录对住院病人抗菌药物处方的影响。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100024
Vanesa Anton-Vazquez, Francesca Ferretti, Deniz Kaya, Shashwat Mishra, Sven Kerneis, Charlotte Eden, Hong Doan, Hiu Fung Leung, Jeanelli Baltazar, Sarah Starkey, Juliet Uwagwu, Martino Dall'Antonia, Jorge Cepeda
{"title":"Impact of penicillin allergy records on antimicrobial prescribing in hospitalised patients.","authors":"Vanesa Anton-Vazquez, Francesca Ferretti, Deniz Kaya, Shashwat Mishra, Sven Kerneis, Charlotte Eden, Hong Doan, Hiu Fung Leung, Jeanelli Baltazar, Sarah Starkey, Juliet Uwagwu, Martino Dall'Antonia, Jorge Cepeda","doi":"10.1016/j.clinme.2024.100024","DOIUrl":"10.1016/j.clinme.2024.100024","url":null,"abstract":"<p><strong>Background: </strong>The overdiagnosis of penicillin allergy and misclassification of non-truly allergic reactions is a growing public health problem, associated with the overuse of broad-spectrum and restricted antimicrobials. We aimed to evaluate the impact of penicillin allergy status on antimicrobial prescribing.</p><p><strong>Methods: </strong>A retrospective study of inpatients with a documented penicillin allergy receiving antimicrobials was conducted from 1 April to 1 July 2021. Antimicrobial prescribing and clinical characteristics were compared between patients with an active penicillin allergy label and those whose label was removed following antimicrobial stewardship team review. Antimicrobials were classified in two categories: i) 'Access' (recommended), ii) 'Watch and Reserve' (restricted) according to WHO AWaRe classification, a tool to guide appropriate antibiotic use.</p><p><strong>Results: </strong>437 patients with a documented penicillin allergy receiving antimicrobials were included. 353 patients with an active penicillin allergy label, more frequently received antimicrobials from the 'Watch and Reserve list' (283;80% vs 30;37%; p<0.001). In contrast, 84 patients who were de-labelled received more often antimicrobials from the 'Access list' (53;63% vs 64;18%; p<0.001).</p><p><strong>Conclusions: </strong>Penicillin allergy reviews and de-labelling strategies may reduce the use of restricted antimicrobials under the 'Watch and Reserve list'. This practice should be encouraged and reinforced in all hospitals.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100024"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The new national clinical guideline for stroke: an opportunity to transform stroke care. 新的《国家卒中临床指南》：转变中风护理的契机。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100025
Ajay Bhalla, Louise Clark, Rebecca Fisher, Martin James
{"title":"The new national clinical guideline for stroke: an opportunity to transform stroke care.","authors":"Ajay Bhalla, Louise Clark, Rebecca Fisher, Martin James","doi":"10.1016/j.clinme.2024.100025","DOIUrl":"10.1016/j.clinme.2024.100025","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100025"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic. 体弱者和患有多种疾病者的心肺复苏术（CPR）：COVID 大流行之前和期间的结果。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-19 DOI: 10.1016/j.clinme.2023.100001
Aled Lloyd, Elin Thomas, Julia Scaife, Nicky Leopold
{"title":"Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic.","authors":"Aled Lloyd, Elin Thomas, Julia Scaife, Nicky Leopold","doi":"10.1016/j.clinme.2023.100001","DOIUrl":"10.1016/j.clinme.2023.100001","url":null,"abstract":"<p><p>Coronavirus 2019 (COVID-19)-era resuscitation guidelines advised personal protective equipment before chest compressions and proactive advanced care planning. We investigated the impact of COVID-19 on cardiopulmonary resuscitation (CPR) outcomes according to scoring of frailty and of multiple health conditions. A retrospective single-centre analysis of clinical and electronic records for all adult cardiac arrest calls on wards between June 2020 and June 2021 was performed. Data were compared with a cohort pre-COVID (March 2017-March 2018). In total, 62 patients received CPR in 2020-21 compared with 113 in 2017-18. Similar rates of return of spontaneous circulation (ROSC) and a statistically insignificant survival increase from 23.8% to 32.2% (p=0.210). There were linear relationships between Clinical Frailty Scale (CFS) or Charlson Comorbidity Index (CCI) and diminished survival in the pooled data (both p<0.001). Both increasing frailty (measured by CFS) and comorbidity (measured by CCI) were associated with reduced survival from CPR. However, survival and ROSC during COVID-19 were no worse than before the pandemic.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 1","pages":"100001"},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11024814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to: Letter to the editor: Sleep measures and cardiovascular disease in type 2 diabetes mellitus. 回应致编辑的信：2型糖尿病患者的睡眠质量与心血管疾病。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-01-01 Epub Date: 2024-02-07 DOI: 10.1016/j.clinme.2024.100023
Caroline J Magri, Sara Xuereb, Rachel-Anne Xuereb, Robert G Xuereb, Stephen Fava, Joseph Galea
{"title":"Response to: Letter to the editor: Sleep measures and cardiovascular disease in type 2 diabetes mellitus.","authors":"Caroline J Magri, Sara Xuereb, Rachel-Anne Xuereb, Robert G Xuereb, Stephen Fava, Joseph Galea","doi":"10.1016/j.clinme.2024.100023","DOIUrl":"10.1016/j.clinme.2024.100023","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100023"},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11024838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139706243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chronic pulmonary aspergillosis - a guide for the general physician. 慢性肺曲霉菌病--全科医生指南》。
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-26 DOI: 10.1016/j.clinme.2024.100019
Charlotte Carter, Rasleen Kahai, Josie Cunningham, Jennifer Kilduff, Natasha Hough, Caroline Baxter, David Connell, Anand Shah
{"title":"Chronic pulmonary aspergillosis - a guide for the general physician.","authors":"Charlotte Carter, Rasleen Kahai, Josie Cunningham, Jennifer Kilduff, Natasha Hough, Caroline Baxter, David Connell, Anand Shah","doi":"10.1016/j.clinme.2024.100019","DOIUrl":"10.1016/j.clinme.2024.100019","url":null,"abstract":"<p><p>This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100019"},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11024841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139569889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the editor: Are we missing pancreatic exocrine insufficiency in 'at-risk' groups? 致编辑的信：我们是否遗漏了 "高危 "人群中的胰腺外分泌功能不全？
IF 4.4 4区 医学
Clinical Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-28 DOI: 10.1016/j.clinme.2024.100022
Moses Silungwe Kapembwa, Simon Charles Fleming, Philip Anthony Batman, George Edward Griffin
{"title":"Letter to the editor: Are we missing pancreatic exocrine insufficiency in 'at-risk' groups?","authors":"Moses Silungwe Kapembwa, Simon Charles Fleming, Philip Anthony Batman, George Edward Griffin","doi":"10.1016/j.clinme.2024.100022","DOIUrl":"10.1016/j.clinme.2024.100022","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100022"},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11024837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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