Archive for November, 2007


A new test for diagnosing Chlamydia trachomatis is quicker and more cost effective than current tests, and has the potential to reduce complications and transmission to sexual partners. 


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Many GP’s and other healthcare professionals don’t know much about ME. (Myalgic Encephalomyelitis [WHO ICD-10:G93.3])

They think it is the same as tiredness and that impression is further reinforced by the recent NICE guidelines that proclaim that tiredness and a sore throat or headache equals ME. Nothing is further from the truth. Here is a quick guideline for BUSY GP’s about ME.

“Many GPs believe ME doesn’t exist or is a form of hysteria. But this is very wrong, just as we were with MS, when we called it hysteria, and with many other medical conditions. So here are some usefull tips when dealing with patients who might have ME.

Tip ONE: if a patient comes to the surgery, have a look at the size of his docs, if he has never been, or only rarely, with real problems, than he is not a malingerer or a hypochondriac.

Tip TWO: there are a lot of differences between hysteria and ME but two easy ones are: Belle indifference and shallowness of affect.

Tip THREE: hysteria has been binned from the DSM when they realised they made a big mistake naming MS hysteria. If you encounter a psychiatrist who still uses the term hysteria you have to be careful because in that version of the DSM homosexuality is still a psychiatric illness.

Tip FOUR: ask how long someone with fatigue needs to recover from even a simple task. Patients with ME don’t recover from simple tasks like healthy people, something you don’t see with (most) other forms of fatigue.

Tip FIVE: discuss CBT, if it cures the patient your diagnosis of ME was wrong.

Tip SIX: ME patients have the so called threshold phenomenon, meaning that they can’t increase their stamina like healthy people. If they can or if GET helps to improve their stamina then again, the diagnosis of ME was wrong.

Tip SEVEN: ask about muscle pain. If they have it, it is so extreme and completely different from a bit of pain after a strenuous run that NSAIDs look like smarties and have the same effect.

Tip EIGHT: have a look at page SIX of the South Australian guidelines where you can find an easy to use tick chart of symptoms to distinguish ME from other illnesses with fatigue. This will help a lot because there is no cure at present for ME but for many other illnesses with fatigue there is. And the patient will be cured and grateful. Print it to have it ready when needed; or >>>>> CLICK HERE FOR PROPER AND UP TO DATE GUIDELINES……….

Tip NINE: take a proper history, examine the patient and do lab tests. This might sound obvious but very often this doesn’t happen and the sooner you diagnose the problem, like with any other (serious) medical problem, the easier it is to cure or deal with. Might also give you a happier patient and one who is less likely to sue you.

Tip TEN: diagnose ME (if so), explain that the body will cure itself in many patients but that it is difficult to say how long that will take, and you have answered all important questions, and your patient will not only be grateful for that, but you won’t have a difficult patient, because he knows what is what. So help him and yourself by using this simple guide.

Last TIP: remember, even if you don’t believe ME exists, you might still get it yourself.

There are studies suggesting that teachers and healthcare workers/doctors are more at risk.


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Five US manufacturers of hip and knee replacements have settled with the federal government after being accused of paying orthopaedic surgeons to use their products.

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Acute bronchiolitis

Andrew Bush, professor of paediatric respirology. BMJ  2007;335:1037-1041 (17 November).

Acute bronchiolitis is a clinical diagnosis. It “is a seasonal viral illness, characterised by fever, nasal discharge and dry, wheezy cough. On examination, there are fine inspiratory crackles and/or high-pitched expiratory wheeze.

Summary points:

• Bronchiolitis caused by respiratory syncytial virus is an important and seasonal cause of respiratory morbidity in the first year of life
No effective preventive or therapeutic strategies exist, and supportive management is offered
Unnecessary investigations and ineffective treatment must be avoided
Many infants have medium to long term post-bronchiolitic symptoms, which should not be confused with true asthma and which do not respond to any current treatments

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A database analysis reported by James N Armitage and colleagues shows that mortality in men admitted to hospital with acute urinary retention is high and increases strongly with age and comorbidity – as many as one in four men admitted to hospital with acute urinary retention will die within a year.

Katia M C Verhamme and Miriam C J M Sturkenboom, in an accompanying editorial, say that since the increased mortality seen in men admitted to the hospital for acute urinary retention is probably the result of comorbid conditions and frailty, multidisciplinary care is warranted in these men.

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BMJ  2007;335:639 (29 September).  

The US has a dismal record on health, despite outspending by a considerable margin every other developed nation in the world.

 Americans and their elected politicians are generally complacent about this sorry state of affairs, writes one leading doctor. Healthcare professionals are probably the best people to unite and shake them out of their complacency.

To do nothing is to accept the US position at the bottom of the league tables on health, when in so many other areas only first place will do.

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BMJ  2007;335:639 (29 September) NEWS:

Serum concentration of triglycerides is an independent risk factor for coronary heart disease.

Because triglycerides are so closely linked to obesity (p 425). Losing weight and taking more exercise is one of the best ways to keep triglycerides under control. In this study, lower concentrations were also associated with eating a decent breakfast.

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