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Archive for the ‘diagnosis’ Category

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BMJ 2008;336:36-40 (5 January). Clinical review
by: Sarah A E Logan, specialist registrar, Eithne MacMahon, consultant Infection and Immunology:

  • Bacterial and viral meningitis cannot reliably be differentiated clinically, and all suspected cases should be referred to hospital
  • Viral meningitis is most common in young children; the incidence decreases with age
  • Enteroviruses are the most common cause at all ages
  • Although most cases are self limiting, morbidity may be considerable
  • Herpes simplex virus causes viral meningitis, which may recur
  • Genital herpes infection may be acquired from a partner after many years within a monogamous relationship
  • Meningitis is a feature of HIV seroconversion
  • In the absence of associated encephalitis, the prognosis is usually good
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Research, BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)
 

What is already known on this topic

  • Increased body mass index is known to increase the risk of adenocarcinoma of the oesophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer in women
  • Body mass index has also been associated with the risk of other, rarer, cancers, but the findings are not yet conclusive

What this study adds

  • High body mass index in women may increase the risk of multiple myeloma, leukaemia, pancreatic cancer, non-Hodgkin’s lymphoma, and ovarian cancer
  • Menopausal status seems to affect the relation between body mass index and risk of breast cancer, endometrial cancer, and colorectal cancer
  • Among postmenopausal women in the UK, 5% of all cancers (about 6000 annually) are attributable to women being overweight or obese
  • Around half of all cases of endometrial cancer and adenocarcinoma of the oesophagus in postmenopausal UK women are attributable to women being overweight or obese

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Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

  • A favourable outcome depends on early, aggressive, treatment
  • Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
  • Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
  • Subtle signs of organ hypoperfusion should be sought in physically robust patients
  • The role of activated protein C and low dose steroids remains to be clarified

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BMJ  2007;335:765-768 (13 October), by:

Patrick Petignat, consultant gynaecological oncologist, Michel Roy, professor and gynaecological oncologist.

  • Cervical cancer is the second most common cancer in women worldwide.
  • Cervical cancer is an important cause of early loss of life as it affects relatively young women. 
  • Cervical biopsy is the most important investigation in diagnosing cervical cancer

Surgery or chemoradiotherapy can cure 80-95% of women with early stage disease (stages I and II) and 60% with stage III disease.

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Rapid response to Professor Gareth William’s editorial on the use of weight loss aid, orlistat, correctly concludes that it is no substitute for a healthy lifestyle;

by: Howard Marsh MRCP MRCGP
Medical Director
GlaxoSmithKline Consumer Healthcare, 1500 Littleton Rd, Parsipanny, New Jersey 07054, USA

GSK launched a non-prescription version of orlistat (brand name alli) in the US in June this year, the first FDA-approved weight loss medicine to be available over-the-counter (OTC).

The weight loss that can be achieved with OTC orlistat requires commitment to adopt a low-fat, reduced calorie diet.

Indeed all our communication, including television advertising, websites, in-store communications as well as materials provided to pharmacists stresses this requirement. These materials specifically state that “alli is not a magic pill” and provide candid information about the consequences of eating too much fat.

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BMJ  2007;335:715-718 (6 October), by: Anne B Ballinger, consultant gastroenterologist.

Colorectal cancer is common, the presenting symptoms are non-specific, and the stage of disease at diagnosis is closely related to survival.

Summary points

  • The lifetime risk of developing colorectal cancer is about 5%
  • Increasing age and a family history of colorectal cancer are the greatest risk factors for the disease
  • Patients presenting with suspicious symptoms and signs should be referred and investigated urgently in a specialised unit
  • Colonoscopy and computed tomographic colonography are of equal sensitivity for detection of colorectal cancer
  • Colonoscopy allows biopsy of suspicious lesions and removal of polyps
  • Population screening by testing for faecal occult blood has begun in the United Kingdom

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us-docs.jpg

Many doctors in the United States are failing to conform to accepted norms in areas of self regulation, managing conflicts of interests, and ordering of unnecessary tests. This is the finding of a survey sponsored by the US Institute of Medicine.

>>>>> CLICK here for more …..

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