Lipid abnormalities are present in over 60% of people with diabetes. The decision to initiate lipid lowering treatment should be based on absolute cardiovascular risk. Calculation of cardiovascular risk is appropriate in most people with diabetes. Statins are firstline therapy for prevention of cardiovascular disease in people with diabetes. Elevated triglyceride levels are common in people with diabetes and treatment may be beneficial in some patients.
The use of multiple drugs, often termed polypharmacy, is commonly defined as using from five to 10 prescription drugs. This polypharmacy is sometimes necessary but may be associated with an increased risk of adverse outcomes.2 The US Center for Medicare and Medicaid Services estimated the annual costs of polypharmacy at over 50 billion dollars in America.
Conventional drug delivery systems are known to provide an immediate release of a drug with little control over where the drug is released or the time period of release. Controlled drug delivery systems offer control over the drug release timing and target site. Osmotic pumps are a promising system for controlled drug delivery. These systems are used for both oral administration and implantation. Laser drilling is one of the most commonly used techniques to create a delivery orifice in the osmotic tablet.
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This month we have a jam packed edition for you. Our features this month include; Opthalmology, Haemotology, Winter Ailment , Neurology and many more.
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Measurement of the serum ferritin level is the most useful diagnostic assay for detecting iron deficiency
but interpretation may be difficult in patients with comorbidities. Identifying the cause of iron deficiency is
crucial. Referral to a gastroenterologist is often required. Faecal occult blood testing is not recommended.
A negative result does not impact on the diagnostic evaluation. Oral iron is an effective first-line treatment
and simple strategies can facilitate patient tolerance. For patients who cannot tolerate oral therapy or require
more rapid correction of iron deficiency, intravenous iron infusions are safe, effective and practical. Intramuscular
iron is no longer recommended for patients of any age.
Chronic rhinosinusitis is defined by two or more of: nasal obstruction, mucopurulent discharge, decreased sense
of smell or facial pain, along with CT or endoscopic evidence of sinus disease. Consider differential
diagnoses according to symptoms; they include allergic rhinitis, headache syndromes such as migraine,
laryngopharyngeal reflux and globus pharyngeus. Once the diagnosis is made, commence a trial of maximal
medical management. If the patient does not respond to maximal medical management then referral to an
ear, nose and throat specialist is warranted for further investigation and medical and possibly surgical
management. Removal of the adenoids is often helpful in children with chronic rhinosinusitis.
The growing problem of antimicrobial resistance has led to calls for antimicrobial stewardship programmes to
control antibiotic use in healthcare settings. Available estimates indicate that between 30% and 50% of
antibiotic use is inappropriate. Improper utilisation of antimicrobials often leads to increased costs, widespread
antimicrobial resistance and medication errors
The cause of thunderclap headache should be considered to be aneurysmal subarachnoid haemorrhage
until proven otherwise. The diagnostic work up involves urgent non-enhanced CT of the brain (with
CT angiography if immediately available), then possibly a lumbar puncture, then cerebral arterial and venous
imaging with either MRI or CT if each preceding investigation has yielded a normal/negative result.
Reversible cerebral vasoconstriction syndrome is usually characterised by recurrent thunderclap headaches
and multifocal, multi-vessel segmental cerebral artery vasoconstriction that usually resolve within 12 weeks.
It can be associated with neurological complications including intracerebral haemorrhage and cerebral
ischaemic infarctions.
Although the ocular surface resists bacterial infection through a variety of mechanisms, conjunctival infection
can occur when an organism is able to overcome the host’s resistance. Host resistance can be impaired in
disease states, in immunocompromised patients or following trauma. Most common bacterial pathogens can
cause conjunctivitis. Bacterial conjunctivitis (BC) can be classified as hyperacute, acute and chronic.
The medico-legal expert witness space appears to have started to
become rather crowded in recent years, with an increasing number of
health professionals believing this to be a desired area of practice,
some virtually immediately postgraduation. As the pool of alleged expertise
grows however, so too do the risks to the reputation of the professional
domain under which an expert is registered and the quality of the
evidence provided if the duties of an expert witness are not properly
respected and understood.
