Res Medica (E-Journal)
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An Estimate of Lyme Borreliosis Incidence in Western Europe
Get PDFBackground: Lyme borreliosis (LB) is the most common zoonotic disease transmitted by ticks in the USA and Europe. This review aims to estimate the regional burden of LB in Western Europe. Data from previous publications were used to calculate the mean incidence. The mean incidence rates were then combined to estimate the regional burden and a population-weighted regional burden of disease based on the standardized incidence from the included studies and the total population at risk.Methods: Reviews and surveillance reports identified by the initial database search were first assessed for eligibility by their title and abstract, and subsequently by a more detailed review of the source for the most recent data regarding LB. 11 sources of incidence data were included in the review, representing 17 countries in total. Incidence estimates were calculated from reported values and population data.Results: Countries in Western Europe have a large variance in the incidence rates. The highest reported incidences for LB were reported in southern Sweden with 464 per 100 000 and the lowest in Italy of 0.001 per 100 000. The unweighted mean for the included data provided an incidence of 56.3 per 100 000 persons per year, equating to approximately 232 125 cases in one year throughout the region. The calculated population-weighted average incidence for the regional burden of LB in Western Europe was 22.05 cases per 100 000 person-years.Conclusions: LB is an emerging disease and the most common zoonotic infection in Western Europe approaching endemic proportions in many European countries. The population-weighted incidence has been estimated by this study to be 22.04 per 100 000 person-years. Concordant and well-conducted surveillance and disease awareness should continue to be encouraged to monitor LB as tick numbers and activity increases
Schizophrenia - From Devilry to Disease
Get PDFSymptoms of psychotic diseases historically instilled fear and distrust in onlookers, who associated them with witchcraft, demonic spirits, and the devil. From Egyptian medicine to medieval witch hunts, psychotic diseases have been associated with the supernatural throughout history. Yet even with advancements in neuroscience and improvements in our understanding of mental illness, stigma surrounding mental health remains prevalent today. Schizophrenia is a psychiatric illness which has evaded a clinical definition until relatively recently; even now, the precise features that constitute a schizophrenic patient are open to dispute. This article explores the ancient history of mental health with a particular emphasis on psychosis, and also considers the changing attitudes and understanding of schizophrenia throughout the last century, leading to its clinical definition as a treatable condition
The Management of Gout in Primary Care - Are We Doing it Right?
Get PDFIntroduction: The soaring incidence of gout in the United Kingdom suggests that medical practitioners should be increasingly aware of optimizing management of gout, which is aimed at pain relief, preservation of joint function and preventing recurrent attacks. Recent guidelines published by the British Society of Rheumatology (BSR), have provided clinicians with a framework for achieving these aims. Aims: To evaluate the management of gout in a primary care centre in North West England against recognized standards. Methods: An electronic search on EMIS Web using the Read codes “gout” and “gouty arthritis”, with a specified period of 2010–2013, generated a cohort of patients who were categorized into 2 groups: those prescribed urate-lowering therapy (allopurinol) and those not. Patients on febuxostat were excluded. Clinical data from the patients were extracted and retrospectively audited. Results: A total of 112 patients were identified, of which only 46% (n = 52) of patients were reviewed after an acute attack. Among those who were prescribed allopurinol, only 19% (n = 12) achieved target serum urate levels while only 67% (n = 42) had their serum urate levels checked regularly and 31% (n = 20) had dosage adjustments. Comparatively, in patients not prescribed allopurinol, a few indications for initiating allopurinol were detected: 29% (n = 12) had more than one attack of gout in a year, 27% (n = 11) suffered from renal insufficiency, 2% (n = 1) presented with tophi, and 17% (n = 7) were on diuretics.Conclusion: Gout management in this primary care centre is not fully concordant to the BSR guidelines. Clearly, there is a need to improve adherence, particularly in the tight monitoring of serum uric acid levels, medications review, appropriate use of allopurinol, where indicated, and patient follow-up
Stereognosis
Get PDFA dissertation read before the Royal Medical Society on Friday, February 2nd, 1968.Stereognosis may be defined as the ability to recognise objects using only tactile (somatic) sensation. The ability is best developed in blind people and depends on memory and on an intact somatic sensory system.Loss of this ability, astereognosis, is usually considered as a defect in somatic sensation. A native of New Guinea, although he might be unable to recognise the objects commonly used to test for stereognosis, would not deserve to be given the diagnosis of a cortical lesion. His failure is a failure of learning. Patients suffering from dementia may show astereognosis as a consequence of a general deterioration in mental function. Learning and memory therefore play an important part in stereognosis, but in clinical practice and in physiology, more interest is taken in the function of the somatic sensory system
Cardiogenic Shock
Get PDFDEFINITION AND PATHOGENESISINCIDENCECardiogenic shock is shock occurring after myocardial infarction. It has been variously described as occurring in 6%, 8%, 10%, 12% and 20% of patients with myocardial infarction. Shock accompanies the onset of pain in few eases and most cases occur in the first twenty-four hours after infarction although they may occur several days after.CLINICAL CRITERIAThe criteria for diagnosis of shock may vary with different authors (hence the anomalous 20% above) but, in general, it is agreed that shock is suggested clinically by the following features: cold, clammy extremities, pallor and cyanosis, rapid, thready pulse, anuria or oliguria, anxiety, restlessness or apathy, and prolonged hypotension. The only objective assessment is of blood pressure and this alone does not define shock. Considerable variation may therefore be expected in diagnosis.In view of the difficulties in defining the criteria for diagnosis of shock, the individual criteria and the interpretations placed upon them warrant further discussion.
A Library Sets Sail
Get PDFHurry down New Bond Street too fast and miss the main entrance of the Sotheby salerooms. It is a small fronting done out in fading cream paint with the apologetic air of a second rate bookie’s office. But inside the building expands into a veritable Ali Baba’s cave for there is no denying the pivotal position of Sotheby & Co. in the world of fine art, of books, of the rare and the beautiful. The front entrance is, by some quirk, no more than a curious self-effacement in the centre of exhibitionist London, and the eighteenth Egyptian dynasty animal statue (circa 1320 BC) perched above the twin doorways and entitled SEKHMET appears to be having the last laugh
Editorial
Get PDF‘My Chinese uncle, gouty, deaf, half-blinded,And more than a little absent-minded,Astonished all St. James’s Square one dayBy giving long and unexceptionally exactdirectionsTo a little coolie girl, who’d lost her way”.— Robert Graves.But what became of him later? If he had lived in Edinburgh his future would have been disturbingly bleak. At present the South-East Region has the least number of long-stay beds in Scotland. Care for the elderly has become one of the darkest betes-noires of the N .H.S., and, as far as expenditure goes, one with potentially the most voracious appetite.
Medical Jargon - An Overview
Get PDF"They do certainly give very strange and new-fangled names to diseases" — Plato (427-347BC)"The Patient\u27s Ears remorseless he assails, Murthers with Jargon where his Med\u27cine fails" - Sir Samuel Garth (1661-1719)That\u27s all very well, gentlemen, but only laymen called it Jargon. The correct medical term is Correct Medical Terminology. We doctors can\u27t go around calling Familial Dysbetalipoproteinaemia "a touch of the nasties", now can we? Any more than we\u27d call Erysipelothrix rhuziopathia "a little bug". So just moderate your language, Sam; and as for you, Plato — run along and play with your friends.Precision is vital to good communication, and medical men use jargon only to define exactly what they mean. Or do they? Occasionally, perhaps, there may be the tiniest hint of Jargon For Jargon\u27s Sake — our profession has few other status symbols left nowadays, and sometimes it is regrettably necessary to subdue an uppity patient by blinding him with science. But under normal circumstances the use of jargon purely to impress people is limited to students and paramedical personnel, showing off their phraseology like a lance-corporal\u27s stripe. Tyro jargoneers hold forth only to the awe-struck laity, since they remain uncomfortably aware that one slip will reveal their bluff and cause cruel hilarity to the initiated. In one hospital where I worked nobody had the kindness to correct a pleasant old nurse who for years referred to "urea and electric lights". (Another fond memory of nursing jargon: a successful enema is always said to have been "given with good result" — a merciful phrase which spares passers-by the details — and I remember a nurse exclaiming after an incontinent patient developed diarrhoea, "There was result everywhere!"
Computed Tomography: A Brief Historical Perspective
Get PDFRadiology, diagnostic imaging, organ imaging, call it what you will, logically may be regarded as part of the physical examination of a patient. It is a more extreme example of the process that started with the invention of the stethoscope, the process of augmentation of our senses. This process may be extended beyond our normal senses so we may now appreciate the electrical activity of the brain or the heart, using the electro-encephalogram or electro-cardiogram. The very complexity of the technical processes involved, however, tends to make us see them as remote from the diagnostic relationship of patient and doctor.The diagnosis of diseases of the brain provides us with a unique example of the role of these "augmented senses". The inaccessibility and delicate nature of the brain restrict the diagnostic tools we may use. The presence of a rigid bony box, the skull, protecting the brain prevents us from using our senses directly to examine the organ. Indeed, if we could examine it in our usual manner, the brain tissue might be destroyed by the use of percussion or palpation. The relative opaqueness of bone to X-rays limits the use of almost all plain radiographs. It is this very limitation that has provided an incentive to devise techniques to demonstrate the brain without damaging the brain tissue
Active management in Serious Genetic Disorders
Get PDFTwenty years ago we were taught to classify the cause of any medical condition into those that were \u27genetic\u27 and those that were \u27acquired\u27. Subsequently the acquired group could be subdivided according to aetiology. Either directly or by implication we were told that genetic disorders were untreatable and that they were always rare, making up an insignificant proportion of medical practice. This article gives a personal view of the field of medical genetics and is based on two established facts, firstly that genetic diseases are now so frequent that every doctor should be conversant with basic genetic principles. Secondly many genetic conditions if not amenable to curative treatment, are at least responsive to careful management which can prolong and increase the quality of life. At this stage we should emphasise one other aspect, which concerns the philosophy behind genetic counselling. Such counselling is not just the calculation of empiric or theoretical risks that a disease will recur, followed by telling the family and then leaving them to come to terms with unpleasant probabilities. In genetic counselling the range of options open to different members of a family can be fully explained in the light of their risks. At the same time counselling of a wider nature can be offered providing emotional support to many members of the family. By allowing individuals within a family to come to terms with the emotional aspects of an inherited condition, counselling, not necessarily provided by a genetic counsellor alone can be actively therapeutic. Let us now select some severe disorders with a major genetic component and examine the therapeutic approaches available