Day: January 8, 2024

#Respiratory

Asthma (adults)

By Dr. Ahmed Hafez

Introduction Asthma is a common chronic inflammatory disorder of the airways. Approximately, 12% of the UK population have a diagnosis of asthma and 5.4 million are receiving treatment for the condition. Clinically it presents with classical features including cough, wheeze, chest tightness, and shortness of breath. It can present acutely as an ‘exacerbation of asthma’, which may be life-threatening. It is characterised by: Reversible airflow limitation Airway hyperresponsiveness Inflammation of the bronchi Over the last decade, the approach to the diagnosis and management of asthma has been changing rapidly. There are currently two broad guidelines for the management of asthma

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#Renal

Acute kidney injury

By Dr. Ahmed Hafez

Overview Acute kidney injury (AKI) is generally defined as a sudden decline in renal function over hours or days. AKI is a common medical condition affecting up to 15% of emergency hospital admissions and the mortality associated with severe AKI can be up to 30-40%. A decline in renal function can lead to dysregulation of fluid balance, acid-base homeostasis and electrolytes. AKI has largely replaced the term ‘acute renal failure’. This change in nomenclature reflects the significance that small decrements in renal function do not lead to overt renal failure, but do have a clinical impact on morbidity and mortality.

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#Oncology

Cord compression

By Dr. Ahmed Hafez

  Defintion Malignant cord compression is defined by radiological evidence of indentation of the thecal sac secondary to cancer. The spinal cord is part of the central nervous system (CNS) and forms the main communication between the brain and peripheral nerves. It is surrounded by the meninges, the dura, arachnoid and pia mater. The thecal sac is a component of the dura mater (the outermost meningeal layer). Due to the similar pathophysiological processes, cauda equina syndrome due to cancer is normally incorporated under the heading of malignant cord compression. The cauda equina refers to the collection of lumbar, sacral and

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#Nervous system diseases #Neurology #Seniors' health

Alzheimer’s disease

By Dr. Ahmed Hafez

Overview Alzheimer’s disease is the most common cause of dementia. Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that causes significant deterioration in mental performance. This leads to impairment in normal social and occupational function. Unfortunately, AD is an incurable condition that has a variable clinical course. It is the most common cause of dementia. Dementia Dementia describes a clinical syndrome that is characterised by a significant deterioration in mental function that leads impairment of normal function. In healthcare, we measure ‘normal function’ by activities of daily living (ADLs). These are a series of routine activities that people should be

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#Infectious Diseases

Cellulitis

By Dr. Ahmed Hafez

Overview Cellulitis is an acute bacterial infection of the skin. Cellulitis refers to an acute bacterial skin infection that affects both the dermis and subcutaneous tissue. It may occur anywhere on the body and ranges form a self-limiting infection to severe necrotising infection. Cellulitis is a very common condition. It can occur at any age, but is mostly seen in middle-aged to older adults and usually affects the lower limbs.     Aetiology & pathophysiology Cellulitis is commonly caused by both Streptococcus and Staphylococcus species. Cellulitis occurs due to disruption of the skin barrier (e.g. cut, abrasion), which allows entry

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#Immunology

Anaphylaxis

By Dr. Ahmed Hafez

Overview Anaphylaxis is a serious systemic hypersensitivity (allergic) reaction that is rapid in onset and may cause death. Anaphylaxis can be a life-threatening condition that is broadly defined as a severe, generalised or systemic hypersensitivity reaction that is characterised by airway and/or breathing and/or circulation problems that is usually associated with skin and mucosal changes (i.e. urticaria and angio-oedema). Features of anaphylaxis are usually sudden with rapid progression so urgent assessment and management is vital. Anaphylaxis is the most severe form of an allergic reaction that forms part of a spectrum. Allergic reactions are characterised by skin changes (e.g. urticaria)

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#Hepatology

Acute liver failure

By Dr. Ahmed Hafez

Overview Acute liver failure is a syndrome of acute liver dysfunction without underlying chronic liver disease. ALF is an uncommon condition associated with a high mortality. It is due to acute liver dysfunction in the absence of underlying chronic liver disease. ALF is characterised by coagulopathy (derangement in clotting) of hepatic origin and altered levels of consciousness due to hepatic encephalopathy (HE). The cause of ALF is numerous, but drug-induced liver injury (DILI) is the most common reason in Europe. This may be divided into paracetamol or non-paracetamol DILI. The true burden of ALF is difficult to quantify, but it

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#Hematology

Acute lymphoblastic leukaemia

By Dr. Ahmed Hafez

Introduction Acute lymphoblastic leukaemia is the most common malignancy of childhood. Leukaemia Leukaemia refers to a group of malignancies that arise in the bone marrow. They are relatively rare but together are the 12th most common cancer in the UK, responsible for around 9,900 cases and 4,700 deaths a year. There are four main types: Acute myeloid leukaemia (AML) Acute lymphoblastic leukaemia (ALL) Chronic myeloid leukaemia (CML) Chronic lymphocytic leukaemia (CLL) Presentation, prognosis and management all depend on the type and subtype of leukaemia. Acute lymphoblastic leukaemia ALL arises from a clone of lymphoid progenitor cells that undergo malignant transformation.

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#Gastroenterology

Overview of gastroenterology

By Dr. Ahmed Hafez

Overview This is a four-part series covering gastrointestinal physiology. Part I – Overview of the gastrointestinal system & the oral cavity. Part II – Digestion: stomach & control of digestion. Part III – Secretion: pancreas & hepatobiliary system. Part IV – Absorption: small intestines. The gastrointestinal (GI) system can be divided into the digestive tract & accessory organs. Digestive tract The digestive tract is a continuous tube that runs from mouth to anus. The lumen of the digestive tract is continuous with the external environment and is therefore not sterile. The digestive tract is approximately 9m in length in its

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#Endocrinology #Growth disorders

Acromegaly

By Dr. Ahmed Hafez

Overview Acromegaly is a condition caused by an excess of growth hormone (GH) most commonly related to a pituitary adenoma. It tends to present with macrognathia, frontal bossing and enlargement of hands and feet. Presentation may also be related to the aetiology – e.g. mass effect of a pituitary adenoma resulting in visual field defects and headache. It is associated with a number of systemic conditions (e.g. cardiovascular disease, diabetes). The condition is thought to be rare though the true prevalence is hard to establish. Recent studies estimate a prevalence of up to 1 in 1000 individuals in patients who

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#Diabetes

Diabetic ketoacidosis (DKA)

By Dr. Ahmed Hafez

Introduction Diabetic ketoacidosis (DKA) is a life-threatening diabetic emergency. DKA is a severe metabolic complication of diabetes. It is typically seen in those with T1DM as a presenting feature, in patients with poor control or intercurrent illness. Hyperglycaemia results in osmotic diuresis and electrolyte abnormalities, which requires prompt recognition and management. The condition is characterised by a biochemical triad of hyperglycaemia, ketonaemia and acidosis. Hyperglycaemia: > 11.0 mmol/L or known DM Ketonaemia: ≥ 3 mmol/L or significant ketonuria (> 2+ on dipstick) Acidosis: bicarbonate < 15.0 mmol/L and/or venous pH < 7.3   Epidemiology DKA represents an acute hyperglycaemic complication

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#Dermatology

Acne vulgaris

By Dr. Ahmed Hafez

Introduction Acne vulgaris is a common chronic dermatological condition resulting from inflammation of the pilosebaceous unit. Acne vulgaris is extremely common in adolescence affecting up to 95% of young people. Though in most cases it is relatively mild, up to 1/3 have moderate or severe disease. It results in comedones and inflammatory lesions that typically affect the face, chest and back. Beyond (and secondary to) its dermatological manifestations it can have a profound impact on self-esteem and mental wellbeing. Most cases respond to topical and/or oral therapies (e.g. antibiotics and retinoids). Specialist dermatological and mental health support can be required.

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#Cardiology

Acute coronary syndrome

By Dr. Ahmed Hafez

Overview Acute coronary syndrome (ACS) refers to three states of myocardial ischaemia: unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). ACS is a medical emergency requiring urgent admission. Around 100,000 people are admitted with ACS in the UK each year. Atherosclerosis represents the most significant aetiological factor. Classification ACS is classified into one of three conditions according to clinical features, ECG findings and cardiac enzymes: STEMI: ST-segment elevation or new-onset left bundle branch block and raised troponins. NSTEMI: Non-specific signs of ischaemia or normal ECG, raised troponins. UA: Characteristic clinical features, non-specific signs of

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