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Medical Topics

Lung cancer

Lung cancer arises from the cells of the respiratory epithelium
 
They are broadly divided into 2 categories -
 Small cell lung cancer ( SLCL ) which is highly malignant tumour of the cells exhibiting neuroendocrine characteristics and accounts for 15 % of lung cancer cases
 Non-small cell lung cancer ( NSCLC ) constitute the majority ( 85 % ) of cases and are further subdivided into 3 groups –

Peripheral leg oedema

Oedema is defined as palpable swelling caused by an increase in 
interstitial fluid volume ( John W Ely et al 2006 )

 

Chronic oedema ( CO ) is a general term used for leg swelling that has been present for atleast 3 months and this includes all form of edema irrespective of etiology and corresponding co-morbidities and risk factors It is a major clinical problem in the community and a challenging issue for primary care –

Community acquired pneumonia ( CAP )

Pneumonia is an infection of the pulmonary parenchyma caused by various organisms. The book also states that pneumonia is not a single disease but a group of specific infections , each with a different epidemiology , pathogenesis , presentation and clinical course ( Harrison’s textbook of medicine )

Our discussion here is focused on community-acquired pneumonia ( CAP )

 

How common –Community acquired pneumonia (CAP ) causes great mortality and morbidity and high costs worldwide ( Lancet 2015 ) WHO reports that pneumonia accounts for 15 % of all deaths of children under 5 killing 808 694 children in 2017
( Pneumonia remains the single largest infectious cause of death in children worldwide ) WHO data from 2015 shows that 3.2 million of the 56.4 million deaths in 2015 were caused by LRTIs making them the most deadly communicable disease and 3rd largest cause of mortality It is well known that CAP remains the main cause of death from infectious disease globally Streptococcus pneumoniae ( pneumococcus ) is the most frequent causative pathogen of CAP regardless of setting The Global disease study 2015 stated that LRTIs are the 3rd most common cause of death globally after IHD and Cerebrovascular disease NICE reports that 
- every year between 0.5 % and 1 % of adults in the UK would suffer with CAP
- pneumonia is diagnosed in 5 % to 12 % of adults who present to GPs with symptoms of LRTI –

Paediatric Observation Priority Score ( POPS ) Chart

Paediatric Observation Priority Score ( POPS ) Chart helps clinicians to identify acutely ill children quickly using a combination of physiological, behavioral and risk identifiers. The data used can be easily obtained and this enables to identify acutely ill children.

Benefits of using the POP score include

  • rapid detection of critically unwell children
  • fewer referral to hospitals ( cost savings )
  • fewer serious adverse events ( missed serious illness )

Chart reproduced here with kind permission of Dr Damian Roland

 

Acute Bronchitis

 

Acute bronchitis can be described as a self limited inflammation of large 
airways of the lung that happens in a patient without chronic lung disease.

 

How common – LRTIS -leading infectious cause of death worldwide among children and adults Not well defined ,but from an epidemiological point of view the term LRTI includes pneumonia ( infection of lung parenchyma ) ,

Aortic Stenosis

Aortic stenosis is a narrowing of the normal tricuspid aortic valve or a congenital bicuspid valve which leads to restricted blood flow and eventually compromised heart function.

 

AVS is the most common valvular heart disease in the developed world Common condition which increases with age- an important public health problem A study in Norway has shown prevalence of AVS
- 0.2 % in the 50-59 age gr
- 1.3 % in the 60-69 age gr
- 3.9 % in 70-79 age gr and 9.8 % in the 80-89 % Studies in US have shown an increase in hospitalization of patients over 65 for aortic valve surgery Experience has shown that AVS is progressive and after the onset of symptoms untreated patients have a poor prognosis ( once symptoms start average survival is 50 % at 2 yrs and 20 % at 5 yrs ) Overall prevalence is estimate to be between 3 % and 23 % A meta-analysis and modeling study by Rubel LJ et al has show that the pooled prevalence of all AVS in the elderly was 12.4 % and the prevalence of severe AVS was 3.4 % Every year about 67,500 surgical aortic valve replacements ( SAVR ) are done in the US Morbidity and mortality from AVS is expected to increase with an aging population The Euro-Heart survey revealed that the patients with valve disease were older ,

Ventricular Septal Defect ( VSD )

Ventricular septal defect -A defect in the interventricular septum that allows shunting of blood between the left
 and right ventricles ( BMJ Best Practice )

 

How common – Commonest congenital heart defect It is widely quoted that isolated VSDs are the most common congenital heart disease Seen less commonly in adults as most VSDs eventually close spontaneously VSDs can occur

 

Atrial Septal Defects ( ASD )

Atrial Septal Defects ( ASD ) happens when there is a failure to close the communication between
 the right and left atria.

 

One of the most common type of congenital heart defects ASD along with PDA is generally regarded as benign and often curable congenital heart defects Prevalence quoted in literature
- ASD constitute about 10 % of congenital cardiac defects and 22-40 % of congenital heart disease in adults
- ASD are the 2nd most common Cong HD in children with an incidence of 0.07 % to 0.2 % and have a female to male ratio of 2 : 1
- About 1 % of children with moderate to large ASD will experience symptoms which usually do not happen until late childhood or older ASD can happen with other congenital heart defects.

Patent Ductus Arteriosus

Persistent PDA is diagnosed when the Ductus Arteriosus does not close after 72 hours

Ductus arteriosus- Is important for foetal circulation and it allows communication between pulmonary artery and the aortic arch distal to the left subclavian artery. This shunt allows oxygenated blood from the placenta to bypass the uninflated fetal lungs and enter the systemic circulation.

Acute Coronary Syndromes

Acute coronary syndromes ( ACS ) constitute a range of conditions as unstable angina and myocardial infarction. This happens due to sudden reduction in blood flow to the heart , usually caused by the rupture of an atherosclerotic plaque within the wall of a coronary artery , and may cause the formation of a clot ( NICE 2014 )

 

How common –

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