Abstract
InnovAiT is produced on a 3-year cycle. However, many articles do not significantly go out of date in that time. This section of InnovAiT summarises articles from the previous cycle of InnovAiT that GPs and GPs in training might still find useful today.
Metformin and its use in chronic kidney disease, cardiovascular disease and cancer
Dr Ramon-Rita Sultana and Dr Sam Rice
InnovAiT 2015 8(2): 69–74
This article reviews aspects of the use of metformin in type 2 diabetes mellitus highlighting evidence for a reduction in the risk of cardiovascular disease, a possible anti-tumour effect and improvements in diabetic control. Adjusting the dose of metformin according to renal function and stopping metformin in acute illness may be necessary to avoid adverse effects.
Hypothyroidism
Dr Emma Roe
InnovAiT 2015 8(2):75–82
Hypothyroidism is common with an annual incidence of 3.5 per 1000 women and 0.6 per 1000 men in the UK. About 3% of the UK population take long-term thyroid replacement therapy. This article considers the diagnosis and management of hypothyroidism stressing the need to consider underlying causes and associated conditions. The starting dose of thyroxine in healthy patients is 100 mgs with more cautious titration in those over 60 years of age.
Adrenal disease: The GP’s role
Dr Ruth Mears and Dr Aled Roberts
InnovAiT 2015 8(2): 83–88
This article explores the diagnosis and management of phaeochromocytoma, primary hyperaldosteronism, Cushing’s syndrome and Addison’s disease. Primary hyperaldosteronism should be considered in young patients with resistant hypertension, hypokalaemia and/or evidence of adrenal adenoma. Endogenous Cushing’s syndrome is rare and the syndrome is more commonly induced by medication.
Blocked ears
Dr Rhiannon Lloyd-Hughes and Mr Iain McKay-Davies
InnovAiT 2015 8(2): 90–97
Patients commonly present with blocked ears in general practice and this is often caused by ear wax. However, there are many other causes and this article reviews other causes, clinical assessment and management, highlighting red-flag symptoms of cholesteotoma, malignancy, necrotizing otitis externa and intracranial complications of otitis media. Sensorineural hearing loss may present with a blocked ear sensation and should be managed as an emergency.
Straightening out vertigo
Mr Tobias Edward Moorhouse and Dr Adrian Bellwood
InnovAiT 2015 8(2): 98–105
A good history is essential in the management of patients presenting with dizziness and balance disorders. Peripheral vestibular disorders will cause rotatory vertigo and the three common such disorders (benign positional vertigo, Meniere’s disease and vestibular neuritis and labyrinthitis) can be distinguished from the history. This article covers diagnosis and management of these conditions, but cautions us to remember vestibular migraine and central causes for dizziness.
Human papilloma virus in head and neck cancer
Dr Jasmine Hart, Mr Richard Alan Steven and Mr Rodney Mountain
InnovAiT 2015 8(2): 106–111
The incidence of head and neck cancers is increasing in younger patients and the human papilloma virus (HPV) is now the leading cause in the developed world and a largely preventable disease. This article examines the causes, presentation and management of HPV-associated head and neck cancer. These usually present as a painless, lateral neck mass and prompt referral to secondary care will improve patient survival. There may be a case for extending the HPV vaccination programme to men.