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International Primary Care Association
 
 
 

Clinical Focus Volume 6 N3

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Editor Admin

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Incidence strongly increases with age, with the median age at diagnosis being 70 years in developed regions. Although 5-year relative survival exceeds 90% in stage I disease, it only marginally exceeds 10% in stage IV disease. This review aims to guide generalists through the early diagnosis, referral, and treatment of colorectal cancer, and highlight current preventive strategies.

The deed is done. Brexit is happening. We shall see what it brings to the NHS, a worsening of frontline medical and non-medical staff by all accounts. A trickle of exits of EU citizens may turn to a deluge if the issue of retaining citizenship is not resolved, early on in the negotiations. The worry is that the UK government may be relying on recruiting from outside the EU, such traditional heartlands as India, Nigeria and other Commonwealth of Nations. I am not sure if this will be easy as the laws on immigration and rights have so parred the advantages that there is unlikely to be a rush of healthcare staff wishing to come to the UK. The double whammy for politicians is that increasing numbers of staff, particularly in primary care, are choosing to retire early, work part time or simply have a career change. Plugging this gap, with the decision for additional places in medical school, will take over a decade for the effect to show. Indeed, the last round of undergraduate medical school places were unfilled and had to be offered in clearing. I cannot remember this happening in my working lifetime, 39 years. Jam tomorrow then!  

A 65 years old lady with a history of type 2 diabetes mellitus and well controlled hypertension is brought to A&E with central chest discomfort of 2 days duration. Her BP was 143/89 mmHg, Pulse 98 regular. Normal ECG. The A&E doctors arranged CT Aortogram to exclude aortic dissection. What is the diagnosis based on the imaging?

Sleep medicine is a fairly new subspecialty with many disorders. In order to understand sleep disorders, it is essential to understand normal sleep. In this review, we discuss normal sleep and how investigate suspected sleep disorders.

The oesophagus is a highly specialised muscular tube, whose function is to transport food from the mouth to the stomach, where the process of digestion starts. This requires an efficient and coordinated process. Due to its proximity to the lungs, disorders of the oesophagus may present to the respiratory physician and may be wrongly treated as respiratory disorders. 

Chronic cough is defined as cough that persists for more than 8 weeks. Its exact prevalence has proved difficult to estimate and recurrent cough is reported by 3-40% of the population1-4 It is also a common reason for attendance to a health clinic and can be very difficult to treat. Chronic cough may be due to underlying oesophageal disorders.

This review article discusses the oesophageal disorders that can present with respiratory symptoms.

 
 

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