Journal Round Up – Q4 2019

a) Medical Republic
 Omega 3 fats and Vitamin D supplements help in treatment of depression when used as an adjunct
b) MJA – Oct / Nov / Dec 2019 – given paucity of useful GP related articles, coverage
of this Journal is being reconsidered
 Low Fe in pregnancy: nil evidence 1st line IV (never used in 1st trimester) is better than PO; oral
lactoferrin recommended
 New diverticulitis guidelines
 Diagnosis
 CT best modality for Dx – particularly first presentation; can use USS if cannot use CT; Nil
MRI
 Initial assessment required FBC + CRP (? >50) and urinalysis
 If ongoing symptoms after 5 days -> CT AP
 All complicated diverticulitis requires colonoscopy 6/52 after acute attack has resolved to rule
out Ca.
 Current confusion of guidelines re: uncomplicated episodes (ie states “concerning findings on
CT”) – safest approach is to refer.
 Complicated l abscess, perforation, bleeding, peritonitis, fistula, stenosis -> ED
 Management – uncomplicated only
 Manage as outpatient if afebrile, clinically stable and uncomplicated
 Augmentin DF 7- 10 days – not for all – only if “indicated”
 Clear liquid diet 2-3 days; low fibre until pain improves; paracetamol plus antispamodics
 Prevention
 Aim BMI < 30; cease smoking; reduce red meat
 Faecal calprotectin
 Is useful in identifying IBD and should be performed; <50 = likely functional issue
 Vitamin D and calcium supplements
 Ca supplements not required for healthy people; low dose VitD supplements are safe
c) AJGP Oct / Nov / Dec 2019
 Atrial fibrillation – article vague on details – use under advisement
 Management
 Identify possible precipitants and reverse if possible: hyperthyroid, electrolyte disturbance,
infection, EtOH
 Routine Ix: FBC; EUC; CMP; TSH; TTE; Holter; polysomonography if symptomatic
 Hence, all need cardio review, rapidly if rate <50 or >110
 Anticoagulation: CHADSVASC: 1 = consider NOAC. 2 and over: needs NOAC.. but not if
valvular
 Given uncertainty, early review is appropriate
 HIV PreP
 92% effective if used properly
 Don't forget: full STI screen included oral and rectal swab for gonorrhoea / Chlamydia
 Autoimmune screen
 Expensive, low pre test probability “screen” will be positive but non-specific
 HLA B27: 8% positive in population; of these only 14% have Alk spond.
 SLE: 1 in 1000
 De Quervain’s
 Finkelstein’s test; always test contralateral side
 Nil XR unless trauma; USS best modality if required
  Treatment: splinting + active therapy (4-6 weeks ?full time splinting), CS injection (with exercises,
nil further splinting), surgery (if nil improvement 3-6 months)
 Idiopathic frozen shoulder
 Insidious onset; pain at point of deltoid insertion; dull and aching; worse at night; NSAIDs nil help;
 Three phases
 Pain + limited active and passive RoM in shoulder – particularly external rotation
 ~60% self resolve after 4 years
 Nil imaging required – clinical diagnosis
 Management
 Conservative: Educate, regular and BT analgesia, early physio input, CS injection,
hydrodilatation
 Pancreatic cancer
 RFs
 increasing age; smoking; obesity; EtOH >4SU daily; DM; Lynch syndrome; BRCA1 / 2; FAP;
1-2 x FDR with same; CF; chronic pancreatitis; familias pancreatitis PRSS12 mut / Peutz-
Jaeger
 Symptoms – nil cardinal symptom
 wt loss + back pain / abdo pain / N&V / D / constipation / New onset DM
 If symptoms + >60YO -> CT AP within 2 weeks
 New onset jaundice >40YO -> straight to specialist + CT (don’t wait for result)
 Stage at presentation: 20% I-II; 50% stage IV; remaining 30% - local structural involvement
 CA19.9
 Not a screening tool prior to diagnosis
 Monitor response with serial CA19.9 once Dx confirmed
 Treatments: beyond scope of this summary – Chemo / radio surgical per stage
 Prognosis – poor: 5YS < 8%
 Facial pain
 Neuralgias; syndromes with CN neurological signs; trigeminal autonomic cephalgias; pure facial
pain with nil neurological signs (sinuses, ear, etc); headaches
 Focus on cavernous sinus syndrome – Pain plus CN signs e.g. painful ophthalmoplegia
 Causes: neoplasia; vascular; inflammatory; infections
 Needs urgent CT if suspected