Anaphylaxis is a serious potentially life-threatening systemic hypersensitivity characterised by airway, breathing and/or circulation compromise. Where feasible, any trigger should be removed. Hypotensive patients should be placed in a supine position with or without leg elevation but those with airway or breathing compromise may prefer to sit up. A standard adrenaline dose of 500 micrograms (0.5 ml of 1:1,000 adrenaline) is recommended in adults, whereas dosage varies in children depending on age/weight. 

The International Association for the Study of Pain has developed a new classification system for chronic pain. A fundamental distinction is made between chronic primary pain and chronic secondary pain. Chronic primary pain is defined as pain in one or more anatomical regions that persists for longer than three months, is associated with disability or emotional distress, not better accounted for by another diagnosis of chronic pain. Chronic primary pain is subdivided into five categories. Chronic secondary pain is pain secondary to an underlying disease.

Psoriatic arthritis (PsA) is a seronegative systemic disease that belongs to the family of spondyloarthropathies. Its worldwide prevalence ranges from 0.05% to 1%, and it appears in 10-40% of patients with skin psoriasis; however, it is believed to be underdiagnosed. More than 80% of patients who are diagnosed with PsA already have skin disease, mainly in the form of plaque psoriasis. However, 15% of patients present with musculoskeletal involvement prior to psoriasis which makes the diagnosis of PsA challenging. It is important to do a thorough clinical assessment, take a family history and actively look for evidence of psoriasis: this includes examining nails, the scalp, intergluteal region and umbilicus.

Polycystic ovary syndrome is a condition characterised by hyperandrogenism, multifollicular ovaries and ovulatory dysfunction. It affects 8-13% of women of reproductive age and is associated with insulin resistance, hyperlipidaemia and obesity. Baseline measurements should include blood pressure and BMI. Clinical signs of hyperandrogenism including hirsutism, acne and androgenic alopecia should be assessed. A hormone profile should be done during days 1-5 of the menstrual cycle or as a random sample when there is amenorrhoea.

Endometriosis affects around one in ten women of reproductive age in the UK. NICE guidance highlights the importance of symptoms in its diagnosis. A normal abdominal or pelvic examination, ultrasound, or MRI should not exclude the diagnosis. Endometriosis should be suspected in women and adolescents who present with one or more of: chronic pelvic pain, significant dysmenorrhoea, deep dyspareunia, period-related or cyclical GI or urinary symptoms, or infertility. If endometriosis is suspected or symptoms persist, patients should be referred for further assessment.

Around 60,000 people in the UK are estimated to have cirrhosis. It is now the third most common cause of premature death. Decompensation represents a watershed moment for patients with cirrhosis, with the median survival falling from > 12 years for compensated cirrhosis to approximately two years. Patients with cirrhosis should undergo six-monthly ultrasound to screen for the early development of primary hepatocellular carcinoma. They should also undergo an initial upper gastrointestinal endoscopy to screen for varices.

Hepatocellular carcinoma (HCC) accounts for around 90% of liver cancer cases and intrahepatic cholangiocarcinoma (CC) for 9-10%. Most cases of HCC occur in the context of chronic liver disease with cirrhosis, particularly in those with chronic hepatitis B or C. Other major risk factors include excessive alcohol consumption, obesity and aflatoxins. Overall, 10-15% of cirrhotic patients will develop HCC within 20 years. Patients presenting with an upper abdominal mass consistent with an enlarged liver should be referred for an urgent direct access ultrasound scan within two weeks. 

The combination of an aggressive disease, vague presenting symptoms and insensitive standard diagnostic tests is a key factor contributing to poor outcomes with only 15% of patients with pancreatic cancer having operable disease at diagnosis. The NICE guideline on referral for suspected cancer recommends urgent referral via a suspected cancer pathway referral if the patient is aged 40 and over with jaundice. It also recommends that an urgent direct access computerised tomography (CT) scan referral should be considered in patients aged 60 and over with weight loss and any of the following: diarrhoea; back pain; abdominal pain; nausea; vomiting; constipation; new onset diabetes. Pancreatic cancer requires a CT scan for diagnosis.

Anaphylaxis is a serious potentially life-threatening systemic hypersensitivity characterised by airway, breathing and/or circulation compromise. Where feasible, any trigger should be removed. Hypotensive patients should be placed in a supine position with or without leg elevation but those with airway or breathing compromise may prefer to sit up. A standard adrenaline dose of 500 micrograms (0.5 ml of 1:1,000 adrenaline) is recommended in adults, whereas dosage varies in children depending on age/weight. 

Just under half of smokers in England who reported visiting their GP in the past year recalled receiving advice on smoking cessation, and only one in three were offered support to quit, a national survey has found. However, current clinical guidelines suggest GPs should use every opportunity to ask patients about smoking and advise and encourage every smoker to stop. There is good evidence that brief advice from a GP helps smokers to quit.

Loneliness is associated with an increased risk of developing depression, a longitudinal cohort study has found. The English Longitudinal Study of Ageing (ELSA) recruited 11,391 participants aged 50 years and over who were living in a private household in 2002. Participants were followed up every two years until 2016/17.

My very first column for The Practitioner, back in 1996, focused on perceptions of risk, something that is every bit as relevant today. However fast the times may change patients change remarkably little.

Oral prednisolone had little effect on respiratory parameters at 24 hours in young children attending an emergency department with acute wheeze, in a study from New Zealand. However, admission rates, and the need for additional oral prednisolone and intravenous medication were lower in children in the prednisolone group.

A history of one or more miscarriages appears to be associated with an increased risk of dying before the age of 70, an analysis of data from the US Nurses’ Health Study II has found. When the cause of death was examined, the strongest association was with cardiovascular disease.