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Hot Topics Blog

Course Preview - Hot Topics Spring 2020

Dr Simon Curtis - 5 Mar, 2020

The Hot Topics GP Update course webinar is fun, inspiring and informative, packed with learning points to take away to use in practice. We make it easy for you to maintain focus by keeping our presentations short, sharp and focussed. We use clinical cases weaved in to bring the literature and guidelines to life. All the material is 100% independent and free from any external influence. All the presented material will be completely new compared to Spring 2019.

All delegates on the course will receive:

  • A detailed, colour 300 page Hot Topics paper book
  • A bigger electronic version of the book, including even more Hot Topics which is hyperlinked to all the original references and is instantly searchable
  • The NB Medical App, across which you can access the full content of the digital course book or just the Keep it Simple Summaries (KISS)
  • Post course MCQs to assess learning
  • The personal email address of the presenters of the course for post course follow up questions

Topics that we shall cover on the day will include:

  • Cardiovascular medicine
    • Hypertension: outline of key changes in the NICE 2019 guideline & recent research on management
    • Lipids: is isolated raised LDL a significant risk, should younger adults know their LDL level and new evidence on secondary prevention LDL targets
    • Loop diuretics, how should we use them?
  • Cancer
    • Early diagnosis of cancer: new research and developments including published results from the National Cancer Diagnosis Audit, and an update (in England) of the QOF cancer diagnosis requirements for the new Quality Improvement domain for 2020/21
    • (In other countries we shall replace the QOF topic, such as in Scotland we shall cover the new Scottish referral guidelines)
    • Lung cancer diagnosis: new research on the sensitivity of CXR and the new NHS CT ‘lung health checks’
  • Respiratory
    • Asthma: concern around increase in asthma deaths and update of latest BTS/SIGN 2019 guidelines
    • Chronic cough management
  • Smoking
    • E-cigarettes & vaping update
  • MSK
    • Hand OA: low dose prednisolone for flares anyone?
  • Women’s Health
    • HRT update, including the evidence leading to the 2019 breast cancer concerns and the updated NICE guidance
    • Perinatal mental health
  • Abnormal blood tests
    • Making sense of inflammatory markers, based on new primary care research
  • Mental Health
    • Depression, new research on initial treatment, treatment resistant depression & withdrawal effects of antidepressants
    • Burnout: is now defined as a condition in ICD-11, but what exactly is it and how do you know if your patient, your colleague or you may have it?
  • Neurology & ENT
    • Assessment of suspected neurological conditions, based on NICE 2019 guidance
    • Acute vertigo assessment, how do we differentiate between a peripheral (benign) and central (serious) cause?
    • Vestibular migraine
    • Headaches update, based on new BASH guidance
  • Infections
    • Covid-19…the latest emerging evidence on the coronavirus outbreak (this presentation will change as the situation evolves)
    • Update on management of common infections, including new NICE guidance on cellulitis and sore throat
  • Gastro
    • Diverticulitis, new NICE guidance and research: how to diagnose, how to manage and when to refer
    • Chronic diarrhoea in primary care: likely IBS-D but could it be bile acid malabsorption or microscopic colitis?
  • Last 30 mins, miscellaneous Hot Topics cases

As ever, we like to keep it practical and pragmatic whilst also considering many of the broader issues and challenges we face. And we like to have a laugh too!

Best Wishes

Simon, Neal, Siobhan, Kate, Zoe, Ahmed, Rob, Stephanie, Sarah, Duncan, Mark and Will

The NB GP Team


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NSAIDs, ACE inhibitors and Fear

Dr Neal Tucker - 18 Mar, 2020

Fear is the enemy of reason.

The last thing we need during this unprecedented world pandemic is fake news fueling anxiety and yet on social media yesterday a story about ibuprofen use worsening Covid-19 raced around the world throwing people into a panic. The psychology of this is hugely interesting but our time is precious right now so let’s focus on the science.

NSAIDs and Covid-19

This originated from a French doctor who tweeted about the potential risks of NSAIDs during fever and illness, a message which was then shared by the French Health Minister, who said ibuprofen should not be used during the illness. This prompted global public and scientific debate on the issue.

The concerns raised are based around theoretical risks and data regarding other ‘routine’ infections. UK Professor of Primary Care, Paul Little, recently discussed in a BMJ editorial that NSAIDs may cause an increase of pyelonephritis when taken for UTI management, but also quoted data suggesting prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used (ref 1 and 2).

The theoretical mechanism here is that NSAIDs may dampen the immune response, prolonging illness, and that Covid-19 may lead to a reduction in an enzyme required in fluid and electrolyte homeostasis that was seen in SARS, given the viruses similarities.

However, there is currently no published data on the effects of NSAIDs in Covid-19 infection. Today Stephen Powis, NHS England Medical Director, clarified the position saying that:

  • “In view of the current lack of clarity the Committee of Human Medicines (an advisory body of MHRA) and NICE have been asked to review the evidence. It is therefore suggested that, in the interim, for patients who have confirmed Covid-19 or believe they have Covid-19, that they use paracetamol in preference to NSAIDs. Those currently on NSAIDs for other medical reasons (e.g. arthritis) should not stop them.”

ACEi/ARB and Covid-10

The other big medical scare this week was that ACEi/ARB use may also lead to worsening outcomes in Covid-19. This was another piece of speculation blown out of proportion and disseminated globally via social media.

Some Covid-19 cases in China demonstrated evidence of arterial hypertension, increasing the risk of mortality. This was then spuriously linked to how the virus infects humans: it binds to ACE2, similar to SARS. Levels of the enzyme may be raised by treatment with ACEi or ARB therefore it was suggested this may be the reason for increased mortality.

The European Society of Cardiology was quick to release a statement to reassure patients on these medications that there is no scientific basis to the claim or evidence to support it. It also reported that animal studies suggest they may in fact have a protective effect from serious lung complications although it stresses there is no data in humans as of yet.

Bottom line: do not stop your ACEi or ARB. The last thing health services around the world need right now is an increase in MIs and stroke.

Fighting the Fear

We are supporting patients through this anxious time, and a huge part of that is calm, reasoned advice based on the best information we have at the time.

New data emerges every day, we are all trying to stay on top of it. NB will do its best to help.

There will no doubt be more fake news, we need to recognise it as such and stop it in its tracks.


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