Hyperpharmacotherapy in ageing cystic fibrosis patients: The first report of an atypical hip fracture.

Cystic fibrosis (CF) is a common autosomal recessive disorder in Caucasian populations with respiratory, gastrointestinal and endocrine manifestations. Thanks to recent advances in medical therapies and infection control, life expectancy of a patient with CF has significantly increased from less than 5 years in the mid-1900s to almost 50 years nowadays. However, as CF patients are living longer, multimorbidity and Hyperpharmacotherapy are becoming more common. This case illustrates a cascade of problems that ensued from medication side-effects, highlighting the increasing challenge of managing an ageing CF population.

Retinal screening of patients with cystic fibrosis-related diabetes in Wales -- a real eye opener.

BACKGROUND: The National Screening Committee recommends annual retinal screening for all diabetic patients over the age of twelve years. Currently, patients on insulin therapy for Cystic Fibrosis-Related Diabetes Mellitus (CFRD) at the All Wales Adult Cystic Fibrosis Service, UK are invited for annual screening. METHODS: Age, sex, FEV(1)%, BMI, HbA1c, duration of diabetes, duration of insulin therapy, presence of retinopathy and attendance at retinal screening in 2012 were examined for patients on insulin therapy for CFRD. RESULTS: 67 of the 228 (29%) patients attending the CF centre were receiving insulin therapy. 24 of the 67 (36%) did not attend retinal screening in 2012. Of the 43 who had retinal scans, 18 (42%) had evidence of retinopathy. Patients with retinopathy had a higher mean HbA1c (p=0.04), mean duration of diabetes and mean duration on insulin (p<0.001). CONCLUSIONS: Almost half of the patients screened had evidence of retinopathy but over a third of the patients with CFRD did not attend screening appointments. Improving patient uptake of retinal scans will become increasingly important in an ageing CF population.

Testing for cervical Chlamydia trachomatis infection in an inner city practice.

The aims of the study were to find the prevalence of cervical Chlamydia trachomatis infection in women attending for a speculum examination, to examine possible risk factors, and to see if we could develop a rational policy for testing for chlamydia in our deprived inner London practice. During 18 months 409 women aged 17-45 (mean 28) who attended for a cervical smear or vaginal examination were tested for chlamydia using the direct immunofluorescent test. They were assessed for possible risk factors: age less than 25, more than one sexual partner in the previous 3 months, sexual contact with men with urethritis, past history of chlamydia infection, purulent vaginal discharge, cervicitis and abnormal cervical cytology. Thirty-six women (8.8%) were chlamydia positive. Chlamydia infection was significantly associated with the presence of purulent vaginal discharge or an inflammatory cervical smear. In view of the prevalence of chlamydial cervicitis, the lack of symptoms and signs, and the potential consequences of untreated infection, ideally all young women in this population should be offered screening when they attend for a speculum examination. If this is not practical, chlamydia testing might be offered to women thought to be in high-risk groups including those with purulent vaginal discharge or an inflammatory cervical smear.