Volume 10, Issue 3, Pages 121 – 172 (2011)

Summer has been a busy time for the British media – phone hacking, atrocities in Norway, famine in Africa, riots, financial crises….hardly the usual ‘silly season’. The lack of health stories on the front pages might suggest that all is calm on the hospital front line. I suspect that most readers will disagree. Certainly in my hospital summer has f lown past with little respite from the pressures of emergency admissions, which now seem to continue all year round. However the wide variety of different conditions presenting on the acute medical take helps maintain our sanity and keeps the grey cells ticking over. The three case reports in this edition highlight this variety. Tanuj Lad reminds us that type 2 respiratory failure does not always mean COPD, while Desai and Sivaramakrishnan present an important differential diagnosis for a patient with diarrhoea. Haemophagocytic syndrome might not be a common cause of fever and rash, but the importance of maintaining a broad differential diagnosis in patients with HIV should noted, even when the CD4 count is not particularly low. These cases also illustrate the excellent learning opportunities for junior doctors on the AMU. Although it is often hard to find the time to teach on our ward rounds, such opportunities must not be missed. Nicola Cooper’s article provides some useful advice on how to maximise these opportunities amidst the continued work pressures.