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see also NSW S4D listing)

other lymphadenopathy persisting for 4-6 weeks Progressive growth : Nodes that continue to increase in size over time Hard, fixed, or irregular nodes : Lymph nodes that feel firm, immobile, or have an irregular texture may indicate serious pathology Generalised lymphadenopathy : Swelling in multiple lymph node regions (neck, armpits, groin) simultaneously Systemic symptoms : Unexplained fever, drenching night sweats, unintentional weight loss (beyond expected GLP-1-related weight reduction), or persistent fatigue Associated symptoms : Difficulty swallowing, breathing difficulties, or hoarseness accompanying neck lymphadenopathy According to NICE guideline NG12 , lymphadenopathy with concerning features should prompt consideration of a suspected cancer pathway referral (2-week wait)

Policy If you feel a change in your heartbeat but it doesnt worry you, its OK to try stopping them at home yourself, says cardiologist Tamanna Singh, MD

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Conclusions I welcome this clear advice from the MHRA, clarifying the frequency of vitamin B12 deficiency in patients taking metformin, especially those on higher doses and longer-term therapy

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