Clinical medicine (London, England)
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People with diabetes are more likely to require surgical intervention than those without and have an increased risk of developing postoperative complications. The Highs and lows review from the National Confidential Enquiry into Patient Outcome and Death reported on inadequate diabetes care in the perioperative period. ⋯ The plan will include dose adjustments of diabetes medication, and use of variable rate insulin infusion or continuous subcutaneous insulin infusion where applicable. The guideline also highlights the importance of improved communication between healthcare teams involved in the perioperative pathway in order to improve outcomes and care.
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Review Case Reports
Hyperosmolar hyperglycaemic state as a stroke cause or stroke mimic: an illustrative case and review of literature.
Hyperosmolar hyperglycaemic state (HHS) is a life-threatening metabolic complication of type 2 diabetes (T2DM) that often presents with neurological symptoms. A 74-year-old man with known T2DM presented to the emergency department with collapse, left-sided weakness and slurred speech (National Institutes of Health Stroke Scale (NIHSS) 3) and a biochemical profile consistent with HHS. When he further deteriorated (NIHSS 20), he was managed for concurrent ischaemic stroke. ⋯ Two further cases of HHS mimicking ischaemic stroke have been reported with symptoms and imaging findings resolving with treatment of HHS. Our case demonstrates how HHS can also accentuate symptoms of a minor stroke, highlighting the importance of excluding ischaemic stroke in HHS patients with neurological dysfunction. We recommend consideration of early MRI and/or computed tomography angiography in this cohort, especially in those appropriate for intervention.
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We present a case of a non-diabetic 84-year-old woman who presented with recurrent falls and hypoglycaemic episodes and was subsequently diagnosed to have a solitary insulinoma. Her multiple fall episodes may have been precipitated by her low blood glucose levels. We discuss the clinical and radiological findings of insulinoma.
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CT imaging is not advocated by British Thoracic Society guidelines after first episode of primary spontaneous pneumothorax (PSP). There is emerging evidence that emphysema-like changes and CT-based dystrophy severity score (DSS) can predict need for early surgery and recurrence. ⋯ DSS seems to predict the need for early surgery and recurrence and CT can be used to risk-stratify patients after a first episode of PSP.
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Dengue is an arboviral infection that is hyperendemic in tropical and subtropical climates. Clinical manifestations of dengue can range from asymptomatic infection to severe infection with multi-organ failure. Dengue haemorrhagic fever (DHF) is a subcategory in dengue infection with a hallmark of plasma leak (ie critical phase). ⋯ In addition, dengue fever may present with extended and unusual manifestations affecting any organ, including the heart, liver, kidney and brain. Studies on vaccine development and vector control are ongoing to prevent this infection of global importance. In this article, the clinicopathological features and management aspects of dengue are discussed.