Clinical medicine (London, England)
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Review
Is immune checkpoint inhibitor-associated diabetes the same as fulminant type 1 diabetes mellitus?
Pembrolizumab is an anti-cancer drug that targets programmed cell death protein-1 (PD-1) receptors on lymphocytes resulting in their activation against tumour cells. PD-1 receptors are also interspersed in endocrine organs and pembrolizumab use has long been associated with hypophysitis and thyroiditis. Since the introduction of immune checkpoint inhibitors (ICI), several cases of fulminant type 1 diabetes mellitus (FT1DM) have been reported. ⋯ Our review showed that ICI-induced diabetes may be a different entity to FT1DM. Furthermore, there is limited evidence for the management of ICI-induced T1DM. Further research into its pathophysiology will improve management and possibly prevent this burdensome complication.
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A case is presented highlighting pulmonary embolism as an important complication of COVID-19 and the abruptness with which deterioration and widespread pulmonary infiltrates can develop even after relatively normal initial investigations, illustrating the importance of follow-up. The role of computed tomography in COVID-19 is also discussed.
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Idiopathic retroperitoneal fibrosis is a rare disease. Symptoms include constitutional symptoms and abdominal/flank pain. Causes of retroperitoneal fibrosis include non-infectious and infectious etiologies. ⋯ We present a case of a 59-year-old man with a retroperitoneal periaortic mass initially diagnosed as tuberculous aortitis. However following biopsy, the diagnosis was later amended to idiopathic retroperitoneal fibrosis with latent tuberculosis. He was successfully treated with prednisone and methotrexate.
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Many secondary care departments receive external advice calls. However, systematic advice-call documentation is uncommon and evidence on call nature and burden infrequent. The Liverpool tropical and infectious disease unit (TIDU) provides specialist advice locally, regionally and nationally. We created and evaluated a recording system to document advice calls received by TIDU. ⋯ Implementing an advice-call recording system was feasible within TIDU. Call and follow-up burden was high with advice regarding fever in returned travellers predominating. Similar systems could improve clinical governance, patient care and service delivery in other secondary care departments.
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Patients with suspected lung cancer require computed tomography (CT), specialist interpretation of the CT and a consultation with a specialist. Significant time savings could be made with rapid access to these components in the front end of the lung cancer pathway. ⋯ Through simple reorganisation of workload, we have significantly reduced the pathway for patients with suspected lung cancer to meet a specialist with a reported CT, something we firmly believe is replicable across all hospitals.