Clinical medicine (London, England)
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Although often underappreciated, a number of bacterial zoonoses are endemic in Africa. Of these, brucellosis, leptospirosis, Q fever, and rickettsioses are responsible for a substantial proportion of febrile illness among patients seeking hospital care. ⋯ These may lead to better outcomes than strategies based exclusively on treatment of human infections. Such strategies are referred to as the 'One Health' approach; the collaborative effort of multiple disciplines to attain optimal health for people, animals and the environment.
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The chikungunya virus (CHIKV) infection epidemic has emerged as a significant public health concern in the last 10-15 years, especially in Asian and south American countries. However, with ever-expanding tourism and migration, cases have now been reported in north America and Europe. CHIKV infection predominantly causes musculoskeletal symptoms with a chronic polyarthritis which may resemble autoimmune inflammatory arthritis. ⋯ There has also been a significant increase in our understanding of the immunopathogenesis of chikungunya infection. This knowledge is being used in the development of new treatment strategies and preventive measures. In this narrative review, we discuss some of the recent advances in the epidemiology, immunopathogenesis, and management of CHIKV arthritis.
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Diabetic ketoacidosis (DKA) is not a rare presentation to hospital, despite being an entirely preventable condition. A concerning number of people also develop DKA while already in hospital. Management of DKA has changed in the last decade, and national guidelines introduced, to help standardise care, spread best practice, and reduce mortality and morbidity.
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There are about 4.7 million people living with diabetes mellitus in the UK and 90% have type 2 diabetes mellitus (T2DM). This burden will only get worse as there are currently about 12.3 million more at risk of T2DM. ⋯ Atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in diabetes, contributes significantly to this. Therefore, there is significant emphasis on the prevention of T2DM especially in at-risk groups with the setting up of initiatives like the Diabetes Prevention Programme. When prevention fails, it is essential to commence glucose-lowering agents to reduce the burden of disease, prevent associated complications and improve quality of life. A patient-centred approach is required to ensure efficacy of treatment strategies and the presence of co-morbidities such as cardiovascular and renal disease should be considered.
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Case Reports
Guillain-Barré syndrome presenting with an 'angina' mimic and posterior reversible encephalopathy syndrome.
A 56-year-old woman presented with severe headache, blurring of vision, hypertensive emergency and severe crushing central chest pain. Extensive evaluation was undertaken to rule out sinister myocardial, pulmonary and mediastinal pathology. ⋯ Nerve conduction studies confirmed a demyelinating Guillain-Barré syndrome. Intravenous immunoglobulin treatment led to rapid resolution of pain, dysautonomia and neuropathic symptoms.