Clinical medicine (London, England)
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Pulmonary embolism (PE) is a significant cause of morbidity and mortality in pregnancy and the puerperium. In severe cases, it causes haemodynamic instability and can lead to cardiac arrest due to obstructive shock. Patients with acute PE can be risk stratified to guide their monitoring and treatment; this article focuses on intermediate- and high-risk PE. ⋯ Diagnostic imaging should not be delayed due to pregnancy. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) can be used during pregnancy and breastfeeding, and systemic thrombolysis can be used in obstetric patients, but there are significant bleeding risks and it should be reserved for high-risk PE with hypotension and shock. Although pregnancy and the puerperium are risk factors for PE, it is important to avoid early diagnostic closure, and to consider other causes for the patient's presentation.
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Asthma is the most common chronic disease to affect pregnant women and can have a significant effect on pregnancy outcomes, with increased rates of preterm birth, premature delivery and caesarean section observed if poorly controlled. Pregnancy can also influence asthma control. ⋯ The majority of asthma treatment can be continued as normal in pregnancy and there is emerging evidence of the safety of biologic medications also. This article aims to summarise the current evidence about asthma in pregnancy and guide the appropriate management of this population.
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Atopic eczema (eczema; also known as atopic dermatitis) is a chronic inflammatory skin condition. The burden of eczema can be very substantial with significant itch, skin pain, secondary infection, sleep disturbance and psychological distress. ⋯ When eczema cannot be adequately managed with skin-directed approaches such as topical preparations and/or phototherapy, systemic therapy may be required to achieve disease control and requires early input from dermatology specialists. The aim of this short review is to summarise this approach.
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Multicenter Study
Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome in Patients with Cancer: A Multicenter Study.
Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. However, limited data about DKA and HHS are available in patients with cancer. The current study aimed to determine characteristics and outcomes of patients with cancer who were admitted with DKA/HHS in a mid-size Canadian city. ⋯ Although DKA or HHS is uncommon in patients with diabetes and cancer, it is the manifestation of undiagnosed diabetes in about one-third of patients with cancer. It has been associated with high hospital mortality in patients with advanced cancer.
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Unidentified obstructive sleep apnoea (OSA) can lead to unexpected perioperative complications, unplanned postoperative admissions and increased length of hospital stay. NICE (National Institute for Health and Care Excellence) recommends a rapid preoperative assessment for patients undergoing elective surgery. ⋯ Prevalence of OSA is high in presurgical patients identified through preoperative screening. A diagnosis of moderate to severe OSA impacts surgical decision and planned anaesthetic route. Prior awareness of the diagnosis may help clinicians to identify the at-risk group. Timely CPAP initiation to facilitate surgery remains a challenge and, despite low compliance, CPAP may reduce postoperative complications. A multidisciplinary team (MDT) approach and a dedicated CPAP pathway post-diagnosis may help the clinicians and patients.