Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Diabetic neuropathy is an often overlooked common complication of diabetes. ⋯ Diabetic neuropathies can be classified as reversible or chronic. The most common type is the chronic, progressive distal symmetric polyneuropathy where sensory symptoms in the lower limbs dominate. These patients often lose their protective sensibility and are at risk of foot ulcers and amputations; distressing pain is another symptom of this disorder. Autonomic neuropathy is often a feature of progressive polyneuropathy, but is rarely symptomatic. Mononeuropathies affecting femoral, truncal or ocular nerves are among the reversible neuropathies of diabetes. Distal symmetric diabetic neuropathy is very common; overall prevalence among diabetic patients is around 20-30%. The prevalence increases with the duration of the disease as well as with poor glycaemic control, height and age. The pathogenesis of diabetic neuropathies is not clear, but possibly involves a complex of metabolic factors inducing nerve ischaemia. We recommend yearly screening for most diabetic patients with a simple screening instrument consisting of four questions and four simple tests. Tight glycaemic control has been shown to protect against or delay the occurrence of neuropathy. Tricyclic antidepressants are still the drugs of choice against painful diabetic neuropathy, but gabapentin and tramadol are new alternatives.
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Febrile illness without focal symptoms in a child who has visited tropical or sub-tropical areas is an increasing health problem in western countries. In the department of paediatrics at Ullevaal University Hospital, malaria, typhoid and paratyphoid fever are the most frequent infectious diseases acquired in tropical or sub-tropical areas. ⋯ Blood cultures prior to administration of antibiotics are important in providing correct diagnosis and appropriate treatment. Before visiting endemic areas, groups at risk should be informed that there are vaccines available against typhoid fever.
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Many Norwegian hospitals have to cancel elective surgery because of acute cases, and ring fencing of elective surgery is a frequently discussed measure. In this article we discuss advantages and disadvantages of ring fencing in relation to the results from a simulation model. ⋯ Our results indicate that ring fencing in itself is not beneficial, as total capacity utilization declines. On the other hand, separate departments may facilitate an increase in efficiency in the elective surgery department; this may shorten waiting time.