Clinical medicine (London, England)
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The co-existence of diabetes mellitus and HIV infection poses significant challenges for both patient and physician. This article reviews the clinical problems, the implications for treatment plans and potential confusions that can arise when managing patients who have both conditions.
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Renal sympathetic denervation is a novel, endovascular treatment with potential utility in resistant hypertension. First pioneered in humans in 2010, conflicting data exist regarding the efficacy of this treatment. This article will review the evidence to date, the scientific rationale for sympathetic denervation as a treatment for hypertension and consider other possible conditions where the therapy may be of benefit.
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Perioperative β-blocker therapy has been advocated to reduce cardiac mortality and morbidity in high-risk cardiac patients undergoing non-cardiac surgery. Core data that supported this intervention and informed international societal guidelines has recently been withdrawn. A subsequent meta-analysis of the remaining data reporting excess mortality has re-opened the debate about the utility of β-blocker therapy in the perioperative period. Criticism of remaining trial designs and new insights into the protective mechanisms of β-blocker therapy in critical illness raise important questions that should now be addressed by a further robust, high-quality randomised control trial.
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Insulin therapy is important in many patients with diabetes, but the UK National Diabetes Inpatient Audit (NaDIA) suggests that insulin therapy in hospital is poorly monitored and managed. Although most hospitals should have access to an inpatient diabetes specialist team, it is important for the non-specialist clinician to be aware of the indications for insulin therapy, types of insulin and insulin regimens, methods of adjusting insulin doses and the need for care with insulin prescribing. Here, we demystify issues around insulin therapy.