Clinical medicine (London, England)
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Technology has revolutionised our society. From the creation of the internet to smartphones and applications (apps), technology has changed how we communicate with each other, undertake regular tasks in our lives and access information at our fingertips. ⋯ With the emergence of a range of widely used technological options that can improve quality of life and metabolic outcomes, general physicians need to be aware of their application in diabetes, as well as how to manage acute diabetes presentations in people using these devices. This article aims to improve the knowledge that general physicians may have with diabetes technologies and guide them on the acute management in people using these technologies.
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Cirrhosis is associated with intestinal dysbiosis, with specific alterations in the gut microbiota linked to particular aetiologies and manifestations of the disease. We review the role of the gut microbiome and the importance of the intestinal barrier in cirrhosis, provide an overview of the terminology and techniques relevant to this emerging area, and discuss the latest developments in therapies targeting the gut-liver axis.
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We determined the impact of a system-wide multicomponent intervention to improve recognition and documentation of cognitive frailty syndromes on hospital administrative coding for delirium. ⋯ A multicomponent intervention increased sensitivity of hospital administrative diagnostic coding for delirium almost six-fold without increasing the false positive diagnosis rate.
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Case Reports
Lessons of the month: Pyroglutamic acidosis: long-term paracetamol and a high anion gap.
An 84-year-old woman presented in extremis with confusion and Kussmaul respiration. She had a history of urosepsis, renal impairment and osteoarthrosis. The venous blood gas showed a marked metabolic acidosis with a high anion gap. ⋯ Paracetamol was stopped and fluids administered; she recovered over 7 days and was sent home. The biochemical diagnosis was confirmed by a central laboratory after discharge. This case emphasises the importance of the anion gap in diagnosis, and one important danger of chronic paracetamol administration.