Clinical medicine (London, England)
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Pulmonary embolism 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. LMWH and 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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The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in CAP patients. ⋯ NLR independently predicts adverse outcomes in hospitalised CAP patients but does not improve the predictive performance of the CURB-65 score.
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If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. ⋯ Certain life-threatening diagnosis' have been further discussed in more detail (Wernicke's encephalopathy, hyponatreamia, hypercalcamia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.