Clinical medicine (London, England)
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Hospital-acquired diabetic ketoacidosis (HADKA) can complicate hospital admission in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). We aimed to determine the characteristics of such patients and the reasons for HADKA. ⋯ HADKA was identified in a significant number of patients at our hospital and was associated with significant mortality. Earlier recognition of ketonaemia and associated medication use may prevent HADKA and improve outcomes.
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A 61-year-old man with hypertension and psoriasis, which was treated with adalimumab, was admitted after a 1-month history of fever following a dental implantation. Computed tomography of the chest revealed a pseudoaneurysm in the aortic arch, and blood culture grew Salmonella enterica A diagnosis of mycotic pseudoaneurysm of the aortic arch due to Salmonella was made, and he was treated with cefoperazone-sulbactam. During his hospital stay, he developed hoarseness followed by haemoptysis, and underwent thoracic endovascular aortic repair followed by emergency open surgical repair. However, he died 5 weeks after the surgery due to acute upper gastrointestinal bleeding, which was confirmed as an aortoesophageal fistula by oesophagogastroscopy.
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Gender bias and sexism in the health profession in the UK has been highlighted as a major problem. Efforts to reduce this must include medical training and examinations. The Situational Judgment Test (SJT) is an examination that must be passed to work as a foundation doctor in the UK; and is taken by all UK medical students. ⋯ We found that senior doctors were more than twice as likely to be men than women, while there was no significant gender difference in representation of foundation year-1 doctors, other health professionals or patients/relatives. This inequality has the potential to reinforce gender biases in healthcare. Medical examinations can, instead, represent an opportunity for prejudices to be challenged.
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Cerebral amyloid angiopathy (CAA) is a common cause of lobar cerebral haemorrhage in elderly populations, which can present as transient focal neurological episodes (TFNEs) or sometimes known as 'amyloid spells'. CAA-TFNE poses a common diagnostic challenge to physicians as it can be difficult to distinguish from transient ischaemic attacks or other transient neurologic syndromes. Prompt recognition of CAA is crucial as it heralds a high risk of intracerebral haemorrhage and to avoid unnecessary investigation with inappropriate long-term prevention treatment.
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Fibromyalgia syndrome (FMS) is a common widespread primary pain condition, with a worldwide prevalence of 2%-4%. Recent research has revealed important evidence for changes in central and peripheral nervous system functions and immunological activity. The diagnosis of FMS can be challenging with no known clinical laboratory investigations to confirm or refute its presence. ⋯ As such, patients may be diagnosed inaccurately with alternative conditions, delaying diagnosis by years. The recent publication of the Royal College of Physicians' guidance aims to support clinicians in the diagnosis of FMS. Its purpose is to provide succinct, relevant information for patients and clinicians about FMS and its diagnosis.