Sodium glucose co-transporter-2 inhibitor-induced diabetic ketoacidosis following tooth extraction: improving awareness among dental practitioners

Sodium glucose co-transporter-2 inhibitors (SGLT-2i) are a relatively new class of oral glucose lowering agents that improve glycaemic control and also provide significant cardiac and renal benefits. However, SGLT-2i use is associated with a small but significant increased risk of diabetic ketoacidosis (DKA) especially during periods of reduced oral intake such as following dental procedures, bowel preparation for colonoscopy, surgery and concurrent illness. In contrast with typical DKA, in many cases of SGLT2i-associated DKA, the blood glucose is normal or only slightly elevated, giving rise to the term euglycaemic DKA (euDKA). Patients with euDKA often present with non-specific symptoms. Moreover, their normal or only mildly elevated blood glucose levels might lead to delayed diagnosis and treatment and hence potentially life-threatening complications. Not only should patients taking an SGLT-2i be informed about the risk of euDKA, and be provided with SGLT-2i sick day management education, but clinicians should also be alert to this diagnosis.

Clinical research potential in Victorian hospitals: the Victorian clinician researcher needs analysis survey

BACKGROUND

The 2012 McKeon Review highlighted the role of clinician researchers in patient based research and the need to foster this capacity. While anecdotal evidence suggests that clinician researchers are under threat and underfunded, Australian data on barriers and enablers of clinician-led research are scant.

AIMS

To describe (i) characteristics of clinician researchers; (ii) for research-active clinicians: areas of research, barriers/enablers of research and factors associated with funding success; and (iii) for research-inactive clinicians: enablers of future research.

METHODS

An online survey distributed through the Bio21 Cluster to clinicians (doctors, nurses, allied health professionals) in 15 Victorian hospitals between November 2011 and January 2012.

RESULTS

Seven hundred and seventy of 1027 (75%) of respondents were research-active and were more likely to be male, medical doctors, aged 45-54 years, to work full-time and have a higher degree (all P < 0.01). Of clinicians with a higher degree, 28% were research-inactive. Clinicians identified protected research time (50%), designated research space (42%), clinical trial coordinators (35%), institutional funding (34%) and mentoring (33%) as critical enablers of research. Research-inactive clinicians identified protected research time as the key enabler of future research.

CONCLUSIONS

To realise recommendations in the McKeon Review, hospitals and research bodies will need to protect research time and provide space and funding. Engaging research-inactive clinicians will build research capacity.

Carbimazole-induced agranulocytosis: does antineutrophil cytoplasmic antibody have a role?

Carbimazole is a drug that is widely used for hyperthyroid disorders, such as Graves' disease. Agranulocytosis is a rare idiosyncratic adverse reaction to the drug which is potentially fatal. This report describes a patient with a history of successfully treated pyoderma gangrenosum, who developed agranulocytosis 3 weeks after commencement of carbimazole for Graves' disease. It may give credence to the theory that implicates antineutrophil cytoplasmic antibodies in the pathogenesis of agranulocytosis induced by antithyroid drugs.

[Pulmonary hypertension and right ventricular failure. Part X. Prostanoids in the treatment of primary pulmonary arterial hypertension]

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. The tenth communication contains consideration of results of controlled trials of prostacyclin and its synthetic analogues in patients with primary (idiopathic) PAH, and PAH associated with diffuse diseases of connective tissue, congenital heart disease, HIV-infection. Continuous intravenous infusion of prostacyclin (epoprostenol) has made a revolution in the treatment of patient with severe PAH because its long-term use is associated with improvement of survival of patients refractory to high doses of calcium antagonists. Subcutaneous administration of treprostinil and especially inhaled iloprost substantially widen possibilities of prolonged use of prostanoids in patients with various forms of PAH. Literature data on application of different prostanoids for long term treatment of patients with PAH, their side effects, indications and counterindications for their administration are analyzed in this communication.

[Pulmonary hypertension and right ventricular failure. Part XIII. Surgical methods of treatment of various forms of pulmonary arterial hypertension]

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. The 13-th communication contains consideration of surgical and interventional procedures used in treatment of patients with severe PAH when drug therapy is not feasible or ineffective. Discussion of criteria of selection of patients for lung transplantation, balloon atrial septostomy, and pulmonary thromboendarterectomy, as well as immediate and long term results of these surgical interventions is also presented. Balloon atrial septostomy is usually performed as a " bridge " to lung transplantation. Pulmonary thromboendarterectomy is used in patients with severe PAH caused by chronic pulmonary artery thromboembolism when 3 month intravenous therapy with epoprostenol turns out to be ineffective.

[Pulmonary hypertension and right ventricular failure. Part XII. Nitrous oxide and phosphodiesterase inhibitors in the treatment of primary pulmonary arterial hypertension]

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. The twelfth communication contains consideration of inhaled nitrous oxide and three available inhibitors of phosphodiesterase type 5 (sildenafil, tadalafil, and vardenafil). The place of nitrous oxide in diagnostics and short term treatment of PAH is discussed. Analysis of results of randomized controlled studies assessing efficacy and safety of sildenafil in patients with primary (idiopathic) PAH and PAH associated with connective tissue diseases and congenital heart diseases with systemic-to-pulmonary shunts is presented.

[Pulmonary hypertension and right ventricular failure. Part IX. Traditional therapy of primary pulmonary arterial hypertension]

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension (PH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the nine communication they describe presentations of PH and methods of its instrumental diagnostics. This part also contains discussion of problems of differential diagnosis of diseases which can be complicated by PH, contemplation of natural course of primary (idiopathic) PH and factors determining its prognosis.

First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey

Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency. However, infection with N. otitidiscaviarum and pulmonary nocardiosis in an immune-competent host remains very rare. We report a 65-year-old immune-competent male with pulmonary N. otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim-sulfomethaxazol. This is the first report of pulmonary N. otitidiscaviarum infection in an immune-competent patient from Turkey.

Removal of mercury (II) from aqueous solution by activated carbon obtained from furfural

The adsorption of Hg(II) from aqueous solution at 293 K by activated carbon obtained from furfural is studied. The carbon is prepared by polymerization of furfural following carbonization and activation of the obtained polymer material with water vapor at 800 degrees C. Adsorption studies of Hg(II) are carried out varying some conditions: treatment time, metal ion concentration, adsorbent amount and pH. It is determined that Hg(II) adsorption follows both Langmuir and Freundlich isotherms. The adsorption capacity of the carbon is 174 mg/g. It is determined that Hg(II) uptake increases with increasing pH. Desorption studies are performed with hot water. The percent recovery of Hg(II) is 6%.

Churg-Strauss syndrome in an HCV seropositive patient

Churg-Strauss syndrome was considered rare until leukotriene modifiers were introduced into medical practice in 1996. Since then, an increasing number of reports considering a possible relationship between leukotriene receptor antagonists and the Churg-Strauss syndrome have been published. Hepatitis C virus (HCV) is a blood-borne infection and a major health problem with an increasing prevalence worldwide. Previously, numerous reports suggested a relationship between HCV and certain autoimmune disorders such as cryoglobulinaemia and polyarteritis nodosa. We present a patient with HCV seropositive Churg-Strauss syndrome and a history of systemic corticosteroid and leukotriene receptor antagonist use, and discuss the possible risk factors in the aetiology of Churg-Strauss syndrome.

Epidemiological, clinical and laboratory features of brucellosis: a prospective evaluation of 120 adult patients

This prospective study was carried out in the department of infectious diseases of Gaziantep University between January 1997 and December 1999 to evaluate the epidemiological, clinical and laboratory features of brucellosis in south-eastern Turkey. One hundred and twenty consecutive patients with active brucellosis were enrolled. The commonest way of transmission was ingestion of milk products from diseased animals. Brucella melitensis was isolated in the specimens of 31 (45.5%) of 68 patients. The commonest abnormalities on physical examination were fever (66.6%), hepatomegaly (63.3%) and splenomegaly (56.6%). Osteoarticular involvement was found in 34 patients (28.3%). Fifteen (12.5%) patients had ocular involvement. Hepatitis, orchiepididymitis, pulmonary involvement and meningitis were found in one (0.8%), four (6.8%), three (2.5%) and one (0.8) patient, respectively. The commonest haematological abnormalities were relative lymphomonocytosis (71.6%) and anaemia (36.6%). In conclusion, brucellosis continues to be a common health problem in communities where the consumption of unpasteurised dairy products is common. Since prevention is as important as early diagnosis in reducing the morbidity of brucellosis, we suggest that improving current health policies with additional educational programmes is essential.

The incidence of exercise-induced bronchospasm in competitive figure skaters

Pediatric commitment to competitive sports is on the rise. Previous reports of the incidence of exercise-induced bronchospasm (EIB) have investigated high school, college, and Olympic athletes in traditional sports. The purpose of this study was to investigate the incidence of EIB in competitive figure skating, a high-intensity, cold-weather sport performed by young athletes. To investigate the incidence of EIB in skaters, 100 competitive skaters from five Mid-Atlantic rinks completed rinkside pulmonary function tests. Results showed an overall incidence of 30%, signaling the need for education and screening for EIB in youth participating in physically demanding, cold-weather sports.

Comparison of a single dose of aerosol salbutamol and fenoterol/ipratropium on bronchial asthmatic patients

A combination dose aerosol of fenoterol hydrobromide (200 micrograms) and ipratropium bromide (80 micrograms) was compared with aerosolized salbutamol (200 micrograms) in 10 stable asthmatic patients. With both treatments a statistically significant improvement was noticed in both FEV1 and PEF measurements starting after 15 minutes and continuing until 330 to 360 minutes. No statistically significant differences in one second Forced Vital Capacity (FEV1) and Peak Expiratory Flow (PEF) was noted between the two treatments. No side effect was noticed. As a result, it was concluded that in bronchial asthmatic patients, the bronchodilator effects of the combination of a beta-2 agonist with anticholinergic drugs was as effective and lasted as long as salbutamol. This combination, in order to prevent cardiovascular complications, could be selected as a suitable treatment for those patients who need high doses of beta-2 agonist drugs.