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.

Change in emotional eating after bariatric surgery: systematic review and meta-analysis.

BACKGROUND: The effect of bariatric surgery on 'emotional eating' (EE) in people with obesity is unclear. This systematic review and meta-analysis aimed to examine changes in self-reported emotional eating behaviour after bariatric surgery. METHODS: Fifteen electronic databases were searched from inception to August 2019. Included studies encompassed patients undergoing primary bariatric surgery, quantitatively assessed EE, and reported EE scores before and after surgery in the same participants. Studies were excluded if they were not in English or available in full text. The systematic review and meta-analysis were conducted according to the PRISMA guidelines. Random-effects models were used for quantitative analysis. Study quality was assessed using the National Heart, Lung, and Blood Institute quality assessment tool for before-after (pre-post) studies with no control group. RESULTS: Some 23 studies containing 6749 participants were included in the qualitative synthesis, with follow-up of from 2 weeks to 48 months. EE scores decreased to 12 months after surgery. Results were mixed beyond 12 months. Quantitative synthesis of 17 studies (2811 participants) found that EE scores decreased by a standardized mean difference of 1·09 (95 per cent c.i. 0·76 to 1·42) 4-18 months after surgery, indicating a large effect size. CONCLUSION: Bariatric surgery may mitigate the tendency to eat in response to emotions in the short to medium term.

ANTECEDENTES: El efecto de la cirugía bariátrica sobre la "alimentación emocional" (emotional eating, EE) en personas con obesidad no esta claro. Esta revisión sistemática y metaanálisis tuvo como objetivo examinar los cambios en el comportamiento de la alimentación emocional referida por los mismos pacientes después de cirugía bariátrica. MÉTODOS: Se realizó una búsqueda en 15 bases de datos electrónicas desde el inicio de las mismas hasta agosto de 2019. Los estudios seleccionados incluían pacientes con cirugía bariátrica primaria, EE evaluada de forma cuantitativa, y descripción de las puntuaciones de EE antes y después de la cirugía en los mismos participantes. Se excluyeron estudios que no estuvieran publicados en inglés o si no se disponía del texto completo. Esta revisión sistemática y metaanálisis se llevó a cabo de acuerdo con las recomendaciones PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Se utilizó un modelo de efectos aleatorios para el análisis cuantitativo. La calidad de los estudios individuales se evaluó utilizando la herramienta de evaluación de la calidad NHLBI para estudios de antes-después (pre-post) sin grupo control. RESULTADOS: Se incluyeron un total de 23 estudios con 6.749 participantes en la síntesis cualitativa, y un seguimiento de 2 semanas a 48 meses. Las puntuaciones EE disminuyeron a los 12 meses postoperatorios. Los resultados fueron variados más allá de los 12 meses. La síntesis cuantitativa de 17 estudios (2.811 participantes) encontró que las puntuaciones EE disminuyeron con una diferencia de medias ponderada de 1,09 (i.c. del 95% 0,76, 1,42) a los 4-18 meses tras la operación, lo que indica una magnitud de efecto grande. CONCLUSIÓN: La cirugía bariátrica puede atenuar la tendencia a comer en respuesta a las emociones en el corto y medio plazo.

Liver transplantation for the treatment of homozygous familial hypercholesterolaemia in an era of emerging lipid-lowering therapies.

Homozygous familial hypercholesterolaemia (FH) causes severe premature coronary artery disease because of very high levels of low density lipoprotein (LDL)-cholesterol. Standard lipid-lowering drugs and LDL-apheresis may not be sufficiently effective. Liver transplantation replaces defective LDL receptors and vastly improves the lipid profile, and we present the first report of an Australian adult to receive this treatment. Emerging drug treatments for FH may be alternatives to LDL-apheresis and transplantation, but long-term safety and efficacy data are lacking for all of these options.

Neurological manifestations of cardiac myxoma: a review of the literature and report of cases.

BACKGROUND AND AIMS: Cardiac myxoma is a rare but important cause of stroke, which affects young people. More recently the diagnosis has been enhanced by the use of echocardiograms. We aimed to review the neurological presentations, including stroke, of cardiac myxoma in this modern era of diagnosis and management. METHODS: Records of patients with neurological presentations at the Austin and Repatriation Medical Centre and The Northern Hospital were retrieved from 1985 to late 2001, using International Classification of Diseases codes for atrial myxoma. Published literature reports were obtained by using Medline search database. An iterative process of bibliography review was utilised to identify reports not found by primary search. Case demographics, neurological presentations, investigations, treatment and outcome were recorded. RESULTS: From the Austin and Repatriation Medical Centre and The Northern Hospital, 6 cases were reported in detail and 107 cases from the published literature were analysed. The mean age of all cases was 43 (range 6-82). There was a female to male predominance (3:2). While there were overlapping neurological presentations, the most common presentation was ischaemic stroke (83% of all patients) most often in multiple sites (41%). The other presentations included syncope (28%), psychiatric presentations (23%), headache (15%) and seizures (12%). Commonest means of reaching the diagnosis was by echocardiography. The myxoma was surgically resected in 69% of cases. Of all cases, 24% were autopsy reports, almost all prior to availability of echocardiograms (in mid-1970s). CONCLUSIONS: Patients who presented with neurological complications of cardiac myxoma were young and stroke was by far the most common single presentation. Importantly, when all clinical manifestations were considered, almost half were potentially reversible. In recent years, echocardiography has made significant contribution to establishing the diagnosis less invasively. There is uncertainty about the role of anticoagulants. The treatment of choice remains surgical excision, although the timing post stroke is debatable. There is a need for large scale collaborative studies to help refine management strategies.

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.