A history of blood glucose meters and their role in self-monitoring of diabetes mellitus.

Self-monitoring blood glucose (SMBG) systems have the potential to play an important role in the management of diabetes and in the reduction of risk of serious secondary clinical complications. This review describes the transition from simple urine sugar screening tests to sophisticated meter and reagent strip systems to monitor blood glucose. Significant developments in design and technology over the past four decades are described since the first meter was introduced in 1970. Factors that have influenced this evolution and the challenges to improve analytical performance are discussed. Current issues in the role of SMBG from the clinical, patient and manufacturer perspectives, notably adherence, costs and regulations, are also considered.

Composition and energy harvesting capacity of the gut microbiota: relationship to diet, obesity and time in mouse models.

BACKGROUND AND AIMS: Increased efficiency of energy harvest, due to alterations in the gut microbiota (increased Firmicutes and decreased Bacteroidetes), has been implicated in obesity in mice and humans. However, a causal relationship is unproven and contributory variables include diet, genetics and age. Therefore, we explored the effect of a high-fat (HF) diet and genetically determined obesity (ob/ob) for changes in microbiota and energy harvesting capacity over time. METHODS: Seven-week-old male ob/ob mice were fed a low-fat diet and wild-type mice were fed either a low-fat diet or a HF-diet for 8 weeks (n=8/group). They were assessed at 7, 11 and 15 weeks of age for: fat and lean body mass (by NMR); faecal and caecal short-chain fatty acids (SCFA, by gas chromatography); faecal energy content (by bomb calorimetry) and microbial composition (by metagenomic pyrosequencing). RESULTS: A progressive increase in Firmicutes was confirmed in both HF-fed and ob/ob mice reaching statistical significance in the former, but this phylum was unchanged over time in the lean controls. Reductions in Bacteroidetes were also found in ob/ob mice. However, changes in the microbiota were dissociated from markers of energy harvest. Thus, although the faecal energy in the ob/ob mice was significantly decreased at 7 weeks, and caecal SCFA increased, these did not persist and faecal acetate diminished over time in both ob/ob and HF-fed mice, but not in lean controls. Furthermore, the proportion of the major phyla did not correlate with energy harvest markers. CONCLUSION: The relationship between the microbial composition and energy harvesting capacity is more complex than previously considered. While compositional changes in the faecal microbiota were confirmed, this was primarily a feature of high-fat feeding rather than genetically induced obesity. In addition, changes in the proportions of the major phyla were unrelated to markers of energy harvest which changed over time. The possibility of microbial adaptation to diet and time should be considered in future studies.

Emergency department follow-up of bereaved relatives: an audit of one particular service.

BACKGROUND: Although much has been written about the treatment of bereaved relatives in emergency departments, very little has been published about their follow-up after they have left the department. METHODS: One model of follow-up is described, in which relatives are invited to a meeting in the department 4-6 weeks after their loss. In this model, it is emphasised that the follow-up is not a counselling session but an opportunity to ask questions, and an audit of the service is presented. RESULTS AND CONCLUSION: It is suggested that the provision of information is theoretically beneficial to the bereavement process.

Early carbon monoxide intoxication: happy to be poisoned?

Carbon monoxide poisoning is the commonest cause of death by poisoning in the UK and chronic exposure is thought to be a frequently missed diagnosis. Early recognition of carbon monoxide poisoning is vital to institute prompt treatment and to prevent exposure to others. An incident of mass exposure to carbon monoxide is presented where euphoria, lasting several hours, was the only symptom reported in approximately one quarter of the casualties. This has not been reported previously and we believe that mild carbon monoxide intoxication should be included in the list of differential diagnoses of inappropriate euphoria.

Naloxone in opioid poisoning: walking the tightrope.

Acute opioid intoxication and overdose are common causes of presentation to emergency departments. Although naloxone, a pure opioid antagonist, has been available for many years, there is still confusion over the appropriate dose and route of administration. This article looks at the reasons for this uncertainty and undertakes a literature review from which a treatment algorithm is presented.

Core-peripheral temperature gradient as a diagnostic test in dyspnoea.

OBJECTIVES: To evaluate whether the core-peripheral temperature gradient could be used to distinguish between cardiac and respiratory causes of dyspnoea. METHODS: In total, 50 patients were enrolled in the study, based on the following inclusion criteria: (a) a primary presenting complaint of dyspnoea; (b) age > 40 years; (c) respiratory rate > 20 breaths/min; (d) hypoxia. The tympanic temperature and the temperature of the nasal tip were recorded, and the patient's discharge data and chest x ray results checked. Where there was discordance, arbitration was carried out by another researcher. RESULTS: Four patients were excluded, hence the final study sample was 46 patients. There was a statistically significant difference between the mean temperature gradients of the two study populations (p < 0.001). A gradient of > 8 degrees C was able to rule in a cardiovascular cause (92% specificity) whereas one of < 5 degrees C could rule it out (100% sensitivity). CONCLUSION: The test is safe, non-invasive and inexpensive. Although there were some limitations to the study, the test can still be commended as a useful adjunct to the emergency assessment of the acutely breathless patient.

Sensory ataxia associated with chronic organophosphate pesticide exposure.

Organophosphorus compounds are widely used in agriculture and industry. Although the immediate and delayed effects of acute exposure have been well described, the clinical sequelae of chronic, low-dose exposure are less certain. This paper describes the case of a farmer who had been exposed to a variety of organophosphate pesticides over a 30-year period, and developed sensory ataxia, which has not previously been described. She was found to have an abnormal cholinesterase phenotype. Mechanisms of possible increased sensitivity to these compounds are discussed which may, in future, allow certain occupational groups to be screened.