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Although adult respiratory distress syndrome (ARDS) is a complication common to both ketotic and non-ketotic diabetic decompensation (1), being arguably attributable to the development of adverse osmotic gradients which generate pulmonary oedema (2), the fact that ARDS is much commoner in diabetic ketoacidosis (DKA) than in hyperosmolar non-ketotic (HONK) diabetic decompensation (3)(4)(5) suggests that th...
Although adult respiratory distress syndrome (ARDS) is a complication common to both ketotic and non-ketotic diabetic decompensation (1), being arguably attributable to the development of adverse osmotic gradients which generate pulmonary oedema (2), the fact that ARDS is much commoner in diabetic ketoacidosis (DKA) than in hyperosmolar non-ketotic (HONK) diabetic decompensation (3)(4)(5) suggests that the discrepancy in prevalence might be attributable to risk factors unique to DKA.
Support for the view that acidosis may be an important risk factor comes from the documentation that the association of tachypnoea and metabolic acidosis can give rise to pulmonary oedema in the animal model of ARDS (6). In humans it has been suggested that the microangiopathy, and, hence, increased capillary permability, documented in the skeletal muscle of diabetic patients might have, as its corollary, an increase in capillary permeability in the presence of ketoacidosis (7). Accordingly, metabolic acidosis and its corollary, ketoacidosis, might be the additional risk factor rendering patients with DKA more liable than their counterparts with HONK to ARDS.
References (1) Kearney T and Dang C. Diabetic and endocrine emergencies. Postgraduate Medical Journal 2007:83:79-86
(2) Kitabachi AE and Wall BM. Diabetic ketoacidosis.
Medical Clinics of North America 1995:79:9-37
(3) Lorber D. Nonketotic hypertonicity in diabetes mellitus. Medical Clinics of North America 1995:79:39-52
(4)Carroll P and Matz R. Adult respiratory distress syndrome complicating severely uncontrolled diabetes mellitus:report of nine cases and a review of the literature
Diabetes care 1982:5:574-80
(5) Marshall SM and Alberti KGMM. Hyperosmolar non-ketotic diabetic coma. The Diabetes Annual 1988;4:235-247
(6) Sinha R., Tinka MA., Hizou R et al. Metabolic acidosis and lung mechanics in dogs. American review of Respiratory diseases 1972:106-881
(7) Brun-Buisson CJL., Bonnet F., Bergeret S., Lemaire F., Rapin M. Recurrent high-permeability pulmonary edema associated with diabetic ketoacidosis. Critical Care Medicine 1985:13:55-56
In the discussion on the medical management of benign prostatic
hyperplasia [1], it was an omission not to make mention of the role of the ingestion of cranberry juice in reducing the recurrence rate of urinary tract infection and/or bacteriuria. The reported antibacterial properties of cranberry juice are attributable to its ability to inhibit bacterial adherence [2], and this has translated into a 12%-2...
In the discussion on the medical management of benign prostatic
hyperplasia [1], it was an omission not to make mention of the role of the ingestion of cranberry juice in reducing the recurrence rate of urinary tract infection and/or bacteriuria. The reported antibacterial properties of cranberry juice are attributable to its ability to inhibit bacterial adherence [2], and this has translated into a 12%-20% reduction in recurrence rate of urinary tract infection(UTI)[3],[4] and a 42% reduction in bacteriuria [3] in adult women. There is no reason to assume that these
results can not be extrapolated to men with benign prostatic hyperplasia, and the benefit might well be that there would be one less indication for transurethral resection of the prostate [5].
References
(1) Connolly SS., Fitzpatrick JM. Medical management of benign prostatic hyperplasia. Postgraduate Medical Journal. 2007:83:73-78
(2) Schmidt DR., Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates. Microbios 1988:55:173-81
(3) Raz R., Chazan B., Dan M. Cranberry juice and urinary tract infection. Clinical Infectious Diseases 2004:38:1413-9
(4) Kontiokari T., Sundqvist K., Nuutinen M.,et al.
Randomised trial of cranberry-lingonberry juice and lactobacillus GG drink for the prevention of urinary tract infections in women.British Medical Journal 2001:322:1-5
(5) Thorpe A., Neal D. Benign prostatic hyperplasia
Lancet 2003:361:1359-67
I am an SHO in the 'old' system. I believe the MMC has certain advantages but I have some serious concerns as well.
The maintenance of a personal portfolio and more time and attention from the educational supervisors sounds quite good.
The concerns are:
1. The training period for acquiring the generic skills varies from person to person. The move from time- based to competency-based training resulting in the curtailing of SHO training raises serious concerns.
2. Considering a particular speciality, for example medicine, six months gives more time to enjoy the specialty, learn the basics, acquire specific
skills and finally decide which specialty to pursue for further training.
3. With the old SHOs undergoing a transition now, the competition is unfair because SHOs with one year's experience are competing with those with 2.5-3 years' experience at the ST2 level.
4. F2 trainees have protected teaching times which range from half a day up to a full day which will compromise the quality of the patient care. Doctors should have protected teaching times, but ward work and
patient care should not be compromised at any cost because that is the difference between a medical student and a PRHO or an SHO.
5. The role of membership exams is still not very clear.
Dear Editor,
Although adult respiratory distress syndrome (ARDS) is a complication common to both ketotic and non-ketotic diabetic decompensation (1), being arguably attributable to the development of adverse osmotic gradients which generate pulmonary oedema (2), the fact that ARDS is much commoner in diabetic ketoacidosis (DKA) than in hyperosmolar non-ketotic (HONK) diabetic decompensation (3)(4)(5) suggests that th...
Dear Editor,
In the discussion on the medical management of benign prostatic hyperplasia [1], it was an omission not to make mention of the role of the ingestion of cranberry juice in reducing the recurrence rate of urinary tract infection and/or bacteriuria. The reported antibacterial properties of cranberry juice are attributable to its ability to inhibit bacterial adherence [2], and this has translated into a 12%-2...
Dear Editor,
I am an SHO in the 'old' system. I believe the MMC has certain advantages but I have some serious concerns as well.
The maintenance of a personal portfolio and more time and attention from the educational supervisors sounds quite good. The concerns are:
1. The training period for acquiring the generic skills varies from person to person. The move from time- based to competency-bas...
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