Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) and posterior cerebral artery ischaemic event : two uncommon complications following posterior fossa decompression

Neurosurgical procedures in cases of Type 1 Arnold Chiari Malformation (ACM) may result in a wide spectrum of complications. We report a case of a sixty-four year lady who underwent an elective posterior fossa decompression for Type 1 ACM. The procedure was complicated by syndrome of inappropriate anti-diuretic hormone secretion (SIADH) and an ischaemic cerebrovascular event affecting the posterior cerebral artery. The association of these complications with the procedure is rarely described in the literature. In spite of the poor prognosis associated with such complications, the patient made a relatively quick and uneventful recovery.peer-reviewe

A large pericardial effusion and bilateral pleural effusions as the initial manifestations of Familial Mediterranean Fever

Familial Mediterranean Fever (FMF) is a condition characterized by recurrent febrile poly-serositis. Typical presentations of the disease include episodes of fever, abdominal pain and joint pains. Chest pain is a less common presentation. We report a case of FMF which presented with a large pericardial effusion and bilateral pleural effusions in a lady who had no positive family history and negative genetic testing.peer-reviewe

Sodium-glucose co-transporter 2 (SGLT2) inhibitors

Type 2 diabetes mellitus is a progressive metabolic disorder. Marked hyperglycaemia leads to serious vascular complications. Hence, addressing this modifiable risk factor is of paramount importance. Sodium-glucose co-transporter 2 (SGLT2) inhibitors represent a relatively new class of antidiabetic agents. They offer an intermediate glucose-lowering effect and through other pleiotropic effects provide cardiac and renal benefits. This review focuses on the mechanism of action, benefits and adverse effects of SGLT2 inhibitors. The authors also delineate the ideal type 2 diabetic candidate to receive SGLT2 inhibitors. This is critical as SGLT2 inhibitors should not be used in a ‘one-size-fits-all approach’ but their use should be individualized based on certain patient characteristics. This patient-centred approach aims at maximizing the benefits and reduce the risks associated with SGLT2 inhibitors.peer-reviewe

Predictors of correct technique in patients using pressurized metered dose inhalers

Background: Correct inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients. Methods: Two hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical. Results: 23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p= 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06). Conclusions: Known predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error.peer-reviewe