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An Asian woman with blurred vision
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Impaired vision and failing eyesight are important issues to the health and well-being of many people. In the UK, cataracts remain the most common cause of visual impairment in the elderly. Cataract extraction continues to be one of the most common and successful surgical procedures, largely due to the development of small-incision surgery and faster rehabilitation. Diabetes predisposes to the early development of both cataracts and retinopathy, and visual impairment is frequently a feature of the disease. This scenario uses the backdrop of type 2 diabetes to explore visual impairment, specifically cataracts and diabetic retinopathy.
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Small fiber predominant peripheral neuropathy occurs when small fibers in the peripheral nervous system are damaged. In the skin, these fibers normally relay pain and temperature. In body organs, they regulate heart rate, breathing, and other automatic functions. Small fiber peripheral neuropathy can signify diabetes mellitus, or may have no underlying cause. It may be one of the earliest signs of prediabetes. Small fiber neuropathy causes pain, burning, and tingling that usually begin in the feet and progress upwards, potentially becoming severe.
Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
The standard assessment tool for peripheral neuropathy is 10 gm Semmes-Weinstein monofilament – insensitivity to the 10 gm monofilament is associated with ×1.8 increased relative risk of DFU development (3). Characteristically, small fibre neuropathy develops first causing abnormalities of pain and temperature perception, followed by large fibre sensory neuropathy resulting in loss of vibration, touch, and proprioception and cutaneous autonomic neuropathy leading to abnormal sweating and dry skin. Motor neuropathy along with sensory neuropathy, may lead to the development of foot deformities, gait abnormalities and balance disorders. The presence of diabetic peripheral neuropathy is also key to the development of Charcot neuroarthropathy (CN).
Maintaining a ‘fit’ immune system: the role of vaccines
Published in Expert Review of Vaccines, 2023
Béatrice Laupèze, T. Mark Doherty
It has long been recognized that the immune system ‘learns’ by adapting to new antigens on exposure, and responding to them as either potentially pathogenic, harmless, or somewhere on a spectrum in-between. The possible outcomes of this learning process – among them, immunity to infection, allergy, or tolerance – shape many aspects of our overall health. For some pathogens, a single infectious episode can lead to lifelong immunity, indicating that the immune system has learnt to effectively neutralize subsequent exposures to the same pathogen. The ability of the immune system to ‘learn’ underlies the concept of vaccination, whereby a small dose of a target antigen or modified pathogen teaches the immune system to recognize the same antigen/pathogen when exposed to it at a later date, and to reproduce a highly specific protective immune response that prevents disease on subsequent exposure.
A rare complication of laparoscopic Roux-en-Y gastric bypass: case report of gastric remnant necrosis
Published in Acta Chirurgica Belgica, 2023
Astrid Rycx, Hendrik Maes, Yves Van Nieuwenhove
In the first place, small bowel obstruction is a relatively common complication after a LRYGB and can have several causes including hernias, adhesions and stenosis or narrowing at the jejunojejunostomy or the gastrojejunostomy [1,3,5]. Small bowel obstruction due to a stenosis or a kinking at the jejunojejunal anastomosis can result in an important dilatation of the gastric remnant, especially when the biliopancreatic limb is involved. This phenomenon can be compared to the afferent limb syndrome, which is known to be a severe complication after a Billroth II procedure but can in fact occur after every surgery in the stomach region with the construction of an afferent limb. Afferent limb syndrome presents with severe epigastric pain, nausea, vomiting and when left untreated, evolves towards symptoms of shock, peritonitis and necrosis or perforation. Acute dilatation of the gastric remnant due to small bowel obstruction can cause a compromised blood flow and result in necrosis [1–6]. This is certainly a valuable hypothesis for the presented case.
Advances in ophthalmic drug delivery technology for postoperative management after cataract surgery
Published in Expert Opinion on Drug Delivery, 2022
Kangmin Lee, Gahye Lee, Soomin Lee, Choul Yong Park
Complete healing of the incision wound after cataract surgery takes between 10 days and 2 weeks [11]. Most modern cataract surgery techniques, such as phacoemulsification, use a small corneal incision that is less than 3.5 mm in most cases. This small incision can prevent aqueous humor from leaking through the incision without suturing. A hydrosealing technique, which injects fluid around the incision and induces corneal edema, can close the incision without sutures. The incision will not reopen with a natural blinking motion or eyelid contact unless localized high pressure is applied to the incision area [12]. However, even if there is no visible wound leak with hydrosealing at the surgical table, microscopic weak fluid leakage is unexpectedly common, and according to one report, microscopic leakage was observed on the day of surgery in 31% of patients [13]. Fortunately, the microscopic leakage disappeared when observed one week after the surgery in the same study [13], but as long as the microscopic leak persists, the passageway through which bacteria on the ocular surface can cause intraocular infection remains open [14]. With hydrosealing, it is not uncommon to observe iris incarceration through corneal incision on the day after surgery, and a case of late iris prolapse (two weeks after the surgery) through the corneal incision after severe vomiting has also been reported [15].