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Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and noninfective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes. [ABSTRACT FROM AUTHOR]

Peri-operative hyperglycaemia, whether the cause is known diabetes, undiagnosed diabetes or stress hyperglycaemia, is a risk factor for harm, increased length of stay and death. There is increasing evidence that peri-operative hyperglycaemia is a modifiable risk factor, and many of the interventions required to improve the outcome of surgery must be instituted before the actual surgical admission. These interventions depend on communication and collaboration within the multidisciplinary team along each stage of the patient journey to ensure that integration of care occurs across the whole of the patient-centred care pathway. [ABSTRACT FROM AUTHOR]

The authors examine the anaesthetist's goal of facilitating drinking, eating and mobilizing (DREAMing) in patients in the immediate post-operative period. They discuss the practice of assessing the quality of a patient's recovery and its implications for anaesthetists. They also describe the role of DREAMing in facilitating earlier hospital discharge.

Background and purpose To describe the long-term follow-up of a cohort of 22 patients with the Miyoshi phenotype of distal muscular dystrophy ( MMD). Methods A long-term clinical follow-up study was conducted. Patients were genotyped for dysferlin ( MMD1) or anoctamin 5 ( MMD3) mutations. Patients also underwent cardiological evaluation. Results There were 10 patients with MMD1, eight patients with MMD3 and four patients with linkage to chromosome 10 ( MMD2). All patients deteriorated over 5.7 (range: 4.2-6.6) years of follow-up. Weakness increased significantly ( P < 0.035) in all but the neck extensor, serratus anterior, and wrist flexor and extensor muscles. The decrease of strength was most pronounced in the iliopsoas (15%), toe extensors (15%), anterior tibial and peroneal muscles (10%). Patients with MMD1 showed early onset of the disease (mean 22 years) with typically symmetrical distribution of weakness starting in the calf muscles. Patients with MMD1 had a worse clinical course compared with patients with MMD3. Ninety percent of the former had to make use of a wheelchair within 15 years after onset of the disease, whereas patients with MMD3, who have a significantly later onset (mean 35 years) of asymmetrical calf muscle weakness and atrophy, remained ambulant during the first 15 years of their disease. None of the patients with MMD2 became fully confined to the wheelchair. None of the 22 MMD phenotype patients had heart disease. Conclusions Patients with MMD1 have a worse clinical course compared with patients with MMD3. There are no cardiological abnormalities in all MMD categories. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 420-433 (2012) Abstract These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 420-433 (2012) Abstract These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery. [ABSTRACT FROM AUTHOR]

The article discusses the management of a patient with chlorhexidine anaphylaxis. Topics discussed include the patient's contact with chlorhexidine during general anaesthesia and surgery, the patient's symptoms which include tachycardia, hypotension and widespread erythematous rash, and the cardiac stabilization of the patient.

The author comments on an article about conducting xenotransplantation on patients in persistent vegetative state (PVS) that was published in a previous issue of the "Journal of Medical Ethics." He claims that it is unethical and much better if the terminally ill patients will be used instead because their body would response more. He adds that terminally ill patients can prolong their life from the process while patients in PVS cannot.

Abstract: Limb girdle muscular dystrophy 2H is a rare autosomal recessive muscular dystrophy, clinically highly variable, caused by mutations in the TRIM32 gene. Here we describe a 35-years-old who experienced progressive muscle weakness. The muscle biopsy revealed an unspecific pattern of atrophic and hypertrophic fibers; the immunohistochemistry for several proteins was normal. Comparative genomic hybridization (CGH) analysis showed a heterozygous deletion of the entire TRIM32 gene. On the other allele we identified the R316X nonsense mutation. The genetic diagnosis of LGMD2H in this case was reached by using a novel high throughput diagnostic tool. [Copyright &y& Elsevier]

Facio Scapulo Humeral Dystrophy (FSHD) is a muscle disease that asymmetrically affects flat muscles. Non-muscle symptoms are deafness and retinopathies. Defects very evocative of FSHD have been observed in mouse model partially deficient for FAT1. In addition, genetic screening of neuromuscular disease patients enabled us to identify the FAT1 mutations in FSHD-like patients. The family of FAT protocadherins (FAT 1–4) is well known to be involved in the Wnt/PCP and in the Hippo pathway in Drosophila, while it plays key roles in homeostasis of mammalian tissues. FAT1 expression is localized in developing limb buds, somites and neural tube as well as in adult kidney. Based on these data and on our previous results, we postulated that FAT1 plays a role in generation and homeostasis of flat muscle tissues. To understand which proteins compose the transduction pathway led by FAT1 in mammals, we first looked at the stability and activation of YAP transcription factor in the Hippo pathway. Although preliminary, results confirmed that FAT1 overexpression affects YAP/TAZ phosphorylation, nuclear localization and transcriptional activity, which may stop cell proliferation and affect cell polarity. Indeed, localization of YAP/TAZ depends from elasticity of the cellular environment through signal transduction from the extracellular matrix (ECM). In mesenchymal stem cells, TAZ and YAP are cytoplasmic when cells are on flexible substrates while nuclear on rigid matrices. Therefore, we plan to test muscle cells reaction to different levels of matrix rigidity and to measure functional consequences of FAT1 alterations to these mechanical stresses. In perspective, our observations will help explain the molecular mechanism involved in the differentiation and tissue response to cellular environment. Moreover, FAT1 alteration may lead to modification of ECM stiffness perception during flat muscle fibers development, thus contributing to pathological mechanism of FSHD. [ABSTRACT FROM AUTHOR]