{"title":"Management of pre-gestational diabetes in pregnancy","authors":"","doi":"10.1016/j.mpmed.2024.07.007","DOIUrl":"10.1016/j.mpmed.2024.07.007","url":null,"abstract":"<div><div>Pre-gestational diabetes – type 1 and type 2 diabetes mellitus – affects 1.7% of all pregnancies in the UK, and 1.3% of all pregnancies worldwide. In the UK there are now more pregnancies in women with type 2 than type 1 diabetes mellitus. Pre-gestational diabetes is associated with increased maternal and fetal risk including congenital abnormalities, stillbirth and pre-eclampsia; diabetic ketoacidosis also affects >1% of pregnancies. There are three targets for pre-pregnancy to reduce complications: glycated haemoglobin <48 mmol/mol (6.5%); folic acid 5 mg for at least 1 month before pregnancy; and avoidance of all teratogenic drugs. In pregnancy, tight glycaemic control is recommended, with a target blood glucose range of 3.5–7.8 mmol/litre. Increased doses of insulin are required through the course of pregnancy because of increasing insulin resistance. Childbirth is generally recommended in all those with pre-gestational diabetes between 37 and 38<sup>+6</sup> weeks because of the risk of stillbirth and other complications. Continuous glucose monitoring and hybrid closed-loop insulin delivery systems have been shown to improve pregnancy outcomes in type 1 diabetes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perinatal mental health","authors":"","doi":"10.1016/j.mpmed.2024.07.009","DOIUrl":"10.1016/j.mpmed.2024.07.009","url":null,"abstract":"<div><div>Pregnancy and the postpartum period are times of elevated risk for mental disorders, which are common and affect up to 20% of expectant and new mothers. Perinatal mental disorders are already the leading complications in the perinatal period, and evidence suggests their prevalence is increasing. Nevertheless, they remain underdiagnosed and undertreated, which is particularly concerning as they are associated with adverse maternal and infant outcomes. Perinatal psychiatry includes conditions that occur outside the perinatal period (e.g. anxiety, depression) and illnesses such as postpartum psychosis. Postpartum depression and psychosis significantly increase the risk of suicide, a leading cause of maternal mortality. Management of perinatal mental illness needs special consideration because of the impact on both the women and their babies. Use of psychotropic medications in pregnancy and breastfeeding requires risk–benefit analysis and careful discussion with specialist multidisciplinary teams and patients. Women tend to be particularly cautious of the potential risks that medication poses to the baby, and less aware of the risks to both mother and infant of untreated mental illness. Screening for mental illness can lead to timely diagnosis, treatment and, if required, specialist perinatal care and admission to a mother and baby unit, which have recently been expanded across the UK.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical consultations on the labour ward: assessment and management of common medical presentations","authors":"","doi":"10.1016/j.mpmed.2024.07.010","DOIUrl":"10.1016/j.mpmed.2024.07.010","url":null,"abstract":"<div><div>Pregnancy and the postpartum period are a time of significant physiological adaptations that can impact on the presentation, assessment and diagnosis of common medical problems. Physicians can have limited postgraduate obstetric experience and yet be called upon to assess a pregnant woman in the context of new or pre-existing medical disease on the labour ward. This article reviews the evaluation and management of breathlessness, chest pain, palpitations, seizures, headache, acute kidney injury and sepsis. Through comprehensive assessment that is cognisant of normal pregnancy physiology, and by using the excellent resources now available from specialist organizations, physicians can offer a unique and valuable perspective for the multidisciplinary care of pregnant individuals.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recreational nitrous oxide use and its clinical implications","authors":"","doi":"10.1016/j.mpmed.2024.07.012","DOIUrl":"10.1016/j.mpmed.2024.07.012","url":null,"abstract":"<div><div>Nitrous oxide, a gas used in healthcare as an analgesic and anaesthetic and in the catering industry as a whipped cream aerosol propellant, has been misused since its discovery in the 18th century. It is commonly inhaled from balloons filled from 8 g whipped cream dispensers (‘whippets’), or more recently from larger 600 g to 2 g canisters. Acute complications include pneumothorax, hypoxia and frostbite from contact of the nitrous oxide canister with the skin or mucous membranes. Chronic use has the potential to cause nitrous oxide-induced neuropathy from sub-acute combined degeneration of the cord relating to functional vitamin B<sub>12</sub> deficiency; methylmalonic acid and homocysteine are biomarkers of nitrous oxide neuropathy. Other chronic effects include neuropsychiatric symptoms, anaemia, toxic leucoencephalopathy, rashes and an increased risk of thrombosis. Management of nitrous oxide neuropathy and other chronic complications consists of educating individuals on the importance of stopping nitrous oxide use, together with treatment with intramuscular vitamin B<sub>12</sub>.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hypertension in pregnancy and pre-eclampsia","authors":"","doi":"10.1016/j.mpmed.2024.07.011","DOIUrl":"10.1016/j.mpmed.2024.07.011","url":null,"abstract":"<div><div>Hypertension affects 8–10% of pregnancies and is the most common medical disorder in pregnancy. Despite continuing research and guideline development, maternal mortality from hypertensive diseases in pregnancy has increased in the last 6 years. It is vital that physicians are aware of the signs and symptoms, along with differing maternal treatment thresholds, of hypertension in pregnancy to ensure expeditious identification and treatment. New-onset hypertension developing at any stage of pregnancy requires a full history, examination and investigations to delineate an underlying cause and assess for target organ damage and the presence of pre-eclampsia to assign risk. Developing a hypertensive disorder in pregnancy increases a woman's life-long cardiometabolic risk; using this opportunity to inform and improve cardiovascular risk factors helps to prevent life-long health implications.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Medical problems in pregnancy","authors":"","doi":"10.1016/j.mpmed.2024.07.006","DOIUrl":"10.1016/j.mpmed.2024.07.006","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2024.07.013","DOIUrl":"10.1016/j.mpmed.2024.07.013","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endocrine disorders in pregnancy","authors":"","doi":"10.1016/j.mpmed.2024.07.008","DOIUrl":"10.1016/j.mpmed.2024.07.008","url":null,"abstract":"<div><div>Endocrine disorders are common in women of childbearing age and are therefore commonly encountered in pregnancy. Physiological adaptions of the endocrine system are essential to meet the demands of pregnancy. Women with pre-existing endocrine disorders require control of their underlying condition to undergo a healthy pregnancy. The clinician must understand the effects that endocrine disorders have on pregnancy, the effects of pregnancy on endocrine physiology and the safety of relevant investigations and medications. In most cases it is appropriate to discuss the management of pre-existing endocrine disorders in pregnancy with the patient during the pre-conception period. Endocrine diseases can present <em>de novo</em> in pregnancy or postpartum, representing a diagnostic challenge, as many symptoms of endocrine diseases overlap with pregnancy symptoms and investigations should be interpreted with consideration of the physiological changes of pregnancy.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurobiology and principles of addiction and tolerance","authors":"","doi":"10.1016/j.mpmed.2024.06.012","DOIUrl":"10.1016/j.mpmed.2024.06.012","url":null,"abstract":"<div><p>Substances of abuse dysregulate key brain systems involved in motivation, reward, decision-making and memory. As drug use evolves into a compulsive addiction, there are adaptations in these systems, mediated by a number of different neurotransmitters. The mesolimbic dopaminergic pathway plays a central role in the reinforcing effects of drugs and the development of addiction. As addiction develops, there is a shift away from positive reinforcement to compulsive, habitual drug-seeking behaviours driven, for example, by craving or aversive withdrawal symptoms. Although the potential for addiction is common to many drugs, the underlying mechanisms, neurotransmission systems and adaptations vary between drugs. This review focuses on the neurobiology of addiction and tolerance for substances including alcohol, benzodiazepines, opioids and stimulants.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delirium","authors":"","doi":"10.1016/j.mpmed.2024.07.002","DOIUrl":"10.1016/j.mpmed.2024.07.002","url":null,"abstract":"<div><p>Delirium is a common neuropsychiatric syndrome. However, it is often misdiagnosed and management can be inconsistent and distressing for patients and their families. It has a diverse multifactorial aetiology and results in cerebral dysfunction. The criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and the International Classification of Diseases, 11th revision, are increasingly unified in describing the core symptoms and profile. The new profiles are characterized by an acute disturbance of attention with a fluctuating pattern and impaired cognition. These profiles then incorporate non-cognitive symptoms, including disordered thinking and hallucinations. Non-pharmacological interventions prioritize staff training, early intervention including physiotherapy, a review of medications and environmental adaptations. Potential pharmacological approaches include the careful use of sedation and low-dose antipsychotics.</p></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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