Insulin Lispro and regular Insulin In Pregnancy A Bhattacharyya, S Brown, S Hughes and P.A.Vice. Insulin Lispro (IL), an analogue of regular human insulin with a peak insulin achieved within an hour of injection, significantly improves post prandial hyperglycaemia. This is very important in diabetic pregnancy, whether gestational or pre-gestational. Patient acceptability has also been […]

Acute Adrenocortical Crisis: Three Different Presentation A Bhattacharyya, J Macdonald, AA LAkhdar. The adrenal cortex normally produces three principal steroid hormones: the glucocorticoid cortisol, the mineralocorticoid adosterone, and a small quantity of sex steroids. In primary adrenocortical insufficiency, there is a deficiency of both cortisol and aldosterone with characteristic clinical and laboratory findings. In contrast, […]

Aetiology and Pathology of Type 2 Diabetes Mellitus A Bhattacharyya Diabetes Mellitus (DM) is a group of metabolic disorders characterized by raised blood sugar due to defects in insulin secretion, action or both. The chronic hyperglycaemia of DM is associated with longterm damage, dysfunction and failure of organs, such as the eyes, kidneys, nerves, blood […]

Treatment of Type 2 Diabetes Mellitus A Bhattacharyya People with type 2 diabetes mellitus (DM) are characterized by a resistance to insulin and a relative, as opposed to absolute, insulin deficiency. At least initially, and often through out their lifetime, they do not need exogenous insulin for survival. Thus although insulin may be required for […]

Diabetes Vignettes, Needle in foot! A Bhattacharyya, Frank Webb A 62 year old patient with type 2 diabetes mellitus on insulin for the last 10 years was referred to our multidisciplinary foot clinic with cellulites of the right foot (figure1). He noted pain and discomfort for 7 days. There is no clinical evidence of osteomyelitis. […]

Obstetric Difficulties due to Grave’s disease A Bhattacharyya, JD Wright, PA Vice A 14 year old girl was referred to the paediatrician with symptoms of hypothyroidism. She had a smooth diffuse goiter with dysthyroid eye disease.(Proptisis, lid lag and lid retraction). Hyperthyroidism was confirmed biochemically (Protein bound iodine 18.8, normal 5-8 ug). She was treated […]

Hyperosmolar Nonketotic State in a patient with Type 1 Diabetes Mellitus A Bhattacharyya, A Howell, A Lakhdar Dreschfeld described the major comas in diabetes mellitus in an address to the Manchestor Medical Society in 1881 as three different syndromes: Diabetic Collapse, The alcoholic form of diabetic coma and Coma from acetonemia. He described diabetic collapse […]

Treatment of Thyroid Diseases A Bhattacharyya and HM Buckler. The treatment of thyroid diseases is relatively straightforward. True thyroid problems should be distinguished from sick euthyroid syndrome and due consideration, should be given to the patient’s age, gender, family and wishes in making treatment decisions. Treatment of thyroid diseases falls in to three main categories. […]

The Aetiology and Pathology of Thyroid Disease A Bhattacharyya and PG Wiles The Thyroid gland is one of the largest endocrine organs, weighing approximately 15-20g in adults. The gland is composed of closely packed sacs, called acini or follicles, which are invested with a rich capillary network. The interior of the follicle is filled with […]