Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh

Background Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN.

Methods This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020.

Insulin delivery devices

Insulin therapy remains the cornerstone of treating patients with diabetes mellitus. All patients with Type 1, and many with Type 2, diabetes are treated with insulin. This article describes the discovery and evolution of insulin preparations and discusses current analogue, standard human and animal insulin preparations available for prescription in the UK, highlighting the advantages and disadvantages of the various preparations. An overview of initiating insulin therapy and typical insulin doses and regimes is given.

Care of the elderly symposium report

This symposium covered a wide range of conditions of interest to the geriatrician, the general physician and the general practitioner, including demographic shift, the epidemiology of ageing, diabetes in older people, investigation and management of falls, an update on stroke (including the role of neurovascular clinics, stroke thrombolysis and rehabilitation) and the management of coronary heart disease in the elderly.

Necrotising otitis externa: an unusual cause of cranial nerve palsy in a diabetic haemodialysis patient

We present an unusual case of necrotising otitis externa (NOE) causing a lower motor neurone facial nerve palsy in a patient with diabetes mellitus and receiving maintenance haemodialysis for end-stage renal disease (ESRD). Pseudomonas aeruginosa is the most common pathogen isolated in NOE, although our case involved the non-typical pathogens Aspergillus flavus and Proteus mirabilis. We discuss the need for diagnostic rigour and the importance of considering atypical infective pathology in patients with ESRD or diabetes mellitus.