Nottingham attacks killer's mental illness 'unmanaged and untreated' - BBC

Thyroid storm and diabetic ketoacidosis (DKA) are life-threatening endocrine emergencies that rarely occur concurrently. Their coexistence presents significant diagnostic and management challenges, particularly when associated with new-onset autoimmune diabetes. We report the case of a 26-year-old female with untreated hyperthyroidism who presented with altered mental status, severe tachycardia, dehydration, and generalized weakness. Laboratory evaluation demonstrated thyroid storm with undetectable thyroid-stimulating hormone (TSH) and markedly elevated thyroid hormone levels. Concurrent findings were consistent with severe DKA, including hyperglycemia (828 mg/dL), high anion gap metabolic acidosis, ketonemia, and ketonuria. Hemoglobin A1c was elevated to 9.5% from 5.4% less than three months earlier, suggesting rapid progression to insulin deficiency. Low C-peptide levels of 0.4 further support evolving autoimmune diabetes. The patient additionally demonstrated severe hyperosmolar hypernatremia, acute kidney injury, supraventricular tachycardia, and elevated cardiac biomarkers likely secondary to metabolic stress. She was treated in the intensive care unit (ICU) with aggressive i

Patients with asthma and chronic obstructive pulmonary disease (COPD) often receive systemic corticosteroids from multiple specialties, and that cumulative exposure is rarely tracked in 1 place. At the same time, the options for reducing reliance on oral steroids have grown, with approvals of dupilumab and mepolizumab for eosinophilic COPD and of depemokimab, a twice-yearly anti-interleukin (IL)-5 agent, for severe asthma.1-4 Clinicians outside pulmonology increasingly manage these patients when specialty access is limited. On October 6, 2026, Mollie Chartoff, FNP-BC, a nurse practitioner on the advanced COPD team at Vanderbilt Lung Institute in Nashville, Tennessee, moderated a virtual clinical forum for advanced practice providers on asthma and COPD. Participants included nurse practitioners and physician assistants in pulmonology, allergy and asthma, dermatology, oncology, and interventional pain practices in Tennessee, Texas, Missouri, and North Carolina. The discussion covered biomarkers, oral corticosteroid (OCS) exposure, biologic selection, and access barriers.

Treatment of pulmonary arterial hypertension (PAH) now spans 5 therapeutic pathways, and the options within them continue to expand. Recent developments include FDA approval of a once-daily single-tablet combination of macitentan and tadalafil, supported by the phase 3 A DUE trial, and a September 2026 European Respiratory Society (ERS) guideline update recommending add-on sotatercept for patients who remain at intermediate-low, intermediate-high, or high risk.1,2 How clinicians sequence oral, inhaled, parenteral, and injectable therapies in practice increasingly depends on risk assessment, payer requirements, and patient preference. In September 2026, Marc Simon, MD, MS, director of pulmonary vascular disease and the Pulmonary Hypertension Comprehensive Care Center at the University of California, San Francisco (UCSF), moderated a clinical forum in San Francisco. Participants included pulmonologists, advanced heart failure and critical care cardiologists, and a nurse practitioner from UCSF, Kaiser Permanente, and California Pacific Medical Center. The discussion covered initial combination therapy, risk reassessment, escalation beyond dual therapy, and long-term monitoring.

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