We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high‐quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of ‘general’ recommendations followed by ‘specific’ recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self‐management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self‐management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis.

Pulmonary artery intimal sarcoma (PAIS) is a very rare tumour. The prevalence of PAIS is estimated to be between 0.001% and 0.003%, but this may be an underestimation because of potential misdiagnosis due to its similar presentation to that of pulmonary thromboembolism. The prognosis is very poor, with median overall survival between 11 and 18 months. We report a case of a 36-year-old man who presented to our cardiac surgery clinic reporting nonspecific symptoms and was found to have PAIS requiring surgical resection and adjuvant chemotherapy. We outline the radiologic features, pathologic characteristics, surgical approach, and chemotherapy treatment utilized.

Objectives: In December 2019, a pneumonia like illness was first reported in Wuhan-China caused by a new coronavirus named corona virus disease-2019 (COVID-19) which then spread to cause a global pandemic. Most of the available data in the literature is derived from Chinese cohorts and we aim to contribute the clinical experience of a single British clinical centre with the characteristics of a British cohort. Design: A prospective case series. Setting: A single clinical centre in the UK. Methods: We have collected the demographics and medical characteristics of all COVID-19 positive cases admitted over two-week period. All cases were diagnosed by PCR. Results: Total of 71 COVID-19 patients were included in this case series. Majority of patients (75%) were [?]75 years old and 58% were men. Pre-existing comorbidities was common (85% of patients). Most patients presented with respiratory symptoms such as fever (59%), shortness of breath (56%) and cough (55%). Gastrointestinal symptoms were second most common presenting compliant such as diarrhoea (10%) and abdominal pain (7%). Opacification in chest X-rays were demonstrated in 45% of patients. All patients received supportive treatment and no specific antiviral therapy was administered in this cohort. So far, 18 (25%) patients have fully recovered, 9 patients (13%) escalated to a higher level of care and 10 (14%) have died. Patients who died were non-significantly older than those who have recovered (78.0 v 69.2 years, p=0.15) but they had a significantly higher clinical frailty scores (5.75 v 3.36, p=0.005). Conclusion: This case series demonstrated that the characteristics of British COVID-19 patients were generally similar to what is published in literature although we report more gastrointestinal symptoms at presentation. We have identified frailty as a risk factor for adverse outcome in COVID-19 patients and suggest that it should be included in the future vaccination recommendations.

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