Clin Med
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The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. ⋯ Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed.
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Chest drain insertion may have unintended consequences; this procedure should only be carried out when there are clear indications to do so.
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A known alcoholic was admitted for a repeated episode of fits abolished by treating the patient's hypocalcaemia. Several mechanisms of hypocalcaemia in alcoholics have been described but in this patient coeliac disease was also diagnosed. Non-compliance with a gluten-free diet led to poor control of the disease, continued hypocalcaemia and an admission with a repeat seizure leading to death.
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Historical Article
A history of the gardens of the Royal College of Physicians of London.
The Royal College of Physicians of London (RCP) was founded in the City of London in 1518 and at that time many of the royal, religious and lay residences had gardens. The gardens were used, among other things, to grow fruit trees, herbs for the kitchen and for strewing on the floor, and for leisure, with lawns, bowling and flowers. So it would have been natural for the RCP Fellows to wish to have a garden of their own. ⋯ The fourth home in Pall Mall East in 1815 was landlocked. Therefore when the fifth (and current) home in Regent's Park was opened in 1964 it was splendid to have a large garden, carefully designed, planted and recorded. In 2004 a wonderful transformation took place when the College created a modern physic garden showing the development of medicinal plants through the ages and in many parts of the world.