BMJ case reports
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Ruxolitinib is a novel inhibitor of the Janus kinase (JAK) pathway that has become available for the treatment of myelofibrosis. There are increasing reports of opportunistic infections associated with ruxolitinib therapy. We present a case of Pneumocystis jiroveci pneumonitis complicating ruxolitinib therapy. Clinicians should consider the use of pneumocystis prophylaxis when using ruxolitinib.
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Two cases of adult intussusception (large bowel and small bowel) are presented highlighting the challenges posed by their often innocuous presentation in addition to significant morbidity resulting from delayed diagnosis.
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Hospitals and specialists in the UK are increasingly prescribing and dispensing off-license drugs such as ketamine which are not routinely included in the prescribing record of the general practitioner (GP). We present the case of a 67-year-old woman who developed an episode of uncontrolled raised blood pressure (BP) (224/124 mm Hg) following hospital introduction of oral ketamine for chronic pain. This raised BP was not followed up, and she was then found to be persistently hypertensive in the community some months later. ⋯ We postulate that long-term ketamine use may have been associated with this unexpected and persistent rise in BP. Clinicians should monitor BP closely during ketamine therapy and be wary of new hypertension associated with its long-term use. Further research is needed on the long-term effects of ketamine on BP.
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A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. ⋯ However, before that, she was given a trial of Acapella, a hand-held oscillatory positive expiratory pressure (OPEP) therapy device, for facilitating airway clearance, with the aim to speed up the recovery. The patient found it easy to use and clear the secretions optimally, thus averting a mini-tracheostomy. This case report highlights the advantages of the OPEP therapy device in effective management of bronchial hygiene in patients with poor respiratory effort.
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Tendon rupture as a complication of distal radius fractures has been documented; however, flexor tendon rupture associated with closed distal radius fractures is rare. We report a case of a 43-year-old man who suffered a closed distal radius fracture. Intraoperatively, it was discovered that the flexor carpi radialis tendon had ruptured. ⋯ After fixation of the fracture with locking plate, the severed tendon was repaired and the wrist immobilised with a splint. The patient has been pain free after 5 months of follow-up, with full range of motion. This outcome demonstrates that timely detection and treatment of concurrent flexor carpi radialis tendon rupture and a closed distal radius fracture can achieve good functional results and outcome.