Clinical medicine (London, England)
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Point-of-care ultrasound (POCUS) is increasingly being used in the management of the acutely unwell patient. Its role in the breathless and shocked patient is well established, but less so for those patients with acute kidney injury (AKI). ⋯ Additionally, negative predictive value was 99% suggesting it is a tool which can reduce the need for departmental ultrasound. More work is needed to see if this data is generalisable to other internal medicine settings, and to assess potential outcomes on patient management and length of stay.
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The investigation and management of pancreatic exocrine insufficiency: A retrospective cohort study.
Pancreatic exocrine insufficiency (PEI) is associated with significant gastrointestinal symptoms, but is readily treated by pancreatic enzyme replacement therapy (PERT). We reviewed our current practice and examined the factors that predict repeating a positive faecal elastase-1 (FE1; <200 μg/g), the repeat FE1 being normal, initiation of PERT and clinical response to treatment. A single-centre retrospective cohort study was conducted. ⋯ Patients with a confirmatory low FE1, abnormal pancreatic imaging or abnormal nutrition blood tests were more likely to be started on PERT (all p<0.05). Patients with abnormal pancreatic imaging were 10 times more likely to respond to PERT (odds ratio 10.70; 95% confidence interval 1.62-70.70; p=0.01). Augmenting clinical judgement with pancreatic imaging and repeat FE1 testing could improve the rate of PERT prescription and inform the approach to non-response, particularly in cases where there is diagnostic doubt.
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There are literature reports of anabolic-androgenic steroid-induced rhabdomyolysis. Here we describe a case of a patient presenting with acute confusion and rhabdomyolysis, following an unwitnessed seizure. He had a background of alcohol excess. ⋯ The brief seizure was itself unlikely to have resulted in the severity of his rhabdomyolysis. Thus, we report a likely case of delayed rhabdomyolysis secondary to anabolic steroid use. The oropharyngeal dysphagia may be secondary to the rhabdomyolysis; there have been cases of this described in literature.
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Oxycodone-induced leukoencephalopathy is a rare diagnosis that should be considered in unconscious patients with appropriate history. We describe a case of a 57-year-old unconscious woman who required intubation and did not respond to naloxone infusion. ⋯ We describe the pathological and radiological features of this condition, and provide a concise review of the limited literature on this condition. Accurate diagnosis of this condition will be valuable to clinicians and patients in terms of their medium-term and long-term prognosis, and potential for rehabilitation.
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Medical students internationally have volunteered and stepped up to support frontline clinical teams during the COVID-19 pandemic. We know very little about the motivation of those volunteering, or their concerns in deploying to a new role. We aim to establish the reasons that medical students volunteered in one Trust and understand to their concerns. ⋯ We must recognise and applaud the motivations of our future workforce who have stepped up to support the NHS at a time of unprecedented demand. The experiences and learning gained during this period will undoubtedly shape their future medical training and careers.