Clinical medicine (London, England)
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The coronavirus disease of 2019 (COVID-19) pandemic has placed many healthcare systems, including the NHS, under unprecedented pressure. Mortality appears to be highest among older people and those with comorbidities, who are also often the most at risk of undernutrition in society. Despite international efforts to identify a specific treatment, therapy remains supportive and is principally focused on optimising respiratory function. ⋯ This piece outlines why nutritional status may be particularly compromised during this crisis, among both the population and hospital inpatients. Practical steps to improve nutritional status at a time when hospital services are particularly stretched are also considered. Finally, the case is made for behaviour change at all levels including government, the general population and healthcare professionals.
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The novel coronavirus SARS-CoV-2, causing the disease COVID-19, first emerged in Wuhan, China in December 2019 and has now spread to 203 countries or territories, infected over 2 million people and caused over 133,000 deaths. There is an urgent need for specific treatments. One potential treatment is chloroquine and its derivatives, including hydroxychloroquine, which have both antiviral and anti-inflammatory effects. ⋯ Although some encouraging outcomes have been reported, and these results have been received enthusiastically, we recommend careful and critical evaluation of current evidence only when all methods and data are available for peer review. Chloroquine is safe and cheap. However, further evidence from coordinated multicentre trials is required before it can be confidently said whether it is effective against the current pandemic.
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Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. ⋯ This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England.
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Case Reports
Piriformis syndrome as the only initial manifestation of septic sacroiliac osteomyelitis.
Piriformis syndrome refers to sciatica symptoms that do not originate from spinal root compression, but involve the overlying piriformis muscle. Diagnosis is clinical since there are no definitive tests to confirm the diagnosis. Piriformis syndrome is often misinterpreted as sciatica or other pains. ⋯ Thus, prompt diagnosis is crucial to the prognosis. Here, we report a patient suffering from acute pelvic osteomyelitis with piriformis syndrome as the only initial manifestation without fever. This unusual manifestation rendered prompt and correct diagnosis difficult.
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The aim was to determine if the 17 June 2014 Tracey judgment regarding 'do not attempt cardiopulmonary resuscitation' decisions led to increases in the rate of in-hospital cardiac arrests resulting in a resuscitation attempt (IHCA) and/or proportion of resuscitation attempts deemed futile. ⋯ The IHCA rate increased immediately after the Tracey judgment while the proportion of resuscitation attempts deemed futile decreased. The precise mechanisms for these changes are unclear.