Clinical medicine (London, England)
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The diagnosis of multiple sclerosis (MS) is through clinical assessment and supported by investigations. There is no single accurate and reliable diagnostic test. MS is a disease of young adults with a female predominance. ⋯ The differential diagnosis includes other inflammatory central nervous system disorders. Magnetic resonance imaging of the brain and lumbar puncture are the key investigations. New diagnostic criteria have been developed to allow an earlier diagnosis and thus access to effective disease modifying treatments.
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Haemolysis is a rare but serious complication of cytomegalovirus (CMV) infection, described mostly in immunocompromised patients, the pathogenesis of which is yet to be fully elucidated. We describe a case of Coombs-positive haemolytic anaemia in an older Caucasian immunocompetent woman after polytrauma, resulting from suspected reactivation of CMV infection and secondary cold agglutinin disease. Clinicians should consider CMV infection in the differential diagnosis of haemolytic anaemia in immunocompetent older adults who are admitted with significant musculoskeletal trauma. Early treatment with B-cell depletion therapy to halt cold agglutinin production can be life-saving.
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The COVID-19 pandemic will impact on how care for chronic conditions is delivered. We use epilepsy to exemplify how care for patients will be affected, and suggest ways in which healthcare systems can respond to deliver the most effective care. ⋯ At the same time, neurologists should support emergency departments and acute medical units, advising on appropriate management of seizures and other acute neurological presentations. Ultimately, the revolution in our clinical practice is unlikely to cease after this pandemic, with reconfiguration of services likely to bring improvements in efficiency and convenience, and a reduced environmental impact.
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Pneumothoraces (1%) and pleural effusions (5%) are two of the less common complications of infection with COVID-19. Following a referral for a pleural drain insertion for a pneumothorax in a patient with COVID-19, we reassessed the infection risks involved in this procedure and its aftercare. ⋯ Consequently, we chose to attach an antiviral filter to the venting port of an underwater seal drain bottle to mitigate this risk. A fluorescein dye experiment was used to demonstrate the reduction in aerosol emission output from the bottle with our described technique, allowing an antiviral filter to be attached to a pleural underwater seal drainage bottle for added protection of patients and staff in the local environment.
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A case is presented highlighting the emerging association of COVID-19 with pneumomediastinum, even in patients who have never received mechanical ventilation or positive airway pressure.