Clinical medicine (London, England)
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The indiscriminate use of antibiotics in clinical practice may be an independent risk factor for the development of antimicrobial resistance. To combat this, our hospital implemented a hospital antibiotic policy which outlines the appropriate antibiotic to be used in an acute admission, based on a continuously updated local antibiogram. ⋯ We show that a simple QIP model combined with the use of a mobile application can serve to improve compliance even in a low-resource setting with minimum infrastructure. This model could be easily extrapolated into similar settings.
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Case Reports
Rhabdomyolysis with acute anuria renal failure caused by surgical injection-induced tetanus in an adult.
Tetanus is a rapidly progressive infection characterised by painful spasms and muscular rigidity with a series of complications including airway obstruction, respiratory failure, pulmonary infection, heart arrhythmias and acute kidney injury. Rhabdomyolysis with acute anuria renal failure is rarely reported as a complication in tetanus. We present a case of an adult who suffered from rhabdomyolysis combined with acute anuria renal failure caused by surgical injection-induced tetanus. ⋯ The patient fully recovered and was discharged from hospital 5 weeks after admission. Good bowel preparation is an important prerequisite for preventing tetanus in a haemorrhoids operation. Effective control of muscle spasms with neuromuscular blockers and early administration of haemoperfusion plus CVVH are vital to the treatment of tetanus-induced rhabdomyolysis with acute renal failure.
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Percutaneous vertebroplasty (PV) involves injection of polymethylmethacrylate bone cement into vertebral body for relief of pain and strengthening of bone in symptomatic vertebral compression fractures. Passage of bone cement into vertebral venous plexus and then into the lungs is a rare and serious complication of PV. The reported incidence up to 26%. ⋯ She was managed conservatively for the PCE as she remained asymptomatic. This case highlights the need for a standard post-PV chest X-ray, as patients with cement embolisms can be completely asymptomatic. Measures to minimise the risk of pulmonary cement embolisms during PV need to be taken.
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The emergence of SARS-CoV-2 has proven to be a challenge to healthcare bodies globally. The virus has been associated with a spectrum of clinical features, from anosmia to gastrointestinal upset to multiorgan dysfunction in the most severe cases. ⋯ Furthermore, in many hospitals, including our own, teenagers aged 16 to 18 years old are admitted under the care of adult medical services. Clinicians should be aware of patients presenting with the novel condition of paediatric inflammatory multisystem disorder - temporarily associated with SARS-CoV-2 (PIMS-TS).
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Percutaneous endoscopic gastrostomy (PEG) provides long-term nutritional support to those unable to tolerate intake orally. The benefits of a PEG depend on the indication and the individual, and are considered when it has the potential to improve mortality, nutritional status or quality of life. Often, family members and healthcare professionals have to act on behalf of the patient. ⋯ This may result in unnecessary PEG placement. For certain indications (dementia for example), there is limited evidence of any benefits a PEG may give and may actually cause harm. Guidance to improve patient selection and increase education for healthcare professionals is essential in achieving the best outcome for the patient.