Clinical medicine (London, England)
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No published protocol to guide the withdrawal of continuous positive airway pressure (CPAP) for patients with COVID-19 exists. ⋯ The use of the protocol ensures a comfortable and dignified death and supports the delivery of individualised care at the end of life. Future research on this topic should focus on qualitative outcomes and consider the applicability of this protocol in other patient groups.
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An 84-year-old man was admitted with urinary tract infection and chest discomfort. He initially responded to conservative acute coronary syndrome management and antibiotics. On day 6 of admission, he developed acute severe abdominal pain; 12-lead electrocardiography showed widespread ST-segment depression in the anterior chest leads with ST-elevation in the posterior leads (V7-9) suggestive of an acute posterior myocardial infarction. ⋯ The case was discussed with the on-call surgical team, who advised that, due to severe frailty, he was not fit for surgical intervention and should be managed conservatively. He was managed with intravenous heparin infusion and supportive measures, but sadly continued to deteriorate and was palliated. He died shortly afterwards.
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Giant cell arteritis (GCA) is a systemic vasculitis with numerous potential complications and societal costs. After the publication of international guidelines, we found a number of deficiencies in the local care pathway of patients suspected to have GCA. These included poor referral and management pathways, and absence of dedicated monitoring and follow-up. ⋯ The introduction of diagnostic ultrasonography has meant that the need for biopsies has dropped by >80% reducing the annual cost of diagnostics by >£140,000. The introduction of a vasculitis specialist nurse has resulted in improving education, contact and speed of access to our service. The improvements in the service resulted in our service becoming a finalist in the Royal College of Physicians Excellence in Patient Care Award in 2020.
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Case Reports
Lessons of the month 2: Ocular manifestations and complications of hepatitis C infection.
We present a case of a man with hepatitis C with acute visual loss in his left eye over a 3-day period. Initial evaluation suggested a possible idiopathic orbital inflammatory syndrome as underlying cause for his symptoms. ⋯ Re-evaluation confirmed a diagnosis of marginal zone B-cell lymphoma. This case illustrates the importance of considering the various ocular manifestations of hepatitis C.
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Case Reports
Lessons of the month 3: Mosaic Klinefelter syndrome unveiled by acute vertebral fracture in a middle-aged man.
Klinefelter syndrome (KS) is the most common sex chromosome disorder in males. It is the result of two or more X chromosomes in a phenotypic male. ⋯ A broad spectrum of phenotypes has been described and many cases remain undiagnosed throughout their lifespan. In this case report, we describe a case of mosaic KS unmasked by acute vertebral fracture.