Anaphylaxis: how to recognise and manage in primary care

2021 ◽  
Vol 32 (6) ◽  
pp. 232-236
Author(s):  
Hannah Kramer ◽  
Rebecca Batt
Keyword(s):  
Primary Care ◽  
Practice Nurse ◽  
Correct Diagnosis ◽  
Insect Sting ◽  
Vulnerable Patients ◽  
Immune Mediated ◽  
Emergency Medication ◽  
Life Threatening ◽  
Systemic Hypersensitivity

Anaphylaxis is a life-threatening emergency. Hannah Kramer and Rebecca Batt explain how correct diagnosis, avoidance and patient education are fundamental in reducing risk Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and can cause death. It is an immune-mediated reaction, which typically occurs when a person is exposed to a trigger, for example a food, drug, or insect sting. This article aims to assist with the recognition of symptoms and to guide management of anaphylaxis in primary care. Beyond the acute, the practice nurse can play a key role in helping patients to manage their allergies in the long-term, particularly for those who are most vulnerable. Patients should be supported in understanding how best to avoid their triggers, in managing their emergency medication, and in the importance of good asthma control.

scholarly journals Successful Surgical Repair of Left-Sided Diaphragmatic Hernia after Adult Orthotopic Liver Transplantation: Case Report

2021 ◽  
pp. 1-3
Author(s):  
Merab Kiladze ◽  
◽  
Murat Kilic ◽  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Diaphragmatic Hernia ◽  
Correct Diagnosis ◽  
Abdominal Approach ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Diaphragmatic Herniation

Postoperative delayed diaphragmatic hernia (DH) is a rare and uncommon event after adult orthotopic liver transplantation (OLT), which however could be potentially life-threatening complication, especially in the absence of early and correct diagnosis and appropriate surgical treatment. We present a case of 48 year-old male with left diaphragmatic herniation of left part of transverse colon, who thirty nine months before underwent OLT with right-sided allograft implantation and which was recently successfully managed by open abdominal approach in our institution. The postoperative course was uneventful and he was discharged at the 8th day after surgery. Our case illustrates, that delayed DH after the OLT in adults could be a new problem, which affect transplant recipients with long-term follow-up period. Hence, we consider, that once the diagnosis of DH is confirmed, the patient should be operated immediately, in order to avoid the possible life-threatening complications.

scholarly journals Multisystem Inflammatory Syndrome in Children and Adolescents Associated with COVID-19: Review

2020 ◽  
Vol 07 (04) ◽  
pp. 13-15 ◽  
Author(s):  
BS Mahapatra ◽  
Keyword(s):  
Early Recognition ◽  
Artery Aneurysm ◽  
Multidisciplinary Care ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Immune Mediated ◽  
Life Threatening ◽  
Adolescent And Young Adults ◽  
Inflammatory Syndrome

Multisystem Inflammatory Syndrome in Children (MIS-C) is a newly recognized multiorgan disease seen in children, adolescent and young adults presumed to be a delayed immune mediated complication of Corona virus 2 (SARS-CoV-2) infection leading to severe acute respiratory syndrome. MIS-C can be associated with life threatening organ dysfunction requiring complex multidisciplinary care. Early recognition is important in order to prevent complication and serious sequalae. Because it is a post infective complication, in most of the cases RT-PCR comes negative though antibodies to COVID-19 are positive. Although SARS-CoV-2 in children are generally mild and nonfatal, there is increasing evidence of MIS-C. Clinical and laboratory features of MIS-C are similar to those of Kawasaki disease like syndrome and Toxic Shock Syndrome. Pathophysiology of MIS-C is still unclear and mainly due to formation of autoantibody and immune complex which activates inflammation. Most of the MIS-C associated with COVID-19, need treatment with ionotropic agents and anticoagulants. The long-term outcome of MIS-C like coronary artery aneurysm formation remain unknown and needs close follow up.

scholarly journals Practice nurse-led proactive care for chronic depression in primary care: A randomised controlled trial

2016 ◽  
Vol 208 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Marta Buszewicz ◽  
Mark Griffin ◽  
Elaine M. McMahon ◽  
Kate Walters ◽  
Michael King
Keyword(s):  
Primary Care ◽  
Practice Nurse ◽  
Controlled Trial ◽  
Intervention Group ◽  
Chronic Depression ◽  
Activity Schedule ◽  
Proactive Care ◽  
The Impact ◽  
Nurse Intervention

BackgroundManagement of long-term depression is a significant problem in primary care populations with considerable on-going morbidity, but few studies have focused on this group.AimsTo evaluate whether structured, nurse-led proactive care of patients with chronic depression in primary care improves outcomes.MethodParticipants with chronic/recurrent major depression or dysthymia were recruited from 42 UK general practices and randomised to general practitioner (GP) treatment as usual or nurse intervention over 2 years (the ProCEED trial, trial registration: ISRCTN36610074).ResultsIn total 282 people received the intervention and there were 276 controls. At 24 months there was no significant improvement in Beck Depression Inventory (BDI-II) score or quality of life (Euroquol-EQ-VAS), but a significant improvement in functional impairment (Work and Social Activity Schedule, WSAS) of 2.5 (95% CI 0.6–4.3, P = 0.010) in the intervention group. The impact per practice-nurse intervention session was –0.37 (95% CI –0.68 to –0.07, P = 0.017) on the BDI-II score and –0.33 (95% CI –0.55 to –0.10, P = 0.004) on the WSAS score, indicating that attending all 10 intervention sessions could lead to a BDI-II score reduction of 3.7 points compared with controls.ConclusionsThe intervention improved functioning in these patients, the majority of whom had complex long-term difficulties, but only had a significant impact on depressive symptoms in those engaging with the full intervention.

Evidence-Based Treatment for the Eating Disorders

2010 ◽  
pp. 451-451
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Evidence-Based Treatment for the Eating Disorders

2012 ◽  
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

scholarly journals Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024980 ◽  
Author(s):  
Tiia T M Reho ◽  
Salla A Atkins ◽  
Nina Talola ◽  
Markku P T Sumanen ◽  
Mervi Viljamaa ◽  
...  
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Occupational Health ◽  
Sick Leave ◽  
Diagnostic Codes ◽  
Frequent Attenders ◽  
Frequent Attendance ◽  
Increased Risk ◽  
Working Age

ObjectivesFrequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs’ sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care.Setting and participantsThis is a longitudinal study using medical record data (2014–2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1–3, 4–14 and ≥15 days).ResultsBoth occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension.ConclusionBoth occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.

Case Report: Delayed Alemtuzumab-Induced Concurrent Neutropenia and Thrombocytopenia in Relapsing-Remitting Multiple Sclerosis

2021 ◽  
pp. 089719002110212
Author(s):  
Akaansha Ganju ◽  
James C. Stock ◽  
Kim Jordan
Keyword(s):  
Multiple Sclerosis ◽  
Case Reports ◽  
Severe Neutropenia ◽  
Cell Counts ◽  
Immune Mediated ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Study Participants ◽  
Relapsing Remitting Multiple Sclerosis

Alemtuzumab is an anti-CD52 monoclonal antibody used to treat relapsing-remitting multiple sclerosis following failure of second-line medications. It is administered intravenously in 2 treatment sequences 1 year apart. This drug is frequently associated with mild infusion reactions within days of administration, increased infection risk, and long term adverse events from secondary autoimmunity. Alemtuzumab-induced serious immune-mediated thrombocytopenia (ITP) is well-reported and occurred in 1.0-2.2% of participants in initial phase 2 and 3 trials for multiple sclerosis. Significant neutropenia, however, is rare and was only observed in 0.1% of study participants. Delayed neutropenia and/or ITP is thought to occur from secondary autoimmunity. Few case reports have described severe neutropenia occurring beyond 2 months of last alemtuzumab dose. We present an unusual case of delayed combined neutropenia and thrombocytopenia that occurred 15 months after the second infusion of alemtuzumab. The patient was asymptomatic and presented following discovery of neutropenia and thrombocytopenia during routine laboratory studies. The patient responded to steroids initially and was discharged, although outpatient cell counts subsequently revealed recurrent neutropenia and ITP. The adverse drug reaction probability (Naranjo) scale was completed and showed probable likelihood that the adverse event was alemtuzumab-related. Long term screening for delayed hematologic abnormalities, at least 4 years after initial dose, is necessary when using alemtuzumab. Greater research is needed to understand the mechanism of drug-associated neutropenia.

scholarly journals Long-term outcomes after penile prosthesis placement for the Management of Erectile Dysfunction: a single-Centre experience

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Valentine Frydman ◽  
Ugo Pinar ◽  
Maher Abdessater ◽  
William Akakpo ◽  
Pietro Grande ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Penile Prosthesis ◽  
Perioperative Outcomes ◽  
Single Centre ◽  
Satisfactory Outcome ◽  
Single Centre Experience ◽  
Life Threatening ◽  
Few Data

Abstract Background Penile prothesis (PP) is the gold-standard treatment of drug-refractory erectile dysfunction (ED). While postoperative outcomes have been widely described in the literature, there are few data about patient satisfaction and intraoperative events. We aimed to assess long-term patient satisfaction and perioperative outcomes after PP implantation in a single-centre cohort of unselected patients using validated scales. Results A total of 130 patients received a PP (median age: 62.5 years [IQR: 58–69]; median International Index of Erectile Function (IEEF-5) score: 6 [IQR: 5–7]). Median follow-up was 6.3 years [IQR: 4–9.4]. Thirty-two (24.6%) patients underwent surgical revision, of which 20 were PP removals (15.4%). Global PP survival rate was 84.6% and previous PP placement was a risk factor for PP removal (p = 0.02). There were six (4.6%) non-life-threatening intraoperative events including two which resulted in non-placement of a PP (1.5%). EAUiaic grade was 0 for 124 procedures (95.4%), 1 for four procedures (3.1%) and 2 for two procedures (1.5%). Of patients who still had their PP at the end of the study, 91 (80.5%) expressed satisfaction. Conclusions PP implantation is a last-resort treatment for ED with a satisfactory outcome. PPs are well accepted by patients.

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

2021 ◽  
Vol 51 (1) ◽  
pp. 10-15
Author(s):  
Kenneth V Iserson ◽  
Sri Devi Jagjit ◽  
Balram Doodnauth
Keyword(s):  
Aortic Dissection ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Handheld Device ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

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