scholarly journals Cerebral Nocardiosis: A Rare Cause of Hemiplegia in the Acute Medicine Unit

2019 ◽  
Vol 18 (1) ◽  
pp. 37-40
Author(s):  
HuaJian Liu ◽  
◽  
H Neil Simms ◽  
Brian Herron ◽  
Sara Hedderwick ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Neurological Complications ◽  
Sudden Onset ◽  
High Morbidity ◽  
Successful Management ◽  
Acute Medicine ◽  
Early Communication ◽  
Acute Medical Unit ◽  
Immunosuppressed Patients ◽  
Cerebral Nocardiosis

Nocardiosis, a rare infection occurring mostly in immunosuppressed patients can present with neurological complications including cerebral abscess formation, and is associated with high morbidity and mortality. We describe the case of a 54-year-old immunocompetent man with cerebral nocardiosis, who presented with sudden onset hemiparesis in an acute medicine unit. He required three craniotomies with excision, following failure to respond to antimicrobial therapy, with subsequent clinical improvement and radiological resolution of multiple cerebral abscesses. Challenges in diagnosis and management of hemiparesis in the acute medical unit are discussed. Successful management of cerebral nocardiosis require early communication with a neurosurgical unit, neuropathology and microbiology services to optimise management with targeted antimicrobial therapy.

Canine Bacterial Endocarditis: A Review

2007 ◽  
Vol 43 (5) ◽  
pp. 258-263 ◽  
Author(s):  
Gordon Peddle ◽  
Meg M. Sleeper
Keyword(s):  
Blood Culture ◽  
Effective Treatment ◽  
Antimicrobial Therapy ◽  
Clinical Presentation ◽  
Bacterial Endocarditis ◽  
Diagnosis And Treatment ◽  
High Morbidity ◽  
Culture Techniques ◽  
Proper Diagnosis ◽  
Echocardiographic Findings

Bacterial endocarditis is a disease of primarily middle-aged to older, large-breed dogs that is associated with high morbidity and mortality. It presents many challenges with respect to diagnosis and effective treatment. This paper reviews the pathogenesis, clinical presentation, progression, methods of diagnosis, and treatment of bacterial endocarditis in dogs. Methods for proper diagnosis, including echocardiographic findings and blood culture techniques, and recommendations for effective antimicrobial therapy are also provided.

Editorial

2008 ◽  
Vol 7 (2) ◽  
pp. 62-62
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
British Society ◽  
Editorial Team ◽  
Clinical Activity ◽  
Acute Medicine ◽  
Acute Medical Unit ◽  
The Future ◽  
The Subject ◽  
Level Of Training ◽  
Areas Of Interest ◽  
To Receive

Whether acute medicine registrars should have the opportunity to acquire a procedural skill during their training has been the subject of considerable debate over recent years. The issue often dominates discussion amongst trainees and trainers alike at national meetings; exchanges are frequently heated and prolonged, highlighting the strength of feeling on all sides regarding the challenges which this creates. So the inclusion of three articles relating to this subject within this edition of Acute Medicine is not in any way disproportionate. In the past, much of the debate has centred on the concept of the ‘Sanity Session’ – the idea being that specialist acute physicians might need some clinical activity outside the acute arena to help prevent ‘burnout’. The three articles in this edition focus more specifi – cally on the issue of bedside investigation in the clinical setting. Many of us will recognise the scenario of the acutely unwell, hypotensive patient, for whom an urgent echocardiogram or ultrasound would enable great strides towards a diagnosis. Extracting a radiologist or cardiologist from their respective departments often requires a talent for negotiation of which a member of the Diplomatic Corps would be proud. Access to the equipment and possession of the necessary skills to undertake such procedures at the bedside would be a great asset for any Acute Medical Unit. While some units are undoubtedly already making great strides in this direction, this often results from the enthusiasm of individuals, many of whom have been trained in other specialities before moving to Acute Medicine. The statement from the British Society of Echocardiography on p95 should be viewed as an important step in identifying a level of training in which is feasible for trainees in acute medicine. The Royal College of Radiologists has also recently produced recommendations for training in ultrasound, which is described in detail by John Lorains; Mark Mallet also highlights some of the practical challenges which may arise in establishing an acute medical ultrasound service. Readers of this journal may note a slight change in the format, with fewer ‘commissioned’ review articles than in previous editions. The editorial team has been pleased to receive an increased number of unsolicited articles over recent months, which has facilitated this change. As the speciality continues to develop, a larger number of research-orientated papers are also beginning to fi lter through, which will be included over future editions. This increased number of submissions requires that a more rigorous review process is introduced. This will require an expanded team of editorial referees in the future. If any reader is interested in volunteering to help in this way, I would be grateful if you could email me at the address on this page, indicating your areas of interest and expertise. In addition any feedback from readers regarding the future format of the journal would be most welcome. I am also keen to establish a ‘correspondence’ section for future editions, so if any of the articles in this edition have raised your heckles, or reminded you of similar experiences which you wish to share, I would be delighted to receive these.

scholarly journals A Hybrid Approach to Radiation-Induced Axillary Artery Hemorrhage

2019 ◽  
Vol 54 (2) ◽  
pp. 172-174
Author(s):  
Elizabeth Hope Weissler ◽  
Kevin W. Southerland
Keyword(s):  
Case Report ◽  
Antimicrobial Therapy ◽  
Squamous Cell Cancer ◽  
Axillary Artery ◽  
Cell Cancer ◽  
Hybrid Approach ◽  
High Morbidity ◽  
Stent Grafting ◽  
Threatening Condition ◽  
Radiation Induced

Axillary artery blowout is a rare life- and limb-threatening condition. The traditional surgical approach of ligation and extra-anatomic bypass is associated with a high morbidity and mortality. We present a case report of a 65-year-old male with axillary artery hemorrhage secondary to an irradiated squamous cell cancer. We propose a staged hybrid approach for the treatment of this unusual clinical entity consisting of emergent stent grafting followed by planned elective extra-anatomic bypass, debridement, and a course of specific antimicrobial therapy.

scholarly journals The value of histopathological diagnosis in rupoid psoriasis accompanied by fever. A case report and a review of the literature

2014 ◽  
Vol 60 (6) ◽  
pp. 282-284
Author(s):  
S.H. Morariu ◽  
M.A. Badea ◽  
M.D. Vartolomei ◽  
Iudita Maria Badea ◽  
O.S. Cotoi
Keyword(s):  
Clinical Signs ◽  
Clinical Manifestations ◽  
Local Therapy ◽  
Signs And Symptoms ◽  
Daily Practice ◽  
Sudden Onset ◽  
Histopathological Diagnosis ◽  
Intermittent Fever ◽  
Immunosuppressed Patients ◽  
Clinical Signs And Symptoms

Abstract Psoriasis is a common dermatosis, however the rupoid type is considered as an exceptional form of this disease. Rupoid scabs are very rare in dermatological daily practice, usually being seen as secondary to syphilis in immunosuppressed patients. Rupoid psoriasis is characterized by thick and multilayered crusts that are resistant to local therapy and present a sudden onset. Severe arthropathy is a common manifestation. We did not found in literature any association of rupoid psoriasis with intermittent fever. We present the case of a patient who exhibited a rush of rupoid boards with severe arthralgia accompanied by intermittent fever. The suspicion of malignant syphilis was raised considering the clinical signs and symptoms and the specific social context of STDs. This suspicion was unconfirmed by TPHA negative reaction and histopathological appearance that showed changes typical of psoriasis. Clinical manifestations were successfully controlled with methotrexate.

scholarly journals Potential Nosocomial Acquisition of EpidemicListeria monocytogenesPresenting as Multiple Brain Abscesses Resembling Nocardiosis

2010 ◽  
Vol 21 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Aleksandra Stefanovic ◽  
James Reid ◽  
A Celine Nadon ◽  
Jennifer Grant
Keyword(s):  
Listeria Monocytogenes ◽  
Brain Abscess ◽  
Antimicrobial Therapy ◽  
Hematological Malignancies ◽  
Solid Organ ◽  
Gram Stain ◽  
Current Case ◽  
Cerebellar Abscess ◽  
Immunosuppressed Patients ◽  
Brain Abscesses

Listerial brain abscesses are rare, and are found mostly in patients with underlying hematological malignancies or solid-organ transplants. A case of a patient with Crohn’s disease and multiple brain abscesses involving the left cerebellum and right sylvian fissure is described. The Gram stain and histopathology of the cerebellar abscess revealed Gram-positive, beaded rods suggestive ofNocardia. However, on culture,Listeria monocytogeneswas identified.Listeriamay appear Gram-variable and has been misidentified as streptococci, enterococci and diphtheroids. The present case is the first reported case ofL monocytogenesresemblingNocardiaon both microbiological and histopathological assessment. Reported cases of listerial brain abscesses are sporadic, while the current case was part of a nationwide listerial outbreak linked to consumption of contaminated deli meats. Broad antimicrobial therapy (including antilisterial coverage) in immunosuppressed patients presenting with brain abscess is crucial, until cultures confirm the identification of the organism.

scholarly journals A hospital-based study on etiology and prognosis of bacterial meningitis in adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jun-Sang Sunwoo ◽  
Hye-Rim Shin ◽  
Han Sang Lee ◽  
Jangsup Moon ◽  
Soon-Tae Lee ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Antimicrobial Susceptibility ◽  
Multiple Logistic Regression Analysis ◽  
Neurological Complications ◽  
High Morbidity ◽  
Coagulase Negative Staphylococci ◽  
Blood Culture Positivity ◽  
Tertiary Center ◽  
Susceptibility Profiles ◽  
Scale 8

AbstractBacterial meningitis is a neurological emergency with high morbidity and mortality. We herein investigated clinical features, etiology, antimicrobial susceptibility profiles, and prognosis of bacterial meningitis in adults from a single tertiary center. We retrospectively reviewed medical records of patients with laboratory-confirmed bacterial meningitis from 2007 to 2016. Patients with recent neurosurgery, head trauma, or indwelling neurosurgical devices were classified as having healthcare-related meningitis. Causative microorganisms were identified by analyzing cerebrospinal fluid (CSF) and blood cultures, and antimicrobial susceptibility profiles were evaluated. We performed multiple logistic regression analysis to identify factors associated with unfavorable outcomes. We identified 161 cases (age, 55.9 ± 15.5 years; male, 50.9%), of which 43 had community-acquired and 118 had healthcare-related meningitis. CSF and blood culture positivity rates were 91.3% and 30.4%, respectively. In community-acquired meningitis patients, Klebsiella pneumoniae (25.6%) was the most common isolate, followed by Streptococcus pneumoniae (18.6%) and Listeria monocytogenes (11.6%). The susceptibility rates of K. pneumoniae to ceftriaxone, cefepime, and meropenem were 85.7%, 81.3%, and 100%, respectively. Among healthcare-related meningitis patients, the most common bacterial isolates were coagulase-negative staphylococci (28.0%), followed by Staphylococcus aureus (16.1%) and Enterobacter spp. (13.6%). Neurological complications occurred in 39.1% of the patients and the 3-month mortality rate was 14.8%. After adjusting for covariates, unfavorable outcome was significantly associated with old age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.06), neurological complications (OR 4.53, 95% CI 1.57–13.05), and initial Glasgow coma scale ≤ 8 (OR 19.71, 95% CI 4.35–89.40). Understanding bacterial pathogens and their antibiotic susceptibility may help optimize antimicrobial therapy in adult bacterial meningitis.

scholarly journals Raman Imaging of Pathogenic Candida auris: Visualization of Structural Characteristics and Machine-Learning Identification

2021 ◽  
Vol 12 ◽  
Author(s):  
Giuseppe Pezzotti ◽  
Miyuki Kobara ◽  
Tenma Asai ◽  
Tamaki Nakaya ◽  
Nao Miyamoto ◽  
...  
Keyword(s):  
Machine Learning ◽  
Raman Spectroscopy ◽  
Fungal Infections ◽  
Structural Characteristics ◽  
Drug Efficacy ◽  
Antifungal Drugs ◽  
High Morbidity ◽  
Clinical Environment ◽  
Candida Auris ◽  
Immunosuppressed Patients

Invasive fungal infections caused by yeasts of the genus Candida carry high morbidity and cause systemic infections with high mortality rate in both immunocompetent and immunosuppressed patients. Resistance rates against antifungal drugs vary among Candida species, the most concerning specie being Candida auris, which exhibits resistance to all major classes of available antifungal drugs. The presently available identification methods for Candida species face a severe trade-off between testing speed and accuracy. Here, we propose and validate a machine-learning approach adapted to Raman spectroscopy as a rapid, precise, and labor-efficient method of clinical microbiology for C. auris identification and drug efficacy assessments. This paper demonstrates that the combination of Raman spectroscopy and machine learning analyses can provide an insightful and flexible mycology diagnostic tool, easily applicable on-site in the clinical environment.

scholarly journals Next- and Third-Generation Sequencing Outperforms Culture-Based Methods in the Diagnosis of Ascitic Fluid Bacterial Infections of ICU Patients

Cells ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 3226
Author(s):  
Hanna Goelz ◽  
Simon Wetzel ◽  
Negin Mehrbarzin ◽  
Stefan Utzolino ◽  
Georg Häcker ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Antimicrobial Therapy ◽  
Pathogenic Bacteria ◽  
Anaerobic Bacteria ◽  
High Morbidity ◽  
Third Generation ◽  
Icu Patients ◽  
Third Generation Sequencing ◽  
Generation Sequencing ◽  
Higher Sensitivity

Objectives: Infections of the ascitic fluid are serious conditions that require rapid diagnosis and treatment. Ascites is often accompanied by other critical pathologies such as gastrointestinal bleeding and bowel perforation, and infection increases the risk of mortality in intensive care patients. Owing to a relatively low success rate of conventional culture methods in identifying the responsible pathogens, new methods may be helpful to guide antimicrobial therapy and to refine empirical regimens. Here, we aim to assess outcomes and to identify responsible pathogens in ascitic fluid infections, in order to improve patients’ care and to guide empirical therapy. Methods: Between October 2019 and March 2021, we prospectively collected 50 ascitic fluid samples from ICU patients with suspected infection. Beside standard culture-based microbiology methods, excess fluid underwent DNA isolation and was analyzed by next- and third-generation sequencing (NGS) methods. Results: NGS-based methods had higher sensitivity in detecting additional pathogenic bacteria such as E. faecalis and Klebsiella in 33 out of 50 (66%) ascitic fluid samples compared with culture-based methods (26%). Anaerobic bacteria were especially identified by sequencing-based methods in 28 samples (56%), in comparison with only three samples in culture. Analysis of clinical data showed a correlation between sequencing results and various clinical parameters such as peritonitis and hospitalization outcomes. Conclusions: Our results show that, in ascitic fluid infections, NGS-based methods have a higher sensitivity for the identification of clinically relevant pathogens than standard microbiological culture diagnostics, especially in detecting hard-to-culture anaerobic bacteria. Patients with such infections may benefit from the use of NGS methods by the possibility of earlier and better targeted antimicrobial therapy, which has the potential to lower the high morbidity and mortality in critically ill patients with ascitic bacterial infection.

scholarly journals https://staging.acutemedjournal.co.uk/investigating-for-pulmonary-embolism-in-pregnancy-five-year-retrospective-review-of-referrals-to-the-acute-medical-unit-of-a-large-teaching-hospital/

2016 ◽  
Vol 15 (2) ◽  
pp. 51-57
Author(s):  
T Brougham ◽  
C Gillett ◽  
L Powter ◽  
Keyword(s):  
Data Collection ◽  
Quality Indicators ◽  
Patient Flow ◽  
Waiting Times ◽  
Electronic System ◽  
Acute Medicine ◽  
Bed Management ◽  
Acute Medical Unit ◽  
Large Teaching Hospital ◽  
Medicine Quality

Aims: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimize working patterns to improve waiting times. Method: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns. Results: The online whiteboard proved effective and popular as a working tool. Data collection improved using the electronic system. Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p < 0.0001). Optimising consultant working patterns did not produced significant changes in waiting times. Conclusions: The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system. Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

scholarly journals Trainee Update September 2014

2014 ◽  
Vol 13 (3) ◽  
pp. 131-131
Author(s):  
Nerys Conway
Keyword(s):  
Internal Medicine ◽  
Chief Executive ◽  
Important Work ◽  
Acute Medicine ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
The Family ◽  
The Uk ◽  
Southmead Hospital ◽  
New Jobs

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.

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