Tackling constipation in patients on high dose antipsychotics

AimsThe aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .BackgroundAntipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.MethodDuring ward rounds enquired on bowel habits and diet.Physical examination of patients complaining of abdominal pain.Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.Result3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.RecommendationBristol stool chart introduced as part of care plan for all patients.Teaching presentation of constipation and its treatment management was given to the PICU team.Involving medical team early on for assessment and prophylactic laxatives prescription.Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.Data and material handed over to next trainee to Re-audit and complete audit cycle.ConclusionAppropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.

FONSECAEA PEDROSOI – A CAUSE OF OCCULAR CHROMOBLASTOMYCOSIS

Fonsecaea pedrosoi (F. pedrosoi) is dematiaceous fungus and is the most common cause for chromoblastomycosis. It affects the exposed skin, mostly of the lower extremities. Arare case of mycotic keratitis was diagnosed in our hospital caused by F. pedrosoi. Corneal sample received in the laboratory was processed by standard mycological methods, F. pedrosoi was isolated, patient was started on antifungals his condition improved and there was no relapse. This case report shows that F. pedrosoi can infect cornea. Further, a prompt diagnosis and vigorous treatment improves patient's clinical condition.

A RARE CASE OF GAS GANGRENE OF ABDOMINAL WALL IN PREGNANCY

Gas gangrene in pregnancy is a rare occurrence although associated with high mortality. We report the case of a patient who developed gas gangrene of abdominal wall post-partum. A 30-year-old G3P2L2 with 6 months of amenorrhea, a neglected ANC with no antenatal visits, a known case of quadriparesis, delivered a preterm male baby. Having a contusion of 20*10cm size on lower abdomen, a blister formed over the same post-partum which had to be debrided. She was treated vigorously with antibiotics and tetanus antitoxin; and appropriate supportive management. Patient’s condition worsened after 36hrs and 46 hrs after admission she went into cardiac arrest. And such we encountered a case in 2019 in modern-day obstetrics, of gas gangrene complicating pregnancy, costing life to both the new-born and parturient. The importance of early suspicion and diagnosis followed by prompt, vigorous treatment cannot be emphasized more.

Nutritional Support for a Child With Juvenile Myelomonocytic Leukaemia at Various Stages of Antineoplastic Therapy: A Clinical Case

Background. Juvenile myelomonocytic leukaemia is a malignant disease with clonal impairment of haematopoiesis, characterized by excessive proliferation of monocytic and granulocytic sprout. Currently, the only way to cure it is hematopoietic stem cell transplantation. Vigorous treatment is accompanied by the development of a large number of complications, including nutritional ones. Nutritional support for these patients is fraught with many difficulties due to the treatment characteristics, patient’s condition, and complications of therapy.Description of a Clinical Case. A child diagnosed with juvenile myelomonocytic leukaemia, 1 year and 11 months old, received antineoplastic therapy — chemotherapy and bone marrow transplantation. In the course of treatment and after it, severe complications developed, which required various types of nutritional support, depending on the clinical situation. It is illustrated how important timely nutritional support is and how long and difficult nutritional disorders can proceed in these children even after termination of the main therapy.Conclusion. Preventive nutritional support with infant formulas is advisable for children with oncological diseases prior to treatment even with normal nutritional indicators. With the potential long-term impossibility of adequate alimentation per os, it is advisable to consider the placement of a gastrostomy tube for enteral nutrition since problems with appetite can be very long.

COMPLEX THERAPY OF INFECTIOUS CONJUNCTIVITIS, ACCOMPANIED BY AN ALLERGIC REACTION

Complex therapy of infectious conjunctivitis (adenovirus, herpetic, bacterial, chlamydial), complicated by toxic-allergic reaction, developing during the acute infectious process or long-term vigorous treatment, includes several treatment algorithms. The method of therapy consists in the use of systemic and local anti-allergic drugs against the background of a specific etiological antibacterial, antiviral or anti-herpetic therapy in combination with symptomatic therapy (anti-infectious, anti-inflammatory, reparative and tear replacement agents). The use of the developed algorithms of therapy can improve the effectiveness of treatment by 12-25%.

Treatment, outcome and predictors of response in elderly depressed in-patients

BackgroundFull recovery rates in naturalistic studies of the treatment of elderly depressives are invariably lower than in clinical trials. This may be the result of inadequate treatment due to the lack of clear treatment strategy recommendations for the elderly.MethodThis is a naturalistic prospective study of depressed elderly in-patients in three Dutch psychiatric hospitals. Patients were included when they suffered from any mood disorder according to DSM - III - R criteria. Severity of the depression was measured on the Montgomery -Asberg Rating Scale.ResultsAntidepressants were prescribed to more than 90% of the patients. More than half of them received only one treatment. The dose of the antidepressants was less than the recommended dose for adults in 55% of cases. Full recovery from the depressive episode was achieved in less than half of the patients (33–45%).ConclusionsIn the present study a relatively poor outcome of the antidepressant treatment of elderly depressives has been found. A combination of low treatment expectations and fear of vigorous treatment seems to have been important.

Suicide in Old Age: A Tragedy of Neglect

Objective: To investigate the incidence and treatment of depression in geriatric suicide. Method: All coroners' records, autopsy and police reports for suicide victims aged 65+ in Ontario (n = 543) over 3 years were examined. Results: Over 80% of the elderly who committed suicide received no psychiatric referral. Of the sample, 87% were untreated while only 13% received antidepressants. Tricyclics, which are lethal in overdose, were the drugs of choice. None of the sample was treated with the safer specific serotonin reuptake inhibitors (SSRIs). Females were 3 times as likely to be treated as were males, and those seeing psychiatrists were 4 times more likely to be treated with antidepressants than those seeing general practitioners (GPs). The physically ill were rarely treated. Conclusions: These findings suggest that early geropsychiatric assessment and vigorous treatment could prevent many suicides in old age.

Neuroleptic Malignant Syndrome - A Cautionary Tale and a Surprising Outcome

Vigilance is required in order to detect the cardinal signs of neuroleptic malignant syndrome (NMS), especially after prolonged exposure to neuroleptics. In this case, NMS was diagnosed in a 29-year-old man, who had been on fluphenazine decanoate for over one year, coinciding with a cessation of his neuroleptic medication. Vigorous treatment, including assisted ventilation, was necessary, extending over three months. On recovery, his mental state and social functioning had undergone a sustained improvement sufficient for his release from hospital.

Healthcare Professionals, Roles and Virtue

Mrs. J. is a 76-year-old woman who had been in good health. When she was brought to the hospital 10 days after being involved in an automobile accident, she was found to have severe brain injury and, despite vigorous treatment, has neverregained consciousness. The consulting neurologist feels that she has no chance to recover completely and the “best case scenario” is that she may regain some consciousness without ever being able to take care of herself or probably without ever being able to interact with her environment in a meaningful fashion. She and her husband have been very close and had just celebrated their 50th wedding anniversary when the accident occurred. After long deliberation, her husband states that his wife had often said that “she would never want to live like this” and that she had always had a fear of being a burden to anyone. He wants active treatment stopped and asks that she only be kept comfortable and allowed to die. Their daughter agrees with this decision, although their son who lives in a distant state, feels that all treatment should continue and that she “certainly wouldn’t be a burden.” Among other considerations brought up by the husband is the fact that there are no financial arrangements to take care of long-term care in a nursing home.