Postgraduate medical journal
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Achieving target door-needle times for ST elevation myocardial infarction remains challenging. Data on emergency department (ED) doctor-led thrombolysis in developing countries and factors causing delay are limited. ⋯ Transfer of responsibility for thrombolysis to the ED doctors did not improve door-needle times despite measures introduced to facilitate this change. Key causative factors for this failure were identified.
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Potentially inappropriate medication (PIM) prescribing is a global problem. Limited data are available on the prevalence of PIMs in elderly patients with chronic kidney disease (CKD). We examined the PIM prevalence in elderly patients with CKD, the most common drugs implicated and the levels of polypharmacy in this group. ⋯ The prevalence of PIMs in elderly inpatients with CKD is high. Inclusion of drugs prescribed acutely and use of the BNF to identify PIMs as well as the Beers' criteria may account for this. Use of screening tools may lead to better identification of PIMs in this high risk group. Routine calculation and documentation of eGFR on the medication chart on admission may help reduce PIMs.
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The Streptococcus anginosus group comprises three species of bacteria classified within the viridans streptococci. This group is known for abscess formation and endocarditis. While a variety of sites in the body claim anginosus streptococci as an agent of infection, osteomyelitis is unusual. The objective of this study was to describe a series of patients with osteomyelitis due to S anginosus group pathogens in terms of demographics, comorbidities, presentation and outcomes. ⋯ Osteomyelitis due to the S anginosus group is uncommonly reported. Our case series illustrates the virulence of these organisms in the context of osteomyelitis and the importance of aggressive management.
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To analyse the clinicopathological presentation, outcome and importance of bone marrow haemophagocytosis in patients with infection-associated haemophagocytic lymphohistiocytosis (IA-HLH) in a tertiary care hospital in Northern India. ⋯ IA-HLH is important because it can obscure the typical clinical features of the underlying primary disease, thus delaying the diagnosis and having a negative effect on the outcome. Although bone marrow haemophagocytosis is not a mandatory diagnostic criterion, we found it to be a useful tool together with biochemical parameters for early recognition of HLH, especially in developing countries lacking molecular and flow laboratories. The severity of pancytopenia and derangement in biochemical markers were significantly higher in the patients who died.
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Despite the importance of timely management of patients with inflammatory arthritis (IA), delays exist in its diagnosis and treatment. ⋯ This review identified three main areas of delay to care for patients with IA and potential solutions for each. A co-ordinated effort will be required by the rheumatology and primary care community to address these effectively.