Clinical medicine (London, England)
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Contact tracing is central to the public health response to COVID-19, but the approach taken has received criticism for failing to make enough of an impact on disease transmission. We discuss what can be learned from contact tracing in other infections, and how the natural history of COVID-19 should shape the strategies used.
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Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient's quality of life. 5-aminosalicylate acid medications remain the first-line treatment for mild to moderate disease. ⋯ Importantly, despite best medical therapy, surgery may be required in a proportion of patients. The future will likely see an array of new therapeutic options for those with ulcerative colitis with the potential for a more personalised treatment approach.
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Loperamide is an over-the-counter medication which is commonly used to treat diarrhoea. In excessive doses, loperamide acts as an opioid on the central nervous system, which contributes to its increasing popularity as an alternative substance for opiate addictions. High doses for prolonged periods can cause prolonged QTc and provoke life-threatening arrhythmias, such as ventricular fibrillation. ⋯ Following syncopal episodes at rest, she was admitted for a period of monitored observation and later discharged with a plan to taper her loperamide in the community. Upon second presentation, her loperamide was replaced with buprenorphine patches, which were then weaned successfully in the community. Despite this, she passed away several months later, most likely from an underlying congenital cardiac arrhythmia which was unmasked by excessive use of loperamide.
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The effects of COVID-19 on sickness of medical staff across departments: A single centre experience.
COVID-19 presents a risk to healthcare workers, incurring harm to staff physical and mental wellbeing and difficulties in provision of care and service planning. ⋯ COVID-19 caused a burden of sickness on the medical workforce which must be accounted for in future workforce planning. The disparity in sickness rates across departments is likely to be multi-factorial. Further study is needed to investigate these factors to protect healthcare staff and their patients.
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Without universal access to point-of-care SARS-CoV-2 testing, many hospitals rely on clinical judgement alone for identifying cases of COVID-19 early. ⋯ COVID-19 clinical risk stratification on initial assessment effectively identifies non-COVID-19 patients. However, diagnosing COVID-19 is challenging and risk of overcalling COVID-19 should be recognised, especially when background prevalence is low.