Clinical medicine (London, England)
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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.
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The Ottawa subarachnoid haemorrhage (SAH) rule and the Emerald SAH rule are clinical decision tools to aid in the decision for computed tomography (CT) of the head in patients attending an emergency department (ED) with acute non-traumatic headache. The objective of this study was to analyse the performance of these rules in a contemporary UK cohort. ⋯ The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort. The Emerald rule did not perform as well in this cohort and is unsuitable for clinical use. The Ottawa rule is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED.
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Coeliac disease (CD) is a common autoimmune-mediated gluten sensitive enteropathy, with a prevalence of around 1%. While the incidence of CD has increased over the last 2 decades, many cases still remain undiagnosed. ⋯ Persisting symptoms in individuals requires re-evaluation, with repeat duodenal biopsies sometimes required. Refractory CD affects a small subset of individuals with CD, requiring specialist input.
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Case Reports
Cough headache as a presenting feature of posterior reversible encephalopathy syndrome (PRES).
A 23-year-old man with chronic renal failure on maintenance haemodialysis was referred to the neurology outpatient clinic with new onset cough headache. On evaluation, his blood pressure was 220/120 mmHg and outpatient fundus photography showed grade IV hypertensive retinopathy. ⋯ Emergent treatment of hypertension led to a rapid resolution of his cough headache. New onset cough headache may be a marker of PRES.