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Archive for September, 2012

A new coronavirus identified in the Middle East

24 Sep, 12 | by Dr Dean Jenkins

There are early reports of a new coronavirus not previously seen in humans. One case of severe respiratory infection is in a 49-year-old man being treated in Intensive Care in London. He was from Qatar and was flown to the UK after being admitted to hospital in Doha. A similar case of a 60-year-old man who died in Saudi Arabia is being investigated.

The UK’s Health Protection Agency has notified the World Health Organisation.

“Coronaviruses are causes of the common cold but can also include more severe illness, such as the virus responsible for SARS (Severe Acute Respiratory Syndrome).”

“The WHO said it was not recommending any travel restrictions but would be seeking further information on the virus.”

“Sars is a serious respiratory infection that caused a global outbreak in 2002, spreading from Hong Kong to more than 30 different countries around the world and killing around 800 people. Although it has not been eradicated its spread was fully contained in 2003. Like other coronaviruses, it is spread through droplets of body fluids – produced by sneezing and coughing.”

Case reports are recognised as a powerful tool in identifying the infective agent in new outbreaks. Subsequent contact tracing can help confirm the modes of transmission, infectivity and range of severity.

Air travel is clearly the principle route for international travel of a new virus. There is likely to be debate on the value of screening (especially with new ‘non-contact’ technologies [1-3] ) at airports and controversy over permission to travel whilst ‘unwell’.

1. Bitar D, Goubar A, Desenclos JC. International travels and fever screening during epidemics: a literature review on the effectiveness and potential use of non-contact infrared thermometers. Euro Surveill. 2009 Feb;14(6). Available from:

2. Tan C-C. SARS in Singapore–key lessons from an epidemic. Ann. Acad. Med. Singap. 2006 May;35(5):345–349. Available from:

3. St John RK, King A, de Jong D, Bodie-Collins M, Squires SG, Tam TWS. Border screening for SARS. Emerging Infect. Dis. 2005 Jan;11(1):6–10. Available from:

TB: Pseudodementia due to intracranial tuberculomas

20 Sep, 12 | by Emma

This report summarises a case history of a 25-year-old woman with a well known complication of tuberculosis, intracranial tuberculoma, manifest clinically with a depressed conscious level and cognitive slowness (“pseudodementia”) a few months after the initiation of anti-TB therapy. CT scan showed several tuberculoma with surrounding oedema. After re-institution of prednisolone the symptoms subside. The learning points, as stated by the authors, are that tuberculoma need not present with focal neurological sequelae and that reversible causes for declining cognitive function should be carefully sought and corrected.

Kirsten Moller

Pseudodementia due to intracranial tuberculomas: an unusual presentation

TB: Paraspinal sinuses? Do remember renal tuberculosis.

13 Sep, 12 | by Emma

Declared a global health emergency by the World Health Organisation in 1993, over one third of population of the world is infected with TB and 7% of all deaths in the developing world are attributed to TB.  We present a series of cases that illustrate the varied presentations of TB.

A small proportion of patients with pulmonary TB develop infection of the genitourinary system. Here the authors report the case of a young woman in India with low back pain and fever…

Seema Biswas

Paraspinal sinuses? Do remember renal tuberculosis.

Clinical Anatomy: Incidental detection of late presenting co-arctation of the aorta on chest x-ray

5 Sep, 12 | by Emma

How better to revisit the applied anatomy of the thorax than in this case of a 31 year old man with shortness of breath on minimal exertion.

Seema Biswas

Incidental detection of late presenting co-arctation of the aorta on chest x-ray: the importance of rib notching

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