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Archive for December, 2012

Pop goes the O2: a case of popper-induced methaemoglobinamia

20 Dec, 12 | by Emma

This is a well written case report of a common presentation in emergency departments (altered mental state associated with alcohol intoxication and a possible head injury). It highlights the importance of a good history and maintaining a high index of suspicion for relatively uncommon diagnoses in patients with this common emergency department presentation. Can the authors please clarify if they considered any other diagnoses (that is, their differential diagnosis) before they became aware of the arterial blood gas result and the CT brain result?

Dr Abel Wakai
Reviewer

Pop goes the O2: a case of popper-induced methaemoglobinamia

The importance of challenging your diagnosis even in straightforward cases

13 Dec, 12 | by Emma

A useful approach to all patients with non-healing wounds can be summarised by the following concept: “Wounds do not heal for no reason.” The development of an ulcer is a priori evidence of some pathological process (e.g. unrelieved pressure). For a wound or an ulcer to persist, there must be a disruption in the elegant cascade of natural events which normally effect healing. Despite its complexity, healing is the NORM. The in-ability to heal is evidence of a disease state.  For a patient to have a non-healing wound or ulcer, there must be factors responsible for the failure of one of the most reliable of physiological processes, that of tissue repair.  Although textbooks and clinical research may force us to think of these ulcers as belonging to clearly defined categories (e.g. venous stasis, diabetic, pressure) the approach to treating them must be based on correcting the agent(s) which produce non-healing, many of which overlap and thus defy categorisation. (In other words, patients with venous ulcers need arterial screening and many patients with pressure ulcers need control of their diabetes.)
 
Clinical practice guidelines from major organisations invariably begin with arterial screening of all non-healing lower extremity ulcers, no matter what the presumed etiology might be (Chronic Wound Care Guidelines). They all include moist wound care, debridement of necrotic material, control of bioburden, control of edema, and off-loading of pressure. When appropriate measures such as these fail to result in healing within 6 weeks, all chronic ulcers should undergo biopsy for histological diagnosis. When a consistent protocol is followed, patients are more likely to get appropriately directed therapy. This case is an excellent example of following such a protocol. A rare condition was discovered and successfully treated “simply” by following a logical plan of assessment and treatment.

Caroline E. Fife, MD
Professor of Medicine, Division of Cardiology
University of Texas Health Science Center, Houston
Director of Clinical Research, Memorial Hermann Center for Wound Healing

The importance of challenging your diagnosis even in straightforward cases

Microbiology: Cryptococccal meningoencephalitis after H1N1 influenza

6 Dec, 12 | by Emma

Here the authors report a case of cryptococcal meningoencehalitis associated with the H1N1 pandemic.

Seema Biswas
Editor-in-Chief

Cryptococccal meningoencephalitis after H1N1 influenza

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