Fan Chung, Gary Wong, Sundeep Salvi, Christopher Carlsten
{"title":"Climate Change and Air Pollution: How Healthcare Providers Can Help Mitigate the Risks to Respiratory Health","authors":"Fan Chung, Gary Wong, Sundeep Salvi, Christopher Carlsten","doi":"10.33590/emj/juyj2358","DOIUrl":"https://doi.org/10.33590/emj/juyj2358","url":null,"abstract":"","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141349125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taniya Yasmin, Sara Glazer, Breanna A. Chen, Farah Abdulsatar
Lemierre’s syndrome (LS) is a rare but potentially life-threatening condition resulting from oropharyngeal infections. It is characterised by septic thrombophlebitis of the internal jugular vein and disseminated metastatic abscesses. However, atypical presentations with unusual sites of thrombosis and spread have been reported. The authors present a case of LS with an atypical presentation in a previously healthy 17-year-old male. This case highlights the need for a high level of suspicion, and comprehensive investigation in cases of unexplained sepsis following oropharyngeal infections, as LS can have atypical presentations and potentially life-threatening complications. The traditional definition of LS may need to be re-evaluated in light of such atypical manifestations.
勒米尔综合征（Lemierre's Syndrome，LS）是一种罕见但可能危及生命的口咽部感染病。其特征是颈内静脉化脓性血栓性静脉炎和播散转移性脓肿。不过，也有非典型表现，血栓形成和扩散部位不寻常的报道。作者介绍了一例以前健康的 17 岁男性 LS 非典型表现病例。该病例强调，在口咽部感染后出现不明原因的败血症时，需要高度怀疑并进行全面检查，因为LS可能有非典型表现和潜在的危及生命的并发症。鉴于这种非典型表现，LS的传统定义可能需要重新评估。
{"title":"Fever, Sore Throat, and Abdominal Pain – Connecting the Dots to a ‘Forgotten’ Disease: A Case Report of Atypical Lemierre’s Syndrome","authors":"Taniya Yasmin, Sara Glazer, Breanna A. Chen, Farah Abdulsatar","doi":"10.33590/emj/whtd3554.","DOIUrl":"https://doi.org/10.33590/emj/whtd3554.","url":null,"abstract":"Lemierre’s syndrome (LS) is a rare but potentially life-threatening condition resulting from oropharyngeal infections. It is characterised by septic thrombophlebitis of the internal jugular vein and disseminated metastatic abscesses. However, atypical presentations with unusual sites of thrombosis and spread have been reported. The authors present a case of LS with an atypical presentation in a previously healthy 17-year-old male. This case highlights the need for a high level of suspicion, and comprehensive investigation in cases of unexplained sepsis following oropharyngeal infections, as LS can have atypical presentations and potentially life-threatening complications. The traditional definition of LS may need to be re-evaluated in light of such atypical manifestations.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Review of the 12th Edition of the European Conference on Rare Diseases and Orphan Products (ECRD) 2024","authors":"Emj","doi":"10.33590/emj/wsst7298","DOIUrl":"https://doi.org/10.33590/emj/wsst7298","url":null,"abstract":"","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erection is a neurovascular response to visual, emotional, and tactile stimuli. It is classified as psychogenic, reflexogenic, and nocturnal. The causes of painful erections are Peyronie’s disease, penile fracture, penile tumours, penile lichen sclerosis, and a rare disorder called sleep-related painful erection syndrome. Here, the authors report six cases of painful spontaneous erection due to penile skin bridges in young males, seen between 2021–2023. They analysed the age, clinical features, treatment offered, and outcome at 3 months post-surgery. Patients’ mean age was 20.5 years (range: 13–35 years), and the haemoglobin genotype was AA. Two males had associated yellowish discharges under the skin bridges. They all had excision of the skin bridges with satisfactory post-operative appearance, and no pain with erection. Penile skin bridge is an uncommon cause of painful penile erection, and the authors recommend that all general practitioners be aware of this entity, and keep it in mind during a thorough physical examination.
{"title":"Penile Skin Bridge: Uncommon Cause of Painful Spontaneous Erection in Young Males","authors":"A.O. Takure","doi":"10.33590/emj/hybw6733","DOIUrl":"https://doi.org/10.33590/emj/hybw6733","url":null,"abstract":"Erection is a neurovascular response to visual, emotional, and tactile stimuli. It is classified as psychogenic, reflexogenic, and nocturnal. The causes of painful erections are Peyronie’s disease, penile fracture, penile tumours, penile lichen sclerosis, and a rare disorder called sleep-related painful erection syndrome. Here, the authors report six cases of painful spontaneous erection due to penile skin bridges in young males, seen between 2021–2023. They analysed the age, clinical features, treatment offered, and outcome at 3 months post-surgery. Patients’ mean age was 20.5 years (range: 13–35 years), and the haemoglobin genotype was AA. Two males had associated yellowish discharges under the skin bridges. They all had excision of the skin bridges with satisfactory post-operative appearance, and no pain with erection. Penile skin bridge is an uncommon cause of painful penile erection, and the authors recommend that all general practitioners be aware of this entity, and keep it in mind during a thorough physical examination.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Central line-associated bloodstream infection (CLABSI) is a serious infection typically increasing morbidity and mortality in patients with chronic kidney disease (CKD). It can be prevented through proper insertion techniques and management of the central line (CL). However, the first step in reducing the CLABSI rate is to define the extent of the problem through proper surveillance. This study aimed to determine the frequency of CLABSI in patients with CKD at a specialised renal care centre. Methods: The authors conducted a retrospective observational study to determine the frequency of CLABSI in patients with CKD between November 2021–September 2022 at their institute. They included all patients with CLs registered at their institute. Primary CLABSI was defined as CLABSI attributable to their hospital, while secondary CLABSI was defined as those not attributed to their hospital. Results: Fifty-nine incidences of CLABSI were identified in a total of 310 patients with CL and 1,413 CL days, giving a total of 42 CLABSI incidences per 1,000 CL days. Primary CLABSI was more common (n=36 [61%]) than secondary CLABSI (n=23 [39%]). Most of the patients recovered (53 [89.8%]); however, four (6.9%) patients expired. Most of the patients who recovered had permanent vascular access (n=32 [60.4%]), internal jugular placement (n=44 [83%]), and primary CLABSI (n=33 [62.3%]), although the p-values were non-significant. Conclusion: Strict implementation of CLABSI prevention bundles for line insertion and its maintenance and regular surveillance using laboratory confirmed cases is needed to reduce the rates of CLABSI.
{"title":"Frequency Determination of Central Line Associated Bloodstream Infection at a Renal Care Centre","authors":"Safia Moin, Bina Salman, Aasim Ahmad","doi":"10.33590/emj/jpqb3019","DOIUrl":"https://doi.org/10.33590/emj/jpqb3019","url":null,"abstract":"Background: Central line-associated bloodstream infection (CLABSI) is a serious infection typically increasing morbidity and mortality in patients with chronic kidney disease (CKD). It can be prevented through proper insertion techniques and management of the central line (CL). However, the first step in reducing the CLABSI rate is to define the extent of the problem through proper surveillance. This study aimed to determine the frequency of CLABSI in patients with CKD at a specialised renal care centre.\u0000\u0000Methods: The authors conducted a retrospective observational study to determine the frequency of CLABSI in patients with CKD between November 2021–September 2022 at their institute. They included all patients with CLs registered at their institute. Primary CLABSI was defined as CLABSI attributable to their hospital, while secondary CLABSI was defined as those not attributed to their hospital.\u0000\u0000Results: Fifty-nine incidences of CLABSI were identified in a total of 310 patients with CL and 1,413 CL days, giving a total of 42 CLABSI incidences per 1,000 CL days. Primary CLABSI was more common (n=36 [61%]) than secondary CLABSI (n=23 [39%]). Most of the patients recovered (53 [89.8%]); however, four (6.9%) patients expired. Most of the patients who recovered had permanent vascular access (n=32 [60.4%]), internal jugular placement (n=44 [83%]), and primary CLABSI (n=33 [62.3%]), although the p-values were non-significant.\u0000\u0000Conclusion: Strict implementation of CLABSI prevention bundles for line insertion and its maintenance and regular surveillance using laboratory confirmed cases is needed to reduce the rates of CLABSI.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141345159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of Nebulisers in the Treatment of Patients with Severe and Very Severe Chronic Obstructive Pulmonary Disease","authors":"Omar Usmani","doi":"10.33590/emj/uxua8923","DOIUrl":"https://doi.org/10.33590/emj/uxua8923","url":null,"abstract":"","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lost in the System: The Labyrinth of Rare Disease Diagnosis","authors":"Peter Fish","doi":"10.33590/emj/dlph7436","DOIUrl":"https://doi.org/10.33590/emj/dlph7436","url":null,"abstract":"","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"How Can We Bridge the Rare Disease Treatment Gap?","authors":"Darcy Richards","doi":"10.33590/emj/hwfd3106","DOIUrl":"https://doi.org/10.33590/emj/hwfd3106","url":null,"abstract":"","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dermatitis artefacta (DA) is a rare psychocutaneous disorder characterised by self-inflicted skin lesions that the patient denies producing. DA poses a complex clinical challenge to clinicians as patients often are resistant to the diagnosis, and can be hesitant to follow up with psychiatric or psychological services. There is a need to understand the optimal approach for management of patients with DA. This systematic review was undertaken to address this gap in knowledge. A search was conducted on PubMed and Embase using the following search strategy: Dermatitis artefacta OR factitious dermatitis OR factitial dermatitis OR artefactual skin AND treatment OR management OR therapy OR psychotherapy OR pharmacotherapy. Included studies were published from inception to 5ᵗʰ April 2023 in peer-reviewed journals, and discussed the treatment and management of DA. Studies were excluded if they were published in a language other than English. A total of 11 retrospective or prospective studies were included in this systematic review. They all found DA to be challenging to treat, with every study reporting patients experiencing a comorbid psychiatric condition or associated psychosocial stressor. Overall, there were better reported outcomes among follow-up patients treated in psychodermatology clinics with multidisciplinary teams of dermatologists, psychiatrists, and psychologists. Medical treatments can help with symptom control and promote wound healing, while psychological and psychiatric treatments can help address underlying psychosocial stressors for the condition. Further research is needed to evaluate optimal management and long-term treatment outcomes in patients with DA.
伪装性皮炎（DA）是一种罕见的皮肤心理疾病，其特征是患者否认是自己造成的皮肤损伤。皮炎给临床医生带来了复杂的临床挑战，因为患者通常对诊断有抵触情绪，对精神或心理服务的后续治疗也会犹豫不决。我们需要了解治疗 DA 患者的最佳方法。本系统性综述旨在填补这一知识空白：在 PubMed 和 Embase 上使用以下检索策略进行了检索：假性皮炎 OR 假性皮炎 OR 假性皮炎 OR 假性皮炎 OR 假性皮肤 AND 治疗 OR 管理 OR 治疗 OR 心理治疗 OR 药物治疗。纳入的研究均发表于同行评审期刊上，时间从开始至 2023 年 4 月 5 日，并讨论了皮炎的治疗和管理。本系统综述共纳入了 11 项回顾性或前瞻性研究。这些研究都发现DA的治疗具有挑战性，每项研究都报告了患者合并有精神疾病或相关的社会心理压力。总体而言，在由皮肤科医生、精神科医生和心理学家组成的多学科团队的精神皮肤病诊所接受治疗的随访患者的疗效较好。医学治疗有助于控制症状和促进伤口愈合，而心理和精神治疗则有助于解决该病症的潜在社会心理压力。需要进一步开展研究，以评估对 DA 患者的最佳管理和长期治疗效果。
{"title":"Treatment of Dermatitis Artefacta: A Systematic Review","authors":"Mariah C. Estill, Mohammad Jafferany","doi":"10.33590/emj/anag6061","DOIUrl":"https://doi.org/10.33590/emj/anag6061","url":null,"abstract":"Dermatitis artefacta (DA) is a rare psychocutaneous disorder characterised by self-inflicted skin lesions that the patient denies producing. DA poses a complex clinical challenge to clinicians as patients often are resistant to the diagnosis, and can be hesitant to follow up with psychiatric or psychological services. There is a need to understand the optimal approach for management of patients with DA. This systematic review was undertaken to address this gap in knowledge.\u0000\u0000A search was conducted on PubMed and Embase using the following search strategy: Dermatitis artefacta OR factitious dermatitis OR factitial dermatitis OR artefactual skin AND treatment OR management OR therapy OR psychotherapy OR pharmacotherapy. Included studies were published from inception to 5ᵗʰ April 2023 in peer-reviewed journals, and discussed the treatment and management of DA. Studies were excluded if they were published in a language other than English.\u0000\u0000A total of 11 retrospective or prospective studies were included in this systematic review. They all found DA to be challenging to treat, with every study reporting patients experiencing a comorbid psychiatric condition or associated psychosocial stressor. Overall, there were better reported outcomes among follow-up patients treated in psychodermatology clinics with multidisciplinary teams of dermatologists, psychiatrists, and psychologists.\u0000\u0000Medical treatments can help with symptom control and promote wound healing, while psychological and psychiatric treatments can help address underlying psychosocial stressors for the condition. Further research is needed to evaluate optimal management and long-term treatment outcomes in patients with DA.","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141346841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The recent emergence of the Nipah virus in the same district of Kozhikode, India, following its outbreak in 2018 and 2021, has elicited heightened apprehension among the public amidst the era of COVID-19. The potential fatality associated with this virus has been effectively mitigated through mass awareness, community and healthcare involvement, and stringent implementation of preventive measures. Nevertheless, the rate of transmission has consistently escalated over a span of several years, suggesting an emerging potential for global public health implications. Although the transmission rate remains low, the elevated mortality linked to the Nipah virus constitutes a potential threat, accentuated by the absence of vaccines and dependable treatments, thereby underscoring the risk to public health and emphasising the necessity for proactive measures to protect the wellbeing of the community. This narrative review provides an overview of the Nipah outbreaks in Kerala, India, and its global impact by conducting a thorough search of databases such as PubMed, Google Scholar, and ResearchGate using the following keywords: “Nipah virus,” “Henipavirus,” and “Kerala.”
{"title":"Nipah Virus in Kerala, India – Unravelling the Local Outbreak and Assessing Global Threats: A Narrative Review","authors":"M. G. Gopika, Raj Mohan, Sayan Roy","doi":"10.33590/emj/ilfc3139","DOIUrl":"https://doi.org/10.33590/emj/ilfc3139","url":null,"abstract":"The recent emergence of the Nipah virus in the same district of Kozhikode, India, following its outbreak in 2018 and 2021, has elicited heightened apprehension among the public amidst the era of COVID-19. The potential fatality associated with this virus has been effectively mitigated through mass awareness, community and healthcare involvement, and stringent implementation of preventive measures. Nevertheless, the rate of transmission has consistently escalated over a span of several years, suggesting an emerging potential for global public health implications. Although the transmission rate remains low, the elevated mortality linked to the Nipah virus constitutes a potential threat, accentuated by the absence of vaccines and dependable treatments, thereby underscoring the risk to public health and emphasising the necessity for proactive measures to protect the wellbeing of the community. This narrative review provides an overview of the Nipah outbreaks in Kerala, India, and its global impact by conducting a thorough search of databases such as PubMed, Google Scholar, and ResearchGate using the following keywords: “Nipah virus,” “Henipavirus,” and “Kerala.”","PeriodicalId":505023,"journal":{"name":"European Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141349156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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