Making Emergency Surgical Decisions Without any Imaging Evidence: A Case Report of Complicated Diverticular Phlegmon.

Acute left-sided diverticulitis is the third most common gastrointestinal disease after acute pancreatitis and cholecystitis requiring hospitalization. From those patients, 15% to 20% were diagnosed with abscess on the computed tomography (CT) scan. Usually, abscess larger than 5 cm are not amenable for medical treatment. A 61-year-old woman presented to emergency department of the general hospital in the remote island with 48-h history of fever, tachypnea, and tachycardia. Physical examination revealed 15 × 7 cm mass occupying the left mid-abdomen and iliac fossa. Patient did not report any unintentional loss of weight or change of bowel habits. She only reported that the last month she felt her lower tummy bloated. Due to absence of radiographer during this period in the hospital there was no possibility for any imaging investigations. Diagnostic laparoscopy revealed a phlegmon in the left abdomen consisting of the sigmoid colon, loops of the small bowel and wrapped by the omentum. Hartmann procedure was performed. Patient recovered uneventfully and was scheduled for reversal procedure. Surgical intervention is the treatment of choice for complicated large diverticular abscess; in the remote island, any delayed diagnosis may lead to life-threatening complications.

Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit.

BACKGROUND: Assessment of possible infection with SARS-CoV-2, the novel coronavirus responsible for COVID-19 illness, has been a major activity of infection services since the first reports of cases in December 2019. OBJECTIVES: We report a series of 68 patients assessed at a Regional Infection Unit in the UK. METHODS: Between 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. RESULTS: Patients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID-19. Microbiological diagnoses included SARS-CoV-2, mycoplasma pneumonia, influenza A, non-SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty-eight received antimicrobials, 15/68 were admitted, 5 due to inability to self-isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials. CONCLUSIONS: The majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID-19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.

Consensus recommendations for resistance testing in the management of chronic hepatitis C virus infection: Public Health England HCV Resistance Group.

The treatment of hepatitis C virus (HCV) infection has been revolutionised by the advent of oral, well-tolerated, direct acting antiviral therapies (DAA), with high cure rates. However, in some scenarios, HCV resistance to antiviral therapies may have an impact on treatment success. Public Health England's HCV Resistance Group was established to support clinicians treating people with HCV, where the issue of resistance may be a factor in clinical decision-making, and this review includes the Group's current recommendations on the use of HCV resistance testing. The authors describe the principles behind and approach to HCV resistance testing and consider evidence from in vitro studies, clinical trials and real world cohorts on the impact of HCV resistance on treatment outcomes for particular DAA regimens. Five scenarios are identified in the UK and similar settings, where, in the Group's opinion, resistance testing should be performed.

Healthcare associated discitis in the era of antimicrobial resistance.

Discitis is a recognized and serious complication of healthcare. We describe the cases of 4 patients, who presented to our unit over a 1 year period. All had exposure to healthcare before the onset of discitis and developed complex infections. There were no additional risk factors for discitis in any of the cases. The risk factors for discitis were peripheral intravenous cannulation in 1 case, intraabdominal surgery in 2 cases and multiple risks including intensive care admission and urethral catheterization in another case. The described cases demonstrate the importance of ascertaining a definitive microbiological diagnosis in healthcare associated discitis and the complex and expensive antibiotic regimens that may be required for the management of such cases. Clinicians should be aware when seeing patients with back pain and recent health care exposure that discitis can be present and complicated and that resistant organisms can be the cause.

Penicillium marneffei presenting as an immune reconstitution inflammatory syndrome (IRIS) in a patient with advanced HIV.

A 62-year-old British man with advanced HIV was established on antiretroviral therapy and treatment for disseminated Mycobacterium avium complex and Cytomegalovirus infections. One month later he re-presented with epigastric pain, an epigastric mass and skin lesions. Abdominal imaging revealed large volume lymphadenopathy, which was not present on previous imaging. Blood cultures yielded Penicillium marneffei, a dimorphic fungus endemic to South-east Asia. The patient had spent several years travelling in Thailand prior to the diagnosis of HIV. Penicilliosis is a common AIDS-defining illness in endemic areas, but remains rare in Europe. In this case, it presented in the context of a rapidly decreasing viral load as an immune reconstitution inflammatory syndrome. The challenges of management in the context of multiple comorbidities and polypharmacy are discussed.

Severe myositis on commencement of efavirenz, abacavir and lamivudine, in the absence of lactic acidosis or classical abacavir hypersensitivity.

Myositis in HIV may be due to HIV itself, or to opportunistic infection, malignancy or drug treatment. Severe myositis or rhabdomyolysis have never been reported with the commonly used nucleoside reverse transcriptase inhibitor abacavir, although creatine phosphokinase may rise modestly, particularly if abacavir hypersensitivity occurs. We report an unusual case of abacavir use associated with a thousand-fold rise in creatine phosphokinase in the absence of features of hypersensitivity. The case was also notable firstly in that there was an absence of the HLA-B5701 allele, the most common human leucocyte antigen (HLA) allele associated with hypersensitivity, and, secondly, as the case occurred in an African patient, African people not being prone to abacavir hypersensitivity.

Introduzindo a política na creche: a educação infantil como prática democrática / Bringing politics into the nursery: early childhood education as a democratic practice / Introduire la politique aux institutions de la petite enfance: éducation des petites enfants en tant que pratique démocratique / Introducción de la política en las guarderías: la educación infantil como práctica democrática

Este artigo explora a possibilidade de que instituições de educação infantil possam ser, antes de tudo, locais de prática política - e especificamente de práticas políticas democráticas. A necessidade de uma primazia de práticas políticas democráticas em instituições de educação infantil se faz mais urgente por conta de dois fenômenos evidentes em muitos países atualmente: o aumento do interesse governamental na educação infantil, conduzindo a uma expansão do atendimento, e a necessidade de revitalizar políticas democráticas. Assim como a introdução da prática democrática na creche, o que significaria e quais condições a possibilitariam, o artigo também considera a prática democrática em outros níveis: não só o institucional, mas também o nacional ou federal, o regional e o local, e como cada nível pode criar 'espaços democráticos' em outros níveis. Por fim, o artigo considera quatro questões relacionadas à democracia na educação infantil incluindo a diversidade paradigmática e o nível europeu.

This paper explores the possibility that early childhood institutions can be, first and foremost, places of political practice - and specifically of democratic politital practice. The case for the primacy of democratic political practice in early childhood institutions is made more urgent by two visible developments in many countries today: the growth of political interest in early childhood education, leading to an expansion of services, and the need to revitalize democratic politics. As well as bringing democratic practice into the nursery, what this would mean and what conditions might enable it, the paper also considers democratic practice at other levels: not only the institutional one but also the national or federal, the regional and the local, and how each level can create ‘democratic space’at other levels. The paper ends by considering four issues related to democracy in early childhood education, including paradigmatic diversity and the European level.

Dans cet article nous précisons l’idée selon laquelle les institutions de la petite enfance peuvent être avant tout des lieux de la pratique politique, et en particulier de pratique démocratique. La question de la primauté de la pratique démocratique dans les institutions de la petite enfance devient urgente en raison de deux phénomènes présents aujourd’hui dans des nombreux pays: l’intérêt politique grandissant pour l’éducation des jeunes enfants qui mène à une augmentation des services de la petite enfance, et le besoin de ranimer les politiques démocratiques. Cet article porte sur la practique démocratique dans les services de la petite enfance, sa signification et les conditions qui la rendent possible, mais aussi à d’autres niveaux: pas seulement au niveau institutionel mais aussi aux niveaux national ou fédéral, régional et local, en se demandant comment chaque niveau peut créer 'des espaces démocratiques' à d’autres niveaux. L’article termine avec quatre questions liées à la démocratie dans l’éducation de la petite enfance, dont le paradigme de la diversité et le niveau de l’Europe.

Este artículo explora la posibilidad que las guarderías puedan ser, en primer lugar y sobre todo, lugares de prácticas políticas - y especialmente de prácticas políticas democráticas. La necesidad de uma primacia de las prácticas políticas democráticas en las guarderías adquiere urgencia a partir de los desarrollos presentes hoy en día en muchos países: el creciente interés gubernamental en la educación infantil, conducente a una expansión de los servicios; y la necesidad de revitalizar las políticas democráticas. Junto a la introducción de las prácticas democráticas en las guarderías, lo que esto significaria y cuales condiciones se requieren, el artículo también considera las prácticas democráticas en otros niveles: no solo el institucional, sino también el nacional o federal, el regional y el local, y como cada nivel puede crear 'espacios democráticos' para otros niveles. El artículo finaliza considerando cuatro temas relacionados com la democracia en la educación infantil, incluyendo la diversidad paradigmática y el nivel europeo.