Suspecting Haemophagocytic Lymphohistiocytosis (Hlh) In Patients With A High Ferritin.

Heamophagocytic Lymphohistiocytosis (HLH) is problematic to diagnose. The conditions that predispose to HLH present in a similar fashion, such as sepsis and haematological cancers. We look at the case of a 66-year-old man with a diagnosis of CLL, who presented with pyrexia and non-specific symptoms which included abdominal discomfort and weight loss. Sepsis, the principal suspicion was thoroughly investigated and excluded. Routine autoimmune pathologies were exhausted with comprehensive panels. The patient was trialled on steroids, presumptively, with a limited response. What was most peculiar in his blood tests was an unusually high Ferritin of > 50000. The parent clinical team was at a loss to explain the unusually high ferritin when a locum consultant suggested the diagnosis of Haemophagocytic Lymphohistiocytosis based on a similar presentation she had observed many years ago. The patient was started on pulsed Etoposide and Dexamethasone, however, unfortunately, he could not make a recovery.

WhatsApp-Delivered Intervention for Continued Learning for Nurses in Pakistan During the COVID-19 Pandemic: Results of a Randomized-Controlled Trial.

The COVID-19 pandemic has necessitated support for continued learning in frontline practitioners through online digital mediums that are convenient and fast to maintain physical distancing. Nurses are already neglected professionals for support in training for infection control, leadership, and communication in Pakistan and other developing countries. For that reason, we aimed to deliver a WhatsApp-based intervention for continued learning in nurses who are currently working in both private and public sector. A 12-week intervention was delivered to 208 nurses (102 in the control group and 106 in the intervention group) who had been employed in the clinical setting during data collection. The analysis reveals that nurses in the intervention group show significantly better results for learning in "infection prevention and control" and "leadership and communication." Results of a content analysis based on participant's feedback also confirm that the WhatsApp-based intervention is a valuable tool for education. This study highlights the effectiveness of online-based digital interventions as a convenient training tool for awareness and management of infectious diseases, leadership, and communication during COVID-19 and beyond. Furthermore, this study emphasizes that group interventions with other healthcare practitioners and the role of on-going longer WhatsApp-based interventions can become integral tools to support continued learning and patient safety practices.