RESUMEN
We present a patient with an unusual enterocutaneous syndrome. Long-term, low-dose acitretin treatment has stabilized the development of gastrointestinal lesions while synchronously reducing cutaneous morbidity.
Asunto(s)
Acitretina/administración & dosificación , Pólipos Adenomatosos/tratamiento farmacológico , Carcinoma de Células Escamosas/tratamiento farmacológico , Poliposis Intestinal/tratamiento farmacológico , Queratolíticos/administración & dosificación , Neoplasias Cutáneas/tratamiento farmacológico , Pólipos Adenomatosos/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Femenino , Genes Relacionados con las Neoplasias/genética , Humanos , Poliposis Intestinal/diagnóstico , Hígado/enzimología , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Síndrome , Resultado del TratamientoRESUMEN
Pasteurella are commensal gram-negative bacteria isolated from the oral cavity of many domesticated animals. Most human infections occur post animal bite or scratch injury resulting in local cutaneous infection; however, case reports suggest that transmission may occur via animal secretions. Pasteurella species can be associated with serious systemic infections particularly in those with underlying disease and in the immunocompromised. We present a case of invasive Pasteurella multocida sinusitis in an immunocompromised renal transplant patient most likely acquired from a pet dog through direct mucosal inoculation via licking.
Asunto(s)
Perros/microbiología , Trasplante de Riñón/efectos adversos , Infecciones por Pasteurella/etiología , Pasteurella multocida , Sinusitis/etiología , Adulto , Animales , Animales Domésticos , Femenino , Humanos , Huésped InmunocomprometidoRESUMEN
Levels of staffing and access to diagnostics at weekends are recognised to be significantly lower than on weekdays. It is unclear if subsequent inpatient mortality and readmission rates for acute medical admissions are increased for weekend admissions compared to those on a weekday. A large Canadian study demonstrated increased weekend mortality but does the Edinburgh healthcare model support these findings? This study analysed all hospital admissions in 2001 to the Royal Infirmary of Edinburgh for six predetermined diagnoses (total 3,244): chronic obstructive pulmonary disease, cerebrovascular accidents, pulmonary embolism, pneumonia, collapse and upper gastrointestinal bleed. We compared hospital mortality rates, readmission rates and hospital length of stay for weekend admissions as compared to those on a weekday. Weekend admission was not associated with significantly higher in-hospital mortality, readmission rates or increased length of stay compared to the weekday equivalent for any of the six conditions. The implementation of an acute medical admissions unit in the Royal Infirmary of Edinburgh, with consistent staffing levels and 24-hour access to diagnostics for the early phase of critical illness, may have helped address the discrepancy in care suggested by previous studies.