RESUMO
This paper outlines a 10-patient case series of chronic non-bacterial osteomyelitis (CNO) of the mandible at a tertiary paediatric hospital in the UK. Our findings highlight the homogeneous presenting signs and symptoms of an intermittently painful, swollen angle and ramus of the mandible. We present the typical laboratory investigative findings (normal inflammatory markers) and imaging appearances (sclerosis and periosteal oedema). Our paper outlines an investigation protocol, including recommendations for extraoral bone biopsies and systemic magnetic resonance imaging (MRI). We explain the importance of multidisciplinary care, with combined care by rheumatologists and infectious disease specialists. Finally we demonstrate the efficacy of our treatment algorithm for oral non-steroidal anti-inflammatory drugs (NSAIDs), and in those cases refractory to NSAIDS, intravenous pamidronate. This paper provides a useful addition to the literature by informing OMF surgeons of this rare condition and given the clinical equipoise in treatments, it can hopefully guide clinicians in an investigation pathway and management protocol.
Assuntos
Doenças Mandibulares , Osteomielite , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Algoritmos , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Crônica , Imageamento por Ressonância Magnética , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológicoRESUMO
INTRODUCTION: Prior to the COVID-19 pandemic, there was concern that virtual or remote multidisciplinary teams (MDT) meetings represented a niche concept that was unlikely to replace traditional face-to-face meetings in the management of cancer. However, the sudden shift to virtual meetings during COVID-19 has been one of the most dramatic changes since the inception of the MDT. This study aims to investigate the effectiveness of virtual skin MDTs since the move to virtual meetings. METHODS: A cross-sectional survey was sent to all Specialist Skin Cancer MDTs (SSMDTs) and the British Association of Plastic, Reconstructive, and Aesthetic Surgeons Skin Oncology Special Interest and Advisory Group. RESULTS: There were 68 responses (55.3% response rate) from 36 SSMDTs in the UK. Respondents felt communication, chairing, and decision-making were similar in virtual and in-person MDTs, but the team working was worse in virtual meetings. Recruitment, data security, and patient confidentiality were maintained in virtual MDTs. Most preferred a hybrid format for future MDTs, with the option to attend virtually. Recommendations for improvement included better connectivity, IT support, training, and staff integration. CONCLUSION: The virtual MDT is here to stay. We highlight the strengths and weaknesses of remote virtual skin MDTs. It is key that we look at ways to retain team working to ensure that the collegiate nature of MDT working, and therefore treatment options for patients, are not lost in this transformation in MDT delivery.
Assuntos
COVID-19 , Neoplasias , Neoplasias Cutâneas , Humanos , Estudos Transversais , Pandemias , Equipe de Assistência ao Paciente , COVID-19/epidemiologia , Reino Unido , Neoplasias Cutâneas/cirurgiaRESUMO
An 80-year-old woman had the anticoagulant effect of dabigatran etexilate reversed using factor eight inhibitor bypassing activity (FEIBA) in order to facilitate emergency surgery for an incarcerated femoral hernia. She had atrial fibrillation was taking the anticoagulant for stroke prevention. That afternoon her international normalised ratio (INR) was 1.3 and activated partial thromboplastin time ratio (APPTr) was 2.17, having taken dabigatran that morning. 3000â units of FEIBA and 10â mg of vitamin K were administered and she was taken to theatre for emergency surgery. Surgery was successful, total blood loss was less than 100â mL and there were no complications. The following morning she had an INR of 1.1 and APPTr of 1.49. She made an uneventful postoperative recovery and was discharged home. There is a limited evidence base guiding practice in the clinical scenario described. The only controlled studies available are animal experiments.
Assuntos
Antitrombinas/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fatores de Coagulação Sanguínea/administração & dosagem , Dabigatrana/efeitos adversos , Hérnia Femoral/cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Idoso de 80 Anos ou mais , Antitrombinas/administração & dosagem , Dabigatrana/administração & dosagem , Medicina de Emergência , Feminino , Humanos , Coeficiente Internacional Normatizado , Tempo de Tromboplastina Parcial , Resultado do TratamentoRESUMO
BACKGROUND: One objective of the United Nations Global Strategy for Women's and Children's Health relates to ensuring a sufficiently skilled workforce. To prepare future healthcare professionals for their role in the 21st century as members of this workforce, awareness of global health is essential, but few studies have explored student perspectives on such education. The main objectives of this study were to establish the views of medical students on learning about women's and children's health in low-income countries, to identify the nature and extent of learning already experienced, and to assess the demand for such learning. DESIGN: A questionnaire survey was conducted at three meetings of the International Federation of Medical Students Associations (IFMSA). Questionnaires were distributed to 500 participants from 75 countries and 336 medical schools, and 492 usable questionnaires were returned. Data were analysed using SPSS Version 20 and statistical analysis was undertaken using Fisher's exact test. RESULTS: There were 492 questionnaires included in the analysis. Forty-eight per cent of participants were from low-middle income countries and 52% were from high-income countries. Less than half (43%) of the respondents had received some teaching on women's and children's health in low-income countries. Teaching received was primarily (96%) through lectures in the second year of study. Ninety-one per cent of respondents thought such teaching would be important and stated that group work (66%) would be the preferred method. In total, only 14% thought they had received sufficient teaching on global health and on women's and children's health in low-income countries. CONCLUSIONS: This study has revealed a high demand among medical students for global health teaching, particularly on women's and children's health in low-income countries. The timing and methods of existing teaching on these topics does not match that desired by medical students. To help address this gap, a collaborative approach is proposed which includes students' views in the processes for revitalising medical curricula to meet the needs of the 21st century.