Penicillin allergy SHACK: Survey of hospital and community knowledge.

AIM: Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation. Clinician awareness of allergy assessment, referral indications, management of allergy and anaphylaxis is therefore vital but globally lacking. We aim to assess the knowledge of penicillin allergy, assessment and management in Western Australian health professionals. METHODS: An anonymous survey was distributed to pharmacists, nurses and physicians within Western Australian paediatric and adult Hospitals, Community and General Practice. RESULTS: In total, 487/611 were completed and included in the statistical analysis. Only 62% (301/487) of respondents routinely assessed for patient medication allergies. Of those who assessed allergy, 9% (28/301) of respondents met the Australian standards for allergy assessment. Only 22% (106/487) of participants correctly cited all indications for management with adrenaline in anaphylaxis to antibiotics and 67% (197/292) of physicians rarely or never referred to an allergy service. Paediatric clinicians had an increased understanding of allergy assessment and anaphylaxis management. Recent penicillin allergy education within a 5-year period led to significant improvements in allergy knowledge. CONCLUSION: Overall, knowledge, assessment and management of penicillin allergies among practitioners in Western Australia are currently inadequate in adults and paediatric clinicians to provide safe and effective clinical care. The implementation of a targeted education program for WA health professionals is urgently required and is expected to improve clinician knowledge and aid standardised penicillin assessment (de-labelling) practices.

An observational cohort study of health outcomes and costs associated with early pregnancy assessment units in the UK.

BACKGROUND: The objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations. METHODS: This was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety. RESULTS: Costs, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84-0.86) at baseline to 0.91 (95% CI 0.90-0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment. CONCLUSIONS: EPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women's health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.

Antioxidant Activity, Physicochemical and Sensory Properties of Stingless Bee Honey from Australia.

This study reports on the physicochemical and sensory attributes, total phenolic content, and antioxidant activity of 36 honey samples produced by two different stingless bee species (Tetragonula carbonaria and Tetragonula hockingsi) from Australia. The findings reveal moisture content across all samples ranges from 24.9% to 30.8% (w/w), electrical conductivity from 1.02 to 2.15 mS/cm, pH levels between 3.57 and 6.54, soluble solids from 69.2 to 75.1 °Brix, trehalulose concentrations from 6.20 to 38.2 g/100 g, fructose levels from 7.79 to 33.4 g/100 g, and glucose content from 3.36 to 26.8 g/100 g. Sucrose was undetectable in all investigated samples. In a sensory analysis involving 30 participants, Australian stingless bee honey was perceived as having a more pronounced sourness compared with New Zealand Manuka honey. The study reveals considerable variability in the composition of Australian stingless bee honey, influenced by factors such as floral availability, geographical origin, and time of harvest. It also demonstrates the presence of phenolic compounds and antioxidant activity in stingless bee honey, underlining their potential as a natural source of antioxidants. All investigated samples contain trehalulose, which supports the findings of other recent studies that propose this unusual disaccharide as a marker compound of stingless bee honey.

Transport of pilgrims during Hajj: Evidence from a discrete event simulation study.

Hajj, the Muslim pilgrimage, is a large mass gathering event that involves performing rituals at several sites on specific days and times in a fixed order, thereby requiring transport of pilgrims between sites. For the past two decades, Hajj transport has relied on conventional and shuttle buses, train services, and pilgrims walking along pedestrian routes that link these sites. To ensure smooth and efficient transport during Hajj, specific groups of pilgrims are allocated with the cooperation of Hajj authorities to specific time windows, modes, and routes. However, the large number of pilgrims, delays and changes in bus schedules/timetables, and occasional lack of coordination between transport modes have often caused congestion or delays in pilgrim transfer between sites, with a cascading effect on transport management. This study focuses on modelling and simulating the transport of pilgrims between the sites using a discrete event simulation tool called "ExtendSim". Three transport modules were validated, and different scenarios were developed. These scenarios consider changes in the percentages of pilgrims allocated to each transport mode and the scheduling of various modes. The results can aid authorities to make informed decisions regarding transport strategies for managing the transport infrastructure and fleets. The proposed solutions could be implemented with judicious allocation of resources, through pre-event planning and real-time monitoring during the event.

Wernicke Encephalopathy following Gastric Bypass: A Case Report.

Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy 2 months after gastric bypass surgery, with additional findings of flat affect and concurrent polyradiculopathy. Her diagnosis was delayed due to unique symptoms and an initial workup with negative imaging findings, making the identification of this disorder more complex.

Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study.

OBJECTIVE: To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. DESIGN: Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes". SETTING: 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. PARTICIPANTS: 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. EXPOSURES: Planned and actual senior clinician presence, unit size, and weekend opening. MAIN OUTCOME MEASURES: Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. RESULTS: 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. CONCLUSIONS: Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

Pulmonary embolism and cardiac enzymes.

BACKGROUND: Pulmonary embolism (PE) is often associated with chest pain, electrocardiographic changes, and right ventricular (RV) dysfunction on echocardiogram. There have been reports of elevated troponin levels with PE. RV dysfunction and elevated troponin levels have prognostic implications in acute PE. The purpose of this retrospective analysis was to determine whether PE was associated with elevated cardiac enzymes and whether there was any difference among patients who presented with or without chest pain. METHODS: Records of 93 consecutive patients with high-probability ventilation/perfusion lung scan results for PE were analyzed for the presence or absence of chest pain on presentation, abnormalities in cardiac enzymes, and evidence of RV dysfunction on echocardiogram. RESULTS: A total of 56 of 93 patients had cardiac enzymes evaluated; 24 of these 56 patients had chest pains, and 32 did not. Only 1 patient of the 56 had abnormal cardiac enzymes. This patient had a known history of coronary artery disease (CAD) and had experienced an acute anterior myocardial infarction. Echocardiograms were performed in 36 of 93 patients. Evidence of RV dysfunction on echocardiograms was found in 22 of these patients. No significant relationship was found between RV dysfunction and chest pains (P > .10). CONCLUSION: We found no significant relationship between high-probability ventilation/perfusion scan results and abnormalities in cardiac enzymes irrespective of the presence or absence of chest pain. Patients with a history of CAD or RV dysfunction did not have a higher incidence of chest pain when compared with those with no known history of CAD or RV dysfunction.

The role of aldosterone and aldosterone-receptor antagonists in heart failure.

Prolonged overactivation of neurohormonal mechanisms in heart failure produces deleterious effects on the cardiovascular system and leads to poor prognosis. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers have been shown to interrupt this excessive overactivity and improve survival. Activation of the renin-angiotensin system leads to increased synthesis of aldosterone in heart failure. Some aldosterone production is independent of ACEs; therefore, ACE inhibition does not entirely suppress the excessive formation of aldosterone. An excess of aldosterone in heart failure leads to sodium retention and myocardial fibrosis. The use of aldosterone antagonists, combined with standard therapy for heart failure, improves morbidity and mortality.

A novel complication of bariatric surgery.

The incidence of obesity in the US is increasing. This has been associated with an increasing incidence and prevalence of diabetes, hypertension, and obstructive sleep apnea. Diet alone has generally been ineffective in attaining significant weight loss. Bariatric surgery is associated with significant weight loss and improvement in diabetes, hypertension, and obstructive sleep apnea. In this article we describe an unusual complication of bariatric surgery.

Attempted suicide in Western Viti Levu, Fiji.

Case records were reviewed of 132 people referred to the FSEG in Lautoka from January 2004 to December 2005 following an attempt at suicide. Seventy five percent of the study group was under age 32, 90% were Indo-Fijian and 66% female; these characteristics were significantly overrepresented compared to the demography of the source population. Findings show that social stress constitutes the primary reason for attempted suicide among all ages, genders, religions and ethnicities and suggest that Fijians and Christians may also be reacting to economic factors. A control group study of non-suicidal persons under stress is needed to distinguish characteristics of suicide attempters. Our tentative findings agree with the current perception and literature on selective demographic risks for attempted suicide -- young age, Indian ethnicity, female gender and social stress.

Diastolic heart failure and left ventricular diastolic dysfunction: what we know, and what we don't know!

Diastolic heart failure is a common form of congestive heart failure that is responsible for significant morbidity and mortality. In contrast to heart failure caused by systolic left ventricular dysfunction, diastolic heart failure is harder to diagnose and less likely to be accepted as a diagnosis. In addition, treatment strategies are much less defined than those for heart failure caused by systolic dysfunction.

Large spontaneous coronary artery-to-right ventricular fistula.

We report a case of the spontaneous formation of a left anterior descending artery to right ventricular fistula. The unprovoked appearance of this fistulous connection was clearly documented by serial angiography and confirmed during surgery.

Spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) should be considered as a cause of the acute coronary syndrome in young patients with few apparent risk factors for coronary artery disease, in females in the peripartum period, and in patients who are at a higher risk for this condition. SCAD can also present as sudden death and cardiogenic shock. Several mechanisms have been described in the pathophysiology of this condition. Urgent coronary angiography is indicated if SCAD is suspected. Percutaneous coronary artery stenting and coronary artery bypass grafting are the main treatment strategies.

Cardiac involvement in non-Hodgkin's lymphoma: with and without HIV infection.

AIDS has resulted in a significant increase in the incidence of both primary and secondary cardiac lymphomas. Prognosis of HIV associate cardiac non-Hodgkin's lymphoma is poor with very limited survival. Many cases of cardiac involvement in lymphoma remain undetected secondary to non-specific symptoms. Chemotherapy may produce remission in some cases. We report two cases of cardiac involvement with B-cell lymphoma. The first patient had a history of AIDS while the second had no evidence of HIV infection.