RESUMO
A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. This patient also has a history of atopy giving a predisposition for developing IgE-mediated allergic reactions. Hymenoptera stings can be severe in atopic individuals and anaphylaxis may ensue. However, it is a rare cause of myocardial infarction (MI) (Kounis syndrome). Multiple wasp stings in the past may have contributed to sensitisation. Kounis syndrome is a rare clinical manifestation which should remain in the minds of physicians, especially with younger patients with no history of ischaemic heart disease or few risk factors.
Assuntos
Oclusão Coronária/complicações , Síndrome de Kounis/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Venenos de Vespas/toxicidade , Anafilaxia/induzido quimicamente , Anafilaxia/etiologia , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Animais , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Eletrocardiografia , Humanos , Himenópteros , Imunoglobulina E/imunologia , Síndrome de Kounis/etiologia , Síndrome de Kounis/imunologia , Masculino , Pessoa de Meia-Idade , Doenças Raras , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Venenos de Vespas/imunologia , VespasRESUMO
This study analyses the attitudes of patients towards the presence of medical students during consultations. It was conducted in a very culturally and ethnically diverse part of London. The study aimed to investigate the factors, particularly ethnicity, which influence patients' attitudes towards medical students. A total of 422 patients participated in the study, which was conducted in general practice and hospital outpatient waiting areas in the London Boroughs of Tower Hamlets and Hackney. In general, the results demonstrate that patients are positive towards medical student participation during consultations. In particular, older patients, patients born in the UK and patients with prior experience of medical students seem to be particularly favourable towards students. However, compared with the White-British population, the non-White-British population appears to be more negative towards medical student participation. This study highlights the need for patient education regarding the importance, for the training of future doctors, of medical student involvement in consultations.