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1.
Acute Med ; 20(2): 144-147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34190742

RESUMO

A 27 year old female presented to the emergency department with intermittent central forehead swelling over several months associated with a headache. She was admitted under the medical team as having had a suspected allergic reaction but the diagnosis of a Pott's Puffy Tumour was quickly made and confirmed through CT and MR imaging. This uncommon condition is related to sinusitis leading to localised abscess formation with osteomyelitis and a subsequent swollen appearance over the affected facial sinus. This patient's sinus abscess extended into the epidural space and caused destruction of the anterior and posterior walls of the frontal sinus. The patient was managed with intravenous antibiotics, analgesia and referral to the local ENT team for surgical intervention.


Assuntos
Sinusite Frontal , Tumor de Pott , Adulto , Antibacterianos/uso terapêutico , Feminino , Sinusite Frontal/complicações , Sinusite Frontal/diagnóstico por imagem , Sinusite Frontal/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Tumor de Pott/diagnóstico , Tumor de Pott/diagnóstico por imagem
2.
Clin Toxicol (Phila) ; 52(8): 868-72, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25200454

RESUMO

BACKGROUND: On 3 September 2012, the licensed indication for acetylcysteine was changed in the United Kingdom (UK) so that all patients with a plasma paracetamol concentration above a "100 mg/L" (4 h post ingestion) nomogram treatment line after an acute paracetamol (acetaminophen) overdose should be treated. This is a lower threshold than that used in the United States, Canada, Australia, and New Zealand. Here we report the impact of this change in the UK on the management of patients with acute overdose in different paracetamol concentration ranges. METHODS: This is a cohort study, consisting of a retrospective analysis conducted on prospectively collected audit data in three UK hospitals. Following appropriate ethical and data protection authority approval, data for patients presenting within 24 h of an acute timed single paracetamol overdose were extracted. Numbers of admissions and use of antidote in relation to different paracetamol concentration bands (< 100 mg/L; 100-149 mg/L; 150-199 mg/L; and ≥ 200 mg/L at 4 h) were analyzed for one-year periods before and after the change. RESULTS: Comparing the year before with the year after the change, there was no change in the numbers of patients presenting to hospital within 24 h of acute timed paracetamol overdose (1246 before and 1251 after), but more patients were admitted (759 before and 849 after) and treated with acetylcysteine (389 before and 539 after). Of the 150 additional patients treated with acetylcysteine in the year following the change, 114 (76%, 95% CI: 68.4-82.6) were in the 100-149 group and 9 (6.0%, 95% CI: 2.8-11.1) in the 150-199 group. CONCLUSIONS: Changes to national guidelines for managing paracetamol poisoning in the UK have increased the numbers of patients with acute overdose treated with acetylcysteine, with most additional treatments occurring in patients in the 100-149 mg/L dose range, a group at low risk of hepatotoxicity and higher risk of adverse reactions.


Assuntos
Acetaminofen/intoxicação , Acetilcisteína/uso terapêutico , Overdose de Drogas/tratamento farmacológico , Antídotos/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/patologia , Hospitalização , Humanos , Fígado/efeitos dos fármacos , Fígado/patologia , Nomogramas , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Reino Unido
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