Posted 4 August, 2007 - 09:39 by steve
Nowadays, C-diff infection has been a big problem especially among elderly patients. Remitting and relapsing trend is also common. In the last stool sample CDT showed "Not detected", they might come back with watery diarrhoea after sometime. CDT positive again. You may know metronidazole is less effective. We use Vancomycin 125 QDS for a few days. If diarrhoea gettting worse, we usually increase the dose to 500 QDS with or without Rifampicin 300 mg BD.
We do Immunoglobin levels which show lower limits or low level in those patients. We have tried Immunoglobulin infusion on 3 patients in last 2 months. Positive result has been found. One consultant recommended VSL 3.
Well, regarding Probitics, this BMJ article is interesting.
Posted 25 July, 2007 - 22:17 by steve
Video EEG is the gold standard investigation used to differentiate NEAD from epileptiform events.
What is videotelemetry?
Videotelemetry is a special type of EEG (brainwave) test. The brainwaves are recorded usually for several days along with a video using a camera. Therefore this is a much longer recording than a standard EEG.
Videotelemetry can only be performed as an in-patient as it requires specialised equipment and specially trained staff usually in a purpose-built unit.
The advantage of videotelemetry is that if you have an attack then the brainwaves and video are recorded together. This can often be very helpful with coming to a diagnosis or further treatment.
Source:
Posted 23 July, 2007 - 16:47 by steve
On the ward, the dietitian would advice you to check daily bloods including Mg, Cal,Po4 when patient with recently introduced NG tube feeding is reviewed? Why?
Refeeding syndrome occurs when previously malnourished patients are fed with high carbohydrate loads, the result is a rapid fall in phosphate, magnesium and potassium, along with an increasing ECF volume, leading to a variety of complications. More about it on
Posted 22 July, 2007 - 16:04 by steve
NICE recommends a CT scan if
- GCS less than 13 at any point since the injury
- GCS equal to 13 or 14 at two hours after the injury.
- Suspected open or depressed skull fracture.
- Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid otorrhoea, Battle’s sign).
- Focal neurological deficit.
- More than one episode of vomiting
- Amnesia for greater than 30 minutes of events before impact. ( cannot recall what he/she was doing just before injury/accident)
Posted 21 July, 2007 - 15:17 by steve
Patients on NBM may need IV phosphate when low PO4. This is an adivce from a local pharmacy of the hosptal where I work.
Preparation is 500ml bottle(100mmol/lit)
Take 90 ml from it (bin the remaining)
Infusion rate 7.5 ml/hour for 12 hours
check BP and HR 30 min after starting of infusion
check K, Mg, Ca 30 min after completion of infusion
Check PO4 level 1 day after infusion
Posted 21 July, 2007 - 15:07 by steve
Normal treatment courses of antibiotics may not eradicate C.diff spores from the gut.
Once treatment stops, normal bowel flora is not present to prevent relapse of disease.
Pulsed or tapered doses are intended to keep spores under control whilst allowing normal flora to be re-esterblished thus reducing likelihood of relapse.
Pulse dose: 125-500mg OD every 3 days for 3 weeks (after course of 500mg QDS)
Tapered: Reducing gradually from 500mg QDS over 3-4 weeks.
<Thanks to Anthony Bartlett, Antibiotic Pharmacist>
Posted 15 July, 2007 - 10:54 by steve
[b]Use of thrombolysis for acute ischaemic stroke[/b]
With an estimated 4.5 million deaths per year worldwide and over 9 million stroke survivors, stroke has an overwhelming impact on public health. In the second of his two part series. Professor Kennedy Lees reviews the use of intravenous thrombolysis in acute ischaemic stroke, specifically in the elderly, and reviews major randomized and observational studies to date.
Although stroke can affect anyone regardless of age, it is predominantly a disease of the elderly. Almost a quarter of all types of stroke occur in those greater than 85 years old and half occur in those over 70 years of age1. Statistics show that age also affects outcome after stroke and it is likely that elderly sufferers require greater care after a stroke than younger counterparts.
Posted 15 July, 2007 - 10:44 by steve
Posted 27 April, 2007 - 12:37 by steve
This website [url=http://www.osteoporosis.ca/english/News/GuidelinesNewsRelease/]ostroporosis.ca [/url]said :The Osteoporosis Society of Canada (OSC) has launched the first evidence-based clinical practice guidelines for osteoporosis in the world.
it also mentions
[quote]Prevention and Treatment
Higher intakes of calcium and vitamin D are recommended, particularly in adults over 50 (calcium 1500 mg/day and vitamin D 800 IU/day).
Children, particularly those entering and passing through puberty, should participate in impact exercise or sports (mainly field and court sports).
Men and women throughout life should participate in exercise, particularly weight-bearing exercises such as brisk walking, running or dancing.
Bisphosphonates (Didrocal, Fosamax and Actonel) and raloxifene (Evista) are first choice therapies for individuals without menopausal (vasomotor) symptoms. Hormone Replacement Therapy (HRT) is no longer the "gold standard" for treatment of osteoporosis.
Posted 27 April, 2007 - 10:54 by steve
Fall is one of the major causes of mobidity and mortality in the elderly. The most effective intervention was a multifactorial falls risk assessment and management programme. It is a research trial in 2004
[url=http://www.bmj.com/cgi/content/abridged/328/7441/680?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=fall&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT]go to BMJ[/url]
