In IIM, the risk of developing ILD is significantly higher in patients of Black ethnicity. Progressive lung damage occurs in an appreciable subgroup of patients with IIM-ILD, heralded by functional lung decline at 1 year despite systemic immunomodulatory treatment.
Nosocomial infections place a heavy burden on overstretched health services. An audit of junior doctors’ sick leave behaviour was undertaken in 1993 and again in 2001. The object was to ascertain the level of common infectious illness and to investigate whether junior doctors were remaining at work inappropriately. The doctors were asked if any factors had influenced their decision to take sick leave or not. Between the two audits several initiatives have been introduced to improve the working conditions of junior doctors, including the New Deal to reduce hours of work. Eighty one junior doctors in a large teaching hospital participated in 1993 and 110 in 2001. The number reporting an infectious illness in the previous six months was similar (61.7% in 1993, 68.2% in 2001). There had been a significant increase in the percentage of infectious illness episodes for which the doctors took sick leave (15.1% in 1993, 36.8% in 2001, p < 0.001). The most common reason for taking less sick leave than was felt necessary was concern about colleagues having to do extra work (72% in 1993, 68% in 2001). Consultant pressure was cited by 26% (1993) and 20% (2001). Use of the staff occupational health unit was minimal, with none of the ill doctors contacting the department in 1993 and only three in 2001. Overall, despite the reduction in the number of infectious doctors not taking sick leave, the majority remained at work. Fundamental changes are needed if potentially infected doctors are not to present a risk of iatrogenic infection.
Pulmonary arterial hypertension (PAH) in pregnancy carries a mortality of 30-56%. There are few published data to guide clinicians in its management. Two pregnant women with severe PAH have been treated at Royal Perth Hospital with a successful result in both. Their presentation and management are described. We review the physiological changes in pregnancy, pathophysiology in PAH, and review the literature describing treatment of PAH in pregnancy.
IntroductionThe prevalence of pulmonary MRSA infection in cystic fibrosis (CF) has been increasing and is associated with accelerated pulmonary function decline and higher mortality rates. Eradication is generally recommended but there is no consensus of the optimal regimen. The current prevalence at our centre is low (3%, n = 20). Method Retrospective review of adult patients with newly acquired MRSA infection (2007)(2008)(2009)(2010)(2011)(2012) confirmed by ≥1 positive sputum culture. Data were retrieved from clinical records. "New" infection was confirmed by ≥3 consecutive preceding negative MRSA cultures over ≥12 months. Reflective of changing practice towards MRSA eradication at our centre, antibiotic therapy was categorised as either "conventional" (pre-2008) -a single oral agent, or "contemporary" (2008 + ) using dual oral therapy (based on sputum susceptibilities). Our primary outcome was successful MRSA eradication from sputum at 3 months. Results 32 infection episodes (n = 25) were identified. 19 patients had a single episode of infection, 5 had 2 and 1 patient had 3, each separated by an MRSA-free period of ≥12 months. 13 episodes were treated by conventional approaches (n = 13), and 13 by contemporary means (n = 12). Eradication was not attempted for 6 episodes. Eradication at 3 months was confirmed by negative sputum cultures after treatment by conventional or contemporary regimens in 45% and 80% episodes, respectively (p = NS).Combined Rifampicin/Fusidic acid (Rif/Fus) and single agent tetracyclines were the most widely used regimens (treatment duration, median 2 weeks (range 1.4-4)). Rif/Fus was used for 8 infection episodes (n = 8), achieving eradication rates at 3 months of 100% (6/6 patients). Negative MRSA sputum cultures were maintained in 75% (6/8) patients at 6 months and 37.5% (3/8) at 12 months. Tetracyclines were used for 9 infection episodes (n = 9), achieving eradication rates of 42.9% at 3 months (3/7), 33.3% at 6 months (3/9) and 33.3% at 12 months (3/9). Rif/Fus was more likely to achieve eradication at 3 months compared with tetracyclines (p = 0.03), but this did not maintain statistical significance at 6 or 12 months. Conclusion Our findings demonstrate contemporary treatment with an antibiotic combination, particularly Rif/Fus, to be an effective MRSA eradication strategy. This requires validation with a prospective controlled trial.
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