Entamoeba histolytica, a pathogenic protozoan that causes amoebiasis, remains the second leading cause of death from parasitic infections worldwide. We present a case series of patients presenting to metropolitan tertiary gastroenterology units in Melbourne, Australia, highlighting the complexities of diagnosing amoebic colitis and the potential for misdiagnosis. These cases illustrate four key lessons in the identification of amoebic colitis: (i) obtaining a thorough travel and exposure history, (ii) having a high index of suspicion, (iii) understanding the limitations of available investigations, and (iv) being aware that amoebic colitis may masquerade as other common conditions.
We report two cases of severe pneumonia due to clone ST93 methicillin-resistant Staphylococcus aureus (MRSA) presenting from a remote Australian Indigenous community within a 2-week period, and the utilization of whole genome sequences to determine whether these were part of an outbreak. S. aureus was isolated from 12 of 92 nasal swabs collected from 25 community households (including the two index households); one isolate was ST93. Three of five skin lesion S. aureus isolates obtained at the community were ST93. Whole genome sequencing of the ST93 isolates from this study and a further 20 ST93 isolates from the same region suggested that recent transmission and progression to disease had not taken place. The proximity in time and space of the two severe pneumonia cases is probably a reflection of the high burden of disease due to ST93 MRSA in this population where skin infections and household crowding are common.
<b><i>Introduction:</i></b> Iron deficiency is a common condition, especially among patients with kidney and heart failure and inflammatory bowel disease. Intravenous iron is the preferred method of treatment in these patients, but it usually requires prolonged iron polymaltose infusions or multiple administrations of alternative preparations. The aim of the study was to confirm the safety and patient acceptance of ultrarapid iron polymaltose infusions as an alternative to slower treatments and ferric carboxymaltose. <b><i>Method:</i></b> An open-label, phase 4 safety study was conducted at a tertiary hospital, with consenting participants diagnosed with iron deficiency and requiring iron polymaltose up to 1,500 mg receiving the infusion over 15 min. The acute adverse event (AE) rates and their severities were compared to historical controls of 1- and 4-h iron polymaltose infusions from a retrospective study of 648 patients from the same study site. Delayed AEs as well as participant infusion acceptability were also studied. <b><i>Results:</i></b> Three hundred participants over a 2-year period received ultrarapid infusions of iron polymaltose with an acute AE rate of 18.7% and severe AE rate of 1.0%. The total and mild infusion AE rates were higher compared to those of slower infusions (<i>p</i> < 0.001), but comparable for moderate and severe AEs. Delayed reactions occurred in 12.5% of participants, with over 95% of them preferring repeat ultrarapid infusions if required again. <b><i>Conclusion:</i></b> Iron polymaltose can be safely infused at ultrarapid rates when compared to slower infusions, with similar safety to ferric carboxymaltose, offering greater convenience for patients and reduced healthcare costs.
Gastrointestinal stromal tumors (GIST) are the most common form of mesenchymal gastrointestinal (GI) tumors. They are most commonly found in the stomach and proximal small bowel, however, may occur anywhere within the GI tract, as well as the omentum and mesentery. 1 They are responsible for approximately one percent of all GI cancers and the estimated incidence is 10-15 per million per year. The median age of diagnosis is approximately 59; however, it can range from 10-100 years old, and gender distribution is approximately equal. [1][2][3] GIST are classically solitary tumors. Multiple GISTs are usually associated with familial syndromes and sporadic multiple GISTs are rarely reported. [3][4][5][6] | CASE REPORTThe patient was a 59-year-old woman who presented initially with iron deficiency anemia (IDA) and subsequent episodes of GI bleeding. Other medical history included a posterior-lateral thoracotomy for a benign schwannoma, cholecystectomy, hypercholesterolemia, migraines, and factor V Leiden deficiency with no history of clots. Her only regular medication was rosuvastatin and she had zopiclone, metoclopramide, sumatriptan, and paracetamol as required. She had no significant family history, particularly of GI bleeding or GI malignancy.She initially had treatment for her IDA 10 years prior and required a further iron infusion two and a half years before diagnosis. Her nadir hemoglobin was 79 g/L at
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