There is an independent incremental association between delays in administrating antibiotics and mortality from adult acute bacterial meningitis. Inappropriate diagnostic-treatment sequences were significant predictors of such treatment delays.

For patients with liver cirrhosis, MCrCl from timed urine collections consistently overestimates the true GFR. For patients requiring complete clinical evaluation, GFR assessment by CIn is justified.

Preoperative autologous blood donation in Canada has increased in the last decade due to concerns about allogeneic blood safety. As economic policies necessitate the validation of autologous blood donation, it is important to assess potential changes. This study examines the motivations and perceptions of patients participating in a Canadian autologous blood donation programme. The study was conducted at the Ottawa Hospital, Civic Campus. Questionnaires were developed and then administered to 100 consecutive adult autologous blood donors. The questionnaires assessed patient demographics, motivation for participation and perceptions about blood safety. Autologous donation was presented to 82% of patients as an option by their physicians. However, 59% of all patients felt that they were motivated to donate by their own fears. Patients (87%) also felt that directed blood donation should be offered due to their perception that directed donation is safer. Three-quarters of patients would be willing to pay for autologous donation. Patients are concerned about the safety of allogeneic blood and they are motivated to seek other alternatives despite the fact that allogeneic blood is very safe. These perceptions and motivations must be taken into account as health care policy changes are considered.

A 33-year-old woman, employed in a dog pound, presented herself to the emergency department complaining of worsening headache, photophobia, and neck pain. One week prior to her presentation she developed a dry cough, sore throat and nasal discharge and was treated with amoxicillin for an upper respiratory tract infection. There was no history of recent vaccination. She remembered having recently been scratched on the hand by a newly encountered dog. Her past medical history included recurrent sinusitis. She also had chronic neck pain which she related to a motor vehicle accident three years previously.On initial examination the patient looked ill, her temperature was 39 o C, her blood pressure was 130/80 mmHg, her pulse was 110 beats per minute, and her respiratory rate was 16 breaths per minute. A general examination did not reveal a rash, peripheral lymphadenopathy or break in the integument despite the history of a dog scratch on the hand. Ear, nose and throat examinations were unremarkable. Neurologically, she was fully oriented and the only finding was meningismus. ABSTRACT: Objective:To describe a case of Pasteurella multocida meningitis associated with acute disseminated encephalomyelitis (ADEM). Case report: A 33-year-old woman employed in a dog pound presented herself to hospital with fever and meningismus and was found to have culture positive Pasteurella multocida meningitis. Despite appropriate antibiotic treatment her clinical course was characterized by a persistent fever and worsening encephalopathy, which prompted further neurological investigation. Spinal fluid exam and serial MRI scans as well as her one-year clinical course were found to be compatible with ADEM. Conclusion: Persistent fever and worsening encephalopathy in meningitis may indicate a para-infectious immune process such as ADEM, and may serve as indications for further neurological investigation. CASE REPORTAdmission laboratory investigations revealed the following: white blood cell count 14.6 X 10 9 /L with neutrophil count 13.4 X 10 9 /L, hemoglobin 129 g/L and platelet count 192 X 10 9 /L. Her electrolytes, urea, and creatinine were within normal limits. Urine and microscopy were unremarkable. The chest roentgenogram and electrocardiogram were normal. A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) containing 680 X 10 6 /L leukocytes (78 % neutrophils, 1 % lymphocytes and 21 % monocytes), an elevated protein level of 0.93 g/L and a glucose level of 3.9 mmol/L. Serum glucose was 7.5 mmol/L.https://www.cambridge.org/core/terms. https://doi