The following case of miliary tuberculosis in an infant of six weeks old presents several unusual features of interest. The possibility of antenatal infection from the placenta is now regarded as established, though of rare occurrence, and in the case here reported seems the most reasonable explanation of very advanced lesions in so young a subject.Clinical hi8tory.-The child, a male, was born at home on December 20th, 1928, at full term and weighed 7 lb. Delivery was normal and the doctor in attendance noticed nothing unusual about the child or the placenta. The child was wholly breist fed and developed satisfactorily until 4 weeks old, when he began to fall off, with diarrhaea, loss of weight and inability to take his food, and at this time a patent food was substituted for the breast milk. One week later, on January 26th, 1929, he was admitted to hospital where he went steadily from bad to worse, being unable to take nourishment and running a temperature up to 102'F. He died on January 31st and an autopsy was performed on the following day.Summary of post-mortem examination.-The peritoneal cavity contained a few ounces of clear straw-coloured fluid. The liver showed a generalized tuberculous lesion in the form of rather irregular crude and miliary tubercles, 1 to 4 mm. in diameter, scattered throughout its substance. The cceliae glands lying between the head of the panereas and the portal fissure showed an advanced caseating tuberculous lesion with central cavitation. The spleen contained innumerable crude and miliary tubercles up to 4 mm. in diameter. The kidneys contained a few small scattered tubercles definitely of crude caseous type, the largest being 2-3 mm..in diameter. The mesenteric glands showed a few small caseous tuberculous foci, much smaller and more recent than those in the cceliac group. The lungs contained numerous crude yellow tubercles up to 7 mm. in diameter, together with many fine miliary tubercles. The bronchial glands were the seat of early caseating tuberculosis. In addition there were scattered miliary tubercles in the adrenals, the gastric and intestinal mucosne, the pleurae and the myocardium. The most advanced lesion was certainly that of the eceliae group of glands.Hi8tological examination.-The liver is uniformly studded with tubercles in which may be distinguished two types of response, occasionally associated in the same tubercle but most frequently occurring separately. (1) There is a definite and typical follicle with epithelioid cells, slight necrosis, formation of giant cells of small size and a little peripheral lymphocytic infiltration. These tubercles stain pink with haemalum and eosin, and contain only an occasional tubercle bacillus. (2) Secondly, there is a lesion which is essentially necrotic with very notable basic staining on account of the abundant pyknotic nuclear material present. In this form tubercle bacilli are present in myriads but there is little cellular reaction and no giant cells are seen. There is considerable lymphocytic infiltration of the portal tra...
Department of Health Start Smart then Focus recommends that successful antimicrobial stewardship (AMS) programmes include a ward-focused antimicrobial team. Nurses are underutilised in AMS, and nurse/pharmacist-led initiatives have not been well described in the literature. A shortage of consultant microbiologists has required the AMS team to consider a creative multidisciplinary approach to post-prescription review and individual feedback at ward level. Discussion This project has demonstrated the value of a nurse/pharmacist collaboration for improving antimicrobial prescribing. The low intervention rate for IVOS was deemed to be due to the timing of intervention in relation to patient admission and has led to a change of focus to areas where duration of stay is typically longer. Future vision is to ensure sustainability in the context of long-term doctor shortages and continue to evidence the value of non-medical prescribers in AMS.
Negative pressure wound therapy (NPWT) is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial.
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