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Crosshouse, United Kingdom

Fitzgerald M.P.,Yorkhill Hospital | Armstrong L.,Crosshouse Hospital | Hague R.,Yorkhill Hospital | Russell R.K.,Yorkhill Hospital
Journal of Crohn's and Colitis

We report a case of Epstein-Barr virus infection with the subsequent development of haemophagocytic lymphohistiocytosis in a teenage Crohn's disease patient treated with azathioprine. We found that the early introduction of the anti-B cell monoclonal antibody rituximab precipitated a rapid fall in circulating B-cells and EBV viral load, resulting in a prompt and sustained recovery from what is a potentially fatal complication of azathioprine therapy in Crohn's disease patients. © 2012 European Crohn's and Colitis Organisation. Source

Chalmers C.,Crosshouse Hospital
Journal of Laryngology and Otology

Objective: To present the first reported case of Haemophilus influenzae type b epiglottitis leading to necrotising fasciitis.Method: Case report and review of the literature regarding the association of necrotising fasciitis with Haemophilus influenzae infection and with epiglottitis.Case report: A previously well, 64-year-old woman presented with epiglottitis, and subsequently developed necrotising fasciitis of her chest wall. The cause of both infections was Haemophilus influenzae serotype b. This organism has frequently been implicated in epiglottitis, but has not previously been reported to cause simultaneous necrotising fasciitis. The patient became critically ill, requiring intensive care management, but following surgical debridement and antibiotic treatment she made a full recovery.Conclusion: Although increasingly uncommon, clinicians must continue to be proficient in the diagnosis and management of epiglottitis, and to be aware of its full range of possible complications. This case report highlights a previously unknown and potentially fatal complication of Haemophilus influenzae type b epiglottitis. Copyright © JLO (1984) Limited 2009. Source

Dunleavy A.D.,Crosshouse Hospital
British Journal of Hospital Medicine

This article will outline some of the common prescribing errors that occur and how to avoid them when prescribing for renal patients including patients with chronic kidney disease, established renal failure and transplant patients. Source

Bal A.M.,Crosshouse Hospital | Gould I.M.,Royal Infirmary
Current Opinion in Infectious Diseases

Purpose of review: Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of successful programs. These include lack of physician participation, lack of diagnostic facility, absence of formal mechanism of data collection, variation between countries, and lack of cooperative strategies. In this review, we suggest strategies to overcome these barriers. Recent findings: In the last few years, it has been recognized that an executive program is necessary for successful implementation of strategies to control the growing antibiotic resistance. Efforts have been made at higher levels of government through organizations such as the European Centre for Disease Prevention and Control. The need for community healthcare involvement has also been recognized. At a local level, strategies to promote cooperation between various committees (e.g. infection control and antimicrobial management teams) have been proposed and adopting antibiotic care bundles as part of patient safety and healthcare is being explored. Summary: We suggest that executive level planning, local cooperation, sustained education, emphasis on de-escalation, and use of care bundles could stem the tide of growing resistance. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Bal A.M.,Crosshouse Hospital
Indian journal of medical ethics

Private medical colleges in India are under the scanner. There is a longstanding debate about the selection methodology that should be followed for admissions in medical colleges. A significant proportion of aspirants are able to afford medical education in private colleges despite not clearing entrance examinations. Others gain entry purely on the basis of caste. Medicine deals with human life and, consequently, there is a widespread feeling that admission criteria in medical schools should be based only on merit as assessed in entrance examinations. This article examines some of these contentious issues. Source

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