CASE PRESENTATION

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CASE PRESENTATION

• By
• DR.JASINTHA KANDASAMY
• Trust Doctor (SHO)
• MBBS, MD (SRILANKA)

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CASE No 1

• Mrs. X
• DOA 19/05/10
• 78 Years
• Presented with sudden onset SOB
• Background Generally healthy
• RH
• Mobile with stick

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INVESTIGATIONS

• CXR Pulmonary Oedema
• ECG Sinus Tachycardia
• TROPONIN 22.02
• WBC on 19/05/10 - 18.5
• Neutrophils - 15.1
• CRP on 19/05/10 - 53

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DIAGNOSIS

• ACUTE LVF SECONDARY TO NSTEMI

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TREATMENT

• ACS protocol, furosemide, statin,
  ramipril,bisoprolol
• IV Co-amoxiclav 1.2gm tds 19/05/10 21/05/10
• Oral Co-amoxiclav 625mg tds 22/05/10 26/05/10

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• 26th Developed diarrhoea
• 27th C.Diff. toxin positive

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• DIAGNOSIS C.DIFFICLE DIARRHOEA
• TREATMENT METRONIDAZOLE 7DAYS

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CASE No 2

• Mrs. Y
• DOA 14/05/10
• 92 Years
• Presented with lower abdominal pain and acute
  retention of urine
• Background Lives alone, carers tds
• Multiple comorbidities
• One week ago Rxed for
  UTI
• with trimethoprim 5days
  by GP

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INVESTIGATIONS

• CXR NAD
• ECG RATE CONTROLLED AF
• BLOODS WCC NORMAL, CRP 24 on 14/05/10
• URINE ANALYSIS LEUCOCYTES , BLOOD
• URINE CULTURE (14/05) POSITIVE
• URINE CULTURE (19/05) NO GROWTH

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TREATED FOR UTI

• Co-amoxiclav 14/05/10 16/05/10
• Nitrofurantoin 20/05/10 25/05/10

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• 24th Developed Diarrhoea
• 25th C.Diff. toxin positive

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• DIAGNOSIS C.Diff. Diarrhoea
• TREATMENT Vancomycin

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Asymptomatic bacteriuria

• Significant number of bacteria in the urine
  without usual symptoms.
• Different from bacterial UTI
• May not need treatment

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HIGH RISK

• Diabetes
• Infected kidney stones
• Kidney transplant
• Older age
• Pregnancy
• Vesicoureteral reflux in young

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CAUSES

• Small number of healthy individuals
• Women gt Men
• Do not need treatment

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EXAMS TEST

• Significant bacterial growth in urine culture

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TREATMENT

• High risk
• Antibiotic to long term urinary catheters may
  cause harm difficult to treat yeast infection
• Before urological procedure.

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WHOM TO TREAT

• Risk factors
• Symptoms
• Overall health

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THANK YOU

• To help dying patients maintain their dignity,
  physicians must put forth every effort to know
  their patients as individuals. What greater gift
  can any human being give to other people?.