When mansplaining kills patients

I hadn’t thought about this call night in a while, as it happened three years ago. It came back into my consciousness this past week, when I re-experienced the events in a dream. (Of note, my stress dreams used to be about my car accident in 2014, which was a high-speed collision that left me in crutches. I guess I can now safely say that some call nights are actually more traumatic than living through a car crash.) This particular night, I was taking care of inpatient floor patients while on call. Another female resident was giving me sign-out about a patient coming up to the floor from the ED. She told me, point-blank, “This patient looks absolutely terrible. She’s hard to arouse. But it’s really weird; everyone thinks it’s fine.” The “everyone” she was referring to was the male fellow, who had taken care of the patient before and the ED attending. When the patient came to the floor, I went to see her. She was lying in bed, staring into space, and barely arousable on my exam. Nothing about her chief complaint could explain her current mental status. I immediately paged my fellow to let him know that her mental status was profoundly altered on my exam, and that I was worried about meningitis. I remember telling him, emphatically, that I had done lumbar punctures on less altered patients in the past due to concerns for meningitis. “I’ve tapped for less!” Continue reading ... Your patients are rating you online...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Emergency Medicine Source Type: blogs

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This study was conducted to assess the diagnostic value of CSF-CRP levels for differentiating between septic (bacterial) and aseptic infantile meningitis.Methods: 49 hospitalized infants aged less than two months with suspected meningitis were enrolled in a cross-sectional analytic study. All of patients underwent lumbar puncture to obtain CSF. smears, cultures, cytological and biochemical analysis and latex agglutination testing were carried out on all CSF samples. Latex agglutination test was carried out on all CSF samples using a commercially available kit. CSF-CRP level of all infants was measured using the immunoturbi...
Source: African Health Sciences - Category: African Health Source Type: research
AbstractPurpose of ReviewDefective cell –mediated immunity is a major risk factor for cryptococcosis, a fatal disease if untreated. Cryptococcal meningitis (CM), the main presentation of disseminated disease, occurs through hematogenous spread to the brain from primary pulmonary foci, facilitated by yeast virulence factors. We revisit r emarkable recent improvements in the prevention, diagnosis and management of CM.Recent FindingsCryptococcal antigen (CrAg), main capsular polysaccharide ofCryptococcus spp. is detectable in blood and cerebrospinal fluid of infected patients with point of care lateral flow assays. Rece...
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research
This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research
Conclusion: Co-existing bacterial meningitis in febrile young infants with urinary tract infection is rare. In those meeting low-risk criteria, a lumbar puncture may not be indicated. A case by case assessment should be made in infants not meeting low-risk criteria.Trial registration: CRD42018105339What is known:•When caring for febrile infants ≤ 3 months with urinary tract infections, clinicians may have uncertainty on whether to perform a lumbar puncture (LP) for possible co-existing meningitisWhat is new:•An up-to-date systematic review of 20 studies found the frequency of co-existing meningitis...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
Meningitis can be caused by several viruses and bacteria. Identifying the causative pathogen as quickly as possible is crucial to initiate the most optimal therapy, as acute bacterial meningitis is associated ...
Source: Journal of Translational Medicine - Category: Research Authors: Tags: Research Source Type: research
Lenggenhager Cordey Kaiser : Meningitis, encephalitis, and myelitis are various forms of acute central nervous system (CNS) inflammation, which can coexist and lead to serious sequelae. Known aetiologies include infections and immune-mediated processes. Despite advances in clinical microbiology over the past decades, the cause of acute CNS inflammation remains unknown in approximately 50% of cases. High-throughput sequencing was performed to search for viral sequences in cerebrospinal fluid (CSF) samples collected from 26 patients considered to have acute CNS inflammation of unknown origin, and 10 patients wit...
Source: Genes - Category: Genetics & Stem Cells Authors: Tags: Article Source Type: research
Publication date: Available online 16 August 2019Source: Journal of Clinical NeuroscienceAuthor(s): A. Skalnaya, V. Fominykh, R. Ivashchenko, D. Averchenkov, L. Grazhdantseva, N. Frigo, E. Negasheva, O. Dolya, L. Brylev, A. GuekhtAbstractThe term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms wit...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic c...
Source: BMC Infectious Diseases - Category: Infectious Diseases Authors: Tags: Research article Source Type: research
Conclusions Fungal sinusitis is uncommon, especially in those without significantly compromised immune systems. Invasive fungal meningitis resulting in meningitis and encephalitis is even rarer. The condition carries high morbidity and mortality that can only be mitigated with a multidisciplinary effort by neurosurgery, otolaryngology, and infectious disease specialists. While there are no clear treatment guidelines, we present an approach that may permit longer term independent survival. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abst...
Source: Journal of Neurological Surgery Reports - Category: Neurosurgery Authors: Tags: Case Report Source Type: research
Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis. PMID: 31258430 [PubMed]
Source: Ochsner Journal - Category: General Medicine Tags: Ochsner J Source Type: research
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