Sunderland Royal Hospital is an acute general hospital in Sunderland, Tyne and Wear. It is managed by the South Tyneside and Sunderland NHS Foundation Trust.
A bruise or haematoma in a non-mobile infant is a red flag prompting concern for non-accidental injury. Bruising does not always signify trauma however and may occur spontaneously due to an underlying medical cause. This case report describes a 3-month-old infant presenting with unexplained faint bruising to the axilla and an associated lump. Point of care ultrasound revealed a chest wall haematoma without any other evidence of trauma prompting blood tests, which demonstrated severely deranged coagulation and conjugated hyperbilirubinaemia. The child was subsequently diagnosed with Alagille Syndrome. Point of care ultrasound is a useful clinical adjunct for providing greater detail to the examination of unusual lumps or swellings which in this case prompted further investigations leading to a rare diagnosis.
Metabolic and Bariatric Surgery (MBS) is an established treatment for obesity and its associated metabolic conditions. As obesity prevalence has risen globally over the past two decades, so too has MBS utilization, spurring interest in same-day discharge (SDD) protocols as a cost-effective alternative to inpatient hospitalization. Following the GRADE methodology, this position statement presents a systematic review of all evidence relevant to same-day discharge in MBS. The current position statement was developed using data from a systematic review and meta-analysis (conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) included 17 studies encompassing 46,578 patients; four were randomized controlled trials (RCTs) analyzed in the primary meta-analysis. The pooled analysis of four RCTs (n = 2,026) revealed no statistically significant differences between SDD and conventional inpatient groups for complication rates (OR: 1.49; 95
INTRODUCTION:Critically ill patients commonly develop acquired neutrophil dysfunction, which increases susceptibility to intensive care unit-acquired infection (ICU-AI). This study aimed to assess whether interferon gamma (IFN-γ) can restore function in dysfunctional neutrophils from critically ill patients and to uncover potential underlying mechanisms. METHODS:This was an observational cohort study. Neutrophils were isolated from whole blood donated by critically ill patients (n=31) in four separate teaching hospital intensive care units (ICUs). Neutrophils were subsequently treated with recombinant human IFN-γ or vehicle for 1 hour following either Fc gamma receptor (FcγR) blockade, selective inhibition of the gamma isoform of phosphoinositide 3-kinase (PI3K-γ) or vehicle control for 30 min. Neutrophil phagocytosis, bacterial killing, superoxide generation, phagocytic receptor expression and small Rho GTPase activity were assessed. Neutrophil dysfunction was defined as <50% of cells ingesting 2 or more zymosan particles in a phagocytosis assay. RESULTS:IFN-γ significantly improved phagocytosis (control 36.5%, IFN-γ 56.0%), bacterial killing (control 31.6%, IFN-γ 82.1%) and superoxide generation (2.8-fold increase relative to control) in dysfunctional neutrophils. IFN-γ also increased the activity of the small GTPases, Rac and Cdc42 (2.4-fold and 1.5-fold increase relative to control, respectively) in dysfunctional neutrophils. Selective inhibition of PI3K-γ prevented the IFN-γ-mediated improvement of phagocytosis (IFN-γ 62.5%, with inhibitor 27.9%), bacterial killing (IFN-γ 82.1%, with inhibitor 30.5%) and superoxide generation (IFN-γ 2.8-fold change relative to control, 0.7 with inhibitor). The IFN-γ-mediated improvement of bacterial killing in dysfunctional neutrophils was also prevented by FcγR blockade (IFN-γ 82.1%, FcγR inhibition 28.7%). CONCLUSIONS:In critically ill patients with known acquired neutrophil dysfunction, ex vivo application of IFN-γ consistently improved a range of neutrophil effector functions.
Chronic gastritis is a common manifestation of Helicobacter pylori infection. Clinical presentations can range from epigastric discomfort to gastrointestinal bleeding. The clinical course and gross endoscopic findings can mimic alternative diagnoses such as gastric adenocarcinoma and gastrointestinal stromal tumors (GISTs). We report a case of H. pylori-associated chronic gastritis that initially presented with frank melena. Subsequent blood tests demonstrated a drop in hemoglobin and a rise in serum urea. The case was managed according to the hospital's upper gastrointestinal bleed protocols. The next day, endoscopy demonstrated a large polypoidal mass in the gastric antrum suspicious for GIST. However, subsequent biopsy and histological examination showed lymphoid aggregates and active inflammation with comma-shaped bacilli consistent with H. pylori infection. The case was subsequently managed with triple eradication therapy. This case underscores the value of prompt management of upper gastrointestinal bleeding and the need to validate diagnoses with definitive modalities to optimize long-term management.
