Diagnosis of human bovine tuberculosis aided by PET/CT scanning and EBUS-TBNA.

Human bovine tuberculosis is a rare zoonotic infection in developed countries which has been achieved predominantly by effective eradication programmes in cattle. The principal modes of transmission are consumption of unpasteurised dairy products and close contact with infected cattle. The clinical and radiological presentation is indistinguishable from tuberculosis caused by The diagnosis should be considered in individuals with relevant risk factors who present with intra/extrathoracic pathology.

Improving the uptake of HIV testing in patients with tuberculosis.

The HIV epidemic has increased the global tuberculosis (TB) burden and focused attention on the need to strengthen links between TB and HIV programmes in order to tackle these public health issues more effectively (World Health Organization (WHO), 2004). HIV testing is now recommended in various healthcare settings and guidelines state that it should include all patients with a diagnosis of active TB (British HIV Association, British Association of Sexual Health and HIV, British Infection Society, 2008; Health Protection Agency (HPA), 2009). This has been shown to standardise HIV testing and improve outcomes as HIV infection will affect the management of active TB and will reduce transmission of the virus within the community (HPA, 2009).

Latent tuberculosis: concordance and duration of treatment regimens.

Over the past century, the UK has made significant progress in combating tuberculosis (TB) through improved health care and better preventative measures. However, it has now been identified as a new threat that needs concerted action. An important component in dealing with this threat is identifying and treating people with latent infection.

Predicting end-of-life in patients with an exacerbation of COPD by routine clinical assessment.

Unlabelled: The purpose of this study was to determine if routine clinical assessment could reliably predict in-hospital death in patients admitted with acute exacerbation of COPD (AECOPD).

Methods: In a case-crossover study the case records of AECOPD related deaths were reviewed. Clinical and laboratory variables including performance status (WHO-PS) and a composite physiological score (early warning score, EWS) at initial clinical assessment on final admission (FA) and penultimate admission (PA) for AECOPD were compared.

Respiratory failure and symptomatic hypercalcaemia complicating pulmonary tuberculosis.

A 47-year-old Caucasian man was admitted to hospital with respiratory failure due to a severe pneumonia, requiring admission to the Intensive Care Unit (ICU) for respiratory support. Bronchial washings cultured Mycobacterium tuberculosis, a rare cause of respiratory failure, and fortunately he responded to standard antituberculous therapy. However, the patient subsequently developed symptomatic hypercalcaemia; an unusual complication of tuberculosis (TB) in the UK, probably contributed to by a combination of sunbathing and activation of 25-hydroxy vitamin D in the TB granuloma.

Managing Pleural Disease in Acute Medicine ( II ) : Spontaneous Pneumothorax.

Spontaneous pneumothoraces occur in individuals who have not experienced antecedent thoracic trauma. Primary spontaneous pneumothorax occurs in otherwise healthy individuals with no clinically apparent lung disease, whereas secondary pneumothorax is a consequence of an underlying lung disease. This review focuses on their management in the acute medical setting.

Managing pleural disease in acute medicine (I): pleural effusion.

A pleural effusion is the accumulation of fluid in the pleural space. It is a relatively common finding in clinical practice. The diagnostic approach to the patient presenting with a pleural effusion is aimed at defining the effusion as a transudate or an exudate.

Platypnoea orthodeoxia in a patient with aortic root dilatation and a patent foramen ovale.

Platypnoea orthodeoxia syndrome is a rare condition in which shortness of breath and hypoxaemia occur when upright and resolve when prone. The hypoxaemia results from increased right to left shunting of deoxygenated blood, when standing, through a patent foramen ovale (PFO), atrial septal defect (ASD) or other right to left shunt, in the absence of raised right-heart pressure. We present the case of a patient with platypnoea orthodeoxia with marked shunting through a large PFO, evaluated by transesophageal and transthoracic echo.

Chemotherapeutic management of malignant pleural effusion.

The management of malignant pleural effusions are a common, and sometimes difficult, therapeutic problem. This article reviews the currently available sclerosing agents and discusses novel agents that show promise for the future. Talc, tetracycline and bleomycin are currently the most widely used agents but none is an ideal sclerosant and certain adverse effects are of concern.