Education

A recent trial of a humanised monoclonal antibody has shown potential in the preventative treatment of migraines in chronic migraine sufferers. It is hoped that the drug can be used to treat the notoriously debilitating Cluster headaches. Fremanezumab is in the class of drugs that block the CGRP pathway. Other drugs with this mechanism of action already on the market include Eptinezumab, Erenumab and Galcanezumab. The new treatment centres around the use of a humanised monoclonal antibody known as Frumenezumab to target…

The Cytokine Cascade or cytokine storm is a relatively recently described autoimmune response in which the body's immune system gets caught in a positive feedback loop leading to a runaway and potentially fatal autoimmune response. A cytokine cascade can be particularly troublesome treat as it is the normal response of a healthy immune system, and so treatment usually focusses on the active interference of the immune processes rather than treatment of the underlying infection. Cytokine cascades have been implicated in…

Sometimes the best way to learn is to observe. The popular perception of a cardioversion is that it's this high intensity, dramatic event with doctors and nurses running around like crazy. The reality is however that they are an almost relaxed affair, which is a testament to the teams experience and professionalism. remaining calm and focussed under pressure is a hallmark of health care professionals in the emergency setting. The list below depicts interesting cases I've come across during my travels through…

An imperforate hymen is a congenital disorder I which the hymen completely occludes the vaginal opening. It is one of the most common female genital tract malformations, occurring in approximately 1 in 2000 girls3. The condition arises due to a failure of the hymen to perforate during fetal development. The condition commonly goes unnoticed until adolescence when the girl passes the age of menarche5 and has not had a period (amenorrhea). Menstrual blood cannot flow freely from the vagina and backs up in the vagina…

Hematometra, otherwise known as hemometra is a condition in which blood is collected and retained in the uterus, commonly the result of an imperforate hymen or transverse vaginal septum. The physical obstruction of menstrual blood from the uterus causes a significant back up of menstrual blood over time, which can cause the uterus to enlarge, putting pressure on other pelvic organs, similar to in the case of hematocolpos. For this reason, the condition tends to worsen to longer the patient prolongs seeking medical…

Hematocolpos is a gynaecological condition in which the vagina fills with menstrual blood, often secondary to an imperforate hymen1. It is often seen in patients who also suffer from Robinow syndrome, double uterus and other congenital conditions. The condition can become severe in nature as the menstrual blood has no way to escape and may grow to take up the majority of the pelvic cavity (fig, 1), making urination and voiding of bowels difficult1. the condition may go unnoticed for some time, with a delayed menarche often…

A double uterus, otherwise known as a uterus didelphys is a congenital uterine defect causing a bifurcation of the lumen of the uterus. It is considered a very rare condition, occurring in only 0.1-0.5% of women in the US, however, this is considered under representative as many women may remain asymptomatic, resulting in nondetection of the condition. Women with the condition may experience dysmenorrhea and dyspareunia3. The majority of cases remain asymptomatic with no obvious signs of abnormality, however, some women may…

An intussusception is a generally acute condition in which a section of the intestine folds into the section next to it. Cases will often involve the small intestine, however cases involving the large intestine do occur. Patients may present with abdominal pain, vomiting, abdominal bloating and blood in the stool. An Intussusception is not considered life threatening unless it has been allowed to develop, or otherwise remained untreated for some time. The mechanics of intussusception often result in occlusion…

Chronic Obstructive Pulmonary Disease (COPD) - also known as Chronic Obstructive Lung Disease (COLD) - is a chronic inflammation of the lungs that causes obstruction of airflow1 and ineffective airway clearance. It is commonly caused by distinct disease processes such as Emphysema and Chronic Bronchitis. COPD is generally caused by long-term exposure to irritating gasses or particulate matter such as those produced by cigarette smoke1. Asthma: Also known as Chronic Reactive Airway Disease is characterised by…

A bezoar is persistent concretion of indigestible material trapped in the gastrointestinal system1. They can be composed of either organic or inorganic materials. It is important not to confuse a bezoar with a psudeobezoar, which is an indugestible object intentionally introduced into the digestive system3. This may be done for treatment reasons, or otherwise may be sself-inflictedby the patient. Bezoars of the esophagus are common in younger children. Esophageal bezoars are also reported in patients who are…