RESUMEN
Methemoglobinemia, due to the oxidation of iron from ferrous to ferric form in the haemoglobin molecule, results in decreased oxygen delivery to the tissues. Phenazopyridine, a commonly used medication for urinary symptoms, is a rare cause of methemoglobinemia. We report an elderly woman with advanced vaginal cancer, who developed methemoglobinemia following the use of phenazopyridine at a dose of 200 mg three times a day for 14 days. She presented with dyspnoea without cyanosis, oxygen saturation of 70%, methemoglobin concentration of 32.2% in arterial blood gas analysis and haemoglobin of 5 g/dL. This condition was identified and treated with methylene blue and oxygen support, which resulted in complete recovery in two days. Though rare, this highlights the importance of ascertaining reversible causes of symptoms, even in palliative care settings. Medications as an aetiology of symptoms should be considered even if they were used on a long-term basis.
RESUMEN
OBJECTIVE: Patients needs should be regularly assessed. We aimed to improve assessment and documentation of needs from baseline 25% in June 2022 to 75% in December 2022. METHODS: The A3, a structured problem-solving continuous-improvement methodology was used. Fish-bone analysis and pareto charts identified root causes; key drivers and interventions were developed. Interventions included (1) documentation templates, (2) a brochure about services, (3) extra team communication skills training, (4) repository in different languages to help patients identify needs, and (5) weekly review meetings. Reliability and sustainability were ensured through ownership and delegation to team members. RESULTS: Documentation of needs increased from baseline 25% to 75% within 3 months. This has been sustained at 83% in August 2023. The total number of patients assessed during the project was 1818. Maximum percentage of documentation was 91%. Mean additional time taken to ask and document needs was 2 min. CONCLUSIONS: Identification and documentation of patient needs and prioritisation are feasible in palliative medicine outpatient clinics. This project has directed the team to provide patient-led palliative care interventions.
RESUMEN
Occupational exposure to silica has been seldom implicated to cause systemic sclerosis. Erasmus syndrome is a rare condition where there is development of systemic sclerosis following silicosis. Early diagnosis is essential for appropriate treatment and symptom control. We describe a 42-year-old stone cutter with silicosis who was subsequently diagnosed to have diffuse pattern of systemic sclerosis. A multidisciplinary team including pulmonologists, specialist palliative care physicians, rheumatologists and radiologists were involved in diagnosis and management. Timely diagnosis and a multidisciplinary team management with pharmacological and non-pharmacological measures was essential in holistic care provision. This is the first report of specialist palliative care team facilitating diagnosis of this rare syndrome and promoting integration in the overall care and management.
RESUMEN
OBJECTIVE: This study compares the stability of three variations of the conductive polymer poly(3,4-ethylenedioxythiophene) or PEDOT for neural micro-stimulation under both in vitro and in vivo conditions. We examined PEDOT films deposited with counter-ions tetrafluoroborate (TFB) and poly(styrenesulfonate) (PSS), and PEDOT: PSS combined with carbon nanotubes (CNTs). METHODS: For the in vitro stability evaluation, implantable micro-wires were coated with the polymers, placed in a vial containing phosphate buffered saline (PBS) under accelerated aging conditions (60°C), and current pulses were applied. The resulting voltage profile was monitored over time. Following the same polymer deposition protocol, chronic neural micro-probes were modified and implanted in the motor cortex of two rats for the in vivo stability comparison. Similar stimulating current pulses were applied and the output voltage was examined. The electrochemical impedance spectroscopic (EIS) data were also recorded and fit to an equivalent circuit model that incorporates and quantifies the time-dependent polymer degradation and impedance associated with tissue surrounding each micro-electrode site. RESULTS: Both in vitro and in vivo voltage output profiles show relatively stable behavior for the PEDOT: TFB modified micro-electrodes compared to the PEDOT: PSS and CNT: PEDOT: PSS modified ones. EIS modeling demonstrates that the time-dependent increase in the polymeric resistance is roughly similar to the rise in the respective voltage output in vivo and indicates that the polymeric stability and conductivity, rather than the impedance due to the tissue response, is the primary factor determining the output voltage profile. It was also noted that the number of electrodes showing unit activity post-surgery did not decay for PEDOT: TFB as was the case for PEDOT: PSS and CNT: PEDOT: PSS. PEDOT: TFB may be an enabling material for achieving long lasting micro-stimulation and recording.