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Prevotella species are usually seen in the intestinal tract including oral cavity as commensal bacteria and can lead to periodontal infections in immunocompetent patients. However, in patients who are immunocompromised, Prevotella can cause infections at other sites. A 35-year-old gentleman presented with 1-month history of high-grade fever and right sided pleuritic chest pain. On examination, he was in discomfort due to pain, with temperature 103 °F, pulse 104 beats per minute, blood pressure 130/90 mmHg, respiratory rate 22 breaths per minute and O2 saturation 94% on room air. Oral cavity revealed poor hygiene with left lower carious incisor. There was reduced chest expansion in right sub-scapular region with reduced vocal fremitus, dull percussion note, absent breath sounds and reduced vocal resonance. WBC count was raised at 43,600 per cm. X-ray followed by HRCT chest demonstrated peripheral opacifications with air-fluid level in right lower zone due to loculated pyopneumothorax and pleural thickening. Ultrasound guided chest tube thoracostomy in the loculated pyoneumothorax aspirated 1200 ml of foul-smelling reddish-tinged pus which revealed growth of anaerobic gram-negative rods of Prevotella Intermediata on culture, which was sensitive to amoxicillin-clavulanate and metronidazole. Work up of immunosuppressive causes was negative. The patient responded well to treatment and was asymptomatic at follow-up after 6 weeks. [ABSTRACT FROM AUTHOR]

Background: The accurate and timely completion of patient admission notes is crucial for high-quality patient care and effective communication among healthcare providers. In the Pulmonology ward, where patients with respiratory conditions receive specialized treatment, comprehensive and prompt documentation of admission information is paramount. The complexity of these conditions and potential for acute exacerbations make accurate and timely documentation even more critical for guiding appropriate interventions and ensuring patient safety. Methodology: This uni-disciplinary audit reviewed prospective admission records and associated data for each patient over one month, with a sample size of 75 patients. The initial audit was conducted from June to July 2023 in the Pulmonology ward of Bahawal Victoria Hospital, Quaid-e-Azam Medical College Bahawalpur. Following initial audit recommendations, a proforma on patient admission notes with pre-written variables was created and explained to house officers and postgraduate residents. A subsequent re-audit was conducted from September to October 2023 to compare results with the initial audit. Results: The audit findings indicated a need for improvement in the timeliness of patient attendance and the documentation of initial assessments, vital signs, and treatment plans. The re-audit suggested improvements in patient attendance timeliness and initial assessment with vital sign recordings. However, the treatment chart signatures, and postgraduate resident stamps still needed improvement. Conclusion: Implementing the suggested recommendations can enhance patient care and ensure compliance with established protocols. Regular monitoring and follow-up audits are recommended to evaluate the effectiveness of the changes. [ABSTRACT FROM AUTHOR]

Acute intermittent porphyria is caused due to deficiency of porphobilinogen deaminase and usually presents with classic triad of neurologic dysfunction, abdominal pain and psychiatric disturbances. A 16-year old unmarried girl presented with 1-day history of recurrent episodes of generalized tonic clonic fits. There was history of mild diffuse abdominal pain for 15 days partially relieved by taking drotaverine. On examination, she was vitally stable and afebrile. Once the fits had stopped, there was no focal motor, sensory or cerebellar neurologic deficit and negative signs of neck rigidity. Initial investigations revealed microcytic anemia and a low normal sodium. Her ESR, CRP, CSF analysis, MRI scan (brain), EEG and aerobic cultures were normal. Urine had a pinkish red color and her 24-hour urine porphobilinogen were raised at 23 mg/24 h (normal range 0-3.4 mg/24 h) with normal fecal porphyrin levels. A diagnosis of Acute Intermittent Porphyria (AIP) was made and 10% dextrose infusion was stared which resulted in recovery. Her attack was most likely precipitated by drotaverine and it was withdrawn. Counseling and education about her diagnosis and possible triggering factors was done. She was asymptomatic at discharge and remained stable on follow-up at 4 weeks. [ABSTRACT FROM AUTHOR]