The Primary role of the Acute Medical Unit is to provide rapid definitive assessment, investigation and treatment for patients admitted urgently or as an emergency from the Emergency Department, and/or referred by their GP. The AMU operates in close association with the Emergency Department.

Recent Submissions

  • Review on interferon beta: from cells to clinical usage

    Hajilou, Fatemeh; Youeseflee, Pouya; Pashaei, Mehrnoosh; Bagheri, Kimiya; Bagheri, Bahador; Bagheri, Kimiya; Medical and Dental; Islamic Azad University, Tehran, Iran; Semnan University of Medical Sciences, Iran; Tehran University of Medical Sciences, Iran; George Eliot Hospital NHS Trust, Nuneaton; University of Zurich, Schlieren, Switzerland (Semnan University of Medical Sciences, 2022-01)
    Introduction: Interferon (IFN) was first introduced by Isaacs and Linddeman in 1957. It referred to a factor that could cause inhibition in the growth of the live influenza virus. Interferons are intracellular proteins that are involved in many cellular processes such as growth, proliferation, differentiation, metabolism of the extracellular matrix, apoptosis, and regulating immune responses. There are different intereferones. Amog them, interferons-beta (IFN-β) is a natural cytokine produced by immune cells in response to biological and chemical stimuli. Signal transduction of IFN-β is initiated throughout a heterodimeric receptor complex that is composed of IFNAR1 and IFNAR2 which leads to expression of various proteins via the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway as well as other pathways. In addition to antiviral effects of IFN-β, it has been shown to have therapeutic effects in some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and lupus. It has recently been shown that the use of IFN-β in combination with other antiviral compounds may be effective in treatment of Covid-19. In this review the various topics about IFN-β are investigated such as signalling pathways, biological functions, therapeutic effects, and side effects of IFN-β therapy.
  • Unexpected Diagnosis

    Gill, Gauravpal S; Govindu, Rukma R; Fouda, Ragai; Ammar, Hussam M; Gill, Gauravpal S; Govindu, Rukma R; Fouda, Ragai; Ammar, Hussam M; Acute Medicine; Medical and Dental; et al. (Cureus, 2019-09-26)
    A 74-year-old man presented to the ER with an eight-month history of shortness of breath, cough, anorexia, and weight loss. He had emigrated from sub-Saharan African to the USA, where he was diagnosed and treated for coronary artery disease, heart failure, and stroke; was hospitalized several times; and underwent hernia surgery. Despite the complex care that he received in the USA for many years, the diagnosis of AIDS was continually missed for years, and the patient was eventually diagnosed at the age of 74.
  • Cerebellar cavernoma

    Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev; Bukhari, Shanzay; Naeem, Asma; Upreti, Rajeev; Acute Medicine; Medical and Dental; George Eliot Hospital, Nuneaton (Elsevier, 2019-06)
    Introduction A cavernoma is a cluster of abnormal blood vessels, usually found in the brain and spinal cord. They're sometimes known as cavernous angiomas, cavernous haemangiomas or cerebral cavernous malformation. A case report of a young male with cavernomas is reported. Methods A 37-year-old man was referred to the ambulatory care unit from the accident and emergency department with a 2-day history of visual disturbance and dizziness. Clinical examinations of all systems were normal including neurologic examination which did not reveal any focal neurological signs. Routine haematology and biochemistry blood tests were all normal. Initially, a computed tomography of the brain was requested which showed no definite acute abnormality, but a small focus of high attenuation present within the left middle cerebellar peduncle may represent a small cavernoma. Further assessment with magnetic resonance imaging was suggested. The patient was then admitted to the acute medical unit for further investigations and workup. Results and discussion An MRI of the brain was performed and revealed multifocal cerebral microhaemorrhages of variable sizes spread randomly throughout the supra- and infra-tentorial compartments of the brain with no predilection for the deep structures (basal ganglia/thalami) to suggest chronic hypertensive encephalopathy. Cavernoma are less common in males at this age, which makes our case more unique. Conclusion A detailed history (personal and family) are key to detect such malformations in young patients, which also helps physicians be aware of its related complexities and further management. Conflict of interest statement None declared.
  • Utility of severity assessment tools in COVID-19 pneumonia: a multicentre observational study.

    Ahmed, Asim; Alderazi, Sayed A; Aslam, Rumaisa; Barkat, Barooq; Barker, Bethan L; Bhat, Rahul; Cassidy, Samuel; Crowley, Louise E; Dosanjh, Davinder Ps; Ebrahim, Hussain; et al. (Elsevier, 2022-01)
    Background: Severity scores in pneumonia and sepsis are being applied to SARS-CoV-2 infection. We aimed to assess whether these severity scores are accurate predictors of early adverse outcomes in COVID-19. Methods: We conducted a multicentre observational study of hospitalised SARS-CoV-2 infection. We assessed risk scores (CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2) in relation to admission to intensive care or death within 7 days of admission, defined as early severe adverse events (ESAE). The 4C Mortality Score was also assessed in a sub-cohort of patients. Findings: In 2,387 participants, the overall mortality was 18%. In all scores examined, increasing score was associated with increased risk of ESAE. Area under the curve (AUC) to predict ESAE for CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2 were 0.61, 0.62, 0.59, 0.59 and 0.68, respectively. AUC to predict ESAE was 0.60 with ISARIC 4C Mortality Score. Conclusion: None of the scores examined accurately predicted ESAE in SARS-CoV-2 infection. Non-validated scores should not be used to inform clinical decision making in COVID-19. Keywords: COVID-19; collaborative; pneumonia; severity score.