Asymptomatic bilateral acute multifocal retinitis in Q fever endocarditis.

A previously healthy cattle farmer in his 40s presented with fever, encephalopathy and hepatitis secondary to acute endocarditis. Dilated funduscopy unexpectedly disclosed bilateral acute multifocal retinitis that was clinically silent yet exhibited inner-retinal hyper-reflectivity on spectral-domain optical coherence tomography. Treatment with doxycycline 100 mg two times per day and weight-adjusted hydroxychloroquine 200 mg three times per day led to complete anatomical and functional recovery by month 10, confirmed by serial imaging.

Audit of enuresis referrals on the waiting list for a tertiary hospital outpatient clinic.

Aim: Enuresis, defined as intermittent incontinence occurring exclusively during sleep, affects 4-19% of children, but can be effectively treated using education and alarm-bell therapies. However, delays in treatment are likely to impact upon the quality of life of the child, parents and carers. Poor quality and incomplete referrals are thought to be a major driver of inefficiencies.