2014

Overlap between dermatomyositis and ANCA vasculitides (2014)

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Type of publication:
Journal article

Author(s):
*Yuste C., *Rapalai M., *Pritchard B.A., *Jones T.J., *Amoasii C., *Al-Ansari A., *Ramakrishna S.B.

Citation:
Clinical Kidney Journal, February 2014, vol./is. 7/1(59-61), 2048-8505;2048-8513 (February 2014)

Abstract:
We present the second report of the association between antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis with dermatomyositis (DM). A 47-year-old woman suddenly developed rapidly progressive renal failure in the context of (DM). The kidney biopsy showed focal and segmental necrotizing glomerulonephritis with crescent formation. Cyclophosphamide treatment was commenced resulting in a significant recovery of kidney function and maintenance of recovery at 6 months. Although the pathophysiology is unknown, we hypothesize that CD8-T-deficient cells and MPO+ neutrophils in the DM lesions play an important role in the disease process.

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UK temporomandibular joint replacement database: Report on baseline data (2014)

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Type of publication:
Journal article

Author(s):
*Idle M.R., Lowe D., Rogers S.N., Sidebottom A.J., Speculand B., Worrall S.F.

Citation:
British Journal of Oral and Maxillofacial Surgery, March 2014, vol./is. 52/3(203-207), 0266-4356;1532-1940 (March 2014)

Abstract:
Our goal is to establish the long-term collection of data on temporomandibular joint replacement from all centres in the UK where this is done. Currently, 16 surgeons have been identified, and 13 of them had entered data when this paper was being prepared. Data are entered online through the Snap Survey and then analysed annually. We report on 402 patients (332 (83%) female and 70 (17%) male) who had 577 joints inserted between 1994 and 2012. The main diagnoses that resulted in total joint replacement were osteoarthritis, failed operation, ankylosis, and seronegative arthritis. Preoperatively, the median (IQR) maximal incisal opening was 20 (15-26) mm (mean 20) and the median pain scores on the visual analogue scale (VAS 0-10) were 8 for both joints. The median (IQR) baseline dietary score (liquid 0 – solid 10) was 4 (3-6). A total of 173 (43%) patients had had one or more open procedure(s) before total replacement, 177 (44%) had not had open operation, and 52 (13%) had no data entered. The 3 primary systems used were the TMJ Concepts System (Ventura, USA), the Biomet System (Biomet/Lorenz Microfixation, Jacksonville, USA), and the Christensen System (TMJ Implants, Golden, USA). The median (IQR) duration of inpatient stay was 3 (2-4) days (mean 3). Follow-up data will be collected to assess patient recorded outcome measures (PROM) and objective measurements of total joint replacements in the UK from 1994 onwards. 2013 The British Association of Oral and Maxillofacial Surgeons.

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BerEP4 and CD34 immunostaining distinguishes basaloid tricholemmoma from basal cell carcinoma (2014)

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Type of publication:
Conference abstract

Author(s):
Turnbull N., Ghumra W., *Mudaliar V., Vella J., Sanders S., Taibjee S., Carr R.

Citation:
American Journal of Dermatopathology, February 2014, vol./is. 36/2(e54-e55), 0193-1091 (February 2014)

Abstract:
Aim: To study of the utility of an immunopanel comprising BerEP4, EMA and CD34 in the differential diagnosis of basaloid tricholemmoma and basal cell carcinoma. Method: An immunopanel comprising BerEP4, EMA and CD34 was applied to 48 tricholemmomas (TL) diagnosed and collected over a 12 year period including 10 tumours with a prominent basaloid component (BTL). Patterns of immunostaining were compared with BCC from our extensive database. Positive immunostaining was defined as moderate to strong intensity in a minimum of 10% of the tumour area. Results: Positivity for BerEP4, EMA and CD34 respectively was as follows: TL – 1/24 (4.1%), 4/21 (19%), 34/34 (100%), BTL- 2/9 (22%), 1/7 (14%), 10/10 (100%) and BCC – 218/219 (99.5%), 10/199 (5%), 0/14 (0%). CD34 in TL was often only focally positive (10% in 5/ 10 cases of BTL). BerEP4 was expressed in at most 20% of the tumour area in basaloid tricholemmomas, but in at least 40% of the tumour area in 95.4% of BCC. Conclusion: Immunostaining for CD34 in combination with BerEP4 helps distinguish BTL from BCC.

Link to more details or full-text: http://gsia.tums.ac.ir/images/UserFiles/12030/Forms/306/XXXIV_Symposium_of_the_International_Society_of_25.pdf

Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination (2014)

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Type of publication:
Journal article

Author(s):
Kammar H., *Carmont M.R., Kots E., Laver L., Mann G., Nyska M., Mei-Dan O.

Citation:
Orthopedics, March 2014, vol./is. 37/3(e298-e301), 0147-7447 (March 2014)

Abstract:
Sural nerve injury is a relatively common complication after surgery on the Achilles tendon. Studies to determine the course of the sural nerve have been performed on cadaveric specimens. The purpose of this cross-sectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. The authors performed ultrasound examination of the posterior triangle of the ankle and Achilles tendon to determine the course of the sural nerve relative to the Achilles tendon in healthy participants. The mean distance between the nerve and the tendon was 21.48, 11.47, 5.8, and 0.81 mm lateral to the Achilles tendon as measured at the insertion and 4, 8, and 11 cm proximally, respectively. Male participants tended to have a nerve that was initially more lateral to the Achilles insertion compared with women. The distance between the sural nerve and the Achilles tendon was found to be lower in older participants, with the nerve passing significantly closer to the tendon at all levels (P

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Nephrotic-range proteinuria on interferon-beta treatment: Immune-induced glomerulonephritis or other pathway? (2014)

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Type of publication:
Journal article

Author(s):
*Yuste C., *Rapalai M., *Pritchard B.A., *Jones T.J., Tucker B., *Ramakrishna S.B.

Citation:
Clinical Kidney Journal, April 2014, vol./is. 7/2(190-193), 2048-8505;2048-8513 (April 2014)

Abstract:
We present a case report of a 37-year-old woman with multiple sclerosis (MS) who developed nephrotic-range proteinuria secondary to membrano proliferative glomerulonephritis (MPGN)-like disease with mesangial C3 deposition without evidence of immune-complex deposition in the context of long-term interferon-beta (IFN-beta) therapy. The complete remission of proteinuria following cessation of IFN-beta, strongly suggests causality. To our knowledge, this is the second case report of MPGN associated with IFN-beta use. This being the case, the negative immune screen, normal inflammatory markers and the absence of immune complex deposits would imply a different pathway to that previously suggested.

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Obesity delays 62 day treatment pathway for breast cancer (2014)

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Type of publication:
Conference abstract

Author(s):
*Lake B., *Pearson L., *Wilkins H., *Rastall S.

Citation:
European Journal of Surgical Oncology, May 2014, vol./is. 40/5(624), 0748-7983 (May 2014)

Abstract:
Introduction: There is increasing obesity in the UK, affecting 26% of women. The highest rate is in the West Midlands. (HSCIC 2013) This growing obese population will significantly impact health care. Breast cancer diagnosis and treatment have a 62 day cancer target. (CRS 2007) Accepted practice is triple assessment which is affected by elevated BMI; more difficult examination, repeated biopsy, technically difficult and time consuming imaging. This can delay diagnosis and treatment of breast cancer. Method: Somerset Cancer Database was used to identify all patients diagnosed with non-invasive or invasive Breast Cancer from 1st April 2012 – 31st March 2013 at Shrewsbury & Telford NHS Trust. Patients having hormone treatment or radiotherapy alone were excluded. Patient demographics were obtained from Pre-operative Anaesthetic Database. Biopsy rate was obtained from review. Imaging was reviewed by Breast Radiographer. SPSS was used to calculate independent T-test for statistical analysis. Results: 505 patients were diagnosed, of these 352 had surgery. Mean age 60 (30-87), mean BMI 28.6(16.5-55), with 35% of patients classified as obese. Number of days to treatment of BMI 35, 36 to 42 days was statistically significant P>0.0438 (T=2.0348, SE 2.949). Time taken for mammogram for super-obese patient BMI compared to normal BMI was significantly longer 7.5 minutes to 3.4 minutes P>0.0001 (T=11.6028, SE 0.353). Conclusion: Obesity significantly delays treatment pathway in Breast Cancer patients, and increases mammographic imaging time. These are important considerations with an increasingly obese population for health care provision planning of such patients.

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Retinopathy of prematurity in English neonatal units: A national population-based analysis using NHS operational data (2014)

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Type of publication:
Journal article

Author(s):
Wong H.S., Santhakumaran S., Statnikov Y., Gray D., Watkinson M., Modi N., Kadalraja R., Kefas J., Srinnel S., Ramesh C., Rackham O., Brearey S., Thirumurugan A., Losa I., McBride T., Amegavie L., Zipitis C., Yadan M., Maddock N., Moise J., Edi-Osagie N., Heal C., Birch J., Al-Zidgali F., Hasib A., Kisat H., Soe A., Long D., Fedee J., Lama M., Gupta R., Rawlingson, De Boer R.C., Rao P., Blake K., Bhaduri A.K., Halahakoon C., *Deshpande, Mohite A., Tewary K.K., Palmer K., Gallagher A., Nycyk J., Simmons P., Morgen I., Underhill H.C., Mahesh Babu R.N., Dalton S., Dixon H., James M., Jayalal V., Dyke M., Babiker S., Soe T., Rubin S., Ogilvy-Stuart A., Evans I., Wickham T., Van Someren V., Watkin S., Blumberg R., Sharief N., Aladangady N., Sullivan C., Alsford L., Sharma B., Khan A., Hamdan S., Ahmed J.S., Foo A., Talekar R., Adiotomre P., Gibson A., Thomas M., Mathur R., Cruwys M., Mannix P., Ariff H., Garbasa M., Lal M., Bosman D., Fenton A., Bolton A.R., Abu-Harb M., Verber I., Olivier J., Larson J., Cherinet Y., Munyard P., Osbourne N., Raman M., Watts T., Hannam S., Walter S., Kuna J., Chang Y.L., Shephard R., Lindo D., Calvert S., Wigfield R., Wylie P.., Misra I., Shettihalli N., Khashu M., Hall M., Groves C., De Halpert P., Schapira D., Kinsey S., Butterworth S., Garg A., Whitehead G., Sanghavi R., Whincup G., Khader K., Mallik A., Amess P., Godden C., Reynolds P., Brannan N., Noble V., Rao A.S., Wardle S., Ratnayaka M., Holman J., Zengeya S., Jones S., Wach R., Tooley J., Mann R.J., Eaton M., Babirecki M., Seal S., Schwartz K., Gibson D., Jampala C., Pairaudeau P., Miall L., Shyamannr K., Qunib M.

Citation:
Archives of Disease in Childhood: Fetal and Neonatal Edition, May 2014, vol./is. 99/3(F196-F202), 1359-2998;1468-2052 (May 2014)

Abstract:
Objectives: To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment. Design: National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011. Setting: 161 (94%) neonatal units in England. Population: Infants born below 32 weeks’ gestation and/or with a birth weight below 1501 g. Main outcome measures: ROP screening status (’on-time’, ’early’, ’late’, ’unknown’) and associated infant and neonatal unit characteristics, ROP treatment. Results: The proportion of infants screened on-time increased over the study period (p

Link to more details or full-text: http://fn.bmj.com/cgi/pmidlookup?view=long&pmid=24361602

Diagnostic accuracy of point-of-care tests for detecting albuminuria: A systematic review and meta-analysis (2014)

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Type of publication:
Journal article

Author(s):
*McTaggart M.P., Newall R.G., Hirst J.A., Bankhead C.R., Lamb E.J., Roberts N.W., Price C.P.

Citation:
Annals of Internal Medicine, April 2014, vol./is. 160/8(550-557), 0003-4819;1539-3704 (15 Apr 2014)

Abstract:
Experts recommend screening for albuminuria in patients at risk for kidney disease. Purpose: To systematically review evidence about the diagnostic accuracy of point-of-care (POC) tests for detecting albuminuria in individuals for whom guidelines recommend such detection. Data Sources: Cochrane Library, EMBASE, Medion database, MEDLINE, and Science Citation Index from 1963 through 5 December 2013; hand searches of other relevant journals; and reference lists. Study Selection: Cross-sectional studies, published in any language, that compared the accuracy of machine-read POC tests of urinary albumin-creatinine ratio with that of laboratory measurement. Data Extraction: Two independent reviewers extracted study data and assessed study quality using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Data Synthesis: Sixteen studies (n = 3356 patients) that evaluated semiquantitative or quantitative POC tests and used random urine samples collected in primary or secondary ambulatory care settings met inclusion criteria. Pooling results from a bivariate randomeffects model gave sensitivity and specificity estimates of 76% (95% CI, 63% to 86%) and 93% (CI, 84% to 97%), respectively, for the semiquantitative test. Sensitivity and specificity estimates for the quantitative test were 96% (CI, 78% to 99%) and 98% (CI, 93% to 99%), respectively. The negative likelihood ratios for the semiquantitative and quantitative tests were 0.26 (CI, 0.16 to 0.40) and 0.04 (CI, 0.01 to 0.25), respectively. Limitation: Accuracy estimates were based on data from singlesample urine measurement, but guidelines require that diagnosis of albuminuria be based on at least 2 of 3 samples collected in a 6-month period. Conclusion: A negative semiquantitative POC test result does not rule out albuminuria, whereas quantitative POC testing meets required performance standards and can be used to rule out albuminuria.

Link to more details or full-text: Hepatology

The use of a remifentanil infusion and elective tracheostomy to avoid ventilation in a patient with tetanus (2014)

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Type of publication:
Journal article

Author(s):
*Redshaw C., *Slater R.

Citation:
Journal of the Intensive Care Society, April 2014, vol./is. 15/2(161-163), 1751-1437

Abstract:
Tetanus is very rare in developed countries but the mortality is still high in the elderly population despite access to intensive care medicine. Death can frequently occur from secondary complications due to the need to sedate, paralyse and ventilate patients in an effort to control spasms. We describe the case of a 77-year-old man with tetanus in whom we successfully controlled tetanic spasms with a remifentanil infusion where conventional treatment failed, thus preventing the need for mechanical ventilation. We also describe the use of an elective percutaneous tracheostomy which was performed for airway protection. This prevented him from developing pneumonia from aspirating the excess secretions caused by the autonomic features of tetanus.