Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.
慢性肾脏病(CKD)影响着全球10%以上的人口。继发性甲状旁腺功能亢进症(SHPT)是慢性肾脏病的一个重要并发症,主要表现为高磷血症、低钙血症导致的甲状旁腺激素水平升高,以及肾功能受损导致的活性维生素 D 低下。SHPT会增加骨畸形、血管钙化、心血管事件和死亡的风险。本综述探讨了慢性肾脏病患者的 SHPT 治疗策略。一线治疗包括磷酸盐结合剂、维生素 D 受体激活剂和降钙剂。当这些治疗方法无效时,可考虑甲状旁腺切除术(PTX)和热消融术等侵入性治疗方案。PTX能有效减轻症状并改善放射学结果,在降低心血管风险和死亡率方面优于单纯的药物治疗。微波、射频、激光或高强度聚焦超声等热消融技术提供了创伤较小的替代方法,并取得了良好的效果。未来的研究应探索甲状旁腺增生的分子机制,并评估各种治疗方法的影响。
{"title":"Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy.","authors":"Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao","doi":"10.1016/j.clinme.2024.100238","DOIUrl":"10.1016/j.clinme.2024.100238","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-02DOI: 10.1016/j.clinme.2024.100240
Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman
Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.
{"title":"Gliomas in adults: Guidance on investigations, diagnosis, treatment and surveillance.","authors":"Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman","doi":"10.1016/j.clinme.2024.100240","DOIUrl":"10.1016/j.clinme.2024.100240","url":null,"abstract":"<p><p>Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-06DOI: 10.1016/j.clinme.2024.100241
Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael
Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.
{"title":"Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study.","authors":"Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael","doi":"10.1016/j.clinme.2024.100241","DOIUrl":"10.1016/j.clinme.2024.100241","url":null,"abstract":"<p><p>Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1016/j.clinme.2024.100234
Michelle S Balaratnam, Fergus J Rugg-Gunn, Rachel Okin, Freya Powell, Stephen Prior, Panayiota Petrochilos, Dhiren Shivji, Salman Haider, Ali Alim-Marvasti, Arvind Chandratheva, Robert Simister, Charlie Lane, Roberto Macarimban, Diego Kaski, Bal Athwal, Rebecca Liu, Timothy Yates, Sanjeev Rajakulendran, Gerry Christofi, Jeremy Sandford, Alexis Ingram, Katherine Bluston, Caroline Weaver, Oluwaseun Odejide, George Glod, Gulsen Gungor, Edmund Nkrumah, Donal Markey, Gary Hotton, Katie Sidle, Jonathan Kennedy, Lisa Penniall, Helen Plum, Anthony Antoniou, Rakhee Prema, Nadia Jeffries, Carole Walters, Valerie L Stevenson, Malini Drysdale, Sabiha Tasnim, Shahrima Hussain, Lily Mackay, Ryan Baulk, Bianca IIii, David Egan, Adrian Capp, Patricia Turner, Christopher Turner
Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times. In preparation for the formation of the integrated care system (ICS), a novel innovative collaboration across multiple NHS trusts developed across North Central London in 2021. We developed a model where neuroscience specialists engage in collaborative care with clinicians outside the specialist hospital setting. Pivotal to the pathway is a multidisciplinary meeting, and collaborative working enables joint clinical reviews, diagnostics and medication initiation. This innovative collaboration has already significantly improved access, addressed inequalities due to borough variation and enhanced the delivery and quality of neuroscience care in our ICS. It is a translatable model that can be adapted to suit other regions in the UK. It fulfils many of the objectives of the integrated care system and these benefits are seen without the need for significantly more resource.
{"title":"An integrated approach to neuroscience care: An innovative model to support the new integrated care system.","authors":"Michelle S Balaratnam, Fergus J Rugg-Gunn, Rachel Okin, Freya Powell, Stephen Prior, Panayiota Petrochilos, Dhiren Shivji, Salman Haider, Ali Alim-Marvasti, Arvind Chandratheva, Robert Simister, Charlie Lane, Roberto Macarimban, Diego Kaski, Bal Athwal, Rebecca Liu, Timothy Yates, Sanjeev Rajakulendran, Gerry Christofi, Jeremy Sandford, Alexis Ingram, Katherine Bluston, Caroline Weaver, Oluwaseun Odejide, George Glod, Gulsen Gungor, Edmund Nkrumah, Donal Markey, Gary Hotton, Katie Sidle, Jonathan Kennedy, Lisa Penniall, Helen Plum, Anthony Antoniou, Rakhee Prema, Nadia Jeffries, Carole Walters, Valerie L Stevenson, Malini Drysdale, Sabiha Tasnim, Shahrima Hussain, Lily Mackay, Ryan Baulk, Bianca IIii, David Egan, Adrian Capp, Patricia Turner, Christopher Turner","doi":"10.1016/j.clinme.2024.100234","DOIUrl":"10.1016/j.clinme.2024.100234","url":null,"abstract":"<p><p>Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times. In preparation for the formation of the integrated care system (ICS), a novel innovative collaboration across multiple NHS trusts developed across North Central London in 2021. We developed a model where neuroscience specialists engage in collaborative care with clinicians outside the specialist hospital setting. Pivotal to the pathway is a multidisciplinary meeting, and collaborative working enables joint clinical reviews, diagnostics and medication initiation. This innovative collaboration has already significantly improved access, addressed inequalities due to borough variation and enhanced the delivery and quality of neuroscience care in our ICS. It is a translatable model that can be adapted to suit other regions in the UK. It fulfils many of the objectives of the integrated care system and these benefits are seen without the need for significantly more resource.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-12DOI: 10.1016/j.clinme.2024.100222
Sara Abou Sherif, Irene Katsaiti, Hannah Jebb, Serena Banh, Rachna Bedi, Jeremy Levy, David Thomas, Damien Ashby, Richard Corbett
Inpatient treatment of hyperkalaemia with insulin and dextrose can be complicated by iatrogenic hypoglycaemia. We sought to assess the incidence of hypoglycaemia in hospitalised patients with renal disease and assess the impact of the introduction of a local guideline incorporating the use of sodium zirconium cyclosilicate (SZC) for patients with moderate hyperkalaemia. After establishing a significant burden of hypoglycaemia in the initial observation period, a requirement for hourly capillary blood glucose monitoring (for up to 6 h) following the administration of insulin for hyperkalaemia was incorporated into the guidelines. The two-fold introduction of SZC alongside changes in patient care after the administration of insulin/dextrose resulted in more appropriate use of insulin/dextrose, as well as a significant (73%) reduction in the iatrogenic burden of hypoglycaemia (P = 0.04).
{"title":"Reducing the harm associated in treating hyperkalaemia with insulin and dextrose.","authors":"Sara Abou Sherif, Irene Katsaiti, Hannah Jebb, Serena Banh, Rachna Bedi, Jeremy Levy, David Thomas, Damien Ashby, Richard Corbett","doi":"10.1016/j.clinme.2024.100222","DOIUrl":"10.1016/j.clinme.2024.100222","url":null,"abstract":"<p><p>Inpatient treatment of hyperkalaemia with insulin and dextrose can be complicated by iatrogenic hypoglycaemia. We sought to assess the incidence of hypoglycaemia in hospitalised patients with renal disease and assess the impact of the introduction of a local guideline incorporating the use of sodium zirconium cyclosilicate (SZC) for patients with moderate hyperkalaemia. After establishing a significant burden of hypoglycaemia in the initial observation period, a requirement for hourly capillary blood glucose monitoring (for up to 6 h) following the administration of insulin for hyperkalaemia was incorporated into the guidelines. The two-fold introduction of SZC alongside changes in patient care after the administration of insulin/dextrose resulted in more appropriate use of insulin/dextrose, as well as a significant (73%) reduction in the iatrogenic burden of hypoglycaemia (P = 0.04).</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-05DOI: 10.1016/j.clinme.2024.100226
Sjx Murphy, Djh McCabe, R L O Donohoe, A J McCarthy
We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases.
{"title":"Vertebral body and spinal cord infarction in a pile-driver operator with fibrocartilaginous disc embolism.","authors":"Sjx Murphy, Djh McCabe, R L O Donohoe, A J McCarthy","doi":"10.1016/j.clinme.2024.100226","DOIUrl":"10.1016/j.clinme.2024.100226","url":null,"abstract":"<p><p>We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-17DOI: 10.1016/j.clinme.2024.100229
Gwenno Mair Edwards, Abdulfattah A Alejmi
We report a case series of two patients with chronic kidney disease (CKD) who developed erythropoietin-induced pure red cell aplasia following a change in erythropoietin preparation. Both patients responded well to immunosuppressive treatments, but unfortunately developed severe infections as a result of being immunosuppressed.
{"title":"Pure red cell aplasia secondary to erythropoietin therapy.","authors":"Gwenno Mair Edwards, Abdulfattah A Alejmi","doi":"10.1016/j.clinme.2024.100229","DOIUrl":"10.1016/j.clinme.2024.100229","url":null,"abstract":"<p><p>We report a case series of two patients with chronic kidney disease (CKD) who developed erythropoietin-induced pure red cell aplasia following a change in erythropoietin preparation. Both patients responded well to immunosuppressive treatments, but unfortunately developed severe infections as a result of being immunosuppressed.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-14DOI: 10.1016/j.clinme.2024.100227
Ali M Alam, Cansu Ozdemir, Nada Reza
Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the UK with strongyloidiasis pooled a total of 1,308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95% CI 17.1-39.5%, I2 = 92%, p < 0.01). At-risk populations included migrants, returning travellers and armed forces personnel. The most common symptoms reported were abdominal pain (WPP 32.1% (95% CI 20.5-44.8%), I2 = 93%, p < 0.01), rashes (WPP 38.4% (95% CI 13.1-67.7%), I2 = 99%, p < 0.01) and diarrhoea (WPP 12.6% (95% CI 6.7-19.9%), I2=70%, p = 0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.
{"title":"Strongyloides stercoralis infection in the UK: A systematic review and meta-analysis of published cases.","authors":"Ali M Alam, Cansu Ozdemir, Nada Reza","doi":"10.1016/j.clinme.2024.100227","DOIUrl":"10.1016/j.clinme.2024.100227","url":null,"abstract":"<p><p>Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the UK with strongyloidiasis pooled a total of 1,308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95% CI 17.1-39.5%, I<sup>2</sup> = 92%, p < 0.01). At-risk populations included migrants, returning travellers and armed forces personnel. The most common symptoms reported were abdominal pain (WPP 32.1% (95% CI 20.5-44.8%), I<sup>2</sup> = 93%, p < 0.01), rashes (WPP 38.4% (95% CI 13.1-67.7%), I<sup>2</sup> = 99%, p < 0.01) and diarrhoea (WPP 12.6% (95% CI 6.7-19.9%), I<sup>2</sup>=70%, p = 0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-07-22DOI: 10.1016/j.clinme.2024.100231
Sulaiman S Alsaif, Wendy Douglas, Joerg Steier, Mary J Morrell, Michael I Polkey, Julia L Kelly
Many patients with obstructive sleep apnoea (OSA) remain undiagnosed and thus untreated, and in part this relates to delay in diagnosis. Novel diagnostic strategies may improve access to diagnosis. In a multicentre, randomised study, we evaluated time to treatment decision in patients referred for suspected OSA, comparing a mandibular movement (MM) monitor to respiratory polygraphy, the most commonly used OSA detection method in the UK. Adults with high pre-test probability OSA were recruited from both northern Scotland and London. 40 participants (70 % male, mean±SD age 46.8 ± 12.9 years, BMI 36.9 ± 7.5 kg/m2, ESS 14.9 ± 4.1) wore a MM monitor and respiratory polygraphy simultaneously overnight and were randomised (1:1) to receive their treatment decision based on results from either device. Compared to respiratory polygraphy, MM monitor reduced time to treatment decision by 6 days (median(IQR): 13.5 (7.0-21.5) vs. 19.5 (13.7-35.5) days, P = 0.017) and saved an estimated 29 min of staff time per patient.
许多阻塞性睡眠呼吸暂停(OSA)患者仍未得到诊断,因此也未得到治疗,这在一定程度上与诊断延误有关。新的诊断策略可能会提高诊断率。在一项多中心随机研究中,我们对因疑似 OSA 而转诊的患者做出治疗决定所需的时间进行了评估,并将下颌骨运动(MM)监测仪与呼吸测谎仪(英国最常用的 OSA 检测方法)进行了比较。我们从苏格兰北部和伦敦招募了测试前可能性较高的 OSA 成人。40名参与者(70%为男性,平均年龄(±SD)为46.8±12.9岁,体重指数(BMI)为36.9±7.5 kg/m2,ESS为14.9±4.1)同时佩戴MM监测仪和呼吸测谎仪过夜,并随机(1:1)根据任一设备的结果决定是否接受治疗。与呼吸测谎仪相比,MM 监测仪将做出治疗决定的时间缩短了 6 天(中位数(IQR):13.5(7.0-21.5) vs. 19.5(13.7-35.5),P=0.017),并为每位患者节省了约 29 分钟的工作人员时间。
{"title":"Mandibular movement monitor provides faster, yet accurate diagnosis for obstructive sleep apnoea: A randomised controlled study.","authors":"Sulaiman S Alsaif, Wendy Douglas, Joerg Steier, Mary J Morrell, Michael I Polkey, Julia L Kelly","doi":"10.1016/j.clinme.2024.100231","DOIUrl":"10.1016/j.clinme.2024.100231","url":null,"abstract":"<p><p>Many patients with obstructive sleep apnoea (OSA) remain undiagnosed and thus untreated, and in part this relates to delay in diagnosis. Novel diagnostic strategies may improve access to diagnosis. In a multicentre, randomised study, we evaluated time to treatment decision in patients referred for suspected OSA, comparing a mandibular movement (MM) monitor to respiratory polygraphy, the most commonly used OSA detection method in the UK. Adults with high pre-test probability OSA were recruited from both northern Scotland and London. 40 participants (70 % male, mean±SD age 46.8 ± 12.9 years, BMI 36.9 ± 7.5 kg/m<sup>2</sup>, ESS 14.9 ± 4.1) wore a MM monitor and respiratory polygraphy simultaneously overnight and were randomised (1:1) to receive their treatment decision based on results from either device. Compared to respiratory polygraphy, MM monitor reduced time to treatment decision by 6 days (median(IQR): 13.5 (7.0-21.5) vs. 19.5 (13.7-35.5) days, P = 0.017) and saved an estimated 29 min of staff time per patient.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-06-27DOI: 10.1016/j.clinme.2024.100225
Neil Powell, Shuayb Elkhalifa, Daniel Hearsey, Michael Wilcock, Jonathan Sandoe
Objectives: We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin.
Methods: Opportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history.
Results: Of the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes.
Conclusions: Using the allergy risk tool, most patients with PenA records were exposed to penicillin appropriately. However, patients meeting high-risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place.
{"title":"The appropriateness of penicillin allergy de-labelling by non-allergist clinical ward teams.","authors":"Neil Powell, Shuayb Elkhalifa, Daniel Hearsey, Michael Wilcock, Jonathan Sandoe","doi":"10.1016/j.clinme.2024.100225","DOIUrl":"10.1016/j.clinme.2024.100225","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin.</p><p><strong>Methods: </strong>Opportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history.</p><p><strong>Results: </strong>Of the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes.</p><p><strong>Conclusions: </strong>Using the allergy risk tool, most patients with PenA records were exposed to penicillin appropriately. However, patients meeting high-risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}