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90 ["Junctional bradycardia caused by ciguatera intoxication"] 10.1136/bcr-2019-229354 http://dx.doi.org/10.1136/bcr-2019-229354 2019-05-31T12:15:32Z [] 9 0 ["1757-790X"] BMJ Case Reports <jats:p>Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.</jats:p> 4 ["http://orcid.org/0000-0001-6099-0948"] ["Rajendra Raman", "Sarah Coppes", "Tessa Hellingman", "Casper Lacl\u00e9"] [""] [""] [""]
84 ["How far are we from a medication use process aiming at well-informed adherent patients with long-term medications in Finland? Qualitative study"] 10.1136/bmjopen-2019-036526 http://dx.doi.org/10.1136/bmjopen-2019-036526 2020-06-22T07:06:08Z ["General Medicine"] 72 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3 years after its launch.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy’s implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012–2014) in 2015.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations).</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>A new conceptual framework was developed based on stakeholders’ views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (<jats:italic>macro</jats:italic>), (2) healthcare professionals (<jats:italic>meso</jats:italic>) and (3) patient (<jats:italic>micro</jats:italic>) levels.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Medication counselling by community pharmacists was the primary implemented action, followed by physicians’ actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of r… 4 ["http://orcid.org/0000-0001-7846-3492"] ["Niina Mononen", "Marika Pohjanoksa-M\u00e4ntyl\u00e4", "Marja SA Airaksinen", "Katri H\u00e4meen-Anttila"] [] ["Elli Turunen Fund of the Finnish Cultural Foundation"] [[""]]
68 ["Drug utilisation among Dutch adolescents: a pharmacy prescription records study"] 10.1136/archdischild-2017-314692 http://dx.doi.org/10.1136/archdischild-2017-314692 2018-06-01T16:16:30Z ["Pediatrics, Perinatology, and Child Health"] 12 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>Studies on adolescent drug use are scarce as most studies do not distinguish between children and adolescents. Therefore, we assessed overall drug use in adolescents.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective cohort study was conducted using pharmacy dispensing records from 62 community pharmacies in the Netherlands. Dispensing records of the previous 5 years were extracted for adolescents (12–18 years).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The study population consisted of 47 421 adolescents who collected at least one medication prescription during adolescence (mean age 15.5±1.8 years; 48.9% males). Half of them collected dermatologicals (46.2% males; 52.3% females), followed by drugs for the respiratory system (43.4% males; 40.3% females) and anti-infectives for systemic use (31.3% males; 39.1% females). The percentage of males using dermatologicals slightly increased, while the percentage of female users decreased with age. The most prescribed active ingredient was methylphenidate.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These insights into adolescent drug use help us to better understand adolescent healthcare use.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Dutch trial register NTR5061.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0001-9059-1278"] ["Richelle C Kosse", "Ellen S Koster", "Tjalling W de Vries", "Marcel L Bouvy"] [""] [""] [""]
83 ["Reliability of administrative data to identify sexually transmitted infections for population health: a systematic review"] 10.1136/bmjhci-2019-100074 http://dx.doi.org/10.1136/bmjhci-2019-100074 2020-04-22T00:34:06Z [] 29 0 ["2632-1009"] BMJ Health & Care Informatics <jats:sec><jats:title>Introduction</jats:title><jats:p>International Classification of Diseases (ICD) codes in administrative health data are used to identify cases of disease, including sexually transmitted infections (STIs), for population health research. The purpose of this review is to examine the extant literature on the reliability of ICD codes to correctly identify STIs.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a systematic review of empirical articles in which ICD codes were validated with respect to their ability to identify cases of chlamydia, gonorrhoea, syphilis or pelvic inflammatory disease (PID). Articles that included sensitivity, specificity and positive predictive value of ICD codes were the target. In addition to keyword searches in PubMed and Scopus databases, we further examined bibliographies of articles selected for full review to maximise yield.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From a total of 1779 articles identified, only two studies measured the reliability of ICD codes to identify cases of STIs. Both articles targeted PID, a serious complication of chlamydia and gonorrhoea. Neither article directly assessed the validity of ICD codes to identify cases of chlamydia, gonorrhoea or syphilis independent of PID. Using ICD codes alone, the positive predictive value for PID was mixed (range: 18%–79%).</jats:p></jats:sec><jats:sec><jats:title>Discussion and conclusion</jats:title><jats:p>While existing studies have used ICD codes to identify STI cases, their reliability is unclear. Further, available evidence from studies of PID suggests potentially large variation in the accuracy of ICD codes indicating the need for primary studies to evaluate ICD codes for use in STI-related public health research.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0002-1121-0607"] ["Brian E Dixon", "Saurabh Rahurkar", "Yenling Ho", "Janet N Arno"] ["T15LM012502"] ["U.S. National Library of Medicine", "National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention"] ["10.13039/100000092", "10.13039/100005258"]
59 ["Diagnosis and management of acute ischaemic stroke"] 10.1136/practneurol-2020-002557 http://dx.doi.org/10.1136/practneurol-2020-002557 2020-06-07T21:19:36Z ["Clinical Neurology", "General Medicine"] 130 0 ["1474-7758", "1474-7766"] Practical Neurology <jats:p>Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.</jats:p> 4 ["http://orcid.org/0000-0002-4226-7681", "http://orcid.org/0000-0001-9535-022X"] ["Robert Hurford", "Alakendu Sekhar", "Tom A T Hughes", "Keith W Muir"] [""] [""] [""]
97 ["Sex, gender or occupational psychology: what matters most to preventing heat-related illnesses and improving outcomes for women in ground close combat?"] 10.1136/bmjmilitary-2020-001480 http://dx.doi.org/10.1136/bmjmilitary-2020-001480 2020-04-28T07:44:52Z [] 0 0 ["2633-3767", "2633-3775"] BMJ Military Health <jats:p>Since the advent of women in ground close combat (WGCC) roles, the impact on women of the attendant risk of heat stress and heat illness has been considered. Much emphasis has been placed on sex differences in thermal physiology. This article considers the application of evidence of sex-associated thermoregulatory variation to the occupational and environmental setting of WGCC, and weighs the relative importance of physiological differences arising from biological sex, and behaviour associated with gender normatives. Quantifying the risk of heat illness to WGCC should draw on data from their real-world occupational context.</jats:p> 4 ["http://orcid.org/0000-0002-6248-6400"] ["Robert M Gifford", "N Taylor", "M Stacey", "D R Woods"] [""] [""] [""]
7 ["Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management"] 10.1136/gutjnl-2019-318404 http://dx.doi.org/10.1136/gutjnl-2019-318404 2019-08-19T15:35:18Z ["Gastroenterology"] 95 13 ["0017-5749", "1468-3288"] Gut <jats:p>Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo −13’910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.</jats:p> 4 ["http://orcid.org/0000-0002-8719-5175", "http://orcid.org/0000-0003-4394-5584"] ["Benjamin Misselwitz", "Matthias Butter", "Kristin Verbeke", "Mark R Fox"] [""] [""] [""]
49 Nature, content and shifts over time of the most impactful unruptured intracranial aneurysms articles: a bibliometric analysis 10.1136/neurintsurg-2020-016238 http://dx.doi.org/10.1136/neurintsurg-2020-016238 2020-06-30T21:27:03Z ["Surgery", "Clinical Neurology", "General Medicine"] 29 0 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>The management of unruptured intracranial aneurysms (UIAs) has evolved significantly over the last few decades. Our objective was to evaluate the 100 most cited UIA articles by bibliometric analysis to identify nature, content and shifts over time.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Elsevier’s Scopus database was interrogated for the 100 most cited articles that focused on UIA. Older versus newer articles were compared, with categorical data analyzed using Pearson’s Chi-square, and continuous data analyzed using Wilcoxon’s rank-sum test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The 100 most cited articles were published between 1975 and 2015, with the majority of these reporting patient clinical outcomes (n=69). There were 47/69 (68%) articles that described surgical intervention, with 38/47 (81%) and 18/47 (38%) including endovascular and open approaches, respectively . Publications peaked in 2004 (n=8), and the most common country of correspondence was the United States (n=59). Compared to older articles, newer articles had statistically higher citation rates (P&lt;0.01), higher number of authors (P&lt;0.01) with more multiple institution collaborations (P=0.01), greater disclosures of funding (P&lt;0.01), more focus on endovascular treatments (P=0.04), in more journals with a clinical, non-surgical focus (P&lt;0.01) published under open access policies (P&lt;0.01).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In the 100 most cited articles about UIAs to date, there is a distinct shift towards more co-authored efforts utilizing multi-institutional efforts focused on endovascular approaches supported by funding. The emergence of endovascular techniques has refreshed the need for more contemporary rupture risk prediction models and natural history data to validate current attitudes towards clinical management after these minimally invasive procedures for UIAs.</jats:p></ja… 4 ["http://orcid.org/0000-0002-9470-5890", "http://orcid.org/0000-0002-3679-3212"] ["Victor M Lu", "Stephanie H Chen", "Christopher C Young", "Robert M Starke"] ["R01NS111119-01A1"] ["Foundation for the National Institutes of Health"] ["10.13039/100000009"]
46 ["Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study"] 10.1136/bmjsrh-2018-200278 http://dx.doi.org/10.1136/bmjsrh-2018-200278 2019-08-17T21:25:18Z [] 25 1 ["2515-1991", "2515-2009"] BMJ Sexual & Reproductive Health <jats:sec><jats:title>Introduction</jats:title><jats:p>In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Self-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0003-0044-5635"] ["Rebecca Elizabeth Finch", "Kevin McGeechan", "Anne Johnstone", "Sharon Cameron"] [""] [""] [""]
44 ["Adult intussusception secondary to diverticular disease"] 10.1136/bcr-2018-226678 http://dx.doi.org/10.1136/bcr-2018-226678 2018-11-09T07:25:40Z [] 9 1 ["1757-790X"] BMJ Case Reports <jats:p>Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.</jats:p> 4 ["http://orcid.org/0000-0003-0461-0861"] ["Habib Syed", "Labib Syed", "Umesh Parampalli", "Mokhtar Uheba"] [""] [""] [""]
34 ["Pneumothorax after acupuncture"] 10.1136/bcr-2018-228770 http://dx.doi.org/10.1136/bcr-2018-228770 2019-06-12T11:35:13Z [] 16 2 ["1757-790X"] BMJ Case Reports <jats:p>Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.</jats:p> 4 ["http://orcid.org/0000-0003-3408-0515"] ["Sofia Costa Corado", "Margarida Gra\u00e7a Santos", "Lu\u00edsa Quaresma", "Jos\u00e9 Rodrigues Baltazar"] [""] [""] [""]
10 ["Prognostic Impact of Parity in 493 Uterine Sarcoma Patients"] 10.1111/igc.0b013e3181aaa950 http://dx.doi.org/10.1111/igc.0b013e3181aaa950 2010-12-03T18:36:56Z ["Obstetrics and Gynaecology", "Oncology"] 28 11 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Introduction:</jats:title><jats:p>Nulliparity has been found to negatively affect prognosis among endometrial cancer patients. Few previous studies have examined the prognostic impact of parity in patients with uterine sarcomas.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>In the present nationwide, register-based study in Norway, we explore whether parity influences survival among 493 women diagnosed with malignant uterine sarcomas. Hazard ratios for total mortality were calculated in Cox proportional hazard regression analyses.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>The 5-year Kaplan-Meier survival rates for the 126 endometrial stromal sarcoma (ESS) patients, 249 leiomyosarcoma (LS) patients, and 118 carcinosarcoma (CS) patients were 74%, 68%, and 55%, respectively, but varied considerably by age at diagnosis and clinical stage. In the univariate analyses, nulliparous women had poorer prognosis than parous women among CS patients (<jats:italic>P</jats:italic> = 0.071, log-rank test) and ESS patients (<jats:italic>P</jats:italic> = 0.15). In analyses adjusted for clinical stage and age at diagnosis, nulliparity was associated with a worse outcome in ESS patients only (hazard ratio, 0.50; 95% confidence interval, 0.22-1.12; parous vs nulliparous women); a trend with increasing number of births was also observed, of borderline significance (<jats:italic>P</jats:italic> = 0.058). No independent prognostic impact of parity was found in LS or CS patients. However, a considerably higher proportion of nulliparous than parous CS patients was diagnosed with advanced-stage disease (<jats:italic>P</jats:italic> = 0.003).</jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p>Nulliparity seems to be associated with poorer prognosis in ESS patients; no independent prognostic impact of parity was seen among LS or CS patients. Further knowledge on underlying biological mechanisms may be valuable for improved treatment.</jats:p></jat… 4 [] ["Grethe Albrektsen", "Ivar Heuch", "Elisabeth Wik", "Helga B. Salvesen"] [""] [""] [""]
22 ["EGFR gene copy number as a predictive/biomarker for patients with non-small-cell lung cancer receiving tyrosine kinase inhibitor treatment: a systematic review and meta-analysis"] 10.1136/jim-2016-000252 http://dx.doi.org/10.1136/jim-2016-000252 2016-09-24T02:48:22Z [] 41 6 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:p>Epidermal growth factor receptor (<jats:italic>EGFR</jats:italic>) gene copy number has been proposed as a candidate biomarker for predicting treatment response to EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced non-small-cell lung cancer (NSCLC). MEDLINE, PubMed, Cochrane, and Google Scholar databases were searched until October 21, 2015 using the following search terms: lung neoplasms/lung cancer/non-small cell lung cancer/NSCLC, EGFR, gene amplification, copy number, erlotinib, gefitinib, tyrosine-kinase inhibitor/TKI, predictor. 17 studies were included in the analysis with a total of 2047 patients. The overall analysis found that increased <jats:italic>EGFR</jats:italic> gene copy number was associated with higher overall response rate (ORR), overall survival (OS) and progression-free survival (PFS; p values ≤0.008) compared with patients without a high <jats:italic>EGFR</jats:italic> gene copy number. Subgroup analysis found that in a population of patients who were primarily Caucasian, a higher <jats:italic>EGFR</jats:italic> gene copy number was also associated with increased ORR, OS, and PFS (p values ≤0.018). The results were similar in a population of Asian patients, except that a higher <jats:italic>EGFR</jats:italic> gene copy number was not associated with improved OS (p=0.248). Sensitivity analysis indicated that no one study overly influenced the results and that the findings are robust. The result of the analysis found that <jats:italic>EGFR</jats:italic> gene copy number was associated with increased OS and PFS, supporting the idea that <jats:italic>EGFR</jats:italic> gene copy number is a biomarker for response to EGFR-TKI therapy in patients with advanced NSCLC.</jats:p> 4 [] ["Xin Zhang", "Yiwen Zhang", "Hailing Tang", "Jianxing He"] [""] [""] [""]
45 ["Success of 4CMenB in preventing meningococcal disease: evidence from real-world experience"] 10.1136/archdischild-2019-318047 http://dx.doi.org/10.1136/archdischild-2019-318047 2020-02-06T22:15:25Z ["Pediatrics, Perinatology, and Child Health"] 0 1 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:p>Meningococcal disease remains one of the most feared infectious diseases worldwide because of its sudden onset, rapid progression and high case fatality rates, while survivors are often left with severe long-term sequelae. Young children have the highest incidence of invasive meningococcal disease (IMD), and nearly all cases in the UK, as in most of Europe and many other industrialised countries, are due to group B meningococci (MenB). The licensure of a broad-coverage, recombinant protein-based MenB vaccine (4CMenB) in 2013 was, therefore, heralded a major breakthrough in the fight against IMD. This vaccine was, however, licensed on immunogenicity and reactogenicity studies only, raising uncertainties about field effectiveness, long-term safety and antibody persistence. In 2015, the UK became the first country to implement 4CMenB into the national infant immunisation schedule and, since then, several countries have followed suit. Seven years after licensure, a wealth of real-world data has emerged to confirm 4CMenB effectiveness, along with large-scale safety data, duration of protection in different age groups, successful strategies to reduce vaccine reactogenicity, impact on carriage in adolescents and the potential for 4CMenB to protect against other meningococcal serogroups and against gonorrhoea. A number of questions, however, remain unanswered, including the investigation and management of vaccine-associated fever in infants, as well as disease severity and assessment of breakthrough cases in immunised children. Increasing use of 4CMenB will provide answers in due course. We now have vaccines against all the major serogroups causing IMD worldwide. Next-generation and combination vaccines against multiple serogroups look very promising.</jats:p> 4 [] ["Catherine Isitt", "Catherine A Cosgrove", "Mary Elizabeth Ramsay", "Shamez N Ladhani"] [""] [""] [""]
50 ["Mediastinal cystic teratoma masquerading as a hydatid cyst"] 10.1136/bcr-2020-234755 http://dx.doi.org/10.1136/bcr-2020-234755 2020-06-30T06:17:26Z [] 8 0 ["1757-790X"] BMJ Case Reports <jats:p>A case is presented in which a preoperatively diagnosed hydatid cyst was found to be a mature cystic teratoma on pathological examination. Diagnostic dilemmas surrounding each disease are discussed.</jats:p> 4 [] ["David Williams", "Fang Zhou", "Max Grovenburg", "Mikhail Vaynblat"] [""] [""] [""]
55 ["MEDICATION USE IN NEONATAL INTENSIVE CARE UNITS ACROSS EUROPE"] 10.1136/archdischild-2015-310148.11 http://dx.doi.org/10.1136/archdischild-2015-310148.11 2015-12-15T08:07:33Z ["Pediatrics, Perinatology, and Child Health"] 0 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Objectives</jats:title><jats:p>This is the first Europe-wide study aiming to describe the medication use in Neonatal Intensive Care Units and to analyse the factors that might influence the prescription pattern.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A pan-European one day point-prevalence study was conducted in 2012 where all of the prescriptions for hospitalised neonates were recorded. A trade name, manufacturer, active pharmaceutical ingredients (API), strength, galenic form and route of administration were registered.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Altogether 2173 prescriptions were administered to 726 neonates from 21 countries, of whom 66% (477/726) were preterm, 12% (84/726) extremely preterm. There was inverse correlation between gestational age (GA) and median number of prescriptions per neonate (group median 2/IQR 1–4, extremely preterm 4/3–6, very preterm 3/2–5, late preterm 2/1–3, full-term 2/1–3). Median number of prescriptions per neonate was highest in the eastern region, among extremely preterm neonates (median=6.5/IQR 6–8.5). Highest prescription rate was for alimentary medicines (93/per 100 admissions), systemic antiinfectives (79/100) and medicines for blood (71/100). Antiinfectives were most frequently prescribed in the southern region (103/100). Multivitamins were most frequently used medications in most regions (western 74, southern 31, northern 31/100), except in eastern region (5/100). Most commonly prescribed API-s were multivitamins (32/100), caffeine (19/100), gentamicin (18/100), amino acids (18/100) and colecalciferol (15/100). Most frequently prescribed medications among extremely preterm neonates were caffeine (60/100), among very preterms multivitamins and caffeine (45 and 43/100), among late preterms multivitamins (44/100) and among full-terms phytomenadione (26/100) and gentamicin (24/100).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our study revealed the most c… 4 [] ["Inge Mesek", "Georgi Nellis", "Jana Lass", "Irja Lutsar"] [""] [""] [""]
72 ["Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis"] 10.1136/archdischild-2019-318207 http://dx.doi.org/10.1136/archdischild-2019-318207 2020-05-25T21:17:07Z ["Obstetrics and Gynaecology", "Pediatrics, Perinatology, and Child Health", "General Medicine"] 39 0 ["1359-2998", "1468-2052"] Archives of Disease in Childhood - Fetal and Neonatal Edition <jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Neurodevelopmental outcomes ≥1 year of corrected age based on validated tools.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>DEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD4… 4 [] ["Chandra Prakash Rath", "Saumil Desai", "Shripada C Rao", "Sanjay Patole"] [""] [""] [""]
85 ["ID: 129: PARTICULATE MATTER DISRUPTS ENDOTHELIAL CELL PERMEABILITY VIA GAP JUNCTION PROTEIN"] 10.1136/jim-2016-000120.124 http://dx.doi.org/10.1136/jim-2016-000120.124 2016-05-10T23:43:02Z [] 0 0 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:sec><jats:title>Introduction</jats:title><jats:p>Particulate matter (PM) is significantly associated with cardiopulmonary morbidity and mortality. We previously demonstrated that PM induces endothelial barrier disruption via reactive oxygen species (ROS)-dependent mechanisms. This study is focused on characterization of PM-regulated endothelial dysfunction via connexin43 (Cx43), a Gap junction protein. Gap junction is designated as intercellular channel which allows cells to communicate with each other, share nutrients, and transfer chemical or electrical signals, in turn, enables cells in a tissue to function in a coordinated manner.</jats:p></jats:sec><jats:sec><jats:title>Methods and Results</jats:title><jats:p>Cx43 protein levels were evaluated by western blotting, and band density quantified using MyImageAnalysis. Real-time PCR was conducted to determine Cx43 mRNA levels. Human pulmonary artery endothelial cell (EC) barrier function was measured using the electrical cell-substrate impedance sensing (ECIS) system (Applied Biophysics) that provides a readout of transendothelial electrical resistance (TER). PM sample (0.1–0.3 µm of aerodynamic diameter) was collected (April of 2005) from the Ft. McHenry Tunnel, Baltimore, MD using a high-volume cyclone collector. PM (100 µg/ml) induced time-dependent increases in EC Cx43 mRNA levels (∼5 fold increase at 4 hr) and protein expression which was attenuated by N-acetyl-cysteine (NAC, 5 mM, 1 hr pretreatment), an ROS scavenger. Unlike Cx43, Cx37, another connexin expressed in ECs, remained unaltered by PM challenge. In addition, EC pretreatment with a Cx43 inhibitor, connexin-mimetic peptide Gap27 (500 µM, 2 hr pretreatment), significantly attenuated PM-reduced TER reduction by 45%, suggesting a central role of Cx43 in PM-induced lung EC barrier integrity disruption and signal transduction.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results suggest Cx43 as a key and novel participant in PM-mediated signal transduction that resu… 4 [] ["X Wu", "X Xu", "JG Garcia", "T Wang"] [""] [""] [""]

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