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1.
Mult Scler Relat Disord ; 68: 104251, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36283323

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the evolution of JCV index over time in Natalizumab treated people with multiple sclerosis. MATERIALS AND METHODS: We retrospectively reviewed antibody index values from pwMS who were treated with Natalizumab for greater than six months and had at least two antibody results available between 2011 and 2019. Survival analysis was performed on those who were JCV index value negative at baseline to evaluate time to seroconversion. In pwMS who had index values available at 48 and/or 96 months post Natalizumab initiation, t-tests were performed to evaluate change in index over time. RESULTS: 1144 JCV antibody index results were available for 132 pwMS. Median time to seroconversion based on survival analysis was 103 months. Annualised seroconversion rate was 5.8%. Initial antibody index and rate of seroconversion did not differ with regards to age or gender. Antibody index increased significantly over time on treatment for the cohort as a whole, initial antibody index (0.27) to final antibody testing (0.86), t(131)=6.45, p<.0005. There was a significant increase in those with initial positive index value, between first (0.95) and final index (2.14), t(33) = 4.85, p<.0005 over a median of 77 months. CONCLUSIONS: In those who were seronegative at baseline there is a long median duration of treatment with Natalizumab prior to seroconversion. In individuals with positive JCV antibody index at treatment initiation, antibody index increases over time.


Subject(s)
JC Virus , Leukoencephalopathy, Progressive Multifocal , Multiple Sclerosis , Humans , Natalizumab/therapeutic use , Multiple Sclerosis/drug therapy , Retrospective Studies , Immunologic Factors/therapeutic use , Antibodies, Viral
2.
Mult Scler Relat Disord ; 38: 101521, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31756609

ABSTRACT

BACKGROUND: Detection of optic neuropathy on MRI has potential implications for the diagnosis and management of Multiple Sclerosis (MS). OBJECTIVE: This study assessed the accuracy of T2 sagittal MRI brain for detection of optic neuropathy, compared to coronal STIR orbit. METHODS AND MATERIALS: Retrospective single-center blinded diagnostic accuracy study of 100 consecutive patients who underwent both T2 sagittal brain and coronal STIR orbit MRI. All were performed on 1.5T scanners. T2 sagittal slice thickness was 4 mm for the first 50 patients (group1) and 3 mm for the second 50 (group2). The MRIs were reviewed in a blinded fashion to determine the presence of optic neuropathy. Coronal STIR orbit sequences were considered the diagnostic reference standard. RESULTS: The sensitivity of T2 sagittal brain imaging for ON was 44% in group 1 and 85% in group 2 (p = 0.007). The specificities were 98% and 97% respectively (p = 0.9). Sensitivity was poorest for evaluation of the intraorbital nerve segment (56% grp1, 69% grp2, p = 0.4). CONCLUSION: T2 sagittal MRI brain has high specificity for the detection of optic neuropathy when compared to coronal STIR orbit. Sensitivity is increased when slice thickness is reduced, but remains poor for evaluation of the intraorbital segment.


Subject(s)
Brain/diagnostic imaging , Magnetic Resonance Imaging/standards , Multiple Sclerosis/diagnostic imaging , Neuroimaging/standards , Optic Nerve Diseases/diagnostic imaging , Optic Neuritis/diagnostic imaging , Adult , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neuroimaging/methods , Retrospective Studies , Sensitivity and Specificity , Single-Blind Method
3.
Emerg Med J ; 26(5): 334-9, 2009 May.
Article in English | MEDLINE | ID: mdl-19386866

ABSTRACT

BACKGROUND: Emergency abdominal aortic aneurysm (EmAAA) represents a spectrum of disease from symptomatic non-ruptured aneurysms to free intraperitoneal rupture, with significantly worse outcomes for patients in a haemodynamically shocked state before surgery. A study was undertaken to see if the preoperative journey and outcome were different in patients who deviated from the classic acutely shocked presentation. METHODS: An observational database compiled from case notes of patients undergoing surgery for EmAAA at Sunderland Royal Hospital between April 2000 and October 2006 was interrogated to examine details of patient preoperative journey, physiological status and 30-day survival. Comparison between groups was performed using chi(2) analysis and the Mann-Whitney U test where appropriate. RESULTS: Records for 98 patients were available for review. Overall 30-day mortality was 49%, and was significantly higher for patients in shock at induction of anaesthesia than in those who were haemodynamically stable (59.6% vs 34.1%, p = 0.01). At presentation, 56 patients were stable and misdiagnosis was significantly more common in these patients than in those who were in shock (58.9% vs 26.2%, p = 0.002), with a significantly increased median time delay from presentation to diagnosis (144 min (IQR 24-366) vs 12 min (IQR 0-42), p<0.0001). Median time from diagnosis to arrival in theatre was significantly longer in patients who were haemodynamically stable at presentation (90 min (IQR 60-150) vs 48 min (IQR 36-90), p = 0.02). Of the 56 patients who were haemodynamically stable at presentation, 19 underwent haemodynamic decompensation before surgery with a significantly increased mortality compared with those who remained stable (73.7% vs 37.8%, p = 0.02). Of these 19 patients, only 5 were correctly diagnosed at presentation. CONCLUSIONS: Diagnosis and treatment of EmAAA in haemodynamically stable patients is often delayed, with the risk of significant rupture and haemodynamic decompensation which is associated with poor outcome. Correct diagnosis and treatment before development of shock has the potential to reduce mortality.


Subject(s)
Aortic Aneurysm, Abdominal/diagnosis , Shock/etiology , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/complications , Aortic Rupture/diagnosis , Aortic Rupture/surgery , Diagnosis, Differential , Emergencies , Emergency Service, Hospital/standards , Epidemiologic Methods , Female , Heart Failure/etiology , Humans , Male , Middle Aged , Time Factors , Treatment Outcome
4.
Anaesthesia ; 63(6): 599-603, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18477270

ABSTRACT

National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p < 0.01). We conclude that auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.


Subject(s)
General Surgery/organization & administration , Hospitals, University/organization & administration , Communication , Emergencies , England , General Surgery/standards , Health Services Research/methods , Humans , Medical Audit , Operating Rooms/statistics & numerical data , Preoperative Care/standards , Surgery Department, Hospital/organization & administration , Time Factors , Waiting Lists
5.
Allergy ; 59(2): 185-91, 2004 Feb.
Article in English | MEDLINE | ID: mdl-14763932

ABSTRACT

BACKGROUND: Studies have demonstrated that families of children with food allergy have significant deficiencies in their knowledge of how to avoid allergen exposure and how to manage allergic reactions. This study aims to assess the impact of a multidisciplinary paediatric allergy clinic consultation on parental knowledge of food allergy and to determine the rate of subsequent allergic reactions. METHODS: Sixty-two subjects (<17 years) referred with food allergy were prospectively enrolled. Parental knowledge was assessed by questionnaire and EpiPen trainer. Families saw a paediatric allergist, clinical nurse specialist and dietician. Knowledge was reassessed after 3 months and rate of allergic reactions after 1 year. RESULTS: After one visit to the paediatric allergy clinic, there was a significant improvement in parental knowledge of allergen avoidance (26.9%, P < 0.001), managing allergic reactions (185.4%, P < 0.0001) and EpiPen usage (83.3%, P < 0.001). Additionally, there was a significant reduction in allergic reactions (P < 0.001). Children with egg, milk or multiple food allergies were more likely to suffer subsequent reactions. CONCLUSIONS: A single visit to a multidisciplinary allergy clinic considerably improves families' abilities to manage allergic reactions to foods with an accompanying reduction in allergic reactions. Young children with egg, milk or multiple food allergies were at greatest risk of further reactions.


Subject(s)
Food Hypersensitivity , Parents/education , Adolescent , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Anaphylaxis/therapy , Asthma/etiology , Asthma/therapy , Child , Child, Preschool , Educational Status , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/prevention & control , Food Hypersensitivity/therapy , Humans , Infant , Male
6.
Clin Exp Dermatol ; 27(2): 115-7, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11952701

ABSTRACT

We report a 38-year-old man who presented with a generalized papular eruption that was clinically and histologically consistent with lichen nitidus. This patient's condition had been persistent for approximately 1 year; however, soon after assuming employment that entailed significant, regular sun exposure, the patient noted marked clearing of his lesions in sun-exposed areas. This case corroborates previous reports that suggest that generalized lichen nitidus can be successfully managed with ultraviolet light therapy.


Subject(s)
Lichen Nitidus/therapy , Ultraviolet Therapy/methods , Adult , Humans , Male , Remission, Spontaneous , Sunlight
10.
Fam Plann Perspect ; 28(5): 228-31, 1996.
Article in English | MEDLINE | ID: mdl-8886766

ABSTRACT

Inaccuracy in women's reports of their abortion histories affects many areas of interest to reproductive health professionals and researchers. The identification of characteristics that affect the accuracy of reporting is essential for the improvement of data collection methods. A comparison of the medical records of 104 American women aged 27-30 in 1990-1991 with their self-reported abortion histories revealed that 19% of these women failed to report one or more abortions. Results of logistic regression analysis indicate that nonwhite women were 3.3 times as likely as whites to underreport. With each additional year that had elapsed since the first recorded abortion, women became somewhat more likely to underreport (odds ratio of 1.3), while each additional year of a woman's education slightly decreased the likelihood of underreporting (odds ratio of 0.7).


PIP: Underreporting of abortion, prevalent both between and within populations, threatens to undermine the validity of research in this area. Estimates of abortion, contraceptive failure, miscarriage, and other reproductive history events that rely on self-reports are vulnerable to bias. This study sought to identify the characteristics associated with the likelihood of underreporting an abortion history. 651 respondents from the Child Health and Development Studies who were 27-30 years old in 1990-91 filled out self-administered reproductive health questionnaires; these results were then compared to the women's 1980-92 medical records. The final sample consisted of 104 women with a medical record of a total of 170 abortions. 90% of women who had at least one abortion in their medical record reported at least one abortion; only 56% reported all of their abortions within 1 year of the medical record date, however. Overall, 19% underreported their abortion history. Of these, half reported no abortions and half reported fewer abortions than were in the medical record. Another 46% reported the exact number of abortions, and 35% reported more abortions than were in the record. Non-White women were 3.3 times more likely than Whites to underreport abortion. For each year that elapsed since the procedure, the odds of underreporting increased by 26%. Finally, every additional year of schooling decreased the likelihood of underreporting abortion by 30%.


Subject(s)
Abortion, Induced/statistics & numerical data , Health Knowledge, Attitudes, Practice , Medical Record Linkage , Adult , California , Demography , Educational Status , Female , Follow-Up Studies , Humans , Logistic Models , Marriage , Odds Ratio , Parity , Pregnancy , Racial Groups , Surveys and Questionnaires
11.
Top Health Rec Manage ; 12(1): 83-8, 1991 Aug.
Article in English | MEDLINE | ID: mdl-10112164

ABSTRACT

The Patient Self-Determination Act should help patients make their own health care decisions without the intervention of the courts. Health care providers will acquire a large responsibility for helping to educate the public concerning the availability and use of advance directives. It is hoped that the additional investment providers will make in administering the provisions of the Act will bear dividends in better informed patients and in loss of time and suffering avoided when health care decisions are required for incapacitated patients.


Subject(s)
Patient Advocacy/legislation & jurisprudence , Patient Participation/legislation & jurisprudence , Advance Directives/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , United States
12.
N Engl J Med ; 318(3): 158-63, 1988 Jan 21.
Article in English | MEDLINE | ID: mdl-3336403

ABSTRACT

Because of allegations that the implantation of many permanent cardiac pacemakers has been unjustified, we reviewed the indications for all new pacemakers implanted at 30 hospitals in Philadelphia County between January 1 and June 30, 1983, and paid for by Medicare. Complete chart data were evaluated for 382 implants. We determined whether the indications for implantation were appropriate and adequately documented on the basis of standard clinical practice. Implants were classified as possibly indicated primarily because of inadequate diagnostic evaluation (63 percent) or inadequate documentation of an accepted indication (36 percent). Implants were classified as not indicated primarily because a rhythm abnormality was incorrectly identified as a justifiable indication (84 percent). We found that 168 implants (44 percent) were definitely indicated, 137 (36 percent) possibly indicated, and 77 (20 percent) not indicated. Unwarranted implantation was both prevalent (73 percent of hospitals had an incidence of 10 percent or more) and independent of the type of hospital (university teaching, university-affiliated, and community hospitals). The additional tests most often required to clarify the need for a pacemaker in inadequately evaluated cases included electrophysiologic studies (37 percent) and ambulatory monitoring (31 percent). We conclude that in a large medical population in 1983, the indications for a considerable number of permanent pacemakers were inadequate or incompletely documented.


Subject(s)
Pacemaker, Artificial/statistics & numerical data , Arrhythmias, Cardiac/classification , Bradycardia/diagnosis , Heart Block/diagnosis , Humans , Methods , Pennsylvania , Pilot Projects , Professional Review Organizations , Tachycardia/diagnosis
13.
Pflugers Arch ; 401(1): 101-3, 1984 May.
Article in English | MEDLINE | ID: mdl-6473063

ABSTRACT

The longitudinal distribution of 42K was measured in strips of frog ventricular muscle placed in a partitioned perfusion chamber. A radiation detector placed directly under the chamber was moved from point to point to scan the longitudinal distribution of 42K. The detector was focussed on a 0.6 mm segment of the strip by means of two slits and two Geiger tubes. A beta-particle from the strip was counted only if it passed through both Geiger tubes. This arrangement improved the spatial resolution and decreased the background and the sensitivity to Compton electrons. The intracellular diffusion constant measured with this system is 3.7 X 10(-6) cm2/s.


Subject(s)
Myocardium/metabolism , Potassium/metabolism , Animals , Diffusion , Membrane Potentials , Methods , Potassium Radioisotopes/metabolism , Ranidae
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