Planned surgery in the COVID-19 pandemic: a prospective cohort study from Nottingham.

PURPOSE: Globally planned surgical procedures have been deferred during the current COVID-19 pandemic. The study aimed to report the outcomes of planned urgent and cancer cases during the current pandemic using a multi-disciplinary prioritisation group. METHODS: A prospective cohort study of patients having urgent or cancer surgery at a NHS Trust from 1st March to 30th April 2020 who had been prioritised by a multi-disciplinary COVID Surgery group. Rates of post-operative PCR positive and suspected COVID-19 infections within 30 days, 30-day mortality and any death related to COVID-19 are reported. RESULTS: Overall 597 patients underwent surgery with a median age of 65 years (interquartile range (IQR) 54-74 years). Of these, 86.1% (514/597) had a current cancer diagnosis. During the period, 60.8% (363/597) of patients had surgery at the NHS Trust whilst 39.2% (234/597) had surgery at Independent Sector hospitals. The incidence of COVID-19 in the East Midlands was 193.7 per 100,000 population during the study period. In the 30 days following surgery, 1.3% (8/597) of patients tested positive for COVID-19 with all cases at the NHS site. Overall 30-day mortality was 0.7% (4/597). Following a PCR positive COVID-19 diagnosis, mortality was 25.0% (2/8). Including both PCR positive and suspected cases, 3.0% (18/597) developed COVID-19 infection with 1.3% at the independent site compared to 4.1% at the NHS Trust (p=0.047). CONCLUSIONS: Rates of COVID-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.

Hydrothorax in association with Scopulariopsis brumptii in an AIDS patient in Chennai, India.

Over the past decade, an increasing number of opportunistic fungal infections have been reported in immunocompromised subjects. Microascus spp. and their anamorphs Scopulariopsis spp. have been recovered from a wide geographical range. We report a case of Scopulariopsis brumptii in a 27-year-old man with AIDS presenting with breathlessness, pericardial effusion and hydrothorax in Chennai, southern India, in February 2007. Because of respiratory arrest, the patient was intubated. However, the patient developed obstructive shock and died due to cardiac dysfunctions. This report underlines the need for a direct, intensive approach to investigations in immunocompromised patients, especially those with AIDS.

IgA-antitissue transglutaminase: validation of a commercial assay for diagnosing coeliac disease.

We have evaluated a commercial assay for serum IgA class antibodies to tissue transglutaminase, the enzyme identified as the major endomysial autoantigen in coeliac disease (CD). Sera were available from 130 adults diagnosed with CD in Southern Derbyshire between 01 01 97 and 31 12 99. Sera from 100 patients without villous atrophy on small intestinal biopsy were controls. The ability of the assay to detect abnormally low total IgA levels was assessed using sera from 18 subjects with IgA deficiency. Sensitivity and specificity of this IgA-anti tissue transglutaminase (tTGA) assay (86.2%, 91.0%) were inferior to endomysial antibody (EMA; 93.8%, 100%). tTGA has significantly higher sensitivity than IgA-antigliadin (76.2%). tTGA was appropriately undetectable (<0.03 U/mL) in 17 of 18 subjects with selective IgA deficiency. The high likelihood ratio (35) for tTGA at levels >9.0 U/mL and methodological advantages over EMA suggest that tTGA could be used as a first line diagnostic test for CD. At tTGA levels of 4-9 U/mL, use of EMA as a second line test would improve specificity.

Depressive thinking and dysfunctional schematic mental models.

OBJECTIVES: To examine the replicability and generalizability of findings suggesting that mood-dependent negative thinking in depression reflects changes in the schematic mental models through which the world is interpreted, rather than a generalized increase in accessibility of negative constructs. DESIGN: Depressed and non-depressed samples were compared on a sentence completion task concerning anticipated outcomes of social approval or success. This task was designed so that the schematic mental models view predicted more positive completions from depressed participants, the construct accessibility view predicting the opposite. METHODS: A total of 98 depressed participants (scoring > 15 on the Center for Epidemiologic Studies Depression Scale; CESD) from a depressive self-help organization, and 50 non-depressed controls (CESD < 16) completed the CESD, Sentence Completion Task and the Dysfunctional Attitude Scale (DAS). RESULTS: Depressed participants made more positive completions in the Sentence Completion Task, and scored higher on the DAS than controls. Subanalyses suggested that the depressed group's increased positive completions were accounted for largely by those currently in psychiatric treatment; these participants also showed greater evidence of dysfunctional schematic models on DAS. CONCLUSIONS: For depressed participants in psychiatric treatment, results replicate previous findings, supporting the view that negative depressive thinking reflects a change in schematic mental models through which the world is interpreted. Results are inconsistent with predictions from the construct accessibility view. The results have methodological implications for the use of the sentence completion task in future studies.

Stimulus-independent thought depends on central executive resources.

Stimulus-independent thoughts (SITs) are streams of thoughts and images unrelated to immediate sensory input. Four experiments examined the contribution of aspects of working memory to production of SITs. In Experiments 1 and 2, interventions that were targeted on, respectively, phonological and visuospatial components of working memory both interfered with production of SITs, but there was evidence that these tasks also made demands on central executive resources. Experiments 3 and 4 specifically examined the hypothesis that production of SITs and control of nonproceduralized tasks both depend on central executive resources, and so should show mutual interference. In Experiment 3, prior practice on pursuit rotor and memory tasks reduced the interference with SITs from concurrent task performance. In Experiment 4, randomness within a task involving random-number generation was less when SITs were being produced concurrently than it was when they were not. The results suggest that production of SITs depends on central executive resources.

The prevalence of coeliac disease in adult diabetes mellitus.

Coeliac disease occurs more commonly in children with insulin-dependent diabetes mellitus (IDDM) than in the general population, but the prevalence of coeliac disease in adults with diabetes is unknown. We therefore screened an adult hospital-based diabetic population using IgA antigliadin antibody (IgA-AGA) to identify those patients requiring intestinal biopsy. In 1 year, 1789 patients (43% IDDM, 57% NIDDM) were screened, and 73 had raised IgA-AGA. Of these patients, 49 agreed to duodenal biopsy and 13 (10 IDDM) had coeliac disease. Selective IgA deficiency was found in eight patients, one of whom had coeliac disease. Of these 14 patients with newly diagnosed coeliac disease, four had microcytic anaemia, nine a low serum ferritin, and four a low albumin-corrected calcium. Eight patients had symptoms which improved on gluten withdrawal. Dietary compliance was maintained in 6/8 symptomatic patients, but only in 1/6 without symptoms. Included in the 1789 patients were four (all IDDM) with known coeliac disease. The overall prevalence of coeliac disease in adult patients with IDDM was 1:50 compared with 1:340 in NIDDM. Coeliac disease is common in adults with IDDM and may cause malabsorption and ill health. It should be suspected in any IDDM patient with gastrointestinal symptoms or unexplained anaemia.

Goal attainment scaling with hospitalized sexual offenders.

Forty-six hospitalized sex offenders participated in a 6-month evaluation of treatment outcome. This study used the concept of goal attainment scaling, an individualized, scaled description of personal goals, for measuring therapeutic outcome. Conjoint therapist and patient goal setting resulted in 180 treatment goals being set. At follow-up, 38 patients exceeded the "expected" success level on a total of 159 treatment goals, whereas eight patients only made minimal progress on 21 of their 40 selected goals. Despite the benign clinical improvement shown by most patients, few patients actually achieved the best anticipated level of attainment on all of their personal goals (usually three to six goals). Retrospective review of all goal attainment scaling protocols indicated that four major content dimensions account for nearly all of the goals devised: sexual deviation, 30 goals; anger and emotional expression, 64 goals; self concept, 31 goals; and poor interpersonal relations, 51 goals. These goal-oriented profiles may have important ramifications for the future assessment, program planning, and rehabilitation of convicted sex offenders.