A protocol for targeted B-lymphocyte depletion for the treatment of IgG4-related disease.

Objectives: To determine the clinical outcomes of patients with immunoglobulin 4-related disease (IgG4-RD) treated with a defined B cell depletion protocol using rituximab.

Methods: Patients were included if they had (1) an IgG4-RD diagnosis at Imperial College Healthcare NHS Trust between February 2017 and October 2022, and (2) >9 months of follow-up data available following the first rituximab dose. The rituximab protocol targeted B cell depletion to < 10 cells/microliter for a maintenance period of two years.

Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study.

Background: Various complications have been reported in patients with COVID-19 including pneumomediastinum.

Methods: The primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum.

Giant cell arteritis presenting with unilateral sixth nerve palsy.

Giant cell arteritis (GCA) usually presents with headache, scalp tenderness and raised inflammatory markers. GCA presenting with a clinically evident cranial nerve palsy is rare and may result in a delayed or missed diagnosis if not suspected. We present the rare case of a woman in her 70s with histologically confirmed GCA presenting with a unilateral sixth nerve palsy, which responded to treatment with high-dose oral prednisolone.

Rituximab administration during the second trimester of pregnancy for systemic lupus erythematosus: Case report and review of the literature on rheumatic disease.

Rituximab (RTX) is an anti-CD20 monoclonal antibody that is used in the treatment of many rheumatic diseases, for both licensed and unlicensed indications. Due to concerns regarding foetal B cell depletion and possible infection, there is conflicting advice about whether the drug should be administered during pregnancy, with some organisations advising administration if the potential benefit to the mother outweighs the risk to the foetus and some advising stopping RTX 6 months prior to conception. Caution in particular is advised about administering RTX in later trimesters when maternal immunoglobulin G (IgG) is transported across the placenta.

Osteolytic lesions as the sole presenting feature of secondary syphilis.

We present the case of a 48-year-old man with a background of well-controlled HIV who presented with bony pain in multiple regions and raised inflammatory markers. After an investigative process, the patient was newly diagnosed with secondary syphilis. Bony pain, secondary to osteolytic lesions and demonstrated on plain radiography, CT and nuclear medicine imaging, was the sole presenting feature.

A case of enteropathic arthritis complicated by superimposed bilateral septic arthritis of the hips.

Polyarticular septic arthritis is an underappreciated clinical entity. Pre-existing joint diseases, such as osteoarthritis and rheumatoid arthritis have been shown to be risk factors for septic arthritis. However, there is a paucity of data in the literature regarding the risk of septic arthritis in those patients with enteropathic arthritis.

Head, heart or checklist? How self-reported decision-making strategies change according to speciality and grade: a cross-sectional survey of doctors.

Purpose: To identify and analyse variations in self-reported decision-making strategies between medical professionals of different specialty and grade.

Study Design: We conducted a cross-sectional survey of doctors of different specialities and grades at St. George's Hospital, London, UK.

A comparison of the academic impact of plastic surgery units in the United Kingdom and Ireland using bibliometric analysis.

Academic output is just one aspect of a successful career as a plastic surgeon. However, for those with a strong interest in academia, the academic output of a department will likely be a key factor when deciding how to rank jobs. The aim of this study was to quantify and rank the academic output of plastic surgery units across the UK and Ireland.

Multispectral Optical Tweezers for Biochemical Fingerprinting of CD9-Positive Exosome Subpopulations.

Extracellular vesicles (EVs), including exosomes, are circulating nanoscale particles heavily implicated in cell signaling and can be isolated in vast numbers from human biofluids. Study of their molecular profiling and materials properties is currently underway for purposes of describing a variety of biological functions and diseases. However, the large, and as yet largely unquantified, variety of EV subpopulations differing in composition, size, and likely function necessitates characterization schemes capable of measuring single vesicles.

New signs to encourage the use of Automated External Defibrillators by the lay public.

Introduction: Public Access Defibrillation - the use of Automated External Defibrillators (AEDs) by lay bystanders before the arrival of Emergency Medical Services - is an important strategy in delivering prompt defibrillation to victims of out-of-hospital cardiac arrest and can greatly improve survival rates. Such public-access AEDs are used rarely: one barrier might be poor understanding and content of current signage to indicate their presence. The aim of this project was to develop a sign, with public consultation, that better indicated the function of an AED, and an associated poster to encourage its use.

Very Early Brain Damage Leads to Remodeling of the Working Memory System in Adulthood: A Combined fMRI/Tractography Study.

The human brain can adapt to overcome injury even years after an initial insult. One hypothesis states that early brain injury survivors, by taking advantage of critical periods of high plasticity during childhood, should recover more successfully than those who suffer injury later in life. This hypothesis has been challenged by recent studies showing worse cognitive outcome in individuals with early brain injury, compared with individuals with later brain injury, with working memory particularly affected.

Out-of-hospital cardiac arrest in schools: A systematic review.

Background: Out-of-hospital cardiac arrest (OHCA) in children and adolescents is rare, with a minority of cases occurring at school. When OHCA does occur at school it is more likely to affect an adult than a student. Developing comprehensive strategies to treat cardiac arrest occurring at schools would be helped by accurate data regarding its epidemiology.

Medication reconciliation: the priority that isn't.

Medication reconciliation is a crucial step in safe care, but it is often done inconsistently or inadequately, or missed altogether. This can be dangerous and even deadly for patients, and expensive for the system. In this article, the authors discuss the current status of medication reconciliation in Canada, barriers to its implementation and steps healthcare organizations across the country are taking to introduce medication reconciliation.