Diagnostic application of the ColonFlag AI tool in combination with faecal immunochemical test in patients on an urgent lower gastrointestinal cancer pathway.

Objective: Colorectal cancer (CRC) is the fourth most common cancer in the UK. Patients with symptoms suggestive of CRC should be referred for urgent investigation. However, gastrointestinal symptoms are often non-specific and there is a need for suitable triage tools to enable prioritisation of investigations.

Evaluation of an ambulatory care pathway for patients with nitrous oxide-induced myeloneuropathy.

Introduction: Cases of nitrous oxide (NO)-induced myeloneuropathy are increasing at UK hospitals. At our centre, a dedicated ambulatory care pathway, endorsed nationally, was established to treat and monitor patients with NO-myeloneuropathy in 2021 and refined through three audit cycles. We analysed the outcomes of patients on this pathway to better understand factors associated with non-engagement.

Fecal Calprotectin in Gastrointestinal Disease.

Background: Inflammatory bowel disease (IBD) comprises a group of chronic conditions characterized by relapsing and remitting inflammation of the gastrointestinal tract. The incidence is increasing worldwide, and the therapeutic options for management are expanding. Endoscopy is the gold standard investigation for diagnosis of IBD and for assessing mucosal healing, which is increasingly being used as a measure of disease control.

Faecal immunochemical testing (FIT) in primary care: a follow-up service evaluation.

Aim: Colorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute for Health and Care Excellence guidance for faecal immunochemical testing (FIT), we introduced a service for the measurement of faecal haemoglobin (f-Hb) in symptomatic patients. Previously, we evaluated the first 6 months of the service in three local boroughs, here we re-examine the use of FIT, over a similar 6 months in the two successive years.

Faecal immunochemical testing for haemoglobin in detecting bowel polyps in symptomatic patients: multicentre prospective cohort study.

Background: Measurement of faecal haemoglobin using faecal immunochemistry testing is recommended in patients presenting with symptoms suspicious for colorectal cancer, to aid in triage and prioritization of definitive investigations. While its role in colorectal cancer has been extensively investigated, the ability of faecal immunochemistry testing to detect adenomas in symptomatic patients is unclear.

Methods: A multicentre prospective observational study was conducted between April 2017 and March 2019, recruiting adults from 24 hospitals across England and 59 general practices in London who had been urgently referred with suspected colorectal cancer symptoms.

Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment.

Recreational use of nitrous oxide (NO) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (NO-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated.

Clinical evaluation of the OC-Sensor Pledia calprotectin assay.

Objectives: Faecal calprotectin (f-Cal) and faecal haemoglobin (f-Hb) are important tests for evaluation of gastrointestinal disease. Samples for measurement of f-Hb are taken by the patient directly into a specimen collection device containing stabilising buffer, which can be placed directly onto the analyser in the laboratory. Samples for f-Cal are usually sent in screw top pots and often require time-consuming extraction procedures prior to analysis.

Faecal calprotectin is not necessarily required as a screen for significant bowel disease in primary care.

Objective: NICE recommends measurement of faecal haemoglobin (f-Hb) using faecal immunochemical test (FIT) when colorectal cancer is suspected and calprotectin (f-Cal) in the context of inflammatory bowel disease, though neither is disease specific. During the COVID-19 pandemic, f-Hb has been a requirement prior to referral for endoscopy in England; f-Cal is often performed simultaneously. The aim of this study was to investigate test performance of both tests for significant bowel disease in those patients referred.

Faecal immunochemical test for patients with 'high-risk' bowel symptoms: a large prospective cohort study and updated literature review.

Background: We evaluated whether faecal immunochemical testing (FIT) can rule out colorectal cancer (CRC) among patients presenting with 'high-risk' symptoms requiring definitive investigation.

Methods: Three thousand five hundred and ninety-six symptomatic patients referred to the standard urgent CRC pathway were recruited in a multi-centre observational study. They completed FIT in addition to standard investigations.

Use of ColonFlag score for prioritisation of endoscopy in colorectal cancer.

Objective: Colorectal cancer (CRC) is the fourth most common cancer in UK. Symptomatic patients are referred via an urgent pathway and although most are investigated with colonoscopy <4% are diagnosed with cancer. There is therefore a need for a suitable triage tool to prioritise investigations.

Use of faecal immunochemical testing as an alternative to faecal calprotectin in children.

Background: Faecal calprotectin has been widely used as a non-invasive marker of intestinal inflammation in children. Measurement of faecal haemoglobin using faecal immunochemical test is well established in adults for detection of colorectal cancer. In adults, faecal haemoglobin has been recommended as a reliable tool to aid identification of those at low risk of significant bowel disease and has also been used in inflammatory bowel disease to assess mucosal healing.

Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer.

Aims: Colorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.

Relationship between faecal metronidazole and lactoferrin concentrations to clinical response of patients with Clostridioides difficile.

Objectives: We investigated patients with Clostridioides difficile-associated diarrhoea to see if clinical resolution correlated with faecal concentrations of metronidazole or markers of inflammation.

Methods: Faecal metronidazole, lactoferrin and serum CRP were measured daily. These were then compared with clinical progress.

Potential roles of artificial intelligence learning and faecal immunochemical testing for prioritisation of colonoscopy in anaemia.

Iron deficiency anaemia (IDA) is the most common cause of anaemia and a frequent indication for colonoscopy, although the prevalence of colorectal cancer (CRC) in IDA is low. Measurement of faecal haemoglobin by immunochemical techniques (FIT) is used to detect symptomatic patients. We studied FIT in patients with anaemia attending a gastroenterology clinic in Plymouth and looked at an artificial intelligence (AI) learning algorithm (ColonFlag™) in these patients, together with a cohort who had undergone colonoscopy for IDA in London.

Fecal Calprotectin.

Calprotectin is a 36kDa member of the S100 family of proteins. It is derived predominantly from neutrophils and has direct antimicrobial effects and a role within the innate immune response. Calprotectin is found in various body fluids in proportion to the degree of any existing inflammation and its concentration in feces is about six times that of plasma.

Multiple myeloma and acquired von Willebrand disease: a combined cause of preanalytical interference causing gel formation?

We report a patient with acquired von Willebrand disease, associated with multiple myeloma. At one stage in his illness, we were unable to analyse a sample sent in a serum separator tube, due to the presence of a gel within the separated serum layer. We suggest this was due to anomalous position of the gel because of the density of the sample caused by its high total protein concentration, exacerbated by fibrin strand formation because of inhibition of appropriate fibrin clot formation secondary to clotting disorder.

Development and validation of a liquid chromatography tandem mass spectrometry assay for the measurement of faecal metronidazole.

Background: Metronidazole is an oral antibiotic which is widely used in the treatment of patients with Clostridium difficile associated disease.

Methods: This article describes the validation of a LC-MS/MS assay for the measurement of metronidazole in human faecal samples.

Results: Matrix matched and aqueous standards showed no significant difference in performance for the routine calibration of the assay.

Faecal calprotectin as a marker for oesophago-gastric cancer.

Background: Faecal calprotectin has been shown to be useful as a non-invasive screening test to differentiate functional from organic bowel disease, and it has been noted to be elevated in colorectal cancer. The aim of this study was to describe concentrations of faecal calprotectin in patients with oesophago-gastric cancer and investigate any potential discriminatory power of the test.

Patients: Faecal calprotectin was measured in samples from 39 patients with known oesophago-gastric cancer and in 191 samples from control subjects.

Appropriateness of prescribing thyroxine in primary care.

Introduction: A practice hypothyroid register is part of the quality and outcomes framework. In literature, the prevalence of hypothyroidism is stated to be 2% but the prevalence, defined from quality and outcomes framework data, is 3.2% in the UK and 3.

Factors affecting blood sample haemolysis: a cross-sectional study.

Objective: To determine the effect of blood sampling through an intravenous catheter compared with a needle in Emergency Department blood sampling.

Methods: We undertook a prospective, cross-sectional study in a UK university teaching hospital Emergency Department. A convenience sample of 985 patients who required blood sampling via venepuncture was collected.

An immunoglobulin G complexed form of thyroid-stimulating hormone (macro thyroid-stimulating hormone) is a cause of elevated serum thyroid-stimulating hormone concentration.

Background: Macrocomplexes can be the cause of elevated serum hormone concentrations and may cause diagnostic confusion. This is well recognized for prolactin and commonly screened for using polyethylene glycol (PEG) precipitation. The phenomenon and a suitable screening method is less familiar with respect to thyroid-stimulating hormone (TSH).

New faecal tests in gastroenterology.

Most abdominal disorders present with a limited number of overlapping symptoms. Blood tests are not routinely available for use in diagnosis and so investigation tends to require complex imaging procedures or endoscopy and biopsy. These are invasive for the patient, may be associated with morbidity and mortality and have considerable resource implications.

Physiological consequences of military high-speed boat transits.

The purpose of this study was to investigate the consequences of a high-speed boat transit on physical performance. Twenty-four Royal Marines were randomly assigned to a control (CON) or transit (TRAN) group. The CON group sat onshore for 3 h whilst the TRAN group completed a 3-h transit in open-boats running side-by-side, at 40 knots in moderate-to-rough seas, with boat deck and seat-pan acceleration recorded.

An IgG complexed form of vitamin B12 is a common cause of elevated serum concentrations.

Objectives: To report detailed investigations in a case of elevated serum B(12) due to the presence of an IgG-B(12) complex, to determine the prevalence of this phenomenon and to review the literature.

Design And Methods: 431 samples with elevated B(12) (median 1250 ng/L, range 901-114,480 ng/L) were treated with polyethylene glycol to precipitate immunoglobulin complexes. Samples with >50% of precipitable B(12) (PPB(12)) were further investigated by protein G adsorption, gel filtration chromatography and measurement of B(12) on different analytical platforms.

Age-related faecal calprotectin, lactoferrin and tumour M2-PK concentrations in healthy volunteers.

Objective: Measurement of the faecal markers calprotectin, lactoferrin and tumour M2-PK has been reported to be useful in the diagnosis and management of a range of gastrointestinal disorders in both children and adults. The aim of this study was to investigate the requirement for age-related reference ranges.

Methods: Faecal samples were obtained from 132 healthy subjects and analysis of calprotectin, lactoferrin and tumour M2-PK performed using commercially available enzyme-linked immunosorbent assay.