The ethylene oxide sterilised Opera acetabular component demonstrates high rates of loosening and revision compared to the gamma irradiated Ogee cup: a cohort study demonstrating potential shortcomings of revision-based registry data.

Aims: To evaluate the long-term clinical outcomes of 2 cemented ultra-high molecular weight polyethylene (UHMWPE) acetabular components, with the main difference between the 2 components being their method of sterilisation.

Patients And Methods: Data was collected prospectively on 352 consecutive total hip replacements, performed between March 2000 and July 2004, at a single centre. A posterior approach was used with a cemented C-Stem femoral component (DePuy, Warsaw, IN, USA) in all cases and either the Ogee (DePuy, Warsaw, IN, USA) or the Opera (Smith & Nephew, Memphis, TN, USA) acetabular implant.

The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: a multicentre retrospective cohort study.

Objectives: This study aims to evaluate the risk of postoperative mortality in octogenarians undergoing emergency laparotomy.

Methods: In compliance with STROCSS guideline for observational studies, we conducted a multicentre retrospective cohort study. All consecutive patients aged over 80 with acute abdominal pathology requiring emergency laparotomy between April 2014 and August 2019 were considered eligible for inclusion.

Alterations in T and B cell function persist in convalescent COVID-19 patients.

Background: Emerging studies indicate that some coronavirus disease 2019 (COVID-19) patients suffer from persistent symptoms, including breathlessness and chronic fatigue; however, the long-term immune response in these patients presently remains ill-defined.

Methods: Here, we describe the phenotypic and functional characteristics of B and T cells in hospitalized COVID-19 patients during acute disease and at 3-6 months of convalescence.

Findings: We report that the alterations in B cell subsets observed in acute COVID-19 patients were largely recovered in convalescent patients.

Self-Reported Real-World Safety and Reactogenicity of COVID-19 Vaccines: A Vaccine Recipient Survey.

An online survey was conducted to compare the safety, tolerability and reactogenicity of available COVID-19 vaccines in different recipient groups. This survey was launched in February 2021 and ran for 11 days. Recipients of a first COVID-19 vaccine dose ≥7 days prior to survey completion were eligible.

Assessment of serum calcium in -patients referred for suspected lung cancer: A quality -improvement project to enhance patient safety in clinical practice.

Background: Hypercalcaemia is a serious complication of lung cancer. A quality improvement project (QIP) was designed based on guidance from the American College of Chest Physician and the European Respiratory Society who recommend measuring serum calcium for patients referred with suspected lung cancer.

Method: Seventy-two patients were included in the initial data to ascertain the delay between referral to the lung cancer pathway and obtaining serum calcium levels as part of the initial work-up.

Hepatitis C standards of care: A review of good practices since the advent of direct-acting antiviral therapy.

Significant steps must be taken to reduce the global incidence and prevalence of hepatitis C virus (HCV) and mortality from HCV infection to achieve the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Proper epidemiological surveillance of the full continuum of care is essential for monitoring progress and identifying gaps that need to be addressed. The tools required for elimination have largely been established, and the issue at hand is more how they should best be implemented in different settings around the world.

Microvascular anastomotic coupler devices versus hand-sewn technique for arterial anastomosis: a systematic review.

The use of microvascular anastomotic coupling devices (MACD) is an established technique for venous anastomosis. However, literature on arterial MACD is conflicting. We report, to our knowledge, the first registered systematic review of its kind to evaluate the safety and efficiency of arterial MACD in free flaps.

X Chromosome Contribution to the Genetic Architecture of Primary Biliary Cholangitis.

Background & Aims: Genome-wide association studies in primary biliary cholangitis (PBC) have failed to find X chromosome (chrX) variants associated with the disease. Here, we specifically explore the chrX contribution to PBC, a sexually dimorphic complex autoimmune disease.

Methods: We performed a chrX-wide association study, including genotype data from 5 genome-wide association studies (from Italy, United Kingdom, Canada, China, and Japan; 5244 case patients and 11,875 control individuals).

Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia.

Background: Coronavirus disease 2019 (Covid-19) is associated with immune dysregulation and hyperinflammation, including elevated interleukin-6 levels. The use of tocilizumab, a monoclonal antibody against the interleukin-6 receptor, has resulted in better outcomes in patients with severe Covid-19 pneumonia in case reports and retrospective observational cohort studies. Data are needed from randomized, placebo-controlled trials.

Meta-analysis and trial sequential analysis of three-port vs four-port laparoscopic cholecystectomy (level 1 evidence).

To compare the outcomes of three-port and four-port laparoscopic cholecystectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port vs four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model.

Introducing the FATLIPS acronym for assessing the red flag clinical features of dental infection.

Introduction Dental infection can progress to life-threatening cervicofacial and deep space infections. Therefore, safe management requires early identification of serious infections in primary care with appropriate referral to secondary care. We have developed an acronym to aid assessment of the red flag clinical features for serious dental infection in primary care by general dental practitioners.

Gallstone Ileus: Uncommon Presentation Followed by Less Common Spontaneous Resolution.

Gallstone ileus is a rare but significant cause of bowel obstruction. An 82-year-old female was admitted to the hospital with abdominal pain and was initially treated for a possible urinary tract infection. Following a surgical review and based on history, clinical examination as well as radiological findings, a diagnosis of gallstone ileus was made.

Intraperitoneal contamination index (Hajibandeh index) predicts nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology: a prospective multicentre cohort study.

Objectives: To assess whether intraperitoneal contamination index (ICI) (Hajibandeh index) derived from combined levels of CRP, lactate, neutrophils, lymphocytes, and albumin can predict the nature of intraperitoneal contamination in patients with acute abdominal pathology and to assess whether ICI can predict postoperative mortality in patients undergoing emergency laparotomy.

Methods: In order to prospectively validate the ICI, developed and validated retrospectively in our previous study, a multicentre prospective cohort study was conducted between January 2019 and June 2020 including all adult patients who presented with acute abdominal pathology requiring emergency laparotomy. ROC curve analysis was performed to determine discrimination and cut-off values of preoperative ICI that could predict the nature of intraperitoneal contamination and postoperative mortality.

Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study.

Background: While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens.

Methods: Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines.

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score.

Objectives: To devise an assessment tool to aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities, and thereby improve the quality of care that patients receive, using a clinical prediction modelling approach.

Design: Observational cohort study with internal and external validation of a predictive tool.

Setting: Two general emergency departments (EDs) and an urgent care centre in the North of England.

Renal myopericytoma: A case report and literature review.

Renal myopericytoma is an extremely rare entity with just 11 cases reported in the literature. We report the case of a 57 year old Caucasian man who was found to have a renal myopericytoma following nephrectomy for suspected renal cell carcinoma. Renal myopericytoma has a distinct morphological overlap with other pericytic tumours and significant histological variation has been noted between cases reported to date.

Difficult airways: a 3D printing study with virtual fibreoptic endoscopy.

Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management.

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria.

Background: Cerebral malaria is a common presentation of severe Plasmodium falciparum infection and remains an important cause of death in the tropics. Key aspects of its pathogenesis are still incompletely understood, but severe brain swelling identified by magnetic resonance imaging (MRI) was associated with a fatal outcome in African children. In contrast, neuroimaging investigations failed to identify cerebral features associated with fatality in Asian adults.

Poorly differentiated mucoepidermoid carcinoma of the thyroid.

Mucoepidermoid carcinomas (MECs) are the most common malignant tumour of the salivary glands. MECs have also been reported to occur in atypical sites. Primary MECs of the thyroid gland are extremely rare, accounting for 0.

Tuberculous mastoiditis in a 2-month-old infant presenting with facial nerve palsy.

We present a rare case of tuberculous mastoiditis in a 2-month-old infant. The patient presented with facial nerve palsy, fever and otorrhoea and was subsequently confirmed to have a infection. Mastoiditis was confirmed with a CT scan of the head, and gastric aspirate analysis with the Xpert MTB/RIF assay (Cepheid, USA) rapidly confirmed tuberculosis (TB), allowing prompt initiation of anti-TB therapy.

'Where have all the doctors gone?' A protocol for an ethnographic study of the retention problem in emergency medicine in the UK.

Introduction: 'Emergency medicine (EM) in the UK has a medical staffing crisis.' Inadequate staffing, in EM and across healthcare, is a problem that affects the quality of patient care globally. Retention of doctors in EM is a particularly acute problem in the UK's National Health Service.

Treatment of fragility ankle fractures using hindfoot nail, systemic review.

With an aging population, the prevalence of fragility ankle fractures is rising. The surgical management of these injuries is challenging and associated with high rates of complications. An extensive literature review (inception of data until September 2019) was undertaken to locate previous studies that have addressed the same topic.

Use of the subclavian vessels for microvascular reconstruction in the vessel-depleted neck.

The previously treated neck is a serious problem if further free tissue transfer reconstruction is required. Vessel depletion is often a terrifying finding that creates the need for novel approaches to access vessels that lie outside the anatomical region of the head and neck. We present what is, to our knowledge, the first case of utilising the subclavian artery and vein in head and neck reconstruction.