Sex hormone-binding globulin, testosterone and type 2 diabetes risk in middle-aged African women: exploring the impact of HIV and menopause.

Objectives: Sex hormone-binding globulin (SHBG) and testosterone are differentially associated with type 2 diabetes (T2D) risk. We investigated whether these associations differ by HIV and menopausal status in Black South African women living with (WLWH) and without HIV (WLWOH).

Design: Cross-sectional observational.

Increased risk for type 2 diabetes in relation to adiposity in middle-aged Black South African men compared to women.

Aims: Despite a higher prevalence of overweight/obesity in Black South African women compared to men, the prevalence of type 2 diabetes (T2D) does not differ. We explored if this could be due to sex differences in insulin sensitivity, clearance and/or beta-cell function and also sex-specific associations with total and regional adiposity.

Methods: This cross-sectional study included 804 Black South African men (n = 388) and women (n = 416).

Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis.

Objective: To evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.

Design: Systematic review and meta-analysis.

Methods: Searching MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Clinical Trials Registry Platform, Health Technology Assessment, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index and Clinical Trials Register, from March 1999 to July 2018, we identified randomised controlled trials (RCTs) of drugs for hypertension, lipid modification, glycaemic control and sodium bicarbonate, compared with placebo, no drug or a drug from another class, in ≥40 adults with CKD stages 3 and/or 4, with at least 2 years of follow-up and reporting renal function (primary outcome), proteinuria, adverse events, maintenance dialysis, transplantation, cardiovascular events, cardiovascular mortality or all-cause mortality.

Risk of infection associated with intravenous iron preparations: protocol for updating a systematic review.

Introduction: The benefits and risk of intravenous iron have been documented in previous systematic reviews and continue to be the subject of randomised controlled trials (RCTs). An ongoing issue that continues to be raised is the relationship between administering iron and developing infection. This is supported by biological plausibility from animal models.

Multicenter Reproducibility of 18F-Fluciclatide PET Imaging in Subjects with Solid Tumors.

Unlabelled: Integrins are upregulated on both tumor cells and associated vasculature, where they play an important role in angiogenesis and metastasis. Fluciclatide is an arginine-glycine-aspartic acid peptide with high affinity for αvβ3/αvβ5 integrin, which can be radiolabeled for PET imaging of angiogenesis. Thus, (18)F-fluciclatide is a potential biomarker of therapeutic response to antiangiogenic inhibitors.

Dystonia.

Introduction: Dystonia is usually a lifelong condition with persistent pain and disability. Focal dystonia affects a single part of the body; generalised dystonia can affect most or all of the body. It is more common in women, and some types of dystonia are more common in people of Ashkenazi descent.

What is the extent of the advantage of video-assisted thoracoscopic surgical resection over thoracotomy in terms of delivery of adjuvant chemotherapy following non-small-cell lung cancer resection?

Objectives: Video-assisted thoracoscopic surgery (VATS) lobectomy for early stage non-small cell lung cancer (NSCLC) is a safe and effective alternative to open lobectomy. Adjuvant chemotherapy is part of the treatment recommended for patients with performance status (PS) 0-1 following resection of NSCLC of stages T1-3 N1-2 M0 and T2-3 N0 M0. If VATS reduces morbidity, does it help delivery of postoperative chemotherapy? We studied our data to compare the delivery and toxicity of chemotherapy in patients following VATS or open lung resections.

The Spectrum of Children's Palliative Care Needs: a classification framework for children with life-limiting or life-threatening conditions.

Objectives: This paper examined the potential of a new classification framework, The Spectrum of Children's Palliative Care Needs, to facilitate identification of children with palliative care needs for the purposes of minimum data set collection and population needs assessment.

Methods: Health and social care professionals (n=50) in a range of paediatric palliative care settings applied The Spectrum to (i) clinical vignettes and (ii) consecutive children on their caseloads. They also provided confidence ratings and written comments about their experiences.

Dystonia.

Introduction: Dystonia is usually a lifelong condition with persistent pain and disability. Focal dystonia affects a single part of the body; generalised dystonia can affect most or all of the body. It is more common in women, and some types of dystonia are more common in people of European Ashkenazi Jewish descent.

A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time.

Introduction: Fresh frozen plasma (FFP) is widely used, but few studies have described patterns of plasma use in critical care. We carried out a multicentre study of coagulopathy in intensive care units (ICUs) and here describe overall FFP utilisation in adult critical care, the indications for transfusions, factors indicating the doses used and the effects of FFP use on coagulation.

Methods: We conducted a prospective, multicentre, observational study of all patients sequentially admitted to 29 adult UK general ICUs over 8 weeks.

Reappraising the concept of massive transfusion in trauma.

Introduction: The massive-transfusion concept was introduced to recognize the dilutional complications resulting from large volumes of packed red blood cells (PRBCs). Definitions of massive transfusion vary and lack supporting clinical evidence. Damage-control resuscitation regimens of modern trauma care are targeted to the early correction of acute traumatic coagulopathy.

The use of fresh-frozen plasma in England: high levels of inappropriate use in adults and children.

Background: Fresh-frozen plasma (FFP) is given to patients across a range of clinical settings, frequently in association with abnormalities of standard coagulation tests.

Study Design And Methods: A UK-wide study of FFP transfusion practice was undertaken to characterize the current patterns of administration and to evaluate the contribution of pretransfusion coagulation tests.

Results: A total of 4969 FFP transfusions given to patients in 190 hospitals were analyzed, of which 93.

Do all patients with hematologic malignancies and severe thrombocytopenia need prophylactic platelet transfusions? Background, rationale, and design of a clinical trial (trial of platelet prophylaxis) to assess the effectiveness of prophylactic platelet transfusions.

Although considerable advances have been made in many aspects of platelet transfusion therapy in the last 30 years, some areas continue to provoke debate, including the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding in patients with bone marrow failure. We have designed a randomized controlled trial to compare prophylactic platelet use with a threshold of a platelet count of 10 x 10(9)/L with no prophylaxis in adult thrombocytopenic patients with hematologic malignancies. The trial question is whether a no-prophylactic policy for the use of platelet transfusions in patients with hematologic malignancies is not inferior to a threshold prophylactic policy at 10 x 10(9)/L, for bleeding at World Health Organization (WHO) grade 2, 3, or 4, up to 30 days from randomization.

Autoreactivity to bullous pemphigoid 180: is this the link between subepidermal blistering diseases and oral lichen planus?

Subepidermal blistering diseases are antibody-mediated diseases. The antigens differ between disease type, but bullous pemphigoid (BP)180 (collagen XVII) is a common finding in several clinical conditions. We report four patients with autoimmune blistering disease [linear Ig A disease (n=2), bullous pemphigoid (n=1), and epidermolysis bullosa acquisita (n=1)], all of whom also developed oral lichen planus (LP).

The microbiology of chronic osteomyelitis: prevalence of resistance to common empirical anti-microbial regimens.

Objectives: This study describes the microbiological spectrum of chronic osteomyelitis and so guides the choice of empirical antibiotics for this condition.

Methods: We performed a prospective review of a 166 prospective patient series of chronic osteomyelitis from Oxford, UK in which a standardised surgical sampling protocol was used.

Results: Staphylococcus aureus was most commonly isolated (32%) amongst a wide range of organisms including gram negative bacilli, anaerobes and coagulase negative staphylococci.

Biloma: an unusual complication in a patient with pancreatic cancer.

The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic (secondary to hepatobiliary surgery), trauma or complications due to choledocholithiasis. A few cases have been reported as complications of cholangiocarcinoma or acute cholecystitis.

A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting.

Background: The Hand Hygiene Liaison Group and Epic Projects (Pratt et al., J Hosp Infect 47[Suppl A], 2001) have asked specifically for further trials of educational interventions to improve hand decontamination compliance and infection control in the hospital setting. This study investigates the efficacy of a 'clean practice protocol' (CPP), derived from international guidelines, to improve compliance of infection-control practices by surgical teams in a large UK teaching hospital.

Human chorionic gonadotropin-secreting clear cell renal cell carcinoma with paraneoplastic gynaecomastia.

A 60-year-man presented with painful gynaecomastia and polycythaemia due to a beta-human chorionic gonadotropin (HCG)-secreting clear cell renal cell carcinoma. A computed tomographic scan of his chest, abdomen and pelvis showed an enhancing 9x9 cm mass in the right kidney suggestive of a renal cell carcinoma. He underwent right radical nephrectomy and the histology showed a clear cell renal cell carcinoma.

The role of superficial venous surgery in the management of venous ulcers: a systematic review.

Background: The complicated natural history of venous ulcers requires the continued development and improvement of treatments to ensure the most effective management. Compression therapy or surgical correction of superficial venous incompetence (SVI) are currently the main methods employed for the treatment for venous ulceration (VU). This review compares and summates the healing and recurrence rates for each treatment modality used over the last thirty years.

Occupational exposure to static and time-varying gradient magnetic fields in MR units.

Purpose: To assess exposure of MR staff to static and time-varying gradient magnetic fields by direct measurement and questionnaire and to compare these to the action values and exposure limits stated in published guidance.

Materials And Methods: Instantaneous and time-averaged exposure to static magnetic fields were measured on clinical and research MR scanners. A questionnaire was sent to 100 clinical MR centers to estimate the average static field exposure.

A need for a simplified approach to venous thromboembolism prophylaxis in acute medical inpatients.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the UK. Studies have shown that pulmonary embolism causes or contributes to approximately 1 in 10 hospital deaths of medical patients admitted to general hospitals in the UK (Lindblad B, Sternby NH, Bergqvist D. BMJ 1991; 302: 709-11), with pulmonary embolus being the most common preventable cause of hospital death.

Child survival: district hospitals and paediatricians.

In a previous article in this series, Zulfiquar Bhutta outlined many of the key sociopolitical issues, both national and international, that currently affect the delivery of health care to children in developing countries. The clear summary of our situation is that we are failing to provide even basic health care (both preventive and curative) that could reduce child mortality globally by more than half. Paediatricians, who have perhaps in the past felt they were at the forefront of articulating and promoting a global health agenda, should be challenged by these conclusions.

Delayed versus immediate exercises following surgery for breast cancer: a systematic review.

Background: Seroma formation, wound healing and fluid drainage are a concern for both surgeons and patients. Excessive fluid production can result in seroma formation, and inadequate drainage of seromas is known to cause infection, pain, discomfort and longer periods of hospitalisation. Postoperative exercises given to maintain movement of the arm are believed to increase the amount of fluid production following surgery.