An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs.

Backgrounds & Aims: Primary biliary cholangitis (PBC) is a chronic liver disease in which autoimmune destruction of the small intrahepatic bile ducts eventually leads to cirrhosis. Many patients have inadequate response to licensed medications, motivating the search for novel therapies. Previous genome-wide association studies (GWAS) and meta-analyses (GWMA) of PBC have identified numerous risk loci for this condition, providing insight into its aetiology.

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).

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening.

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.

Myxedema Coma.

Myxedema may be the first presentation of patients with undiagnosed hypothyroidism. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. There is no consensus about preferred thyroid hormone regimen.

Atherogenic lipids and vascular complications in a selected diabetic population with normal urinary albumin/creatinine ratios.

Objective: To test the hypothesis that at different urinary albumin/creatinine ratios within the normal ranges, diabetics have low but similar prevalence of metabolic and micro vascular disease.

Methods: The study sample consisted of normotensive diabetics not taking any medications known to effect blood pressure and lipids. The data were collected from the Diabetes Register.

Predicting end-of-life in patients with an exacerbation of COPD by routine clinical assessment.

Unlabelled: The purpose of this study was to determine if routine clinical assessment could reliably predict in-hospital death in patients admitted with acute exacerbation of COPD (AECOPD).

Methods: In a case-crossover study the case records of AECOPD related deaths were reviewed. Clinical and laboratory variables including performance status (WHO-PS) and a composite physiological score (early warning score, EWS) at initial clinical assessment on final admission (FA) and penultimate admission (PA) for AECOPD were compared.

Minimizing the risk of infection in the operating department: a review for practice.

Much press speculation has projected the controversy of infection control amidst raised public concern over fatalities caused by nosocomial infections. Attention to detailed ultra-cleanliness can never be compromised in the preservation of life, health and wellbeing of the evermore discerning patient. Moreover, complacency to best practice and theatre etiquette potentially endangers a practitioner's own protection, and infringes their Code of Conduct substantiating possible professional disciplinary and/or legal action.

Caecal metastasis from breast cancer presenting as intestinal obstruction.

Background: Gastrointestinal metastsasis from the breast cancer are rare. We report a patient who presented with intestinal obstruction due to solitary caecal metastasis from infiltrating ductal carcinoma of breast. We also review the available literature briefly.

Patient perceptions of factors influencing adherence to medication following kidney transplant.

Research has shown that most patients with end-stage kidney failure prefer treatment by transplantation. This entails taking immunosuppressant drugs daily throughout the life of the kidney. Failure to do so causes transplant rejection and a return to dialysis, or sometimes even death.

Living with a kidney transplant: a qualitative investigation of quality of life.

Research has shown that transplantation improves quality of life for patients with end stage renal disease (ESRD), although it does not return to pre-kidney failure levels. This study used focus groups to explore the experience of living with a transplanted kidney. The data were analysed, using thematic analysis, and the following themes were identified: medicalization; fear; gratitude; and coping.

An unusual presentation of an idiopathic omental pseudocyst: a case report and literature review.

Background: Idiopathic omental pseudocysts occur very rarely in adults. Pseudocyst patients usually have a history of either trauma (e.g.

Metastatic prostate carcinoma presenting as supraclavicular lymphadenopathy - is it unusual?

Prostate carcinoma presenting initially as supraclavicular lymphadenopathy has been increasingly reported as an uncommon presentation of the disease. The diagnosis is often made on lymph node biopsy as these patients rarely undergo digital rectal examination or serum prostate-specific antigen level measurement as part of their initial investigations. A 74-year-old man presented with supraclavicular lymphadenopathy and subsequently deteriorated with severe shortness of breath associated with venous congestion of the head and neck.

An audit of advice on fitness to drive during accident and emergency department attendance.

Introduction: Large numbers of patients attending accident and emergency (A&E) departments drive to and from the consultation. This audit set out to examine if patients attending A&E were advised about their fitness to drive.

Method: The authors carried out a retrospective audit over a one month period.

Tranilast reduces mesenteric vascular collagen deposition and chymase-positive mast cells in experimental diabetes.

The mast cell has a central role in the pathogenesis of fibrosis a common feature of diabetic microvascular complications. Increased mast cell numbers have been demonstrated in diabetic nephropathy in association with renal fibrosis, and diabetes acutely increases mast cell infiltration in the mesentery. Antimast cell agents such as tranilast may ameliorate the acute vascular changes in diabetes due to stabilisation of mast cells and/or reduction in mast cell numbers.

Assessing patients' nutritional needs in the wound-healing process.

Like all illnesses, successful wound management depends on appropriate nutritional support. This article outlines which nutrients are relevant to the various stages of wound healing and discusses the consequences of poor nutrition.