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Discussion ACA is a cutaneous manifestation of late Lyme disease, caused by chronic infection with I Borrelia burgdorferi i , most commonly the I Borrelia afzelii i subspecies.1 The tick-bite infection precedes the rash by months to years. We report the case of a 75-year-old woman presenting with acrodermatitis chronica atrophicans affecting the right hand dorsum, developing after an insect bite sustained in Greece. Learning points ACA is a cutaneous manifestation of late Lyme disease, with the tick-bite infection occurring months to years previously. [Extracted from the article]

Summary: A weekly teledermatology intradisciplinary team (IDT) meeting, attended by consultant dermatologists and dermatology trainees, was established at our centre in July 2020 to help with the diagnosis and management of challenging 2‐week‐wait skin cancer teledermatology cases. To assess the usefulness of the meeting, an electronic survey of attendees (consultants n = 7; trainees n = 4) was performed 6 months after introduction. The results showed that 71.4% of consultants and 100% of trainees felt the IDT meeting improved their confidence in assessing dermoscopic photographs and in managing patients via teledermatology; 100% of attendees considered the meeting would improve patient safety; and 85.7% of consultants and 100% of trainees found the meeting contributed to their professional development, demonstrating its educational value. A retrospective analysis of patient outcomes before and after implementation of the IDT meeting demonstrated an increase in the direct discharge rate from 44.7% to 56.3% and a reduction in biopsy rate from 39.6% to 30.2% (n = 400; P = 0.02). The teledermatology IDT meeting is a model that could be introduced at other centres to support clinician confidence in teledermatology, and to help with clinical decision‐making and teledermatology training. [ABSTRACT FROM AUTHOR]

We present a new, multimission catalogue of ultraluminous X-ray source (ULX) candidates, based on recent data releases from each of the XMM–Newton, Swift , and Chandra observatories (the 4XMM-DR10, 2SXPS, and CSC2 catalogues, respectively). This has been compiled by cross-correlating each of these X-ray archives with a large sample of galaxies primarily drawn from the HyperLEDA archive. Significant efforts have been made to clean the sample of known non-ULX contaminants (e.g. foreground stars, background active galactic nuclei, supernovae), and also to identify ULX candidates that are common to the different X-ray catalogues utilized, allowing us to produce a combined 'master' list of unique sources. Our sample contains 1843 ULX candidates associated with 951 different host galaxies, making it the largest ULX catalogue compiled to date. Of these, 689 sources are catalogued as ULX candidates for the first time. Our primary motivation is to identify new sources of interest for detailed follow-up studies, and within our catalogue we have already found one new extreme ULX candidate that has high S/N data in the archive: NGC 3044 ULX1. This source has a peak luminosity of L X,peak ∼ 1040 erg s−1, and the XMM–Newton spectrum of the source while at this peak flux is very similar to other, better-studied extreme ULXs that are now understood to be local examples of super-Eddington accretion. This likely indicates that NGC 3044 ULX1 is another source accreting at super-Eddington rates. We expect that this catalogue will be a valuable resource for planning future observations of ULXs – both with our current and future X-ray facilities – to further improve our understanding of this enigmatic population. [ABSTRACT FROM AUTHOR]

Background Diagnostic methods for Covid-19 have improved, both in speed and availability. Because of atypical and asymptomatic carriage of the virus and nosocomial spread within institutions, timely diagnosis remains a challenge. Machine learning models trained on blood test results have shown promise in identifying cases of Covid-19. Aims To train and validate a machine learning model capable of differentiating Covid-19 positive from negative patients using routine blood tests and assess the model's accuracy against atypical and asymptomatic presentations. Design and methods We conducted a retrospective analysis of medical admissions to our institution during March and April 2020. Participants were categorized into Covid-19 positive or negative groups based on clinical, radiological features or nasopharyngeal swab. A machine learning model was trained on laboratory parameters and validated for accuracy, sensitivity and specificity and externally validated at an unconnected establishment. Results An Ensemble Bagged Tree model was trained on data collected from 405 patients (212 Covid-19 positive) producing an accuracy of 81.79% (95% confidence interval (CI) 77.53–85.55%), the sensitivity of 85.85% (CI 80.42–90.24%) and specificity of 76.65% (CI 69.49–82.84%). Accuracy was preserved for atypical and asymptomatic subgroups. Using an external data set for 226 patients (141 Covid-19 positive) accuracy of 76.82% (CI 70.87–82.08%), sensitivity of 78.38% (CI 70.87–84.72%) and specificity of 74.12% (CI 63.48–83.01%) was achieved. Conclusion A machine learning model using routine laboratory parameters can detect atypical and asymptomatic presentations of Covid-19 and might be an adjunct to existing screening measures. [ABSTRACT FROM AUTHOR]

Summary: Background: Children aged ≥ 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16‐week, randomized, placebo‐controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)‐4/IL‐13 signalling, significantly improved signs and symptoms with acceptable safety; longer‐term safety and efficacy data are lacking. Objectives: To report the pharmacokinetic profile and long‐term safety and efficacy of dupilumab in children (aged ≥ 6 to < 12 years) with severe AD. Methods: Children (aged ≥ 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study and subsequent open‐label extension (OLE) study. Patients received single‐dose dupilumab 2 or 4 mg kg−1 followed by 8‐week pharmacokinetic sampling, then 2 or 4 mg kg−1 weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration–time profile and treatment‐emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP‐NRS) score. Results: Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target‐mediated pharmacokinetics characterized dupilumab concentrations (week 24–48 mean serum concentrations: 2 mg kg−1, 61–77 mg L−1; 4 mg kg−1, 143–181 mg L−1). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg−1, 47%; 4 mg kg−1, 56%) and AD exacerbation (29% and 13%, respectively). Single‐dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP‐NRS improved by −37%/−33% and −17%/−20% at week 2 (phase IIa) and −92%/−84% and −70%/−58% at week 52 (OLE), respectively. Conclusions: These safety and efficacy results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. What is already known about this topic?Severe atopic dermatitis (AD) has a marked negative impact on patient quality of life and can cause financial burden owing to a lack of effective treatments.Dupilumab significantly improved signs and symptoms of AD with an acceptable safety profile in a 16‐week randomized, double‐blind, placebo‐controlled phase III study in children aged ≥ 6 to < 12 years with severe AD. What does this study add?This study extends information on the safety, efficacy and pharmacokinetic profile of dupilumab treatment for up to 52 weeks in children aged ≥ 6 to < 12 years with severe AD.The results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. Linked Comment: Sibbald. Br J Dermatol 2021; 184:792–793. [ABSTRACT FROM AUTHOR]

One of the few positive outcomes of the COVID-19 pandemic has been an unprecedented flexibility and willingness to embrace innovation in the delivery of healthcare services in the UK National Health Service (NHS). PHRs are already in use in some areas of the NHS and present a significant opportunity to help digitize the NHS, empower patients to self-manage their disease and support remote consultations and PIFU pathways. Implementation of PIFU is one of the NHS outpatient transformation requirements laid out in the 2021/22 Operational Planning Guidance,4 and has a key role in phase 3 of the NHS response to the COVID-19 pandemic.5 Dermatology has been earmarked as one of the specialties particularly amenable to PIFU pathways. [Extracted from the article]

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Motivation Non-coding rare variants (RVs) may contribute to Mendelian disorders but have been challenging to study due to small sample sizes, genetic heterogeneity and uncertainty about relevant non-coding features. Previous studies identified RVs associated with expression outliers, but varying outlier definitions were employed and no comprehensive open-source software was developed. Results We developed Outlier-RV Enrichment (ORE) to identify biologically-meaningful non-coding RVs. We implemented ORE combining whole-genome sequencing and cardiac RNAseq from congenital heart defect patients from the Pediatric Cardiac Genomics Consortium and deceased adults from Genotype-Tissue Expression. Use of rank-based outliers maximized sensitivity while a most extreme outlier approach maximized specificity. Rarer variants had stronger associations, suggesting they are under negative selective pressure and providing a basis for investigating their contribution to Mendelian disorders. Availability and implementation ORE, source code, and documentation are available at https://pypi.python.org/pypi/ore under the MIT license. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

Background: This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease. Methods: Data on adrenalectomies were extracted from a national surgeon‐reported registry. Preoperative diagnosis, surgical technique, length of hospital stay, morbidity and in‐hospital mortality were examined. Results: Some 3994 adrenalectomies were registered among patients with a median age of 54 (i.q.r. 43–65) years (55·9 per cent female). Surgery was performed for benign disease in 81·5 per cent. Tumour size was significantly greater in malignant disease: 60 (i.q.r. 34–100) versus 40 (24–55) mm (P < 0·001). A minimally invasive approach was employed in 90·2 per cent of operations for benign disease and 48·2 per cent for cancer (P < 0·001). The conversion rate was 3·5‐fold higher in malignant disease (17·3 versus 4·7 per cent; P < 0·001). The length of hospital stay was 3 (i.q.r. 2–5) days for benign disease and 5 (3–8) days for malignant disease (P < 0·050). In multivariable analysis, risk factors for morbidity were malignant disease (odds ratio (OR) 1·69, 1·22 to 2·36; P = 0·002), tumour size larger than 60 mm (OR 1·43, 1·04 to 1·98; P = 0·028) and conversion to open surgery (OR 3·48, 2·16 to 5·61; P < 0·001). The in‐hospital mortality rate was below 0·5 per cent overall, but significantly higher in the setting of malignant disease (1·2 versus 0·2 per cent; P < 0·001). Malignant disease (OR 4·88, 1·17 to 20·34; P = 0·029) and tumour size (OR 7·47, 1·52 to 39·61; P = 0·014) were independently associated with mortality in multivariable analysis. Conclusion: Adrenalectomy is a safe procedure but the higher incidence of open surgery for malignant disease appears to influence postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: In 2018, AJCC TNM staging changed for differentiated (DTC) and anaplastic (ATC) thyroid carcinoma. The impact of this change on mortality rates was investigated and compared with the MACIS prognostic score. Methods: Analysis of a prospective database of DTC/ATC was undertaken. Patients were staged according to TNM7 and TNM8 criteria, and MACIS scores calculated. Five‐year disease‐specific mortality rates were determined. Proportions were compared with Fisher's exact and χ2 goodness‐of‐fit tests. Results: Between August 2002 and December 2016, 310 patients had primary surgery for thyroid cancer. After exclusions, 159 patients (154 DTC, 5 ATC) remained to be studied. The MACIS score was less than 6 in 105 patients (66·0 per cent), 6–6·99 in 19 (11·9 per cent), 7–7·99 in 14 (8·8 per cent) and 8 or more in 21 (13·2 per cent), with corresponding disease‐specific 5‐year mortality rates of 0, 5, 14 and 86 per cent. For TNM7 the distribution was stage I in 53·5 per cent (85 patients), stage II in 10·1 per cent (16), stage III in 14·5 per cent (23) and stage IV in 22·0 per cent (35), and differed from that for TNM8: 76·7 per cent (122), 10·7 per cent (17), 4·4 per cent (7) and 8·2 per cent (13) respectively (P < 0·001). Overall disease‐specific 5‐year mortality rates by stage for TNM7 versus TNM8 were: stage I, 0 of 85 versus 3 of 100 (P = 0·251); stage II, 0 of 16 versus 6 of 16 (P = 0·018); stage III, 3 of 23 versus 2 of 7 (P = 0·565); stage IV, 20 of 32 versus 11 of 11 (P = 0·020). Conclusion: Compared with TNM7, TNM8 downstaged more patients to stage I and accurately reflected worse prognosis for stage IV disease. TNM8 is an inferior predictor of mortality compared with MACIS. [ABSTRACT FROM AUTHOR]

Introduction: Drugs can become short in supply for many reasons including increased demand and reduced production1. Drug shortages have the potential to impact patients and pharmacists. A recent study reported pharmacists spending up to 11 hours per week dealing with drug shortages2. However, the overall impact of experiencing and dealing with drug shortages on pharmacists and patients has not been fully investigated, particularly within community pharmacy, an area of practice that has been struggling with drug shortages. Aim: To highlight the challenges pharmacists face and the constraints within the current system when dealing with drug shortages. Methods: The study was reviewed and received ethical approval. This was a survey study involving practising community pharmacists in the UK. Pharmacists were invited through social media and professional networks to complete a validated online survey during the period of September to December 2021. Survey data was analysed using descriptive statistics. Results: 100 responses were received from 11 regions in the UK. Eighty three percent of the respondents were experiencing drug shortages 3 or more times per week and more than 70% spent 1-3 hours per week dealing with them. The majority of the respondents (93%, n = 93) indicated that drug shortages were a problem for them and sixty one (n = 100) respondents reported that they had worsened since the start of the pandemic. In addition, sixty five (n = 100) respondents believed that drug shortages had had an impact on patient care. How the respondents dealt with prescriptions for drugs that were in shortage varied with a third (34%) responding they would contact the prescriber and suggest an alternative. The respondents suggested ways for improving the management of drug shortages including giving pharmacists more legal power to change prescriptions, increasing the number of Serious Shortage Protocols (SSPs) and providing early and transparent communications. Discussion/Conclusion: Spending time dealing with drug shortages impacts on the pharmacists' workloads and quality of patient care. There was a variation between how respondents indicated they dealt with drug shortages. Patients should be able to obtain their medicine(s) and pharmacists need to respond in a way that ensures delivery of person-centred care. How pharmacists deal with shortages and why they do this needs further exploration. Some respondents suggested ways to help manage drug shortages. An increase in number of SSP's may not be the best approach as they can be inflexible and time consuming. Initiatives such as more legal powers have received attention by the Royal Pharmaceutical Society (RPS) who believes an amendment in law to allow pharmacists to make minor changes to prescriptions affected by drug shortages would improve patient access to medicines and reduce the burden on the healthcare system. This comes at a time when community pharmacists are under pressure to offer services such as minor ailments, blood pressure checks and contraception. Despite the survey being undertaken over a year ago and the small sample size, drug shortages continue to be an issue that impacts community pharmacists, which requires further investigation. References: 1. Bhamra, S. K., Parmar, J., & Heinrich, M. (2021). Impact of the coronavirus pandemic (COVID-19) on the professional practice and personal well-being of community pharmacy teams in the UK. International Journal of Pharmacy Practice, 29(6), 556-565. 2. Burns, C. (2023). Community pharmacies spending twice as much time managing drug shortages as last year. The Pharmaceutical Journal, PJ. Available at: https://pharmaceutical-journal.com/article/news/community-pharmacies-spending-twice-as-much-time-managing-medicines-shortages-as-last-year (accessed: 7 May 2023). [ABSTRACT FROM AUTHOR]

Summary: Remote dermatology consultations largely superseded face‐to‐face (FTF) consultations during the peak of the COVID‐19 pandemic in the UK. Remote examination of patients with hidradenitis suppurativa (HS) brings particular challenges, given the propensity of HS to affect intimate body areas. To understand the impact of remote consultations on the care of patients with HS, a retrospective analysis was conducted of all consultations from 2 April to 29 October 2020 at the HS clinic at Imperial College Healthcare NHS Trust. In this group of patients with HS, 46.3% were black, compared with 7.0% of patients attending general dermatology clinics (P < 0.001). The majority (65.9%) of patients had previously received or were currently taking adalimumab. All consultations were performed by telephone and in 50.7% of the consultations, patients were assessed as having unstable (u)HS, with 81.1% of these uHS episodes leading to a change in pharmacological therapy. The decision‐making process was aided by patient‐submitted photographs at only 8.1% of consultations involving uHS, for reasons of patient privacy, comfort and data security. The data suggest that HS is an inherently unstable disease despite maximal medical therapy, and this study highlights important reasons for the assessment of patients with HS by FTF consultations where safely possible. [ABSTRACT FROM AUTHOR]

A 49-year-old man was transferred to the intensive care unit (ICU) at our centre from a local hospital, having experienced a spontaneous intracranial bleed requiring neurosurgical intervention. A joint decision to treat the patient with dexamethasone and anakinra was made, following which gradual clinical and biochemical improvement was observed, and the patient was able to leave ICU after a further 3 weeks. [Extracted from the article]

Summary: Background: Standardized quality‐of‐life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). Objectives: To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5‐dimensions (5‐D) itch scales for assessing burden of AD in adults and to compare their performance. Methods: Self‐administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. Results: DLQI, ItchyQoL and 5‐D all had good content validity. DLQI, mean ItchyQoL and 5‐D itch all had strong correlations with frequency of AD symptoms (Patient‐Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0·001 for all). DLQI and 5‐D itch showed good internal consistency (Cronbach's alpha = 0·89 and 0·84), although ItchyQoL appeared to have several redundant items (alpha = 0·96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5‐D itch. DLQI, ItchyQoL and 5‐D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5‐D itch were 2 min. Conclusions: The DLQI, ItchyQoL and 5‐D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice. What's already known about this topic? Dermatology Life Quality Index (DLQI), 5‐dimensions (5‐D) itch and ItchyQoL are quality‐of‐life assessments that have been used to assess the burden of inflammatory and/or pruritic skin disorders.Conflicting and/or limited results have been demonstrated about their validity, reliability and feasibility, particularly in atopic dermatitis. What does this study add? This study demonstrates that DLQI, ItchyQoL and 5‐D itch had good construct validity and responsiveness, and similar amounts of time for completion in the assessment of adult atopic dermatitis, with no observed floor or ceiling effects. What are the clinical implications of this work? DLQI, ItchyQoL and 5‐D itch all appear to have sufficient validity and feasibility to be used as assessments of burden in adults with atopic dermatitis in clinical practice. Linked Comment: Apfelbacher and Ofenloch. Br J Dermatol 2019; 180:979–980. Respond to this article [ABSTRACT FROM AUTHOR]

Summary: The in‐depth understanding of skin resident memory CD8+ T lymphocytes (TRM) may help to uncover strategies for their manipulation during disease. We investigated isolated TRM from healthy human skin, which expressed the residence marker CD69, and compared them to circulating CD8+ T cell populations from the same donors. There were significantly increased proportions of CD8+CD45RA–CD27– T cells in the skin that expressed low levels of killer cell lectin‐like receptor G1 (KLRG1), CD57, perforin and granzyme B. The CD8+ TRM in skin were therefore phenotypically distinct from circulating CD8+CD45RA–CD27– T cells that expressed high levels of all these molecules. Nevertheless, the activation of CD8+ TRM with T cell receptor (TCR)/CD28 or interleukin (IL)‐2 or IL‐15 in vitro induced the expression of granzyme B. Blocking signalling through the inhibitory receptor programmed cell death 1 (PD)‐1 further boosted granzyme B expression. A unique feature of some CD8+ TRM cells was their ability to secrete high levels of tumour necrosis factor (TNF)‐α and IL‐2, a cytokine combination that was not seen frequently in circulating CD8+ T cells. The cutaneous CD8+ TRM are therefore diverse, and appear to be phenotypically and functionally distinct from circulating cells. Indeed, the surface receptors used to distinguish differentiation stages of blood T cells cannot be applied to T cells in the skin. Furthermore, the function of cutaneous TRM appears to be stringently controlled by environmental signals in situ. [ABSTRACT FROM AUTHOR]

Background We report on the development of the ‘STOP Diabetes’ education programme, a multi-component lifestyle behaviour change intervention for the prevention of type 2 diabetes and cardiovascular risk factors in adults with intellectual disabilities (ID). Methods We combined qualitative stakeholder interviews with evidence reviews to develop the intervention, guided by the MRC Framework and informed by intervention mapping and two existing diabetes prevention programmes. We conducted two pilot cycles drawing on additional stakeholder interviews to inform and refine the intervention. Results The STOP Diabetes education programme employed a theoretical framework, using sound learning and behavioural principles and concrete kinaesthetic methods, to provide the grounding for innovative games and activities to promote health behaviour change in adults with ID. Qualitative data also suggested that two educators and one support person delivering a programme of one carer session followed by seven 2.5-h sessions over 7 weeks was acceptable to service users, carers and educators and appeared to benefit the participants. Conclusions The STOP Diabetes education programme was successfully developed and is suitable for a definitive randomized controlled trial. [ABSTRACT FROM AUTHOR]

Summary: Background: Several patient‐reported outcomes have been used to assess the burden of atopic dermatitis (AD). Some are disease specific, such as the Patient‐Oriented Eczema Measure (POEM), while others pertain to itch, for example the numerical rating scale (NRS)‐itch, ItchyQoL and 5‐D itch, or dermatological disease in general, for example the Dermatology Life Quality Index (DLQI). Development of severity strata is essential for proper interpretability of these assessments. Objectives: To confirm previously developed strata for POEM, DLQI and raw ItchyQoL, and develop strata for the NRS‐itch, mean ItchyQoL and 5‐D itch scale for use in adults with AD. Methods: Self‐administered questionnaires were completed by 210 adults with AD in a dermatology practice setting. Strata were selected using an anchoring approach based on patient‐reported disease severity. Results: We confirmed the existing strata for POEM (mild 0–7, moderate 8–16, severe 17–28; κ = 0·440), DLQI (mild 0–5, moderate 6–10, severe 11–30; κ = 0·398) and NRS‐itch (mild 0–3, moderate 4–6, severe 7–10; κ = 0·499). However, the preferred band for raw ItchyQoL was mild 22–58, moderate 59–74 and severe 75–110 (κ = 0·379) and for mean ItchyQoL, mild 1–2·9, moderate 3·0–3·9, severe 4·0–5·0 (κ = 0·374). The preferred band for 5‐D itch scale was mild 0–11, moderate 12–17 and severe 18–25 (κ = 0·331). Conclusions: Existing strata for POEM and DLQI performed well in adult AD. Previously reported strata for visual analogue scale‐itch performed best for NRS‐itch. We identified banding for the raw ItchyQoL for our AD population that varies slightly from the banding published for a more heterogeneous population. Finally, we proposed strata for mean ItchyQoL and 5‐D itch scale in adult AD. [ABSTRACT FROM AUTHOR]

Background Scoring systems for assessing the signs of atopic dermatitis ( AD) are complex and difficult to interpret. Severity strata are helpful to interpret these assessments properly. Objectives To confirm previously reported strata for the Eczema Area and Severity Index ( EASI), Scoring Atopic Dermatitis ( SCORAD) and the objective component of SCORAD ( oSCORAD), and to develop strata for the modified EASI ( mEASI), Atopic Dermatitis Severity Index ( ADSI) and body surface area ( BSA) for use in adults with AD. Methods Skin examination was performed in 673 adolescents and adults (age ≥ 13 years) with diagnosed AD, in a dermatology practice setting. Strata were selected using an anchoring approach based on a four-point Investigator's Global Assessment of severity (clear of active skin lesions, mild, moderate or severe disease). Results We determined potential severity strata for EASI (0 clear, 0·1-5·9 mild, 6·0-22·9 moderate, 23·0-72 severe; κ = 0·69), mEASI (0-0·9 clear, 1-8·9 mild, 9·0-29·9 moderate, 30·0-90 severe; κ = 0·71), oSCORAD (0-7·9 clear, 8·0-23·9 mild, 24·0-37·9 moderate, 38·0-83 severe; κ = 0·70), SCORAD (0-9·9 clear, 10·0-28·9 mild, 29·0-48·9 moderate, 49·0-103 severe; κ = 0·68), ADSI (0-1·9 clear, 2-5·9 mild, 6·0-8·9 moderate, 9·0-15 severe; κ = 0·55) and BSA (0 clear, 0·1-15·9 mild, 16·0-39·9 moderate, 40·0-100 severe; κ = 0·66). oSCORAD values > 0 were found in clear skin due to the presence of xerosis, which is scored in oSCORAD. Similarly, SCORAD values > 0 were found in clear skin due to the scoring of xerosis, pruritus and sleeplessness. Similarly, mEASI and ADSI scores > 0 occurred in patients with clear skin due to scoring of pruritus. Conclusions We recommend using these strata for interpretation of their respective measures in clinical trials of AD. There are important differences between the five assessments, which profoundly impact the interpretation of their scores. [ABSTRACT FROM AUTHOR]

Int J Dermatol 2020; 59: 221 - 8. 3 Petryszyn P, Staniak A, Wolosianska A, Ekk-Cierniakowski P. Faecal calprotectin as a diagnostic marker of inflammatory bowel disease in patients with gastrointestinal symptoms: meta-analysis. A 20-year-old black woman presents to clinic with a 2-year history of recurrent nodules and abscesses affecting her groins and axillae. Option (a) is not required in our patient but is performed in patients with fistulating perianal and genital disease to assess the anatomy of the sinus tracts. [Extracted from the article]

Background and aim Patients with a para-oesophageal hernia (POH) report a range of symptoms and quality of life (QOL) issues. Clinicians often utilise existing health-related quality of life tools to identify patients eligible for surgical management and to evaluate the benefit of surgical intervention. However, the most commonly used tools for this purpose are not disease specific. Therefore, crucial POH-specific symptoms which impact QOL may not be captured. To address this, a modified Delphi consensus study was undertaken to establish a HRQOL instrument specific to POH. Methods A two-round modified Delphi consensus study was conducted with a group of international experts. Participants were identified through their authorship in landmark POH studies and the professional networks of the study investigators. Before the Delphi process, a scoping survey was undertaken to generate a list of candidate items. Participants were asked to rate the items' importance in assessing patients with POH using a 5-point Likert scale. The a priori threshold for inclusion was 80% for scores of 4 or 5. If consensus was not achieved, the item was carried through to the next round. Results The candidate list of items consisted of 64 symptoms, refined to 20 for inclusion within the first modified Delphi round. Four symptoms; 'difficulty getting solid foods down', 'chest pain after meals', 'difficulty getting liquids down' and 'shortness of breath only after meals', reached consensus threshold of 80% in the first round and additionally, 'early feeling of fullness after eating', reached consensus in the second. A total of 26 participants took part in the first and 24 in the second round. These five symptoms form the initial version of the Para-Oesophageal Hernia Symptom Tool (POST). Conclusion POST is the first tool that aims to capture POH-specific symptoms that impact HRQOL. Prior to clinical use, this tool will be presented in international patient workshops to assess its construct validity. Thereafter, we aim to assess the content validity of the tool through a longitudinal study in a cohort of patients with undergoing POH repair. This tool aims to serve as a decision-support tool for clinicians when evaluating the risk–benefit of surgical intervention in this cohort of patients. [ABSTRACT FROM AUTHOR]

We investigated whether the incidence of brain metastasis (BM) from primary esophageal and esophagogastric cancer is increasing. A single-institution retrospective review identified 583 patients treated from January 1997 to January 2016 for stages I through IV cancer of the esophagus and esophagogastric junction (follow-up, =3 months). Collected data included demographic information, date and staging at primary diagnosis, histologic subtype, treatment regimen for primary lesion, date of BM diagnosis, presence or absence of central nervous system symptoms, presence or absence of extracranial disease, treatment regimen for intracranial lesions, and date of death. The overall cohort included 495 patients (85%) with adenocarcinoma and 82 (14%) with squamous cell carcinoma (492 [84%] were male; median age at diagnosis, 68 years [range: 26-90 years]). BM was identified in 22 patients (3.8%) (median latency after primary diagnosis, 11 months). Among patients with BM, the primary histology was adenocarcinoma in 21 and squamous cell carcinoma in 1 (P = 0.30). BMdeveloped in 12 who were initially treated for locally advanced disease and in 10 stage IV patients who presented with distant metastases. Overall survival (OS) after BM diagnosis was 18% at 1 year (median, 4 months). No difference in OS after BM diagnosis was observed in patients initially treated for localized disease compared to patients who presented with stage IV disease; however, OS was superior for patients who initially had surgical resection compared to patients treated with whole brain radiotherapy or stereotactic radiosurgery alone (1-year OS, 67% vs. 0%; median OS, 13.5 vs. 3 months; P = 0.003). The incidence of BMis low in patients with esophageal cancer. Outcomes were poor overall for patients with BM, but patients who underwent neurosurgical resection had improved survival. [ABSTRACT FROM AUTHOR]

Background Certification of completion of training in general surgery in the UK requires demonstration of competence in index operations by means of three level 4 competence consultant-validated procedure-based assessments ( PBAs). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance levels for curriculum-defined indicative operations with respect to numbers performed and training time. Methods Logbook data from consecutive higher general surgical trainees were compared with PBA evaluations to determine the relationship between PBA performance level, operative experience, training time and indicative numbers. Learning curve gradients were calculated using the inverse trigonometric function of tan related to operative experience and training time. Results Eighty-four surgical trainees participated. Median caseload to achieve three level 4 competence assessments was 64 (range 18-110) for inguinal hernia, 83 (15-177) for emergency laparotomy, 87 (23-192) for laparoscopic cholecystectomy, 95 (22-209) for appendicectomy, 45 (17-111) for segmental colectomy and 16 (6-28) for Hartmann's procedure. Median learning curve gradients to achieve level 4 competence for emergency laparotomy were 15·3° and 33·7° by caseload and training time respectively, compared with 73·3° and 59·9° for Hartmann's procedure. Significant variance was observed in the gradients of all learning curves related to both the caseload between the first level 3 and the first level 4 PBA ( P = 0·001), and between the first and third level 4 PBAs ( P < 0·001). Conclusion Significant learning curve gradient variance was observed, with discrepancies between expected indicative operative numbers and the point at which competence was judged to have been achieved. Numbers of index operations to achieve certification of completion of training warrant further examination. [ABSTRACT FROM AUTHOR]

We present Submillimeter Array (SMA) 1.35 mm subarcsecond angular resolution observations towards the LkHα234 intermediate-mass star-forming region. The dust emission arises from a filamentary structure of ~5 arcsec (~4500 au) enclosing VLA 1-3 and MM 1, perpendicular to the different outflows detected in the region. The most evolved objects are located at the southeastern edge of the dust filamentary structure and the youngest ones at the northeastern edge. The circumstellar structures around VLA 1, VLA 3, and MM 1 have radii between~200 and~375 au and masses in the~0.08-0.3M⊙ range. The 1.35 mm emission of VLA 2 arises from an unresolved (r ≲ 135 au) circumstellar disc with a mass of ~0.02 M⊙. This source is powering a compact (~4000 au), low radial velocity (~7 km s-1) SiO bipolar outflow, close to the plane of the sky. We conclude that this outflow is the 'large-scale' counterpart of the short-lived, episodic, bipolar outflow observed through H2O masers at much smaller scales (~180 au), and that has been created by the accumulation of the ejection of several episodic collimated events of material. The circumstellar gas around VLA 2 and VLA 3 is hot (~130 K) and exhibits velocity gradients that could trace rotation. There is a bridge of warm and dense molecular gas connecting VLA 2 and VLA 3. We discuss the possibility that this bridge could trace a stream of gas between VLA 3 and VLA 2, increasing the accretion rate on to VLA 2 to explain why this source has an important outflow activity. [ABSTRACT FROM AUTHOR]

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Background The epidemiology of atopic dermatitis ( AD) in the U.S.A. has been described largely via US population-based questionnaire studies. However, the validity of the questions used for self- and caregiver-reported eczema has not been previously demonstrated. Objectives To validate the assessment of self- and caregiver-reported eczema. Methods We performed a prospective multicentre dermatology-practice-based study (three sites) to determine the validity of caregiver- and self-reported ever having eczema and 1-year history of eczema. Questionnaires were administered to unselected patients prior to their encounter. Patients ( n = 782) were then evaluated by expert dermatologists trained in utilizing the Hanifin and Rajka criteria for AD. Sensitivity, specificity, positive predictive value ( PPV) and negative predictive value were determined. Results Caregiver-reported 1-year history of childhood eczema was found to have a sensitivity (95% confidence interval) of 0·70 (0·59-0·80), specificity of 0·96 (0·93-0·99) and PPV of 0·87 (0·78-0·96) when compared with a physician's diagnosis of AD at that visit. Similarly, self-reported 1-year history of adult eczema was found to have a sensitivity of 0·70 (0·59-0·80), specificity of 0·95 (0·93-0·97) and PPV of 0·76 (0·64-0·85). The specificities and PPVs of a history of ever having caregiver- (0·89, 0·82-0·96 and 0·81, 0·70-0·93) and self-reported eczema (0·97, 0·95-0·99 and 0·91, 0·85-0·97) were high, with a high sensitivity in children (0·83, 0·72-0·95) but not in adults (0·43, 0·37-0·51). Conclusions Self- and caregiver-reported diagnosis of eczema ever or in the past year based on a single question demonstrates sufficient validity for the epidemiological study of AD. [ABSTRACT FROM AUTHOR]

As many countries start to recover from a second wave of COVID-19 infection, the dermatology community must now seriously consider how it wishes dermatology services to be provided in future. We support the employment of innovative technology to enhance the patient experience, but consider that dermatology patient care is overall best administered FTF, and hope that the dermatology community supports efforts to reinstitute FTF consultations when safe to do so. [Extracted from the article]

Perforation of gastrointestinal (GI) tract by ingested bone fragments, toothpicks and dentures is rare but remains an important life-threatening condition, and the outcomes are poorer when the diagnosis is delayed. Invariably, clinical and radiographic diagnosis is difficult as most patients will have no recollection of ingesting a foreign body, whereas these subtle objects are often not visible on radiographs. In search for the diagnosis, CT is the modality of choice, but ultrasound imaging may be first requested in patients presenting with symptoms of acute appendicitis, cholecystitis, pyelonephritis or pelvic inflammatory disease when an ingested foreign body is not considered. Although ultrasound has limited value in depicting a foreign body, it can frequently uncover secondary signs of perforation. However, the rarity of this condition combined with non-specific clinical presentation and the propensity of these small perforating objects to be subtle makes establishing the correct diagnosis by the radiologist challenging. Therefore, understanding of the appearances of GI perforation seen on CT images or general abdominal ultrasound will aid the radiologist in the diagnosis of this important yet often unsuspected condition. This will lead to earlier diagnosis and surgical management. In this article, we illustrate the spectrum of CT, radiographic and ultrasound imaging features seen in GI perforation caused by swallowed bone fragments, toothpicks, cocktail sticks and dentures. [ABSTRACT FROM AUTHOR]

Funding Acknowledgements Type of funding sources: None. Atherosclerosis has been recognised as inflammatory conditions which involves activation of MMPs of which increased MMP2 & MMP9 expression has been correlated with the development of human aortic plaques.The Sympathetic Nervous System exerts complex control over inflammation in atherosclerosis both: on systemic scale and at the regional level.Protein gene product9.5 (PGP9.5) is a cytoplasmic neuron & is a reliable marker for visualisation of the cardiovascular system innervation.There have been no studies in the existing literature on the expression of PGP 9.5 and MMP2, MMP9 on human aorta.Aim:To study the expression of MMP2, MMP9 and PGP9.5 in the human aorta & gain insights into atherosclerosis & neural modulation in the aorta.Materials & Methods This is a single centre, prospective cohort, pilot study with a sample size of 87 patients,done over 2 years at AIMS,Kochi.During CABG, punch biopsy of the aorta taken & processed.One paraffin embedded section used for routine H&E staining & others used for IHC.IHC detection kits use 3, 3'-DABChromogen as a substrate of HRP for visualisation of antigenic structures in the tissues.Positive & negative control tissue were run for all 3 Antibodies.Interpretation done as Diffuse/Focal & Intense/Moderate/ Weak classification based on intensity signals observed on IHC by an experienced Cardiac Pathologist.Results:7 Controls with well matched baseline characteristics: Controls-Aorta samples taken from patients who were undergoing Aortic Valve Surgery for Aortic Valve disease with normal coronaries documented on a coronary angiogram.65.9% of patients with Positive MMP2 & 28.6 % of patients in the Control group was found to have significant difference when compared to positive & negative outcomes amongst the 2 groups.89.3% of patients with positive MMP2 had significant co-relation with PGP9.5 levels expressed in the same specimen analysed.MMP9 also had a p value of 0.002 suggesting a significant co-relation between MMP9 & PGP9.5.Statistically significant Co-relation seen between the Age, CRP & the levels of MMP 9 expressed in the Aorta observed.MMP2 & MMP9 expression have a definite & significant co-expression with PGP9.5 expression in human aorta,suggesting a novel marker of neuromodulation in atherosclerotic process in human aorta. Expression of MMP2, MMP9 and PGP 9.5 in human aorta in patients with coronary artery disease Open in new tab Download slide Cases vs Control [ABSTRACT FROM AUTHOR]

Introduction Frailty is associated with poor outcomes following transcatheter aortic valve implantation (TAVI). Rockwood is the widely used score for this population. In a recent trial, a more objective score, the Essential Frailty Toolset (EFT) outperformed Rockwood's in predicting mortality and disability 1-year post-TAVI. Whether it predicts in-hospital length of stay (LOS) and discharge destination post-TAVI remains unclear. Method A cohort of patients undergoing TAVI for aortic stenosis was recruited, demographic characteristics collected, and frailty assessed with EFT and Rockwood scores. Primary outcomes were LOS post-TAVI, categorised as 'not prolonged' (≤2 days) or 'prolonged' (>2 days) and discharge destination, characterised as 'home' or 'non-home'. Results 86 patients were recruited, with median age 82 years (IQR 78–86). 54% were male. EFT identified 35% and Rockwood 11% as frail. 19% were cognitively impaired. 5 chair rises were completed by 70%, with 30% managing under 15 seconds. Median haemoglobin was 121 g/L (IQR 109.5–136). Median albumin was 36 g/L (IQR 33–39). 84% of procedures were transfemoral. 20% had moderate–severe left ventricular systolic dysfunction. Median LOS post-TAVI was 2 days (IQR 2–5). 94% were discharged home, 6% to referring local hospital or rehabilitation centre. 46% were NYHA class III-IV. A model for prolonged LOS including comorbidities, showed frailty determined by EFT (OR 4.80, CI 95% 1.52–15.2, p = 0.008) but not Rockwood (OR 5.00, CI 95% 0.865–29.0, p = 0.072) was the only significant independent predictor for prolonged LOS. A model adjusting for comorbidities also showed EFT to be an independent predictor for non-home discharge destination of borderline significance (OR 2.57 CI 95% 0.994–6.66, p = 0.051) but Rockwood was not (OR 1.38 CI95% 0.485–3.91, p = 0.548). Conclusion In a real-world elderly population, EFT score was a stronger, more independent predictor of prolonged LOS and non-home discharge post-TAVI, than Rockwood's. EFT would be an effective pre-operative assessment tool for LOS and discharge destination for TAVI. [ABSTRACT FROM AUTHOR]

We report multi-epoch Very Long Baseline Interferometry (VLBI) H2O maser observations towards the compact cluster of young stellar objects (YSOs) close to the Herbig Be star LkHα 234. This cluster includes LkHα 234 and at least nine more YSOs that are formed within projected distances of ∼10 arcsec (∼9000 au). We detect H2O maser emission towards four of these YSOs. In particular, our VLBI observations (including proper motion measurements) reveal a remarkable very compact (∼0.2 arcsec = ∼180 au), bipolar H2O maser outflow emerging from the embedded YSO Very Large Array (VLA) 2. We estimate a kinematic age of ∼40 yr for this bipolar outflow, with expanding velocities of ∼20 km s−1 and momentum rate Ṁw Vw ≃ 10−4–10−3 M⊙ yr−1 km s−1 × (Ω/4π), powered by a YSO of a few solar masses. We propose that the outflow is produced by recurrent episodic jet ejections associated with the formation of this YSO. Short-lived episodic ejection events have previously been found towards high-mass YSOs. We show now that this behaviour is also present in intermediate-mass YSOs. These short-lived episodic ejections are probably related to episodic increases in the accretion rate, as observed in low-mass YSOs. We predict the presence of an accretion disc associated with VLA 2. If detected, this would represent one of the few known examples of intermediate-mass stars with a disc–YSO–jet system at scales of a few hundred astronomical units. [ABSTRACT FROM AUTHOR]

Background A recent Cochrane review suggested that laparoscopic cholecystectomy carried out early following mild gallstone pancreatitis was safe. This study compared the cost-effectiveness of laparoscopic cholecystectomy performed within 3 days of admission, during the same admission but after more than 3 days, or electively in a subsequent admission. Methods A model-based cost-utility analysis was performed estimating mean costs and quality-adjusted life-years ( QALYs) per patient in the UK National Health Service with a 1-year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources for mild gallstone pancreatitis, including one-way and probabilistic sensitivity analyses. Results The costs of laparoscopic cholecystectomy performed within 3 days of admission, beyond 3 days but in the same admission, and electively in a subsequent admission were €2748, €3543 and €3752 respectively; the QALYs were 0·888, 0·888 and 0·884 respectively. Early laparoscopic cholecystectomy had a 91 per cent probability of being cost-effective at the maximum willingness to pay for a QALY commonly used in the UK. It is acknowledged that many hospitals do not have access to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, especially at weekends, and that implementing a 3-day target is unrealistic without allocating new resources that could erode the cost-effectiveness. Conclusion Performing laparoscopic cholecystectomy for mild gallstone pancreatitis within 3 days of admission is cost-effective, but may not be feasible without significant resource allocation. After 3 days there is little financial advantage to same-admission operation. [ABSTRACT FROM AUTHOR]

We have carried out continuum and line polarization observations of two protoplanetary nebulae (PPNe), CRL 618 and OH 231.8+4.2, using the Submillimeter Array in its compact configuration. The frequency range of observations, 330–345 GHz, includes the CO(J = 3→2) line emission. CRL 618 and OH 231.8+4.2 show quadrupolar and bipolar optical lobes, respectively, surrounded by a dusty envelope reminiscent of their asymptotic giant branch phase. We report a detection of dust continuum polarized emission in both PPNe above 4σ but no molecular line polarization detection above a 3σ limit. OH 231.8+4.2 is slightly more polarized on average than CRL 618 with a mean fractional polarization of 4.3 and 0.3 per cent, respectively. This agrees with the previous finding that silicate dust shows higher polarization than carbonaceous dust. In both objects, an anticorrelation between the fractional polarization and the intensity is observed. Neither PPNe shows a well-defined toroidal equatorial field, rather the field is generally well aligned and organized along the polar direction. This is clearly seen in CRL 618 while in the case of OH 231.8+4.2, the geometry indicates an X-shaped structure coinciding overall with a dipole/polar configuration. However in the later case, the presence of a fragmented and weak toroidal field should not be discarded. Finally, in both PPNe, we observed that the well-organized magnetic field is parallel with the major axis of the 12CO outflow. This alignment could indicate the presence of a magnetic outflow launching mechanism. Based on our new high-resolution data we propose two scenarios to explain the evolution of the magnetic field in evolved stars. [ABSTRACT FROM AUTHOR]

Fast-tracking teledermatology into dermatology trainee timetables, an overdue necessity in the COVID era and beyond As skin cancer services must be consultant-led, and teledermatology is particularly amenable to solitary working, there is a risk that the need to educate trainees in the practice of teledermatology is being neglected. Fast-tracking teledermatology clinics into trainee timetables is an essential step to prepare the trainee for life as a consultant, which will inevitably involve some aspect of regular teledermatology work in the years ahead. [Extracted from the article]

In this paper we analyse multi-epoch very long baseline interferometry water maser observations carried out with the Very Long Baseline Array towards the high-mass star-forming region AFGL 2591. We detected maser emission associated with the radio continuum sources VLA 2 and VLA 3. In addition, a water maser cluster, VLA 3-N, was detected ∼0.5 arcsec north of VLA 3. We concentrate the discussion of this paper on the spatio-kinematical distribution of the water masers towards VLA 3-N. The water maser emission towards the region VLA 3-N shows two bow-shock-like structures, northern and southern, separated from each other by ∼100 mas (∼330 au). The spatial distribution and kinematics of the water masers in this cluster have persisted over a time span of 7 yr. The northern bow shock has a somewhat irregular morphology, while the southern one has a remarkably smooth morphology. We measured the proper motions of 33 water maser features, which have an average proper motion velocity of ∼1.3 mas yr−1 (∼20 km s−1). The morphology and the proper motions of this cluster of water masers show systematic expanding motions that could imply one or two different centres of star formation activity. We made a detailed model for the southern structure, proposing two different kinematic models to explain the three-dimensional spatio-kinematical distribution of the water masers: (1) a static central source driving the two bow-shock structures and (2) two independent driving sources, one of them exciting the northern bow-shock structure, and the other one, a young runaway star moving in the local molecular medium exciting and moulding the remarkably smoother southern bow-shock structure. Future observations will be necessary to discriminate between the two scenarios, in particular by identifying the still unseen driving source(s). [ABSTRACT FROM PUBLISHER]

We present five epochs of VLBI water maser observations around the massive protostar Cepheus A HW2 with 0.4 mas (0.3 au) resolution. The main goal of these observations was to follow the evolution of the remarkable water maser linear/arcuate structures found in earlier VLBI observations. Comparing the data of our new epochs of observation with those observed 5 yr before, we find that at 'large' scales of arcsec (700 au) the main regions of maser emission persist, implying that both the surrounding medium and the exciting sources of the masers have been relatively stable during that time-span. However, at smaller scales of arcsec (70 au) we see large changes in the maser structures, particularly in the expanding arcuate structures R4 and R5. R4 traces a nearly elliptical patchy ring of ∼70 mas size (50 au) with expanding motions of ∼5 mas yr (15 km s), consistent with previous results of Gallimore and collaborators. This structure is probably driven by the wind of a still unidentified YSO located at the centre of the ring (∼0.18 arcsec south of HW2). On the other hand, the R5 expanding bubble structure (driven by the wind of a previously identified YSO located ∼0.6 arcsec south of HW2) is currently dissipating in the circumstellar medium and losing its previous degree of symmetry, indicating a very short lived event. In addition, our results reveal, at scales of ∼1 arcsec (700 au), the simultaneous presence of a relatively slow (∼10-70 km s) wide-angle outflow (opening angle of ), traced by the masers, and the fast (∼500 km s) highly collimated radio jet associated with HW2 (opening angle of ), previously observed with the VLA. This simultaneous presence of a wide-angle outflow and a highly collimated jet associated with a massive protostar is similar to what is found in some low-mass YSOs. There are indications that the primary wind(s) from HW2 could be rotating. The implications of these results in the study of the formation of high-mass stars are discussed. [ABSTRACT FROM AUTHOR]

Aim: The objective is to develop an automated image analysis protocol to quantify the cell volume fraction of filamentous fungi ( Trichoderma reesei) and estimate the biomass concentration. Methods and Results: Both dry weight and image analyses were performed on samples collected periodically from 7-l stirred tank fermentations. Using the projected area of lactophenol blue-stained hyphae, the fraction occupied by the cells in a given volume was estimated. Combined with the biomass dry weight obtained by filtration, the method was used to estimate the density of filamentous fungi. Knowing the density of fungi, the algorithm was employed to quantitatively assess the biomass evolution during the course of fermentation even in the presence of solid particles. Conclusions: A density of 0.334 g dry weight cm−3 was found for T. reesei RUT C-30. The image analysis protocol allowed successful estimation of biomass concentration in the presence or absence of solid particles. Significance and Impact of the Study: Methods to quantify biomass during the industrial production of cellulase with T. reesei are often limited due to the presence of solid substrates. The image analysis protocol presented here offers a quick and easy way to estimate biomass concentration of filamentous micro-organisms in insoluble medium. [ABSTRACT FROM AUTHOR]

Such long haulers pose social and ethical dilemmas relating to RT-PCR positivity and quarantine practices. However, as per the National guidelines and institutional discharge policy, the test-based discharge policy has been discontinued, in favor of emerging evidences.2,3 She was discharged and is being followed up in post-COVID clinic. Despite symptomatic improvement, she continued RT-PCR positivity for over 60 days and finally turned negative after 65 days. [Extracted from the article]

Aims: To determine the efficacy of solar disinfection (SODIS) in disinfecting water contaminated with poliovirus and Acanthamoeba polyphaga cysts. Methods and Results: Organisms were subjected to a simulated global solar irradiance of 850 Wm−2 in water temperatures between 25 and 55°C. SODIS at 25°C totally inactivated poliovirus after 6-h exposure (reduction of 4·4 log units). No SODIS-induced reduction in A. polyphaga cyst viability was observed for sample temperatures below 45°C. Total cyst inactivation was only observed after 6-h SODIS exposure at 50°C (3·6 log unit reduction) and after 4 h at 55°C (3·3 log unit reduction). Conclusions: SODIS is an effective means of disinfecting water contaminated with poliovirus and A. polyphaga cysts, provided water temperatures of 50–55°C are attained in the latter case. Significance and Impact of the Study: This research presents the first SODIS inactivation curve for poliovirus and provides further evidence that batch SODIS provides effective protection against waterborne protozoan cysts. [ABSTRACT FROM AUTHOR]

Background: it is not known if mobile stroke teams can achieve the good results seen in trials of geographically discrete stroke wards (stroke units). Objective: to establish the effectiveness of mobile stroke teams. Design: systematic review of controlled clinical trials that compared peripatetic systems of organised stroke care (stroke team care) with alternative hospital services. Methods: systematic review and meta-analysis (using Cochrane Collaboration methodology and involving the primary trialists). Clinical outcomes included death, dependency, the need for institutional care and measures of the process of care such as the delivery of key investigations and treatments. Results: six clinical trials (1,085 patients) were identified; five (781 patients) compared some form of stroke team care with conventional care in general medical wards and one (304 patients) compared team care with a comprehensive stroke unit. Compared with care in general wards, stroke team care improved some aspects of the process of care, but clinical outcomes were similar. Compared with a comprehensive stroke unit, stroke team patients were significantly less likely to survive (P< 0.001), return home (P< 0.001) or regain independence (P< 0.0001). Most aspects of the process of care were also poorer than in the stroke unit. Conclusions: care from a mobile stroke team had no major impact on death, dependency or the need for institutional care. [ABSTRACT FROM AUTHOR]

Objective. To assess the effectiveness and safety of the lidocaine patch 5%, a targeted peripheral analgesic, in the treatment of postherpetic neuralgia, painful diabetic neuropathy, and low back pain patients with incomplete responses to their current analgesic treatment regimen containing gabapentin.Design. This was a 2-week, open-label, nonrandomized, multicenter pilot trial in the clinical setting. Patients with postherpetic neuralgia, painful diabetic neuropathy, or low back pain with partial responses (average daily pain intensity >4/10) to their current analgesic treatment regimen were included. Treatment consisted of daily application of up to four lidocaine patches to areas of maximal peripheral pain. Effectiveness was evaluated using the Brief Pain Inventory (BPI). Safety was assessed by adverse events, physical and neurologic examinations, vital signs, and clinical laboratory tests.Results. Significant improvements in BPI measures of pain intensity and pain relief were reported for all groups of patients after 2 weeks of lidocaine patch 5% treatment. Significant improvements in BPI measures of pain interference with general activity, mood, walking ability, normal work, relationships with others, sleep, and enjoyment of life were noted. The lidocaine patch 5% was found to be safe and well tolerated.Conclusions. Results of this study highlight the potential advantages achieved with rational polypharmacy using a targeted peripheral analgesic, the lidocaine patch 5%, with centrally acting agents such as the anticonvulsant gabapentin. Controlled trials are warranted to further define the impact of such combination therapy. [ABSTRACT FROM AUTHOR]

Aims To compare the clinical efficacy and tolerability of two intravenous sedatives for physician-led DC cardioversion of atrial arrhythmias. Methods and results One hundred and forty-one patients attending for elective DC cardioversion of atrial arrhythmias were randomized to intravenous midazolam or diazepam. Sedation was administered using titration protocols. Procedure times, operator satisfaction scores and adverse events were documented. The patients' immediate, 24- and 48-h recall and awareness of after-effects were obtained from questionnaires. Seventy-one patients received midazolam (mean 12.5 mg) and 70 patients received diazepam (mean 28.1 mg). There were 16 minor adverse events with midazolam (20% hypotension, 3% oxygen desaturation) and nine with diazepam (7% hypotension, 6% required additional analgesia), P=0.14. There were no major adverse events. Sedation time was 5.0±3.4 min for midazolam and 6.5±3.4 min for diazepam (P=0.0016). Patients awoke 77±46 min post-sedation with midazolam and 39±24 min with diazepam (P<0.0001). There was no recall of the procedure at 48 h and no difference in awareness of after-effects between the two groups at 24 or 48 h, P=ns. Conclusion Physician-led cardioversion of atrial arrhythmias using intravenous sedation is effective and well tolerated. Sedation with diazepam was associated with fewer minor adverse events and a quicker recovery time than midazolam. [ABSTRACT FROM PUBLISHER]

Aims To evaluate whether a single decapolar electrode is a reliable and cost-effective substitute for the ‘Halo’ catheter to map the circuit and detect bidirectional isthmus block during atrial flutter (AFL) ablation. Methods and Results Twenty-four patients underwent AFL ablation by using the decapolar electrode in the infero-lateral wall of right atrium (group A) while a ‘Halo’ catheter was used in 11 patients (group B). Both groups had similar clinical characteristics. Anti-clockwise rotation (20 patients), clockwise (3 patients) or both forms of AFL (1 patient) were detected in group A. All patients in group B had anti-clockwise AFL. Bidirectional isthmus block was completed in 22 patients of group A and in 9 of group B (P=NS) while incomplete isthmus block was detected in 2 patients in each group (P=NS). Mean fluoroscopy and procedure time was 27±47 min, 107±36 min in group A and 14±19 min, 114±65 min in group B (P=NS). AFL relapsed in 3 patients of group A (follow-up 7±4 months) and in 2 of group B (4±2 months). Conclusion A single decapolar electrode is a reliable method to map the circuit and demonstrate bidirectional isthmus block during AFL ablation. The cost of the decapolar electrode is a quarter of that of the ‘Halo’ catheter. This represents a significant saving particularly for centres with a substantial number of AFL ablations. [ABSTRACT FROM PUBLISHER]

We present NH[sub 3](1,1) and (2,2) observations of MBM 12, the closest known molecular cloud (65-pc distance), aimed at finding evidence for on-going star formation processes. No local temperature (with a T[sub rot] upper limit of 12 K) or linewidth enhancement is found, which suggests that the area of the cloud that we have mapped (∼15-arcmin size) is not currently forming stars. Therefore this nearby ‘starless’ molecular gas region is an ideal laboratory to study the physical conditions preceding new star formation. A radio continuum source has been found in Very Large Array archive data, close to but outside the NH[sub 3] emission. This source is likely to be a background object. [ABSTRACT FROM AUTHOR]

The use of the transjugular intrahepatic portosystemic shunt (TIPS) has emerged as an important nonoperative modality for variceal bleeding, intractable ascites, and for selected cases of hepatic venous obstruction. We believe that TIPS should be viewed as a 'bridge' to liver transplantation and should be carried out only in experienced centres. The adverse haemodynamic changes on the cardiopulmonary system after TIPS should be borne in mind. Prospective trials to evaluate the role of TIPS versus sclerotherapy in variceal bleeding will be watched with interest. There is, however, an urgent need to improve long-term results of TIPS as stent thrombosis and stenosis occur frequently. We advocate routine surveillance to detect these problems at an early stage. [ABSTRACT FROM PUBLISHER]