64 research outputs found
Langerhans cell histiocytosis (histiocytosis X)
There has been a renewed interest in Langerhans cell histiocytosis in recent years due both to advances in basic research and to improvements in diagnostic and treatment approaches. In this article, we review the various aspects of the disease and the potential implications of these recent scientific researches for our understanding and management of the disorder.published_or_final_versio
The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set
Background
Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables.
Methods
Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set.
Results
Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001).
Conclusions
The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy
Whole-genome sequencing reveals host factors underlying critical COVID-19
Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease
Introduction
Muslim marriages are far from homogeneous, and the inherent variability of norms and practices is often missing in the framing of such marriages in Western societies. Marriage and family laws in Muslim-majority contexts are sights of contention, debate, and development. These debates often centre around family as a site of state governance driven by overlapping national and international agendas; gender equality and calls for marriage law reform; and tensions between Islamic jurisprudence, state laws, and lived realities. This introductory article sets the scene for this special issue focussing on the plurality of norms and practices in Muslim marriages within Muslim-majority jurisdictions
Introduction
Muslim marriages are far from homogeneous, and the inherent variability of norms and practices is often missing in the framing of such marriages in Western societies. Marriage and family laws in Muslim-majority contexts are sights of contention, debate, and development. These debates often centre around family as a site of state governance driven by overlapping national and international agendas; gender equality and calls for marriage law reform; and tensions between Islamic jurisprudence, state laws, and lived realities. This introductory article sets the scene for this special issue focussing on the plurality of norms and practices in Muslim marriages within Muslim-majority jurisdictions
Introduction
Muslim marriages are far from homogeneous, and the inherent variability of norms and practices is often missing in the framing of such marriages in Western societies. Marriage and family laws in Muslim-majority contexts are sights of contention, debate, and development. These debates often centre around family as a site of state governance driven by overlapping national and international agendas; gender equality and calls for marriage law reform; and tensions between Islamic jurisprudence, state laws, and lived realities. This introductory article sets the scene for this special issue focussing on the plurality of norms and practices in Muslim marriages within Muslim-majority jurisdictions
Use of a portable bladder scanner to reduce the incidence of bladder catheterisation prior to laparoscopy
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