Is computed tomography of the head justified in patients with minor head trauma presenting with Glasgow Coma Scale 15/15?

Background: In keeping with radiology departments in tertiary referral hospitals in developing countries offering computed tomography (CT) head scan services, the radiology department at Groote Schuur Hospital (GSH) in the Western Cape of South Africa undertakes several such scans annually. Of these scans, many are undertaken for post-trauma patients with minor head injury (MHI). While there is agreement that MHI patients with Glasgow Coma Scale (GCS) scores of 13–14/15 may well benefit, there is doubt as to the clinical utility of routine CT head scanning in MHI patients with GCS scores of 15/15. Objectives: This retrospective descriptive study of patient records was undertaken to determine the frequency and clinical significance of any abnormalities found on CT head scans of 460 patients with MHI and GCS scores of 15/15, scanned at GSH between 2012 and 2014. Method: Ethical clearance was obtained and the records of 460 MHI patients with GCS scores of 15/15, loss of consciousness (LOC) and amnesia who underwent CT head scanning at GSH between 2012 and 2014 were then retrieved from the Philips picture archiving and communication system (PACS). Patient records, containing illegible referral forms or technically inadequate CT head scans, were excluded from the study. Patients’ biographical, clinical and CT head scan data were entered into sequentially numbered data collection forms. These data were tabulated and summed as percentage distributions. Patients’ CT head scan findings were reviewed and classified as either showing normal or abnormal features. Abnormalities detected on CT head scans were classified as being either clinically significant or clinically non-significant. Results: Referral forms and CT scan reports were obtained for 460 MHI patients from a sample of 497 patients, calculated by using the equation for estimating a single proportion from a large sample (precision 1.5%). The sample obtained yielded an acceptable response rate of 460/497 (92.6%). Of 460 (100%) scan reports, 320 (69.6%) showed no abnormality, while 140 (30.4%) showed abnormality. Of the 140 abnormal scans, 107 (23.3%) showed clinically non-significant abnormality, while 33 (7.2%) revealed clinically significant abnormality. Twenty-two (4.8%) of these clinically significant scans showed brain contusion and 11(2.4%) showed skull fracture. No subdural or extradural haematoma, shift or herniation were reported and none of the 33 patients whose CT scans showed clinically significant abnormality underwent urgent neurosurgical intervention. Conclusion: Of the 460 CT head scans performed at GSH for MHI with LOC but normal GCS between 2012 and 2014, none required urgent neurosurgical intervention. This is in accordance with the 2012 Kimberley Hospital Rule (KHR), a management protocol which indicates that CT head scanning in patients with MHI and GCS scores of 15/15 can safely be delayed for 8 h. An audit of the records of patients excluded from this study coupled with an analysis of data from other Western Cape hospital CT head scan databases could help ensure that this scarce resource is used cost-beneficially for all head-injured patients in the Western Cape catchment area

A retrospective study of computed tomography angiography versus digital subtraction angiography in penetrating neck trauma at Groote Schuur Hospital, South Africa

Background: Penetrating neck trauma is commonly encountered in South African trauma units, and is associated with high mortality and morbidity rates. The imaging protocol for stable patients with penetrating neck trauma remains controversial. There is only sparse data validating the use of computed tomography angiography (CTA) in the evaluation of penetrating neck trauma in South Africa. Objectives: To assess the sensitivity and specificity of CTA versus digital subtraction angiography (DSA) in detecting arterial injury and secondarily evaluate the ability of CT to assess non-arterial injury. Method: Using hospital and radiology databases, 23 patients were identified who had undergone both CTA and DSA for penetrating neck trauma. The data was retrospectively anonymised and randomised. A radiologist experienced in the interpretation of both trauma CTA and DSA re-reported all the imaging and the findings were compared and analysed. Results: Twenty-four arterial injuries were detected. The sensitivity of CTA for detecting arterial injury was 78% and the specificity 83%. The ability of CTA to delineate wound track and detect non-arterial visceral injury was also confirmed. Conclusion: CTA is an attractive initial diagnostic investigation that, along with clinical evaluation, effectively guides further investigation and intervention. It is important for the radiologist to understand the limitations of CTA and have a low threshold for DSA in equivocal cases

The complexity of HIV vasculopathy

We present a case and discuss stroke related to human immunodeficiency virus (HIV) infection and the difficulties of reaching a firm diagnosis of the cause of the aneurysmal vasculopathy. In the absence of a clear aetiology we suggest looking for varicella zoster virus (VZV) replication in the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) and treating with intravenous acyclovir, aiming for HIV control with appropriate antiretroviral therapy and providing suitable antiplatelet agents. If there is a high index of suspicion of VZV, therapy with acyclovir may be prudent even if the CSF PCR is negative (as may occur after the first 2 weeks of reactivation of infection). Determination of a VZV plasma:CSF IgG ratio is not readily available and would only provide surrogate support for a previous VZV infection in the central nervous system compartment

Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus

Sirolimus, a potent inhibitor of B- and T-cell activation. is a commonly used immunosuppressant after renal transplantation. Withdrawal of sirolimus from the immunosuppression regimen may reduce B-cell surveillance. We present a case of rapidly progressive central nervous system (CNS) polymorphic Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disorder following the withdrawal of sirolimus

Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis

The original publication is available at http:// www.plosone.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Introduction: Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. Methods: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score $10), ‘Possible TBM’ (diagnostic score 6–9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of ,6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. Results: CT scan criteria for BME had good intra-rater agreement (k range 0.35–0.78) and fair to moderate inter-rater agreement (k range 0.20–0.52). Intra- and inter-rater agreement on the CCD components were good to fair (k = ranges 0.47–0.81 and 0.21–0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%–100%), but insensitive (5.9%–29.4%). Similarly, the imaging components of the CCD were highly specific (69.2–100%) but lacked sensitivity (0–56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. Discussion: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.Funding: KB received funding from the Discovery Foundation (Academic Fellowship Award; http://www.discovery.co.za/portal/loggedout-individual/discoverycommunity- about), College of Neurology of South Africa (K.M. Browse Award; http://www.collegemedsa.ac.za/Default.aspx ) and the University of Stellenbosch. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Publisher's versio

Crop Updates 2001 - Weeds

This session covers forty six papers from different authors: 1. INTRODUCTION, Vanessa Stewart, Agriculture Western Australia PLENARY 2. Wild radish – the implications for our rotations, David Bowran, Centre for Cropping Systems INTEGRATED WEED MANAGEMENT IWM system studies/demonstration sites 3. Integrated weed management: Cadoux, Alexandra Wallace, Agriculture Western Australia 4. A system approach to managing resistant ryegrass, Bill Roy, Agricultural Consulting and Research Services Pty Ltd, York 5. Long term herbicide resistance demonstration, Peter Newman, Agriculture Western Australia, Cameron Weeks, Tony Blake and Dave Nicholson 6. Integrated weed management: Katanning, Alexandra Wallace, Agriculture Western Australia 7. Integrated weed management: Merredin, Vanessa Stewart, Agriculture Western Australia 8. Short term pasture phases for weed control, Clinton Revell and Candy Hudson, Agriculture Western Australia Weed biology – implications for IWM 9. Competitivness of wild radish in a wheat-lupin rotation , Abul Hashem, Nerys Wilkins, and Terry Piper, Agriculture Western Australia 10. Population explosion and persistence of wild radish in a wheat-lupin rotation, Abul Hashem, Nerys Wilkins, Aik Cheam and Terry Piper , Agriculture Western Australia 11. Variation is seed dormancy and management of annual ryegrass, Amanda Ellery and Ross Chapman, CSIRO 12. Can we eradicate barley grass, Sally Peltzer, Agriculture Western Australia Adoption and modelling 13. Where to with RIM? Vanessa Stewart1 and Robert Barrett-Lennard2, 1Agriculture Western Australia, 2Western Australian Herbicide Resistance Initiative (WAHRI) 14. Multi-species RIM model, Marta Monjardino1,2, David Pannell2 and Stephen Powles1 1Western Australian Herbicide Resistance Initiative (WAHRI), 2ARE, University of Western Australia 15. What causes WA grain growers to adopt IWM practices? Rick Llewellyn, WAHRI/ARE, Faculty of Agriculture, University of WA New options for IWM? 16. Fuzzy tramlines for more yield and less weeds, Paul Blackwell Agriculture Western Australia, and Maurice Black, Harbour Lights Estate, Geraldton 17. Inter-row knockdowns for profitable lupins, Paul Blackwell, Agriculture Western Australia and Miles Obst, Farmer Mingenew 18. Row cropping and weed control in lupins, Mike Collins and Julie Roche, Agriculture Western Australia 19. Cross seedimg suppresses annual ryegrass and increases wheat yield, Abul Hashem, Dave Nicholson and Nerys Wilkins Agriculture Western Australia 20. Weed control by chaff burial, Mike Collins, Agriculture Western Australia HERBICIDE RESISTANCE 21. Resistance in wild oats to Fop and Dim herbicides in Western Australia, Abul Hashem and Harmohinder Dhammu, Agriculture Western Australia 22. Triazine and diflufenican resistance in wild radish: what it means to the lupin industry, Aik Cheam, Siew Lee, David Nicholson and Peter Newman, Agriculture Western Australia 23. Comparison if in situ v seed testing for determining herbicide resistance, Bill Roy, Agricultural Consulting and Research Services Pty Ltd, York HERBICIDE TOLERANCE 24. Phenoxy herbicide tolerance of wheat, Peter Newman and Dave Nicholson, Agriculture Western Australia 25. Tolerance of wheat to phenoxy herbicides, Harmohinder S. Dhammu, Terry Piper and Mario F. D\u27Antuono, Agriculture Western Australia 26. Herbicide tolerance of new wheats, Harmohinder S. Dhammu, Terry Piper and David F. Nicholson, Agriculture Western Australia 27. Herbicide tolerance of durum wheats, Harmohinder S. Dhammu, Terry Piper and David F. Nicholson, Agriculture Western Australia 28. Herbicide tolerance of new field pea varieties, Harmohinder S. Dhammu, Terry Piper, David F. Nicholson, and Mario F. D\u27Antuono, Agriculture Western Australia 29. Herbicide tolerance of Cooke field peas on marginal soil, Harmohinder S. Dhammu, Terry Piper, David F. Nicholson, and Mario F. D\u27Antuono, Agriculture Western Australia 30. Herbicide tolerance of some annual pasture legumes adapted to coarse textured sandy soils, Clinton Revell and Ian Rose, Agriculture Western Australia 31 Herbicide tolerance of some annual pasture legumes adapted to fine textured clay soils, Clinton Revell and Ian Rose, Agriculture Western Australia WEED CONTROL IN LUCERNE 32. Management of weeds for Lucerne establishment, Diana Fedorenko, Clayton Butterly, Stuart McAlpine, Terry Piper and David Bowran, Centre for Cropping Systems, Agriculture Western Australia 33. Management of weeds in the second year of Lucerne, Diana Fedorenko, Clayton Butterly, Stuart McAlpine, Terry Piper and David Bowran, Centre for Cropping Systems, Agriculture Western Australia 34. Residual effects of weed management in the third year of Lucerne, Diana Fedorenko, Clayton Butterly, Stuart McAlpine, Terry Piper and David Bowran, Centre for Cropping Systems, Agriculture Western Australia 35. Herbicide tolerance and weed control in Lucerne, Peter Newman, Dave Nicholson and Keith Devenish Agriculture Western Australia HERBICIDES – NEW PRODUCTS/PRODUCE USES; USE New products or product use 36. New herbicide options for canola, John Moore and Paul Matson, Agriculture Western Australia 37. Chemical broadleaf weed management in Peaola, Shannon Barraclough and Lionel Martin, Muresk Institute of Agriculture, Curtin University of Technology 38. Balance® - a new broad leaf herbicide for the chickpea industry, Mike Clarke, Jonas Hodgson and Lawrence Price, Aventis CropScience 39. Marshmallow – robust herbicide strategies, Craig Brown, IAMA Agribusiness 40. Affinity DF – a prospective option for selective in-crop marshmallow control, Gordon Cumming, Technical Officer, Crop Care Australasia 41. A new formulation of Carfentrazone-ethyl for pre-seeding knockdown control of broadleaved weeds including Marshmallow, Gordon Cumming, Technical Officer, Crop Care Australasia Herbicide use 42. Autumn applied trifluralin can be effective! Bill Crabtree, Scientific Officer, Western Australian No-Tillage Farmers Association 43. Which knockdown herbicide for small ryegrass? Peter Newman and Dave Nicholson, Agriculture Western Australia 44. Poor radish control with Group D herbicides in lupins, Peter Newman and Dave Nicholson, Agriculture Western Australia WEED ISSUES 45. Distribution and incidence of aphids and barley yellow dwarf virus in over-summering grasses in the WA wheatbelt, Jenny Hawkes and Roger Jones, CLIMA and Agriculture Western Australia 46. e-weed, Vanessa Stewart, Agriculture Western Australia CONTRIBUTING AUTHOR CONTACT DETAIL

What are the holistic experiences of adults living long-term with the consequences of cancer and its treatment? A qualitative evidence synthesis

© 2020 Elsevier Ltd Purpose: The number of people living with and beyond cancer is increasing; a significant number of these people will experience the long-term and late effects of cancer and its treatment. Research into this group has been identified as a priority to better understand healthcare needs. This review identified and synthesised qualitative research data relating to the lived experience of the consequences of cancer and its treatment. Methods: A systematic search via electronic databases was conducted in July 2019. Literature was identified that explored the experience of adults living beyond cancer from their own perspective. Thematic synthesis was used to extract and analyse data. Results: Six articles were reviewed. Three main themes were identified with four subthemes:1. Living with an altered sense of self; 2. Things are never going to be quite the same again (2.1. The unexpected. 2.2 The uncertain.); 3. Ways of coping with the unexpected and the uncertain. (3.1. Drawing on internal resilience. 3.2. The influence and impact of external relationships.). The findings showed that the participants’ world-view changed after cancer and this affected everyday lives both positively and negatively. Conclusions: The experience of having had cancer remains significant long after diagnosis and treatment, yet effective preparation and ongoing support for living beyond cancer is lacking. The experience of living long-term after cancer is characterised by an altered sense of self and has implications for long-term wellbeing. Further research should explore healthcare needs and services required to adequately meet the needs of this growing group of people