Yield of Muscle Biopsy in Patients with Findings of Myopathy on Electrodiagnostic Testing

Background: The evaluation of neuromuscular diseases includes detailed clinical assessment, blood testing, electrodiagnostic studies (EDS), biopsy, and genetic tests. EDS alone cannot provide a specific diagnosis. Further testing in the form of genetic tests or muscle biopsy (MB) is required. Objective The objective of the study is to evaluate the yield of MB in patients with findings of myopathy on electrodiagnostic testing and assess the factors affecting an abnormal biopsy outcome. Methods: Electromyography (EMG)/nerve conduction studies (NCS) performed for suspected myopathy over 5 years from 2011 to 2016, at the neurophysiology department of a tertiary care center in Pakistan, were reviewed. Based on inclusion criteria, records of 58 patients were retrospectively reviewed. Results: After an EMG/NCS diagnosis of myopathy, the frequency of MB testing was only 10.1%. The median age of patients was 26.5 years. The clinically suspected diagnosis was categorized into hereditary myopathy (n = 15, 25.9%) and acquired myopathy (n = 18, 31%). The positive predictive value of EMG is 77.2%. Twenty-eight (48.2%) patients had abnormal MB whereas 20 (34.4%) revealed normal findings. Factors significantly influencing an abnormal outcome of biopsy included moderate-to-severe elevation of creatine kinase (\u3e2,000 U/L),presence of denervation changes, and severe myopathy on EMG. Conclusion: Even though the overall yield of MB testing may not be very high in our setting due to the unavailability of special techniques and expertise, certain factors can help to improve the diagnostic yield. Clinicians should encourage MB testing, especially in cases with strong clinical, laboratory and electrodiagnostic suspicion, and absence of genetic testing for suspected myopathy

Translating knowledge for action against stroke – using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke)

Participant timeline. (DOCX 48 kb

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

ZnSe-rGO nanocomposites as photocatalysts for purification of textile dye contaminated water: A green approach to use wastewater for maize cultivation

Disputes about the probable availability of safe water and the efficacy of processed wastewater are key issues that necessitate a suitable solution to enhance the quality of clean water. The current research emphasizes the synthesis of ZnSe-reduced graphene oxide nanocomposites (ZnSe:rGO) with different weight ratios of rGO (represented as X = 0.6, 1 and 1.6 g)via one-step hydrothermal method. The photocatalytic performance for the degradation of methyl violet (MV) dye was investigated under visible light irradiation by varying the reaction parameters. The crystal structure, elemental composition, surface functionality and morphology of the synthesized ZnSe-XrGO nanocomposites were estimated by powder X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX), Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopic (SEM) techniques. UV–visible spectroscopy was used to investigate the optical properties. The highest efficiency is obtained for ZnSe-XrGO in 1:1 and it showed pseudo 1st order behavior with rate constant of 0.0167min−1and 94 % photodegradation of MV in just 3 h. Furthermore, hazardous effects of MV were investigated on the germination and growth of Zea mays seeds by giving them aqueous solution of MV (0, 8, 12, 24 and 48 ppm) and the decontaminated water after photodegradation of MV with the synthesized photoactive composite. The results showed profound negative effect on both germination and seedling growth at higher concentration (>12 ppm) of the dye solution. No hazardous effects were observed on both these parameters when it was given the dye degraded water which reflects the practical use of the synthesized catalyst for water remediation. The current study fulfills the goal of designing an efficient visible-light active nano-photocatalyst and its direct applicability on life sciences for water purification

Rider skill affects time and frequency domain postural variables when performing shoulder-in

In equestrian sports the novice rider learns first to follow the movements of the horse's back and then how to influence the horse's performance. One of the rider's challenges is to overcome inherent horse/rider asymmetry patterns when riding in straight lines, mirroring the movements on the left and right sides when turning. This study compares the performance of novice and advanced riders when riding in sitting trot on straight lines and when riding shoulder-in to the left and right sides. Eight novice and eight advanced horse-rider combinations performed sitting trot in a straight line, shoulder-in left and shoulder-in right while wearing a full body set of inertial sensors. An experienced dressage judge indicated when the movements were being performed correctly and assigned scores on a scale of 0-10 for the quality of performance. Kinematic data from the inertial sensors were analysed in time and frequency domain. Comparisons were made between trotting on the straight, shoulder-in left and shoulder-in right. Advanced riders received higher dressage scores on all three movements, but significantly (p<0.05) lower scores were found for shoulder-in right across the two groups. When riding shoulder-in, advanced riders had greater hip extension (advanced=-5.8±17.7; novice=7.8±8.9 degrees) and external rotation (advanced=-32.4±15.5; novice=-10.8±13.2 degrees) in the outside leg compared with novices (p<0.05) and reflects an important cue in achieving the required body rotation in the horse. Lower scores for shoulder-in right may be linked to significant (p<0.05) changes in harmonics of trunk to pelvis rotation

Beyond Breaking the Chains: Decolonisation as transformation

The eruption of anger that came about after the brutal murder of the African-American, George Floyd in 2021, was translated into a worldwide Black Lives Matter movement which has had long lasting repercussions in the UK. There is a new and generalised feeling of urgency for radical action and a growing knowledge and awareness of historical racial injustice has emerged into the mainstream and within higher education. This is exemplified by the new research centre, the Global Race Centre for Equality (GRACE) at the University of Central Lancashire (UCLan). The aim of this paper is to focus on efforts in transforming decolonisation in the School of Social Work, Care and Community at UCLan. Awareness of the need for decolonisation is an important first step to inclusivity in the curriculum. However, inclusivity is not an end in itself as, in the context of the UK, minority groups might be paradoxically included and excluded at the same time. The complexity of attempts to truly decolonise the curriculum should begin with simple measures, such as reviewing reading lists for students. However, the successful interpretation of inclusivity requires a whole system approach to change, which is nothing less than a radical transformation of structures, norms, routines and habits which many ethnic ‘Anglo-Saxon’ teaching staff at university carry with them, often unconsciously. We say ‘Anglo-Saxon’ in inverted commas and in the knowledge, as described a long time ago by Fanon (1967), that people of different ethnicities are also capable of colonised behaviour, among themselves and towards different ethnicities, as part of the struggle to speak the language of Fanon’s ‘white world’ (p. 15). At the same time, it is also true that all people of colour are objects of difference compared to white people in the Western world. This is the point made by Robinson (1995, pp. 1-2) who chooses to include different ethnicities under the term ‘black’. This article discusses the development of an innovative strategy for change being developed at UCLan

Utility of severity assessment tools in COVID-19 pneumonia: a multicentre observational study.

BACKGROUND Severity scores in pneumonia and sepsis are being applied to SARS-CoV-2 infection. We aimed to assess whether these severity scores are accurate predictors of early adverse outcomes in COVID-19. METHODS We conducted a multicentre observational study of hospitalised SARS-CoV-2 infection. We assessed risk scores (CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2) in relation to admission to intensive care or death within 7 days of admission, defined as early severe adverse events (ESAE). The 4C Mortality Score was also assessed in a sub-cohort of patients. FINDINGS In 2,387 participants, the overall mortality was 18%. In all scores examined, increasing score was associated with increased risk of ESAE. Area under the curve (AUC) to predict ESAE for CURB65, qSOFA, Lac-CURB65, MuLBSTA and NEWS2 were 0.61, 0.62, 0.59, 0.59 and 0.68, respectively. AUC to predict ESAE was 0.60 with ISARIC 4C Mortality Score. CONCLUSION None of the scores examined accurately predicted ESAE in SARS-CoV-2 infection. Non-validated scores should not be used to inform clinical decision making in COVID-19

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally