Retroperitoneal Sarcoma With Infected Necrosis: An Unfavourable Prognostic Factor

Purpose. To report the phenomenon of infected retroperitoneal sarcoma (RPS)

Pulmonary Tumour Embolism Complicating a Case of Leiomyosarcoma

Patient. A case of peripheral leiomyosarcoma presenting with features of pulmonary thromboembolism is described

Laboratory-based surveillance of Campylobacter and Salmonella infection and the importance of denominator data

Laboratory data are the cornerstone in surveillance of infectious disease. We investigated whether changes in reported incidence of Campylobacter and Salmonella infection might be explained by changes in stool sampling rates. Data were extracted from a national database on 585 843 patient stool samples tested by microbiology laboratories in Wales between 1998 and 2008. Salmonella incidence fell from 43 to 19 episodes/100 000 population but Campylobacter incidence after declining from 111/100 000 in 1998 to 84/100 000 in 2003 rose to 119/100 000 in 2008. The proportion of the population sampled rose from 2·0% in 1998 to 2·8% in 2008, mostly due to increases in samples from hospital patients and older adults. The proportion of positive samples declined for both Salmonella and Campylobacter from 3·1% to 1·1% and from 8·9% to 7·5%, respectively. The decline in Salmonella incidence is so substantial that it is not masked even by increased stool sampling, but the recent rise in Campylobacter incidence may be a surveillance artefact largely due to the increase in stool sampling in older people

Ethnic variation in outcome of people hospitalised during the first COVID-19 epidemic wave in Wales (UK):an analysis of national surveillance data using Onomap, a name-based ethnicity classification tool

Objective To identify ethnic differences in proportion positive for SARS-CoV-2, and proportion hospitalised, proportion admitted to intensive care and proportion died in hospital with COVID-19 during the first epidemic wave in Wales.Design Descriptive analysis of 76 503 SARS-CoV-2 tests carried out in Wales to 31 May 2020. Cohort study of 4046 individuals hospitalised with confirmed COVID-19 between 1 March and 31 May. In both analyses, ethnicity was assigned using a name-based classifier.Setting Wales (UK).Primary and secondary outcomes Admission to an intensive care unit following hospitalisation with a positive SARS-CoV-2 PCR test. Death within 28 days of a positive SARS-CoV-2 PCR test.Results Using a name-based ethnicity classifier, we found a higher proportion of black, Asian and ethnic minority people tested for SARS-CoV-2 by PCR tested positive, compared with those classified as white. Hospitalised black, Asian and minority ethnic cases were younger (median age 53 compared with 76 years; p<0.01) and more likely to be admitted to intensive care. Bangladeshi (adjusted OR (aOR): 9.80, 95% CI 1.21 to 79.40) and ‘white – other than British or Irish’ (aOR: 1.99, 95% CI 1.15 to 3.44) ethnic groups were most likely to be admitted to intensive care unit. In Wales, older age (aOR for over 70 years: 10.29, 95% CI 6.78 to 15.64) and male gender (aOR: 1.38, 95% CI 1.19 to 1.59), but not ethnicity, were associated with death in hospitalised patients.Conclusions This study adds to the growing evidence that ethnic minorities are disproportionately affected by COVID-19. During the first COVID-19 epidemic wave in Wales, although ethnic minority populations were less likely to be tested and less likely to be hospitalised, those that did attend hospital were younger and more likely to be admitted to intensive care. Primary, secondary and tertiary COVID-19 prevention should target ethnic minority communities in Wales

Primary Cutaneous Melanoma-Management in 2024

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy

Identifying outbreaks of sexually transmitted infection: who cares?

BACKGROUND: Current routine surveillance schemes for sexually transmitted infections (STIs) in the United Kingdom (UK) are not designed for outbreak identification. Recognising STI outbreaks, therefore, depends almost entirely on the alertness of health professionals. The objective of this study was to explore health professionals' knowledge of, and attitudes towards, identification and investigation of STI outbreaks in Wales. METHODS: We conducted a cross-sectional survey in Wales in June 2005, and sent a questionnaire to consultants of genitourinary medicine (GUM, n = 11), a consultant microbiologist from each laboratory (n = 14), all consultants in communicable disease control (n = 5), and to epidemiologists of the National Public Health Service (n = 4). RESULTS: 26 (76%) of 34 survey recipients responded. Of these, 17 (65%) ranked the investigation of STI outbreaks as important or very important, and 19 (73%) perceived participation in the investigation of an STI outbreak as part of their responsibility. Only six (25%) respondents had actively searched their computer system or patient records for a possible STI outbreak in the previous twelve months, and 15 (63%) had never looked for an outbreak. Of seven GUM physicians who said they had identified at least one STI outbreak, three had never informed public health authorities. CONCLUSION: Prompt identification and coordinated investigation of outbreaks, usually through a multidisciplinary outbreak control team, is central to the control of many infectious diseases. This does not appear to be the case for STIs, which we believe represents a lost opportunity to reduce transmission. Besides improved surveillance methods, a change in culture towards STI outbreaks is needed among health professionals in Wales

Objects as Curricula: rethinking the capacities and affects of Blackfoot material artefacts

The late Frank Weasel Head, a Blackfoot Elder, observed of Blackfoot artefacts held in museum collections worldwide that these were not merely objects, but curricula. This paper will discuss the Mootookakio’ssin/Distant Awareness project, which brings together Indigenous and Non-Indigenous artists, museum professionals, archaeologists and anthropologists, led by Blackfoot ceremonial leaders, which has made digital captures of Blackfoot items in UK museum collections (Clark et. al. 2022; Minkin et. al. 2022). This paper asks what capacities were supported and permitted by the process of digital imaging, and what is the effect of considering material artefacts as curricula? Over the last twenty years or more, material culture studies have become an intellectual battleground, with competing accounts of the proper way to study material artefacts debated; from symmetrical archaeology and object oriented ontology, to new materialism. All of these accounts have been influenced by metaphysics, while some of them have also been influenced by, often unacknowledged, Indigenous accounts (see e.g., Todd 2016). Rather than merely giving Indigenous accounts lip service, this paper asks what happens when we take Indigenous philosophies seriously? How does this guide our practices and interpretations? What capacities do digital models have to teach us

Mootookakio’ssin Distant Awareness: Digital Imaging, Remote Viewing and Blackfoot items in the collections of Marischal Museum and National Museums Scotland

‘New and changing technologies can work against the people or be harnessed and used in their own worldview’: Narcisse Blood. Mootookakio’ssin began with a circle gathering of Blackfoot Elders and researchers in July 2018 to discuss the digitization of Blackfoot items currently held in museum collections in the UK, and has since expanded to create a trans-Atlantic network of Indigenous and non-Indigenous artists, museum professionals, digital specialists, anthropologists, and archaeologists, guided by Blackfoot ceremonial leaders. Knowledge Holders felt that virtual access utilising digital imaging techniques and spatial web technology would fit with their ongoing efforts to assist in processes of knowledge renewal and transmission. The name, Mootookakio’ssin, was given to the project by Dr. Leroy Little Bear. In English it means distant awareness. The name proved prescient as our collaboration moved from in person events and collection visits to virtual interactions over the pandemic period. Prior to the COVID 19 pandemic, we were planning for members of our group to visit Marischal Museum at the University of Aberdeen, where staff have a long-standing connection with the Blackfoot nations, and the National Museums Collection Centre (NMCC) in Edinburgh, which cares for Blackfoot items never before visited by Blackfoot people. Once it became clear that this visit would not be happening, a new research question emerged: how might we design a remote viewing experience to support the cultural revitalization for Indigenous communities when in-person access is not an option? In this paper we bring our interdisciplinary perspectives to bear on the practicalities, benefits and possibilities of remote viewing. Drawing on our virtual visits to Marischal Museum and NMCC we illustrate how interdisciplinary learning can be used as a methodology to interrogate complex problems and advocate for a greater understanding of the usage and impact of digital imaging practices across disciplines