Water intoxication presenting as maternal and neonatal seizures: a case report.

Introduction We present an unusual case of fitting in the mother and newborn child, and the challenges faced in the management of their hyponatraemia due to water intoxication. Case presentation A previously well 37-year-old, primigravid Caucasian woman presented with features mimicking eclampsia during labour. These included confusion, reduced consciousness and seizures but without a significant history of hypertension, proteinuria or other features of pre-eclampsia. Her serum sodium was noted to be low at 111 mmol/litre as was that of her newborn baby. She needed anti-convulsants with subsequent intubation to stop the fitting and was commenced on a hypertonic saline infusion with frequent monitoring of serum sodium. There is a risk of long-term neurological damage from central pontine myelinolysis if the hyponatraemia is corrected too rapidly. Mother and baby went on to make a full recovery without any long-term neurological complications. Conclusion There is little consensus on the treatment of life-threatening hyponatraemia. Previous articles have outlined several possible management strategies as well as their risks. After literature review, an increase in serum sodium concentration of no more than 8–10 mmol/litre in 24 hours is felt to be safe but can be exceeded with extreme caution if life-threatening symptoms do not resolve. Formulae exist to calculate the amount of sodium needed and how much hypertonic intravenous fluid will be required to allow safer correction. We hypothesise the possible causes of hyponatraemia in this patient and underline its similarity in symptom presentation to eclampsia

Clinical features of colorectal cancer before diagnosis: a population-based case-control study

This is the final version of the article. Available from the publisher via the DOI in this record.Most colorectal cancers are diagnosed after the onset of symptoms. However, the risk of colorectal cancer posed by particular symptoms is largely unknown, especially in unselected populations like primary care. This was a population-based case-control study in all 21 general practices in Exeter, Devon, UK, aiming to identify and quantify the prediagnostic features of colorectal cancer. In total, 349 patients with colorectal cancer, aged 40 years or more, and 1744 controls, matched by age, sex and general practice, were studied. The full medical record for 2 years before diagnosis was coded using the International Classification of Primary Care-2. We calculated odds ratios for variables independently associated with cancer, using multivariable conditional logistic regressions, and then calculated the positive predictive values of these variables, both individually and in combination. In total, 10 features were associated with colorectal cancer before diagnosis. The positive predictive values (95% confidence interval) of these were rectal bleeding 2.4% (1.9, 3.2); weight loss 1.2% (0.91, 1.6); abdominal pain 1.1% (0.86, 1.3); diarrhoea 0.94% (0.73, 1.1); constipation 0.42% (0.34, 0.52); abnormal rectal examination 4.0% (2.4, 7.4); abdominal tenderness 1.1% (0.77, 1.5); haemoglobin 10 mmol l(-1) 0.78% (0.51, 1.1): all P < 0.001. Earlier diagnosis of colorectal cancer may be possible using the predictive values for single or multiple symptoms, physical signs or test results.Project funding from the Department of Health. The funding source had no role in study design, data collection, analysis or writing of the report. All authors had full access to all data, and take final responsibility for publication. WH was funded through his research practice (Barnfield Hill, Exeter) and RCGP/BUPA and NHS Fellowships. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. We wish to thank all 21 general practices in Exeter, the Dendrite personnel, and the Patients and Practitioners Service Authority, without which this project would not have been successful

Risk of ovarian cancer in women with symptoms in primary care: population based case-control study.

addresses: NIHR School for Primary Care Research, Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA, UK. [email protected]: PMCID: PMC2731836types: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov'tCopyright © 2009 by the BMJ Publishing Group Ltd. This articles was first published in: BMJ, 2009, Vol. 339, pp. b2998 -To identify and quantify symptoms of ovarian cancer in women in primary care

The consequences of feminization in breeding groups of wild fish

EHP is a publication of the U.S. government. Publication of EHP lies in the public domain and is therefore without copyright. Research articles from EHP may be used freely; however, articles from the News section of EHP may contain photographs or figures copyrighted by other commercial organizations and individuals that may not be used without obtaining prior approval from both the EHP editors and the holder of the copyright. Use of any materials published in EHP should be acknowledged (for example, "Reproduced with permission from Environmental Health Perspectives") and a reference provided for the article from which the material was reproduced.BACKGROUND: The feminization of nature by endocrine-disrupting chemicals (EDCs) is a key environmental issue affecting both terrestrial and aquatic wildlife. A crucial and as yet unanswered question is whether EDCs have adverse impacts on the sustainability of wildlife populations. There is widespread concern that intersex fish are reproductively compromised, with potential population-level consequences. However, to date, only in vitro sperm quality data are available in support of this hypothesis. OBJECTIVE: The aim of this study was to examine whether wild endocrine-disrupted fish can compete successfully in a realistic breeding scenario. METHODS: In two competitive breeding experiments using wild roach (Rutilus rutilus), we used DNA microsatellites to assign parentage and thus determine reproductive success of the adults. RESULTS: In both studies, the majority of intersex fish were able to breed, albeit with varying degrees of success. In the first study, where most intersex fish were only mildly feminized, body length was the only factor correlated with reproductive success. In the second study, which included a higher number of more severely intersex fish, reproductive performance was negatively correlated with severity of intersex. The intersex condition reduced reproductive performance by up to 76% for the most feminized individuals in this study, demonstrating a significant adverse effect of intersex on reproductive performance. CONCLUSION: Feminization of male fish is likely to be an important determinant of reproductive performance in rivers where there is a high prevalence of moderately to severely feminized males.Funding for this work was derived through the Endocrine Disruption in Catchments project, which was supported by the U.K. Department for Environment Food and Rural Affairs and the U.K. Environment Agency

Prescribing of medication for attention deficit hyperactivity disorder among young people in the Clinical Practice Research Datalink 2005-2013: analysis of time to cessation

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.The aim of this study was to examine the time to cessation of ADHD medication amongst young people with ADHD aged 16 in the period 2005-2013. Previous studies of prescribing in primary care reported high rates of medication cessation amongst 16 and 17 year olds with ADHD. The examination of trends since the introduction of new NICE guidance in 2008 will support service planning and improvement of outcomes over the vulnerable transition period from child to adult services. We used primary care records from the Clinical Practice Research Datalink and identified cases prescribed ADHD medication at the time of their 16th birthday during the study period. The outcome was time to medication cessation from the age of 16. Cessation of medication was defined as occurring at the beginning of a gap of over 6 months in prescriptions. 1620 cases were included. The median time to cessation was 1.51 years (95% CI 1.42-1.67).The estimated probability of remaining on medication was 0.63 (95% CI 0.61-0.65) at age 17 (i.e., at 1 year) and 0.41 (95% CI 0.39-0.43) at age 18. Young people with ADHD remain at high risk of cessation of medication during the transition from child to adult services. Despite the restriction that only primary care prescribing data were available, the results suggest continuing disparity between expected levels of symptom persistence and continuation of medication.This research was funded as part of a Doctoral Research Fellowship from the National Institute for Health Research held by Tamsin Newlove-Delgado (Reference: DRF-2012-05-221). Tamsin Newlove-Delgado is currently funded by an NIHR Academic Clinical Lectureship. Ken Stein and Obioha C. Ukoumunne were funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at Royal Devon and Exeter NHS Foundation Trust. This report is independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health

The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study

© 2009 Hamilton et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Colorectal cancer is generally diagnosed following a symptomatic presentation to primary care. Although the presenting features of the cancer are well described, the risks they convey are less well known. This study aimed to quantify the risk of cancer for different symptoms, across age groups and in both sexes

The risk of oesophago-gastric cancer in symptomatic patients in primary care: a large case-control study using electronic records

ArticleBACKGROUND: Over 15 000 new oesophago-gastric cancers are diagnosed annually in the United Kingdom, with most being advanced disease. We identified and quantified features of this cancer in primary care. METHODS: Case-control study using electronic primary-care records of the UK patients aged ≥40 years was performed. Cases with primary oesophago-gastric cancer were matched to controls on age, sex and practice. Putative features of cancer were identified in the year before diagnosis. Odds ratios (ORs) were calculated for these features using conditional logistic regression, and positive predictive values (PPVs) were calculated. RESULTS: A total of 7471 cases and 32 877 controls were studied. Sixteen features were independently associated with oesophago-gastric cancer (all P5% in patients ≥55 years was for dysphagia. In patients <55 years, all PPVs were <1%. CONCLUSION: Symptoms of oesophago-gastric cancer reported in secondary care were also important in primary care. The results should inform guidance and commissioning policy for upper GI endoscopy

Energy-Efficient Ferroelectric Field-Effect Transistor-Based Oscillators for Neuromorphic System Design

Neuromorphic or bioinspired computational platforms, as an alternative for von-Neumann structures, have benefitted from the excellent features of emerging technologies in order to emulate the behavior of the biological brain in an accurate and energy-efficient way. Integrability with CMOS technology and low power consumption make ferroelectric field-effect transistor (FEFET) an attractive candidate to perform such paradigms, particularly for image processing. In this article, we use the FEFET device to make energy-efficient oscillatory neurons as the main parts of neural networks for image processing applications, especially for edge detection. Based on our simulation results, we estimated a significant energy efficiency compared with other technologies, which shows roughly 5-120\times reduction, depending on the design

Thunderclap headache triggered by micturition: responsive to nimodipine

Primary thunderclap headache (TCH) is a rare condition, of which the onset can be triggered by coughing, exercise, and sexual activity. Micturition is a recognized trigger of secondary TCH with pheochromocytoma in bladder, but not of primary TCH. We describe a patient with an apparent primary TCH, which repeatedly occurred immediately after micturition until she achieved a therapeutic dosage of nimodipine

Event-Based Processing of Single Photon Avalanche Diode Sensors

© 2001-2012 IEEE. Single Photon Avalanche Diode sensor arrays operating in direct time of flight mode can perform 3D imaging using pulsed lasers. Operating at high frame rates, SPAD imagers typically generate large volumes of noisy and largely redundant spatio-temporal data. This results in communication bottlenecks and unnecessary data processing. In this work, we propose a neuromorphic processing solution to this problem. By processing the spatio-temporal patterns generated by the SPADs in a local, event-based manner, the proposed 128\times 128 pixel sensor-processor system reduces the size of output data from the sensor by orders of magnitude while increasing the utility of the output data in the context of challenging recognition tasks. To test the proposed system, the first large scale complex SPAD imaging dataset is captured using an existing 32\times 32 pixel sensor. The generated dataset consists of 24000 recordings and involves high-speed view-invariant recognition of airplanes with background clutter. The frame-based SPAD imaging dataset is converted via several alternative methods into event-based data streams and processed using the proposed 125\times 125 receptive field neuromorphic processor as well as a range of feature extractor networks and pooling methods. The output of the proposed event generation methods are then processed by an event-based feature extraction and classification system implemented in FPGA hardware. The event-based processing methods are compared to processing the original frame-based dataset via frame-based but otherwise identical architectures. The results show the event-based methods are superior to the frame-based approach both in terms of classification accuracy and output data-rate