Septic emboli secondary to Infective Endocarditis

A 31 year old lady was brought to casualty by a friend, unconscious and incontinent of urine and faeces. She was responsive to verbal stimuli with a Glasgow Come Scale (GCS) of 10 and noted to have a fever of 39.6oC. She had a blood pressure (BP) of 116/65 mmHg and a pulse rate of 160 bpm. She was allegedly unresponsive for two days prior to admission. She is a known intravenous drug user (IVDU). Physical examination revealed bilateral puncture wounds in the groin. In view of her poor general condition she was admitted to the intensive therapy unit (ITU). She was started in empirical antibiotics which included both G+ and G- coverage. Blood culture eventually grew a methicillin sensitive staphylococcus areus (MSSA), and the antibiotics were eventually downgraded to flucloxacillin. A transoesophageal echocardiogram (TOE) showed a massive infective endocarditis of the mitral valve, which was rendered incompetent. An MRI scan of the brain revealed multiple septic emboli resulting in several cerebral infarcts.peer-reviewe

Assessing the see-and-treat approach for the management of high-grade squamous intraepithelial cervical lesions

Objectives: To assess local histological outcomes in patients with HSIL cytology results on cervical smears, in both the see-and-treat and three-step approach. Study Design: A retrospective analysis of patients with HSIL on cervical cytology was performed, obtaining an 83 patient cohort. The histological result following the primary investigation (colposcopic-directed biopsy or excisional procedure) was noted for each patient together with their demographic variables and HPV status. Results: Of 83 patients with HSIL cytology on cervical smear, 43 underwent LLETZ as a primary procedure, while 40 patients underwent a colposcopic-directed biopsy. There was no statistically significant difference in terms of dermographics and HPV status between the two groups. In those patients who had LLETZ as a primary procedure, 29 had CIN2+ on histology. On the other hand, following colposcopic-directed biopsies, 17 resulted in CIN2+ on histology. Conclusion: The conventional approach within our local setting potentially has inferior sensitivity in picking up CIN2+ lesions when compared to the see-and-treat approach. On the other hand, primary excisional procedures were associated with an overtreatment rate of at least 20.9%, subjecting patients to unnecessary risks. Local improvement of colposcopic skill will aid to reduce this overtreatment rate and missed lesions at biopsy.peer-reviewe

Imaging of low back pain in a public health centre : a study of test request behaviour of doctors

Background Lumbosacral spine radiography is a proven and valuable procedure for evaluating the vertebrae, disk spaces, facet and uncovertebral joints, neural foramina and paravertebral soft tissues. The purpose of radiographic examinations is to identify or exclude anatomic abnormalities or disease processes of the spine and related tissues. The written or electronic requests should provide the necessary information to show the medical need for the examination and allow for its appropriate performance and interpretation. Objective Our study was conducted to evaluate the appropriateness of lumbar spine radiography requests for low back pain in a public health centre. The benchmarks used were the 2009 NICE guidelines on the management of persistent non-specific low back pain and the 2011 Royal College of Radiologists’ referral guidance. Method A descriptive, retrospective, cross-sectional study design was applied. A random sample of 100 lumbosacral spine radiographs was analyzed as recommended by the Royal College of Radiologists guideline tool and the 2009 NICE guidelines. Data was obtained from the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). Results Sixty-four percent (n=64) of lumbar radiographs performed for low back pain were indicated and judged as appropriate as per existing guidelines. One radiograph (1%) was performed for non-specific low back pain. Conclusion This study reached its objectives of evaluating the appropriateness of lumbar spine radiography requests for low back pain. It was noted that there is a need to increase awareness of the Royal College of Radiologists guidelines to enhance appropriate use of lumbosacral spine radiography to ensure more efficient resource utilisationpeer-reviewe

The impact of biologic therapy for moderate-to-severe psoriasis on the immune responses to SARS-CoV2 infection and vaccination

Dear Editor, we explored the impact of biologics and conventional therapies for psoriasis on humoral and T-cellular responses to SARS-CoV-2 infection and vaccine. The study (EUDRA 2020-004965-37 Humanitas ICH Ethic Committee) was conducted at the Istituto Clinico Humanitas-Rozzano, Milan, and at the University of Verona, Italy. The enrolled patients were affected by moderate-to-severe psoriasis and were divided into two groups: those who had developed COVID-19 infection (group 1, n=95) and those who underwent COVID-19 vaccination (group 2, n=77

Concept and design of a genome-wide association genotyping array tailored for transplantation-specific studies

Background: In addition to HLA genetic incompatibility, non-HLA difference between donor and recipients of transplantation leading to allograft rejection are now becoming evident. We aimed to create a unique genome-wide platform to facilitate genomic research studies in transplant-related studies. We designed a genome-wide genotyping tool based on the most recent human genomic reference datasets, and included customization for known and potentially relevant metabolic and pharmacological loci relevant to transplantation. Methods: We describe here the design and implementation of a customized genome-wide genotyping array, the ‘TxArray’, comprising approximately 782,000 markers with tailored content for deeper capture of variants across HLA, KIR, pharmacogenomic, and metabolic loci important in transplantation. To test concordance and genotyping quality, we genotyped 85 HapMap samples on the array, including eight trios. Results: We show low Mendelian error rates and high concordance rates for HapMap samples (average parent-parent-child heritability of 0.997, and concordance of 0.996). We performed genotype imputation across autosomal regions, masking directly genotyped SNPs to assess imputation accuracy and report an accuracy of >0.962 for directly genotyped SNPs. We demonstrate much higher capture of the natural killer cell immunoglobulin-like receptor (KIR) region versus comparable platforms. Overall, we show that the genotyping quality and coverage of the TxArray is very high when compared to reference samples and to other genome-wide genotyping platforms. Conclusions: We have designed a comprehensive genome-wide genotyping tool which enables accurate association testing and imputation of ungenotyped SNPs, facilitating powerful and cost-effective large-scale genotyping of transplant-related studies. Electronic supplementary material The online version of this article (doi:10.1186/s13073-015-0211-x) contains supplementary material, which is available to authorized users

Upadacitinib for the treatment of concomitant psoriasis and atopic dermatitis: a case series

Purpose: The overlap of psoriasis and atopic dermatitis (AD) is rare and treating moderate-to-severe cases can be challenging. Conventional immune-suppressive drugs cannot be used long-term, and no biological drugs are currently approved for treating both conditions. Method: We report the cases of four patients with overlapping features of both psoriasis and AD. Result: After being treated with several systemic drugs, including gold-standard treatments for both psoriasis and AD, they received upadacitinib 15 or 30 mg, achieving complete remission. Upadacitinib is an inhibitor of Janus Kinase 1, currently approved for treating moderate-to-severe AD. Conclusion: To date, very limited data are available regarding the efficacy of upadacitinib in psoriasis. In a phase-3 trial on the efficacy of upadacitinib 15 mg in patients affected by psoriatic arthritis, 52.3% of patients achieved a 75% improvement in Psoriasis Area and Severity Index (PASI75) after one year. Currently, no clinical trials are evaluating the efficacy of upadacitinib in plaque psoriasis