Statin Autoimmune Necrotizing Myopathy Diagnosed After a Motor Vehicle Accident

One of the most commonly prescribed lipid lowering medications are statins. In most cases, statins are well tolerated. In rare instances, statin induced necrotizing autoimmune myositis (SINAM) can occur. The following case presents a patient with a 15 year history of simvastatin use who developed SINAM following a motor vehicle accident

Null Killing Vector Dimensional Reduction and Galilean Geometrodynamics

The solutions of Einstein's equations admitting one non-null Killing vector field are best studied with the projection formalism of Geroch. When the Killing vector is lightlike, the projection onto the orbit space still exists and one expects a covariant theory with degenerate contravariant metric to appear, its geometry is presented here. Despite the complications of indecomposable representations of the local Euclidean subgroup, one obtains an absolute time and a canonical, Galilean and so-called Newtonian, torsionless connection. The quasi-Maxwell field (Kaluza Klein one-form) that appears in the dimensional reduction is a non-separable part of this affine connection, in contrast to the reduction with a non-null Killing vector. One may define the Kaluza Klein scalar (dilaton) together with the absolute time coordinate after having imposed one of the equations of motion in order to prevent the emergence of torsion. We present a detailed analysis of the dimensional reduction using moving frames, we derive the complete equations of motion and propose an action whose variation gives rise to all but one of them. Hidden symmetries are shown to act on the space of solutions.Comment: LATEX, 41 pages, no figure

Assisting Small and Mid-Size Farmers to Increase Their Access to Markets: A Case Study of an Extension Program to Facilitate Food Hubs in Georgia

This article provides a case study on how Extension can facilitate the creation of food hubs and connect farmers and suppliers with these hubs. To accomplish this, we conducted two surveys: a baseline survey of food hubs in Georgia and a needs assessment survey of farmers. Survey results were then translated into a web-based resource consisting of an interactive map, regional resources, and contact information for personalized assistance in order to facilitate stakeholder communication and connect growers to food hubs. Extension personnel can use this model in other locations where connections between food hubs and farmers are not readily apparent

Aseptic meningitis in a patient taking etanercept for rheumatoid arthritis: a case report

Background \ud We report a case of a 53 year old lady recently commenced on etanercept, an anti-TNF (tumour necrosis factor) therapy for rheumatoid arthritis presenting with \ud confusion, pyrexia and an erythematous rash. \ud \ud Case presentation \ud A lumbar puncture was highly suggestive of bacterial meningitis, but CSF cultures produced no growth, and polymerase chain reactions (PCR) for all previously reported bacterial, fungal and viral causes of meningitis were negative. \ud \ud Conclusions \ud This case report describes aseptic meningitis as a previously unreported complication of etanercept therapy, and serves as a reminder of the rare but potentially lifethreatening risk of serious infections in patients taking anti-TNF therapy for a variety of conditions

Inadequate reporting of research ethics review and informed consent in cluster randomized trials : review of random sample of published trials

Peer reviewedPublisher PD

Exploring the interface between adolescent dysmenorrhoea and endometriosis: a protocol for a cohort and nested case–control study within the QResearch Database

Introduction Dysmenorrhoea affects up to 70%–91% of adolescents who menstruate, with approximately one-third experiencing severe symptoms with impacts on education, work and leisure. Dysmenorrhoea can occur without identifiable pathology, but can indicate underlying conditions, including congenital genital tract anomalies or endometriosis. There is a need for evidence about the management and incidence of dysmenorrhoea in primary care, the impact of treatments in adolescence on long-term outcomes and when to consider the possibility of endometriosis in adolescence. Methods and analysis This study aims to improve the evidence base for adolescents presenting to primary care with dysmenorrhoea. It comprises three interlinked studies. Using the QResearch Database, the study population includes all female at birth participants aged 10–19 years any time between 1 January 2000 and 30 June 2021. We will undertake (1) a descriptive study documenting the prevalence of coded dysmenorrhoea in primary care, stratified by demographic variables, reported using descriptive statistics; (2) a prospective open cohort study following an index cohort of all adolescents recorded as attending primary care with dysmenorrhoea and a comparator cohort of five times as many who have not, to determine the HR for a diagnosis of endometriosis, adenomyosis, ongoing menstrual pain or subfertility (considered singly and in combination) anytime during the study period; and (3) a nested case–control study for adolescents diagnosed with endometriosis, using conditional logistic regression, to determine the OR for symptom(s) preceding this diagnosis. Ethics and dissemination The project has been independently peer reviewed and received ethics approval from the QResearch Scientific Board (reference OX46 under REC 18/EM/0400)

Uptake, effectiveness and safety of COVID-19 vaccines in individuals at clinical risk due to immunosuppressive drug therapy or transplantation procedures: a population-based cohort study in England

: Background: Immunocompromised individuals are at increased risk of severe COVID-19 outcomes, underscoring the importance of COVID-19 vaccination in this population. The lack of comprehensive real-world data on vaccine uptake, effectiveness and safety in these individuals presents a critical knowledge gap, highlighting the urgency to better understand and address the unique challenges faced by immunocompromised individuals in the context of COVID-19 vaccination. Methods: We analysed data from 12,274,946 people in the UK aged > 12 years from 01/12/2020 to 11/04/2022. Of these, 583,541 (4.8%) were immunocompromised due to immunosuppressive drugs, organ transplants, dialysis or chemotherapy. We undertook a cohort analysis to determine COVID-19 vaccine uptake, nested case–control analyses adjusted for comorbidities and sociodemographic characteristics to determine effectiveness of vaccination against COVID-19 hospitalisation, ICU admission and death, and a self-controlled case series assessing vaccine safety for pre-specified adverse events of interest. Results: Overall, 93.7% of immunocompromised individuals received at least one COVID-19 vaccine dose, with 80.4% having received three or more doses. Uptake reduced with increasing deprivation (hazard ratio [HR] 0.78 [95%CI 0.77–0.79] in the most deprived quintile compared to the least deprived quintile for the first dose). Estimated vaccine effectiveness against COVID-19 hospitalisation 2–6 weeks after the second and third doses compared to unvaccinated was 78% (95%CI 72–83) and 91% (95%CI 88–93) in the immunocompromised population, versus 85% (95%CI 83–86) and 86% (95%CI 85–89), respectively, for the general population. Results showed COVID-19 vaccines were protective against intensive care unit (ICU) admission and death in both populations, with effectiveness of over 92% against COVID-19-related death and up to 95% in reducing ICU admissions for both populations following the third dose. COVID-19 vaccines were generally safe for immunocompromised individuals, though specific doses of ChAdOx1, mRNA-1273 and BNT162b2 raised risks of specific cardiovascular/neurological conditions. Conclusions: COVID-19 vaccine uptake is high in immunocompromised individuals on immunosuppressive drug therapy or who have undergone transplantation procedures, with documented disparities by deprivation. Findings suggest that COVID-19 vaccines are protective against severe COVID-19 outcomes in this vulnerable population, and show a similar safety profile in immunocompromised individuals and the general population, despite some increased risk of adverse events. These results underscore the importance of ongoing vaccination prioritisation for this clinically at-risk population to maximise protection against severe COVID-19 outcomes