bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of Genetic And Epigenetic Diversity Across A Range Expansion in The White-Footed Mouse (Peromyscus Leucopus)
Authors: Rubi T L , Prado J R do , Knowles L L , Dantzer B
Published: October 2023

Synopsis

Populations at the leading front of a range expansion must rapidly adapt to novel conditions. Increased epigenetic diversity has been hypothesized to facilitate adaptation and population persistence via non-genetic phenotypic variation, especially if there is reduced genetic diversity when populations expand (i.e., epigenetic diversity compensates for low genetic diversity). In this study, we use the spatial distribution of genetic and epigenetic diversity to test this hypothesis in populations of the white-footed mouse (Peromyscus leucopus) sampled across a purported recent range expansion gradient. We found mixed support for the epigenetic compensation hypothesis and a lack of support for expectations for expansion populations of mice at the range edge, which likely reflects a complex history of expansion in white-footed mice in the Upper Peninsula of Michigan. Specifically, epigenetic diversity was not increased in the population at the purported edge of the range expansion in comparison to the other expansion populations. However, input from an additional ancestral source populations may have increased genetic diversity at this range edge population, counteracting the expected genetic consequences of expansion, as well as reducing the benefit of increased epigenetic diversity at the range edge. Future work will expand the focal populations to include expansion areas with a single founding lineage to test for the robustness of a general trend that supports the hypothesized compensation of reduced genetic diversity by epigenetic variation observed in the expansion population that was founded from a single historical source.
Improved statistical methods for estimating infestation rates in quarantine research when hosts are naturally infested
Authors: Wright Carole , Wyatt Pauline , Mayer David , Leach Peter
Published: October 2023

Trading partners often require phytosanitary or quarantine treatments for fresh horticultural produce to ensure no economically important pest species are moved with the imported product. When developing such treatments, it is essential that the level of treatment efficacy can be determined. This is often based on the mortality of the total number of target pests exposed to treatment, but in naturally infested products this number is not always known. In such cases, the infestation rate and subsequently an estimate of the number of pests are obtained directly from a set of untreated control samples of the host product. The International Plant Protection Convention (IPPC) Secretariat has provided 2 formulas for these situations that place an interval around the point estimate obtained from the control samples to obtain an estimate of the infestation rate. However, these formulas do not allow a confidence level to be assigned to the estimate, and there are concerns with the assumptions regarding the distribution and the measure of variability used in the formulas. In this article, we propose 2 alternative formulas. We propose that the lower one-sided confidence limit should be applied to all infestation datasets that are approximately normally distributed. As infestation data are sometimes skewed, it is proposed the lower one-sided modified Cox confidence limit is applied to data approximately log-normal distributed. These well-recognized formulas are compared to the formulas recommended by the IPPC and applied to 3 datasets involving natural infestation.
The Galactic supernova remnant CTB 1: optical and X-ray emission analysis
Authors: Reyes-Iturbide J , Ambrocio-Cruz P , Silva R , Rosado M , Arias L , Gabbasov R , Trigueros D
Published: October 2023

We present the kinematic results for the supernova remnant (SNR) CTB 1, obtained with the PUMA equipment of the 2.1-m telescope at San Pedro Mártir National Astronomical Observatory, Baja California, Mexico. The observations were made on the H α line using a Fabry–Perot interferometer. The kinematics derived from the Fabry–Perot velocity cubes allowed us to estimate a kinematic distance for this SNR. We estimate that CTB1 is about 3.8 kpc from the sun, corresponding to a linear diameter of 19 pc, with an expansion velocity of $286 \rm ~ km ~s^{-1}$. Additionally, we analyse the diffuse X-ray emission from CTB 1 using data from the XMM–Newton observatory. From the best fits to the spectrum of southwest and northeast regions, we obtained a hot plasma temperature $\sim 0.1-0.3 ~\rm keV$ with an overabundance in O and Ne and a lower abundance in Fe, which could be caused by a SNR with a stellar progenitor between 10 to $70 \, \rm {\rm M}_{\odot }$. The initial energy of the supernova explosion is estimated between (0.6–1.0) × 1050 erg for soft X-ray emission. The X-ray emission also presents a non-thermal component of low surface brightness in the hard X-ray band. Images in radio and X-ray emission allow us to classify CTB 1 as mixed-morphology supernova type. The evolution models show that the cloudy ISM model is the only one that reproduces the mixed morphology type observed in the SNR CTB 1.
GLIOMA-15 RETROSPECTIVE REVIEW OF GLIOBLASTOMA MULTIFORME CASES MANAGED AT A TERTIARY LEVEL HOSPITAL IN KENYA
Authors: Sharma Karishma , Mansour Manel Haj
Published: October 2023

Glioblastoma Multiforme(GBM) is one of the most aggressive tumors of the central nervous system. Though rare, it accounts for the commonest primary brain tumor in adults. Despite recent advances in the treatment of patients with GBM, it portends a poor prognosis. There is limited published data of GBM from sub-Saharan Africa(SSA). We performed a retrospective chart review of 24 patients seen in the Medical Oncology service at the Aga Khan University Hospital between January 2018 and December 2020. Clinical, radiological, pathological outcomes were investigated, analyzed and compared with data from the literature. A total of twenty-four patients were seen at the medical oncology clinic over the 3-year period. The median age of the patients was 54 years (IQR 44.7-65) and majority of patients (>80%) were of African descent. Of the 24 patients, 13(54.2%) were male and 11(45.8%) were female. Headaches were the commonest clinical presentation and frontal lobe was commonest tumor location on imaging. The median size of the tumor was 4.5cm (IQR 3.8-6.45). Following diagnosis, eighteen(75%) patients underwent maximal safe resection of the tumor with presence of residual tumor in thirteen (56%) of the post-operative scans. Nineteen patients(83%) were initiated on concurrent chemotherapy (Temozolamide) and Radiation therapy (CCRT) as part of adjuvant treatment. Of those initiated on adjuvant Temozolamide following CCRT, more than one-third completed one year of treatment. At 6 months following diagnosis, 25% of patients remained stable while 25% had disease progression. Our study adds to the literature which demonstrates that patients seen in SSA with GBM present at younger age, with bigger tumor size but tend to do better compared to those in the west. Understanding of the molecular alterations within the tumor and larger prospective studies are needed to define the behavior of GBM in SSA.
OTHER-09 RATES AND PATTERNS OF CENTRAL DIABETES INSIPIDUS AFTER SURGERY FOR SELLAR AND PARASELLAR TUMORS AT THE KENYATTA NATIONAL HOSPITAL
Authors: Ngetich Gilbert , Kitunguu Peter , Magoha Michael , Karanja Susan
Published: October 2023

BACKGROUND

Central Diabetes Insipidus (DI) is a common post operative complication after procedures for sellar and parasellar tumors. It is associated with increased morbidity, mortality and prolonged hospital stay. It is diagnosed clinically by symptoms of polyuria and polydipsia and measuring serum sodium and osmolality as well as urine osmolality and specific gravity (SG). There is limited data on rates and patterns of post operative central DI for tumors in this anatomically complex region even with increasing number surgeries being done for these tumors.

OBJECTIVE

To determine the rates and patterns of post-operative central Diabetes Insipidus in patients with sellar and parasellar tumors at the (Kenyatta National Hospital) KNH.

STUDY DESIGN

This was a descriptive cross-sectional study. Study Setting: The study was conducted at KNH Neurosurgery units and critical care units. Methodology: This study involved 24 participants following surgery for sellar and parasellar tumors. Informed consent was obtained from the participants. Clinical assessment for presence polyuria and polydipsia and laboratory measurement of serum sodium and urine SG for features for central DI was done.

DATA RESULTS

The mean age of the patients was 28.69 years, 70.8% were female and 29.2% were male. The most common tumor as confirmed by histology was craniopharyngioma seen in 33.3% of the patients. With regards to age craniopharyngioma, pilocytic astrocytoma and arachnoid cyst was seen in paediatric age group predominantly while meningioma and pituitary adenoma was more common in adults. Polyuria and polydipsia were the main clinical features seen post operatively in patients with Central DI. 69.2% presented with both polyuria and polydipsia, 30.8% presented with polyuria alone without polydipsia. The rate of post operative Central DI after surgery for sellar and parasellar tumors was 54.2%. The most common pattern was transient type occurring in 76.9% of the cases. Biphasic pattern was seen in 23.1%.
OTHER-13 A RETROSPECTIVE STUDY OF BRAIN TUMOURS IN YAOUNDE CAMEROON.
Authors: Fonkem Ekokobe , Fezeu Francis , Fotso Mounir Bennis , Djientcheu Vincent , Besong Yaya , Betts Colton
Published: October 2023

A brain tumour (BT) or intracranial tumour, is an abnormal mass of tissue where cells grow uncontrollably and unaffected by typical cell regulatory systems. In Sub-Saharan Africa, however, these tumours continue to go unnoticed. The aim of this 5-year retrospective study (January 2018 to March 2023), was to determine the relative frequency and histologic types of brain tumours that exist, and to analyze the costs of treatment and diagnostic methods used. The study was conducted within the oncology and neurosurgery departments of 2 Cameroonian hospitals: Yaoundé Central Hospital and Yaoundé General Hospital. A total of 78 complete case files, or 1.05% of all admissions to the various units, were analyzed. The male to female ratio was 0.95 (38M: 40F). 15.4% of cases involved patients below the age of 14. 84.6% involved patients 15years of age and above. 94.9% of the cases were primary brain tumours. In 60.3% of instances, individuals with primary brain tumours were between the ages of 22 and 57. Meningioma (30.8%) was the most common histological form, followed by astrocytoma (25.6%) and pituitary adenomas (16.7%). Most patients experienced symptoms of increased intracranial pressure, with headaches occurring 94.9% of the time. The average diagnostic cost was 235 000 CFA, average operation cost was 337 500 CFA, and average treatment cost was 750 000 CFA, putting the total cost at 1 322 500 CFA. The country's minimum wage is estimated at 40 000CFA (net income), with average household income of 100 000CFA.The age group that is most impacted is young adults, who were more likely to develop meningioma, astrocytoma, and pituitary adenomas than any other types of brain tumours. The total cost of treatment is 33 times the minimum wage or 13 times the average income. To evaluate the long-term outcome of patients with BTs, more research is required.
PAEDIATRIC-09 DIAGNOSIS AND MANAGEMENT OF PEDIATRIC BRAIN TUMORS IN SUB-SAHARAN AFRICA; A CASE STUDY OF UGANDA
Authors: Katasi Victoria Mwebe , Naitala Ronald , Muwonge Peter Wasswa , Bakulumpagi Deogratius , Nabukeera Joan , Akullo Ann , Nakirulu Annet , Munube Deo , Zungu Jennifer
Published: October 2023

BACKGROUND

Pediatric brain tumors are the commonest solid tumors in children and the 2nd commonest childhood cancer globally. In Sub-Saharan Africa, there is paucity of data on their diagnosis and management.

OBJECTIVES

To describe the presentation, investigations done, treatment modalities and outcome of pediatric patients with brain tumors seen at Mulago National Referral Hospital in Uganda from May 2019 to March 2023.

METHODS

A retrospective study was conducted in Mulago National Referral Hospital, pediatric oncology unit, in patients below 18 years of age, admitted with a radiological finding of a brain tumor from May 2019 to March 2023.

RESULTS

The total number of children treated for a brain tumor in this period was 121.Majority (69 /121 (57 %)) of patients were males. The commonest symptom at presentation was headache (42%). Brain Ct-Scans were done in all, and majority (52%) had infratentorial tumors. The commonest diagnosis was glioma (38%), craniopharyngioma (26%), medulloblastoma (11%). Fifty-two patients had surgical resection and a histological diagnosis. Ten percent of patients had no diagnosis. Only 24(20%) patients received radiotherapy. Twenty patients received chemotherapy. Sixty-six are still alive and attending clinical reviews. The overall one-year survival was 63% (95%CI (50.3.0-73.4).

CONCLUSION

Gliomas were the commonest diagnosed pediatric brain tumor at the Mulago National Referral Hospital, pediatric oncology unit.
Prenatal diagnosis techniques
Authors: Oury J F
Published: October 2023

There are many techniques for prenatal diagnosis: sampling of chorionic villi, amniotic fluid, fetal blood, urine. The method used is dependent on the anomaly being looked for and gestational age. Collaboration between geneticist, obstetrician, and laboratory is essential to ensure appropriate testing, taking into consideration the diagnosis sought for any one case.
Laboratory techniques
Authors: Boué André
Published: October 2023

Despite progress in the refinement of laboratory techniques it is not always possible to obtain a diagnosis directly from a fetal sample, either because there are too few cells in the sample (amniotic fluid in a pellet, for example), or because of a particular quality required to apply the techniques; some require live, dividing cells (cytogenetic analysis) or metabolically active cells (biochemical assay with labelled precursors).
Chromosomal anomalies
Authors: Boué André
Published: October 2023

The cause of numerical chromosomal anomaly is a mechanical error, either at the time of gametogenesis, at conception or during first division of the zygote. The majority of parents are chromosomally normal.
Diagnosis of neural tube defects
Authors: Boué A Bou , Muller F
Published: October 2023

In many countries the frequency of this malformation at birth remains high, but large variation is observed between regions and over time. The highest frequencies were observed several years ago by Carter (1971) in Scotland and Northern Ireland (6-8/1000). In western European countries and in North America the frequency remains at 1-3/1000 births, with equal proportions of anencephaly and spina bifida. In France, a high frequency has been reported in Brittany (2.7/1000 in the early 1970s). The frequency is much lower in the rest of France (less than 1/1000 births in most recent years).
Intracranial tumour
Authors: Bannister Sir Roger
Published: October 2023

The term intracranial tumour, though primarily applied to neoplasms, is extended a little loosely to include other space-occupying lesions of slow growth such as a tuberculoma. Other inflammatory conditions such as an abscess may sometimes produce a clinical picture indistinguishable from that of a neoplasm, and the same is true of some parasitic cysts. Intracranial neoplasm may also be simulated by certain forms of hydrocephalus and by a subdural haematoma. Since intracranial neoplasm, however, is by far the commonest cause of increased intracranial pressure, that condition will first be considered in relation to its pathological physiology and symptomatology, and the other conditions which may be confused with it will be dealt with later, more particularly in relation to diagnosis and treatment. The commonest form of intracranial tumour is cerebral secondary deposits.
Poliomyelitis
Authors: Bannister Sir Roger
Published: October 2023

Poliomyelitis, or infantile paralysis, is an acute infective disease due to a virus with a predilection for the cells of the anterior horns of the grey matter of the spinal cord and the motor nuclei of the brainstem, destruction of which causes muscular paralysis and subsequent atrophy. Poliomyelitis had become rare but the fall in the number of immunized individuals has led to more increase in Western countries in recent years. Three strains of the virus have been isolated, known as Types 1, 2, and 3. These can be grown in tissue culture. The virus can be obtained from the nasopharyngeal mucous membranes of patients in the acute stage, of healthy contacts, and of convalescents, and also from the stools. It is believed that the usual route of infection in man is the alimentary tract. The virus is capable of ascending the peripheral nerves, but may also be disseminated through the bloodstream.
Toxic and deficiency disorders
Authors: Bannister Sir Roger
Published: October 2023

In starvation and malabsorption neurological symptoms and signs may be caused by a wide variety of deficiencies. In addition to lack of vitamins, there may be a lack of glucose and minerals, particularly calcium, potassium, magnesium, sodium, or iron. The relationship of dietary deficiency to toxic factors is sometimes complex. For example, excessive cyanide intake from foods or from smoking may play a part in the production of the neurological symptoms of ‘tobacco’ amblyopia and Leber’s optic atrophy, because vitamin Bu is concerned in the detoxication of cyanide. Cyanide may also play a role in the production of neurological symptoms in vitamin B12 neuropathy. In some neurological syndromes found in the tropics it is difficult to separate dietary factors and the effects of certain chronic inflammatory diseases, such as syphilis.
Fatigue and emotional disorders
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

In this chapter we consider fatigue and psychiatric disorders. Psychiatric disorder is a term not without problems of concept and definition (see Sharpe1 and Chapter 10). For this chapter we shall consider psychiatric disorders from a pragmatic rather than a philosophical perspective. Psychiatric disorders are what the international classifications of diseases say they are - operationally defined concepts based on particular constellations of symptoms. In practice although the number of psychiatric disorders is so vast that it is covered by a separate volume of the International Classification of Diseases (ICD-10), and a large and indigestible manual produced by the American Psychiatric Association (DSM-IV), most of this chapter will be devoted to the two most common disorders, depression and anxiety.
CFS in children
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

In Chapter 2 we noted that fatigue was one of the commonest symptoms experienced by adults, and one of the most common complaints in the GP’s surgery. In contrast, children appear less likely to complain of excessive fatigue, and it is an uncommon reason for consultation before puberty. In Morrell’s study of 21 098 consultations in a single general practice, of the 58 that were for a principal complaint of low energy, only four occurred in those under 15. Of the 14 symptoms that he studied, tiredness was the most unusual reason for consultation by a child1. In the UK National Morbidity survey the category ‘malaise, fatigue, debility, tiredness’ was extremely uncommon before adolescence2• In a Swedish population study no children under 10, and only 3 per cent of those under 14, reported fatigue3• Children tend to complain more of somatic symptoms such as pain or headache, and less of fatigue.
A Preliminary Analysis Of Interactions Between Smoking And Infant Feeding
Authors: Pollock Jonathan I
Published: October 2023

Although many reports exist in the epidemiological literature linking maternal smoking to unfavourable, and breast-feeding to favourable outcomes in the child, the strong negative associations these two types of maternal behaviour have with each other and with psychosocial and socio-economic circumstances have rarely been allowed for. However, given a sufficient sample size and a broad database, multivariate techniques enable researchers to separate more efficiently individual influences from confounding factors, and to examine statistical interactions between them. It is possible, therefore, not only to look at associations between smoking or breast-feeding and child health and development in a more rigorously controlled fashion, but also to test the hypothesis that the effects of maternal smoking may be different in infants fed in different ways. This is of topical interest because although the rates of smoking in women of childbearing age have levelled out recently (Office of Population Censuses and Surveys 1988), breast-feeding in the United Kingdom (Martin and White 1988) and in much of the Western world has risen substantially from its lowest prevalence, reached in the early 1970s. Although smokers are less likely to breast-feed their babies than non-smokers a large population of mothers exists who both smoke and breast-feed.
Anti-Smoking Intervention During Pregnancy: Impact On Smoking Behaviour And Birth Weight
Authors: Gillies Pamela
Published: October 2023

The associations between maternal smoking, low birth weight babies and perinatal morbidity and mortality are well established (Royal College of Physicians 1977), as are the risks of smoking to the mothers' own health (Doll et al. 1980). In view of the smoking-related health hazards for women and their babies, it is surprising that relatively few attempts have been made in industrialized countries to provide women with additional help to give up smoking during pregnancy and evaluate the effectiveness of intervention (Windsor and Orleans 1986). The findings from recent randomized controlled trials of anti-smoking interventions in the UK (Donovan 1977; MacArthur et al. 1987) and USA (Sexton and Hebel 1984; Windsor et al. 1985; Simmons 1988), which had relatively large sample populations are summarized in Table 15.1. On balance, the evidence indicates that anti-smoking intervention in pregnancy is likely to have a positive impact on levels of tobacco consumption and can, in the USA, also affect smoking cessation rates. The evidence pertaining to the impact of intervention on smoking and thereby on birth weight is, however, equivocal. Simmons' (1988) study of low income women in the USA found no effect of anti-smoking intervention on smoking or birth weight. Donovan (1977) in the UK found decreased tobacco consumption levels but no impact on birth weight, whilst MacArthur et al. (1987) noted decreased consumption levels and a slight, though not statistically significant, effect on birth weight in first-born babies only. Sexton and Hebel (1984) found an impact on smoking behaviour and a significantly higher birth weight in babies born to women in their intervention group.
Summary And Conclusions
Authors: Waller Robert
Published: October 2023

The most striking aspect of this symposium was the demonstration of the large variety of adverse effects on reproductive outcome of exposure to tobacco smoke and the different role played by its various constituents. The topic of fecundity in relation to smoking, introduced by Dr Baird, was generally considered to have received too little attention to date and not enough was known about possible effects through the male. While smoking was far short of a method of birth control, the indications were that smoking (by the female) could account for about 10 per cent of infertility problems and, as such, it had an appreciable public health impact. The incidence of ectopic pregnancy in smoking mothers-to-be has also to be taken into account when assessing infertility and the public health implications. The study reported by Professor Anderson on the well-known reductions in birth weight raised interesting points about interrelationships between smoking, alcohol, and other factors in birth weight reductions. Changes in the morphology of the placenta, in the placental circulation and oxygen transfer, and animal experiments on embryo growth all pointed to the noxious influence of smoking on growth of the fetus. Even the lower pre-eclampsia rate in smokers as compared with non-smokers should not be claimed as a benefit as, when pre-eclampsia did occur among smokers it was more severe and had a greater effect on perinatal mortality.
Autism
Authors: Baron-Cohen Simon , Bolton Patrick
Published: October 2023

What causes autism? What happens to children with autism when they grow up? Does autism run in families? What kind of educational setting is best? In collaboration with the National Autistic Society, the authors have discovered the questions on the minds of parents and professionals, and have attempted to answer them. Autism is a puzzling disorder. It begins in early childhood, and disrupts many aspects of development, leaving the child unable to form social relationships or communicate in the usual way. This fascinating book explains in a clear, straightforward manner what is known about the condition. It also provides helpful information about all the relevant organizations. Written first and foremost as a guide for parents, but required reading for interested professionals, it covers the recognition and diagnosis of autism, its biological and physiological causes, and the various treatments and educational techniques available. It presents the facts, allowing the reader to take an informed position about children with autism.
Reiter’s syndrome and reactive arthritis
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Reiter’s syndrome is classically defined as the triad of nongonococcal urethritis, conjunctivitis, and arthritis, the latter usually an asymmetric oligoarthritis predominantly involving lower extremity joints (Bauer and Engleman 1942). Brodie in the early nineteenth century described the relationship of urethritis with an episodic arthritis involving predominantly lower extremity joints and the co-occurrence of conjunctivitis (Brodie 1818, 1836). The description by Reiter (1916) of a young soldier with nongono-coccal urethritis, conjunctivitis, and severe arthritis following an episode of bloody diarrhoea focused attention on the syndrome in the European literature and highlighted the possible aetiologic role of a dysenteric illness. The introduction of the concept of reactive arthritis by Ahvonen et al. (1%9) in 1969, the description of incomplete Reiter’s syndrome by Arnett et al. (1976) in 1976, and the recognition that Reiter’s syndrome and reactive arthritis form part of a spectrum of, synovitis occurring as a consequence of infection involving either the gastrointestinal or genitourinary tract (Keat 1983) permits these conditions to be considered together as part of the spectrum of seronegative spondyloarthropathies (Moll et al. 1974; Arnett 1987; Khan and van der Linden 1990).
Quality of life as a decision-making criterion
Authors: Campbell A G M
Published: October 2023

Perhaps the strangest of all the publications to follow the Baby Doe controversy in the United States is a report entitled ‘Medical discrimination against children with disabilities’ (US Commission on Civil Rights 1989). This bulky volume attacks the integrity and motives of those pediatricians and parents who together decide that life-sustaining treatments should be withheld or withdrawn from severely abnormal or damaged infants. What was accepted for generations as the exercise of ‘reasonable medical discretion’ in the face of a family tragedy is labelled as ‘discrimination’ against the handicapped and, in the Commission’s view, as equivalent to the invidious discrimination practiced against individuals or groups on the basis of such morally irrelevant criteria as sex, race, colour, or religion.
Religious influences on decision-making
Authors: Harvey David
Published: October 2023

The newborn baby presents a challenge to anyone concerned with the ethics of medical care. Whereas an adult can usually be asked to make rational decisions about her or his care, an infant is clearly unable to express views on such a decision. This has been recognized for a long time; but modern advances in neonatal care now result in our having to make difficult decisions on an infant’s behalf more frequently than in the past. This is because of the use of life-saving treatment such as ventilation and intravenous feeding. The use of such techniques has to be balanced against the suffering which can be produced by very prolonged intensive care when the prospects of survival are very slim or when the baby’s brain has been damaged by a congenital malformation or a severe disorder arising after birth, such as periventricular leukomalacia. Therefore discussions about ethical conduct of neonatal care, particularly intensive care, are a daily activity in maternity and children’s hospitals. The cultural and religious aspects of care are clearly very important in reaching a consensus decision by the parents, guardians, professional staff, and those, such as priests, who represent the religion to which the family belongs. These decisions are a source of potential conflict, particularly when the parents themselves have different religions and where these differ from the religions common in the country where they live or the religious persuasions of the professional staff.
Fluids
Authors: Morton N S
Published: October 2023

The commonest cause of blood transfusion reactions is failure to check blood correctly with a double check by another member of staff. Only doctors and nurses should check blood.
Equipping And Staffing The Recovery Area
Authors: Holmes E , Morton N S
Published: October 2023

It is now expected that all patients after surgery will be cared for in a designated recovery area. Many hospitals have such an area adjacent to or integrated into the operating theatre suite while others have had to reorganize space or improvise from smaller spaces. A recovery room is a specialist area providing specific individualized care for all postoperative patients with a high ratio of trained nursing staff to patients. This is vital for patient safety as up to 1 in 5 of all complications after surgery and anaesthesia occur in the early postoperative period. Some recovery areas also act in part as high dependency units for patients who need closer observation than can be provided in the general ward but who do not need intensive care, The staffing of such a high dependency area must be more intense.
Prevention And Control Of Pain
Authors: Morton N S
Published: October 2023

In modern practice, pain should be anticipated and pain killers given before the tissues are injured, whenever possible. There are good reasons for this. It is now known that by giving pain relief before the painful wound occurs, less pain-producing substances are released by the wounded tissues and the area near to the wound is less sensitive in the period after the operation. The non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, diclofenac and ketorolac produce most of their pain-killing effect by working in this way in the tissues. If less pain-producing substances are in or near the wound, fewer pain signals will pass along the nerve fibres to the spinal cord and on to the brain.
Metabolic
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Symptoms include thirst, lethargy, coma, convulsions, muscular tremor and rigidity, and an increased risk of intracranial haemorrhage. Treatment depends upon the cause and whether there is normal, low or elevated total body sodium stores and normal or low body water.
Neurological
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Coma is a state of unconsciousness from which the patient cannot be aroused. It should be distinguished from the ‘locked in’ syndrome and psychogenic unresponsiveness. Patients with the ‘locked in’ syndrome are aware but cannot respond to stimuli except perhaps by vertical eye movements and blinking.
Radiology of dialysis amyloidosis
Authors: Maldague B , Malghem J , Berg B Vande
Published: October 2023

Although uncommon until the advent of chronic haemodialysis, amyloidosis has been and remains a fascinating disease for the radiologist (Ros and Sobin 1994). In 1986, over 75 known radiographic manifestations of amyloidosis had been demonstrated in 14 different organ systems of nondialysed patients (Neils 1986). However, until the 1970s, there were only scarce case reports on the musculoskeletal system, which is the principal target of dialysis amyloidosis. In a review of the world literature published in 1972, Wiernik tabulated 24 cases of amyloid joint disease published from 1938 to 1972, in addition to 16 probable cases of amyloid arthropathies reported in the older literature, from 1873 to 1937. Hence, both the pathological and radiological pattern of amyloid-rclated lesions were progressively recognized.
Involvement of ß2-microglobulin modified with AGEs in dialysis-related amyloidosis
Authors: Miyata Toshio , Maeda Kenji
Published: October 2023

Dialysis-related amyloidosis (Af32m) affects bone and joint structures in long-term haemodialysis patients. Beta2-microglobulin (132m) is a major constituent of amyloid fibrils. The molecular heterogeneity of 132m appears relevant to the pathogenesis of Af32m, for example polymerization (Gorevic et al. 1986), deamidation (Odani et al. 1987), and truncation (Linke et al. 1989). However, the pathological role of such modified l32m remains to be determined.
Factors modifying removal and production of ß2-microglobulin
Authors: Zingraff Johanna , Driieke, Tilman B , Chanard Jacques
Published: October 2023

Although the precise mechanism of amyloidogenesis is not completely elucidated, abnormalities of the precursor protein are frequently detected. This may be the consequence of either aberrant processing of the molecule or the existence of a variant (mutant) protein. When the precursor is a naturally occurring plasma protein, as is the case of 132-microglobulin (132m), its presence in excessive amounts is almost certainly a prerequisite for the generation of amyloid fibrils. Excess of the molecule can occur via an increased concentration in defined extracellular spaces, via an extended distribution volume, or both.
Prevention and treatment of β2-microglobulin amyloidosis
Authors: Ypersele Charles van , Jadoul Michel
Published: October 2023

Both the prevention and the treatment of 132-microglobulin amyloidosis (Al32m) remain debated. This chapter critically reviews available evidence in order to define appropriate strategies. Attempts at prevention need to take into account the fact that long-term retention of l32m is a prerequisite for l32m amyloid formation. We will therefore consider: the determinants of serum l32m levels in patients on renal replacement therapy, the effects of dialysis strategies, and of dialysis membranes on the clinical onset and progression of Al32m and, finally, the factors which, in addition to l32m accumulation, might enhance amyloid deposition.
Shiftwork
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

Like transmeridian travel, participation in shiftwork can disrupt human circadian rhythms. It should be noted that crossing time-zones and working shifts are not chronobiologically identical. When multiple time-zones are crossed, a person is normally exposed to all the zeitgebers of the new environment, whereas during rotating shiftwork that includes nightwork, any change in the phasing of a person’s rhythms has occurred while being exposed to some zeitgebers still associated with a diurnal existence (e.g. the light-dark cycle). A consideration of shiftwork is further complicated by the fact that the rhythm disturbances may not be isolated events, as in transmeridian travel, but can be frequent, occurring every time a shift may rotate. In this chapter, shiftwork schedules and their effects on the human are discussed. The influence of working unusual hours on performance and leisure pursuits are given special attention. Solutions to the problem of shiftwork are also examined through the application of chronobiological theory.
The menstrual cycle and exercise
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

In ancient civilizations, it was thought that extraordinary natural phenomena accompanied historic human events, such as births, deaths, and battles and it was also usual to link such occurrences with the phases of the moon. The effects of the lunar tide are more evident in marine than in human life. Nevertheless, rhythms with a period of about a month exist and are known as circamensal. The most obvious human rhythm of this length is the female menstrual cycle, although there is no link between the lunar cycle and the menstrual cycle.
Research
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

In this book we have attempted to summarize what is known about rhythms and physical performance. It is clear that many questions remain to be answered and such answers will require well-designed experiments to be performed. Are there any special guidelines that apply to such experiments? This chapter represents a collation of advice and recommendations for the conduct of these studies.
What is epilepsy?
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

The human brain contains about 100 000 million nerve cells, each of which is connected to many others—perhaps as many as 50 000 others. The brain is the organ of our thinking and of our memory. It integrates information from the outside world and so allows us to perceive objects and events around us. It organizes our response to these events by movements or other action. It organizes our social behaviour. Messages are passed between nerve cells by the extraordinarily rapid secretion of tiny packets of specialized chemicals known as neurotransmitters. As a neurotransmitter acts on the next cell in a chain, a brief electric current is generated.
Aeromedical evacuation
Authors: Frca N Mcguire
Published: October 2023

A 23-year-old male was admitted to hospital following a fracture dislocation of the cervical spine, sustained when he dived into the shallow end of a swimming pool. He had been on a backpacking holiday in the USA. It was requested that he be repatriated to the UK, using an aeromedical evacuation flight.
Carbon monoxide poisoning
Authors: Frca M R Hamilton-Farrell Mrcp
Published: October 2023

A 30-year-old woman was found unconscious at her home, by paramedics who had been called by the patient 10 minutes earlier. She rapidly regained consciousness after administration of oxygen by facemask, and by the time of admission to hospital had a GCS of 15. She appeared generally unwell and complained of a headache. She explained that she had not been well for 3 days before this incident. SpO was 98%.
Malaria
Authors: Doherty J F , Chiodini P L
Published: October 2023

A 31-year-old woman was found unconscious at home 13 days after returning from a holiday in Zambia. At presentation, she was febrile 39°e, jaundiced, and dehydrated with a disconjugate gaze. She was flexing in response to painful stimuli and had generalized muscle twitching. She had generalized hypertonia without localizing signs. There was no hep atosplenomegaly. She weighed 70 kg.
Acute pancreatitis
Authors: Frcs T Davidson Ch.M Mrcp
Published: October 2023

A 62-year-old male is admitted via the A&E department with an 8-hour history of severe increasing upper abdominal pain. The pain radiates from the epigastrium through into the back and is associated with nausea and retching. The patient has not had previous similar episodes and there is no history of abdominal surgery or drug ingestion. He is tachycardic; pulse 110/min; respiratory rate 30/min; BP 100/65 mmHg. Clammy peripheries and upper abdominal peritonism. Sweating and distressed, but not jaundiced.
Critical care neuropathy
Authors: Frcp J H Coakley
Published: October 2023

A 68-year-old, previously fit woman was admitted to the ITU following a respiratory arrest. After resuscitation and investigation she was found to have septic shock due to pneumonia. Her initial management was complicated by the development of a pneumothorax, requiring intercostal drain insertion. After blood, sputum, and urine cultures were taken she was treated with intravenous cefuroxime and erythromycin. Subsequently, pneumococcal septicaemia was confirmed.
Metabolic acidosis
Authors: Frca C Hamilton-Davies
Published: October 2023

A 65-year old, male, insulin-dependent diabetic was admitted to ITU for intermittent positive pressure ventilation following routine coronary artery bypass grafts. Previous medical history revealed insulin-dependent diabetes, myocardialinfarction 3 years previously, and a preoperative ejection fraction .of 40%. Preoperative renal function was impaired: creatinine 256 µ.mol/1; urea 27 mmol/1.
Haemolysis, elevated liver enzymes, and low platelets (HELLP)
Authors: Ffarcs G C Hanson Frcp
Published: October 2023

A white female ageo 36 years, with two previous pregnancies both complicated by hypertension towards term, was admitted at 28 weeks pregnancy with a 3-day history of malaise, nausea, and epigastric pain. On admission she had minimal facial and ankle oedema; BP was 160/90 mmHg. There was minimal tenderness in the right hypochondrium. Over the next 3 days the patient deteriorated with increasing oedema, theonset of a headache with irritability, and development of haematuria. She then developed sudden hypotension, tachycardia, and oliguria.
Thrombocytopaenia
Authors: Frcpath S J Machin Frcp
Published: October 2023

A 35-year-old, caucasian primigravida was admitted as an emergency by her GP when 34 weeks pregnant. On examination she weighed 104 kg (compared to 85 kg at 12 weeks). She was hypertensive (BP 160/115 mmHg), there was gross oedema of her legs and feet, and urine showed 4+ proteinuria. A diagnosis of preedampsia was made and an emergency Caesarian section was carried out that evening.
Meningococcal sepsis
Authors: Mrcp I Murdoch D Ch.
Published: October 2023

A 20-month.:old child arrived in A&E, collapsed with a florid purpuric rash. He was febrile (central temperature 39.1°C) but had cold, dusky peripheries. Initial -assessment revealed a BP of 45/30 mmHg; pulse 150/min; capillary refill time > 3 seconds. Respirations were shallow at a rate of 50/min. He was rousable but agitated and did not respond to his parents.
The Anaesthetist
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

Of the three viruses, HBV, HCV, and HIV, HBV is the most infectious. Infectious blood may contain 106 infectious units per ml. Even 0.04 ml blood may be enough to infect an anaesthetist. Infectivity of HBeAg-positive blood may be over 30% following needle-stick injuries. For HCV the figure is 2-5%. For HIV, seroconversion after needle-stick injuries has been documented as 0.36%. Hollow needles are more dangerous than solid needles. After innoculation with Hepatitis B virus the surface antigen (HBsAg)is found in the blood both during the latter part of incubation andduring the acute phase of the infection. During these periods theindividual is infectious. HbsAg persists in chronic carriers. Antibodyto HBsAg (anti-HBs) is associated with disappearance of virus inthose recovering from infection. Anti-HBs is produced in response to immunization. Hepatitis Be antigen (HBeAg) is associated with a high concentration ofvirus. These individuals are highly infectious. HBeAg-positive healthworkers are not allowed to perform exposure-prone procedures. Anti-HBeindicates low infectivity and disappearance of HBeAg. Antibody to hepatitis B core antigen (anti-HBc) is associated with naturalimmunity. It is not developed in response to vaccine, which contains surfaceantigen only. Vaccination against hepatitis B is by three injections at 0,1, and 6 months.Seroconversion should be checked two months after last dose. A booster isrequired every five years. There are very few genuine non-responders whoshould be warned accordingly but can continue to practice.
Neuropharmacology
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

Drugs are the mainstay of the biological treatment of a whole range of psychiatric disorder . Con cquently, knowledge of some of the advances in neuropharmacology greatly aids the clinician in his day-to-day prescribing. This is so mainly for the unwanted effect:. rather than the main therapeutic effects, the scientific basis for the latter remaining empirical rather than rational.
Blood disorders
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

Children with a haemoglobinopathy may develop acute symptoms from their disease or need A & E treatment for another related problem, such as trauma.

Infection is frequently due to pneumococcal disease associated with defective splenic function even in the presence of a large or normal spleen. A seriously ill sickle cell patient probably has pneumococcal or salmonella septicaemia. Urgent paediatric help should be requested and intravenous penicillin or ampicillin given.
Legal aspects
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 If there are complaints about your management of a patient, full and accurate medical records are usually the best defence.

2 Ensure medical confidentiality.

3 Parental consent is not necessary for the emergency treatment of a seriously ill or injured child.

Medical complaints are more frequent in A & E departments than in some other hospital departments for three reasons. Firstly, the demands of an open-door service, where patients’ injuries and illnesses range from the trivial to the lifethreatening, can stress all staff and render mistakes and misunderstandings more likely. Secondly, the problems with which patients present range across the whole spectrum of medicine requiring a broad basis of knowledge and experience from doctors who may be relatively inexperienced. Thirdly, patients and their relatives attending an A & E service are often anxious and frightened. This can impede the doctor-patient relationship.
Menstruation: a cultural and historical perspective
Authors: Drife James O
Published: October 2023

Attitudes to menstruation have an important influence on the practice of gynaecology. Menstruation is surrounded by myths and taboos in many cultures. Like any physiological process, it can become dysfunctional but doctors and indeed women themselves may find it difficult to define the difference between normal menstruation and pathological bleeding. The dividing line may be strongly influenced by the culture in which the woman and her medical attendants live. The effect of culture has been discussed by Philip Rhodes: Culture consists of everything which has ever been accepted as a way of doing or thinking, and so taught by one person to another ... The child in her growth learns what is done and what is not done partly by being told explicitly, but more importantly, by observing for herself what actions of herself and others appear to receive approval or disapproval. It is these cultural attitudes which in large measure mould her thinking, and which determine her values and philosophy of life.