bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Properties of Poly(vinyl Chloride) Filled with Silica Particles
Authors: Nakamura Yoshinobu , Okabe Seiji , Iida Takeo , Nagata Kazuya , Nigo Hideyuki
Published: January 2025

In general, the yield stress of a ductile polymer is decreased by incorporating filler particles. The effects of particle shape, size, content and changes in the adhesion of particle/matrix interfaces on the yield stress were investigated qualitatively in silica particle-filled poly(vinyl chloride). For this purpose, spherical and irregular-shaped silica particles having different mean sizes, ranging from 2 - 50 μm, were incorporated. The particle contents were 6 and 16% by volume. In the untreated silica-filled resins, the yield stress decreased with increasing particle content and size. The yield stress was higher in the irregular-shaped than in the spherical particle silica-filled resins. The particles were treated with γ-aminopropyl methyldiethoxysilane as a silane coupling agent to improve the adhesion of the particle/matrix interfaces. The yield stress was increased by the treatment and the tendency was more noticeable in the irregular-shaped than in the spherical systems. That is, the yield stresses of the treated irregular-shaped silica systems were higher than that of unfilled poly(vinyl chloride) and they were independent of particle content within the measured range. It was confirmed that the yield stress of the particle-filled composite was affected by the above factors and the importance of particle shape and the adhesion of particle/matrix interface were particularly noteworthy.
Keratin Positive Giant Cell Rich Tumor of the Pelvic Bone with a HMGA2::NCOR2 Fusion: A Case Report
Authors: Geuens Lise , Sciot Raf , Vanden Bempt Isabelle , Douchy Thomas , Sinnaeve Friedl , Wafa Hazem
Published: January 2025

Keratin positive giant cell rich tumor is a rare mesenchymal tumor first described in 2025. It can occur in both soft tissue and bone and predominantly affects young women. The tumor's biological behavior remains uncertain despite its low-grade classification. Characterized by keratin expression and a HMGA2::NCOR2 gene fusion, keratin positive giant cell rich tumors resemble conventional giant cell tumors but lacks H3-3A gene mutations. This article presents a 31-year-old woman with a keratin positive giant cell rich tumor in the pelvic bone, detailing her clinical presentation, diagnostic process, treatment, and postoperative recovery. Histological examination revealed numerous osteoclast-like giant cells within a mononuclear stroma, with RNA sequencing confirming the HMGA2::NCOR2 fusion. The patient's management included surgical resection, with no recurrence at six months follow-up. The discussion emphasizes the need for further research to understand keratin positive giant cell rich tumors pathogenesis and explore potential targeted therapies.
From Perseverance of Effort to Perceived Employability in First-Generation College Students: The Mediating Role of Career Adaptability and Career Engagement
Authors: Ayvaz Ahmet , Elhatip Yaser Emir
Published: January 2025

Although constraining contextual and extrinsic factors pose significant challenges for first-generation college students, intrinsic and individual strengths also play a crucial role in facilitating positive outcomes in their career development. To better understand the role of these factors, this study aimed to examine the relationships among perseverance of effort, career adaptability, career engagement, and perceived employability, within the framework of Career Construction Theory. Data were collected from 308 senior first-generation college students in Türkiye. Using PROCESS v4.3 for R, we found that perseverance of effort significantly predicted both career adaptability and career engagement. Career adaptability significantly predicted both career engagement and perceived employability, while career engagement also significantly predicted perceived employability. Additionally, career adaptability and career engagement serially mediated the relationship between perseverance of effort and perceived employability. This study revealed that adaptivity, adaptability, and adapting responses were crucial internal factors leading to positive outcomes for first-generation college students. The implications, limitations, and future directions of this research are also discussed.
“Intrableb pigmentation following XEN implantation: A case series”
Authors: Tatti Filippo , Demarinis Giuseppe , Dore Stefano , Sacchi Matteo , Fossarello Maurizio , Peiretti Enrico , Giannaccare Giuseppe
Published: January 2025

Purpose

To evaluate the incidence and to describe the characteristics of the intrableb pigmentation (IBP) following XEN63 implantation.

Methods

Retrospective case series of three eyes presenting a pigment dispersion in the filtering bleb after a XEN63 implantation for uncontrolled IOP. Demographic, clinical and imaging data were obtained from medical records.

Results

Three out of 40 patients who underwent XEN implantation (average age 70.67 years) showed an IBP during the 12 months postoperative period. The mean time of IBP onset was 50 days (range, 15–90). The slit lamp examination showed two IBP patterns: a “diffuse” pattern (2 patients) with multiple spots of pigmentation inside the bleb; a “punctiform” pattern (1 patient), with a single spot at the distal end of the device. The AS-OCT imaging confirmed the presence of IBP appearing as a hyperreflective spot/s in the context of the filtering bleb. The patient with the punctiform IBP experienced a distal XEN ostium obstruction with a decrease in bleb function. In one case the diffuse IBP occurred after a successful needling procedure. All the patients’ IOP reported at the end of the follow-up was below 21 mmHg.

Conclusion

The development of IBP might occur after XEN implantation in various times and with different patterns. The IBP pattern can provide meaningful clues on the bleb filtering function. A proper follow-up based on slit lamp biomicroscopy, IOP measurement, and AS-OCT imaging is recommended to manage potential complications related to IBP.
Does the sustainability of universities influence their organizational legitimacy? / ¿La sostenibilidad de las universidades influye en su legitimidad organizativa?
Authors: Díez-Martín Francisco , Blanco-González Alicia , Cachón-Rodríguez Gabriel , Díez-de-Castro Emilio
Published: January 2025

Current explanations of the business consequences of achieving sustainability goals are incomplete. This paper provides empirical evidence of the effect of environmental and social sustainability on organizational legitimacy. Using structural equation modelling, in a sample of 77 Spanish state and private universities, the results show that achieving environmental and social sustainability goals positively influences organizational legitimacy. Furthermore, there is a positive relationship between environmental sustainability and social sustainability. In the field of legitimacy, this research expands our knowledge on the antecedents of organizational legitimacy. In the field of sustainability, it sheds light on the effects of environmental and social sustainability on organizations. At the same time, we provide empirical support to the link between environmental and social sustainability. For practising professionals, the results justify the relevance of actions supporting environmental and social sustainability.
PAPER: GENETIC MEDICINE - TODAY’S PERSPECTIVE*
Authors: Emery AEH
Published: January 2025

Over the last 50 years, developments in genetics have revolutionised our approach to understanding the nature and cause of much human disease. These advances include being able to diagnose and offer prevention through prenatal diagnosis for many serious single-gene disorders. Furthermore new treatments through gene and stem-cell therapy are being researched. It is also becoming possible to determine an individual’s response to drug treatments and susceptibility to various infections. Recent evidence suggests that particular pathogens may affect the clinical manifestations of certain single-gene disorders. In fact understanding the role of pathogens in both rare unifactorial disorders and in more common multifactorial conditions will be one of the major challenges facing medicine in the future.
Shaken baby syndrome: theoretical and evidential controversies
Authors: Minns RA
Published: January 2025

Recent controversies have focused on whether shaking can injure the infant brain and if a diagnosis of SBS can be confidently made and distinguished from accidents (short falls) and non-traumatic conditions.

This article reviews documented cases, animal, biomechanical, and computer-modelling evidence to support the contention that shaking alone without additional impact results in a rotational brain injury with tearing of cortical emissary veins, parenchymal shearing, cervico-medullary, and hypoxic-ischaemic injury.

While the terminology SBS is best avoided because it implies a mechanism in what is usually an unwitnessed injury, a more secure diagnosis of NAHI can be offered, with varying degrees of certainty, based on clinical, imaging, and ophthalmological findings after excluding conditions simulating these features.

The type of brain injury (inertial, contact, hypoxic-ischaemic) and the context in which it is sustained, may enable an opinion about whether the mechanism is consistent with either a purely rotational or rotational impact-deceleration injury, compressive, penetrative or other combined mechanism.
Britain’s Siberia Mary Coutts’s account of the asylum system
Authors: Beveridge A
Published: January 2025

This paper examines a pamphlet entitled Britains Siberia. The High Statistics of Insanity Explained by a Certified Lunatic. Research has revealed that the writer was Mary Coutts and that she had been a detained patient in the Aberdeen Royal Asylum. The paper analyses what Coutts had to say about her experiences and compares this to the official asylum records and what they reveal about her inmate stay. The paper also relates Coutts’ account to that of other patients who have written about their experiences. As one of the few women to have left a record of life in the asylum, Coutts’ story is of particular interest.
Diabetes and lipids
Authors: Marshall G , Fisher M
Published: January 2025

The benefits of statin therapy to lower cholesterol in patients with coronary heart disease are well established. Patients with type 2 diabetes have a high prevalence of coronary heart disease, and, while some consider type 2 diabetes a coronary risk factor, others consider it a disease equivalent. This raises the question ‘Should all diabetic patients receive statin therapy regardless of the presence of coronary heart disease?’ Review of the major secondary prevention lipid-lowering trials: the Scandinavian Simvastatin Survival study (4S study), the CARE trial, and the LIPID trial demonstrates that statin therapy is effective in reducing the incidence of major coronary events in diabetic patients. This supports the use of statin therapy in diabetic patients with known CHD, and the more recent HPS extends this recommendation to include patients with ‘low to normal’ cholesterols. The evidence for primary prevention in patients with diabetes has, until recently, been less clear, as the early primary prevention lipid-lowering studies had too few diabetic subjects to provide conclusive data. However, HPS and the recently published CARDS have shown that statin therapy results in a significant reduction in cardiovascular events, including coronary events, in patients with type 2 diabetes and no previous history of cardiovascular disease. Once again these benefits were seen in patients without ‘elevated’ cholesterol levels. On the basis of all of these studies it seems reasonable to treat all diabetic patients with statins regardless of previous cardiovascular disease or pre-treatment cholesterol levels.
Scots doctors and their compatriots in the service of eighteenth-century Czars
Authors: Doyle D
Published: January 2025

Scots doctors, several of them from one Dumfriesshire village – Lochmaben – played a key role in eighteenth-century Russia, several as personal physicians to the Czars. Some gained fame and fortune through their clinical skills, others through their acceptance in high society, others as a result of their contribution to the establishment of civilian and military health services and medical education, and a few through their influence on the Imperial and Privy Councils.
Palliative medicine: the first 18 years of a new sub-specialty of General Medicine
Authors: Doyle D
Published: January 2025

In 1987 the UK became the first country in the world to make palliative medicine a subspecialty, to be followed by Australia, Hong Kong, New Zealand, Poland, Romania, Singapore, and Taiwan. Eighteen years later there are, in the UK, 310 consultant specialists, 161 SpRs, 6 professorial chairs, increasing research and palliative medicine is taught in all medical schools. This paper looks at the history of the subspecialty, the criteria that had to be met for specialist status, developments in palliative care provision in the UK and the challenges facing the young specialty, and those undergoing training.

A fuller version of this paper with more tables plus information about the situation in other countries where palliative medicine is, or is expected to become, a specialty can be found online: http://www.rcpe.ac.uk/publications/the_journal.php
An update on biochemical evaluation, imaging and treatment of phaeochromocytoma
Authors: Goh KP , Subramaniam T
Published: January 2025

The diagnosis of phaeochromocytoma requires both a biochemical demonstration of inappropriately increased catecholamine production as well as anatomical localisation of the tumour. The addition of plasma metanephrine and serum chromogranin A has increased the repertoire of biochemical tests available. Recent advances in functional imaging like MIBG and somatostatin receptor scintigraphy have improved the diagnostic yield in extra-adrenal, metastatic and recurrent tumours which may not be easily recognised on conventional imaging. Although excision of the tumour remains the mainstay of treatment, the importance of good peri-operative control of blood pressure and post-operative follow up care cannot be over-emphasised. This paper reviews the various tests currently available and their roles in the evaluation of phaeochromocytoma. It also highlights some of the peri-operative issues in the management of this condition.
Image-guided breast biopsy
Authors: Ralleigh G
Published: January 2025

Image-guided percutaneous biopsies are increasingly preferred to surgical biopsies. This technique rarely misses breast cancers (0???%), and correlation of clinical, imaging, and histological findings usually identify lesions requiring re-biopsy quickly. Communication of results to patients requires that the implications of the findings and their bearing on management are explained. Society is increasingly passing responsibility for ensuring follow-up to clinicians.
Avian influenza in humans – an update
Authors: Yuen KY
Published: January 2025

Despite control of the poultry outbreak by culling and sometimes vaccination, poultry outbreaks and sporadic cases in humans continue to occur in South East Asia and is spreading to Europe. The human disease is characterised by a rapidly progressive community-acquired pneumonia and frequently diarrhoea with leukopenia, lymphopenia and impaired liver functions. Virus can be detected in the intestine, spleen, serum, cerebrospinal fluid, in addition to the respiratory secretions. Acute encephalitis or acute gastroenteritis were occasionally reported as early manifestations. Most of the cases are caused by poultry-to-human transmission. Human-to-human transmission is still inefficient but has occurred in health care workers and family contact. In endemic areas, patients presenting as community-acquired pneumonia with a history of contact with sick or dead birds should be isolated, investigated and empirically treated for H5N1 infection. Infection control measures should include contact, droplet and airborne precautions. The globalisation of this avian epidemic by migratory birds and the crude fatality rate of 50% in humans have triggered a global response of preparedness for a coming influenza pandemic which may occur with genetic reassortment or mutations conferring the virus the capability of efficient human to human transmission.
Current treatment of heart failure
Authors: Padfield GJ , McMurray JJV
Published: January 2025

European and American guidelines were published in 2005 that comprehensively summarised the evidence supporting currently recommended diagnostic and therapeutic approaches in HF. The need for these updates reflects the continuing progress in the management of this condition. In this article we briefly overview the current evidence-based treatment of HF. We focus on patients with reduced left ventricular systolic function, as there is no firmly evidence-based treatment for HF with preserved systolic function. Our review discusses treatments shown to favourably modify the natural history of HF when added to diuretic treatment. Diuretics should be used, as needed, to prevent sodium and water retention that can lead to peripheral and pulmonary oedema. Although diuretic treatment is empirical rather than evidence-based, it is widely agreed that the minimum dose needed to maintain ‘dry weight’ should be used.
Recommendations and conclusions from a minisymposium on self-blood glucose monitoring
Authors: Reynolds RM , Webb DJ
Published: January 2025

It is agreed that all patients with insulin-treated diabetes should regularly self-monitor their blood glucose to guide insulin doses and detect and avoid hypoglycaemia, but there remains little consensus as to the value of SBGM in patients with type 2 diabetes treated with diet and/or tablets. This Royal College of Physicians of Edinburgh mini-symposium brought together a panel of experts to examine the current evidence surrounding SBGM in this context. The aim of this document is to provide an overview of the points raised and where consensus was achieved. The document summarises the general situations where SBGM may or may not be useful, and it is hoped that this will be a platform for production of specific guidelines for healthcare professionals to use to advise a monitoring programme for an individual patient. These recommendations include results of evidence published since November 2004.
‘The heart less bounding’: treating angina pectoris
Authors: Butler AR
Published: January 2025

Although one group of drugs (including amyl nitrite and glyceryl tinitrate) has been used in the treatment of angina for over 100 years, the mode of action became clear only after the endothelium-derived relaxing factor had been identified as nitric oxide in 1987. Originally sodium nitrite was included in this group of drugs but it rapidly fell out of favour. Recently, however, interest in its therapeutic use has been revived. The medical uses of saltpetre (potassium nitrate) may be due to the presence of nitrite as an impurity.
Public health interventions symposium 2006
Authors: Price J
Published: January 2025

This showcase symposium, co-ordinated by the heads of academic public health departments in Scotland, addressed the evidence of effectiveness for interventions in areas of major public health importance. Topics ranged from how best to gather the evidence, where there is (and is not) already a body of evidence, and how available evidence influences national policy.
Epilepsy
Authors: Aylward R
Published: January 2025

Epilepsy is common and has a variety of causes. This article discusses the aetiology of the epilepsies, particularly the genetic causes, and provides up-todate information on how the condition should be diagnosed, classified, and treated. Some guidance is provided about tailoring the choice of drug treatment according to classification, and the best approach to treatment during pregnancy. Recent data from the UK Epilepsy and Pregnancy register are included. The management of patients with particularly severe and intractable epilepsies is discussed as well as the latest guidelines on the management of status epilepticus. The approach to treatment has to be modified for certain groups of patients, including teenagers and those with learning difficulties. A good service can be provided only if structures are in place to ensure that all patients have rapid and responsive access to advice and information.
Assisted ventilation in acute exacerbation of chronic obstructive pulmonary disease
Authors: Telfer M , Lwin A , Jenkins P
Published: January 2025

In the UK, over three million people suffer from COPD, and over 30,000 people die as a result each year. Acute exacerbations of COPD are a particularly heavy burden to patients, and to the Health Service. Patients often present with AHRF, and this presentation accounts for 20% of all COPD admissions. Non-invasive ventilation is of proven efficacy in the management of AHRF associated with an exacerbation of COPD. Systematic reviews and metaanalysis have shown that the use of NIV in addition to standard medical therapy significantly reduces in-hospital mortality, the need for invasive ventilation, and the length of stay in hospital, when compared with standard medical therapy alone. Non-invasive ventilation is associated with greater improvements at one hour in pH, PaCO2, and respiratory rate.

Ideally, patients who require NIV should be able to protect their airway, be cooperative with (and tolerant of) the technique, and be otherwise medically stable. It must be remembered that COPD with AHRF patients who survive treatment with NIV have a high risk of subsequent death and life-threatening events. At the same time the reported outcome for patients admitted with AHRF secondary to COPD tends to be worse in the group not treated with NIV. However, it is not sufficiently poor to render IMV inappropriate for COPD populations as a whole.

A decision on the appropriateness of intubation and mechanical ventilation if NIV fails should be taken before NIV is initiated and this decision should be taken by senior medical staff with input from a critical care physician if necessary. Noninvasive ventilation should not be used as a substitute for tracheal intubation when the latter intervention is clearly more appropriate. In addition, it is suggested that patients with a pH <7·25, or who are candidates for intubation, should be managed on ITU if at all possible, and should certainly have critical care input in their management.
Medical Atlanticism
Authors: Booth C
Published: January 2025

The term ‘Atlanticism’ is used to define the cooperation between Western European and North American nations, usually in matters of politics or defence. The purpose of this paper is to show that from the time of the Spanish conquistadors, there has been an effective communication in medical matters across the Atlantic that can best be defined as ‘Medical Atlanticism’. As colonies developed in North America, there were increasing contacts with European nations. During the eighteenth century, the University of Edinburgh played a major role but later, in the nineteenth century, France, then Germany and Vienna, shaped the development of medicine in the United States. Britain was to be greatly influenced by the example of first Germany, then the United Staes. Today,‘Medical Atlanticism’ is an outmoded term since medicine has become global.
Sir Robert Christison (1797–1882): the man, his times, and his contributions to nephrology
Authors: Cameron JS
Published: January 2025

Sir Robert Christison was a professor of Medicine in Edinburgh for 50 years, and twice President of the Royal College of Physicians there. Despite this, few modern descriptions and assessments of either him or his work have been published. In particular, his major work in the field of renal disease, which allows him to be considered one of the fathers of nephrology, has been almost completely forgotten, even in Scotland. In this paper, Christison and his work in renal disease are described, trying to place his sometimes apparently paradoxial views and actions as a physician in the context of a man who lived across major changes in medicine.
Terrorism – doctors and wrongdoing
Authors: Finlayson NDC
Published: January 2025

The world is now well-used to terrorism, but doctors and the wider public are particularly shocked when those whose actions harm others are members of our profession. Unfortunately, the record shows that doctors are not strangers to such actions, and while few doctors deliberately harm their patients or others, we are drawn from the societies in which we live and share the characteristics of those societies. We may not know why individuals embark on harming others, and we certainly have no evidence-base for preventive action, but we should consider how the risks of such actions might be reduced. Possible actions include better selection for medical school, more liberal education during and after medical school, better supervision of professional aspects of training and correction of deficiencies, and closer scrutiny of untoward occurrences in medical practice. Our College, with its worldwide membership should support the development of such measures.
A family tradition of Scottish medicine
Authors: de Vos Meiring P
Published: January 2025

In the late nineteenth and early twentieth centuries, Edinburgh was among the most popular of all destinations for South Africans seeking a medical education. Scotland was thus the fountainhead of much of the knowledge and skill that subsequently led to the development of a high standard of medical education in South Africa. This article describes how four members of a South African family received their medical education at the University and Royal Colleges of Physicians and Surgeons of Edinburgh and a fifth family member obtained the Membership of the Royal College of Physicians and was later elected to Fellowship. This is the story of a relationship spanning three generations between a family in which medicine had almost become a hereditary trait and the best of Scottish medical education
A proposal to reduce medication errors made by newly qualified doctors by adopting the drills used for ab initio aviation training
Authors: Burt RAP
Published: January 2025

Recent articles in the lay and medical press have again drawn attention to the preponderance of medication errors made by inexperienced, newly qualified physicians. With medical training currently undergoing transformation, perhaps there remains an opportunity to adapt some of the drills used in aviation training, which concentrate on the provision of safety above all. Aviation and medicine share many characteristics, and the concept of crew resource management, created to understand and minimise errors in aviation, has already been adapted and transferred to some of those areas of medical practice that involve teamwork across different disciplines. This paper describes some of the drills used in early aviation training and discusses how these might be adapted and applied towards the reduction of medication errors by newly qualified doctors.
Clinical aspects of delirium
Authors: Hoyle G , Sharma V , MacLullich A , Seymour DG
Published: January 2025

Delirium is a common and frequently missed condition in elderly people admitted to hospital, and represents a considerable financial and health burden. It is important to recognise both those suffering from and those at high risk of delirium at the time of admission to hospital, which allows preventative and therapeutic measures to be instituted. Management of delirium is a multicomponent and multidisciplinary undertaking, with important considerations throughout hospital stay and following discharge.
Aspects of pain management in the older person
Authors: Tan HN , Leong IYO
Published: January 2025

Pain is a common symptom in an older person and is often undermanaged. In this article, we discuss the comprehensive assessment of pain and propose a multidisciplinary approach. The principles of pharmacological treatment are highlighted, while not forgetting the need to consider interventional procedures in appropriate conditions where pain relief can be achieved for a period of time. When prescribing, consideration should be given to the underlying co-morbidities, functional status and psychosocial situation of the individual, and the patient should be monitored for any improvement of the pain and for the development of any adverse effects. The pharmacological approach follows that of the guidelines of the WHO analgesic ladder. We will also discuss in greater detail the approach to neuropathic pain and pain management in older persons with cognitive impairment. For neuropathic pain, agents that may be useful include antidepressants, anticonvulsants, opioid analgesics and N-methyl-D-aspartate antagonists. Accurate assessment of pain in the older person with cognitive impairment poses a significant barrier to pain management. The principles of management in this group of individuals will be discussed and the variety of pain behaviours in an older person will be highlighted.
Infant welfare, philanthropy and entrepreneurship in Glasgow: Sister Laura’s Infant Food Company
Authors: Weaver LT
Published: January 2025

Laura Smith was sister-in-charge of the Children’s Dispensary in Glasgow from 1897 to 1922. In 1911 she established Sister Laura’s Infant Food Company to market a special milk formula of her own invention. The directors of the Dispensary were not amused. As the ‘outdoor’ department of the Royal Hospital for Sick Children (Yorkhill), the Dispensary was at the forefront of efforts to combat child ill health and malnutrition. This paper considers Laura Smith’s initiative within the context of the health and care of infants of the time – high infant mortality, public and professional concerns for infant welfare, technological advances in food science, changing recommendations and practices of infant feeding and ambiguous relations between medicine and commerce.
Stem cell therapies: hype or reality?
Authors: Crawford J , Turner M
Published: January 2025

Advances in stem cell research provide great hope that these cells can be used to help tissue repair and avoid the need for complex surgery or organ transplantation. Despite extensive media coverage and enthusiasm for their therapeutic potential in patients, it may be years before such therapies reach their full potential. In this article, Dr Julie Crawford and Professor Marc Turner from the MRC Centre for Regenerative Medicine give a balanced view to help us decide whether stem cell therapy is ‘hype or reality’.
Auto-erythrocyte sensitisation syndrome– an unusual cause of bruising
Authors: Yasmin A , Soutar R , McKay P , Doig A
Published: January 2025

Autoerythrocyte sensitisation syndrome or Diamond-Gardner syndrome is a rare disorder characterised by painful and spontaneous purpura occurring in women with mental health problems. It should be considered in the differential diagnosis of spontaneous, painful bruising, especially in patients with mental health problems. Awareness of this condition may prevent unnecessary investigations and allow early referral to psychiatry or psychology. We present the case of a 45-year-old woman who was referred to our haematology clinic with a history of recurrent episodes of spontaneous painful bruising. She had already attended rheumatologists and dermatologists and was proving to be a diagnostic dilemma. Extensive investigations, including full blood count, coagulation screen, factor VIII complex and connective tissue screen, were normal. An autoerythrocyte sensitisation test resulted in the appearance of a bruise preceded by tingling and a stinging sensation similar to her usual symptoms. Although not mentioned in the referral letter and not elicited at the initial consultation, on further questioning a history of psychiatric morbidity was obtained. Having established the likely diagnosis, the patient was agreeable to referral for psychiatric support.
Nephrotic syndrome in a bee keeper: rediscovery of an extinct disease?
Authors: Hiemstra TF , Smith KGC , Hamilton DV
Published: January 2025

An elderly beekeeper presented with nephrotic syndrome due to secondary amyloidosis. He developed progressive renal impairment and ultimately required dialysis. The patient had received multiple bee stings per day over seven decades without any allergic reactions. Here, we report secondary amyloidosis associated with recurrent bee venom exposure.
Melorheostosis: an unusual cause of dactylitis
Authors: Kamath N , Mootoo R , Jawad ASM
Published: January 2025

A 17-year-old boy presented with a six-month history of spontaneous pain and stiffness in his right index finger. On examination there was mild diffuse swelling and tenderness of the right index finger, particularly over the metacarpophalangeal and proximal interphalangeal joints. A plain radiograph provided the diagnosis of melorheostosis, clearly showing the flowing candle waxlike appearance over the second and third metacarpals and the phalanges of the index and middle fingers.
Advances in the treatment of the motor symptoms of Parkinson’s disease
Authors: Turnbull C , Fitzsimmons P
Published: January 2025

Parkinson’s disease is a chronic progressive neurodegenerative condition. It damages central nervous system dopaminergic but also serotonergic and noradrenergic pathways. There is no known cure, and no existing therapy has been proven to slow or reverse progress of the disease. Treatment aims to alleviate symptoms and preserve functional independence while minimising adverse affects.
Dissection of the internal carotid artery causing transient ischaemic attack and Horner’s syndrome
Authors: Puthiyaveetil S Ahamed , Elkhatim R
Published: January 2025

Dissections of the internal carotid artery continue to be one of the underrecognised causes of transient ischaemic attack and stroke, especially in the young. The prompt identification of the dissection as a cause of stroke or transient ischaemic attack is essential for the initiation of appropriate treatment. We report a case of spontaneous extracranial carotid dissection presenting as a transient ischaemic attack followed by the development of Horner’s syndrome in a 57-yearold male patient. The diagnosis was confirmed by magnetic resonance angiography. Prompt anticoagulation was initiated, and the patient remained stable and well at the end of three months.
The selection of pacing modalities according to NICE recommendations
Authors: Choo WK , Tilling L , Gupta S
Published: January 2025

The National Institute for Health and Clinical Excellence (NICE) recommends the use of dual-chamber pacemakers for all bradycardic patients except in a few situations. We aimed to compare our performance to the then new national guidelines. We retrospectively studied the data of all 200 patients who received single-chamber ventricular pacemakers and dual-chamber pacemakers between January 2003 and December 2005 inclusive. Pacemakers were selected based on local opinions prior to the formal adoption of NICE guidelines. In retrospect, our compliance to the guidance was 72%. Of this 72% of patients, 12% were symptomatic at one year, compared with 21% from the noncompliant group (p=0.12). In terms of mortality, 2% of the patients from the compliant group died, compared with 5% from the non-compliant group (p=0.36). Multiple factors influence clinical judgements in selecting a pacing modality. Stringent compliance with the current NICE recommendations may not necessarily reduce mortality and morbidity.
Azathioprine use in inflammatory bowel disease in South Durham – an insight into clinical practice
Authors: McDonnell MJ , Dhar A
Published: January 2025

Azathioprine is the most common immunosuppressant used in the management of inflammatory bowel disease (IBD). Most of the available data on the effectiveness of this drug emerge from large university teaching hospitals, where there is a referral bias towards complex patients combined with a need for specialist expertise and early initiation of therapy. There are limited data on the use of azathioprine in district general hospitals in the UK, particularly related to efficacy and side effect profile, with concerns about its safety potentially contributing to a reluctance to commence treatment with the drug until late in the course of the disease. This audit was a retrospective case note review of patients attending gastroenterology clinics in South Durham over a decade (1997–2007). The population of the region is 250,000. The Rotherham IBD Database for County Durham was used to identify patients who had ever been exposed to azathioprine. Efficacy and side effect profile were determined. Remission was defined as being steroid-free at 12 months after starting azathioprine. Relapse was defined as active disease requiring steroids or surgical intervention after starting azathioprine. Of 400 patients with IBD, 58 were treated with azathioprine over the ten-year period (13.1%), 29/318 with ulcerative colitis (9.1%), and 29/82 with Crohn’s disease (35.4%). Overall, 21/58 (36.2%) patients were found to be steroid-free within a mean period of five months’ treatment. Among factors favouring response to treatment, a disease phenotype of Crohn’s disease was the only significant one; age, sex, disease distribution and dose were not significant. 27.6% patients relapsed despite treatment, with the relapse rate being lower in ulcerative colitis. Although 47% patients reported some side effect, myelotoxicity was recorded in only 12%. This audit reflects the efficacy and safety of azathioprine when used in the district hospital setting, comparable to larger tertiary centres. Overall, the use is lower than at specialist centres, but this is likely to change with time.
Respiratory symposium report
Authors: Miller JJ
Published: January 2025

This respiratory symposium focused on pleural disease, allergy and the new guidelines for oxygen delivery. The management of pleural disease is changing, partly due to safety concerns. For example, safer designs of the Seldinger drain are being developed and chest ultrasound is now recommended prior to siting an intercostal drain. Greater availability of medical and surgical thoracoscopy means there is less use of the Abrams pleural biopsy, although this has implications for the organisation and provision of services. British Thoracic Society guidelines advocate that doctors now prescribe oxygen including the mode of delivery and target oxygen saturations. The incidence and epidemiology of allergic conditions was presented. The incidence of allergic disease is rising and lifestyle factors such as exercise and obesity may be implicated. The remaining presentations focused on respiratory disease in relation to driving, osteoporosis and liver disease. Doctors have a role in alerting patients to the legal implications of their medical condition with respect to driving. Obstructive sleep apnoea/hypopnoea syndrome is increasing in incidence; it is a treatable condition but has implications for driving if untreated. Inhaled and oral corticosteroids use results in bone demineralisation and osteoporosis, which in turn results in increased fracture risk. Bisphosphonates are indicated for steroid-induced osteoporosis, and as this develops most rapidly on initiation of corticosteroid, bone protection should be considered when therapy is commenced. The symposium ended with a presentation of the two pathologically distinct vascular syndromes linking pulmonary and hepatic disease. Hepatopulmonary syndrome is associated with pulmonary venous dilatation, and can be treated with liver transplant, whereas porto-pulmonary hypertension is associated with pulmonary venous constriction and may respond to vasodilators.
Hyponatraemia
Authors: CJ Thompson  , RK Crowley
Published: January 2025

Hyponatraemia is the most common electrolyte abnormality in hospital inpatients, and is associated with complications such as seizures, increased mortality and prolonged hospitalisation. The risk of symptoms, complications and death increases with severity of hyponatraemia. A wide variety of illnesses and therapies can cause hyponatraemia, and the treatment of the underlying condition is always important. There are three main pathophysiological causes of hyponatraemia. Hypovolaemic hyponatraemia is characterised by clinical and biochemical evidence of dehydration and is best treated by intravenous sodium chloride solution. Hypervolaemic hyponatraemia presents with fluid overload, which usually requires diuretic therapy. Euvolaemic hyponatraemia, of which the syndrome of inappropriate antidiuretic hormone secretion is an example, is traditionally treated with fluid restriction, although the new vasopressin antagonists, the vaptans, show great potential for future therapy. An accurate diagnosis of the cause of hyponatraemia is necessary for appropriate treatment. Severe hyponatraemia is potentially life-threatening and, if cerebral irritation is present, intensive therapy with saline infusion may be necessary; because of the risk of central pontine myelinolysis, this should always be given under specialised, highly experienced direction. Plasma sodium should be checked every two hours, and the rate of elevation of plasma sodium concentration should not exceed 0.5 mmol/l/h.
Authors’ reply
Authors: Keeling David , Curry Nikki
Published: January 2025

We agree that there are little data on the venometer. A recent Health Technology Assessment concluded that plethysmography techniques appear to have a limited role in the diagnosis of clinically suspected DVT.1 The authors estimated that strain-gauge plethysmography has a sensitivity and specificity of 83% and 8l% and that there was some evidence that diagnostic performance depended on the prevalence of DVT in the cohort and the setting for recruitment. They recommended the evaluation of the role of plethysmography, its interaction with other diagnostic tests, outcome of low-risk patients with negative plethysmography and measurement of the costs of providing plethysmography as areas for research but concluded that diagnostic algorithms based on a combination of Wells score, D-dimer and ultrasound (with repeat if negative) are feasible at most UK hospitals and are among the most cost-effective.
The Role of Electroencephalography Following CAR-T Cell Therapy in Clinical Practice
Authors: Matthews Alexander J , Starkie Fiona E , Staniaszek Lydia E , Kane Nicholas M
Published: January 2025

Objectives:Neurotoxicity, encephalopathy, and seizures can occur following chimeric antigen receptor (CAR)-T cell therapy. Our aim was to assess what value electroencephalography (EEG) offers for people undergoing CAR-T treatment in clinical practice, including possible diagnostic, management, and prognostic roles. Methods: All patients developing CAR-T related neurotoxicity referred for EEG were eligible for inclusion. Reasons for EEG referral and qualitative EEG findings were analysed and reported. The relationship between objective quantitative EEG (QEEG) encephalopathy grade and clinical neurotoxicity (immune effector cell-associated neurotoxicity syndrome; ICANS) grade was determined. The prognostic ability of QEEG grade was assessed for survival and functional status. Results: Twenty-eight patients with 53 EEG recordings were included. Common reasons given on EEG referrals were possible seizure diagnosis (n = 38), reduced consciousness (n = 8), and superimposed cerebral infection (n = 4). Four focal seizures were detected on three (3/53; 5.7%) EEGs. There was a moderately positive correlation between QEEG grade and ICANS grade (r = + 0.41, p = .030). QEEG grade could not predict survival at 3 months (Area Under Curve; AUC = 0.673) or 6 months (AUC = 0.578), nor could it predict functional status at 1 month (r = + 0.40; p = .080), 3 months (r = + 0.19; p = .439), or time to return to baseline (r = + 0.32; p = .156). Conclusions: EEG was useful in seizure diagnosis. QEEG has a possible role as a specific biomarker of encephalopathy/neurotoxicity. EEG generated no tangible changes in patient management. QEEG was unable to prognosticate survival or functional status.
Continuous Glucose Monitors and Programmed Shared Medical Appointments in Managing Type 2 Diabetes Mellitus Among First Nation Women in Australia: A Co-Designed Feasibility Study
Authors: Stevens John , Firth Willow , Dooley Lynne , Longbottom Hayley , Wills Kalinda , Egger Garry , Morgan Bob
Published: January 2025

First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46 mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. Trial Registration: The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. The trial web page = https://www.anzctr.org.au/ACTRN12622000650796.aspx .
Glycemia Risk Index is Associated With Risk of Albuminuria Among Individuals With Type 1 Diabetes
Authors: Kim Ji Yoon , Yoo Jee Hee , Kim Nam Hoon , Kim Jae Hyeon
Published: January 2025

Background:

The glycemia risk index (GRI) is a novel composite continuous glucose monitoring (CGM) metric composed of hypoglycemia and hyperglycemia components and is weighted toward extremes. This study aimed to investigate the association between GRI and the risk of albuminuria in type 1 diabetes.

Methods:

The 90-day CGM tracings of 330 individuals with type 1 diabetes were included in the analysis. Glycemia risk index was divided into five risk zones (A-E), and hypoglycemia and hyperglycemia components were divided into quintiles. Albuminuria was defined as a spot urine albumin-to-creatinine ratio ≥30 mg/g. Associations of albuminuria with GRI and its hypoglycemia and hyperglycemia components were estimated.

Results:

Mean GRI and glycated hemoglobin (HbA1c) were 40.9 ± 21.3 and 7.3 ± 1.0%, respectively, and the overall prevalence of albuminuria was 17.6%. Prevalence of albuminuria differed significantly by GRI zone ( P = .023). In logistic regression analysis, the adjusted odds ratio (OR) of albuminuria per increase in the GRI zone was 1.70 (95% confidence interval [CI]: 1.19-2.41) after adjusting for various factors affecting albuminuria. The association remained significant after adjusting for achievement of the recommended target of time in range (70-180 mg/dL; >70%) or HbA1c (<7%). The hyperglycemia component of GRI was also associated with albuminuria, and the association remained significant even after adjusting for HbA1c level itself (adjusted OR 1.44, 95% CI: 1.05-1.98).

Conclusions:

Glycemia risk index is significantly associated with albuminuria in individuals with type 1 diabetes.