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BCG vaccination given early in infancy may prevent the development of atopy in African children.

Reduced general cell mediated immunity may contribute to the higher long term mortality in children who have had measles compared with recipients of standard measles vaccine and to the higher child mortality in the rainy season in west Africa.

This article examines the use of expert evidence, and quantum tools in a failure to appropriately treat DVT claim based on a case recently conducted by the authors. Particular issues and problems are highlighted, and the procedural tactics employed by the Claimant's legal representatives to overcome those problems. Case summaryIn January 2005, the Deceased, a 40-year-old telephone engineer was admitted as an emergency to his local NHS Trust. He was complaining of abdominal pains which were radiating through to his back and had started coughing up blood. He was diagnosed with a suspected pulmonary embolism (PE) but differential diagnoses included hypertension and left-sided pneumothorax. The diagnosis of pulmonary embolus was confirmed on CT pulmonary angiogram and he was prescribed Warfarin for a period of three months. Approximately one week after he had been gradually weaned off Warfarin, he presented to the Trust with pain in his right calf. The ultrasound undertaken showed a distal deep vein thrombosis (DVT), i.e. a DVT isolated to the intramuscular veins in his calf. A D-Dimer test was also positive showing an elevated level of 858. He was advised to return in a week's time for a further scan. He duly re-attended one week later and underwent a second ultrasound which showed a continued DVT in the calf, but there was no proximal DVT, i.e. the DVT had not extended to above his knee. Since it had not extended to above his knee the treating doctors decided not to re-start him on anticoagulants and he was discharged.By this point he had returned to normal work on light duties and it was anticipated that he would return to full duties very shortly. Recently married and planning to have a baby with his new wife, the Deceased had a strong and supportive family close to him. He was keen to progress his career and was undertaking a degree in business studies part-time, and was a valued employee. He did not drink or smoke and was a keen runner.Eight days after the second appointment with his treating hospital he became seriously ill at home and suffered respiratory arrest. He was taken to hospital but attempts at resuscitation were unsuccessful and he was pronounced dead. The cause of death was a pulmonary embolism secondary to a DVT. The Claim and the DefenceThe Claimant argued that in light of the Deceased's previous history of a confirmed PE, when he re-presented with symptomatic DVT in June 2005 he was at a high risk of a developing a subsequent PE and should have been re-started on anticoagulants. The literature suggested that his history of a PE meant that he was at greater risk of developing a further PE in the future. The Claimant also argued that the risk of death from PE if he was not started on anticoagulants was so great as to outweigh any risks associated with taking anticoagulants, especially in light of his history of having taken them without incident over 3 months previously. It was accepted, however, that the risks increase with the length of time a patient takes anticoagulants, and age. However, no d...

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