Five-day prophylactic GM-CSF completely abolishes postnatal neutropenia and sepsis-induced neutropenia in preterm neonates at high risk of sepsis, and so removes an important risk factor for sepsis and sepsis-related mortality.GM-CSF, preterm neonates, neutropenia, sepsis.
BackgroundRecent National Institute for Health and Care Excellence (NICE) CG149 guidelines suggest considering performing a lumbar puncture (LP) to investigate for meningitis in early-onset sepsis in a neonate when a C-reactive protein (CRP) level >10mg/L, but the evidence for this recommendation is poorly defined.MethodsData on trust-wide LP protocols, neonatal meningitis incidence, lumbar punctures, and CRP levels seen in cases of neonatal meningitis were asked of all 137 trusts in England that recorded a birth in 2017. Our local Kingston Hospital data on every LP performed was obtained to estimate the specificity of CRP rises.Results73/123 (59.3%) of trusts follow the NICE CG149 recommendation of considering an LP if the CRP >10mg/L. The national incidence of neonatal meningitis was 0.467/1,000 births, and an LP was performed in 1.37% of all babies, which was significantly higher in trusts considering the CRP > 10mg/L cut-off. A CRP > 10mg/L cut-off sensitivity was 88.9% based on the highest CRP level 4 days around the LP from national data of 199 cases; specificity was 78.8% based on our single-unit analysis.ConclusionsProposing a universal CRP > 10mg/L cut-off for a lumbar puncture has been counter-productive in England. Following it generates significantly more LPs, to the point that 40.7% of trusts have chosen not to follow it. It also has poor sensitivity missing over 11% of meningitis. We therefore do not recommend a universal cut-off, rather considering the whole clinical picture (including prematurity) when considering whether to do an LP.
the planned surveillance date, either due to inadequate biopsies being taken to delay/discharge or appropriate date of surveillance already booked. 15/125 (12%) patients were either discharged or had their OGD delayed. If all procedures had been compliant with BSG standards this might have led to more than three times as many patients having their surveillance discontinued or delayed (48/125:38%). Conclusion Using the 2013 BSG guidelines enables departments to safely discharge patients with Barrett's oesophagus or increase surveillance intervals. This will save money and reduce the risk and discomfort inherent with this program. Endoscopists adherence to the Seattle biopsy protocol is poor, and this is the main barrier preventing more patients from being discharged.
Aims: To determine: (1) whether children diagnosed with a urinary tract infection (UTI) visited their general practitioner (GP) more frequently before the diagnosis of UTI was established compared to children never diagnosed with a UTI; and (2) whether those children with evidence of renal scarring at their first diagnosed UTI visited their GPs more frequently before diagnosis compared to children who did not have evidence of renal scarring when their first UTI was investigated. Methods: Case-control study of 77 children with a UTI identified from a hospital radiology database (37 with and 40 without renal scarring), and 77 age, sex, and general practice matched controls. Main outcome measures were entries in general practice clinical records for types of illness, antibiotic prescriptions, and urine samples requested prior to the diagnosis of first UTI (cases) or equivalent time periods for controls. Results: Cases had a mean 2.94 additional visits or 21% more visits (95% CI 1% to 41%) in the period (mean 2.4 years) prior to the visit at which their first UTI was diagnosed, including a mean 2.5 additional visits or 23% more visits for infectious illness (95% CI 1% to 45%). The cases had 114% (95% CI 41% to 184%) more visits for symptoms relating to the genitourinary tract, though the actual number of these visits was small. They were febrile at 49% more visits (95% CI 1% to 99%) and received significantly more courses of antibiotics than controls (5.2 v 4.1). They had more urine samples requested (37 v 3). Both the cases with and without renal scarring had similar excess GP visits. Conclusion: Compared to controls, children diagnosed with a first UTI had more visits at which symptoms of infection were recorded and more antibiotics prescribed prior to the visit at which the first UTI was diagnosed. These excess visits may have included undiagnosed UTIs. Both those with and without renal scarring had a similar degree of excess visits; additional aetiological factors must have played a role in scar formation. U rinary tract infections (UTIs) are most common in the first years of life, but reported incidences vary by country and setting. Studies in general practice in the UK found the incidence in children under 2 years of age ranged from 0% to 4%.
Introduction Virtually all published data on colonic endoscopic mucosal resection (EMR) comes from expert centres and yet it is likely that the majority of these procedures are performed outside these hospitals. At our centre, like many others, a single endoscopist (JMS) provides an EMR service that the other eight colonoscopists have referred to over the last 5+ years. We evaluated its use, effi cacy and safety. Methods Sessile and fl at colonic polyps >10 mm assessed for resection were identifi ed prospectively and follow-up data collection started. These would include referrals to the EMR service as well as lesions resected by JMS at the index endoscopy. Multi-session resections were done within 3 months. Standard endoscopic follow-up was at 3 months for piecemeal resections. For en-bloc resections follow-up was at a minimum as per BSG guidelines but additional surveillance procedures may
Inclusion criteria was a normal preoperative bilirubin and pre and postoperative Ca 19-9 measurements (n¼76). The primary endpoint was death or recurrence of disease. Data were also analysed for TNM staging, resection margin status and overall survival. Results 70 patients with pancreatic ductal adenocarcinoma were in the study. An elevated post operative CA19-9 (n¼33) had a significantly poor mean survival of 26.8 months compared to patients with normal levels (n¼37) who had a mean survival of 45.5 months (p¼0.004). For patients with a postoperative value $200 U/ml (n¼13) mean survival was 19.8 months compared with levels <200 U/ml (n¼57) being 43.9 months (p¼0.001). A <75% fall in post operative ca19-9 levels in comparison to preoperative levels (45 vs 25 patients) resulted in poor mean survival of 34.9 vs 45.9 months but did not reach statistical significance (p¼0.218). Conclusion In patients who have undergone pancreaticoduodenectomy for ductal adenocarcinoma having a normal postoperative Ca 19-9 is a marker for improved outcome where as a level in excess of 200 U/ml is a negative predictive factor. A <75% fall in post operative readings of CA19-9 results in poor survival (11 months) but was not statistically significant.
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