Abstractobjectives To assess the risk of gentamicin toxicity and potential number of neonates exposed annually to this risk, through treatment with WHO-recommended first-line antibiotics (gentamicin with penicillin) for the 6.9 million neonates with possible serious bacterial infection (PSBI).methods Systematic literature review and assessment of the evidence using Cochrane and GRADE criteria. Meta-analysis was undertaken for pooled estimates where appropriate.results Eleven studies (946 neonates) were included (nine randomised controlled trials and two prospective cohort studies). Six trials reported consistently measured ototoxicity outcomes in neonates treated with gentamicin, and the pooled estimate for hearing loss was 3% (95% CI 0-7%). Nephrotoxicity could not be assessed due to variation in case definitions used. Estimates of the number of neonates potentially affected by gentamicin toxicity were not undertaken due to insufficient data.conclusion Given wider scale-up of outpatient-based and lower-level treatment of PSBI, improved data are essential to better assess the risks from neonatal gentamicin treatment without assessment of blood levels, to maximise benefit and reduce harm.
Introduction The British Society of Gastroenterology (BSG) updated guidelines for colonoscopic screening of people with family history (FH) of colorectal cancer (CRC) in 2010. In the UK, most patients anxious about their FH of CRC are referred by primary care doctors to non-specialist hospitals. Previous studies indicate guideline adherence is poor with significant clinical, medico-legal, and resource implications. Methods Our study analysed adherence to the 2010 BSG guidelines in a district general hospital (catchment population of 300 000). Observational data were collected from all colonoscopies in which FH was the primary indication over a 16-month period from guideline publication up to April 2011 at our centre. Results Of the 91 cases found (mean age 49.1 years, range 24.7e73.2), there were 11 high, 24 high moderate and 20 low moderate risk cases identified. 36 were low risk and did not fulfil criteria for initial colonoscopic screening. The 55 within guideline were screened on average 4.0 years early (p<0.0002; paired T test; 0e24.2 years early), with 18 cases screened early. 17 of the 91 cases were offered unnecessary follow-up colonoscopies. Yield for polyps and CRC was significantly lower in screened individuals (16/91 (18%)) compared to patients offered colonoscopies for other indications during the same period (246/838 (25%); p¼0.018; c 2 test). Referrers recorded "reassurance" in 29 cases as a factor for screening. Conclusion The BSG guidelines are based on robust evidence. Despite this, many patients (40%) undergoing screening in our centre do not meet guideline criteria. Some (33%) were screened too early, and others (19%) had unnecessary follow-up. Therefore, some patients are exposed to the risk of colonoscopy decades younger than recommended without justifiable benefits. This is reflected in similar data from other centres. Non-adherence to guideline occurs at multiple levels from referral and beyond. Clinicians often feel compelled to offer screening against guidelines for the reassurance of anxious patients. Our study identifies multiple opportunities where intervention could result in better adherence to guidelines; interventions such as the development of family cancer clinics outside clinical genetics centres to improve management of these patients.Abstract PWE-073 Table 1
BackgroundJoubert’s syndrome is a rare condition affecting an estimated 1:80,000–1:100,000 individuals. There is underdevelopment of the cerebellar vermis resulting in a characteristic molar tooth sign on cross sectional axial magnetic resonance imaging. It can occur in association with multi-organ involvement; in such cases it is classified as Joubert’s syndrome and related disorders. To date, there are no cases of Joubert’s syndrome and related disorders from sub-Saharan Africa described in the literature.Case presentationAn 8 year old black Kenyan female child was diagnosed in Joubert’s syndrome in her first year of life. She was noted to have dysmorphic facies and hypotonia in the neonatal period and cranial MRI showed dysplasia of the cerebellar vermis and typical molar tooth malformation. She was subsequently lost to follow up for several years and later presented with anaemia. Further investigation revealed bilateral multicystic kidneys and significant renal impairment consistent with a diagnosis of end stage renal failure and polycystic kidney disease. She underwent home peritoneal dialysis for 7 months.ConclusionsJoubert’s syndrome and related disorders is a rare condition. This case report demonstrates that home peritoneal dialysis is feasible in a low resource setting. Although it is scarcely provided in African countries, it is an effective renal replacement strategy for patients with end stage renal disease.
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