Abstract-Thisarticle describes an open cross-sectional observational study involving 47 participants with Parkinson disease (PD) and 47 (age-and sex-matched) nondisabled controls without PD. The aim was to determine the profiles of subjective visual vertical (SVV) perception and sense of smell perception in both groups. There was a statistically significant difference (p < 0.001) between patients and controls on their smell test performance. Controls were more likely to correctly identify odors, with a median score of 10 out of 12 compared with 6.5 out of 12 for patients with PD. The median SVV error for the PD group when the frame was untilted was 0.75 degrees compared with 0.50 degrees for controls. This difference was statistically significant (p = 0.02). When the frame was tilted, the median SVV error for the PD group was 2.31 degrees compared with 2.00 degrees for controls (not statistically significant), with both groups showing similar distribution pattern of errors. There was no statistical correlation between number of correctly identified odors and an individual's SVV error. However, a statistically significant negative correlation (r = 0.45, p = 0.01) was found between Mini-Mental State Examination score and mean time taken to complete each rod and frame test in patients with PD, suggesting that SVV errors might be more correlated with cognitive function than with loss of sense of smell.
BSG abstractsantibodies (TTG) should be performed in patients with a diagnosis of lymphocytic duodenosis (LD), which may herald CD. The main objectives of this study were to determine the indications and histological findings for duodenal biopsies in a teaching hospital setting, and the prevalence of LD and new diagnoses of CD in this cohort. Methods 1043 patients with duodenal biopsies taken during upper gastrointestinal endoscopy in a teaching hospital setting in 24 months were studied retrospectively. Demographics, indications and histological findings were documented. Patients with known CD were excluded from the study; if an individual had more than one biopsy in the time period then only the first biopsy was included. When a specific abnormality was targeted for biopsy this was recorded. For LD patients, TTG results were recorded where available. Results The patients' median age was 60 (range 16-97); 55% were female. Anaemia was the commonest indication for biopsy (in 51% of patients) followed by weight loss and abdominal pain.76% of biopsies were normal. LD was found in 155 patients (15%), of whom 64% were female. Biopsy appearances of CD with positive TTG were found in 13 patients (1.2%). Documentation of serology was not always available and so the incidence of CD in this population may be underestimated. Crohn's disease was diagnosed in 3 biopsies (0.29%). Graft versus host disease, drug effect, lymphangiectasia and infection were seen (1 Giardia, 1 atypical mycobacteria, 1 Strongyloides).70 duodenal biopsies (7%) targeted specific abnormalities, including 6 malignancies (3 adenocarcinoma, 1 carcinoid tumour and 1 lymphoma) and 6 benign polyps including 2 adenomas. Of the 973 non-targeted biopsies, 772 (79%) were normal.There were no statistical differences between positive biopsy results and specific indications. Conclusion Whilst the majority of biopsies were normal, significant abnormalities were found in 24% and LD was present in 15%.
Granulomatosis with polyangiitis (GPA) is a multi-system necrotising vasculitis, particularly affecting small vessels. Upper respiratory tracts, lungs and kidneys are common target organs, while cardiac involvement would also be the first and rare manifestation of the disease. In GPA with cardiac involvement, structures such as the pericardium, myocardium, endocardium and conduction system could be involved. In the literature, there are reports of an association between autoimmune diseases and silica exposure. In our case, a 73-year-old sculptor with regular exposure to silica presented with pericarditis and was later diagnosed with granulomatosis with polyangiitis. This report provides additional evidence of an association between silica exposure and autoimmune vasculitis.
Our data showed that mean average ED arrival to medical review was faster by 2 hr 32 min (5 hr 10 min to 2 hr 38 min) and ED arrival to PTWR was faster by 3 hr 45 min (11 hr 2 min to 7 hr 17 min). Questionnaire feedback from staff was largely positive and constructive during the process and alterations were made according to their suggestions. Conclusions This project improved visibility of ED documentation, reduced unnecessary duplication, reduced waiting times and overall improved efficiency for staff and patients. It was widely supported by ward staff and management, thus ensuring its sustainability. This method is a middle ground between 'single' clerking and conventional (ie 'double') clerking. It reaps many of the benefits seen with single clerking but with minimal change to the organisational processes. Patient flow was faster and this combined process could be implemented in other trusts without significant difficulty. Looking to the future, we hope to improve the system further with more automation of data collection such as digital admission documentation to further improve the admission process for patients and staff. ■
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