BackgroundThe incidence of acute pancreatitis has increased sharply in many European countries and the USA in recent years.AimTo establish trends in incidence and mortality for acute pancreatitis in Wales, UK, and to assess how incidence may be linked to factors including social deprivation, seasonal effects and alcohol consumption.MethodsUse of record linked inpatient, mortality and primary care data for 10 589 hospitalised cases of acute pancreatitis between 1999 and 2010.ResultsThe incidence of acute pancreatitis was 30.0 per 100 000 population overall, mortality was 6.4% at 60 days. Incidence increased significantly from 27.6 per 100 000 in 1999 to 36.4 in 2010 (average annual increase = 2.7% per year), there was little trend in mortality (0.2% average annual reduction). The largest increases in incidence were among women aged <35 years (7.9% per year) and men aged 35–44 (5.7%) and 45–54 (5.3%). Incidence was 1.9 times higher among the most deprived quintile of patients compared with the most affluent (3.9 times higher for alcoholic acute pancreatitis and 1.5 for gallstone acute pancreatitis). Acute pancreatitis was increased significantly during the Christmas and New Year weeks by 48% (95% CI = 24–77%) for alcoholic aetiology, but not for gallstone aetiology (9%). Alcoholic admissions were increased with higher consumption of spirits and beer, but not wine.ConclusionsThe study shows an elevated rate of alcoholic acute pancreatitis during the Christmas and New Year period. Acute pancreatitis continues to rise, most rapidly for young women, while alcoholic acute pancreatitis is linked strongly with social deprivation.

ObjectivesRitonavir (RTV) at doses of 400 mg twice a day (bid) or higher adversely affects serum lipids. However, the effect of RTV 100 mg bid on serum lipids is unknown. We conducted a study to evaluate the effect of RTV 100 mg bid on fasting serum lipid profiles in HIV-negative healthy volunteers. MethodsRitonavir 100 mg bid was administered for 14 days to 20 healthy HIV-seronegative adults with normal serum lipids. After a 7-day washout, lopinavir/ritonavir (LPV/RTV) 400/100 mg bid was administered for 14 days. Fasting serum lipid parameters were measured twice at baseline, after 14 days of RTV, and after 14 days of LPV/RTV, and comparisons were made at each time-point for levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, the total/HDL cholesterol ratio and triglycerides.Results After 14 days of RTV 100 mg bid, total cholesterol level increased by 10.2% (Po0.001), LDL cholesterol level increased by 16.2% (Po0.001), triglyceride levels increased by 26.5% (Po0.001), HDL cholesterol level decreased by 5.4% (Po0.01) and the total/HDL cholesterol ratio increased by 17.3% (Po0.001). The addition of LPV 400 mg bid to RTV 100 mg bid resulted in no significant further changes in LDL cholesterol or triglyceride level or total/HDL cholesterol ratio, but there were significant increases in both total cholesterol (8.0% increase; P 5 0.007) and HDL cholesterol levels (6.7% increase; P 5 0.008). ConclusionsRitonavir dosed at 100 mg bid significantly increased the concentration of total cholesterol, LDL cholesterol, total/HDL cholesterol ratio and triglycerides and reduced HDL cholesterol concentration. The addition of LPV 400 mg bid to RTV 100 mg bid further increased both total and HDL cholesterol levels without affecting the total/HDL ratio. IntroductionTreatment of HIV/AIDS changed dramatically in the mid1990s with the introduction of highly active antiretroviral therapy (HAART), which initially consisted of one or more HIV protease inhibitors (PIs) together with two nucleoside reverse transcriptase inhibitors (NRTIs). PI-based HAART resulted in dramatic reductions in mortality [1], hospitalization [2], and the incidence of most opportunistic infections [1,3]. However, PI therapy has been associated with a number of adverse effects, including hyperlipidaemia [4]. Preliminary data suggest that PI-induced hyperlipidaemia is associated with an increased risk of atherosclerotic heart and cerebrovascular disease [5], as with genetic/dietary hyperlipidaemia. When the PI ritonavir (RTV) was introduced, it was used as the sole PI therapy at a dosage of 600 mg twice daily. The initial studies of RTV monotherapy demonstrated that RTV caused significant increases in serum cholesterol, and marked increases in serum triglycerides [6,7]. In a study of 11 HIV-negative volunteers who received 2 weeks of RTV 500 mg twice daily, fasting cholesterol level increased by In recent years, the use of RTV at 'full' doses of 600 mg twice daily has nearly disappeared from clinical ...

SUMMARY BackgroundThere is little up-to-date review evidence on the prevalence of Helicobacter pylori across Europe. AimTo establish regional and national patterns in H. pylori prevalence across Europe. Secondly, to establish trends over time in H. pylori prevalence and gastric cancer incidence and, thirdly, to report on the relationship between H. pylori prevalence and age group across Europe. MethodsA review of H. pylori prevalence from unselected surveys of adult or general populations across 35 European countries and four European regions since 1990. Secondly, an analysis of trends over time in H. pylori prevalence and in gastric cancer incidence from cancer registry data.

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessness levels; one RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB, those with moderate to severe COPD being most likely to benefit. Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit The use of Pursed Lips Breathing in stable COPD: a systematic review of the evidence Abstract Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable COPD. Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management. Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means. Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to The Grading of Recommendations Assessments, Development and Evaluation (GRADE) system, with the remaining studies being of low quality. Although no high quality evidence was identified, with the exception of one low quality study, the direction of effect for PLB was consistently towards benefit. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate during use at rest and reduces time taken to recover to pre-exercise breathlessnes...

This study found 9 of 13 of patients taught PLB continued with long-term use and 8 of 13 reporting definite benefit from PLB. The role of PLB in increasing patients' confidence in their ability to manage their breathlessness and, use at night, were novel findings.