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Feakins R.M.,Barts Health NHS Trust
Histopathology | Year: 2014

The interpretation of colorectal biopsies taken for the initial diagnosis of chronic idiopathic inflammatory bowel disease (IBD) is challenging. Subclassification of IBD as ulcerative colitis (UC) or Crohn's disease, which may be particularly difficult, is the subject of this review. Biopsies taken at first presentation are emphasised, partly because their features have not been modified by time or treatment. Aspects of longstanding disease and of resections are also mentioned. The first part of the review comprises background considerations and a summary of histological features that are discriminant, according to published evidence, between UC and Crohn's disease in initial biopsies. Pitfalls and problems associated with making the distinction between UC and Crohn's disease are then discussed. These include: mimics of IBD; inadequate clinical details; unreliable microscopic features; absence of histological changes in early IBD; discontinuity in UC; cryptolytic granulomas; differences between paediatric and adult UC; reliance on ileal and oesophagogastroduodenal histology; and atypical features in IBD resections. Avoidance by pathologists of known pitfalls should increase the likelihood of accurate and confident subclassification of IBD, which is important for optimum medical and surgical management. © 2013 John Wiley & Sons Ltd.

Singh N.,Barts Health NHS Trust | Gilks C.B.,University of British Columbia | Wilkinson N.,St Jamess Hospital | Mccluggage W.G.,Belfast Health and Social Care Trust
Histopathology | Year: 2014

The revised FIGO 2013 staging for carcinomas of the ovary, fallopian tube and peritoneum has introduced a single system for tumours originating at these sites. The system requires pathologists to assign a primary site (ovary, tube or peritoneum), but does not provide guidance to aid this assignment. This is particularly problematic in cases of advanced-stage (stage II or greater) high-grade serous carcinoma (HGSC), where there is commonly involvement of two or more sites by tumour, and practice among pathologists in determining where a tumour has arisen varies widely. This has significant implications for recording of tumour incidence and mortality, data collection by cancer registries, and entry into clinical trials. We propose guidelines for assigning the primary site of HGSC based on careful macroscopic and histological assessment. The use of these guidelines, in conjunction with the new FIGO staging system, is intended to act as an impetus to promote debate and provide a uniform and consistent approach in assigning primary tumour site which will facilitate comparison of data between centres. © 2014 John Wiley & Sons Ltd.

Millar M.R.,Barts Health NHS Trust
Public Health Ethics | Year: 2015

Individuals are at risk of acquiring untreatable agents of infection when they travel to countries where antibioticresistant agents of infection are prevalent, and particularly when they travel for healthcare. Uncertainty with respect to the overall political and economic consequences seems to underlie the reluctance of public health authorities to issue relevant travel advisories. The conditions of choice, the act of choice and the consequences of choice can each be a primary focus of ethical appraisal of public health policy. The 'value of choice' account provided by Scanlon draws attention to the value of the choices that individuals are given, and the potential for reasonable rejection of policies that do not give adequate emphasis to the conditions of individual choice. There is both instrumental and symbolic value in informing people of the risk of acquisition of antibiotic-resistant microbes associated with health tourism. We cannot reasonably reject a principle of actively informing unless there are insurmountable countervailing reasons. These reasons should be explicit and subject to review. If health tourism is a concern then we might also consider how best to facilitate alternative choices. © The Author 2015.

Clark D.A.,Barts Health NHS Trust
Clinical Microbiology and Infection | Year: 2016

Human herpesvirus 6 (HHV-6) comprises two separate viruses, HHV-6A and HHV-6B, although this distinction is not commonly made. HHV-6B is ubiquitous in the population with primary infection usually occurring in early childhood, and often resulting in febrile illness. HHV-6B is also recognized as a pathogen in the immunocompromised host, particularly in transplant recipients. HHV-6A is less well characterized and may have a more restricted prevalence. Both viruses are unique among the human herpesviruses in that the entire viral genome can be found integrated into the telomeric regions of host cell chromosomes. Approximately 1% of persons have inherited integrated viral sequences through the germline, and these individuals characteristically have very high viral loads in blood and other sample types. Emerging evidence suggests that HHV-6A and HHV-6B chromosomal integration may not just be an uncommon biological observation, but more likely a characteristic of the replication properties of these viruses. The integrated viral genome appears capable of excision from the chromosomal site and potentially allows viral replication. The clinical consequences of inherited chromosomally integrated HHV-6 have yet to be fully appreciated. © 2016 European Society of Clinical Microbiology and Infectious Diseases.

Agency: GTR | Branch: MRC | Program: | Phase: Intramural | Award Amount: 1.79M | Year: 2010

Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.

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