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Bedford, United Kingdom

Shulgina L.,University of East Anglia | Cahn A.P.,Bedford Hospital NHS Trust | Clark A.B.,University of East Anglia | Wilson E.C.F.,University of East Anglia | And 6 more authors.
Thorax | Year: 2013

Background: Idiopathic pulmonary fibrosis (IPF) is a fatal condition with limited treatment options. However, in a previous small study, co-trimoxazole was found to be beneficial. Methods: In a double-blind multicentre study, 181 patients with fibrotic idiopathic interstitial pneumonia (89% diagnosed as definite/probable IPF) were randomised to receive co-trimoxazole 960 mg twice daily or placebo for 12 months in addition to usual care. Measurements were made of forced vital capacity (FVC) (primary endpoint), diffusing capacity of carbon monoxide (DLCO) and EuroQol (EQ5D)-based utility, 6-minute walk test (6MWT) and Medical Research Council (MRC) dyspnoea score (secondary endpoints). All-cause mortality and adverse events were recorded (tertiary endpoints). Results: Co-trimoxazole had no effect on FVC (mean difference 15.5 ml (95% CI -93.6 to 124.6)), DLCO (mean difference -0.12 mmol/min/kPa (95% CI 0.41 to 0.17)), 6MWT or MRC dyspnoea score (intention-to-treat analysis). The findings of the per-protocol analysis were the same except that co-trimoxazole treatment resulted in a significant improvement in EQ5D-based utility (mean difference 0.12 (95% CI 0.01 to 0.22)), a reduction in the percentage of patients requiring an increase in oxygen therapy (OR 0.05 (95% CI 0.00 to 0.61)) and a significant reduction in all-cause mortality (co-trimoxazole 3/53, placebo 14/65, HR 0.21 (95% CI 0.06 to 0.78), p=0.02)) compared with placebo. The use of co-trimoxazole reduced respiratory tract infections but increased the incidence of nausea and rash. Conclusions: The addition of co-trimoxazole therapy to standard treatment for fibrotic idiopathic interstitial pneumonia had no effect on lung function but resulted in improved quality of life and a reduction in mortality in those adhering to treatment. Source


Muttalib M.,Bedford Hospital NHS Trust | Ibrahem R.,University of Nottingham | Khashan A.S.,University College Cork | Hajaj M.,Kettering General Hospital Foundation Trust
Clinical Radiology | Year: 2014

Aim To evaluate the performance of breast magnetic resonance imaging (MRI) in determining the size of invasive lobular carcinoma (ILC) compared to histopathology, and its influence on breast surgical management. Materials and methods Prospective evaluation was undertaken of standardized contrast-enhanced MRI images of 51 consecutive women over an 18 month period with pure ILC or with lobular features as the dominant subtype on breast core biopsy. Image interpretation was performed by one consultant radiologist (M.H.). The lesion size at MRI was compared with the size at final histopathology after surgical excision using a Bland-Altman agreement plot. Results Of the 51 prospectively imaged consecutive women, seven were excluded as they had diffuse ILC. The remaining 44 patients had a mean histological tumour size of 34.9 mm (range 4-77 mm). MRI underestimated tumour size in 26 (59.1%) cases. In 21 (47.7%) patients, this discrepancy was small, ranging up to 16 mm. The largest underestimation occurred in five (11.4%) cases with a difference ranging between 31 and 48 mm. Fifteen (34.1%) tumours were overestimated by MRI where the discrepancy ranged up to 22 mm. In three (6.8%) patients MRI and histological size matched. The Bland-Altman agreement plot demonstrated that in 95% of cases the size at histopathology will be between 0.36 and 2.31 times the MRI size at extremes. MRI correlated better with histopathology in tumours up to T2 (<5 cm) size leading to a change in surgical management for nine of the 44 (20.5%) patients. Conclusion MRI enables surgical management decisions to be made with increased confidence in patients with ILC up to T2 size. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. Source


Wassif W.S.,Bedford Hospital NHS Trust | Ross A.R.,Assiut University
Vitamins and Hormones | Year: 2013

Few organ systems are spared the progressive deterioration seen in critically ill patients with anorexia nervosa. Most of the endocrine disturbances discussed are due to starvation and represent appropriate metabolic adaptation of the body to food restriction and negative energy balance. In a starving patient, a lowered metabolic rate, increased cortisol and growth hormone level and reduced fertility are all appropriate adaptations to an abnormal and highly stressful state. Most metabolic abnormalities can be reversed with a well-planned refeeding program and nutritional recovery. © 2013 Elsevier Inc. Source


Pledger J.,Bedford Hospital NHS Trust | Hicks D.,NHS Enfield Community Services | Down S.,Somerset PCT
Journal of Diabetes Nursing | Year: 2012

It is estimated that approximately 800 000 people in the UK use injectable therapies to treat their diabetes (Forum for Injection Technique, 2010). Injectable agents, both old and new, rely for optimal effect on the correct dose being injected at the right site, using the right technique every time. This article explains the importance of correct injection technique and how it may be achieved. Choice of injection site, optimal needle length, possible use of skin folds and rotation of injection sites are discussed, as are the consequences of incorrect injection technique, including lipohypertrophy. The development of the first UK recommendations to promote best practice in injection technique for all healthcare professionals involved in diabetes care and the education of people with diabetes is outlined. Source


Naderi A.,Bedford Hospital NHS Trust | Naderi A.,University of Cambridge
Cancer Genetics and Cytogenetics | Year: 2010

Multiple basal cell carcinomas (BCCs) are a hallmark of Gorlin syndrome (nevoid basal cell carcinoma syndrome), which is caused by mutation in the PTCH1 gene on 9q22.3. However, there are several reports of familial cases with multiple BCCs without the associated defects of Gorlin syndrome. The possibility of underlying genetic abnormalities in these familial BCCs has not been explored previously. The present study investigated a possible genetic abnormality in two members of a family with multiple nonsyndromic BCCs. The possibility of Gorlin syndrome in this family was excluded by both the absence of any clinical and radiological features and the lack of mutation in PTCH1. Notably, whole-genome comparative genomic hybridization (CGH) identified a microdeletion in chromosome 22q11.1 in both of the studied cases. A tiling path CGH array of the 22q11.1 region confirmed this microdeletion and mapped it between 14.46 and 14.5 Mb on chromosome 22q. The 34-kb region of this microdeletion includes three annotated genes: LOC644525, LOC100132389, and LOC729057. Although future studies of other families with the hereditary nonsyndromic BCCs are still warranted, this study identified an association between a microdeletion of 22q11.1 and two familial cases of BCC. © 2010 Elsevier Inc. Source

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