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News Article | November 28, 2016

A clinical trial of a smart bandage which changes colour when it detects infections is beginning using samples from burns patients from four UK hospitals. The technology, developed at the University of Bath, has potential to detect infection earlier, allowing improved treatment for burns patients as well as reducing the use of antibiotics, helping combat the threat of drug-resistant bacteria. The trial, at Southmead Hospital Bristol, Bristol Royal Hospital for Children, Chelsea and Westminster Hospital and Queen Victoria Hospital East Grinstead will see swabs and used dressings taken from hundreds of patients to be used in laboratory tests at the University of Bath. These double-blind tests will establish statistically how sensitive the bandages are to infections, and how specifically they react to infections they are designed to detect. The samples will also undergo tests by scientists at the University of Brighton seeking genomic data from infection-causing bacteria which will help improve the bandages' performance further. The nature of burns wounds unfortunately means signs and symptoms of infections are common but true infection is rare. A colour-changing bandage will provide an early-warning that infection is developing, allowing better and timelier treatment for patients. It will also prevent unnecessary tests in patients who do not have infection. Existing diagnosis methods take up to 48 hours and require removing wound dressings, a painful and distressing process for the patient which can slow healing and cause scarring. Currently in cases of suspected infection precautionary courses of antibiotics are often prescribed. The colour-changing bandage would reduce this need, helping tackle the global problem of bacteria developing antibiotic resistance and saving the NHS money on drugs. Professor Toby Jenkins, who is leading the study, said: "We believe our bandages have great potential to improve outcomes for patients, reduce unnecessary use of antibiotics and save the NHS money. "These trials are an exciting and essential step towards getting the bandages into hospitals to help treat people, allowing us to find out exactly how well they work using real samples from patients. We hope as many people as possible agree to take part in the trial, which is completely non-invasive." Dr Amber Young, consultant paediatric anaesthetist at Bristol Royal Hospital for Children's hospital and the lead clinician on the trial, said: "Using patients' samples to test the dressing's ability to detect infection will take us closer to the use of the dressing in patients. "Diagnosing wound infection at the bedside in patients with burns will allow targeted treatment of those with true infection; allowing earlier healing and reduced scarring as well as preventing overuse of antibiotics and unnecessary dressing removal in those patients with no infection. This will benefit both patients and the NHS." If the trials demonstrate that the bandages are effective then manufacturing could begin as early as next year. The trial has been funded by the Medical Research Council (MRC).

Shah P.L.,Royal Brompton Hospital | Shah P.L.,Chelsea and Westminster Hospital | Shah P.L.,Imperial College London | Herth F.J.F.,University of Heidelberg | Herth F.J.F.,Translational Lung Research Center
Thorax | Year: 2014

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Emphysema is a component of COPD characterised by hyperinflation resulting in reduced gas exchange and interference with breathing mechanics. Endoscopic lung volume reduction using one-way valves to induce atelectasis of the hyperinflated lobe has been developed and studied in clinical trials over the last decade. Methods: Searches for appropriate studies were undertaken on PubMed and Clinical Trials Databases using the search terms COPD, emphysema, lung volume reduction and endobronchial valves. Results: The evidence from the randomised clinical trials suggests that complete lobar occlusion in the absence of collateral ventilation or where there is an intact lobar fissure are the key predictors for clinical success. Other indicators are greater heterogeneity in disease distribution between upper and lower lobes. The proportion of patients that respond to treatment improves from 20% in the unselected population to 75% with appropriate patient selection. The safety profile for endobronchial valves in this severely affected group of patients with emphysema was acceptable and the main adverse events observed were an excess of pneumothoraces. Conclusion: Selected patients have the potential of significant benefit in terms of lung function, exercise capacity and possibly even survival. These considerations are essential in-order to maximise patient benefit in a resource-limited environment and also to ensure that beneficial treatments are available for the appropriate patient.

Fell J.M.E.,Chelsea and Westminster Hospital
Archives of Disease in Childhood | Year: 2013

Eosinophilic oesophagitis (EO) is a chronic immune/ antigen-mediated oesophageal disease, with the immune reaction most likely directed to foods but on occasion also to aeroallergens. Clinically, it is characterised by symptoms of oesophageal dysfunction in subjects who typically have other indicators of an atopic tendency. Older children (and adults) frequently present with dysphagia and can have strictures (which may require dilatation). The diagnosis is dependent on an eosinophilpredominant oesophageal inflammation, with 15 or more eosinophils per high-powered field, now generally accepted as a necessary cut-off level of infiltration, which together with other clinical data (eg, oesophageal pH/impedance studies) can help discriminate EO from other potential causes of symptoms such as gastrooesophageal reflux disease. Recommended therapies, which may need to be long term, are dietary antigen exclusion (with elemental feeds or an exclusion diet) and/or topical corticosteroids.

Joshi D.,King's College | O'Grady J.,King's College | Dieterich D.,Mount Sinai Hospital | Gazzard B.,Chelsea and Westminster Hospital | Agarwal K.,King's College
The Lancet | Year: 2011

Introduction of effective combined antiretroviral therapy has made HIV infection a chronic illness. Substantial reductions in the number of AIDS-related deaths have been accompanied by an increase in liver-related morbidity and mortality due to co-infection with chronic hepatitis B and C viruses. Increases in non-alcoholic fatty liver disease and drug-induced hepatotoxicity, together with development of hepatocellular carcinoma, also potentiate the burden of liver disease in individuals with HIV infection. We provide an overview of the key causes, disease mechanisms of pathogenesis, and recommendations for treatment options including the evolving role of liver transplantation. © 2011 Elsevier Ltd.

Fell J.M.E.,Chelsea and Westminster Hospital
Archives of Disease in Childhood | Year: 2012

Up t o 25% of patients with Crohn's disease and ulcerative colitis present before the age of 18 years. Although the pathophysiology of inflammatory bowel disease presenting in childhood does not differ fundamentally from that presenting in adulthood, managing these younger patients requires special consideration in light of growth and the potential long term consequences of both the disease and its treatments. Therapeutic approaches have changed in recent years, and there is a fuller appreciation of the role (and risks) of anti-tumour necrosis factor monoclonal therapy.

Fox P.A.,Chelsea and Westminster Hospital
Sexual Health | Year: 2012

There is a growing range of treatment options for anal intraepithelial neoplasia (AIN). In HIV-positive patients, sustained treatment is often required to achieve clearance. The treatments considered are topically applied fluorouracil, imiquimod, cidofovir and trichloroacetic acid, the potential treatments of topical lopinavir and photodynamic therapy with aminolevulenic acid, and the surgical methods of electrosurgery, infrared coagulation and laser. Destructive treatment methods, possibly including TCA, are more effective than self applied topical treatments. Combining or alternating different treatments should be considered. Journal compilation CSIRO © 2012.

Fuller L.C.,International Foundation for Dermatology | Fuller L.C.,Chelsea and Westminster Hospital
Current Opinion in Infectious Diseases | Year: 2013

PURPOSE OF REVIEW: Scabies is a common skin infestation globally, particularly in the developing world. With the launch of the International Alliance for the Control of Scabies (IACS) in 2012, this review aims to present the recent evidence of the current epidemiological situation for scabies across the globe. Mindful of the fact that the downstream complications of scabies infestations, pyoderma, streptococcal glomerulonephritis and subsequent chronic renal impairment and rheumatic fever, have been recognized as being more significant to global health than previously acknowledged, the review focusses also on the epidemiological evidence from developing countries. RECENT FINDINGS: Scabies occurrence rates vary in the recent literature from 2.71 per 1000 to 46%. Although it is responsible for larger disease burdens and complications such as pyoderma and renal and heart disease in the tropics, scabies outbreaks in the developed world amongst vulnerable communities and health institutions contribute a significant cost to the health services managing them. SUMMARY: Scabies remains common across the world, but is such a health issue in the developing world that the suggestion that it be considered a neglected tropical disease is a pertinent one. Standardized diagnostic criteria and even a point-of-care diagnostic test would be a major contribution to the understanding of this epidemic. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Bridges N.,Chelsea and Westminster Hospital
Paediatric Respiratory Reviews | Year: 2013

Cystic fibrosis related diabetes (CFRD) is a common complication of cystic fibrosis, caused by a fall in insulin secretion with age in individuals with pancreatic insufficiency. CFRD is associated with worse clinical status and increased mortality. Treatment of CFRD with insulin results in sustained improvements in lung function and nutrition. While clinical experience with insulin treatment in CF has increased, the selection of who to treat and glycaemic targets remain unclear. © 2013.

Bower M.,Chelsea and Westminster Hospital
Blood | Year: 2010

HIV-associated plasmablastic multicentric Castleman disease is an increasingly frequent diagnosis. Kaposi sarcoma herpesvirus is found in the monotypic polyclonal plasmablasts that characterize this disease. Unlike Kaposi sarcoma, the incidence does not correlate with CD4 cell count or use of highly active antiretroviral therapy. It is a relapsing and remitting illness, and diagnostic criteria are emerging that define disease activity based on the presence of a fever and raised Creactive protein coupled with a list of clinical features. Treatment protocols increasingly stratify therapy according to performance status and organ involvement. I advocate rituximab monotherapy for good performance status patients without organ involvement and rituximab with chemotherapy for more aggressive disease. The success of antiherpesvirus agents in controlling active disease is limited, but valganciclovir may have a role as maintenance therapy in the future. © 2010 by The American Society of Hematology.

Tziotzios C.,University of Cambridge | Profyris C.,Chelsea and Westminster Hospital | Sterling J.,University of Cambridge
Journal of the American Academy of Dermatology | Year: 2012

The evidence base underpinning most traditional scar reduction approaches is limited, but some of the novel strategies are promising and accumulating. We review a number of commonly adopted strategies for scar reduction. The outlined novel agents are paradigmatic of the value of translational medical research and are likely to change the scenery in the much neglected but recently revived field of scar reduction therapeutics. © 2010 by the American Academy of Dermatology, Inc.

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