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Khan A.,Guys and St Thomas Hospital NHS Trust | Coakley G.,Queen Elisabeth | Cosgrove C.,St Georges Healthcare NHS Trust | Lockwood D.,London School of Hygiene and Tropical Medicine
BMJ Case Reports | Year: 2010

A 74-year-old woman with a history of psoriatic arthritis was referred to the Hospital for Tropical Diseases following investigation of a skin lesion that had failed to heal after a visit to Malta 2 years previously. Skin biopsy had revealed invasion of Leishmania amastigotes. She reported a recent history of weight loss, dry cough and dyspnoea, and was investigated for pancytopenia and hepatosplenomegaly. Bone marrow biopsy confirmed the diagnosis of visceral leishmaniasis and she responded well to treatment with intravenous liposomal amphotericin B. Recent rheumatological treatment with adalimumab, a monoclonal antibody to tumour necrosis factor α, was thought to be the factor responsible for causing the cutaneous lesion to become disseminated. This case highlights an unexpected adverse effect of novel immunosuppressants. As the use of biologics becomes widespread, there is an increasing need for clinical surveillance.

Navalkissoor S.,Royal Free Hospital NHS Trust | Nowosinska E.,Royal Free Hospital NHS Trust | Gnanasegaran G.,Guys and St Thomas Hospital NHS Trust | Buscombe J.R.,Addenbrookes Hospital
Nuclear Medicine Communications | Year: 2013

This review focuses on the current evidence available on the use of single-photon emission computed tomography-computed tomography (SPECT-CT) in infection imaging. The single-photon functional agents commonly used to image infection include In-111-labelled or Tc-99m-labelled leucocytes, Ga-67 citrate, Tc-99m-biphosphonates and radiolabelled antigranulocyte antibodies. Although many of these agents have been available for a long time, the development of hybrid SPECT-CT technology has led to a wider use of these agents. This review shows that the application of CT to single-photon imaging techniques for imaging infection can significantly improve the accuracy of the technique by increasing the specificity and better defining the location and extent of suspected disease. Hybrid fusion images also increase the confidence of the individual in reporting and seem to be applicable to a wide range of clinical situations. We believe that, overall, SPECT-CT, by providing a clearer assessment of whether infection is present and an accurate localization of the disease so that optimum treatment can be initiated, has a role in infection imaging. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Cox S.,Guys and St Thomas Hospital NHS Trust
Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2011

Project groups are working to improve the move between paediatric and adult services for adolescents who receive kidney care.

Boffito M.,St Stephens Center | Fox J.,Guys and St Thomas Hospital NHS Trust | Bowman C.,Royal Hallamshire Hospital | Fisher M.,University of Sussex | And 7 more authors.
Vaccine | Year: 2013

Background: Combination antiretroviral therapy (cART) is the main therapeutic management tool for HIV/AIDS. Despite its success in controlling viral load and disease progression, cART is expensive, associated with a range of significant side effects and depends for its efficacy on the patient's life-long commitment to high levels of treatment adherence. Immunotherapeutic agents can provide potential solutions to these shortcomings. Here we describe a Phase Ib trial of HIV-v, a synthetic immunotherapy that elicits T- and B-cell effector responses against HIV infected cells. Methods: Fifty-nine cART-naive HIV-infected males aged 18-50 years with viral load of 5000-500,000. copies/ml and CD4 counts >350/μl were recruited for this multi-centre, randomised, double blind study. Volunteers received one low (250. μg) or high (500. μg) dose of HIV-v, either alone or adjuvanted (ISA-51). Safety, immunogenicity, CD4 count and viral load were monitored over 168 Days. Results: HIV-v was well tolerated and the adjuvanted formulations elicited IgG responses in up to 75% of volunteers. The high adjuvanted dose also elicited cellular responses in 45% of tested volunteers. In these responding subjects viral loads were reduced by over 1. log ( p= 0.04) compared to Placebo and non-responders. No changes in CD4 count were observed. Conclusions: HIV-v is safe and can elicit T- and B-cell responses in ART-naive HIV patients that significantly reduce viral load. Improved dosing regimens and further research on long term efficacy are required, but HIV-v appears to have potential as an immunotherapeutic anti-viral agent.Trial registered as EudraCT-2009-010593-37 (ClinicalTrials.gov Identifier: NCT01071031). © 2013 Elsevier Ltd.

Jindal M.,Russells Hall Hospital | Riskalla A.,Guys and St Thomas Hospital NHS Trust | Jiang D.,Guys and St Thomas Hospital NHS Trust | Connor S.,Guys and St Thomas Hospital NHS Trust | O'Connor A.F.,Guys and St Thomas Hospital NHS Trust
Otology and Neurotology | Year: 2011

OBJECTIVE: A systematic review to determine whether the diffusion-weighted (DW) magnetic resonance imaging scan can reliably detect residual or recurrent cholesteatoma after mastoid surgery. DESIGN: A systematic review. DATA SOURCES: Databases including EMBASE, MEDLINE, CINAHL, Web of Science, and Cochrane Review were searched for studies published without language restriction from the start of the databases. Additional studies were identified from cited references. SELECTION CRITERIA: Initial search identified 402 publications, of which 16 studies met the inclusion criteria for the systematic review. The DW imaging (DWI) scan was used to detect residual or recurrent cholesteatoma and subsequent second-look surgery was performed to correlate the findings. REVIEW METHODS: Studies were assessed for their selection of patients for radiologic investigations, imaging parameters, and subsequent surgery. Outcome measures included sensitivity, specificity, positive and negative predictive values of the DWI, and the incidence and size of residual or recurrent cholesteatoma. RESULTS: Two different modalities of DWI sequences have been described. Eight studies with 225 patients analyzed echo-planar imaging (EPI) and 8 studies with 207 patients described the "non-EPI" scanning techniques. Non-EPI parameters are more reliable in identifying residual or recurrent cholesteatoma with sensitivity, specificity, and positive and negative predictive values of 91%, 96%, 97%, and 85%, respectively. CONCLUSION: The available evidence suggests that non-EPI such as half-Fourier acquisition single-shot turbo spin echo sequences are more reliable in identifying residual or recurrent cholesteatoma. This is a promising radiologic investigation; however, we think further studies are required with more patients and long-term results to establish its place as an alternative to a second-stage surgery after canal wall up surgery. © 2011, Otology &Neurotology, Inc.

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