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Vergnano S.,St Georges, University of London | Menson E.,Evelina Childrens Hospital | Kennea N.,St. Georges Hospital NHS Trust | Embleton N.,Royal Infirmary | And 5 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2011

Introduction: Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time. Design: Prospective multicentre surveillance using a web-based database. Setting: 12 English neonatal units. Participants: Newborns admitted in 2006-2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days. Outcome measure: Incidence, age at infection, pathogens and antibiotic resistance profiles. Results: With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007-2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS). Conclusions: The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.


Guly H.R.,Derriford Hospital | Bouamra O.,University of Manchester | Spiers M.,Hope Hospital | Dark P.,University of Manchester | And 2 more authors.
Resuscitation | Year: 2011

Aim: The Advanced Trauma Life Support (ATLS) system classifies the severity of shock. The aim of this study is to test the validity of this classification. Methods: Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. For each patient, the blood loss was estimated and patients were divided into four groups based on the estimated blood loss corresponding to the ATLS classes of shock. The median and interquartile ranges (IQR) of the heart rate (HR) systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Score (GCS) were calculated for each group. Results: The median HR rose from 82 beats per minute (BPM) in estimated class 1 shock to 95. BPM in estimated class 4 shock. The median SBP fell from 135. mm Hg to 120. mm Hg. There was no significant change in RR or GCS. Conclusion: With increasing estimated blood loss there is a trend to increasing heart rate and a reduction in SBP but not to the degree suggested by the ATLS classification of shock. © 2011 Elsevier Ireland Ltd.


Roberts I.S.D.,John Radcliffe Hospital | Benamore R.E.,Churchill Hospital | Benbow E.W.,Royal Infirmary | Lee S.H.,Royal Infirmary | And 7 more authors.
The Lancet | Year: 2012

Background: Public objection to autopsy has led to a search for minimally invasive alternatives. Imaging has potential, but its accuracy is unknown. We aimed to identify the accuracy of post-mortem CT and MRI compared with full autopsy in a large series of adult deaths. Methods: This study was undertaken at two UK centres in Manchester and Oxford between April, 2006, and November, 2008. We used whole-body CT and MRI followed by full autopsy to investigate a series of adult deaths that were reported to the coroner. CT and MRI scans were reported independently, each by two radiologists who were masked to the autopsy findings. All four radiologists then produced a consensus report based on both techniques, recorded their confidence in cause of death, and identified whether autopsy was needed. Findings: We assessed 182 unselected cases. The major discrepancy rate between cause of death identified by radiology and autopsy was 32 (95 CI 26-40) for CT, 43 (36-50) for MRI, and 30 (24-37) for the consensus radiology report; 10 (3-17) lower for CT than for MRI. Radiologists indicated that autopsy was not needed in 62 (34; 95 CI 28-41) of 182 cases for CT reports, 76 (42; 35-49) of 182 cases for MRI reports, and 88 (48; 41-56) of 182 cases for consensus reports. Of these cases, the major discrepancy rate compared with autopsy was 16 (95 CI 9-27), 21 (13-32), and 16 (10-25), respectively, which is significantly lower (p<0·0001) than for cases with no definite cause of death. The most common imaging errors in identification of cause of death were ischaemic heart disease (n=27), pulmonary embolism (11), pneumonia (13), and intra-abdominal lesions (16). Interpretation: We found that, compared with traditional autopsy, CT was a more accurate imaging technique than MRI for providing a cause of death. The error rate when radiologists provided a confident cause of death was similar to that for clinical death certificates, and could therefore be acceptable for medicolegal purposes. However, common causes of sudden death are frequently missed on CT and MRI, and, unless these weaknesses are addressed, systematic errors in mortality statistics would result if imaging were to replace conventional autopsy. Funding: Policy Research Programme, Department of Health, UK. © 2012 Elsevier Ltd.


Schiffmann R.,Baylor Research Institute | Waldek S.,Hope Hospital | Benigni A.,Mario Negri Institute for Pharmacological Research | Auray-Blais C.,Universite de Sherbrooke
Clinical Journal of the American Society of Nephrology | Year: 2010

It is suggested that biomarkers of renal complications of Fabry disease are likely to be useful for diagnosis and to follow the natural disease progression or the effect of specific therapeutic interventions. Traditionally, globotriaosylceramide (Gb3) in urine has been used to evaluate the effect of specific therapy, such as enzyme replacement therapy (ERT). Although urinary Gb3 decreases significantly with ERT, it has not yet been shown to be a valid surrogate marker in treatment trials. We propose a detailed study of the nature and origin of Gb3 combined with a prospective collaborative trial that combines Gb3 changes with the effect of ERT on clinical nephrological outcome measures. Existing biomarkers such as general proteinuria/albuminuria or specific proteins such as N-acetyl-β-D- glucosaminidase should be evaluated along with novel proteomic or metabolomic studies for biomarker discovery using mass spectrometry or nuclear magnetic resonance. Standard scoring of all pathologic aspects of kidney biopsies may also be a promising way to assess the effect of therapy. Copyright © 2010 by the American Society of Nephrology.


Guly H.R.,Derriford Hospital | Bouamra O.,University of Manchester | Little R.,University of Manchester | Dark P.,University of Manchester | And 3 more authors.
Resuscitation | Year: 2010

Aim: The Advanced Trauma Life Support system classifies the severity of shock. The aim of this study is to test the validity of this classification. Methods: Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. Patients were divided into groups representing the four ATLS classes of shock, based on heart rate (HR) systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Score (GCS). The relationships between variables were examined by classifying the cohort by each recorded variable in turn and deriving the median and interquartile range (IQR) of the remaining three variables. Patients with penetrating trauma and major injuries were examined in sub-group analyses. Results: In blunt trauma patients grouped by HR, the median SBP decreased from 128. mm. Hg in patients with HR < 100. BPM to 114. mm. Hg in those with HR > 140. BPM. The median RR increased from 18 to 22. bpm and the GCS reduced from 15 to 14. The median HR in hypotensive patients was 88. BPM compared to 83. BPM in normotensive patients and the RR was the same. When grouped by RR, the HR increased with increasing RR but there were no changes in SBP. Conclusion: In trauma patients there is an inter-relationship between derangements of HR, SBP, RR and GCS but not to the same degree as that suggested by the ATLS classification of shock. © 2010 Elsevier Ireland Ltd.

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