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Edwards D.S.,Public Health England | Milne L.M.,HPA Bedfordshire and Hertfordshire Health Protection Unit | Morrow K.,HPA Bedfordshire and Hertfordshire Health Protection Unit | Sheridan P.,HPA Bedfordshire and Hertfordshire Health Protection Unit | And 6 more authors.
Epidemiology and Infection | Year: 2014

A foodborne outbreak with 49 cases (22 culture positive for Campylobacter sp.) following a wedding party in the East of England was investigated. A retrospective cohort study identified an association between consumption of chicken liver pté and infection with Campylobacter jejuni/coli. There was a statistically significant association between dose (amount of chicken liver pté eaten) and the risk of disease ['tasted': odds ratio (OR) 1·5, 95% confidence interval (CI) 0·04-∞; 'partly eaten': OR 8·4, 95% CI 1·4-87·5; 'most or all eaten': OR 36·1, 95% CI 3·3-2119). The local authority found evidence that the preparation of chicken livers breached Food Standards Agency's guidelines. This epidemiological investigation established a clear dose-response relationship between consumption of chicken liver pté and the risk of infection with Campylobacter. The continuing need to raise public awareness of the risk to human health posed by undercooked chicken liver is evident. © 2013 Cambridge University Press.


Fernando P.M.,Luton and Dunstable University Hospital
Sri Lankan Journal of Anaesthesiology | Year: 2013

The concept of 'Enhanced Recovery' is changing the face of surgical care pathways in western countries, benefiting patients as well as healthcare providers. The improvement in outcomes claimed would be of even greater benefit to developing countries, where resources are harder to come by. However, implementation of such a program in a developing country such as Sri Lanka needs to be preceded by thorough study of the obstacles to early discharge of patients, and the program customised to address problems specific to the local healthcare environment.


Malaga E.G.,Derbyshire Community Health Services | Aguilera E.M.M.,University College London | Eaton C.,Luton and Dunstable University Hospital | Ameerally P.,Northampton General Hospital
Journal of Oral and Maxillofacial Surgery | Year: 2016

Clinicians face numerous challenges when managing psychiatric patients who self-inflict injuries within the maxillofacial region. In addition to a complex clinical examination, there are both surgical and psychiatric factors to consider, such as the risk of damaging vital structures, the exacerbation of the patient's psychiatric status, and the long-term psychosocial and esthetic sequelae. We present 2 cases of adolescents who repeatedly self-inflicted wounds and/or inserted foreign bodies (FBs) into the face, scalp, and neck. The different treatment modalities were based on full evaluation of the patient's clinical, medical, and diagnostic test findings coupled with a psychiatric assessment. The decision for conservative management or surgical intervention was made according to the presence and location of the FBs, degree of hemorrhage, signs and symptoms of infection, and unpleasant scars that could lead to long-term psychological impairment. In most cases, the FBs were removed and the wounds were toileted and closed under local or general anesthesia. We advocate a holistic approach via a multidisciplinary team, which is deemed essential to provide the highest quality of care for patients to reduce the risk of further relapses. Lastly, a satisfactory esthetic outcome is always paramount to achieve long-term psychological and physical welfare. © 2016 The American Association of Oral and Maxillofacial Surgeons.


Battersby C.,Imperial College London | Santhakumaran S.,Imperial College London | Upton M.,A+ Network | Radbone L.,A+ Network | And 2 more authors.
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2014

Objective: To evaluate a quality improvement (QI) programme to increase the use of maternal breast milk (MBM) in preterm infants. Design: Interrupted time series analysis. Setting: 17 neonatal units in the East of England (EoE) Perinatal Network; 144 in the rest of the UK Neonatal Collaborative (UKNC). Patients: Infants born ≤32+6 weeks gestation admitted to neonatal care between 2009 and 2012. Intervention: A 'care bundle' to promote MBM in the EoE. Outcomes: Percentage of infants receiving exclusive or any MBM at discharge and care days where any MBM was received. Methods: Data were extracted from the National Neonatal Research Database; outcomes were compared preintervention and postintervention, and in relation to the rest of the UKNC. Results: Exclusive and any MBM use at discharge increased from 26% to 33% and 50% to 57% respectively in the EoE, though there was no evidence of a step or trend change following the introduction of the care bundle. Exclusive MBM use at discharge improved significantly faster in EoE than the rest of the UKNC; 0.22% (95% CI 0.11 to 0.34) increase per month versus 0.05% (95% CI 0.01 to 0.09, p=0.007 for difference). The percentage of infants receiving MBM at discharge and care days where any MBM was received was not significantly different between EoE and the rest of the UKNC. Conclusions: This QI programme was associated with some improvement in MBM use in preterm infants that would not have been evident without the use of routinely recorded national comparator data.


Prasad R.,Queen Mary, University of London | Chan L.F.,Queen Mary, University of London | Hughes C.R.,Queen Mary, University of London | Kaski J.P.,Inherited Cardiovascular Diseases Unit | And 7 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Classic ACTH resistance, due to disruption of ACTH signaling, accounts for the majority of cases of familial glucocorticoid deficiency (FGD). Recently FGD cases caused by mutations in the mitochondrial antioxidant, nicotinamide nucleotide transhydrogenase, have highlighted the importance of redox regulation in steroidogenesis. Objective: We hypothesized that other components of mitochondrial antioxidant systems would be good candidates in the etiology of FGD. Design: Whole-exome sequencing was performed on three related patients, and segregation of putative causal variants confirmed by Sanger sequencing of all family members. A TXNRD2-knockdown H295R cell line was created to investigate redox homeostasis. Setting: The study was conducted on patients from three pediatric centers in the United Kingdom. Patients: Seven individuals from a consanguineous Kashmiri kindred, six of whom presented with FGD between 0.1 and 10.8 years, participated in the study. Interventions: There were no interventions. Main Outcome Measure: Identification and functional interrogation of a novel homozygous mutation segregating with the disease trait were measured. Results: A stop gain mutation, p.Y447X in TXNRD2, encoding the mitochondrial selenoprotein thioredoxin reductase 2 (TXNRD2) was identified and segregated with disease in this extended kindred. RT-PCR and Western blotting revealed complete absence of TXNRD2 in patients homozygous for the mutation. TXNRD2 deficiency leads to impaired redox homeostasis in a human adrenocortical cell line. Conclusion: In contrast to the Txnrd2-knockout mouse model, in which embryonic lethality as a consequence of hematopoietic and cardiac defects is described, absence of TXNRD2 in humans leads to glucocorticoid deficiency. This is the first report of a homozygous mutation in any component of the thioredoxin antioxidant system leading to inherited disease in humans. Copyright © 2014 by the Endocrine Society.

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