Tin W.,James Cook University |
Brunskill G.,Newcastle General Hospital |
Kelly T.,Newcastle General Hospital |
Fritz S.,Northern Neonatal Nursing Initiative Trial Group
Pediatrics | Year: 2012
BACKGROUND: Observational study of 543 infants who weighed <1850 g, published in 1988 reported seriously impaired motor and cognitive development at 18 months in those with recurrent, asymptomatic hypoglycemia (plasma glucose level ≤2.5 mmol/L on ≥3 days). No study has yet replicated this observation. AIM: To quantify disability in a similar cohort of children followed up throughout childhood. POPULATION: All children born at <32 weeks' gestation in the north of England in 1990-1991 and had laboratory blood glucose levels measured daily for the first 10 days of life. RESULTS: Forty-seven index children of the 566 who survived to 2 years had a blood glucose level of ≤2.5 mmol/L on ≥3 days. All of these children and hypoglycemia-free controls, matched for hospital of care, gestation, and birth weight, were assessed at age 2. No differences in developmental progress or physical disability were detected. The families were seen again when the children were 15 years old, and 38 of the index children (81%) and matched controls agreed to detailed psychometric assessment. Findings in the 2 groups were nearly identical (mean full-scale IQ: 80.7 vs 81.2). Findings in the 21 children with a level of ≤2.5 mmol/L on ≥4 days, 7 children with a level this low on 5 days, and 11 children with a level of <2.0 mmol/L on 3 different days did not alter these conclusions. CONCLUSIONS: This study found no evidence to support the belief that recurrent low blood glucose levels (≤2.5 mmol/L) in the first 10 days of life usually pose a hazard to preterm infants. Copyright © 2012 by the American Academy of Pediatrics.
Mitchell P.,Newcastle General Hospital
British Journal of Neurosurgery | Year: 2010
In science, when a prevailing model does not fit reality the model is changed to fit better. The process is often accompanied by noisy attempts from some quarters to change reality to fit the model. So it is with randomised trials in surgery, the letter of Helmy et al.1 being an example. The randomised model used in drug trials does not fit surgery well for several well-rehearsed reasons2, a significant point of poor fit being the question of equipoise. © 2010 The Neurosurgical Foundation.
Hawthorne G.,Newcastle General Hospital
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2011
Pregnant women with diabetes have to manage both the effect of pregnancy on glucose control and its effect on pre-existing diabetic complications. Most women experience hypoglycaemia as a consequence of tightened glycaemic control and this impacts on daily living. Less commonly, diabetic ketoacidosis, a serious metabolic decompensation of diabetic control and a medical emergency, can cause foetal and maternal mortality. Microvascular complications of diabetes include retinopathy and nephropathy. Retinopathy can deteriorate during pregnancy; hence, regular routine examination is required and, if indicated, ophthalmological input. Diabetic nephropathy significantly increases the risk of obstetric complications and impacts on foetal outcomes. Pregnancy outcome is closely related to pre-pregnancy renal function. Diabetic pregnancy is contraindicated if the maternal complications of ischaemic heart disease or diabetic gastropathy are known to be present before pregnancy as there is a significant maternal mortality associated with both of these conditions. © 2010 Elsevier Ltd. All rights reserved.
Abinun M.,Newcastle General Hospital
Pediatric Health | Year: 2010
The clinical need for better treatments as well as the significant progress in understanding the pathophysiology of inflammation on one hand, and the progressive development of biotechnology on the other, were the driving force for the emergence of new treatments for autoimmune disorders at the beginning of the 21st century, heralding the 'age of biologic response modifying agents or biologics. This new class of drugs, although in use for just over a decade, has revolutionized the treatment of many inflammatory disorders, such as rheumatic, connective tissue disorders, autoimmune and autoinflammatory diseases. They have already made an immense impact on the quality of life of patients experiencing many years of combined immunosuppressive and anti-inflammatory treatments for chronic and often debilitating diseases. As these drugs were developed with the aim of altering specific components in the immune system function and, in particular, the inflammatory response, it is not surprising that infectious complications, including the severe and unusual, are among the serious side effects alongside other features of dysregulated immune system function, such as autoimmunity, lymphoproliferation and malignancy. The aim of this article is to highlight and anticipate further the infectious risks of the most commonly used biologics in children. © 2010 Future Medicine Ltd.
Currie A.,Newcastle General Hospital
Asian Journal of Sports Medicine | Year: 2010
There is strong and consistent evidence that eating disorders are prevalent in sport and especially in weight sensitive sports such as endurance, weight category and aesthetic sports as well as jumping events. These illnesses are not only common but lead to significant physical and psychological morbidity and impaired performances. Sports organizations, and by extension the professionals whose job it is to help and support athletes, have important roles in dealing with these conditions. Preventative practices can be adopted if there is an understanding of how the sports environment contributes to the development of eating disorders. Some disorders can be difficult to detect especially in a sports environment and simple screening instruments are available. Athletes may also need help to access appropriate treatment whilst they are recovering. In many sports prevention, screening and support programs have been developed for a variety of medical conditions or sports-related injuries. Similar programs should be developed for eating disorders. © 2010 by Sports Medicine Research Center, Tehran University of Medical Sciences, All rights reserved.
Gennery A.R.,Newcastle General Hospital
Advances in Experimental Medicine and Biology | Year: 2010
Abstract Several DNA repair pathways have evolved to recognise and repair DNA damaged by exogenous and endogenous agents, in order to maintain genomic integrity. Defects in these pathways can lead to replication errors, loss or rearrangement of genomic material, mutation or cancer and eventual death. The creation of many diverse lymphocyte receptors to identify potential pathogens has evolved by breaking and randomly resorting the gene segments coding for antigen receptors. Subsequent steps utilise the ubiquitous repair proteins. Individuals with defective repair pathways are increasingly recognised with immunodeficiency, many of whom exhibit radiosensitivity. Our understanding of the role of repair proteins in the development of adaptive immunity by VDJ recombination, antibody isotype class switching and affinity maturation by somatic hyper-mutation has made significant progress over the last few years, partly by the identification of new genes involved in human disease. We describe the mechanisms involved in the development of adaptive immunity relating to DNA repair and describe the clinical consequences and treatment developments of primary immunodeficiency resulting from such defects. © 2010 Landes Bioscience and Springer Science+Business Media.
Todd N.V.,Newcastle General Hospital
British Journal of Neurosurgery | Year: 2010
A logical, rational and reasonable guideline for the management of patients with suspected cauda equina syndrome (CESS) is proposed. This article is intended to promote debate. Ideally spinal surgeons can agree a standard of care that can be applied nationally to the benefit of our patients, our colleagues and, as neurosurgeons and spinal surgeons, ourselves. © 2010 The Neurosurgical Foundation.
Shabbir F.,Newcastle General Hospital
Dental update | Year: 2011
The oral cavity is an uncommon site for a true lipoma. A distinct histological variant is chondrolipoma, which is a rare oral lesion. A case of chondrolipoma in a 71-year-old male is reported and histology and differential diagnosis are discussed. Clinical Relevance: An oral lump is a common presenting complaint and requires further investigation.
Jaiser S.R.,Newcastle General Hospital |
Winston G.P.,National Hospital for Neurology and Neurosurgery
Journal of Neurology | Year: 2010
Acquired copper deficiency has been recognised as a rare cause of anaemia and neutropenia for over half a century. Copper deficiency myelopathy (CDM) was only described within the last decade, and represents a treatable cause of non-compressive myelopathy which closely mimics subacute combined degeneration due to vitamin B12 deficiency. Here, 55 case reports from the literature are reviewed regarding their demographics, aetiology, haematological and biochemical parameters, spinal imaging, treatment and outcome. The pathophysiology of disorders of copper metabolism is discussed. CDM most frequently presented in the fifth and sixth decades and was more common in women (F:M = 3.6:1). Risk factors included previous upper gastrointestinal surgery, zinc overload and malabsorption syndromes, all of which impair copper absorption in the upper gastrointestinal tract. No aetiology was established in 20% of cases. High zinc levels were detected in some cases not considered to have primary zinc overload, and in this situation the contribution of zinc to the copper deficiency state remained unclear. Cytopenias were found in 78%, particularly anaemia, and a myelodysplastic syndrome may have been falsely diagnosed in the past. Spinal MRI was abnormal in 47% and usually showed high T2 signal in the posterior cervical and thoracic cord. In a clinically compatible case, CDM may be suggested by the presence of one or more risk factors and/or cytopenias. Low serum copper and caeruloplasmin levels confirmed the diagnosis and, in contrast to Wilson's disease, urinary copper levels were typically low. Treatment comprised copper supplementation and modification of any risk factors, and led to haematological normalisation and neurological improvement or stabilisation. Since any neurological recovery was partial and case numbers of CDM will continue to rise with the growing use of bariatric gastrointestinal surgery, clinical vigilance will remain the key to minimising neurological sequelae. Recommendations for treatment and prevention are made. © 2010 Springer-Verlag.
Slatter M.A.,Newcastle General Hospital |
Gennery A.R.,Newcastle General Hospital |
Gennery A.R.,Northumbria University
Expert Reviews in Molecular Medicine | Year: 2010
DNA-repair pathways recognise and repair DNA damaged by exogenous and endogenous agents to maintain genomic integrity. Defects in these pathways lead to replication errors, loss or rearrangement of genomic material and eventually cell death or carcinogenesis. The creation of diverse lymphocyte receptors to identify potential pathogens requires breaking and randomly resorting gene segments encoding antigen receptors. Subsequent repair of the gene segments utilises ubiquitous DNA-repair proteins. Individuals with defective repair pathways are found to be immunodeficient and many are radiosensitive. The role of repair proteins in the development of adaptive immunity by VDJ recombination, antibody isotype class switching and affinity maturation by somatic hypermutation has become clearer over the past few years, partly because of identification of the genes involved in human disease. We describe the mechanisms involved in the development of adaptive immunity relating to DNA repair, and the clinical consequences and treatment of the primary immunodeficiency resulting from such defects. © Cambridge University Press 2010.