Preschool age children (PSAC) are excluded from community based praziquantel treatment programs mainly due to paucity of evidence on the magnitude of schistosomiasis, efficacy and safety of this treatment in P...
Fri Apr 05, 2019 03:00
Prevalence of erectile dysfunction (ED) in diabetic men is considerably high but it is often underdiagnosed and undermanaged. There were no data available about the prevalence and the risk factors of ED in our...
Fri Apr 05, 2019 03:00
Ethiopia is among the 30 high tuberculosis (TB) burden countries with annual estimated TB incidence of 164/100,000 population and death rate of 28/100,000 population for 2017. We analyzed the trend in magnitud...
Fri Apr 05, 2019 03:00
Contemporary clinical guidelines endorsed that glycemic control is the ultimate goal in the management patients with diabetes. The aim of this study was to assess the prevalence of glycemic control and to iden...
Thu Apr 04, 2019 03:00
The purpose of the present study was to investigate healthcare workers' physical exercise levels linked to their quality of life. Healthcare workers' from all departments of a General hospital participated in ...
Thu Apr 04, 2019 03:00
An 84-year-old woman presented to hospital with severe clinical and metabolic sequelaesequelae of a massive paracetamol overdose (concentration=822 mg/L). In spite of N-acetylcysteine therapy, she deteriorated with evidence of mitochondrial dysfunction. Although the EXtracorporeal TReatments In Poisoning group recommend adjunct haemodialysis (HD) in such a context, this was difficult to start due to haemodynamic instability. Instead, a trial of continuous venovenous haemodiafiltration (CVVHDF) was...
Sat Apr 06, 2019 08:56
Prostate cyst, as an extrarenal manifestation in patients with autosomal dominant polycystic kidney disease, although infrequent, nevertheless goes beyond tenuous concomitance and may rarely contribute to recurrent urinary tract infection or outflow obstruction and mostly remains asymptomatic. In this context, we report a case of incidentally detected, an asymptomatic prostatic cyst in a patient of autosomal dominant polycystic kidney disease.
Sat Apr 06, 2019 08:56
Sat Apr 06, 2019 08:56
Herpes zoster is a clinical manifestation of reactivation of varicella-zoster virus (VZV) that lies dormant in the dorsal root ganglia after a past primary infection. It can be associated with severe pain, a crop of vesicles in typical dermatomal distribution but the neuralgic pain persists long, making the patient uncomfortable and often disturbing patient's sleep. There are cases reported after trauma or post surgeries that are mainly related to organ transplant or malignancy. In the literature,...
Sat Apr 06, 2019 08:56
Should the laparoscopic approach be the norm for appendicectomy in the third trimester of pregnancy?
Our case describes a pregnant woman with acute appendicitis who presented in the third trimester and underwent a laparoscopic appendicectomy. She made a rapid postoperative recovery and the pregnancy was otherwise uncomplicated, ending with a spontaneous vaginal birth at 41 weeks. The diagnosis of acute appendicitis can be unclear in pregnancy. Difficulty in establishing diagnosis due to atypical presentation often leads to delay in surgery, resulting in significant maternal and fetal morbidity and...
Sat Apr 06, 2019 08:56
An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection...
Sat Apr 06, 2019 08:56
We report two women who were diagnosed with hypothyroidism due to what was thought to be Hashimoto's thyroiditis 18 and 16 years ago, respectively. They had been euthyroid on stable doses of levothyroxine for many years, and they presented to our clinic with clinically and biochemically overt hyperthyroidism that persisted even after stopping levothyroxine. Immunological and imaging workups were consistent with Graves' disease. Both patients were treated medically and then received definitive treatment....
Sat Apr 06, 2019 08:56
Post-traumatic bronchobiliary fistula (BBF) is a rare entity, with only a few cases reported worldwide. Bilioptysis is pathognomonic of the condition, however, bronchoscopy and bronchoalveolar lavage along with CT are used for confirmation. We describe this condition in a young woman who presented to us with bilioptysis following a laparotomy for blunt torso trauma. Diagnosis was made of BBF, followed by surgical management and complete recovery. We emphasise the signs of early diagnosis, confirmatory...
Sat Apr 06, 2019 08:56
Sat Apr 06, 2019 08:56
We report the case of an individual from Nigeria seeking asylum in the USA on the basis of persecution for being gay, who was physically and sexually assaulted in Nigeria and detained upon arrival to the USA. We present physical examination findings and the results of a brief mental health evaluation performed at Elizabeth Detention Center in New Jersey for his asylum evaluation. Individuals are able to seek asylum as members of a "particular social group", in this case, being gay. They seek asylum...
Sat Apr 06, 2019 08:56
Idiopathic intracranial hypertension (IIH) is a challenging disease with unclear pathophysiology. Recognition of venous sinus stenting to improve intracranial pressure is increasing. We present a 56-year-old man diagnosed with IIH. A parasagittal meningioma abutting the sagittal sinus causing venous compression was found. Venous sinus stenting via endovascular approach using a WALLSTENT was performed. Intravascular pressures recorded after stenting demonstrated resolution of the pressure gradient....
Sat Apr 06, 2019 08:56
Diabetic euglycaemic ketoacidosis is a possible adverse effect of sodium–glucose co-transporter-2 inhibitors (SGLT2i). We report a case in which the combination of SGLT2i and a strict very low-carbohydrate diet led to severe diabetic ketoacidosis in a young Caucasian man with type 2 diabetes.
Sat Apr 06, 2019 08:56
Gastrointestinal duplications are extremely rare congenital abnormalities having definite difficulties to be diagnosed preoperatively. Most of them are presented at the oesophagus and ileum and only involve colon from 4% to 18%. We illustrate a case report of an 18-year-old female patient with transverse colon duplication. There were symptom manifestations such as chronic constipation with flatulence accompanied with abdominal pain. We demonstrate this case report due to non-specific clinical presentation...
Sat Apr 06, 2019 08:56
Thu Apr 04, 2019 21:05
Takotsubo syndrome is an intriguing condition of often stress induced reversible cardiac dysfunction mimicking myocardial infarction, but without explanatory coronary obstructions. The pathogenesis of the syndrome is not yet fully understood, though altered sympathetic regulation or response to cardiac sympathetic stimuli is likely to be involved. We present a unique and clinically detailed report of identical twin sisters, who both developed Takotsubo syndrome in association to mental stress shortly...
Thu Apr 04, 2019 21:05
A 41-year-old woman with menorrhagia secondary to adenomyosis underwent an elective uncomplicated total laparoscopic hysterectomy after failed medical therapy. She developed fever, epigastric pain, nausea and diarrhoea on postoperative day (POD) 2. CT of abdomen and pelvis performed on POD 3 revealed an 8x3x3 cm fluid collection superior to the bladder. She did not respond to conservative treatment with intravenous antibiotics and therefore underwent an ultrasound-guided drainage on POD 7. The green-debris-laden...
Thu Apr 04, 2019 21:05
Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. The term was coined more than 100 years ago. This occurs due to superimposed bacterial infection. The presentation of primary varicella in adults is more severe with catastrophic systemic complications as compared with children. These complications include necrotising fasciitis, disseminated intravascular coagulation, wet/dry gangrene and death, as was seen in our case. Survival...
Thu Apr 04, 2019 21:05
Thu Apr 04, 2019 21:05
A 17-year-old man presented to the emergency department with complaints of retro-orbital pain of the left eye and an altitudinal visual field defect for 2 weeks. Fundus examination revealed ipsilateral hyperaemic optic disc oedema, and the patient was admitted with the presumptive diagnosis of left optic neuritis. Subsequently, during follow-up, the patient developed a retinal granulomatous lesion in the superior temporal arcade with vitritis and fibrotic strands extending to the mid-periphery. Serum...
Thu Apr 04, 2019 21:05
Thu Apr 04, 2019 21:05
Carteolol, a non-selective beta-antagonist with a potential risk of severe bronchial constriction in patients with asthma, is one of the most commonly prescribed medication for managing ocular pressure in glaucoma. We present a case of a 24-year-old woman with a history of atopy but no known asthma who presented an insidious onset of clinical manifestations compatible with drug-induced asthma after the initiation of carteolol for ocular hypertension control. The patient developed progressive chest...
Thu Apr 04, 2019 21:05
A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial effusion requiring drainage. Evaluation for pericardial infection, malignancy, autoimmune disease and pacemaker lead perforation was negative. After fourth recurrence and fifth pericardial drainage in...
Thu Apr 04, 2019 21:05
We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery...
Thu Apr 04, 2019 21:05
ObjectivesTo investigate the impact of natural disasters on communities in the Barisal division of Bangladesh, exploring community approaches to disaster preparedness and mitigation. SettingCommunities in all districts of the Barisal division of Bangladesh. ParticipantsQuantitative data were collected through a cross-sectional household survey (n=9263 households; n=38 981 individuals). Qualitative data were collected through in-depth interviews (n=7) and focus group discussions (n=23) with key...
Thu Apr 04, 2019 21:04
IntroductionDecreasing participation levels in health surveys pose a threat to the validity of estimates intended to be representative of their target population. If participants and non-participants differ systematically, the results may be biased. The application of traditional non-response adjustment methods, such as weighting, can fail to correct for such biases, as estimates are typically based on the sociodemographic information available. Therefore, a dedicated methodology to infer on non-participants...
Thu Apr 04, 2019 21:04
ObjectivesThe purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients. DesignA qualitative descriptive study. SettingThis study took place in a community hospital ICU located in a medium size Canadian city. ParticipantsPurposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated. MethodsA...
Thu Apr 04, 2019 21:04
Hearing loss (≥26 dB threshold in the better ear), as a common chronic condition in humans, is increasingly gaining attention. Relevant research in China is relatively scarce, so we conduct a population-based study to investigate the prevalence of hearing loss among age groups, genders and ears in Zhejiang province, China, from September 2016 to June 2018. Study designPopulation-based cross-sectional study ParticipantsA total of 3754 participants aged 18–98 years and living in Zhejiang province,...
Thu Apr 04, 2019 21:04
IntroductionPsychological distress is a prevalent condition often overlooked following a motor vehicle crash (MVC), particularly when injuries are not severe. The aim of this study is to examine whether biomarkers of autonomic regulation alone or in combination with other factors assessed shortly after MVC could predict risk of elevated psychological distress and poor functional recovery in the long term, and clarify links between mental and physical health consequences of traffic injury. Methods...
Thu Apr 04, 2019 21:04
ObjectiveTo determine if an educational intervention focused on the role of spirituality in healthcare positively affects medical students' attitudes and perceptions relating to this topic. DesignA pre-post cohort study. SettingAn undergraduate medical institution affiliated with an academic medical center in the USA. ParticipantsA total of 110 medical students currently on their clinical rotations received the educational intervention, of whom 71 (65%) completed both the presurvey and postsurvey....
Thu Apr 04, 2019 21:04
IntroductionSurgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions. To address this, we will perform a network meta-analysis (NMA) and systematic review to compare the efficacy and safety of surgical and invasive procedures for adults with degenerative lumbar spinal stenosis. Methods and analysisWe will include randomised controlled...
Thu Apr 04, 2019 21:04
Background and objectivesMany donors and recipients report an improved bond posttransplantation; however, unexpected conflicts and tension may also occur. Insights into the lived experiences of the donor–recipient relationship can inform strategies for interventions and support. We aimed to describe donor and recipient expectations and experiences of their relationship before and after living kidney donor transplantation. Design, setting and participantsSemistructured interviews were conducted with...
Thu Apr 04, 2019 21:04
ObjectiveTo assess the effects of using health social media on different days of the working week on web activity. DesignIndividually randomised controlled parallel group superiority trial. SettingTwitter and Weibo. Participants194 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. There were no human participants. InterventionsThree randomly ordered slightly different messages (maximum of 140 characters), each containing a short URL to the freely...
Thu Apr 04, 2019 21:04
ObjectiveThe aim of this study was to assess the spatial distribution and determinant factors of anaemia among reproductive age women in Ethiopia. MethodsAn in-depth analysis of the 2016 Ethiopian Demographic and Health Survey data was undertaken. Getis-Ord Gi* statistics were used to identify the hot and cold spot areas for anaemia among women of reproductive age. A multilevel logistic regression model was used to identify independent predictors of anaemia among women of reproductive age. ResultsOlder...
Thu Apr 04, 2019 21:04
IntroductionFirst line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms? Methods and analysisClinical trials will be identified through database...
Thu Apr 04, 2019 21:04
ObjectiveElectronic cigarettes (e-cigarettes) which utilise prefilled 'pods' (pod devices) entered the US market in 2015. One brand, JUUL, captured more than half the e-cigarette market in early 2018, and the US Food and Drug Administration recently warned its manufacturer about adolescent uptake. This is the first qualitative study to describe distinct features of pod devices that appear to contribute to their popularity among young people. DesignQualitative interview study of young adults who...
Thu Apr 04, 2019 21:04
BackgroundMedia can influence public and policy-makers' perceptions of causes of, and solutions to, public health issues through selective presentation and framing. Childhood obesity is a health issue with both individual-level and societal-level drivers and solutions, but public opinion and mass media representations of obesity have typically focused on individual-level framings, at the cost of acknowledgement of a need for regulatory action. Objective and settingTo understand the salience and...
Thu Apr 04, 2019 21:04
IntroductionUse of patch angioplasty in carotid endarterectomy (CEA) is suggested to reduce the risk of restenosis and recurrent ipsilateral stroke. The objective is to conduct a systematic review with meta-analysis and trial sequential analysis as well as Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessments comparing the benefits and harms of CEA with primary closure of the arterial wall versus CEA with patch angioplasty in patients with a symptomatic and significant...
Thu Apr 04, 2019 21:04
ObjectiveTo systematically synthesise qualitative research that explores children's and caregivers' perceptions of mandatory reporting. DesignWe conducted a meta-synthesis of qualitative studies. Data sourcesSearches were conducted in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Criminal Justice Abstracts, Education Resources Information Center, Sociological Abstracts and Cochrane Libraries. Eligibility criteriaEnglish-language, primary, qualitative studies...
Thu Apr 04, 2019 21:04
ObjectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative...
Thu Apr 04, 2019 21:04
ObjectiveTo explore lay understanding and perceptions of schizophrenia in university students. DesignQualitative study using semi-structured interviews and thematic analysis. SettingThe University of Birmingham, West Midlands. Participants20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1). ResultsFindings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms...
Thu Apr 04, 2019 21:04
ObjectiveTo translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process. DesignMulticentre cross-sectional study. SettingSecondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain). ParticipantsPatients with chronic diseases...
Thu Apr 04, 2019 21:04
IntroductionHyperemesis gravidarum (HG) is a pregnancy condition characterised by excessive nausea and vomiting resulting in dehydration, weight loss and serious adverse pregnancy outcomes including termination of pregnancies. Even though evidence in low-income and middle-income countries (LMICs) is limited, the prevalence of HG in pregnancy ranges from 0.3% to 10.8%. With this systematic review and meta-analysis, we aim to determine the prevalence/burden, risk factors, and maternal and perinatal...
Thu Apr 04, 2019 21:04
Introduction An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising...
Thu Apr 04, 2019 21:04
IntroductionBariatric surgeries are effective in treating obesity related comorbidities, including type 2 diabetes mellitus. More robust evidence is needed to facilitate choice of procedure. In this systemic review, we aim to investigate the comparative long-term effectiveness in inducing remission of type 2 diabetes, halting diabetic complications, reducing mortality and the safety of conventional and emerging bariatric surgeries. Methods and analysisDatabases including Cochrane Central Register,...
Thu Apr 04, 2019 21:04
IntroductionObstructive sleep apnoea (OSA) is a prevalent disease associated with cardiovascular events. Hypertension is one of the major intermediary mechanisms leading to long-term cardiovascular adverse events. Intermittent hypoxia and hypercapnia associated with nocturnal respiratory events stimulate chemoreflexes, resulting in sympathetic overactivity and blood pressure (BP) elevation. Continuous positive airway pressure (CPAP) is the primary treatment for OSA and induces a small but significant...
Thu Apr 04, 2019 21:04
A dispute between NHS England and Oxford University Hospitals NHS Foundation Trust over plans to outsource the trust's cancer scanning to a private company has been referred to the health secretary,...
Fri Apr 05, 2019 19:21
A survey of members of the BMA's UK General Practitioners Committee found that most male members did not believe that the committee needed to reflect the diversity of the doctors it represents.The...
Fri Apr 05, 2019 19:10
OMICS, a publisher of "predatory" academic journals that earn revenue by charging fees to authors, must pay $50.1m (£38m; €45m) to the US government after a federal court in Nevada found that its...
Fri Apr 05, 2019 18:41
A former junior doctor in paediatrics has been spared jail after police found dozens of images of serious child sexual abuse on his laptop during a raid on his home.Ralph Harper, 31, was given an...
Fri Apr 05, 2019 18:01
A group of women who, in 1869, were the first to study medicine at a UK university are to be awarded posthumous degrees in recognition of their role in widening access to education.The women, who...
Fri Apr 05, 2019 17:01
A test of cyber defences at UK universities has found that hackers are able to get into data systems and gain access to "high value" information, including research data, in just two hours.Simulated...
Fri Apr 05, 2019 16:16
Women outlive men everywhere in the world, and the gap in life expectancy would be even wider if women in low income countries had better access to healthcare, a new global report shows.The World...
Fri Apr 05, 2019 15:31
A 64 year old woman presented to the emergency department with a history of sudden onset severe generalised headache after waking, associated with nausea. She had no medical history. On examination,...
Thu Apr 04, 2019 13:10
The NHS will have "discretion" over whether to put services out to competitive tender under new reform proposals that should cut transaction costs, health officials have told MPs.But the use of...
Thu Apr 04, 2019 13:06
MumpsPHE issues alert after university outbreakPublic Health England reported 268 suspected cases of mumps at two universities. The outbreak was reported at Nottingham Trent University and the...
Thu Apr 04, 2019 13:05
In this paper by Sheppard and colleagues (BMJ 2018;361, doi:10.1136/bmj.k2478, published 27 June 2018) the authors would like to acknowledge that author F D Richard Hobbs is supported by the National...
Thu Apr 04, 2019 12:56
Two studies this week concern strategies to reduce cervical cancers: by screening and by human papillomavirus vaccination.A case-control study from Sweden finds that women who attended cervical...
Thu Apr 04, 2019 12:46
Cannabis and psychosisA case control study at 12 sites in Europe and South America found that people with a first episode of psychosis were four times more likely to report daily cannabis use than...
Thu Apr 04, 2019 12:40
NHS policy makers should take action to try to reduce the risk of disputes developing between doctors and parents over the treatment of critically ill children and to tackle them when they arise, the...
Thu Apr 04, 2019 18:35
The patient information sheet accompanying an article on iliotibial band syndrome (https://www.bmj.com/content/364/bmj.l980) (doi:10.1136/bmj.l980) has been updated to clarify the wording of the...
Thu Apr 04, 2019 18:06
The new conservative majority on the US Supreme Court has ruled 5-4 against a request for a stay of execution from a Missouri death row inmate who argued that his rare medical condition meant that a...
Thu Apr 04, 2019 17:40
The doctors behind accusations of sexism and inappropriate behaviour among senior members of the BMA have reported their lack of faith in the organisation's own conduct processes.In an article for...
Thu Apr 04, 2019 15:41
Working in geriatric medicine 40 years ago, I was taught about the problems of overmedicating the frail elderly.1 So, this is not a new problem; it is probably less so now. But, even then, we did not...
Thu Apr 04, 2019 11:31
As a doctor who has recently completed foundation training, I have seen many colleagues choose to take up non-training medical roles in the UK and abroad and am not at all surprised by the continued...
Wed Apr 03, 2019 17:56
A 32 year old Indian man, with a smoking history of 15-20 "bidis" (bid cigarettes)/day for the past 15 years, presented with bilateral lower limb claudication and spontaneous auto-amputation of...
Thu Apr 04, 2019 12:41
What you need to knowCannabis based products for medicinal use contain cannabinoids derived from the cannabis plant, including ∆8-tetrahydrocananbinol (THC), cannabidiol (CBD), or a combination of...
Thu Apr 04, 2019 12:40
Mathew's column on giving statins to patients over 75 was thought provoking, but we are concerned that readers may be tempted to withhold lifesaving drugs from older patients without giving ample...
Thu Apr 04, 2019 12:36
AbstractObjectiveTo quantify the effect on cervical disease at age 20 years of immunisation with bivalent human papillomavirus (HPV) vaccine at age 12-13 years.DesignRetrospective population study,...
Thu Apr 04, 2019 01:30
BackgroundThirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general practitioners and additional training for care home staff. We assessed and compared the effect on hospital use for residents in residential and nursing homes, respectively.MethodsUsing linked care home and administrative hospital data, we examined people aged 65 years or...
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