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  • 1
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    Online Resource
    171 Alemtuzumab induced neutropaenia: women at risk
    BMJ ; 2019
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 90, No. 12 ( 2019-12), p. e45.3-e45
    Details
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 90, No. 12 ( 2019-12), p. e45.3-e45
    Abstract: Alemtuzumab, a CD52 - specific monoclonal antibody depletes T and B cell population to reduce relapse in multiple sclerosis. Neutrophils also express low levels of CD52 and can be depleted transiently by alemtuzumab, increasing the risk of infection in the post-alemtuzumab treatment period. Aim In this study in the Greater Manchester Neuroscience Centre (GMNC) we investigated at risk population for alemtuzumab induced neutropaenia. The outcome of these patients is also discussed. Method Retrospective study of patients who developed neutropaenia following treatment with alemtuzumab at the GMNC. Data of patient demographics, grade of neutropeania, symptoms while neutropaenic and management were evaluated. Results Of the 131 patient (86 F: 45 M) treated with alemtuzumab (1.9 F: 1 M ratio), 18 patient (13.7%) developed neutropaenia (17 F Vs 1 M, 19.8% F Vs 2.2% M). Moderate to severe (grade 2–4) neutropaenia was only observed in females. Average duration to develop neutropaenia was 41 days. While neutropaenic 16 patients were asymptomatic, 1 developed flu-like illness and 1 had recurrent chest infection requiring antibiotic. Conclusion In our experience, women are at significantly higher risk of alemtuzumab induced neutropaenia. Monthly serial blood monitoring is adequate for most patients and specific intervention rarely required.
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    URL: Article
    DOI: 10.1136/jnnp-2019-ABN-2.152
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 1480429-3
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  • 2
    Online Resource
    Online Resource
    Necrosis of infantile haemangioma with propranolol therapy
    BMJ ; 2020
    In:  Archives of Disease in Childhood Vol. 105, No. 6 ( 2020-06), p. 608-608
    Details
    In: Archives of Disease in Childhood, BMJ, Vol. 105, No. 6 ( 2020-06), p. 608-608
    Type of Medium: Online Resource
    ISSN: 0003-9888 , 1468-2044
    URL: Article
    DOI: 10.1136/archdischild-2018-316478
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1481191-1
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  • 3
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    PO141 Audit of the first line oral disease modifying treatments in greater manchester
    BMJ ; 2017
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 88, No. Suppl 1 ( 2017-12), p. A50.1-A50
    Details
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 88, No. Suppl 1 ( 2017-12), p. A50.1-A50
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    URL: Article
    DOI: 10.1136/jnnp-2017-ABN.171
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 1480429-3
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  • 4
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    Solitary fibrous tumour of the pleura: an incidental finding
    BMJ ; 2022
    In:  BMJ Case Reports Vol. 15, No. 3 ( 2022-03), p. e247582-
    Details
    In: BMJ Case Reports, BMJ, Vol. 15, No. 3 ( 2022-03), p. e247582-
    Abstract: We herein report a relatively rare case of a woman in her 30s with an incidental lung finding. She subsequently underwent resection for what was considered to be a solitary fibrous tumour of the pleura (SFTP). SFTPs are rare, slow-growing neoplasms from mesenchymal origin. These tumours are histologically characterised by proliferation of bland-looking spindled cells, arranged in a patternless pattern, with hypocellular and hypercellular areas set in a hyalinised stroma. Complete en bloc surgical excision (with margin negativity) is the treatment of choice for both benign and malignant SFTPs. Due to the possibility of local recurrence with benign and malignant SFTPs, clinical and radiological follow-up is recommended.
    Type of Medium: Online Resource
    ISSN: 1757-790X
    URL: Article
    DOI: 10.1136/bcr-2021-247582
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2467301-8
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  • 5
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    Online Resource
    INTRACEREBRAL HAEMORRHAGE IN NORMOTENSIVE PATIENT WITH PROBABLE NEUROSAROIDOSIS
    BMJ ; 2016
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 87, No. 12 ( 2016-12), p. e1.55-e1
    Details
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 87, No. 12 ( 2016-12), p. e1.55-e1
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    URL: Article
    DOI: 10.1136/jnnp-2016-315106.148
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2016
    detail.hit.zdb_id: 1480429-3
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  • 6
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    Meropenem-induced thrombocytopenia: a paediatric case
    BMJ ; 2021
    In:  BMJ Case Reports Vol. 14, No. 9 ( 2021-09), p. e243443-
    Details
    In: BMJ Case Reports, BMJ, Vol. 14, No. 9 ( 2021-09), p. e243443-
    Abstract: Meropenem is a broad-spectrum carbapenem widely used to treat both Gram-positive and negative bacterial infections, including extended-spectrum beta-lactamase-producing microbes. We describe the occurrence of thrombocytopenia and hypersensitivity in a boy receiving intravenous meropenem for intra-abdominal sepsis secondary to perforated appendicitis. The patient developed a pruritic maculopapular rash with occasional petechiae, associated with severe thrombocytopenia, after 7 days of meropenem administration. Investigations for other causes of thrombocytopenia, including possible line sepsis, were unfruitful, and the thrombocytopenia did not resolve until cessation of meropenem. Drug-induced reactions should be considered in children receiving meropenem who present with a rash and thrombocytopenia.
    Type of Medium: Online Resource
    ISSN: 1757-790X
    URL: Article
    DOI: 10.1136/bcr-2021-243443
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2467301-8
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  • 7
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    Online Resource
    Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study
    BMJ ; 2020
    In:  BMJ
    Details
    In: BMJ, BMJ
    Abstract: To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. Design International, multicentre cohort study. Setting 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. Participants The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. Main outcome measures Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. Results Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). Conclusions ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. Trial registration ClinicalTrials.gov NCT03009929 .
    Type of Medium: Online Resource
    ISSN: 1756-1833
    URL: Article
    DOI: 10.1136/bmj.m2917
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 1479799-9
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  • 8
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    Online Resource
    Progressive encephalomyelitis with rigidity and myoclonus (PERM)
    BMJ ; 2022
    In:  Practical Neurology Vol. 22, No. 1 ( 2022-02), p. 48-50
    Details
    In: Practical Neurology, BMJ, Vol. 22, No. 1 ( 2022-02), p. 48-50
    Abstract: Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a subtype of stiff-person syndrome (formerly stiff-man syndrome). It is rare and disabling, and characterised by brainstem symptoms, muscle stiffness, breathing issues and autonomic dysfunction. We describe a 65-year-old man who presented with odynophagia together with tongue and neck swelling, followed by multiple cranial nerve palsies culminating in bilateral vocal cord paralysis with acute stridor. He subsequently developed progressive generalised hypertonia and painful limb spasms. Serum antiglycine receptor antibody was strongly positive, but antiglutamic acid decarboxylase and other antibodies relating to stiff-person syndrome were negative. We diagnosed PERM and gave intravenous corticosteroids and immunoglobulins without benefit; however, following plasma exchange he has made a sustained improvement.
    Type of Medium: Online Resource
    ISSN: 1474-7758 , 1474-7766
    URL: Article
    DOI: 10.1136/practneurol-2021-003087
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2075532-6
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  • 9
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    Preventing diabetes after pregnancy with gestational diabetes in a Cree community: an inductive thematic analysis
    BMJ ; 2020
    In:  BMJ Open Diabetes Research & Care Vol. 8, No. 1 ( 2020-05), p. e001286-
    Details
    In: BMJ Open Diabetes Research & Care, BMJ, Vol. 8, No. 1 ( 2020-05), p. e001286-
    Abstract: Historical and political factors underpin the disproportional burden of type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) in women, a harbinger of future T2DM, in Indigenous populations. There is a need for T2DM prevention strategies driven by the voices of Indigenous women. In this study, we aimed to understand the perspectives of Cree women with prior GDM living in northern Quebec, where over a quarter of pregnancies are complicated by GDM. Research design and methods A local healthcare worker invited women with GDM in the prior 5 years to participate in semistructured interviews. A Cree-origin research partner and a researcher jointly conducted interviews in-person or by teleconference. Open-ended questions addressed GDM experience, maintaining a healthy lifestyle, and needs/preferences pertinent to designing a T2DM prevention program aimed at women affected by GDM. We adopted an inductive thematic analysis framework to categorize experiences and opinions. Results Among the 13 mothers interviewed, some success with health behavior changes during pregnancy was reported but there were difficulties postpartum resulting from time constraints, costs of healthy foods, discomfort at the gym related to not being perceived as athletic, and safety concerns. They acknowledged the existence of programs addressing T2DM prevention in their community but did not participate. They endorsed preferences for group sessions, with family collaboration and childcare, that addressed healthy cooking and physical activity and incorporated traditional elements. Conclusion Cree mothers with a history of GDM highlighted several barriers to diabetes prevention. We are working to address these barriers through the creation of a Cree-facilitator-led community-based intervention.
    Type of Medium: Online Resource
    ISSN: 2052-4897
    URL: Article
    DOI: 10.1136/bmjdrc-2020-001286
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2732918-5
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  • 10
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    Online Resource
    Neurosarcoidosis associated with intracerebral haemorrhage: a challenge in diagnosis and management
    BMJ ; 2018
    In:  Practical Neurology Vol. 18, No. 3 ( 2018-06), p. 246-249
    Details
    In: Practical Neurology, BMJ, Vol. 18, No. 3 ( 2018-06), p. 246-249
    Abstract: Sarcoidosis is an idiopathic multisystem granulomatous disorder of unknown cause. Nervous system involvement (central and/or peripheral) is uncommon, developing in 5%–10%. The presenting symptoms are variable, reflecting the level of involvement, and frequently fluctuate and progress. Diagnosing neurosarcoidosis in people with previously confirmed systemic disease may be relatively straightforward, but diagnosing primary neurosarcoidosis is challenging. Managing neurosarcoidosis is primarily consensus based; corticosteroid is its mainstay, alongside corticosteroid-sparing agents and emerging novel therapies. We describe a 39-year-old woman who presented with cranial neuropathy. Serial imaging, cerebrospinal fluid sampling and tissue biopsy gave a diagnosis of probable neurosarcoidosis. Her clinical course was complicated by intracerebral haemorrhage following intravenous corticosteroids for neurological relapse. This is a very rare complication of neurosarcoidosis; we discuss its possible causes and suggest ways to reduce its risk.
    Type of Medium: Online Resource
    ISSN: 1474-7758 , 1474-7766
    URL: Article
    DOI: 10.1136/practneurol-2017-001794
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2075532-6
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