Nagy M.T.; Hla S.M.; Keys G.W. BMJ Case Reports

Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers.

Citation: BMJ Case Reports, June 2013, 1757-790X (05 Jun 2013)
Author(s): Nagy M.T.; Hla S.M.; Keys G.W.

Abstract: Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immune-competent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient’s ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has
difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery.

Copyright 2013 BMJ Publishing Group.

Publication Type: Journal: Article
Source: EMBASE

Perspectives on Medical Education: Sept 2013

September 2013,

Open Access This content is freely available online to anyone, anywhere at any time.

An integrated model for developing research skills in an undergraduate medical curriculum: appraisal of an approach using student selected components


Student selected components (SSCs), at that time termed special study modules, were arguably the most innovative element in Tomorrow’s Doctors (1993), the document from the General Medical Council that initiated the modernization of medical curricula in the UK. SSCs were proposed to make up one-third of the medical curriculum and provide students with choice, whilst allowing individual schools autonomy in how SSCs were utilized. In response, at the University of Edinburgh the undergraduate medical curriculum provides an integrated and sequential development and assessment of research skill learning outcomes, for all students in the SSC programme. The curriculum contains SSCs which provide choice to students in all 5 years. There are four substantial timetabled SSCs where students develop research skills in a topic and speciality of their choice. These SSCs are fully integrated and mapped with core learning outcomes and assessment, particularly with the ‘Evidence-Based Medicine and Research’ programme theme.

Read the full article

New academy web portal for NHS staff

Extract from The Guardian – Healthcare Professionals Network

A new organisation that aims to improve training for NHS staff is to be launched on Thursday. The employer-led National Skills Academy for Health (NSA Health) will support NHS trusts and organisations in providing training across a wide range of job fields.

One of its key goals will be to tackle the skills gap in the health service. Although not providing education itself, the academy will direct trusts and other employers to education providers in their own areas and offer some opportunities for e-learning.

Candace Miller, its director, said: “We were hearing real concerns from employers about the availability of good training and educational support for healthcare assistants and other groups in their areas. The creation of the NSA Health will attempt to address this gap.”

Britton E.J.; Saravanan R.; Woodhouse T.; Koss K.; Gut – poster


Transient elastography in the risk stratification of patients with abnormal liver function tests.
Citation: Gut, July 2012, vol./is. 61/(A195), 0017-5749 (July 2012)

Author(s): Britton E.J.; Saravanan R.; Woodhouse T.; Koss K.

Abstract: Transient elastography (TE) (Fibroscan) is a well validated method for assessing liver fibrosis in a trial setting. Gastroenterology Department at Macclesfield DGH is one of the first centres in the UK to adopt Fibroscan examination into the diagnostic pathway of patients with abnormal LFT. This is the first publication of our data of unselected patients undergoing liver stiffness measurement (LSM) demonstrating practicalities and limitations of Fibroscan. Methods: Data were collected from 366 patients with abnormal LFT attending Gastroenterology Clinic from July 2010 to December 2011. Fibroscan examination was performed by two gastroentrology consultants and one specialist nurse. The cohorts of Fatty liver disease (FLD) and Alcoholic liver disease (ALD) were further analysed comparing fibrosis score from TE with clinical findings, laboratory blood tests, ultrasound imaging and liver biopsy.

Results: Patients diagnosis were as follows: FLD 35.8% (n=131), ALD 14.8% (n=54),
Chronic hepatitis C 15.6% (n=57), PSC/PBC 7.7% (n=28), chronic hepatitis B 4.6%
(n=17), haemochromatosis 2.2% (n=8), AIH 1.4% (n=5), chronic usage of Methotrexate 1.9% (n=7). Additionally 42 healthy volunteers participated. The mean time duration for each successful scan was 173 (30-1363) seconds with 18% of patients requiring the XL probe due to central obesity. The fibrosis scores recorded for all patients scanned were F0-1 41% (n=150), F2 6.3% (n=23), F3 7.1% (n=26) and F4 26% (n=95). 15% of scans were considered to be failed as LSM/IQR was >33, most prevalent in the FLD group 16.8% (n=22) and wasn’t operator or probe dependent. Significant proportion of patients with liver fibrosis (F3-4) had no clinical signs of chronic liver disease. 80% of patients F3-F4 fibrosis demonstrated portal hypertension on imaging and 32% of patients in that
group had low platelets (3. The sensitivity and specificity of low platelets for significant fibrosis was 32% and 91% and for portal hypertension on imaging was 64% and 89% respectively. There was significant correlation between liver fibrosis scoring on TE and Metvir fibrosis scoring on biopsy in patients without high degree of inflammation. However, coexisting acute inflammation in some cases contributed to false positive results on Fibroscan.

Conclusion: The Fibroscan technology has allowed rapid stratification of patients with chronic liver diseases. Significant proportion of patients (40%) were appropriately reassured without need of undergoing liver biopsy. 20% of patients without stigmata of chronic disease and without conventional laboratory markers of liver fibrosis were diagnosed with liver cirrhosis. Early experience has shown difficulties of performing TE in patients with central obesity and FLD. Fibroscan finds its valuable role in the care pathway of patients with abnormal LFT.

Publication Type: Journal: Conference Abstract – Poster
Source: EMBASE
Full Text: Available from Highwire Press in Gut.  Athens required

This month’s Eyes on Evidence

Surveillance data from Australia suggests a reduced incidence of genital warts following the introduction of vaccination against human papillomavirus for girls and young women.
A meta-analysis shows that, compared with placebo, pramipexole, ropinirole, rotigotine, gabapentin enacarbil and pregabalin improve symptoms in people with long-term moderate to severe primary restless legs syndrome.
A longitudinal study finds that social isolation and loneliness in older people may be associated with increased all-cause mortality.
An observational study suggests that the risk of thromboembolism after in vitro fertilisation is low but persists into the first trimester of pregnancy.
A meta-analysis notes that COX-2 inhibitors and diclofenac are associated with increased incidence of major vascular events.
A randomised controlled trial suggests that acupuncture for seasonal allergic rhinitis may improve disease-specific quality of life and reduce use of antihistamines.
We highlight a new example from the QIPP collection demonstrating how NHS organisations have implemented new local practices that have both cut costs and improved quality.

Noormohamed M.S.; Neophytou C.; Jain Y.; Rawat S.; BMJ Case Reports

A 66-year-old male with lower abdominal lump: an unusual presentation of an uncommon abdominal pathology. 

Citation: BMJ case reports, 2012, vol./is. 2012/, 1757-790X (2012)

Author(s): Noormohamed M.S.; Neophytou C.; Jain Y.; Rawat S.

Abstract: A 66-year-old Caucasian male was admitted following symptoms of intermittent umbilical pain aggravated after meals and associated with vomiting of contents. Physical examination revealed a tender, partially reducible swelling suspicious of complicated umbilical hernia. Abdominal x-ray revealed dilated small bowel loops which appeared consistent with clinical diagnosis. He underwent a laparotomy subsequently which revealed a small defect in the linea alba with viable small bowel and two firm mesenteric masses encroaching the lumen approximately two feet from the ileocaecal junction. The histology of the excised bowel and masses revealed that the tumour composed of bland spindle cells with slender to plump nuclei and eosinophilic cytoplasm.

Mesenteric fibromatosis are the most common primary tumours of the mesentery and constitute about 3.5% of all fibrous tissue tumours. Intra-abdominal desmoids are very rare and benign tumours but are very aggressive and should be considered in the differential diagnosis of acute abdominal pain.

Publication Type: Journal: Article
Source: EMBASE