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Research Interests: Immunology, Biology, Virology, Medicine, Virus, and 11 moreClinical Sciences, MHC class II, Public health systems and services research, Major histocompatibility complex, Amino Acid Profile, Cell Proliferation, Virus infection, epitope, Sequence similarity, Paediatrics and reproductive medicine, and Insulin dependent diabetes mellitus
We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G-CSF). A 72-year-old woman with a history of thyrotoxicosis presented with sore... more
We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G-CSF). A 72-year-old woman with a history of thyrotoxicosis presented with sore throat and fever two weeks after starting carbimazole. Investigations confirmed a leucopenia and neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.
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A 65-year-old woman, referred to the endocrine clinic for investigation of tiredness and arthritis, was diagnosed as having diabetes on the basis of a positive family history and a raised glycated haemoglobin (HbA1) measurement.... more
A 65-year-old woman, referred to the endocrine clinic for investigation of tiredness and arthritis, was diagnosed as having diabetes on the basis of a positive family history and a raised glycated haemoglobin (HbA1) measurement. Subsequently, she was shown not to have diabetes but to have a persistently raised haemoglobin F (HbF) level. Initial assessment of HbF level by electroendosmosis demonstrated a normal HbF level but high values were confirmed using HPLC. Thalassaemia was excluded following DNA analysis. This case illustrates the importance of a glucose tolerance test following WHO criteria for the diagnosis of diabetes and emphasises that HbA1 is not a diagnostic test for diabetes.
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Weekend admission is associated with higher in-hospital mortality than weekday admission. Whether providing enhanced weekend staffing for acute medical inpatient services reduces mortality or length of stay is unknown Methods This paper... more
Weekend admission is associated with higher in-hospital mortality than weekday admission. Whether providing enhanced weekend staffing for acute medical inpatient services reduces mortality or length of stay is unknown Methods This paper describes a retrospective analysis of in-hospital mortality and length of stay before and after introduction of an enhanced, consultant-led weekend service in acute medicine in November 2012. In-hospital mortality was compared for matching admission calendar months before and after introduction of the new service, adjusted for case volume. Length of stay and 30-day post-discharge mortality were also compared; illness severity of patients admitted was assessed by cross-sectional acuity audits. Results Admission numbers increased from 6,304 (November 2011–July 2012) to 7,382 (November 2012–July 2013), with no change in acuity score in elderly medical patients but a small fall in younger patients. At the same time, however, a 57% increase in early-warni...
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This paper provides updated cohort tables of life expectancy for individuals in the United Kingdom. Using 2008-based projections from the UK Office for National Statistics (ONS) cohort and period expectation of life tables (the Ogden... more
This paper provides updated cohort tables of life expectancy for individuals in the United Kingdom. Using 2008-based projections from the UK Office for National Statistics (ONS) cohort and period expectation of life tables (the Ogden tables); predicted future life expectancies were calculated for quintiles of age from 0-90 years in men and women with mortality ratios between 100% and 1000%. Period tables have been included to illustrate the differences between period and cohort life expectancy in men and women at various ages. These tables are not intended to predict specific life expectancy in individuals but may indicate the mean life expectancy of a cohort of similarly affected people in the UK.
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ABSTRACT Clinical trials have demonstrated that treatment of hypertension in patients with diabetes can reduce microvascular and macrovascular complications. The aim of this study was to measure the prevalence of normotension, untreated... more
ABSTRACT Clinical trials have demonstrated that treatment of hypertension in patients with diabetes can reduce microvascular and macrovascular complications. The aim of this study was to measure the prevalence of normotension, untreated and treated hypertension and to assess whether targets based on current recommended guidelines had been achieved.We undertook a cross-sectional, analytic prospective study of consecutive patients attending a diabetes clinic in a district general hospital in the UK (n =1631; 86% participation). Blood pressure (BP) was measured using the average of two clinic readings and the type and frequency of use of antihypertensive agents were recorded using a questionnaire. In 220 patients with type 1 diabetes, the mean BP was 129/77mmHg. Twenty-six per cent were hypertensive, with BP greater than 140/90mmHg, 95% of the hypertensive patients were prescribed treatment and 76% had reached a target BP of 140/80mmHg. In 1411 patients with type 2 diabetes, the mean BP was 147/82mmHg, 51% were hypertensive with 90% prescribed treatment but only 52% reaching target BP recommendations.The results of the study show that hypertensive diabetic patients are being identified and the majority are being prescribed treatment, but in patients with type 2 diabetes, the target BP recommendations are not being achieved. The study underlines the need for more aggressive antihypertensive therapy in hypertensive patients with diabetes. Copyright © 2003 John Wiley & Sons, Ltd.
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Objectives To determine the life expectancy and mortality rates in patients with type 2 diabetes mellitus when compared with the UK general population; to measure the years of life lost. Design Longitudinal and retrospective cohort study.... more
Objectives To determine the life expectancy and mortality rates in patients with type 2 diabetes mellitus when compared with the UK general population; to measure the years of life lost. Design Longitudinal and retrospective cohort study. Setting The Wirral Peninsula in the northwest of England. Participants Total of 13 620 patients with type 2 diabetes mellitus on the Wirral Diabetes Register. Main Outcome measure All-cause mortality, from 1 January 2000 to 31 December 2007. Results Over the 8-year period of the study, there were a total of 16 692.5 person-years lived and 3888 deaths; 2041 (52.5%) males and 1847 (47.5%) females with corresponding mean ages at death of 75.6±10.3 years and 80.2±10.2 years, respectively. Although prevalence rates increased linearly (from 1.06% in 2000 to 4.39% in 2007) a decrease in mortality rates (from 117 to 46 per 1000 population) in both sexes was observed. This coincided with a progressive fall in cardiovascular risk factors in this population. ...
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www.thelancet.com Vol 381 March 16, 2013 901 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ northwest of England. We followed up almost 15 000 patients over an 8-year period using a... more
www.thelancet.com Vol 381 March 16, 2013 901 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ northwest of England. We followed up almost 15 000 patients over an 8-year period using a district-wide diabetes register encompassing both primary and secondary care. Our fi ndings indicate a falling mortality rate in type 2 diabetes. Simmons and colleagues recruited a large number of individuals in the screening and control practices, but a relatively small number of patients with diabetes was followed up. The intraclass correlation coeffi cient, which can only be indirectly estimated owing to the confounding eff ects in the two paired clusters, is unreliable. It is also possible to overestimate the stability of a trial of less than 40 clusters owing to the probability of large standard errors. Furthermore, the validity of permutation tests becomes unreliable since there are imbalances in the cohort cluster size and consequently distortion in the paired matching results. The assumptions of the Cox proportional hazard modelling, which tests the mortality risks in the screened and controlled cohorts, is normally based on error variations in the cohort groups and not within matched pairs. Finally, Simmons and colleagues have not revealed whether there were adjustments for other covariates in the all-cause mortality in both cohorts. We suggest that Simmons and colleagues present their hazard ratios alongside a measure of time such as median time to death in comparison with the screened and controlled cohorts.
Research Interests: Demography, Type 2 Diabetes, Medicine, Population, Humans, and 15 moreDiabetes mellitus, Female, Male, Cohort, Lancet, Proportional hazards model, Neoplasms, Cardiovascular Diseases, Type 2 Diabetes Mellitus, Mortality rate, confounding, The Lancet, mass Screening, Medical and Health Sciences, and hazard ratio
This study documents expression of dopamine (DA) receptors on leukocyte subpopulations using flow cytometric techniques to identify dopamine receptors with subtype-specific antibodies. Of the D1-like receptor family (D(1) and D(5)), only... more
This study documents expression of dopamine (DA) receptors on leukocyte subpopulations using flow cytometric techniques to identify dopamine receptors with subtype-specific antibodies. Of the D1-like receptor family (D(1) and D(5)), only D(5) was detected, and of the D2-like receptor family (D(2), D(3) and D(4)), all dopamine receptors were detected. T-lymphocytes and monocytes had low expression of dopamine receptors, whereas neutrophils and eosinophils had moderate expression. B cells and NK cells had higher and more consistent expression. Dopamine receptors D(3) and D(5) were found in most individuals whereas D(2) and D(4) had more variable expression. D(1) was never found.
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Consecutive patients coming as an emergency with chest pain due to myocardial ischemia or esophageal disease were interviewed on admission to the hospital, before they had been fully investigated. Classical features of angina pectoris... more
Consecutive patients coming as an emergency with chest pain due to myocardial ischemia or esophageal disease were interviewed on admission to the hospital, before they had been fully investigated. Classical features of angina pectoris were equally common in both groups and "crescendo angina" was often found in patients with esophageal disease. Features that helped to distinguish esophageal from cardiac pain were: an atypical response to exercise, pain that continued as a background ache, retrosternal pain without lateral radiation, pain that disturbed sleep, and the presence of certain esophageal symptoms. A positive diagnosis will be made more often in cases of suspected but unsubstantiated coronary disease by clinicians who are aware that esophageal pain and angina may be indistinguishable.
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MEN1 is an autosomal dominant disorder characterized by parathyroid, pituitary, and pancreatic tumors. The MEN1 gene is located on chromosome 11q13 and encodes a 610-amino acid protein. MEN1 mutations are of diverse types and are... more
MEN1 is an autosomal dominant disorder characterized by parathyroid, pituitary, and pancreatic tumors. The MEN1 gene is located on chromosome 11q13 and encodes a 610-amino acid protein. MEN1 mutations are of diverse types and are scattered throughout the coding region, such that almost every MEN1 family will have its individual mutation. To further characterize such mutations we ascertained 34 unrelated MEN1 probands and undertook DNA sequence analysis. This identified 17 different mutations in 24 probands (2 nonsense, 2 missense, 2 in-frame deletions, 5 frameshift deletions, 1 frameshift deletional-insertion, 3 frameshift insertions, 1 donor splice site mutation, and a g→a transition that resulted in a novel acceptor splice site in intron 4). The intron 4 mutation was found in 7 unrelated families, and the tumors in these families varied considerably, indicating a lack of genotype-phenotype correlation. However, this intron 4 mutation is the most frequently occurring germline MEN1 ...
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Research Interests: Genetics, Biology, Medicine, Humans, Polymorphism (computer Science), and 13 moreRisk factors, Phenotype, Gene Polymorphism, Odds ratio, Linkage Disequilibrium, Genetic Polymorphism, Risk Factors, Type 2 Diabetes Mellitus, Allele, alleles, Gene frequency, Human leukocyte antigen, and Insulin dependent diabetes mellitus
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An autistic patient living in a residential home presented with symptoms of weight loss and abdominal pain. On investigation, she was found to have lead poisoning from an unusual source. Her treatment proved difficult due to failure to... more
An autistic patient living in a residential home presented with symptoms of weight loss and abdominal pain. On investigation, she was found to have lead poisoning from an unusual source. Her treatment proved difficult due to failure to cooperate, and a 'best-case' protocol was devised. The positive identification of a source of exposure can be difficult in a single case of exposure, but this was eventually achieved by means of stable lead isotope analysis following painstaking detective work.
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Projections of life expectancy are widely used in medicine, actuarial practice, and in the medicolegal and insurance fields. For individuals considered to have average future survival, nationally-derived life expectancy tables are... more
Projections of life expectancy are widely used in medicine, actuarial practice, and in the medicolegal and insurance fields. For individuals considered to have average future survival, nationally-derived life expectancy tables are available, referred to as the Ogden Tables. In the United Kingdom, updated tables (the 8th edition) were published in July 2020. We have calculated impaired projected life expectancies for the United Kingdom based on age and gender, derived from the 8th edition of the Ogden Tables together with various assumed lifelong mortality ratios.
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We have recently constructed tables of the estimated life expectancies of impaired lives on the basis of mortality ratios and the cohort life expectancy tables given in the 8th edition of the Ogden Tables, which are derived from the ONS... more
We have recently constructed tables of the estimated life expectancies of impaired lives on the basis of mortality ratios and the cohort life expectancy tables given in the 8th edition of the Ogden Tables, which are derived from the ONS 2018-based population projections for the United Kingdom.1,2 The life expectancy of impaired lives may also be estimated using excess death rates. In this paper, we give tables of life expectancies for impaired lives using a range of excess death rates for males and females from age 0 to age 100. As both mortality ratios and excess death rates are widely used in medical and legal settings, it is hoped that these additional tables of life expectancies will be of practical value.
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The prevalence of adrenal incidentaloma has increased with the increasing use of imaging techniques. While majority are benign adenoma, a small but significant minority may be primary adrenal carcinoma or have endocrine hyper secretion.... more
The prevalence of adrenal incidentaloma has increased with the increasing use of imaging techniques. While majority are benign adenoma, a small but significant minority may be primary adrenal carcinoma or have endocrine hyper secretion. Existing guidance suggests that excess catecholamine and cortisol secretion should be ruled out in all cases and excess aldosterone secretion should be ruled out in hypertensive patients. Repeat evaluation after a period of time is also suggested. We have reviewed the management of adrenal incidentaloma in a large district general hospital in the North West of England.
Research Interests: Medicine, England, Cortisol, Humans, Diabetes mellitus, and 15 moreAldosterone, Female, Male, Incidental Findings, Endocrine, Clinical Sciences, Aged, Prevalence, Middle Aged, Adult, Retrospective Studies, X ray Computed Tomography, Adenoma, Adrenocortical Carcinoma, and Paediatrics and reproductive medicine
Background: Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and meta-analysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to... more
Background: Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and meta-analysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to determine gaps in current research. Methods: A comprehensive literature search was undertaken for studies (published 1990–2010) on mortality in type 2 diabetes. The study reports on the measure of mortality as defined by RR for all-cause and cause-specific mortality, heterogeneity, sensitivity analyses and biases. Results: In total 35 studies (220,689 patients; mean follow-up of 10.7 years) were eligible for inclusion: 33 studies reported increased mortality risks; 24 had full data on 95% confidence intervals (CIs), one study reported no excess mortality in men diagnosed after 65 years whereas three reported increased mortality in similar age groups in both sexes. Meta-analysis showed RR = 1.85 (95% CI 1.79–1.92) for all-cause mortality [men RR=1.5...