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Christmas Wrapping The Waitresses, a new wave band from Akron Ohio, released their Christmas single “Christmas Wrapping” in 1982 The band’s lead singer Patty Donahue delivered a cynical, alternative take on the Christmas season The TIP/S in question stand for tobramycin inhalation powder / solution, used in cystic fibrosis as a chronic suppressive therapy for pulmonary infection with Pseudomonas aeruginosa
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Correspondence to Dr Nick Brown, Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden;nickjwbrown@gmail com As the first anniversary of the first adult COVID-19 cases approaches, we reflect on what we’ve learned since December 2019 and could be excused a frisson of excitement about what the soon-to-be-released vaccines might offer Primary treatment is generic to all species and includes: non-weight bearing and simple analgesia;immobilisation of the bitten part of the body so it lies below the level of the heart;referral to a medical facility with attention to the airway, oxygenation and prevention of aspiration and gaining intravenous access in an unaffected limb Shabeer Syed and colleagues’ systematic review of test validation studies eruditely pools the positive predictive values for a range of warning diagnoses (fractures, abstinence syndrome in children for example) and later ascertainment/corroboration
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In their commentary, Brewster and colleagues present provide a summary of the evidence that suggests its time to put that box in a back closet and remember that ‘we cannot let our emotions override critical thinking when trying to protect ourselves and our patients ’ Novel approaches to diagnosis in paediatric EM Ultrasound has a lot of advantages when it comes to paediatric patients, including lack of radiation, ability to be performed at the bedside (maybe even in Mom’s arms) and the speed of diagnosis that may shorten their ED stay In a study by Snelling et al from Australia, nurse practitioners performed ultrasound on paediatric patients 4–16 years old with suspected, non-angulated distal forearm fractures, finding quite respectable sensitivity and specificity
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In this edition of Thorax (see page 64) Pearson and colleagues present intriguing data showing that chloride transport through TMEM16A may be a key requirement for human respiratory syncytial virus replication and inhibition of TMEM16A may be a new target for antiviral therapies In this issue of Thorax (see page 37) Tsai and colleagues assessed the QoL of 1816 patients with Interstitial Lung Disease from the CAnadian REgistry for Pulmonary Fibrosis to validate the Minimal Important Difference between the European Quality of Life 5-Dimensions 5-Levels questionnaire (EQ-5D-5L) and its associated Visual Analogue Scale (EQ-VAS) scores Using weighted gene co-expression network analysis, overcoming challenges associated with control tissue, they identify key molecular pathways that lead to the development of fibrosis and identify further molecular targets for therapeutic intervention
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Patients with idiopathic pulmonary fibrosis (IPF) may develop pulmonary hypertension, out of proportion to the degree of interstitial disease Much like Gregory being transferred from the front of the football team to the back, hyper-polarised Xenon is transferred from the alveolar air space, leading to dissolution in the lung parenchyma and plasma and then into the red blood cells In this issue of Thorax (see page 134) Chu and colleagues performed single cell sequencing analysis on matched bronchoalveolar lavage cells and peripheral blood monocytes and used supervised and unsupervised learning methods to identify a new cluster of genes ME31 which associated with different severity of disease in a way that was not distinguishable by genotype alone
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Sethi et al have used a ‘before and after’ study design to retrospectively assess the effect on Emergency Department Clinical Quality Indicators of hospital-wide interventions to improve patient flow through the hospital (the ‘Reader’s choice’ for this month) [ ]Man et al studied the long waiting times for Emergency Medical Services (EMS), due to delayed handover from ambulance to the Emergency Department (referred to as ‘ambulance ramping’) [ ]the simple ‘AEI’ communication tool described is one that I find elegant, effective and have adopted into my practice
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Worryingly, despite relatively better placings on injury-related deaths, total mortality has increased year on year since 2013 among adolescent girls and in an estimated two thirds of UK deaths due to asthma and a quarter of deaths in children with epilepsy there were avoidable factors Adolescent health Female genital mutilation Ali’s examination of referral and outcome data in girls seen at London FGM specialist clinic over 5 years (2014–2019) find that the number and proportions to be substantially lower than expected based on UK prevalence estimates Literature in this area is accumulating, but, little as directly implicating as Bhatt’s report showing clinical, immunological and histological evidence of a pulmonary hypersensitivity reaction in a ‘casual vaper’, triggers likely being propylene glycol, vegetable glycerides or the flavourings inherent to the experience
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[ ]neurologists are sometimes asked about vaccination, typically by patients with immune-mediated neurological disorders, especially multiple sclerosis, or those taking immunosuppressive agents Some predictions made with confidence despite COVID-19: patients will still develop neurological disorders;neurologists will continue to perform a neurological examination (with appropriate precautions) and will still undertake investigations to make diagnoses Clinical examination is essential in assessing functional disorders, and a clinical sign gave the key to the diagnosis of functional weakness in a patient in intensive care (page 470)
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[ ]party confounding… The polling stations will need to ensure that there is social distancing, that face masks are worn, hand hygiene is adhered to and ventilation in the polling station meets health and safety standards A major concern in the upcoming US Presidential Election should a republican to democrat transition be required, is that the signalling that is needed to ensure a normal transition may be subverted and lead to disorder
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[ ]you may be interested to read a paper by Fuller and colleagues from Sheffield, who conducted an observational cohort study with the aim of estimating the risk of adverse outcome after mild head injury in patients taking DOACs to guide emergency department management Head home Children are no exception where head injuries are concerned, it is estimated that more than 700 000 of them in the UK attend hospital every year with a head injury and less than 1% of these need neurosurgical intervention Previous studies have shown that up to 46% of cardiac troponin (cTn) testing in the ED is deemed inappropriate and results in not just wasted costs but unnecessary procedures [ ]it can also cause alarm and anxiety without adding value
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