Hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic:A single-centre study

BACKGROUND The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019(COVID-19)pandemic.These were partially lifted on 15 June and further eased on 4 July.Changes in social behaviour,including increased alcohol consumption were described at the time.However,there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions,specifically alcoholrelated acute pancreatitis(AP).This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown.AIM To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United Kingdom.METHODS All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this study.Patient demographics,their initial presentation with AP,any recurrent admissions,disease severity and length of stay,were evaluated using ANOVA andχ^(2)and Kruskal–Wallis tests.RESULTS One hundred and thirty-six patients were included in the study.The highest total number of AP admissions was seen in March–September 2019 and the highest single-month period was in March–May 2020.Admissions for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years,for example,2016(P<0.05).Furthermore,the rate of admissions decreased by 38.89%between March–May 2020 and June–September 2020(P<0.05),coinciding with the easing of lockdown restrictions.This significant decrease was not observed in the previous year groups during those same time periods.Admissions for recurrent AP were highest in 2019.The median length of hospital stay did not differ between patients from each of the year groups.CONCLUSION An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced;a fall in figures was noted when restrictions were eased.

Predicting the Outcome of Nerve Conduction Studies in Patients with Suspected Carpal Tunnel Syndrome: Using an Existing Carpal Tunnel Assessment Tool

This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire;it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cut-off score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.

Haemofiltration and Noradrenaline Corrects life-Threatening Cardiovascular Instability Following Delayed Anaphylactic Reaction to Patent Blue Dye in Sentinel Node Biopsy for Breast Cancer

The aim of this case report is to present a novel approach to the management of very severe anaphylactic reaction to Patent Blue Dye used in Sentinel Node Biopsy for breast cancer treatment. The severity and duration of cardiovascular effects has not been described previously in this setting. Comprehensive ICU support including heamofiltration resulted in the patients’ complete recovery and successful long-term well-being despite a change to our routine cancer care plan.

Turnaround times for molecular testing of pediatric viral cerebrospinal fluid samples in United Kingdom laboratories

BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inpatient stays.However,use of molecular assays can vary widely.AIM To evaluate current practice for molecular testing of pediatric cerebrospinal fluid(CSF)samples across the United Kingdom using a structured questionnaire.METHODS A structured telephone questionnaire survey was conducted between July and August 2020.Data was collected on the availability of viral CSF nucleic acid amplification testing(NAAT),criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.RESULTS Of 196/212(92%)microbiology laboratories responded;63/196(32%)were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples.Of 133 Laboratories included in the study,47/133(35%)had onsite facilities for viral CSF NAAT.Hospitals currently undertaking onsite NAAT(n=47)had much faster turnaround times with 39 centers(83%)providing results in≤24 h as compared to those referring samples to neighboring laboratories(5/86;6%).CONCLUSION Onsite/near-patient rapid NAAT(including polymerase chain reaction)is recommended wherever possible to optimize patient management in the acute setting.

Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children

Background:Abdominal pain-related functional gastrointestinal disorder(AP-FGID)comprises of 4 main conditions:functional dyspepsia,irritable bowel syndrome,abdominal migraine and functional abdominal pain.AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood.There is limited evidence for pharmacological therapies.Data sources:This review article discusses non-pharmacological management of AP-FGID based on the current literature including systematic reviews,randomized controlled trials,cohort and case control studies.We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID.Results:Managing AP-FGIDs can be challenging.This should follow a stepwise approach with focused history,identification of“red flag”signs and symptoms,physical examination and investigations done following initial consultation.Family needs explaining that there is nothing seriously wrong with the child’s abdomen.This explanation and reassurance can achieve symptom control in large number of cases.Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies.Dietary interventions vary depending on the type of AP-FGID.Bio-psychosocial therapies such as hypnotherapy,cognitive behavioral therapy and yoga aim at stress reduction.Conclusion:There is increasing evidence for use of non-pharmacological interventions in children with AP-FGID.