Hertford County Hospital

Artificial intelligence (AI) has emerged as a major frontier in computer science research. Although AI has been available for some time and found its application in many fields of medicine, its use in dermatology is comparatively new and limited. A sound understanding of the concepts of AI is essential for dermatologists as skin conditions with their abundant clinical and dermatoscopic data and images can potentially be the next big thing in the application of AI in medicine. There are already a number of artificial intelligence studies focusing on skin disorders, such as skin cancer, psoriasis, atopic dermatitis and onychomycosis. This article presents an overview of AI and new developments relevant to dermatology, examining both its current applications and future potential.

SummaryA controlled clinical trial was carried out in 40 patients at risk of osteoporosis because of long-term treatment with prednisolone (5 to 20 mg/day) to determine the efficacy and tolerance of microcrystalline hydroxyapatite compound (MCHC) when used to prevent the appearance or progression of osteoporosis: 32 patients were treated with 6 to 8 g MCHC for 12 months and 8 served as an untreated control group. The two groups were well matched as regards age, sex and underlying disease; 37 patients (29 MCHC, 8 control) successfully completed the trial. The majority (68%) of the patients had back pain prior to the trial, the severity of which was graded at 3-monthly intervals. In the MCHC-treated group, there was a dramatic and significant (p<0. 001) reduction in pain during the trial, almost to the point of its disappearance. Of 19 patients with initial back pain only 2 still reported any pain at all after 12-months' MCHC treatment. In the control group, back pain severity increased during the trial in 3 patients and was unchanged in the fourth. Neither MCHC-treated nor control group patients showed any significant change in standing or stem height during the 12-months' trial period. Both mean cortical thickness and mean metacarpal index figures showed small, insignificant decreases during 12-months' MCHC treatment but much more marked decreases in the control group which, despite the small number of patients, came close to being statistically significant. Fifteen (52%) of the MCHC-treated patients expressed dissatisfaction with the palatability of the powder formulation of MCHC and 9 (31%) were changed to an equivalent dose of tablets; all then completed the trial successfully. There were no reports of drug-related side-effects in the MCHC-treated putients. Laboratory tests of renal and hepatic function revealed no signs of toxicity during MCHC therapy. There was a significant (p<0.01) increase in plasma calcium levels associated with a similar increase in phosphate levels during MCHC treatment. Calcium × phosphate product therefore increased, producing the necessary biochemical environment for bone remineralization. The results indicate that, with MCHC therapy, dramatic reductions in symptoms (skeletal pain) in patients developing osteoporosis due to long-term corticosteroid treatment are associated with favourable biochemical and bone changes, which could probably be expected to progress further during longer-term MCHC therapy.

Cefuroxime and ampicillin were compared in a randomized double-blind trial in the treatment of severe lower respiratory tract infections. 750 mg of cefuroxime were given to 57 patients and 500 mg of ampicillin to 54 patients by intramuscular injection three times daily for 7-10 days. The patients had acute exacerbations of chronic bronchitis with or without pneumonia, a few had bronchiectasis and an underlying bronchial carcinoma was present in nearly a quarter. By the end of treatment the sputum, initially always mucopurulent, had become mucoid in 87.7% of patients receiving cefuroxime in comparison to 48.1% of those receiving ampicillin. A satisfactory clinical response was observed in 94.7 and 68.5%, respectively. Both these differences between cefuroxime and ampicillin are statistically significant (p less than 0.001).

The treatment of entrapment neuropathy in the upper extremity with surgical decompression has generally provided good results. Recurrence of symptoms, however, is not uncommon, and its management is both challenging and difficult. Autologous vein graft wrapping is an alternative technique, and it is recommended for the treatment of recalcitrant upper limb nerve compression in which 2 or more previous surgical procedures have failed to resolve the problem. Each patient underwent both subjective and objective evaluation. To our knowledge, this is the largest reported single series of vein wrapping cases in the upper limb outside the United States and the first to report results using the well-validated patient evaluation measure.

A. PINES; Successful treatment of respiratory tract infections in patients with chronic respiratory disease—how to make objective conclusions, Journal of Antimi

INTRODUCTION: To improve the public health system's ability to prevent and control chronic diseases, we must first understand current practice and develop appropriate strategies for measuring performance. The objectives of this study were to measure capacity and performance of local health departments in diabetes prevention and control and to investigate characteristics associated with performance. METHODS: In 2005, we conducted a cross-sectional mailed survey of all 85 North Carolina local health departments to assess capacity and performance in diabetes prevention and control based on the 10 Essential Public Health Services and adapted from the Local Public Health System Performance Assessment Instrument. We linked survey responses to county-level data, including data from a national survey of local health departments. RESULTS: Local health departments reported a median of 0.05 full-time equivalent employees in diabetes prevention and 0.1 in control. Performance varied across the 10 Essential Services; activities most commonly reported included providing information to the public and to policy makers (76%), providing diabetes education (58%), and screening (74%). The mean score on a 10-point performance index was 3.5. Characteristics associated with performance were population size, health department size and accreditation status, and diabetes-specific external funding. Performance was not better in localities where the prevalence of diabetes was high or availability of primary care was low. CONCLUSION: Most North Carolina local health departments had limited capacity to conduct diabetes prevention or control programs in their communities. Diabetes is a major cause of illness and death, yet it is neglected in public health practice. These findings suggest opportunities to enhance local public health practice, particularly through targeted funding and technical assistance.

BACKGROUND: Healthcare workers (HCWs) are at increased risk of coronavirus 2019 (COVID-19) infection. Personal protective equipment (PPE) and infection control guidelines help limit transmission. However, poor confidence leads to higher levels of anxiety rates and infection. We assessed knowledge and confidence in PPE among HCWs and associated anxiety. METHODS: A cross-sectional, multi-centre survey using a validated questionnaire assessing actual and self-perceived knowledge on PPE was distributed among HCWs across the UK. Confidence in PPE and levels of anxiety were assessed using the General Anxiety Disorder-7 (GAD-7) tool. RESULTS: In total, 1,055 responses were received; 99% had familiarity with PPE guidance; however, only 15% correctly answered questions on PPE guidance; 86% and 80% had received mask-fitting and donning-doffing training, respectively; 33% indicated poor/very poor hospital communication. Confidence and anxiety were related to: profession; comorbidities; self-perceived knowledge; and PPE training and communication. CONCLUSION: Confidence in PPE was poor and anxiety was related to inadequate information and training. Thus, improved communication is required for effective response to subsequent COVID-19 waves and similar pandemics.

Temazepam, a common metabolite of diazepam and oxazepam, was evaluated as a sleep inducer. A dose of 20 mg, in a Scherer capsule formulation, was compared with 200 mg of amylobarbitone sodium in a between-patients, randomized study. Patient and staff assessments were used. No statistically significant difference as to onset of sleep, duration or quality of sleep or morning drowsiness was found using the patients' assessments. The staff recorded significantly less daytime dozing and morning hangover in patients receiving temazepam. Side-effects were mild and confined mainly to drowsiness on awakening. Two patients, both on amylobarbitone sodium, withdrew from the study because of increasing confusion.

Hypoxic responses in infants Subjecting infants to low oxygen concentrations seems unethicalEditor-The ethics of Parkins et al's study depend partly on whether there is any potential benefit to the infants from the experiment. 1 If parents subject their infant to low oxygen concentrations in an aeroplane they take a risk which is balanced against the benefit of air travel.Unless there is some real prospect of identifying infants at risk and offering useful protection against the sudden infant death syndrome, it seems to me to be unethical to subject those infants to the risk of exposure to low oxygen concentration.The fact that some of the families had previously experinced the loss of a child may have increased the likelihood of compliance.This makes me even more worried about the ethics of the study.

A clinical trial has been carried out comparing ten day courses of oral tetroxoprim, TXP, (100 mg) combined with sulphadiazine, SDZ, (250 mg), one tablet twice daily, with ampicillin, 500 mg four times daily in 60 patients with respiratory tract infections. TXP/SDZ was effective in treatment with an efficacy comparable with that of ampicillin. No side effects occurred in the TXP/SDZ group, whereas three patients taking ampicillin experienced gastrointestinal disturbances, in two cases necessitating withdrawal oftreatment. Subsequent to the course of treatment there were more relapses in the TXP/SDZ group, although the difference from ampicillin was not significant. Abnormalities of liver function tests were found in similar numbers of patients in both treatment groups and appeared to be related to severity of illness rather than treatment. TXP/SDZ has some advantages and some disadvantages as compared with ampicillin and could be used as an alternative to ampicillin for treating respiratory tract infections.

The physical characterization of exoplanets will require to take spectra at several orbital positions. For that purpose, a direct imaging capability is necessary. Direct imaging requires an efficient stellar suppression mechanism, associated with an ultrasmooth telescope. We show that before future large space missions (interferometer, 4-8 m class coronograph, external occulter or Fresnel imager), direct imaging of giant planets and close-by super-Earth are at the cross-road of a high scientific interest and a reasonable feasibility. The scientific interest lies in the fact that super-Earths share common geophysical attributes with Earths. They already begin to be detected by radial velocity (RV) and, together with giant planets, they have a larger area than Earths, making them detectable with a 1.5-2 m class telescope in reflected light. We propose such a (space) telescope be a first step before large direct imaging missions.

A. PINES; The tetracyclines in purulent exacerbations of chronic bronchitis, Journal of Antimicrobial Chemotherapy, Volume 9, Issue 5, 1 May 1982, Pages 333–335

A program is described which is used daily for the elaboration of case histories in a neurological department. Using a dialogue procedure, the input is done by the physician himself after taking the case history and the clinical findings on admission. The system compiles the case history from stored texts for the normal findings and entered texts for the pathological findings. The completeness and the standardization of the case history within the clinic is an essential benefit. In addition, statistical analyses are possible using the case history as original material.

BACKGROUND: Personal lubricants with different formulations and properties, including ingredients designed to enhance sensation or feeling, can be used to alleviate vaginal dryness and affect sexual function. Clinical data to support their safety and efficacy are limited. AIM: Determine safety and efficacy of two sensate personal lubricants for relief of discomfort associated with vaginal dryness in female participants, and report the impact on sexual satisfaction in female participants and male partners. METHODS: A two-arm, parallel design study was performed in women (18-65 years) experiencing vaginal dryness. Participants were randomized to one of two sensate lubricants (water-based [tingling] or silicone-based [warming]), which had to be used during vaginal intercourse at least once a week over a 4-week period. OUTCOMES: Primary outcome: change from baseline in total Female Sexual Function Index (FSFI) score after 4 weeks of lubricant use. Secondary outcomes: change from baseline in FSFI domain scores; adverse events (AE); vulvovaginal and oral tolerance; female participant and male partner perception of lubricants; improvement in sexual intimacy (assessed using Subject Perceived Questionnaires [SPQ] and Patient Global Impression of Change). RESULTS: Sixty-six female participants completed the study. The primary endpoint (prespecified increase in FSFI ≥4 points from baseline) was achieved for both lubricants. A positive change was observed across all six FSFI domains. All AEs were mild in severity; no serious AEs were reported; the discontinuation rate was 1.5% (one female participant; warming lubricant). For both lubricants, vulvovaginal tolerance was "good/very good" and oral tolerance was generally "very good" ("acceptable" for one participant in each treatment arm). For both lubricants, most female participants and their male partners agreed that first penetration during vaginal sex was smoother, and there was an improvement in sexual intimacy. CLINICAL IMPLICATIONS: Safety and efficacy of both lubricants containing sensate ingredients was demonstrated, giving reassurance that they can be safely recommended by healthcare professionals to relieve vaginal dryness and enhance sexual pleasure. STRENGTHS/LIMITATIONS: Evidence is provided for the safety and efficacy of two sensate lubricants for relieving vaginal dryness and improving sexual pleasure in healthy participants across a wide age range. The SPQ is not a clinically validated tool, and the sample of participants was not diverse, which may limit the generalizability of data. CONCLUSIONS: The use of sensate lubricants showed significant improvement in sexual function coupled with improved satisfaction for both male and female participants. No severe or serious AE were reported during the study period.

Rolandic epilepsy is frequent in children but seizures are rarely seen by the physician or captured by video-EEG monitoring. In most children the attacks are few and sporadic and generally occur at night. Also, a high percentage of children with benign epilepsy with centro-temporal spikes (BECTS) have characteristic centro-temporal spikes based on routine EEG monitoring and therefore do not require further tests such as telemetry or sleep studies. We report a video-EEG recording of a seizure in a patient with rolandic epilepsy which may be useful for educational purposes.

A previously fit and well 53-year-old man was referred to the otolaryngology clinic with intermittent stridor and was found to have bilateral vocal fold paresis. Subsequent airway compromise necessitated emergency surgical tracheostomy. The man was discharged home with tracheostomy in situ and a diagnosis of idiopathic bilateral vocal cord palsy, as all primary investigations were negative. Neurological disease was suspected following readmission to hospital several weeks later with diplopia. Electromyography and serum antibody testing confirmed a diagnosis of anti-muscle-specific tyrosine kinase antibody positive myasthenia gravis (MuSK-MG); a subset of MG where autoantibodies are directed against MuSK. Resolution of bilateral vocal fold paresis was found 8 months after a short course of immunoglobulin (intravenous immunoglobulin (IVIg)) and daily mycophenolate therapy was commenced. Multidisciplinary teamwork between ear, nose and throat surgeons, neurologists and speech therapists enabled successful decannulation of tracheostomy. The patient has recovered well and remains minimally symptomatic.

This study looks at the impact of reduced clinical services on infection rates in a small suburban genitourinary medicine clinic, and compares the rates with the national trends. Data were gathered from the KC60 reports and compared with national data on the Health Protection Association Website. Between 1996 and 2001, waiting time for appointments increased along with the number of patients not attending appointments. There was an apparent drop in the number of cases of chlamydial infection in contrast to a national increase; however, when the figures were adjusted for the fall in clinic size, a small rise was seen. The incidence of gonorrhoea, in contrast, rose in excess of national trends, and new HIV/AIDS diagnoses tripled. A disproportionate number of wart virus infections were seen. It seems that long waits for appointments and high DNA rates are skewing diagnosis rates for the clinic, and the shrinking service appears not to be meeting the community's needs.

The administration of 6 g. cephaloridine daily produced large numbers of hyaline casts during treatment, occasionally accompanied by red and white cells and albumin. These cleared when treatment ended and are of uncertain and doubtful significance.

The efficacy of parenteral mecillinam was evaluated in 105 elderly patients with lower respiratory tract infections or urinary tract infections. Another antibiotic, usually amoxycillin, was given concurrently in cases of respiratory infection. An adequate response was note in 86% of chest infections and in all of the urinary tract infections assessed. Mecillinam proved to have a low toxicity profile and intramuscular injections were very well tolerated.

Edward D. Fox, Peter Kersey; Dermatology in the Soviet Union Report of a cultural exchange visit to dermatological departments in the Soviet Union, Clinica