Audit of the Aetiological Investigations Performed in Children with Sensorineural Hearing Loss At Salford

Objective: This project aims to look at the Audiovestibular Physician’s practice at Salford and how closely it aligns with the gold standard guidelines set in the protocol lately published by the British Association of Audiological Physicians. Method: An audit was done retrospectively on 20 patients suffering from sensorineural hearing loss. As such, patient notes were utilised to ascertain which aetiological investigations have been completed and which were not. Any inadequacy in the aetiological work up has been dissected to help know the underlying reasons. Results: All patients had a thorough history taken and were comprehensively physically examined. 95% of patients underwent imaging in the form of MRI/CT. 80% received CMV testing. 75% underwent ECG testing. 60% received family hearing tests. Only 35% had ophthalmology examinations and 25% underwent urine and genetic testing. Conclusion: In some cases, the low compliance rates were due to the Audiovestibular Physician not ordering the investigation as part of the aetiological work up. This could be improved with the use of a dedicated checklist to act as an aid to the physician. Moreover, genetic counselling has been proposed to attempt to boost the compliance rates with genetic testing and similarly, leaflets briefing patients’ families about the importance of undergoing hearing tests themselves is another promising proposition to help improve the adherence

How is the face formed and when it goes wrong: In relation to Cleft Lip/Palate

The normal development of the face relies upon the correct morphogenesis of structures in utero that usually occurs within the first trimester of embryonic life. The face is a very complex structure involving many genes and factors and with it being such a crucial part of life, both physically and aesthetically and therefore mentally, its important for everything to be just right. However, when the normal process doesn’t go to plan this results in dysmorphogenesis, which cleft lip and palate (CLP) is an example of as the lip/palate doesn’t fuse together and the infant is left with a gap. Although the exact cause of CLP is unknown, it is thought to be a mixture of genetics, environment and the teratogens the mothers are exposed to within the environment. This report will demonstrate the normal development of the face for the purpose of understanding how it goes wrong, resulting in CLP. Since there is still a lot to be understood about CLP it will also shed light on recent advances in relating SHH and certain genes as a possible cause for this dysmorphogenesis. The report will also briefly look at the relation of CLP with the genes associated with syndromic and non-syndromic diseases and the different types of CLP. There are many other facial defects that are a result of dysmorphogenesis, however as CLP is one of the most common yet poorly understood facial defect, it will be the main focus of this report.

Journal Club Summary 2020

This is a summary of journal club-cum-teaching series organised by the Manchester Medical Journal to teach students critical appraisal skills.

Is Fat Tissue a Suitable Source of Stem Cells for Musculoskeletal Regenerative Medicine Therapies: Literature Review

This review found that adipose-derived stem cells are suitable for treating osteoarthritis. Besides joint replacement the current treatments do not reverse the underlining pathology, whereas this therapy replaces lost or damaged tissue and could represent a cure. Bone marrow is the traditional source of stem cells, however adipose tissue is more appropriate because of ease of harvesting, abundance, the concentration of stem cells and potential cosmetic benefits. Subcutaneous fat-derived stem cells are more effective for treating osteoarthritis when compared to visceral fat-derived. Human and animal models have shown its efficacy but with limitations. It has been less successful in older and/or patients with greater joint degeneration. Its cost-effectiveness when compared to current treatment has not been shown. A gold standard production and implantation method have yet to be developed, meaning there are no guidelines for its use. Current studies aim to address these issues, with implementation on the horizon.

A community-based drop-in service for NHS health checks: evaluation of uptake

Background: A community-based drop-in service aimed to deliver cardiovascular health checks to people living in areas of high socioeconomic deprivation. Methods: Retrospective cohort study using data collected from 1092 cardiovascular health checks performed across a one-year time period in community venues across the city of Manchester. Participants were adults aged between 40–74 years, with no pre-existing cardiovascular disease who were registered with a primary care centre within the intervention catchment area.Results: Of the total eligible population in Manchester across the study period 110194, it was found 7025(6.4%) had a cardiovascular health check, of these 1092(29%) were performed by the community-based service. Attendance was highest in younger females aged 40-45. Most patients were either in a managerial/professional occupation or unemployed. The higher risk population of cardiovascular disease (CVD were in highest attendance. Amongst the registered attendees, the checks discovered 129 new cases of hypertension, 64 new cases of type 2 diabetes, the vast majority of patients required an additional form of intervention, be that lifestyle or behaviour. Conclusions: A community-based cardiovascular check service is a viable method of delivering CD prevention intervention in areas of high socioeconomic deprivation.

The evolution of the international emergency care workforce: a thematic analysis

Acute care has historically been a relatively peripheral area on the global health agenda. Emergency care was first identified as a global priority at the WHO’s 60th World Health Assembly in 2007. The WHO first mandated international coordination over the global shortage of human resources in health (HRH) in 2006. Little research has focused on the intersection of these problems, regarding the international workforce working in acute care.MethodsA systematic search was conducted to retrieve articles evaluating components of secondary-level local, local, regional or national acute services published in academic journals from 2000 onwards. A thematic analysis of selected articles was completed with a focus on human resource capacities, utilising a framework-based synthesis approach. Results73 articles based in 44 countries were retrieved, of which 43 were cross-sectional studies and 22 were qualitative case reports. Articles largely reported inadequate competencies, training opportunities and insufficient physical resource within local emergency medical systems. Emergency departments worldwide are widely staffed by unspecialised personnel. Task-shifting within the acute care sector is frequently employed across the Subsaharan African region. Workforce issues were not restricted to low-income settings. However, a rigorous and stratified global dataset of workers in this category is not available and would be useful.ConclusionEmergency medical systems are undergoing a period of development worldwide. Inadequacies regarding supervision, infrastructure, and support services are not frequently addressed and should not be neglected in human resource policy. Identifying the successes and failures of systems on a global scale to date can prove useful for health systems planning and policy.

Mesenchymal stem cell- mediated immunomodulation and the potential therapeutic application in Crohn’s Disease

Mesenchymal stem cells (MSCs) are self-renewing stromal cells that possess a multipotent differentiation capacity as they can differentiate into numerous cell types such as adipose, bone and cartilage cells. MSCs have generated considerable interest for their remarkable tissue-reparative and immunomodulatory properties whereby MSCs can develop into functional cells at the injury site and control the body’s response to tissue damage respectively. Consequently, MSCs have vast therapeutic potential in treating Crohn’s disease (CD) which is a lifelong inflammatory bowel disease where tissue damage to a section of the gastrointestinaltract occurs. The review aims to discuss the properties of MSCs and explore their potential application in treating CD. This review highlights the tissue-reparative properties of MSCs and specifically focuses on the immunomodulatory properties of MSCs. Results from clinical trials regarding the efficacy and safety of MSCs have been promising, proving that MSCs could potentially be used to treat CD.

Quality and Evaluation Report: Virtual Fracture Clinic at Wythenshawe Hospital

Background: Following its introduction at Glasgow Royal Infirmary in 2011, the Virtual Fracture Clinic model of managing outpatient musculoskeletal injuries has grown significantly in popularity. Wythenshawe Hospital introduced this model to their orthopaedic department in 2015. Aims: How do individual consultants vary in terms of discharge rate versus face-to-face follow up when reviewing cases in a Virtual Fracture Clinic? To assess patients’ level of satisfaction with the management of their injury under a Virtual Fracture Clinic System. Methods: A retrospective study of a cohort of patients over 12 months from 11th May 2017 to 11th May 2018. Data regarding the number of patients reviewed in Virtual Fracture Clinic during this time was collected and the numbers of patients discharged or recalled for follow up analysed. A telephone questionnaire based on the NHS Friends and Family Test was collected from 50 patients within this cohort to assess overall satisfaction with their care. Results: 3361 patients were referred to virtual fracture clinic during the inclusion period. The mean percentage of cases discharged from virtual fracture clinic is 30.4% with a median of 30.5%. The rates of discharge ranged from Consultant G at 13% to Consultant K at 39%. 88% of patients would recommend this service to their friends and family and 80% would rate the service at the level of good or excellent. Conclusion: A virtual fracture clinic model has been successfully implemented at Wythenshawe saving approximately 1157 appointments in 12 months. There is significant variation in discharge rates between consultants which appears to be influenced by the number of patients seen. Individual factors which affect this require further investigation. Patients are very satisfied with their care through the Virtual Fracture Clinic at Wythenshawe Hospital and an overwhelming majority would recommend this to others.

The Role of Anti-Inflammatory Cytokines in Heart Failure

Coronary occlusion promotes a state of ischaemia that results in myocardial infarction; it is a major cause of mortality accounting for one hospital admission every three minutes. At the site of infarct, sterile inflammation is initiated due to pro-inflammatory secretions from cardiac and innate immune cells. The focus of this review is to explore the role of a newly discovered innate immune complex, the nod-like receptor family pyrin domain containing 3 inflammasome. This review discusses the potential of this immune complex in decreasing the proportion of functional myocardium during ischaemia and ischaemia-reperfusion injury. Due to the central role of this inflammasome in promoting cardiac dysfunction following an acute myocardial infarction, the risk of port-infarction heart failure increases. With an intention of highlighting the importance of improving current management of patients with acute myocardial infarction, this review addresses novel therapeutic agents that have demonstrated cardioprotective outcomes in recent studies. This follows discussion concerning the therapeutic potential of these agents, intending to form the basis of heart failure therapy.