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Showing papers by "London Bridge Hospital published in 2019"


Journal ArticleDOI
TL;DR: This work presents successful adjunctive use of cefiderocol for a patient with persistently bacteremic healthcare-associated native aortic valve endocarditis due to an extended-spectrum beta-lactamase–positive Pseudomonas aeruginosa susceptible in vitro only to colistin, following failure of conventional therapeutic options.
Abstract: Serious infections such as endocarditis due to extremely drug-resistance gram-negative bacteria are an increasing challenge. Here, we present successful adjunctive use of cefiderocol for a patient with persistently bacteremic healthcare-associated native aortic valve endocarditis due to an extended-spectrum beta-lactamase-positive Pseudomonas aeruginosa susceptible in vitro only to colistin, following failure of conventional therapeutic options.

46 citations


Journal ArticleDOI
TL;DR: The most recent in vivo and in vitro studies related to the use of stem cell therapy in the treatment of discogenic low back pain are presented.
Abstract: Chronic low back pain has both substantial social and economic impacts on patients and healthcare budgets. Adding to the magnitude of the problem is the difficulty in identifying the exact causes of disc degeneration with modern day diagnostic and imaging techniques. With that said, current non-operative and surgical treatment modalities for discogenic low back pain fails to meet the expectations in many patients and hence the challenge. The objective for newly emerging stem cell regenerative therapy is to treat degenerative disc disease (DDD) by restoring the disc's cellularity and modulating the inflammatory response. Appropriate patient selection is crucial for the success of stem cell therapy. Regenerative modalities for discogenic pain currently focus on the use of either primary cells harvested from the intervertebral discs or stem cells from other sources whether autogenic or allogenic. The microenvironment in which stem cells are being cultured has been recognized to play a crucial role in directing or maintaining the production of the desired phenotypes and may enhance their regenerative potential. This has led to a more specific focus on innovating more effective culturing techniques, delivery vehicles and scaffolds for stem cell application. Although stem cell therapy might offer an attractive alternative treatment option, more clinical studies are still needed to establish on the safety and feasibility of such therapy. In this literature review, we aim to present the most recent in vivo and in vitro studies related to the use of stem cell therapy in the treatment of discogenic low back pain.

27 citations


Journal ArticleDOI
28 Jan 2019-Lupus
TL;DR: Recently, a collaborative USA/UK study analysed a comprehensive panel of ‘non-criteria’ aPL tests in a series of 175 patients from the St Thomas Hospital Lupus Clinic including 68 with the features of � ‘seronegative APS’.
Abstract: In 2003, on the 20th anniversary of the antiphospholipid syndrome (APS), we wrote . . . ‘as awareness increases, and the number of patients with APS grows, it comes as no surprise that ‘‘seronegative APS’’ provides the focus of day to day clinical discussion – the patient with migraine, stroke, several previous miscarriages, thrombocytopenia, and livedo reticularis, whose antiphospholipid (aPL) tests are doggedly negative’. This description reminded us of the previous clinical labels in the world of autoimmune diseases – ‘seronegative arthritis’ and ‘seronegative lupus’. History showed that both labels proved both useful and, in fact, more than temporary clinical compromises. Seronegative arthritis, for example, catalysed the description of psoriatic arthritis and of the spondyloarthropathies, while seronegative lupus turned out in many cases to be the Ro-positive variant. The public history of ‘seronegative APS’ has been interesting. Few subjects have triggered so much animated discussion, and at meetings and congresses the topic invariably raises the temperature. Yet in clinical practice, there are at least two observations supporting the concept. Firstly, the clear therapeutic response to anticoagulant treatment when the clinical decision is made to treat, and secondly, the strong family history of APS and other autoimmune conditions in many of these patients – including a small number of identical twins discordant in aPL positivity. What are the possible reasons for ‘seronegative APS’? Firstly, that the diagnosis is wrong – unlikely in the case of the many ‘classic’ features of APS. Secondly, that a previous positive aPL has become negative. Yes, this does happen, but surprisingly uncommonly. Thirdly, and most likely, that our current aPL tests (anticardiolipin, lupus anticoagulant and anti-beta 2 glycoprotein 1 antibodies) are not sufficient in some cases. Over the past several years, new variants in aPL testing have emerged which support the concept of ‘non-criteria’ aPL. Recently, a collaborative USA/UK study analysed a comprehensive panel of ‘non-criteria’ aPL tests in a series of 175 patients from the St Thomas Hospital Lupus Clinic including 68 with the features of ‘seronegative APS’. One-third of the ‘seronegative’ sera gave positive results. The study concluded that patients with clinical features of APS but negative for conventional criteria markers should undergo additional testing for non-criteria biomarkers. ‘Failure to diagnose APS can result in severe clinical consequences.’ One wonders how many patients attending, for example, young stroke clinics, migraine clinics, ‘MS’ clinics and, of course, obstetric departments, would benefit from diagnosis and treatment of ‘seronegative’ APS.

15 citations