Wishaw General Hospital

About: Wishaw General Hospital is a healthcare organization based out in Wishaw, Scotland, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 256 authors who have published 222 publications receiving 4324 citations.

Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya

Abstract: Introduction: The aim of this study was to ascertain the incidence of acute mountain sickness (AMS) at different altitudes in the Solu-Khumbu. This was a pilot to examine the feasibility of investigating demographic, behavioral, and physiological factors related to the etiology of AMS and to assess the region's suitability for a future study. Methods: A convenience sample of 150 recreational trekkers staying in teahouses was interviewed at altitudes above 2500 m. Two interviews were performed, firstly in the evening and then the subsequent morning. Trekker's age, gender, ascent profile, and use of acetazolamide were noted. A Lake Louise score was calculated to determine the presence of AMS. Results: The incidence of AMS was 0% at 2500-3000 m, 10% between 3000-4000 m, 15% between 4000-4500 m, 51% between 4500-5000 m, and 34% over 5000 m. There was no significant association between age or gender and the altitude studied or incidence of AMS. Subjects with AMS ascended significantly further in the preceding 72 h than subjects without AMS, with a mean altitude gained of 846 m vs. 722 m. Discussion: We concur with the literature that incidence of AMS increases with altitude. We found an abrupt increase in incidence over 4500 m. This appears to be a new finding. A future study examining factors predisposing to AMS would be most effectively performed above 4500 m. No association was found between age or gender and AMS. Mean vertical ascent gained in the previous 72 h was significantly higher among the trekkers with AMS but remained within recommended guidelines.

Management of clinical fractures of the scaphoid: results of an audit and literature review.

Abstract: Objectives:Two to 5% of scaphoid fractures are missed on initial presentation. The failure of early recognition and treatment are considered to contribute to delayed union and non-union. Despite advances in diagnostic imaging, a dogmatic approach has persisted in the management of patients with clin

How to measure renal function in clinical practice: eating cooked meat alters serum creatinine concentration and eGFR significantly.

Abstract: Traynor et al state that serum creatinine concentration, and therefore eGFR, may only be slightly affected by ingestion of meat.1 In the data from the modification of diet in renal disease study that were used to generate the eGFR equations,2 samples were taken from predominantly fasting subjects (AS Levey, personal communication). In clinical practice, however, samples for serum creatinine concentration and eGFR are generally used in situations …

The ROMA (Risk of Ovarian Malignancy Algorithm) for estimating the risk of epithelial ovarian cancer in women presenting with pelvic mass: is it really useful?

Abstract: Diagnosis of ovarian cancer is often made at an advanced stage when prognosis is poor. Diagnosis is based on invasive procedures (laparoscopy or laparotomy) and inadequate surgical exploration may adversely affect survival. A number of biomarkers have been proposed for diagnosis or screening but few have made it into clinical practice. As with many conditions where a single sensitive and specific marker is unavailable, algorithms using multiple biomarkers in combination with clinical and/or imaging data have been assessed. In this study, Montagnana et al. assessed the Risk of Ovarian Malignancy Algorithm (ROMA) in determining risk of epithelial ovarian cancer (EOC) in women presenting with a pelvic mass. ROMA uses CA125 and human epididymis protein 4 (HE4) concentrations and menopausal status to determine a risk score. In this study, 104 women with a pelvic mass and 49 healthy female controls were enrolled. Receiver operating characteristic (ROC) analyses were used to evaluate ROMA as well as each of the biomarkers alone. Median CA125 and HE4 concentrations were significantly higher in patients with EOC than healthy controls and those with a benign pelvic mass (both P , 0.0001). HE4 had improved the diagnostic performance over CA125, with an area under the curve (AUC) of 0.77 in premenopausal and 0.94 in postmenopausal women (compared with 0.64 and 0.84, respectively, using CA125). Using ROMA, the AUC was 0.77 and 0.92, respectively. The limited number of subjects in this study may have affected the results. However, the study highlights an important point – use of an algorithm should be assessed against the component parts alone to determine if its use improves the performance. In this study, HE4 alone performed slightly better than ROMA. Additionally, in the differentiation of EOC and benign pelvic mass, HE4 performed better than CA125. Further investigation is required to determine the value HE4 may have in routine practice.

Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification.

Abstract: Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of the study was to review the current knowledge on the nomenclature, etiology, pathophysiology, clinical presentation, diagnostic workup, and risk stratification of post-ERCP pancreatitis (PEP). A structured search in PubMed and Scopus databases was performed using search terms related to the subject of diagnosis, pathophysiology, risk stratification of post-ERCP pancreatitis, including full text articles and abstracts in the English language. Several causes, operating both at a local and systemic level, might play an important role in the pathogenesis of PEP. Different patient-related risk factors can help predict post-ERCP pancreatitis; diagnosis depends on clinical presentation, imaging and laboratory investigations. As an outpatient procedure, post-ERCP pancreatitis may be safe in a selected group of low-risk patients. Further investigation of the etio-pathogenesis of post-ERCP pancreatitis is required in order to improve diagnosis and treatment. Early identification and severity stratification of post-ERCP pancreatitis greatly affects the patient's outcome. There is still controversy concerning the risk factors related to PEP. More studies are needed to clarify early and definite diagnosis, risk and severity stratification, as well as treatment of post-ERCP pancreatitis.