s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caled... more s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caledonian Society for Endocrinology Queen Mother Conference Centre, Royal College of Physicians of Edinburgh, Edinburgh 24 and 25 September 2010 Invited Speaker Presentations Immunity and disease – unwelcome complexity or opportunity for clinicians?
s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caled... more s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caledonian Society for Endocrinology Queen Mother Conference Centre, Royal College of Physicians of Edinburgh, Edinburgh 24 and 25 September 2010 Invited Speaker Presentations Immunity and disease – unwelcome complexity or opportunity for clinicians?
Due to an increase in bovine tuberculosis in cattle in the United Kingdom, we investigated the ch... more Due to an increase in bovine tuberculosis in cattle in the United Kingdom, we investigated the characteristics of Mycobacterium bovis infection in humans and assessed whether extensive transmission of M. bovis between humans has occurred. A cross-sectional study linking demographic, clinical, and DNA fingerprinting (using 15-locus mycobacterial interspersed repetitive-unit–variable-number tandem-repeat [MIRU-VNTR] typing) data on cases reported between 2005 and 2008 was undertaken. A total of 129 cases of M. bovis infection in humans were reported over the period, with a decrease in annual incidence from 0.065 to 0.047 cases per 100,000 persons. Most patients were born pre-1960, before widespread pasteurization was introduced (73%), were of white ethnicity (83%), and were born in the United Kingdom (76%). A total of 102 patients (79%) had MIRU-VNTR typing data. A total of 31 of 69 complete MIRU-VNTR profiles formed eight distinct clusters. The overall clustering proportion determine...
In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genot... more In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with pre-existing chronic liver disease (CLD). To determine the role of HEV in patients with decompensated CLD. Prospective HEV testing of 343 patients with decompensated CLD at three UK centres and Toulouse France, with follow-up for 6 months or death. IgG seroprevalence was compared with 911 controls. 11/343 patients (3.2%) had acute hepatitis E infection, and three died. There were no differences in mortality (27% vs. 26%, OR 1.1, 95% CI 0.28-4.1), age (P = 0.9), bilirubin (P = 0.5), alanine aminotransferase (P = 0.06) albumin (P = 0.5) or international normalised ratio (P = 0.6) in patients with and without hepatitis E infection. Five cases were polymerase chain reaction (PCR) positive (genotype 3). Hepatitis E was more common in Toulouse (7.9%) compared to the UK cohort (1.2%, P = 0.003). HEV IgG seroprevalence was higher in Toulouse (OR 17, 95% CI 9.2-30) and Truro (OR 2.5, 95% CI 1.4-4.6) than in Glasgow, but lower in cases, compared to controls (OR 0.59, 95% CI 0.41-0.86). Hepatitis E occurs in a minority of patients with decompensated chronic liver disease. The mortality is no different to the mortality in patients without hepatitis E infection. The diagnosis can only be established by a combination of serology and PCR, the yield and utility of which vary by geographical location.
The British journal of general practice : the journal of the Royal College of General Practitioners, 1999
Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying fa... more Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying factors are needed. To determine the principal diagnoses, demographic, and socioeconomic factors associated with emergency medical admissions. Cohort study based on the Greater Glasgow Health Board population of 810,423 adults. A fully anonymized dataset linkage of 43,247 adult emergency admissions to Glasgow medical beds in 1997 was obtained. Emergency admission rates were analysed by diagnosis, age, sex, Carstairs' deprivation category, and by individual general practices (after adjustment for other factors). The commonest principal diagnoses were chest pain (9.6%), chronic obstructive airways disease (5.6%), angina (5.4%), heart failure (4.1%), and acute myocardial infarction (3.9%). Twenty-one per cent of patients were coded as having 'ill-defined signs or symptoms'. Emergency medical admission rates rose with the age of the patient, doubling with every two decades' age...
Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health... more Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health Service (NHS), and routine MRSA screening of hospital inpatients has recently been introduced in both Scotland and England. The UK National Screening Committee states that public pressure for widening the eligibility criteria of a proposed screening programme should be anticipated and any related decisions scientifically justifiable. A literature review was conducted to examine whether MRSA screening in Scotland should be expanded to include the routine screening of healthcare workers (HCWs). There are no published prevalence studies reporting the overall MRSA carriage rate in HCWs in NHS hospitals. Estimates of HCW carriage from the worldwide literature vary widely depending on the country, hospital specialty and setting (endemic, non-endemic or outbreak). Recent studies conducted in endemic hospital settings report non-outbreak carriage rates of 0-15%. The role of HCW carriage in the transmission of MRSA is not well understood. Persistent carriage could act as a reservoir for infection and HCWs have been implicated as the source in a number of published outbreak reports. There are no published controlled trials examining the impact of routine HCW screening as an intervention in the prevention and control of MRSA infections in the endemic hospital setting. Most of the evidence for HCW screening comes from outbreak reports where the outbreak was brought to an end following the introduction of staff screening as part of a suite of infection control measures. Further research is required before a recommendation could be made to introduce routine MRSA screening of HCWs in the NHS in Scotland.
Three cases of Legionnaires' disease caused by Legionella longbeachae Sg 1 associated with po... more Three cases of Legionnaires' disease caused by Legionella longbeachae Sg 1 associated with potting compost have been reported in Scotland between 2008 and 2009. The exact method of transmission is still not fully understood as Legionnaires' disease is thought to be acquired by droplet inhalation. The linked cases associated with compost exposure call for an introduction of compost labelling, as
s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caled... more s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caledonian Society for Endocrinology Queen Mother Conference Centre, Royal College of Physicians of Edinburgh, Edinburgh 24 and 25 September 2010 Invited Speaker Presentations Immunity and disease – unwelcome complexity or opportunity for clinicians?
s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caled... more s of Societies Scottish Society of Physicians – 52nd Annual Meeting In association with the Caledonian Society for Endocrinology Queen Mother Conference Centre, Royal College of Physicians of Edinburgh, Edinburgh 24 and 25 September 2010 Invited Speaker Presentations Immunity and disease – unwelcome complexity or opportunity for clinicians?
Due to an increase in bovine tuberculosis in cattle in the United Kingdom, we investigated the ch... more Due to an increase in bovine tuberculosis in cattle in the United Kingdom, we investigated the characteristics of Mycobacterium bovis infection in humans and assessed whether extensive transmission of M. bovis between humans has occurred. A cross-sectional study linking demographic, clinical, and DNA fingerprinting (using 15-locus mycobacterial interspersed repetitive-unit–variable-number tandem-repeat [MIRU-VNTR] typing) data on cases reported between 2005 and 2008 was undertaken. A total of 129 cases of M. bovis infection in humans were reported over the period, with a decrease in annual incidence from 0.065 to 0.047 cases per 100,000 persons. Most patients were born pre-1960, before widespread pasteurization was introduced (73%), were of white ethnicity (83%), and were born in the United Kingdom (76%). A total of 102 patients (79%) had MIRU-VNTR typing data. A total of 31 of 69 complete MIRU-VNTR profiles formed eight distinct clusters. The overall clustering proportion determine...
In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genot... more In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with pre-existing chronic liver disease (CLD). To determine the role of HEV in patients with decompensated CLD. Prospective HEV testing of 343 patients with decompensated CLD at three UK centres and Toulouse France, with follow-up for 6 months or death. IgG seroprevalence was compared with 911 controls. 11/343 patients (3.2%) had acute hepatitis E infection, and three died. There were no differences in mortality (27% vs. 26%, OR 1.1, 95% CI 0.28-4.1), age (P = 0.9), bilirubin (P = 0.5), alanine aminotransferase (P = 0.06) albumin (P = 0.5) or international normalised ratio (P = 0.6) in patients with and without hepatitis E infection. Five cases were polymerase chain reaction (PCR) positive (genotype 3). Hepatitis E was more common in Toulouse (7.9%) compared to the UK cohort (1.2%, P = 0.003). HEV IgG seroprevalence was higher in Toulouse (OR 17, 95% CI 9.2-30) and Truro (OR 2.5, 95% CI 1.4-4.6) than in Glasgow, but lower in cases, compared to controls (OR 0.59, 95% CI 0.41-0.86). Hepatitis E occurs in a minority of patients with decompensated chronic liver disease. The mortality is no different to the mortality in patients without hepatitis E infection. The diagnosis can only be established by a combination of serology and PCR, the yield and utility of which vary by geographical location.
The British journal of general practice : the journal of the Royal College of General Practitioners, 1999
Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying fa... more Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying factors are needed. To determine the principal diagnoses, demographic, and socioeconomic factors associated with emergency medical admissions. Cohort study based on the Greater Glasgow Health Board population of 810,423 adults. A fully anonymized dataset linkage of 43,247 adult emergency admissions to Glasgow medical beds in 1997 was obtained. Emergency admission rates were analysed by diagnosis, age, sex, Carstairs' deprivation category, and by individual general practices (after adjustment for other factors). The commonest principal diagnoses were chest pain (9.6%), chronic obstructive airways disease (5.6%), angina (5.4%), heart failure (4.1%), and acute myocardial infarction (3.9%). Twenty-one per cent of patients were coded as having 'ill-defined signs or symptoms'. Emergency medical admission rates rose with the age of the patient, doubling with every two decades' age...
Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health... more Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health Service (NHS), and routine MRSA screening of hospital inpatients has recently been introduced in both Scotland and England. The UK National Screening Committee states that public pressure for widening the eligibility criteria of a proposed screening programme should be anticipated and any related decisions scientifically justifiable. A literature review was conducted to examine whether MRSA screening in Scotland should be expanded to include the routine screening of healthcare workers (HCWs). There are no published prevalence studies reporting the overall MRSA carriage rate in HCWs in NHS hospitals. Estimates of HCW carriage from the worldwide literature vary widely depending on the country, hospital specialty and setting (endemic, non-endemic or outbreak). Recent studies conducted in endemic hospital settings report non-outbreak carriage rates of 0-15%. The role of HCW carriage in the transmission of MRSA is not well understood. Persistent carriage could act as a reservoir for infection and HCWs have been implicated as the source in a number of published outbreak reports. There are no published controlled trials examining the impact of routine HCW screening as an intervention in the prevention and control of MRSA infections in the endemic hospital setting. Most of the evidence for HCW screening comes from outbreak reports where the outbreak was brought to an end following the introduction of staff screening as part of a suite of infection control measures. Further research is required before a recommendation could be made to introduce routine MRSA screening of HCWs in the NHS in Scotland.
Three cases of Legionnaires' disease caused by Legionella longbeachae Sg 1 associated with po... more Three cases of Legionnaires' disease caused by Legionella longbeachae Sg 1 associated with potting compost have been reported in Scotland between 2008 and 2009. The exact method of transmission is still not fully understood as Legionnaires' disease is thought to be acquired by droplet inhalation. The linked cases associated with compost exposure call for an introduction of compost labelling, as
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Papers by O. Blatchford