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Objective: Although amygdala abnormalities are sometimes suspected in "imaging-negative" patients with video EEG confirmed unilateral focal epilepsy suggestive of temporal lobe epilepsy (TLE), amygdala asymmetry is difficult to assess visually. This study examined a group of "imaging-negative" TLE patients, estimating amygdala volumes, to determine whether cryptic amygdala lesions might be detected.Methods: Review of video EEG monitoring data yielded 11 patients with EEG lateralised TLE and normal structural imaging. Amygdala volumes were estimated in this group, in 77 patients with pathologically verified hippocampal sclerosis (HS), and in 77 controls.Results: Seven of 11 "imaging-negative" cases had both significant amygdala asymmetry and amygdala enlargement, concordant with seizure lateralisation. Although significant amygdala asymmetry occurred in 35 of 77 HS patients, it was never attributable to an abnormally large ipsilateral amygdala. Compared with patients with HS, patients with amygdala enlargement were less likely to have suffered secondarily generalised seizures (p<0.05), and had an older age of seizure onset (p<0.01).Conclusion: Abnormal amygdala enlargement is reported in seven cases of "imaging-negative" TLE. Such abnormalities are not observed in patients with HS. It is postulated that amygdala enlargement may be attributable to a developmental abnormality or low grade tumour. It is suggested that amygdala volumetry is indicated in the investigation and diagnosis of "imaging-negative" TLE. [ABSTRACT FROM AUTHOR]

B Background: b Penicillin allergy is a significant public health issue impacting patients and the appropriate use of antimicrobials. Penicillin allergy decision support tools are urgently required to identify low risk allergies that do not require skin testing. PEN-FAST: A validated penicillin allergy clinical decision rule - Implications for prescribing. [Extracted from the article]

Aim: To compare the characteristics of and outcomes for people with malignancies with and without a co‐diagnosis of diabetes. Methods: Emergency department and hospital discharge data from a single centre for the period between 1 January 2015 and 31 December 2017 were used to identify people with a diagnosis of a malignancy and diabetes. Multivariate Cox regression models were used to estimate the effect of diabetes on all‐cause mortality. A truncated negative binomial regression model was used to assess the impact of diabetes on length of hospital inpatient stay. Prentice–Williams–Peterson total time models were used to assess the effect of diabetes on number of emergency department re‐presentations and inpatient re‐admissions. Results: Of 7004 people identified with malignancies, 1195 (17.1%) were also diagnosed with diabetes. A diagnosis of diabetes was associated with a greater number of inpatient re‐admissions [adjusted hazard ratio 1.13 (95% CI 1.03, 1.24)], a greater number of emergency department re‐presentations [adjusted hazard ratio 1.13 (95% CI 1.05, 1.22)] and longer length of stay [adjusted incidence rate ratio 1.14 (95% CI 1.04, 1.25)]. A co‐diagnosis of diabetes was also associated with a 48% increased risk of all‐cause mortality [adjusted hazard ratio 1.48 (95% CI 1.22–1.76)]. Conclusions: People with malignancies and diabetes had significantly more emergency department presentations, more inpatient admissions, longer length of hospital stay and higher rates of all‐cause mortality compared to people with a malignancy without diabetes. What's new?: It has been shown that a diagnosis of diabetes is associated with an increased risk of the development and progression of malignancies, and of mortality in people with malignancies, a number of suggested explanations for which include hyperinsulinaemia and hyperglycaemia.The findings of the present study highlight the increased risk of emergency department presentatios, inpatient admission, longer length of hospital stay and all‐cause mortality associated with a diagnosis of diabetes and malignancy.This work emphasizes the importance of avoiding diabetes, and highlights that people who have already developed diabetes and have a co‐diagnosis of a malignancy represent a high‐risk group that may benefit from additional treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Adjusting the dietary cation–anion difference (DCAD) is one of the most efficient ways to stimulate calcium homeostasis in periparturient dairy cattle. However, adjusting DCAD to the recommended negative values (−100 to −150 mEq/kg) is associated with decreased food intake and metabolic acidosis. The critical conditions of the animals at peripartum (i.e. drastic hormonal changes, decreased appetite and negative energy balance) can be detrimental to the health, productivity and welfare of the animals if combined with decreased feed intake caused by unpalatable acidogenic salts. Methods: In a cross‐sectional study, we analysed the ration of eight small to large dairy herds with intensive husbandry systems, including 6949 dry cows. Sodium, potassium, chlorine and sulfur concentrations in the feed were determined and DCAD was calculated. The DCAD of the ration of the farms ranged from –33.5 to +24.7 mEq/kg. Parturient paresis (PP, or milk fever) prevalence was investigated and correlated to DCAD values. Results: Clinical PP occurrence in the dairies of this investigation on average declined by 87% (ranging from a 97% decline to 5% increase). This indicates that adjusting DCAD at neutral values (0 ± 30 mEq/kg range) may both lower the PP prevalence and increase ration palatability by lowering acidogenic salts in the ration. Conclusions: Further research is recommended to investigate the effects of neutral DCAD on subclinical hypocalcaemia and food intake of the cattle. [ABSTRACT FROM AUTHOR]

Introduction: Optimal treatment duration for residual osteomyelitis (OM) post-amputation in diabetic foot infection (DFI) remains unclear, with resultant heterogeneity in prescribing noted in clinical practice. We aimed to identify a difference in outcomes of long duration of antibiotics (LD) with short duration (SD) in patients with culture-positive proximal bone specimen post-amputation.Methods: In this single-centre retrospective cohort study (Melbourne, Australia), we analysed antibiotic duration of DFI patients requiring amputation with culture-positive proximal bone specimen over a 31 month period (January 2019-September 2021). Primary outcome was reamputation or debridement at the same and/or contiguous site of amputation at 6 months. Secondary outcomes were readmission to hospital and/or recommencement of antibiotics for DFI at the same and/or contiguous site at 6 months.Results: Among 92 patients (83% male, median age 67 years), 26 received <4 weeks (SD) and 66 received ≥4 weeks (LD) antibiotic therapy. In the SD group, primary outcome occurred in 9 patients (35%) compared with 15 patients (23%) in the LD group (P = 0.246). Both secondary outcomes occurred in 12 patients (46%) in the SD group compared with 18 patients (27%) in the LD group (P = 0.086). Adjusted logistic regression analysis showed SD was not significantly associated with primary outcome [OR 1.12 (95% CI 0.38-3.31)] or secondary outcomes [OR 1.67 (95% CI 0.60-4.66)].Conclusions: This single-centre experience did not demonstrate significant difference in outcomes between antibiotic duration of <4 weeks and ≥4 weeks in DFI patients with culture-positive proximal bone specimen post-amputation. These data provide background for larger international randomized control trials to establish optimal treatment duration. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Assess the clinical utility of non-invasive distributed EEG source modelling in focal epilepsy. Methods: Interictal epileptiform discharges were recorded from eight patients – benign focal epilepsy of childhood (BFEC), four; mesial temporal lobe epilepsy (MTLE), four. EEG source localization (ESL) applied 48 forward–inverse–subspace set-ups: forward – standardized, leadfield-interpolated boundary element methods (BEMs, BEMi), finite element method (FEMi); inverse – minimum norm (MNLS), L1 norm (L1), low resolution electromagnetic tomography (LORETA), standardized LORETA (sLORETA); subspace – whole volume (3D), cortex with rotating sources (CxR), cortex with fixed sources (CxN), cortex with fixed extended sources (patch). Current density reconstruction (CDR) maxima defined ‘best-fit’. Results: From 19,200 CDR parameter results and 2304 CDR maps, the dominant variables on best-fit were inverse model and subspace constraint. The most clinically meaningful and statistically robust results came with sLORETA–CxR/patch (lower Rolandic in BFEC, basal temporal lobe in MTLE). Computation time was inverse model dependent: sub-second (MNLS, sLORETA), seconds (L1), minutes (LORETA). Conclusions: From the largest number of distributed ESL approaches compared in a clinical setting, an optimum modelling set-up for BFEC and MTLE incorporated sLORETA (inverse), CxR or patch (subspace), and either BEM or FEMi (forward). Computation is efficient and CDR results are reproducible. Significance: Distributed source modelling demonstrates clinical utility for the routine work-up of unilateral BFEC of the typical Rolandic variety, and unilateral MTLE secondary to hippocampal sclerosis. [ABSTRACT FROM AUTHOR]

Presents several abstracts on neurology. 'Subcellular Localisation of Calbindin-28kDa in Hippocampal and Cerebellar Neurons,' by J.C. Macleod, R.J. Sayer, M.J. Hubbard; 'Effects of Medial Supramammillary Lesions on Spatial Learning, Acquisition of Non-reward Schedules and Hippocampal Theta Rhythm,' by W. Pan and N. McNaughton; 'Intermittent Cold Nerve Injury,' by M. Pollock.