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Background: Previous studies identifying associations between influenza and acute cardiac events may have been confounded by climatic factors. Differing seasonal patterns of influenza activity in Hong Kong and England and Wales provide a natural experiment to examine associations with myocardial infarction (MI) independent of cold weather effects.Methods: Weekly clinical and laboratory influenza surveillance data, environmental temperature and humidity data, and counts of MI-associated hospitalizations and deaths were obtained for England and Wales and for Hong Kong for the period 1998-2008. We used Poisson regression models that included environmental and seasonal variables to investigate the relationship between influenza and MI.Results: There were ≥1.2 million MI-associated hospitalizations and 410,204 MI-associated deaths in England and Wales, with a marked peak in the winter season. In Hong Kong, the incidence of MI, on the basis of 65,108 hospitalizations and 18,780 deaths, had a large winter and smaller summer peak, mirroring patterns of influenza activity. There was strong evidence for a link between influenza and MI both in England and Wales, where 3.1%-3.4% of MI-associated deaths (P < .001) and 0.7%-1.2% of MI-associated hospitalizations (P < .001) were attributable to influenza, and in Hong Kong, where the corresponding figures were 3.9%-5.6% (P = .018) and 3.0%-3.3% (P = .002).Conclusions: Influenza was associated with an increase in MI-associated deaths and hospitalizations in 2 contrasting settings. [ABSTRACT FROM AUTHOR]

Background: Gamma-hydroxybutyrate (GHB) is used as a recreational drug, with significant associated morbidity and mortality; it is therefore a class C drug under the Misuse of Drugs Act (1971). However, its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD) remain legally available despite having similar clinical effects. [ABSTRACT FROM PUBLISHER]

We report the case of an unusual presentation of myasthenia gravis with tongue atrophy and fasciculation. Myasthenia gravis is an autoimmune condition associated with weakness and fatigability of voluntary muscles. In >50%, the initial symptoms and signs are related to extraocular muscle weakness, such as diplopia or ptosis [Tsung K, Seggev JS. An unusual cause of dysphagia. West J Med 1995; 163: 159-60]. Rarely, it is known to affect bulbar muscles and can lead to dysphagia and respiratory compromise. [ABSTRACT FROM AUTHOR]

The article focuses on intimate partner violence's (IPV) screening in a London, England, HIV clinic and characteristics of those screening positive. Topics discussed include demographics of 348 screened patients, high lifetime risk for IPV and warrant in HIV patients and finding evidence of differences when comparing men who screened positive for IPV according to risk group.

Summary: Background: Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. Objectives: To quantify the risks of acute non‐postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. Methods: We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age‐, sex‐ and practice‐matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan–Meier‐estimated 3‐month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster‐specific complications. We also assessed whether antivirals during acute zoster protected against the complications. Results: In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster‐specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34–0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0–0·01) for disseminated zoster, 0·04% (95% CI 0·03–0·05) for zoster death and 0·97% (95% CI 0·92–1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44–0·51) for neurological complications, 1·33% (95% CI 1·28–1·39) for ocular complications, 0·29% (95% CI 0·26–0·32) for cutaneous complications and 0·78% (95% CI 0·73–0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53–0·70). Conclusions: Non‐PHN complications of zoster were relatively common, which may affect cost‐effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN. What is already known about this topic?Herpes zoster is typically mild and self‐limiting; however, it can cause serious cutaneous, visceral, neurological and ocular complications.Some complications lead to severe illness, high healthcare costs and mortality, while others can seriously affect quality of life.Better knowledge of the frequency of, and risk factors for, such zoster complications would be helpful to inform zoster vaccination policy. What does this study add?In this large cohort study among UK adults with zoster, we found raised risks of neurological, ocular, cutaneous, visceral and zoster‐specific complications in the 3 months after zoster diagnosis.Estimated absolute risks attributable to zoster were 0·48% [95% confidence interval (CI) 0·44–0·51] for neurological complications, 1·33% (95% CI 1·28–1·39) for ocular complications, 0·29% (95% CI 0·26–0·32) for cutaneous complications and 0·78% (95% CI 0·73–0·84) for visceral complications. Linked Comment: Kridin and Cohen. Br J Dermatol 2021; 184:994–995. [ABSTRACT FROM AUTHOR]

Problem: The need to improve the clinical assessment and management of acutely poisoned patients presenting to an NHS hospital emergency department (ED). Design: Creation of an electronic clinical toxicology database to prospectively collect all aspects of clinical information on poisoned-patient presentations. Systematic analysis of collated information to identify shortfalls in patient assessment and management. Bimonthly audit meetings, and design and implementation of educational interventions to address identified shortfalls, Ongoing audit to demonstrate continued improvement in patient care. Background and setting: ED in tertiary-level inner-city London teaching hospital. Study conducted by staff from the ED and clinical toxicology service. Key measures for improvement: Demonstration of overall reduction in the incidence of predefined shortfalls in patient assessment and management during 12-month study period. Strategies for improvement: Targeted educational lectures and case-based clinical scenarios addressing identified deficiencies in the knowledge required to effectively manage poisoned patients. Weekly case-based anonymised feedback report sent electronically to staff involved in caring for poisoned patients. Effects of change: Implementation of targeted teaching of ED staff and regular electronic distribution of teaching cases. Between the first and second 6 months of the study, there was a significant increase in the proportion of presentations for which clinical management was graded as "good" (77.6% to 89.4%, p<0.0001) and a significant reduction in the proportion of "major" (9.9% to 5.8%, p=0.012) and "minor" (12.6% to 4.8%, p<0.0001) shortfalls. Lessons learnt: Systematic collection of clinical information, using a dedicated electronic database and subsequent review and audit of collated data by interested clinicians, enabled design and implementation of targeted educational interventions to address shortfalls in patient management. This process has led to significant improvements in the clinical care of acutely poisoned patients presenting to the ED. [ABSTRACT FROM AUTHOR]