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Background: In this study, we report on a patient with acute stimulant toxicity following the use of two bath salt products purchased over the Internet in the UK, where two novel cathinones and a substituted phenylmorpholine were detected on toxicological screening. Case Report: A 52-year-old male with ADHD presented to ED with chest pain, shortness of breath, sweating, and agitation after nasal insufflation of Internet purchased 'bath salt' products "Ocean Burst" and "Lunar Wave". He was anxious and agitated, but did not have delusions, paranoia or delirium. On examination, he was tachycardic (113bpm), hypertensive (171/115mmHg), and normothermic (36.0°C). He was tremulous, but his tone and reflexes were normal and there was no clonus. Initial blood tests were normal and initial Troponin I was 32.2ng/L; reduced to 28.3ng/L on repeat (low risk for ACS if =34 ng/L on repeat). ECG showed sinus rhythm (99bpm) left axis deviation, QTc 462msecs, QRS 100msecs, with no ischaemic changes. He was treated with oral diazepam (total 25mg) and IV fluids in the ED. Following the admission, he required a further 60mg of oral diazepam for ongoing agitation. His symptoms resolved within 24 hours and he was discharged. Analytical Results: Serum, urine and drugs samples analysed using ultra performance liquid chromatography interfaced to high resolution accurate mass spectrometry: - 'Ocean Burst': N-ethyl pentedrone, alpha PHiP; - 'Lunar Wave': 3-chlorophenmetrazine, 4-methylmethamphetamine, alpha PHiP; - Serum/urine: the cathinones N-ethylpentedrone and alpha-PHiP were detected, along with the substituted phenylmorpholine 3-Chlorophenmetrazine. Conclusion: The novel cathinones detected in this patient, related to the use of 'bath salts', were associated with acute stimulant toxicity. Analytical confirmation of NPS products in patients presenting with acute NPS toxicity is important in the surveillance of the NPS currently available and to inform public health interventions. [ABSTRACT FROM AUTHOR]

Cancer patients treated with capecitabine and oxaliplatin (XELOX) often develop hand‐foot syndrome (HFS) or palmar‐plantar erythrodysesthesia. Genetic variation in ST6GAL1 is a risk factor for type‐2 diabetes (T2D), a disease also associated with HFS. We analysed genome‐wide association data for 10 toxicities in advanced colorectal cancer (CRC) patients from the COIN and COIN‐B trials. One thousand and fifty‐five patients were treated with XELOX ± cetuximab and 745 with folinic acid, fluorouracil and oxaliplatin ± cetuximab. We also analysed rs6783836 in ST6GAL1 with HFS in CRC patients from QUASAR2. Using UK Biobank data, we sought to confirm an association between ST6GAL1 and T2D (17 384 cases, 317 887 controls) and analysed rs6783836 against markers of diabetes, inflammation and psoriasis. We found that 68% of patients from COIN and COIN‐B with grade 2‐3 HFS responded to treatment as compared to 58% with grade 0‐1 HFS (odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.02‐1.2, P = 2.0 × 10−4). HFS was also associated with improved overall survival (hazard ratio = 0.92, 95% CI = 0.84‐0.99, P = 4.6 × 10−2). rs6783836 at ST6GAL1 was associated with HFS in patients treated with XELOX (OR = 3.1, 95% CI = 2.1‐4.6, P = 4.3 × 10−8) and was borderline significant in patients receiving capecitabine from QUASAR2, but with an opposite allele effect (OR = 0.66, 95% CI = 0.42‐1.03, P =.05). ST6GAL1 was associated with T2D (lead SNP rs3887925, OR = 0.94, 95% CI = 0.92‐0.96, P = 1.2 × 10−8) and the rs6783836‐T allele was associated with lowered HbA1c levels (P = 5.9 × 10−3) and lymphocyte count (P = 2.7 × 10−3), and psoriasis (P = 7.5 × 10−3) beyond thresholds for multiple testing. In conclusion, HFS is a biomarker of treatment outcome and rs6783836 in ST6GAL1 is a potential biomarker for HFS with links to T2D and inflammation. [ABSTRACT FROM AUTHOR]

Objective: Troublesome hot flushes and night sweats (HFNS) are experienced by many women after treatment for breast cancer, impacting significantly on sleep and quality of life. Cognitive behavioural therapy (CBT) is known to be effective for the alleviation of HFNS. However, it is not known if it can effectively be delivered by specialist nurses. We investigated whether group CBT, delivered by breast care nurses (BCNs), can reduce the impact of HFNS.Methods: We recruited women with primary breast cancer following primary treatment with seven or more HFNS/week (including 4/10 or above on the HFNS problem rating scale), from six UK hospitals to an open, randomised, phase 3 effectiveness trial. Participants were randomised to Group CBT or usual care (UC). The primary endpoint was HFNS problem rating at 26 weeks after randomisation. Secondary outcomes included sleep, depression, anxiety and quality of life.Results: Between 2017 and 2018, 130 participants were recruited (CBT:63, control:67). We found a 46% (6.9-3.7) reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% (6.5-5.5) reduction in the UC arm (adjusted mean difference -1.96, CI -3.68 to -0.23, P = .039). Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly.Conclusion: Our results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting. [ABSTRACT FROM AUTHOR]

The menopause affects all women, and nurses in any role will come across women who have menopausal symptoms. Some women will need more help than others to manage their symptoms. In 2015 the National Institute for Health and Care Excellence produced guidelines for its diagnosis and management. This article gives an overview of menopause and strategies and treatment for the symptoms women experience. It looks at symptoms, consequences and treatments including lifestyle and medication. The aim is to provide up-to-date information for nurses and an overview of the new NICE guidance. [ABSTRACT FROM AUTHOR]

Primary hyperhidrosis is characterised by sweating in excess of that needed for normal thermoregulation. The condition often goes unreported because of embarrassment, and management is hindered by a poor evidence base and lack of clinical guidelines. Anxiety about social situations and relationships, and problems with daily living, such as an inability to hold a pen at work, can affect quality of life. Hyperhidrosis may be associated with bromhidrosis (unpleasant odour) from the byproducts of bacteria that colonise sweaty areas. Subjective perceptions of the condition's impact on the person's life, and therefore its severity, can make confirmation of diagnosis and effective management challenging. This review aims to provide an update on identifying this condition, instigating appropriate management, and when to refer to a specialist. [ABSTRACT FROM AUTHOR]

Adventure racing requires competitors to perform various disciplines ranging from, but not limited to, mountain biking, running, kayaking, climbing, mountaineering, flat- and white-water boating and orienteering over a rugged, often remote and wilderness terrain. Races can vary from 6 hours to expedition-length events that can last up to 10-consecutive days or more. The purpose of this article is to provide evidence-based nutritional recommendations for adventure racing competitors. Energy expenditures of 365-75Okcal/hour have been reported with total energy expenditures of 18 000-80 000 kcal required to complete adventure races, and large negative energy balances during competitions have been reported. Nutrition, therefore, plays a major role in the successful completion of such ultra-endurance events. Conducting research in these events is challenging and the limited studies investigating dietary surveys and nutritional status of adventure racers indicate that competitors do not meet nutrition recommendations for ultra-endurance exercise. Carbohydrate intakes of 7-12 g/kg are needed during periods of prolonged training to meet requirements and replenish glycogen stores. Protein intakes of 1.4-1.7g/kg are recommended to build and repair tissue. Adequate replacement of fluid and electrolytes are crucial, particularly during extreme temperatures; however, Sweat rates can vary greatly between competitors. There is considerable evidence to support the use of sports drinks, gels and bars, as they are a convenient and portable source of carbohydrate that can be consumed during exercise, in training and in competition. Similarly, protein and amino acid supplements can be useful to help meet periods of increased protein requirements. Caffeine can be used as an ergogenic aid to help competitors stay awake during prolonged periods, enhance glycogen resynthesis and enhance endurance performance. [ABSTRACT FROM AUTHOR]

Abstract: Currently there is no standard way of carrying out research into finger mark enhancement techniques. Individuals, groups or establishments tend to use different methodologies depending on a number of factors, especially finance and time. However, data published in the literature can be misleading to the forensic community if the data generated reflects research involving very few finger marks or if those finger marks have been deliberately doped with an unnatural balance of sweat or an unusual contaminant. This paper presents an experimental methodology which is intended to establish minimum standards for those carrying out finger mark enhancement research (at least within the United Kingdom) and bring some consistency to the process. It will aim to identify the many variables encountered when dealing with finger marks and suggest experimental methods to take these into account. It will also present the key stages of the progression of a process from a laboratory concept to a tool used on operational work. [Copyright &y& Elsevier]

Hyperhidrosis is a condition in which individuals suffer from excessive and uncontrollable sweating. While its prevalence within the UK is unknown, it is a relatively common dermatological complaint encountered by GPs. It can cause a great deal of embarrassment for many sufferers as well as interference with daily activities. A holistic approach is therefore essential in the assessment and management of this condition. Clinicians should be aware of the treatment options available in both primary and secondary care. [ABSTRACT FROM PUBLISHER]

A multidisciplinary group (representing various professional bodies and supported by the Cystic Fibrosis Trust) has developed evidence-based guidelines for the performance of the sweat test in the UK. The guidelines cover patient information, subject suitability, sweat collection, sweat analysis, quality, interpretation of results, and responsibility for testing and training. The guidelines were produced following a detailed literature search by the process described by the Royal College of Paediatrics and Child Health (RCPCH), using the Scottish Intercollegiate Guidelines Network 1 (SIGN 1) criteria to grade the evidence. Recommendations are graded A, B, or C, depending on the level of evidence. The grade B recommendations (there were no grade A recommendations) were subsequently appraised and endorsed as part of the RCPCH process, according to Appraisal of Guidelines for Research and Evaluation in Europe (AGREE). The recommendations are summarized in tabular form representing the final version incorporating the comments from the appraisal process. Both the appraisal comments and the full evidence base can be found on www.rcpch.ac.uk/publications/clinical_docs.html. The full guidelines can also be found on http://www.ukneqas.org.uk/guidelines.htm. [ABSTRACT FROM AUTHOR]

Discusses the study about the various approach to control sweating of the human body in Great Britain. Two fundamentally different types of stimuli to evoke sweat response; Connection of sweat glands on the sympathetic nervous system; Approaches for suppression of sweating thru various drugs.

The article presents the case of a 24 year old Bangladeshi woman who suffered from a series of fever, night sweats and cervical lymphadenopathy months after arriving in Great Britain. Information about the health history, diagnosis and treatment of the woman's disease was discussed. Medical examination performed suggests that her case might be due to tuberculosis.

Determines the accuracy of sweat tests in diagnosing cystic fibrosis in adults. Examination on patients with cystic fibrosis; Use of fludrocortisone in suppression test; Study on sweat sodium concentration.

Focuses on the role of plasma exchange in controlling sweats and pruritus in malignant disease in Great Britain. Presentation of a case reports supporting the role of plasma exchange; Causes of sweats and itching; Effectivity of plasma exchange in controlling the mechanism producing sweats and pruritus.