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  1. Article ; Online: Herpes simplex virus encephalitis in a patient receiving ustekinumab associated with extensive cerebral oedema and brainshift successfully treated by immunosuppression with dexamethasone.

    Van Den Tooren, Harriet Kay / Bharambe, Viraj / Silver, Nicholas / Michael, Benedict D

    BMJ case reports

    2019  Volume 12, Issue 8

    Abstract: Herpes simplex virus (HSV) encephalitis affects 2-4 people per million/year. Immunocompomised patients can have atypical presentations of HSV encephalitis, including a lack of cerebrospinal fluid (CSF) pleocytosis. We present the case of a patient who ... ...

    Abstract Herpes simplex virus (HSV) encephalitis affects 2-4 people per million/year. Immunocompomised patients can have atypical presentations of HSV encephalitis, including a lack of cerebrospinal fluid (CSF) pleocytosis. We present the case of a patient who was receiving ustekinumab therapy for psoriasis which inhibits interleukin (IL)-12 and IL-23 signalling pathways. The initial presentation was suggestive of encephalitis, but he was discharged prior to the reporting of HSV positivity due to the lack of CSF pleocytosis. On representation, he had worsening symptoms and imaging showed midline shift, indicating cerebral oedema despite the immunosupressant effects of ustekinumab. He required intensive care unit support and treatment with high dose aciclovir and dexamethasone; after a month of treatment he made a good recovery. This case is the first to report a link between ustekinumab and HSV encephalitis, and also emphasises that imunocompromised patients can lack CSF pleocytosis and develop significant cerebral oedema which responds to immune suppression.
    MeSH term(s) Acyclovir/administration & dosage ; Acyclovir/therapeutic use ; Adult ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/administration & dosage ; Antiviral Agents/therapeutic use ; Brain Edema/chemically induced ; Brain Edema/diagnosis ; Brain Edema/diagnostic imaging ; Brain Edema/drug therapy ; Dermatologic Agents/adverse effects ; Dexamethasone/administration & dosage ; Dexamethasone/therapeutic use ; Diagnosis, Differential ; Encephalitis, Herpes Simplex/cerebrospinal fluid ; Encephalitis, Herpes Simplex/chemically induced ; Encephalitis, Herpes Simplex/diagnosis ; Encephalitis, Herpes Simplex/drug therapy ; Humans ; Immunocompromised Host ; Male ; Psoriasis/drug therapy ; Ustekinumab/adverse effects
    Chemical Substances Anti-Inflammatory Agents ; Antiviral Agents ; Dermatologic Agents ; Dexamethasone (7S5I7G3JQL) ; Ustekinumab (FU77B4U5Z0) ; Acyclovir (X4HES1O11F)
    Language English
    Publishing date 2019-08-13
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2019-229468
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Comment on: Consequences of Delayed Dental Extraction in Lesch-Nyhan Disease.

    Van Den Tooren, Harriet / Davies, Benjamin M / Silverdale, Monty / McKee, David

    Movement disorders clinical practice

    2016  Volume 4, Issue 3, Page(s) 463–464

    Language English
    Publishing date 2016-10-28
    Publishing country United States
    Document type Journal Article
    ISSN 2330-1619
    ISSN (online) 2330-1619
    DOI 10.1002/mdc3.12440
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Acute seizure risk in patients with encephalitis: development and validation of clinical prediction models from two independent prospective multicentre cohorts.

    Wood, Greta K / Babar, Roshan / Ellul, Mark A / Thomas, Rhys Huw / Van Den Tooren, Harriet / Easton, Ava / Tharmaratnam, Kukatharmini / Burnside, Girvan / Alam, Ali M / Castell, Hannah / Boardman, Sarah / Collie, Ceryce / Facer, Bethany / Dunai, Cordelia / Defres, Sylviane / Granerod, Julia / Brown, David W G / Vincent, Angela / Marson, Anthony Guy /
    Irani, Sarosh R / Solomon, Tom / Michael, Benedict D

    BMJ neurology open

    2022  Volume 4, Issue 2, Page(s) e000323

    Abstract: Objective: In patients with encephalitis, the development of acute symptomatic seizures is highly variable, but when present is associated with a worse outcome. We aimed to determine the factors associated with seizures in encephalitis and develop a ... ...

    Abstract Objective: In patients with encephalitis, the development of acute symptomatic seizures is highly variable, but when present is associated with a worse outcome. We aimed to determine the factors associated with seizures in encephalitis and develop a clinical prediction model.
    Methods: We analysed 203 patients from 24 English hospitals (2005-2008) (Cohort 1). Outcome measures were seizures prior to and during admission, inpatient seizures and status epilepticus. A binary logistic regression risk model was converted to a clinical score and independently validated on an additional 233 patients from 31 UK hospitals (2013-2016) (Cohort 2).
    Results: In Cohort 1, 121 (60%) patients had a seizure including 103 (51%) with inpatient seizures. Admission Glasgow Coma Scale (GCS) ≤8/15 was predictive of subsequent inpatient seizures (OR (95% CI) 5.55 (2.10 to 14.64), p<0.001), including in those without a history of prior seizures at presentation (OR 6.57 (95% CI 1.37 to 31.5), p=0.025).A clinical model of overall seizure risk identified admission GCS along with aetiology (autoantibody-associated OR 11.99 (95% CI 2.09 to 68.86) and Herpes simplex virus 3.58 (95% CI 1.06 to 12.12)) (area under receiver operating characteristics curve (AUROC) =0.75 (95% CI 0.701 to 0.848), p<0.001). The same model was externally validated in Cohort 2 (AUROC=0.744 (95% CI 0.677 to 0.811), p<0.001). A clinical scoring system for stratifying inpatient seizure risk by decile demonstrated good discrimination using variables available on admission; age, GCS and fever (AUROC=0.716 (95% CI 0.634 to 0.798), p<0.001) and once probable aetiology established (AUROC=0.761 (95% CI 0.6840.839), p<0.001).
    Conclusion: Age, GCS, fever and aetiology can effectively stratify acute seizure risk in patients with encephalitis. These findings can support the development of targeted interventions and aid clinical trial design for antiseizure medication prophylaxis.
    Language English
    Publishing date 2022-09-05
    Publishing country England
    Document type Journal Article
    ISSN 2632-6140
    ISSN (online) 2632-6140
    DOI 10.1136/bmjno-2022-000323
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

    McManus, I C / Harborne, Andrew Christopher / Horsfall, Hugo Layard / Joseph, Tobin / Smith, Daniel T / Marshall-Andon, Tess / Samuels, Ryan / Kearsley, Joshua William / Abbas, Nadine / Baig, Hassan / Beecham, Joseph / Benons, Natasha / Caird, Charlie / Clark, Ryan / Cope, Thomas / Coultas, James / Debenham, Luke / Douglas, Sarah / Eldridge, Jack /
    Hughes-Gooding, Thomas / Jakubowska, Agnieszka / Jones, Oliver / Lancaster, Eve / MacMillan, Calum / McAllister, Ross / Merzougui, Wassim / Phillips, Ben / Phillips, Simon / Risk, Omar / Sage, Adam / Sooltangos, Aisha / Spencer, Robert / Tajbakhsh, Roxanne / Adesalu, Oluseyi / Aganin, Ivan / Ahmed, Ammar / Aiken, Katherine / Akeredolu, Alimatu-Sadia / Alam, Ibrahim / Ali, Aamna / Anderson, Richard / Ang, Jia Jun / Anis, Fady Sameh / Aojula, Sonam / Arthur, Catherine / Ashby, Alena / Ashraf, Ahmed / Aspinall, Emma / Awad, Mark / Yahaya, Abdul-Muiz Azri / Badhrinarayanan, Shreya / Bandyopadhyay, Soham / Barnes, Sam / Bassey-Duke, Daisy / Boreham, Charlotte / Braine, Rebecca / Brandreth, Joseph / Carrington, Zoe / Cashin, Zoe / Chatterjee, Shaunak / Chawla, Mehar / Chean, Chung Shen / Clements, Chris / Clough, Richard / Coulthurst, Jessica / Curry, Liam / Daniels, Vinnie Christine / Davies, Simon / Davis, Rebecca / De Waal, Hanelie / Desai, Nasreen / Douglas, Hannah / Druce, James / Ejamike, Lady-Namera / Esere, Meron / Eyre, Alex / Fazmin, Ibrahim Talal / Fitzgerald-Smith, Sophia / Ford, Verity / Freeston, Sarah / Garnett, Katherine / General, Whitney / Gilbert, Helen / Gowie, Zein / Grafton-Clarke, Ciaran / Gudka, Keshni / Gumber, Leher / Gupta, Rishi / Harlow, Chris / Harrington, Amy / Heaney, Adele / Ho, Wing Hang Serene / Holloway, Lucy / Hood, Christina / Houghton, Eleanor / Houshangi, Saba / Howard, Emma / Human, Benjamin / Hunter, Harriet / Hussain, Ifrah / Hussain, Sami / Jackson-Taylor, Richard Thomas / Jacob-Ramsdale, Bronwen / Janjuha, Ryan / Jawad, Saleh / Jelani, Muzzamil / Johnston, David / Jones, Mike / Kalidindi, Sadhana / Kalsi, Savraj / Kalyanasundaram, Asanish / Kane, Anna / Kaur, Sahaj / Al-Othman, Othman Khaled / Khan, Qaisar / Khullar, Sajan / Kirkland, Priscilla / Lawrence-Smith, Hannah / Leeson, Charlotte / Lenaerts, Julius Elisabeth Richard / Long, Kerry / Lubbock, Simon / Burrell, Jamie Mac Donald / Maguire, Rachel / Mahendran, Praveen / Majeed, Saad / Malhotra, Prabhjot Singh / Mandagere, Vinay / Mantelakis, Angelos / McGovern, Sophie / Mosuro, Anjola / Moxley, Adam / Mustoe, Sophie / Myers, Sam / Nadeem, Kiran / Nasseri, Reza / Newman, Tom / Nzewi, Richard / Ogborne, Rosalie / Omatseye, Joyce / Paddock, Sophie / Parkin, James / Patel, Mohit / Pawar, Sohini / Pearce, Stuart / Penrice, Samuel / Purdy, Julian / Ramjan, Raisa / Randhawa, Ratan / Rasul, Usman / Raymond-Taggert, Elliot / Razey, Rebecca / Razzaghi, Carmel / Reel, Eimear / Revell, Elliot John / Rigbye, Joanna / Rotimi, Oloruntobi / Said, Abdelrahman / Sanders, Emma / Sangal, Pranoy / Grandal, Nora Sangvik / Shah, Aadam / Shah, Rahul Atul / Shotton, Oliver / Sims, Daniel / Smart, Katie / Smith, Martha Amy / Smith, Nick / Sopian, Aninditya Salma / South, Matthew / Speller, Jessica / Syer, Tom J / Ta, Ngan Hong / Tadross, Daniel / Thompson, Benjamin / Trevett, Jess / Tyler, Matthew / Ullah, Roshan / Utukuri, Mrudula / Vadera, Shree / Van Den Tooren, Harriet / Venturini, Sara / Vijayakumar, Aradhya / Vine, Melanie / Wellbelove, Zoe / Wittner, Liora / Yong, Geoffrey Hong Kiat / Ziyada, Farris / Devine, Oliver Patrick

    BMC medicine

    2020  Volume 18, Issue 1, Page(s) 136

    Abstract: Background: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of ...

    Abstract Background: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors.
    Method: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail.
    Results: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs.
    Conclusions: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.
    MeSH term(s) Female ; Humans ; Male ; Schools, Medical/standards ; Students, Medical/statistics & numerical data ; United Kingdom
    Language English
    Publishing date 2020-05-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131669-7
    ISSN 1741-7015 ; 1741-7015
    ISSN (online) 1741-7015
    ISSN 1741-7015
    DOI 10.1186/s12916-020-01572-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

    Devine, Oliver Patrick / Harborne, Andrew Christopher / Horsfall, Hugo Layard / Joseph, Tobin / Marshall-Andon, Tess / Samuels, Ryan / Kearsley, Joshua William / Abbas, Nadine / Baig, Hassan / Beecham, Joseph / Benons, Natasha / Caird, Charlie / Clark, Ryan / Cope, Thomas / Coultas, James / Debenham, Luke / Douglas, Sarah / Eldridge, Jack / Hughes-Gooding, Thomas /
    Jakubowska, Agnieszka / Jones, Oliver / Lancaster, Eve / MacMillan, Calum / McAllister, Ross / Merzougui, Wassim / Phillips, Ben / Phillips, Simon / Risk, Omar / Sage, Adam / Sooltangos, Aisha / Spencer, Robert / Tajbakhsh, Roxanne / Adesalu, Oluseyi / Aganin, Ivan / Ahmed, Ammar / Aiken, Katherine / Akeredolu, Alimatu-Sadia / Alam, Ibrahim / Ali, Aamna / Anderson, Richard / Ang, Jia Jun / Anis, Fady Sameh / Aojula, Sonam / Arthur, Catherine / Ashby, Alena / Ashraf, Ahmed / Aspinall, Emma / Awad, Mark / Yahaya, Abdul-Muiz Azri / Badhrinarayanan, Shreya / Bandyopadhyay, Soham / Barnes, Sam / Bassey-Duke, Daisy / Boreham, Charlotte / Braine, Rebecca / Brandreth, Joseph / Carrington, Zoe / Cashin, Zoe / Chatterjee, Shaunak / Chawla, Mehar / Chean, Chung Shen / Clements, Chris / Clough, Richard / Coulthurst, Jessica / Curry, Liam / Daniels, Vinnie Christine / Davies, Simon / Davis, Rebecca / De Waal, Hanelie / Desai, Nasreen / Douglas, Hannah / Druce, James / Ejamike, Lady-Namera / Esere, Meron / Eyre, Alex / Fazmin, Ibrahim Talal / Fitzgerald-Smith, Sophia / Ford, Verity / Freeston, Sarah / Garnett, Katherine / General, Whitney / Gilbert, Helen / Gowie, Zein / Grafton-Clarke, Ciaran / Gudka, Keshni / Gumber, Leher / Gupta, Rishi / Harlow, Chris / Harrington, Amy / Heaney, Adele / Ho, Wing Hang Serene / Holloway, Lucy / Hood, Christina / Houghton, Eleanor / Houshangi, Saba / Howard, Emma / Human, Benjamin / Hunter, Harriet / Hussain, Ifrah / Hussain, Sami / Jackson-Taylor, Richard Thomas / Jacob-Ramsdale, Bronwen / Janjuha, Ryan / Jawad, Saleh / Jelani, Muzzamil / Johnston, David / Jones, Mike / Kalidindi, Sadhana / Kalsi, Savraj / Kalyanasundaram, Asanish / Kane, Anna / Kaur, Sahaj / Al-Othman, Othman Khaled / Khan, Qaisar / Khullar, Sajan / Kirkland, Priscilla / Lawrence-Smith, Hannah / Leeson, Charlotte / Lenaerts, Julius Elisabeth Richard / Long, Kerry / Lubbock, Simon / Burrell, Jamie Mac Donald / Maguire, Rachel / Mahendran, Praveen / Majeed, Saad / Malhotra, Prabhjot Singh / Mandagere, Vinay / Mantelakis, Angelos / McGovern, Sophie / Mosuro, Anjola / Moxley, Adam / Mustoe, Sophie / Myers, Sam / Nadeem, Kiran / Nasseri, Reza / Newman, Tom / Nzewi, Richard / Ogborne, Rosalie / Omatseye, Joyce / Paddock, Sophie / Parkin, James / Patel, Mohit / Pawar, Sohini / Pearce, Stuart / Penrice, Samuel / Purdy, Julian / Ramjan, Raisa / Randhawa, Ratan / Rasul, Usman / Raymond-Taggert, Elliot / Razey, Rebecca / Razzaghi, Carmel / Reel, Eimear / Revell, Elliot John / Rigbye, Joanna / Rotimi, Oloruntobi / Said, Abdelrahman / Sanders, Emma / Sangal, Pranoy / Grandal, Nora Sangvik / Shah, Aadam / Shah, Rahul Atul / Shotton, Oliver / Sims, Daniel / Smart, Katie / Smith, Martha Amy / Smith, Nick / Sopian, Aninditya Salma / South, Matthew / Speller, Jessica / Syer, Tom J / Ta, Ngan Hong / Tadross, Daniel / Thompson, Benjamin / Trevett, Jess / Tyler, Matthew / Ullah, Roshan / Utukuri, Mrudula / Vadera, Shree / Van Den Tooren, Harriet / Venturini, Sara / Vijayakumar, Aradhya / Vine, Melanie / Wellbelove, Zoe / Wittner, Liora / Yong, Geoffrey Hong Kiat / Ziyada, Farris / McManus, I C

    BMC medicine

    2020  Volume 18, Issue 1, Page(s) 126

    Abstract: Background: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of ... ...

    Abstract Background: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).
    Method: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times.
    Results: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content.
    Discussion: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.
    MeSH term(s) Curriculum/standards ; Education, Medical, Undergraduate/organization & administration ; Female ; Humans ; Male ; Surveys and Questionnaires ; United Kingdom
    Language English
    Publishing date 2020-05-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131669-7
    ISSN 1741-7015 ; 1741-7015
    ISSN (online) 1741-7015
    ISSN 1741-7015
    DOI 10.1186/s12916-020-01571-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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