Design and Methods: A cohort of patients with type 1 diabetes who attended a secondary care outpatient diabetes clinic between 1991 and 1996 were reviewed in 2001and 2006. Comparison is made between current biophysical markers and those obtained in 2001.

Results: Only 81.9% (n = 214) of the original cohort attended in 2006. These patients had an average duration of diabetes of 23.46 (SD ± 8.06) years. There were 134 male patients (62.62%). In these patients HbA1c had reduced by 0.4% (absolute reduction); a relative reduction of 4.41% (P = 0.0001). Statistically significant reductions in diastolic blood pressure (74–68 mmHg) and total cholesterol (5.37–4.62 mmol/l) occurred. However, weight (75.04–82.31 kg) and BMI (25.32–27.72 kg/m²) significantly increased. There was no statistically significant change in insulin dose (units/kg), serum creatinine, urinary ACR or systolic blood pressure.

Conclusions: An urban setting, mobile population and patient non-attendance can complicate modern diabetes care. Despite these difficulties, input by the diabetes team working with the patients can achieve small improvements in Hba1c and cardiovascular risk factors by increased use of long acing insulins, metformin, statins and blood pressure medication.

Aim: To investigate delays to PPM implantation and their causes.

Design: Prospective observational study in a UK regional pacing centre and its referring district hospitals.

Methods: A total of 95 consecutive patients receiving first PPM implant for bradycardia indications from 1 June 2006 to 31 August 2006 were included. Hospital records from the referring and implanting centres were reviewed to determine the timings of: symptom onset; first hospital contact; documented pacing indication (defined by 2002 ACC/AHA/NASPE guidelines); referral to implanter; and PPM implantation.

Results: Forty-eight patients (51%) were referred for pacing urgently; median delay from symptoms to PPM 15 days (range 0–7332 days). Forty-seven patients (49%) were referred electively; median delay from symptoms to PPM 380 days (range 33–7505 days), P < 0.0001. Twenty-three of the 47 elective patients (49%) had previous hospitalization with symptoms suggestive of bradycardia. Thirty-three of the 95 patients (35%) had a Class I or IIa pacing indication which did not trigger a pacing referral.

Conclusions: There are significant delays to PPM implantation in the United Kingdom, longer in those treated electively than those managed as emergencies. Some delays are due to ‘process’ problems including waiting lists, but a substantial proportion of patients had delays due to failure to refer for pacing once a pacing indication was documented.

Aim: Review our experience of ALI secondary to haematological malignancies.

Patients and methods: Patients admitted to the liver unit with ALI secondary to a haematological malignancy between 1996 and 2006 were identified. A retrospective review was made of their case notes and our database.

Results: Of the 752 cases of ALI, six cases of ALI secondary to haematological malignancy were identified. Common features were a prodromal illness (median duration of 5 weeks; range 2–6 weeks) and jaundice (median bilirubin 208 µmol/l; range 112–238 µmol/l). The majority of patients (5/6) had hepatomegaly. Liver biopsy was performed in two patients and confirmed the diagnosis in both cases. In other cases, the diagnosis was made following lymph node biopsy (1), bone marrow examination (2) or from post-mortem examination (1). Median time from jaundice to encephalopathy was 12 days; range 1–22 days. A single patient underwent liver transplantation but died in the immediate post-operative period. All patients died soon after admission with a median survival of 8 days (range 3–26 days).

Conclusion: Haematological malignancy should be considered in ALI patients presenting with a prodromal illness, jaundice and hepatomegaly. Biopsy is essential to confirm the diagnosis but the benefit of definitive therapy such as chemotherapy and/or transplantation in this setting is unclear and survival is poor.

Objectives: To determine prevalence of POTS in patients with CFS/ME.

Design: Observational cohort study.

Methods: Fifty-nine patients with CFS/ME (Fukuda criteria) and 52 age- and sex-matched controls underwent formal autonomic assessment in the cardiovascular laboratory with continuous heart rate and beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz Austria). Haemodynamic responses to standing over 2 min were measured. POTS was defined as symptoms of orthostatic intolerance associated with an increase in heart rate from the supine to upright position of >30 beats per minute or to a heart rate of >120 beats per minute on standing.

Results: Maximum heart rate on standing was significantly higher in the CFS/ME group compared with controls (106 ± 20 vs. 98 ± 13; P = 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9% (5) in the control population (P = 0.006). This difference was predominantly related to the increased proportion of those in the CFS/ME group whose heart rate increased to >120 beats per minute on standing (P = 0.0002). Increasing fatigue was associated with increase in heart rate (P = 0.04; r² = 0.1).

Conclusions: POTS is a frequent finding in patients with CFS/ME. We suggest that clinical evaluation of patients with CFS/ME should include response to standing. Studies are needed to determine the optimum intervention strategy to manage POTS in those with CFS/ME.

Aim: To review the characteristics and outcomes of patients seen by a newly implemented bacteraemia service.

Methods: Retrospective review of data collected at time of consultation. Economic analyses and benchmarking of outcomes were also performed.

Results: One hundred and fifty-one patients were seen by the service over an 18-month period. Staphylococcus aureus was the most common isolate and central venous lines the most common source. Antibiotics were changed and additional investigations suggested in 62% and 61% of patients, respectively. The 30-day mortality was 19%. Implementation and delivery of the service over the 18-month study period cost £22 663 (£15 109 per year). The cost per change in antibiotic prescription was £244. The cost per ‘near-miss’ detected was £1193. Overall mortality was no higher and possibly lower than in published studies.

Conclusion: We believe that this model of care may be suitable for the management of patients with bacteraemia. A study assessing the cost-effectiveness of this approach is required.

Aim: To assess the effect of an 8-week intervention with vodka or red wine on plasma tHcy and B vitamin concentrations in healthy male volunteers. To assess the effect on tHcy according to methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype.

Design and methods: A randomized controlled crossover intervention study measuring tHcy and serum folate and vitamin B₁₂ concentrations was conducted in 78 male subjects (21–70 years). Following a 2-week washout period during which no alcohol was consumed, all subjects consumed 24 g alcohol (either 240 ml red wine or 80 ml vodka)/day for a 2-week period. Following a further 2-week washout, participants consumed the alternate intervention for 2 weeks.

Results: A significant increase in plasma tHcy was observed after the 2-week red wine intervention (5%, P = 0.03), and a non-significant increase in tHcy with vodka intervention (3%, P = 0.09). When the two interventions were compared, the change in tHcy did not differ between the vodka and red wine interventions (P = 0.57). There were significant decreases in serum vitamin B₁₂ and folate concentrations, and this decrease did not differ between interventions. The increase in tHcy observed in both interventions did not vary by MTHFR 677C>T genotype.

Conclusions: A 2-week alcohol intervention resulted in a decrease in folate and vitamin B₁₂ status and an increase in plasma tHcy. The effect of alcohol intervention on tHcy, folate and vitamin B₁₂ concentrations did not differ between the red wine and vodka intervention groups.

Aims: To assess final year medical student knowledge of proper and street names for recreational drugs.

Design: Questionnaire survey of final year medical students attending a revision lecture.

Methods: There were two questionnaires used in this study. The first contained either proper names of recreational drugs or names sounding similar to recreational drugs or licensed pharmaceutical products; students were asked to identify which of these were recreational drugs. The second contained street names of recreational drugs and the students were asked to identify which recreational drug the street name referred to.

Results: One hundred and thirty-five students completed the questionnaire 1. The mean total score (±SD) of correct answers was 7.15 ± 2.26 (range 2–13) out of a maximum of 15. One hundred and fifteen students completed questionnaire 2. The mean total score (±SD) of correctly identified street names was 11.0 ± 2.6 (range 0–17) out of a maximum of 24. No individual student was able to correctly identify all the street names for the recreational drugs listed in the survey.

Conclusions: We have shown that final year medical students have variable knowledge of both the proper and street names of recreational drugs. There is a need for improved education of medical students in the names of recreational drugs and the sources of information available to assist them in identifying what drugs an individual has taken.

Aim: To analyse the frequency of medical vs. surgical acute abdomen, and to characterize the poorly understood thyrotoxic medical acute abdomen phenomenon.

Design: Retrospective review of case notes.

Methods: All case files with a simultaneous diagnosis of thyrotoxicosis and acute abdomen admitted between 1994 and 2004 were traced and audited.

Results: Thirteen had a history of thyrotoxicosis while 12 were newly diagnosed. The commonest cause was Graves’ disease. Twenty-three (92%) cases were thyrotoxic, of whom six (24%) had thyroid crisis, while two (8%) had subclinical thyrotoxicosis. The provisional diagnosis of acute abdomen was correct in 14 cases (56%), but discordant with the final diagnosis in 11 cases (44%). Eight cases (32%) without any demonstrable pathology were medical, vs. four (16%) with surgical acute abdomen, while 11(44%) had gastritis, hepatobiliary–pancreatic disorders or diverticulitis conservatively managed. The epigastrium and/or central abdomen (72.7%) were the commonest affected regions in medical acute abdomen.

Conclusions: Although the majority of acute abdomen in thyrotoxicosis was medical in nature, our experience indicates that surgical conditions were not uncommon. Thus, serious causes requiring life-saving surgery should be excluded before attributing it to medical acute abdomen.

Aim: To determine CVD risk profile and disease burden in subjects with type 2 diabetes mellitus (T2DM) across different categories of body weight as defined by BMI.

Design: Prospective observational study.

Methods: CVD risk including metabolic syndrome (MetS) and prevalence of macrovascular complications were determined for each category of body weight as defined by the World Health Organisation (WHO) classification.

Results: A total of 390 subjects were included in this study of which 35.9% were non-obese (BMI <30 kg/m²). Although increasing obesity as defined by BMI was associated with higher prevalence of central abdominal obesity, hypertension and MetS (P < 0.05), dyslipidaemia and macrovascular complications were not significantly different across the various body weight categories (P = NS). Similar observation was seen in non-obese (BMI <30 kg/m²) and obese subjects (BMI >30 kg/m²). Among non-obese (including normal weight) cohort, the majority of these subjects had adverse CVD risk profile including presence of at least two co-existing risk factors.

Conclusions: Subjects with T2DM possess adverse CVD risk factors with significant burden of macrovascular disease irrespective of their baseline body weight.

Aim: To determine the clinical characteristics of patients with thyrotoxicosis newly diagnosed during hospitalization.

Design: A retrospective computer-based search was undertaken to detect patients that were hospitalized in our medical centre during 1999–2006, and discharged with thyrotoxicosis or thyroiditis as the primary diagnosis.

Results: Fifty-eight patients (36F/22M; mean age 52.1 ± 17.5 years) were identified. Weakness, weight loss and palpitations were the most common manifestations (50, 40 and 35%, respectively) and were predominantly present in patients with hyperthyroidism. Sore throat was present in 41% of patients with thyroiditis. Sinus tachycardia and atrial fibrillation occurred in 65.5 and 15.5% of the patients, more common in those with hyperthyroidism. The diagnoses on discharge were Graves’ disease, subacute thyroiditis and multinodular goiter in 39.7, 34.5 and 8.9%, respectively.

Conclusions: Weakness, weight loss and palpitations were the main symptoms in patients diagnosed with thyrotoxicosis during hospitalization. Thyrotoxicosis should be included in the differential diagnosis when patients are admitted to the hospital with those symptoms.

Methods: The multinational Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was an observational study to assess the safety and efficacy of thrombolytic therapy, when administered within the first 3 h after onset of ischaemic stroke. SITS-MOST was embedded within the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR), an internet-based, international monitoring registry for auditing the safety and efficacy of routine therapeutic use of thrombolysis in acute ischaemic stroke. We performed an analysis of data contributed to SITS-MOST and SITS-ISTR from UK centres.

Results: A total of 614 patients received thrombolysis for stroke between December 2002 and April 2006, 327 were registered to SITS-MOST and 287 to SITS-ISTR. Thirty-one centres treated patients in the UK, of which 23 registered patients in both SITS-MOST and SITS-ISTR and eight solely to SITS-ISTR. The median age from the UK SITS-MOST was identical to the non-UK SITS-MOST register: 68 years (IQR 59–75). The majority (96.1%) of patients from the UK were treated between 8.00 a.m. and 9.00 p.m., and only 18.4% were treated on weekend days, reflecting the difficulties of maintaining provision of a thrombolytic service out of hours. Median onset-to-treatment-time was 155 min (IQR 130–170 min) for the UK, compared to 140 min (IQR 114–165 min) for the non-UK SITS-MOST group (P < 0.001). UK SITS-MOST patients at baseline had more severe stroke in comparison with non-UK patients [median NIHSS 14.5 (IQR 9–19) vs. 12 (IQR 8–17) (P < 0.001)]. Forty-eight percent of UK patients achieved mRS of 0–2 (independence), compared to 55% of the non-UK SITS-MOST register. There was no significant difference in symptomatic intracerebral haemorrhage rate in the UK compared with the non-UK SITS-MOST patients [2.5% (95% CI 1.3–4.8) vs. 1.7% (95% CI 1.4–2.0) P = 0.28]. In the multivariate analysis, there was no statistically significant difference in any outcome between UK and non-UK SITS-MOST patients.

Conclusion: Thrombolytic therapy for stroke has been implemented successfully at a small number of UK stroke centres, with patchy provision throughout the country. The low frequency of treatment outwith office hours suggests deficient infrastructure to support delivery. UK patients tended to be more severely affected at baseline and to be treated later. Outcomes are comparable to those seen at the non-UK SITS centres.