The south-east Scotland dermatology workload study: 30 years' analysis.

BACKGROUND: Dermatological activity data have been collected for the same region of south-east Scotland (population 1·24 million), approximately every 5 years, since 1981. This has allowed assessment of trends in demand from primary and secondary care, and activity within secondary care dermatology services, assisting planning of dermatological services. OBJECTIVES: To quantify dermatology outpatient workload across the same population to allow comparison with previous studies for trends in practice. METHODS: During November 2010, a standardized proforma was completed for all National Health Service and private practice dermatology outpatient consultations. Demographic data, source and reason for referral, diagnoses, investigations, treatments and disposal were recorded, and comparisons made with five previous studies. RESULTS: A total of 5470 consultations were recorded: 2882 new and 2588 review patients (new to review ratio 1 : 0·9, male to female 1 : 1·3, mean age 49 years, range 1 month to 101 years). Ninety-one per cent of referrals came from primary care and 9% from secondary care. Fifty-eight per cent of referrals were for diagnosis and 32% for hospital management. Diagnostic concordance between referrer and dermatologist ranged from 94% for acne to 14% for melanoma. Benign tumours accounted for 30% of referrals, malignant tumours 13%, dermatitis 13·3%, psoriasis 6·2% and acne/rosacea 5%. The referral rate rose to 23·2/1000 population per annum, with the increase coming mainly from primary care. CONCLUSIONS: Demand for dermatology continues to increase: new referrals have risen by 134% in 30 years, with a 36% increase in the last 5 years, despite corresponding population increases of 5·3% and 3%, respectively.

An assessment of the perceived benefits and challenges of participating in a practice-based research network.

BACKGROUND: A survey was conducted to describe the benefits of and challenges to practitioner participation in the Practitioners Engaged in Applied Research and Learning (PEARL) Network, a dental practice-based research network (PBRN). The results were compared with results from medical PBRNs across different tiers of participation (based on practitioner-investigators previous involvement with PEARL research protocols). METHODS: A 39-item web-based survey addressed the benefits of PBRN participation on three levels: individual/practitioner, practice (office), and community/professional. Participants were also asked to rate challenges to participation. RESULTS: A total of 153 of 216 PEARL practitioner-investigators participated, a response rate of 71%. The majority (70%) was male, with a median of 23 years in private practice. 'Means to stay informed of new developments in my profession' was considered a 'very important' benefit for nearly three-quarters of the sample (71%). 'Opportunity to improve clinical procedures' was considered as 'very important' by 73% of respondents. In terms of benefits related to the community and profession, 65% of respondents reported 'means to directly contribute to the evidence base of dental practice' as being 'very important'. 'Disruption in practice routine/clinical practice' was considered the most important challenge to participation. CONCLUSIONS: The benefits of and challenges to participation identified did not differ across tiers of participation and were similar to benefits identified by participants in medical PBRNs. The results of this study will help facilitate the design of future PBRN protocols to encourage greater participation by the profession. Results suggest that practitioners with similar interests could be recruited to collaborative studies between medicine and dentistry.

MR imaging of fistula in ano: indications and contribution to surgical assessment.

BACKGROUND: Magnetic Resonance Imaging (MRI) is the imaging modality of choice for fistula in ano. The purpose of this study was to analyse the use of MRI, and to assess its contribution towards the assessment of this sometimes difficult condition. METHODS: A retrospective analysis of all patients with fistula in ano between January 2003 and December 2007 was performed, focussing on those who had MRI assessment. The primary pathology, indication for MRI and the contribution of this investigation to assessment of fistula in ano were analysed. RESULTS: MRI was performed in 40 patients. The primary pathologies included: perianal sepsis in 20 (50%), Crohn's disease in 11 (27.5%), primary fistula in ano in 6 (15%) and others in 3 (7.5%) patients. Indications for MRI were to assess the fistula anatomy in 17 (42.5%), to assess a clinically suspected fistula in 12 (30%), to assess a complex fistula found at Examination Under Anaesthesia (EUA) in 6 (15%) and to exclude a fistula in 5 (12.5%). MRI was considered helpful in 34 (85%) of all cases. MRI established the fistula anatomy and guided further surgery in 47.1%, correlated with EUA findings in 38.2% and excluded a suspected fistula in 14.7% of these. CONCLUSIONS: This study further supports the benefit of using MRI to assess fistula in ano. When used in selected patients, it was of benefit in 85% of cases, by establishing fistula anatomy and guiding further surgery, correlating EUA findings or excluding a clinically suspected fistula.

An overview of recent developments in corneal immunobiology: potential relevance in the etiogenesis of corneal disease in the horse.

This paper overviews some recent developments in mammalian corneal immunobiology, and discusses how these may act as pointers towards understanding the immunology underlying some common corneal diseases in the horse, including infectious ulceration and presumptively immune-mediated non-ulcerative disease. Specifically, three aspects of corneal immunobiology are examined: the role of Toll-like receptors in surface immunity and in the etiogenesis of microbial ulceration, the relationship between conjunctiva associated lymphoid tissue (CALT) and immunoprotection of the corneal surface, and the mechanisms determining corneal immune privilege (IP) and how down regulation of IP may be an important factor in the genesis of corneal immunoinflammatory disease.

Stem-loop SL4 of the HIV-1 psi RNA packaging signal exhibits weak affinity for the nucleocapsid protein. structural studies and implications for genome recognition.

Encapsidation of the genome of the human immunodeficiency virus type-1 (HIV-1) during retrovirus assembly is mediated by interactions between the nucleocapsid (NC) domains of assembling Gag polyproteins and a approximately 110 nucleotide segment of the genome known as the Psi-site. The HIV-1 Psi-site contains four stem-loops (SL1 through SL4), all of which are important for genome packaging. Recent isothermal titration calorimetry (ITC) studies have demonstrated that SL2 and SL3 are capable of binding NC with high affinity (K(d) approximately 140 nM), consistent with proposals for protein-interactive functions during packaging. To determine if SL4 may have a similar function, NC-interactive studies were conducted by NMR and gel-shift methods. In contrast to previous reports, we find that SL4 binds weakly to NC (K(d)=(+/-14 microM), suggesting an alternative function. NMR studies indicate that the GAGA tetraloop of SL4 adopts a classical GNRA-type fold (R=purine, N=G, C, A or U), a motif that stabilizes RNA tertiary structures in other systems. In combination with previously reported gel mobility studies of Psi-site deletion mutants, these findings suggest that SL4 functions in genome recognition not by binding to Gag, but by stabilizing the structure of the Psi-site. Differences in the affinities of NC for SL2, SL3 and SL4 stem-loops can now be rationalized in terms of the different structural properties of stem loops that contain GGNG (SL2 and SL3) and GNRA (SL4) sequences.

Lens opacities in the horse: a clinical classification.

Lens opacities, including cataracts, are frequent findings during routine ophthalmic examination in the horse, and clinicians often experience difficulty in predicting the potential progression and consequences on visual function of these opacities. This has particular relevance to the prepurchase examination. The present study proposes a descriptive classification of the more common lens opacities observed in the horse based principally on their morphological origin. This classification provides a basis for objective prediction of the probable progression of lens opacities, in particular cataracts, in the horse.

Scintigraphic demonstration of postural induced drainage stasis in an en bloc renal allograft.

Within 6 months after an en bloc transplantation of two kidneys from a cadaveric pediatric donor, the recipient was referred for further scintigraphic evaluation because of clinical suspicion of having a postural related function impairment of the grafted kidneys. Tc-99m MAG3 imaging, modified by varying the position of the patient during the procedure, resulted in detection of drainage stasis only with the patient standing. This drainage stasis had not been appreciated in the preceding routine examinations performed with the patient supine. Although the positional outflow stasis by itself may not be severe enough to cause alarming dysfunction of the grafted kidneys, it could conceivably be a significant contributing factor.

The equine fundus. II: Normal anatomical variants and colobomata.

A wide range of fundic variants are encountered during routine ophthalmoscopic examination of visually normal horses, often causing the examiner difficulty in assessing their clinical significance. Many of these are anatomical variants having no significant effect on visual function, and lie within the limits of normality in the horse. This paper illustrates this range of variants and discusses their anatomical basis and physiological consequences. Colobomata are non-progressive discontinuities in the structure of the anatomic fundus, occasionally noted as incidental findings during ophthalmoscopy. This paper illustrates typical and atypical colobomata of the equine fundus, the latter occurring outside the embryonic optic fissure. The anatomical basis of these colobomata and their possible consequence on vision is discussed.

The equine fundus. III: Pathological variants.

A wide range of ophthalmoscopic variants are encountered during routine examination of the horse. Some result from minor anatomical anomalies, cause no significant effect on vision and may be considered to lie within the limits of 'biological normality'. Others are a consequence of pathological disruption of the anatomical integrity of the fundus, and may directly or indirectly affect the neurosensory retina and produce some degree of visual deficit. This paper illustrates the ophthalmoscopic appearance of a number of pathological variants of the anatomic fundus, and discusses their possible effect upon vision. Among the abnormalities discussed is peripapillary chorioretinitis, which commonly presents as the so-called peripapillary 'butterfly lesion'. It is concluded that, although this lesion may occur in conjunction with signs of more generalised posterior segment disease, eg posterior capsular cataract, in the absence of concurrent signs of anterior uveitis there is no reason to associate the lesion with equine recurrent uveitis (periodic ophthalmia).