Review of the 94th Annual Meeting of the British Association of Dermatologists, Glasgow 2014.

This is a review of the 94th Annual Meeting of the British Association of Dermatologists, held in Glasgow from 1 to 3 July 2014. The conference covered some of the latest developments in the treatment of atopic dermatitis, psoriasis and cancer, a follow-up on the methylisothiazolinone contact allergy epidemic, advances in genetically inherited disorders and somatic mutations underlying birth marks. In addition, there was an international perspective on vitiligo, leprosy and HIV, and a session discussing the regulatory process behind pharmaceutical development.

Epidemiology, management, and outcome of sport-related ankle fractures in a standard UK population.

BACKGROUND: The literature on the outcome of sport-related ankle fractures has focused on operatively managed fractures, despite a large proportion being treated nonoperatively. We describe the epidemiology, management, and outcome of acute sport-related ankle fractures in a UK population. METHODS: All sport-related ankle fractures sustained during 2007 to 2008 in the Lothian Population were prospectively collected when patients attended the only adult orthopaedic service in Lothian. Fractures were classified using the Lauge Hansen and the Pott's Classification. The presence of fracture displacement was also recorded. Patients were contacted in February 2011 to ascertain their progress in return to sport. RESULTS: Ninety-six sport-related ankle fractures were recorded in 96 patients. Eighty-four fractures (88%) were followed up at a mean interval of 36 months (range, 30-42). Most common associated sports were soccer (n = 49), rugby (n = 15), running (n = 5), and ice skating (n = 3). The mean time for return to sport was 26 weeks (range, 4-104), the return rate to sport 94%, and the persisting symptom rate 42%. Fifty-two fractures (all nondisplaced) were managed nonoperatively-43 isolated lateral malleolar (30 Weber B, 13 Weber A), 2 isolated medial malleolar, 7 bimalleolar. Forty-four fractures were managed operatively-42 were displaced (2 isolated lateral malleolar, 3 isolated medial malleolar, 18 bimalleolar equivalent, 9 bimalleolar, 3 trimalleolar equivalent, 7 trimalleolar), 2 were un-displaced (2 trimalleolar). The mean times for return to sport were 20 weeks (range, 4-52) for the nonoperative cohort (NOC) and 35 weeks (range, 8-104) for the operative cohort (OC) (P < .001), the return rates to sport were 100% for NOC and 87% for OC (P < .016), and the persisting symptom rates were 17% for NOC and 71% for OC (P < .001). CONCLUSIONS: Nondisplaced ankle fractures in athletes were successfully managed with nonoperative care. They had greater return rates to sport, quicker return times, and lower persisting symptom rates but had less severe injuries. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

[Sir Arthur Conan Doyle, Sherlock Holmes and infectious diseases]. / Sir Arthur Conan Doyle, Sherlock Holmes y las enfermedades infecciosas.

Besides a pleasant author of best sellers, Sir Arthur Conan Doyle was a medical doctor, writing excellent short stories about the exercise of his profession in England. However, even he mentions The British Medical Journal and The Lancet in the Sherlock Holmes's stories, when in the plot introduces infectious diseases, Conan Doyle ignores important discoveries in the field of tetanus. Anyway, the appearing of infectious diseases in the adventures of the detective are rare: one mention of tetanus, another of leprosy and- the most analyzed in medical literature a case of murder by inoculation of bacteria, probably the agent of melioidosis. Also he makes his hero discovers the toxic actions of a medusa and a transplant of solid organ. Little for a physician and less for an author who also wrote science fiction: it seems that the history of the great medical discoveries at the end of nineteenth century and beginning of the twentieth has passed by his side.., and he just couldn't see it.

Sir Arthur Conan Doyle, Sherlock Holmes y las enfermedades infecciosas / Sir Arthur Conan Doyle, Sherlock Holmes and infectious diseases

Sir Arthur Conan Doyle, además de ameno escritor de best sellers, era médico y escribió excelentes cuentos sobre el ejercicio de su profesión en Inglaterra. Sin embargo, a pesar de mencionar The British Medical Journal y The Lancet en sus historias de Sherlock Holmes, al introducir enfermedades infecciosas en sus tramas, ignora descubrimientos importantes ya realizados en su época en el campo del tétanos. En todo caso, las apariciones de las enfermedades infecciosas en las historias del detective son escasas: una mención del tétanos, otra de la lepra y -la más analizada en la literatura médica- un caso de asesinato realizado mediante la inoculación de una bacteria, probablemente del agente de la melioidosis. También hizo a su héroe descubrir las acciones tóxicas de una medusa y de un trasplante de órganos. Poco para un médico y poco para un autor que también escribía ciencia ficción: pareciera que la historia de los grandes descubrimientos médicos de fines del siglo XX y comienzos del XXI pasó por su lado... y no la vio.

Besides a pleasant author of best sellers, Sir Arthur Conan Doyle was a medical doctor, writing excellent short stories about the exercise of his profession in England. However, even he mentions The British Medical Journal and The Lancet in the Sherlock Holmes’s stories, when in the plot introduces infectious diseases, Conan Doyle ignores important discoveries in the field of tetanus. Anyway, the appearing of infectious diseases in the adventures of the detective are rare: one mention of tetanus, another of leprosy and- the most analyzed in medical literature -a case of murder by inoculation of bacteria, probably the agent of melioidosis. Also he makes his hero discovers the toxic actions of a medusa and a transplant of solid organ. Little for a physician and less for an author who also wrote science fiction: it seems that the history of the great medical discoveries at the end of nineteenth century and beginning of the twentieth has passed by his side… and he just couldn’t see it.

"But it just has that sort of feel about it, a leper"--stigma, smoke-free legislation and public health.

INTRODUCTION: The Scottish smoke-free legislation has had considerable success, with high compliance resulting in significant health benefits and the increased denormalization of smoking. International literature on the impact of smoke-free legislation has mostly focused on the success of such policies. Relatively little consideration has been given to the potentially negative, albeit unintended, consequences of smoke-free policies within different social and cultural contexts, in particular the increased stigmatization of smokers. METHODS: A 3-wave longitudinal qualitative study in 4 localities in Scotland using repeat in-depth interviews. Participants comprised a panel of 40 current and recent ex-smokers, interviewed before and after implementation of the legislation in 2 socioeconomically advantaged and 2 disadvantaged localities in Scotland. RESULTS: Smokers perceived the smoke-free legislation to have increased the stigmatization of smoking. By separating, albeit temporarily, those who were smoking from those who were not had led to increased felt stigma. This had led to a social milieu that fostered self-labeling and self-stigmatization by smokers of their own smoking behavior, even when they were not smoking. While there was little reported direct discrimination, there was a loss of social status in public places. Smokers attempted to ameliorate stigmatization by not smoking outside, reducing going out socially, joining in the stigmatization of other smokers, and/or acknowledging the benefits of smoke-free environments. DISCUSSION: The unintended negative consequences of smoke-free legislation for some suggest that tobacco control strategies need to consider how smokers who experience increased stigma are supported by public health to address their smoking while continuing to create smoke-free environments.

Eponymous doctors associated with Edinburgh, part 3--Abraham Colles, Sir William Ferguson, John S Haldane, Argyll Robertson, Thomas Young.

In the first papers in this series, it was shown that eponyms were often bestowed on physicians and surgeons who were already famous, had made many discoveries never honoured with eponyms, and were often the leading doctors of their day. Only occasionally was the eponym suggested by a friend or colleague; more usually it was a doctor abroad who wanted to show respect to a great man but the choice of the particular syndrome or discovery was a random one. Eponyms may have had their uses. They were usually much shorter than a detailed description of a medical syndrome or anatomical feature and may sometimes have been used as euphemisms in much the same way as, until recently, bedside teachers protected the patients by speaking of 'mitotic lesions' or 'neoplasms', 'Hansen's Disease' or 'acid-fast bacilli'. The conferring and use of eponyms appears to be lessening but, as shown in this final paper, they are still used and possibly useful, and can tell us things of interest about the recipient and the proposer.

Humoral defence factors in the breast milk of Ethiopian women with leprosy and healthy controls.

Secretory IgA, lactoferrin, albumin, and total protein were quantitated in colostrum and milk samples obtained from 215 Ethiopian nursing mothers over a period ranging from 1 day to 2 yr postparturition. IgG, IgM, C3, and C4 complement components were quantitated in 11 day 1 samples. The subjects were classified into three groups: lepromatous leprosy, borderline lepromatous leprosy, and a nonlepromatous group consisting of women with tuberculoid leprosy and healthy controls. Results obtained from the above groups were also compared with a group from Edinburgh. No major variation in levels of secretory IgA, lactoferrin, albumin, and total protein was found between the three groups of Ethiopian women. Results from the Edinburgh group were significantly higher, mainly in the level of total protein. When the individual proteins were expressed as a percentage of the total protein, there was no difference between the milk samples from the Ethiopian and Edinburgh mothers.