UK NEQAS and BSHI guideline: Laboratory testing and clinical interpretation of HLA genotyping results supporting the diagnosis of coeliac disease.

Coeliac disease is a common immune-mediated inflammatory disorder caused by dietary gluten in genetically susceptible individuals. While the diagnosis of coeliac disease is based on serological and histological criteria, HLA-DQ genotyping can be useful, especially in excluding the diagnosis in patients who do not carry the relevant DQ heterodimers: DQA1*05 DQB1*02, DQB1*03:02 or DQA1*02 DQB1*02 (commonly referred to as DQ2.5, DQ8 and DQ2.2, respectively). External quality assessment results for HLA genotyping in coeliac disease have revealed concerning errors in HLA genotyping, reporting and clinical interpretation. In response, these guidelines have been developed as an evidence-based approach to guide laboratories undertaking HLA genotyping for coeliac disease and provide recommendations for reports to standardise and improve the communication of results.

BSHI and BTS UK guideline on the detection of alloantibodies in solid organ (and islet) transplantation.

Solid organ transplantation represents the best (and in many cases only) treatment option for patients with end-stage organ failure. The effectiveness and functioning life of these transplants has improved each decade due to surgical and clinical advances, and accurate histocompatibility assessment. Patient exposure to alloantigen from another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. Such exposure to alloantigen's can lead to the formation of circulating alloreactive antibodies which can be deleterious to solid organ transplant outcome. The purpose of these guidelines is to update to the previous BSHI/BTS guidelines 2016 on the relevance, assessment, and management of alloantibodies within solid organ transplantation.

A critical review of nitrogen mineralization in biosolids-amended soil, the associated fertilizer value for crop production and potential for emissions to the environment.

International controls for biosolids application to agricultural land ensure the protection of human health and the environment, that it is performed in accordance with good agricultural practice and that nitrogen (N) inputs do not exceed crop requirements. Data from the scientific literature on the total, mineral and mineralizable N contents of biosolids applied to agricultural land under a wide range of climatic and experimental conditions were collated. The mean concentrations of total N (TN) in the dry solids (DS) of different biosolids types ranged from 1.5% (air-dried lime-treated (LT) biosolids) to 7.5% (liquid mesophilic anaerobic digestion (LMAD) biosolids). The overall mean values of mineralizable N, as a proportion of the organic N content, were 47% for aerobic digestion (AeD) biosolids, 40% for thermally dried (TD) biosolids, 34% for LT biosolids, 30% for mesophilic anaerobic digestion (MAD) biosolids, and 7% for composted (Com) biosolids. Biosolids air-dried or stored for extended periods had smaller total and mineralizable N values compared to mechanically dewatered types. For example, for biosolids treated by MAD, the mean TN (% DS) and mineralizable N (% organic N) contents of air-dried materials were 3% and 20%, respectively, compared to 5% and 30% with mechanical dewatering. Thus, mineralizable N declined with the extent of biological stabilization during sewage sludge treatment; nevertheless, overall plant available N (PAN=readily available inorganic N plus mineralizable N) was broadly consistent across several major biosolids categories within climatic regions. However, mineralizable N often varied significantly between climatic regions for similar biosolids types, influencing the overall PAN. This may be partly attributed to the increased rate, and also the greater extent of soil microbial mineralization of more stable, residual organic N fractions in biosolids applied to soil in warmer climatic zones, which also raised the overall PAN, compared to cooler temperate areas. It is also probably influenced by differences in upstream wastewater treatment processes that affect the balance of primary and secondary, biological sludges in the final combined sludge output from wastewater treatment, as well as the relative effectiveness of sludge stabilization treatments at specific sites. Better characterization of biosolids used in N release and mineralization investigations is therefore necessary to improve comparison of system conditions. Furthermore, the review suggested that some international fertilizer recommendations may underestimate mineralizable N in biosolids, and the N fertilizer value. Consequently, greater inputs of supplementary mineral fertilizer N may be supplied than are required for crop production, potentially increasing the risk of fertilizer N emissions to the environment. Thus greater economic and environmental savings in mineral N fertilizer application are potentially possible than are currently realized from biosolids recycling programmes.

The use of alum sludge to improve cereal production on a nutrient-deficient soil.

Alum sludge from wastewater treatment was applied at five rates on a phosphorus-deficient sand, and the effects on cereal growth and nutrition were investigated over 2 years. An inorganic fertilizer treatment, reapplied in the second year, was also included. The grain yield for inorganic fertilizer was 44% higher than the control in year 1 and 58% higher in year 2. Alum sludge was an adequate source of nitrogen for crop growth, and supplied sufficient residual nitrogen to meet crop requirements in year 2. However, grain yield in the alum sludge treatment applied at an equivalent available nitrogen rate to the inorganic fertilizer was 62% (year 1) and 69% (year 2) of the yield achieved by the inorganic fertilizer, though greater than the control. No toxic forms of aluminium were detected in the soil at any rate of alum sludge application. Plant shoot tissue analysis indicated that wheat sown in alum sludge-amended soil and the control were phosphorus deficient, whereas phosphorus was adequate in the inorganic fertilizer treatment. There was no evidence of any other nutrient deficiency. Alum sludge amendment resulted in an increase in soil phosphorus; however, further soil analysis indicated that forms of phosphorus present in alum sludge-amended soil may not be available for crop uptake; this is consistent with phosphorus deficiency observed in plant tissue in alum sludge-treated soil. It is suggested that on this nutrient-poor sand, the ability of alum sludge to provide sufficient phosphorus for plant production was limited in the 2 years after application.

Diclofenac for acute pain in children.

BACKGROUND: Diclofenac is commonly used for acute pain in children, but is not licensed for this indication in all age groups. OBJECTIVES: 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research. SEARCH STRATEGY: Seventeen databases indexing clinical trial reports were searched in February 2005 (with an update search as part of this first review in May 2008). A hand search of Paediatric Anaesthesia was undertaken and summaries obtained of adverse reaction reports from the UK Yellow Card Scheme and World Health Organization (WHO) Monitoring Centre. The reference lists of included studies were also searched. SELECTION CRITERIA: Any published report, in any language, involving the administration of diclofenac to a patient aged 18 years or younger for acute pain and detailing either monitoring of efficacy or safety. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study quality and extracted the data. Authors were contacted where necessary. Review Manager version 5 was used for analysis. MAIN RESULTS: 1) EFFICACY: randomised controlled trials (RCTs) comparing diclofenac with placebo/any other treatment by using pain scores (assessed or reported), or need for rescue analgesia.2) SAFETY: any type of study seeking adverse events (regardless of cause). An adverse event was defined as any reported adverse or untoward happening to a patient being treated with diclofenac for acute pain.Seven publications on diclofenac efficacy and 79 on safety (74 studies plus five case reports) were included in the final analysis. Compared with placebo/no treatment, diclofenac significantly reduced need for post-operative rescue analgesia (relative risk [RR] 0.6; number needed to treat to benefit [NNT] 3.6; 95% confidence interval [CI] 2.5 to 6.3).Compared with any other non-NSAID, patients receiving diclofenac suffered less nausea or vomiting, or both (RR 0.6; NNT 7.7 [5.3 to 14.3]). There appeared to be no increase in bleeding requiring surgical intervention in patients receiving diclofenac in the peri-operative period. Serious diclofenac adverse reactions occurred in fewer than 0.24% of children treated for acute pain. The types of serious adverse reactions were similar to those reported in adults. AUTHORS' CONCLUSIONS: Diclofenac is an effective analgesic for perioperative acute pain in children. It causes similar types of serious adverse reactions in children as in adults, but these are rare. More research on optimum dosing and safety in asthmatic children is required.

Transmission, screening and treatment of hepatitis C.

This article describes the risk of hepatitis C being transmitted from a healthcare worker to a patient, pre-employment screening, and health surveillance. It also outlines the latest treatment options and harm minimisation strategies.