Lessons learnt from syphilis-infected blood donors: a timely reminder of missed opportunities

2021 ◽  
pp. sextrans-2021-055034
Author(s):  
Heli Harvala ◽  
Claire Reynolds ◽  
Alvin Fabiana ◽  
Joanne Tossell ◽  
Gillian Bulloch ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Blood Donors ◽  
Clinical History ◽  
Recent Infection ◽  
Syphilis Infection ◽  
Missed Opportunities ◽  
Infected Blood ◽  
Period Data ◽  
The Uk ◽  
Surveillance Database

ObjectiveDue to the increased number of syphilis infections diagnosed in the UK and beyond, we reviewed our data on blood donors infected with syphilis in the UK and Ireland between 2016 and 2019.MethodsData were extracted from the surveillance database for all blood donors confirmed positive for syphilis in the UK and Ireland between 2016 and 2019, together with the total number of donations tested during that period. Data on positive cases included gender, age group, reported treatment, symptoms and confirmatory results. All cases were divided into recently acquired within 24 months and past syphilis infection. We also reviewed the information on symptoms characteristic of syphilis reported by blood donors with an untreated syphilis infection during the postdonation discussions.ResultsScreening of 8 246 600 blood donations for treponemal antibodies identified 316 blood donors with confirmed syphilis infection in the UK and Ireland between 2016 and 2019 (1.6 per 100 000 donations). 42% of them (133 of 316) were classed as a recent infection based on their donation testing results, previous donation date and clinical history provided, and they were hence considered potentially infectious. Most of these blood donors (202 of 316, 64%) had not been previously diagnosed or treated for syphilis, although 50 of them reported symptoms consistent with syphilis infection and 19 had been misdiagnosed despite seeking medical help.ConclusionsThis observational study shows that syphilis infection remains undiagnosed, especially among heterosexual men, and that infectious syphilis is often missed as a differential diagnosis even when donors have presented with genital or oral ulceration, rashes in the genital area and lymphadenopathy. Considering the recent resurgence of syphilis infections in the UK and beyond and our generally expanding sexual networks, it is important to consider syphilis in differential diagnosis even if specific risk factors have not been identified.

scholarly journals Equine seroprevalence of West Nile virus antibodies in the UK in 2019

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Arran J. Folly ◽  
Elisabeth S. L. Waller ◽  
Fiona McCracken ◽  
Lorraine M. McElhinney ◽  
Helen Roberts ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Rna Virus ◽  
Clinical History ◽  
Immunoglobulin M ◽  
Serum Samples ◽  
West Nile ◽  
Recent Infection ◽  
Igm Antibodies ◽  
Epidemiological Surveys ◽  
The Uk

Abstract Background West Nile virus (WNV) is a single-stranded RNA virus that can cause neurological disease in both humans and horses. Due to the movement of competent vectors and viraemic hosts, WNV has repeatedly emerged globally and more recently in western Europe. Within the UK, WNV is a notifiable disease in horses, and vaccines against the virus are commercially available. However, there has been no investigation into the seroprevalence of WNV in the UK equine population to determine the extent of vaccination or to provide evidence of recent infection. Methods Equine serum samples were obtained from the Animal and Plant Health Agency’s equine testing service between August and November 2019. A total of 988 serum samples were selected for horses resident in South East England. WNV seroprevalence was determined using two enzyme-linked immunosorbent assays (ELISAs) to detect total flavivirus antibodies and WNV-specific immunoglobulin M (IgM) antibodies. Positive IgM results were investigated by contacting the submitting veterinarian to establish the clinical history or evidence of prior vaccination of the horses in question. Results Within the cohort, 274 samples tested positive for flavivirus antibodies, of which two subsequently tested positive for WNV-specific IgM antibodies. The follow-up investigation established that both horses had been vaccinated prior to serum samples being drawn, which resulted in an IgM-positive response. All the samples that tested positive by competition ELISA were from horses set to be exported to countries where WNV is endemic. Consequently, the positive results were likely due to previous vaccination. In contrast, 714 samples were seronegative, indicating that the majority of the UK equine population may be susceptible to WNV infection. Conclusions There was no evidence for cryptic WNV infection in a cohort of horses sampled in England in 2019. All IgM-seropositive cases were due to vaccination; this should be noted for future epidemiological surveys in the event of a disease outbreak, as it is not possible to distinguish vaccinated from infected horses without knowledge of their clinical histories.

The Covid-19 lockdown in the United Kingdom and subjective well-being: Have the self-employed suffered more due to hours and income reductions?

2021 ◽  
pp. 026624262098676 ◽  
Author(s):  
Wei Yue ◽  
Marc Cowling
Keyword(s):  
United Kingdom ◽  
Rare Events ◽  
Well Being ◽  
The Self ◽  
Subjective Well Being ◽  
Data Set ◽  
The United Kingdom ◽  
Hours Of Work ◽  
Period Data ◽  
The Uk

It is well documented that the self-employed experience higher levels of happiness than waged employees even when their incomes are lower. Given the UK government’s asymmetric treatment of waged workers and the self-employed, we use a unique Covid-19 period data set which covers the months leading up to the March lockdown and the months just after to assess three aspects of the Covid-19 crisis on the self-employed: hours of work reductions, the associated income reductions and the effects of both on subjective well-being. Our findings show the large and disproportionate reductions in hours and income for the self-employed directly contributed to a deterioration in their levels of subjective well-being compared to waged workers. It appears that their resilience was broken when faced with the reality of dealing with rare events, particularly when the UK welfare support response was asymmetric and favouring waged employees.

Epidemiologic comparison of human T-lymphotropic virus type I-infected blood donors from endemic and nonendemic regions over a 3-year period

Transfusion ◽  
1994 ◽  
Vol 34 (3) ◽  
pp. 198-201 ◽  
Author(s):  
V Massari ◽  
MH Elghouzzi ◽  
F Agis ◽  
C Rannou ◽  
E Gordien ◽  
...  
Keyword(s):  
Virus Type ◽  
Blood Donors ◽  
Type I ◽  
Infected Blood ◽  
T Lymphotropic Virus

scholarly journals TO ANALYSE THE DEFERRAL INCIDENCE AND ITS PATTERN AMONG THE BLOOD DONORS IN A TERTIARY CARE CENTRE IN NORTH INDIA.

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Dr. Surbhi Jain
Keyword(s):  
Blood Donor ◽  
Blood Donors ◽  
Blood Donation ◽  
Selection Process ◽  
Tertiary Care ◽  
Clinical History ◽  
North India ◽  
Tertiary Care Centre ◽  
One Year ◽  
Donor Deferral

Background: Blood donor programme is vital to any transfusion service. This process of blood donation involves voluntary and non remunerated blood donors. The objective of donor screening is to minimize the chances of transmitting infectious agents to recipients. Material and Method: The study was conducted during one year duration from 2017-2018. A total of 700 donors are deferred against 9556 blood donors recruited on the basis of clinical history and brief medical examination in blood bank and voluntary blood donation camps. Donors were deferred temporarily or permanently. Result: Out of 700 deferred donors; 546 were voluntary and 154 were replacement blood donors. Male (601) outnumbered female (99). There were 682 temporary and 18 permanent deferral. Most common age group for deferral was 17-30 yrs (490). Common causes included anemia(142), on medication(108), underweight(83) and high blood pressure(72). Conclusion: Donor selection process is a most important preliminary step in blood banking and should follow stringent medical and regulatory rules. Studying and analysing the profile of blood donors will help to identify sections of the population which could be targeted to increase the pool of voluntary blood donors. Every attempt should be made to decrease the donor deferral keeping in view the safety of both donor and recipients. Keywords: Blood donor, Deferral, Voluntary, Temporary, Permanent.

Frequency ofTrypanosoma cruziparasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission

Transfusion ◽  
2017 ◽  
Vol 57 (6) ◽  
pp. 1426-1432 ◽  
Author(s):  
David A. Leiby ◽  
Megan L. Nguyen ◽  
Melanie C. Proctor ◽  
Rebecca L. Townsend ◽  
Susan L. Stramer
Keyword(s):  
Blood Donors ◽  
Infected Blood ◽  
Parasite Lineage ◽  
Potential Association

scholarly journals Cytokine Profile and Immunomodulation in Asymptomatic Human T-Lymphotropic Virus Type 1–Infected Blood Donors

2001 ◽  
Vol 27 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Edgar M. Carvalho ◽  
Olívia Bacellar ◽  
Aurélia F. Porto ◽  
Silvane Braga ◽  
Bernardo Galvão-Castro ◽  
...  
Keyword(s):  
Virus Type ◽  
Blood Donors ◽  
Cytokine Profile ◽  
Infected Blood ◽  
T Lymphotropic Virus

Diagnostic Reasoning in the Pain-Focused Encounter

2019 ◽  
pp. 103-116
Author(s):  
Beth B. Hogans
Keyword(s):  
Differential Diagnosis ◽  
Negative Impact ◽  
Diagnostic Testing ◽  
Clinical History ◽  
Diagnostic Reasoning ◽  
Problem List ◽  
Patient Centered ◽  
Clinical Model ◽  
Error Disclosure ◽  
The Impact

Chapter 7 addresses the processes and pitfalls of evaluating, reasoning about, and attending to the needs of patients with pain. This chapter builds on Chapter 6, which addressed clinical assessment, explaining in detail the process of extracting and abstracting information from the pain narrative (clinical history or interview) to lay the foundation for a problem list and differential diagnosis. The problem list and differential diagnosis are described and contrasted so that clinicians will be comfortable with both. A clinical model explains the need for patient-centered approaches to be omnipresent but balanced with an appropriate disease-centered knowledge base that is likewise informed by understanding the patient’s healthcare-related values and motivations. A balanced approach is emphasized. The process of planning for diagnostic testing, including imaging, laboratory testing, provocative maneuvers, and targeted referrals, is described. The last section of the chapter addresses the impact and nature of cognitive and affective biases that can mitigate the effectiveness of diagnostic reasoning. A coordinated strategy to limit the negative impact of diagnostic reasoning biases is presented in a memorable way. Finally, the ethics of errors and error disclosure are discussed as well as the process of error disclosure.

scholarly journals Orthostatic hypotension: clinical review and case study

2020 ◽  
Vol 29 (9) ◽  
pp. 506-511
Author(s):  
Rachael Bailey ◽  
Gerri Mortimore
Keyword(s):  
Orthostatic Hypotension ◽  
Epileptic Seizures ◽  
Clinical History ◽  
Underlying Disease ◽  
Correct Treatment ◽  
Increased Risk ◽  
Patients At Risk ◽  
Mortality Causes ◽  
The Uk

Transient loss of consciousness (TLOC) accounts for 3% of all attendance in emergency departments within the UK. More than 90% of TLOC presentations are due to epileptic seizures, psychogenic seizures or syncope. However, in England and Wales in 2002, it was estimated that 92 000 patients were incorrectly diagnosed with epilepsy, at an additional annual cost to the NHS of up to £189 million. This article will reflect on the case study of a 54-year-old female patient who presented with a possible TLOC, and had a background of long-term depression. Differential diagnoses will be discussed, but the article will focus on orthostatic hypotension. Being diagnosed with this condition is independently associated with an increased risk of all-cause mortality. Causes of orthostatic hypotension and the pathophysiology behind the condition will be discussed, highlighting the importance of obtaining an accurate clinical history. This is extremely pertinent if a patient collapses in an NHS setting and this is witnessed by nurses because they can contribute to the history of the type of collapse, to aid diagnosis and correct treatment. In addition, nurses have a valuable role to play in highlighting polypharmacy to doctors, and non-medical prescribers, as a contributing factor to orthostatic hypotension is polypharmacy. It is therefore important to accurately distinguish TLOC aetiology, not only to provide appropriate management, but to also identify patients at risk of morbidity/mortality related to underlying disease.

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