Maria Eduarda Ferreira Bruco’s research while affiliated with Oxford University Hospitals NHS Trust and other places

Aims Miscarriage and stillbirth has been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth and induced abortion). Methods and Results Observational studies reporting risk of CVD, coronary heart disease (CHD) and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge and Cochrane Library (to January 2020). Data were extracted, and study quality assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CI) were calculated using inverse variance weighted random-effects meta-analysis. Twenty-two studies involving 4,337,683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95%CI:1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95%CI:1.09-1.82), CHD (RR = 1.51, 95%CI:1.04-1.29) and stroke risk (RR = 1.33, 95%CI:1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95%CI:1.18-1.39).). One or more abortions was associated with a higher CVD (RR = 1.04, 95%CI:1.02-1.07), as was recurrent abortion (RR = 1.09, 95%CI:1.05-1.13). Conclusion Women with previous pregnancy loss are at a higher CVD, CHD and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.

Background The beta-lactam antibiotic amoxicillin and the beta-lactamase inhibitor clavulanic acid in combination with amoxicillin are known to both cause immediate and non-immediate type hypersensitivity. Objective To characterize a large cohort of patients with a history of amoxicillin or amoxicillin-clavulanic acid hypersensitivity. Methods Retrospective analysis of demographics, presentation, investigation, and management of 331 patients presenting to one allergy center with a history of hypersensitivity to amoxicillin or amoxicillin-clavulanic acid. Results Hypersensitivity was confirmed in 37/221 (17%) patients who took amoxicillin and 47/110 (43%) patients who took amoxicillin-clavulanic acid as the index drug. In immediate hypersensitivity, skin testing confirmed the diagnosis in 66/139 (47%) patients. Penicillin cross-reactivity was observed in 16/36 (44%). 13/16 (81%) cross-reactive patients reacted to amoxicillin-clavulanic acid as the index drug. All skin test negative patients (73/139) underwent drug provocation. The negative predictive value of skin tests was 89%. In non-immediate hypersensitivity, delayed intradermal tests confirmed diagnosis in 12/170 (7%). 8/12 (67%) skin test positive patients presented with DRESS. All skin test negative patients (158/170) underwent drug provocation. The negative predictive value of skin tests was 95%. Penicillin cross-reactivity was observed in 3/12 (25%). Ten patients were diagnosed with hypersensitivity to clavulanic acid. Conclusion The negative predictive value of skin tests in both immediate and non-immediate hypersensitivity reactions is excellent and excludes severe allergy. Non-immediate hypersensitivity is rare. Confirmed hypersensitivity is more likely if amoxicillin-clavulanic acid is the index drug. Cross-reactivity was more common in patients presenting with immediate hypersensitivity, most commonly involving benzylpenicillin. A minority of patients were allergic to clavulanic acid.

Introduction Young adult hip pain is increasingly recognized as an early warning sign for development of debilitating arthritis later in life. Two common causes for young adult hip pain are femoroacetabular impingement (FAI) and dysplasia. Yet, no universal referral pathway exists in the UK for young patients experiencing hip pain. Our aim was to investigate the timeline and journey of patients seen in a specialist young adult hip clinic at a tertiary orthopaedic centre. Method We conducted a case series using a two-part open question questionnaire given to 40 patients at a young adult hip clinic at a tertiary orthopaedic centre between March and November 2019. Results Average time from onset of symptoms to appointment in specialist clinic was 2.9 (± 3.9) years, with range between 1 month and 23 years. Average time between first GP appointment and appointment at a tertiary centre was 2.1 (±2.4) years. A total of 33 (83%) patients were seen in secondary care prior to referral to a specialist clinic at a tertiary centre. Imaging modalities prior to attendance were as follows: 23 (58%) patients had a hip X-ray, 15 (38%) a CT scan, 30 (75%) an MRI scan and 6 (15%) an ultrasound scan of their hip. A total of 23 (58%) patients had corticosteroid injections prior to referral to a specialist clinic. Conclusions Large variation seen in our results highlights an opportunity for service improvement and development of a universal referral pathway to improve patient care and reduce burden on other services.