布里斯托尔皇家医院

Objective To study the clinical and radiological characteristics of stroke due to intracerebral haemorrhage (ICH) in people living with HIV (PLWH) in Malawi. Methods Using a cross-sectional design, we compared the clinical and radiological characteristics of ICH in PLWH and HIV negative patients. We rated ICH location as deep, or lobar, using the Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS), and radiological features, including periventricular and deep white matter hyperintensities (PVWM and DWM) using the Fazekas score. Reviewers were blinded to HIV status. We compared findings using the t-test, Mann-Whitney U or Fisher exact test. Results We included 39 participants with ICH (10 PLWH; 29 HIV-negative). The median age was 60 (IQR 48–68); 22 (56%) were female. Among the HIV-positive ICH-group, the median (IQR) CD4 count was 364 cells/mm 3 (164,411), and 7 (70%) were naïve to HIV treatment. Compared with HIV-negative controls, HIV-positive patients were younger (median (IQR) 49.5 (35, 60) v 62(54,69), p = 0.049), and less frequently hypertensive (80% v 90%, p = 0.431). HIV-positive patients with ICH often had lobar haematoma location (40% v 0, p = 0.000, and p = 0.002 after controlling for age). White matter hyperintensities (PVWM 77% vs 79%, p = 0.547; DWM 60% vs 69%, p = 0.604) were prevalent and comparable between the groups despite the age disparity. Conclusions In PLWH and ICH-Stroke, we found a younger age and more frequent lobar location, signifying different underlying mechanisms compared to HIV-negative controls. Moreover, hypertension and cerebral small vessel disease markers were common in both groups, suggesting that better treatment of hypertension could reduce the burden of stroke due to ICH regardless of HIV status.

Background:Clinical triage requires integrating multiple information sources to identify patients at risk of deterioration. Tools capturing global health assessments beyond disease-specific scores are being developed using either bottom-up aggregation of simple indicators or top-down machine learning from large datasets. Their alignment with expert clinical judgment remains poorly characterized. Objective:This study evaluates 2 latent health measurement approaches: Frailty Index-laboratory, a transparent bottom-up tool aggregating laboratory abnormalities via deficit accumulation theory, and ETHOS-ARES (Enhanced Transformer for Health Outcome Simulation-Adaptive Risk Estimation System), a transformer-based foundation model generating multidimensional patient representations from electronic health records. We assess whether each tool's severity rankings align with clinical consensus and whether they offer utility in triage decisions. Methods:In this 3-phase mixed methods study, at least 30 clinicians across hospital specialties reviewed 20 emergency department presentations derived from Medical Information Mart for Intensive Care IV-Emergency Department. Phase 1 compared unaided clinician severity and urgency judgments against model outputs using Spearman rank correlation, with a Turing-inspired indistinguishability test assessing whether model rankings fell within the distribution of clinician assessments. Phase 2 allocated clinicians to receive Frailty Index-laboratory or ETHOS-ARES outputs, measuring anchoring effects via within-person pre-post comparisons and exploring clinical utility through semistructured interviews analyzed using the Framework Method. Results:Ethics approval was granted in June 2025 (KCL Research Ethics Office; MRSP-24/25-48707). Recruitment began in October 2025 (32 clinicians recruited as of manuscript submission), with data collection expected to be completed in January 2026 and analysis planned for March or April 2026. Conclusions:This study will quantify model-clinician agreement, measure anchoring effects, and generate qualitative insights on utility, trust, and adoption. The findings will inform the implementation of latent health measurement tools in clinical practice and provide a framework for the early-stage evaluation of artificial intelligence-based clinical decision support systems.

Abstract A 63-year-old woman presented with a 2.5-year history of recurrent facial erythema, with episodes affecting the eyelids, neck, chest and flexural aspects of the arms. The erythema was associated with pruritus, burning and tightness, with subsequent desquamation. The rash was relieved with the use of topical corticosteroids. She worked in food packing for a local company and regularly handled herbs and spices. Our patient had wondered whether turmeric was the causative agent for the rash as she had noticed a possible relationship between exposure and flares. Prior to her appointment, she had taken precautions to avoid turmeric, and her symptoms had improved as a result. She had also stopped eating food products containing turmeric but reported no oral or systemic symptoms, suggesting immediate IgE-mediated reaction. She was patch tested to the British Society for Cutaneous Allergy standard series, cosmetics series, baker series and diluted ground turmeric 2% in petrolatum. She had a strong positive reaction to turmeric. All other patch test results were negative. Turmeric (Curcuma longa) belongs to the ginger family, Zingiberaceae. It is a rhizome that is frequently used in South Asian and Middle Eastern cuisine. It has long been used in traditional medicine as an anti-inflammatory agent and more recently in health products and the wellness industry. Much of the literature on contact dermatitis to turmeric originates from Southern India, where its topical application has important cultural and religious significance. It is custom among certain communities to apply kumkum – a mixture of turmeric and slake lime – as ‘bindi’ between the eyebrows or ‘sindoor’ along the hair parting. It is also used to dye the thread on mangalsutra, a nuptial string to signify marriage. This case highlights the importance of identifying an uncommon airborne allergen as a cause of occupational dermatitis.

Introduction Psoriatic arthritis (PsA) is a form of inflammatory arthritis linked to psoriasis. Previous research from the UK has found that many people feel unsupported when diagnosed with PsA and lack confidence in managing their condition. This realist review aims to understand what works and does not work for whom and in what circumstances, in relation to healthcare professionals engaging with people to support them in developing self-management skills.Methods and analysis This protocol was developed by defining the scope of the review, using a brief directed literature review to support discussion by an expert group of researchers, healthcare professionals and a patient partner. A theoretical domains framework was generated, consisting of nine initial programme theories. These were further refined with input from Patient and Public Involvement and Engagement groups and used to develop a database search strategy.A systematic search of MEDLINE, CINAHL, Embase, Emcare and APA PsycINFO will be carried out, supplemented by citation tracking, exploration of grey literature and a mixed methods survey of rheumatology health professionals. Data selection will be performed by a minimum of two reviewers and data from included sources will be extracted using a template. Data will be synthesised narratively with respect to the identified initial programme theories, using these data to refine or refute these theories. This will generate refined programme theories to explain what works for whom and in what circumstances.Ethics and dissemination Ethical approval for the health professionals survey was granted through the Research Ethics Committee, University of the West of England (Project ID: 10991848). Outputs will be disseminated to the research community through conference presentations and a peer-reviewed journal article. The strategy for sharing outputs with patients and health professionals will be discussed and agreed with knowledge user groups.