The Great Western Hospital is a large hospital in Swindon, Wiltshire, England, near junction 15 of the M4 motorway. It opened in 2002 and is run by the Great Western Hospitals NHS Foundation Trust.
OBJECTIVE:To evaluate temporal changes in rates of newly recorded diagnoses for 19 long term conditions in England in relation to the covid-19 pandemic by disease, age group, sex, socioeconomic status, and ethnicity. DESIGN:Population based cohort study. SETTING:Primary care and hospital admission data, with the approval of NHS England. PARTICIPANTS:29 995 025 individuals registered with general practices in England contributing data to the OpenSAFELY-TPP platform. MAIN OUTCOME MEASURES:Temporal trends in age and sex standardised incident and prevalent diagnosis rates for 19 long term conditions between 1 April 2016 and 30 November 2024. Differences between expected and observed diagnosis rates after the onset of the covid-19 pandemic were compared using seasonal autoregressive integrated moving-average models, based on modelled projections of expected rates from pre-pandemic patterns. RESULTS:All 19 conditions showed a sharp decline in newly recorded diagnoses during the first year of the pandemic, followed by variable recovery. As of November 2024, cumulative reductions in diagnoses remained evident for conditions such as depression (734 800 (27.7%) fewer diagnoses than expected; 95% prediction interval (PI) 703 100 to 766 400), asthma (152 900 (16.4%) fewer diagnoses; 95% PI 137 500 to 168 300), chronic obstructive pulmonary disease (COPD) (90 100 (15.8%) fewer diagnoses; 95% PI 81 400 to 98 900), psoriasis (54 700 (17.1%) fewer diagnoses; 95% PI 50 100 to 59 200), and osteoporosis (54 100 (11.5%) fewer diagnoses; 95% PI 47 100 to 61 100). Conversely, diagnoses of chronic kidney disease have increased by 34.8% above expected levels during the pandemic recovery period, corresponding to 359 000 additional diagnoses (95% PI 333 500 to 384 500). Unadjusted subgroup analyses stratified by ethnicity and socioeconomic status indicated that, after an initial decrease, dementia diagnosis rates have risen above pre-pandemic levels for people of white ethnicity and in less deprived socioeconomic areas, but not for those from other ethnicities and more deprived areas. CONCLUSIONS:Since the covid-19 pandemic, there have been fewer diagnoses than expected for conditions such as depression, asthma, COPD, and osteoporosis, in contrast with a rapid increase in diagnoses of chronic kidney disease since 2022. Unadjusted analyses stratified by ethnicity and socioeconomic status suggest differential patterns of recovery, particularly for individuals with dementia. This study highlights the potential for near real time monitoring of disease epidemiology using routinely collected health data, informing strategies to enhance case detection and investigate inequities in healthcare.
BACKGROUND:Hepatitis E virus (HEV) infection is a common and usually asymptomatic infection but can be fatal in the context of prolonged immune suppression, such as during a hematopoietic stem cell transplant (HSCT). CASE REPORT:We describe the case of a 74-year-old man with primary central nervous system lymphoma (PCNSL) who required an autologous stem cell transplant (ASCT) as part of curative treatment for this condition but was identified to have acute HEV infection at the time of CD34 stem cell harvest. This meant he would be re-exposed to a contaminated product with HEV infection at high viral load precisely at the time of most severe immune suppression. RESULTS:This is the first case of the prospective use of a CD34-contaminated hepatitis E stem cell product with a high viral load (2,950,000 IU/mL) in an autologous stem cell transplant setting. We describe the successful prophylaxis with ribavirin. This case provides a practical management strategy for a HSCT, particularly in the allogeneic setting, where time-critical donor CD34 products are required where acute HEV infection is detected. Our patient remains alive at >12 months post-transplant with no evidence of HEV re-activation.
Dryness (sicca) of mucosal surfaces is the hallmark of adult-onset Sjogren's disease (SjD). In our experience, clinicians frequently lack confidence in managing the sicca symptoms effectively. Successful management requires an understanding of the condition and personalisation of care. We have reviewed the available evidence and, when necessary, used personal and expert experience to provide comprehensive advice on the management of ocular, oral, and systemic sicca, enabling the treating physician to support their patients and manage their symptoms effectively and prevent long-term damage. Our objective is to ensure that the non-specialist feels confident in managing the myriad manifestations of sicca in SjD.
