Westminster Hospital was a hospital in London, England, founded in 1719. In 1834 a medical school attached to the hospital was formally founded.In 1939 a newly built hospital and medical school opened in Horseferry Road, Westminster. In 1994 the hospital closed, and its resources were moved to the new Chelsea and Westminster Hospital at the old St Stephen's Hospital site in Fulham Road.
In people without HIV, raised coronary artery calcium scores (CACS) are linked to increased cardiovascular risk. HIV is associated with elevated CACS, but risk factors beyond smoking and diabetes are not well established. Data on 779 individuals with HIV who underwent a CACS scans (median age 55) were collected. CACS better predicted adverse outcomes (e.g. major adverse cardiovascular events (MACE), death, heart failure) than Q-risk scores. Advanced imaging research may improve major cardiovascular risk prediction in people ageing with HIV.
Objectives: We evaluated antiviral effectiveness and safety of doravirine (DOR)-based regimens in people with HIV (PWH) in routine clinical practice. Design: A retrospective, noninterventional study across 16 sites in five European countries [United Kingdom (UK), France, Spain, Belgium, Netherlands]. Methods: The study was conducted in both treatment-experienced and treatment-naive PWH who either switched to, or initiated DOR-containing antiretroviral therapy (ART). The primary endpoints were virological success (defined as the percentage of participants with HIV RNA <50 copies/ml, using FDA Snapshot method) and virological failure (FDA Snapshot, HIV RNA >= 50 copies/ml) at 48 weeks after initiation of DOR regimen. Results: Between August 2017 and February 2022, 394 participants were enrolled, 63 naive and 331 treatment-experienced. 75.4% were men, with a median age of 45 years, and 92.2% received DOR in combination with tenofovir disoproxil fumarate and lamivudine or emtricitabine. The proportion of participants with virological success at week 48 after initiation of DOR regimen was 90.6% [95% confidence interval (CI) 87.3-93.3] overall, 87.3% (95% CI 76.5-94.4) in the ART-naive group, and 91.2% (95% CI 87.7-94.1) in the switch group. The proportion of participants with virological failure was 3.3% (95% CI 1.8-5.6) overall, 1.6% (95% CI 0-8.5) in the ART-naive group and 3.6% (95% CI 1.9-6.2) in the switch group. Of the 394 included participants, two (0.5%) were lost to follow-up and 13 (3.3%) discontinued the DOR regimen, four (1%) due to adverse events. Conclusion: Our results show high levels of efficacy and low levels of side effects in DOR-containing regimens in both treatment-naive and treatment-experienced PWH.
OBJECTIVES:Migrant women often experience difficulties in accessing sexual healthcare services. We assess the knowledge and acceptability of preexposure prophylaxis (PrEP) in migrant women. METHODS:We carried out a survey exploring HIV and PrEP knowledge in a cohort of adult migrant women residing in Padua (Italy). Subsequently, women were counselled about PrEP, screened for sexually transmitted infections (STIs) and asked about PrEP acceptability. We assessed factors correlating with PrEP acceptability using logistic regression. RESULTS:Two hundred and twenty-one migrant women were included, mostly Nigerian (122, 55.2%), asylum seekers (78, 35.3%), with a low level of education (179, 81%), with a median age of 31 [interquartile range (IQR): 26-37] years and a median time in Italy of 59 months (IQR: 16-82). Of these, 86% disclosed a regular sexual activity, 17.4% reported to have experienced nonconsensual sexual intercourse, and 9.5% to have been paid for sex. Only 14.5% disclosed to regularly use condoms during sexual intercourse. Since their arrival in Italy, 35.7% had undergone a gynaecological examination, and 50.2% had received a STI screening. 85.5% women did not know how to access contraception, and 28.5% knew about PrEP. After counselling, 16.7% women said they would accept PrEP. PrEP acceptability was associated with living in an asylum seeker centre [adjusted odds ratio (AdjOR): 0.08, P = 0.03], international protection status (AdjOR: 4.98, P = 0.041), and natural contraception use (AdjOR: 5.27, P = 0.024). CONCLUSION:Sexual health awareness/care and PrEP uptake in migrant women were low and highlighted the urgency of tackling the HIV/STI risk in this vulnerable population, by adopting specific outreach programmes and ensuring they receive information, support, and empowerment about options to make their sexual health safer.
Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and general surgical conditions. It has only been in recent years that laparoscopy has become an acceptable surgical alternative to open surgery in pregnancy. To date there is little clinical guidance pertaining to laparoscopic surgery in pregnancy. This is why the BSGE commissioned this guideline. MEDLINE, EMBASE, CINAHL and the Cochrane library were searched up to February 2017 and evidence was collated and graded following the NICE-approved process. The conditions included in this guideline are laparoscopic management of acute appendicitis, acute gall bladder disease and symptomatic benign adnexal tumours in pregnancy. The intended audience for this guideline is obstetricians and gynaecologists in secondary and tertiary care, general surgeons and anaesthetists. However, only laparoscopists who have adequate laparoscopic skills and who perform complex laparoscopic surgery regularly should undertake laparoscopy in pregnant women, since much of the evidence stems from specialised centres.
The aim of effective healing is to restore comparable structure and function to tissues. In some circumstances, this is not achieved, resulting in fibrotic scar tissue formation. Although this may have offered survival advantages in the past, fibrosis leads to functional disruption, organ failure and even death. Fibrosis affects many tissues types, but its ramifications are arguably most conspicuous in the skin. Dermal fibrosis impacts millions of people worldwide, and currently, treatment is not directed against a given molecular abnormality. Research demonstrates a complex picture of cellular and molecular interaction culminating in the deposition of fibrotic tissue. This article discusses key molecular mechanisms of fibrosis within tissues and highlights the similarities and differences amongst key pathways. There is compelling evidence for the involvement of toll-like receptor-4 and transforming growth factor β within fibrosis throughout all tissue types. With regards to other molecules, although there are similarities between tissues, evidence is inconsistent. In order to gain therapeutic advances in the prevention or treatment of fibrosis, research should strive to understand specific molecular mechanisms in models that closely replicate human disease. Further, there should be a healthy scepticism regarding the applicability of given molecular targets between settings. This review highlights a number of prime movers to fibrosis that are the focus of current research.
