Warrensmith2620

Potassium-rich volcanism occurring throughout the Alpine-Himalayan belt from Spain to Tibet is characterized by unusually high Th/La ratios, for which several hypotheses have brought no convincing solution. Here, we combine geochemical datasets from potassic postcollisional volcanic rocks and lawsonite blueschists to explain the high Th/La. Source regions of the volcanic melts consist of imbricated packages of blueschist facies mélanges and depleted peridotites, constituting a new mantle lithosphere formed only 20 to 50 million years earlier during the accretionary convergence of small continental blocks and oceans. This takes place entirely at shallow depths ( less then 80 km) without any deep subduction of continental materials. High Th/La in potassic rocks may indicate shallow sources in accretionary settings even where later obscured by continental collision as in Tibet. This mechanism is consistent with a temporal trend in Th/La in potassic postcollisional magmas The high Th/La signature first becomes prominent in the Phanerozoic, when blueschists became widespread.

To assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children.

Population based cohort study on behalf of NHS England using the OpenSAFELY platform.

Patient level data were obtained for more than 17 million people registered with a general practice in England that uses TPP software. Electronic health records were linked with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service.

Adults (aged 16-105 years) and children (<16 years) from two cohorts wave 1 (registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The main exposure group consisted of people on a general practice learning disability register; a subgroup was defined as those having profound or severe learning disability. People with Down's syndrome and cerebral palsy were identified (whether or lthcare is warranted for this vulnerable group, and prioritisation for covid-19 vaccination and other targeted preventive measures should be considered.

To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).

Prospective cohort study.

21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).

116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.

The main outcome was development of IBD, including Crohn's disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.

Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile rangev NCT03225586.

ClinicalTrials.gov NCT03225586.Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojejunal anastomosis and confirmed as adenocarcinoma of D-IV. He received adjuvant chemotherapy and is doing well at 1 year of follow-up. This report describes about the rare case of isolated adenocarcinoma of the D-IV presented as intussusception which is never reported before and successfully treated by segmental resection of the duodenum and jejunum.As with past illnesses, an approach has been taken to vaccinate the population and halt the spread of COVID-19. On 13 April 2021, the US Food and Drug Administration called for a halt in the administration of the Johnson & Johnson (J&J) COVID-19 vaccine due to reports of thrombosis and thrombocytopenia being associated with vaccination. We present the case of a 43-year-old woman with a history of dyslipidaemia, depression, gastro-oesophageal reflux disease and obesity presenting with dyspnoea, headache and light headedness of 3 days' duration. Ten days prior, she had received the J&J COVID-19 vaccine. She was found to have thrombocytopenia, elevated D-dimers, pulmonary emboli and presented 1 day after discharge with an arterial clot despite being on apixaban. Six other US-based cases of venous thrombotic events are being reviewed at present. Patients should be informed of the possibility of such events to provide informed consent.A 59-year-old woman presented with fever and malaise and was found to have Lactococcus lactis bacteraemia. L. lactis infection is rare in humans with few reported cases, with most associated with dairy food product ingestion. The patient reported use of a multistrain over-the-counter probiotic supplement. After isolation of L. lactis from blood culture, the patient was treated empirically with ertapenem and amoxicillin and displayed clinical improvement. She remained well after completion of antibiotic regimen and discontinued probiotic supplementation use. We review the clinical presentation of L. Sunitinib lactis infection including diagnosis, identification and treatment.The novel coronavirus SARS-CoV-2 became a global pandemic in late 2019, and is still ongoing in 2021 causing significant morbidity and mortality. The advent of vaccinations heralded the turning of the tide. The Oxford jab, a vector-based vaccine was favoured due to its low cost and ease of storage. However, its potential association with thromboembolic adverse events resulted in controversy and disrupted its roll-out and use. The aetiopathogenesis of these thromboembolic events and its association with the Oxford vaccine are still speculative and uncertain, more so in the background of SARS-CoV-2 infection being highly thrombogenic in its own right. This paper presents a case of an otherwise healthy 50-year-old Caucasian man who developed acute abdominal pain 7 days following the first dose of Oxford vaccine and was found to have coeliac and splenic artery thrombosis complicated with splenic infarction.Sarcoidosis is a granulomatous disease with a wide spectrum of clinical manifestations. A 28-year-old previously healthy woman presented with multifocal pneumonia, mediastinal lymphadenopathy which was thought to be caused by actinomyces infection. Despite antibiotics, she developed cavitary lung lesions and had worsening lymphadenopathy prompting evaluation for alternative aetiologies like malignancy, autoimmune or immunodeficiency disorders. Further workup also revealed low CD4, CD8 cell counts, elevated soluble interleukin-2 levels. Over the due course of time, she developed granulomatous pan-uveitis, classical skin lesions leading to the diagnosis of sarcoidosis. Our case highlights the rare manifestations of sarcoidosis which can mimic immunodeficiency disorders especially when these patients develop secondary infections. Our goal is to raise awareness among clinicians about these atypical presentations of sarcoidosis which can lead to substantial delay in diagnosis thus leading to progression of the disease in the absence of appropriate treatment.We present a 69-year-old transgender woman who underwent gender-affirming surgery in 1998 and gender-affirming hormone therapy (cyproterone acetate (CPA) and estradiol) since this time. Following an MRI scan to investigate tremor in 2013, an incidental left anterior clinoid and right petrous meningioma were identified. Subtotal surgical resection was achieved for the anterior clinoid meningioma (WHO grade 1, meningothelial subtype). At follow-up in 2016, an olfactory groove meningioma and left greater wing of sphenoid meningioma were identified. By 2017, both tumours, along with the petrous meningioma, demonstrated significant growth. In 2018, clinical decline was evident and MRI demonstrated further tumour growth. Surgery was scheduled and the olfactory groove meningioma was completely resected (WHO grade 2, chordoid subtype). Hormones were stopped, after which regression of the petrous meningioma was observed. This case demonstrates an association between high-dose CPA and estradiol and the development, growth and regression of meningiomas in a transgender woman.

To assess the associations between statins and adverse events in primary prevention of cardiovascular disease and to examine how the associations vary by type and dosage of statins.

Systematic review and meta-analysis.

Studies were identified from previous systematic reviews and searched in Medline, Embase, and the Cochrane Central Register of Controlled Trials, up to August 2020.

Randomised controlled trials in adults without a history of cardiovascular disease that compared statins with non-statin controls or compared different types or dosages of statins were included.

Primary outcomes were common adverse events self-reported muscle symptoms, clinically confirmed muscle disorders, liver dysfunction, renal insufficiency, diabetes, and eye conditions. Secondary outcomes included myocardial infarction, stroke, and death from cardiovascular disease as measures of efficacy.

A pairwise meta-analysis was conducted to calculate odds ratios and 95% confidence intervals for each outcome between statins ad muscle disorders or diabetes. The increased risks did not outweigh the reduction in the risk of major cardiovascular events. Atorvastatin, lovastatin, and rosuvastatin were individually associated with some adverse events, but few significant differences were found between types of statins. An E

dose-response relationship was identified for the effect of atorvastatin on liver dysfunction, but the dose-response relationships for the other statins and adverse effects were inconclusive.

For primary prevention of cardiovascular disease, the risk of adverse events attributable to statins was low and did not outweigh their efficacy in preventing cardiovascular disease, suggesting that the benefit-to-harm balance of statins is generally favourable. Evidence to support tailoring the type or dosage of statins to account for safety concerns before starting treatment was limited.

PROSPERO CRD42020169955.

PROSPERO CRD42020169955.

Patients presenting to Emergency Department (ED) with non-specific low back pain can receive more unnecessary, intensive and costly care than is recommended. The COVID-19 pandemic has provided an unprecedented opportunity to examine how health systems prioritise necessary care that provides clear benefits to patients. The purpose of this study was to examine the impact of COVID-19 on care of low back pain in the ED.

We performed a retrospective analysis of electronic medical record data on care for low back pain from three public hospitals in Sydney. We included patients diagnosed with spinal conditions who presented between March and May in 2019 and in 2020. Outcomes were the total number of patients presenting with spinal conditions to ED, the proportion diagnosed with non-specific low back pain, and the proportion receiving potentially unnecessary aspects of care (ambulance use, imaging, opioids, hospital admissions). We calculated relative risk with 95% CIs and examined plots with locally weighted smoothed curves.