No abstract

The probably most fundamental information about a particle is contained in the matrix elements of its energy momentum tensor (EMT) which are accessible from hard-exclusive reactions via generalized parton distribution functions. The spin decomposition of the nucleon and Ji sum rule are one example. Less prominent but equally important information is encoded in the stress tensor, related to the spatial components of the EMT, which shows in detail how the strong forces inside the nucleon balance to form a bound state. This provides not only unique insights on nucleon structure. It also leads to fascinating new applications to hadron spectroscopy which allow us to formulate new interpretations of the charmonium-nucleon pentaquarks discovered by LHCb. Recent progress is reviewed in this short overview article.

DESCRIPTIONAn 80-year-old woman with type 2 diabetes and hypertension was admitted to hospital with lethargy and confusion. A collateral history revealed she suffered from chronic constipation and had not opened her bowels 'for a few days'. On examination, she was in urinary retention. A catheter was inserted and she was started on treatment for a urinary tract infection.Subsequently, the patient became tachycardic and hypotensive. Abdominal examination revealed generalised tenderness and hard faecal matter per rectum. Blood tests showed raised inflammatory markers with C reactive protein of 298 mg/L and a white cell count of 18.3×10 9 /L. CT of the abdomen and pelvis showed marked rectosigmoid faecal impaction, compression of the urinary bladder (figure 1) and inflammatory changes in the wall of the rectum and lower sigmoid, consistent with a diagnosis of stercoral colitis (figures 2 and 3). The patient was treated with enemas and intravenous antibiotics; despite this, she continued to deteriorate and, given the high operative risk, was deemed unsuitable for surgery and subsequently died.Stercoral colitis is an uncommon but important complication of chronic constipation. A faecaloma forms, causing distension of the colonic lumen, which decreases the blood supply to the area, 1 causing a colitis that can progress to ulceration and perforation. A CT scan often shows the classical appearance of a thickened rectum impacted with faeces, dilation of the sigmoid colon and fat stranding of the adjacent bowel.

Background The UK National Institute for Health and Care Excellence (NICE) updated its guidelines on stable chest pain in 2016 and recommended computed tomography coronary angiography (CTCA) as fi rst line investigation for all patients with new onset symptoms. We implemented the guideline and audited downstream testing. Methods We undertook a retrospective search of the local radiology database from January 2017 to May 2018. Results Six-hundred and fifty-two patients underwent CTCA (mean age of 55 years, 330 were male). Thirty-four patients were found to have severe coronary artery disease (CAD), with 30 undergoing invasive coronary angiography (ICA) which confirmed severe CAD in 22, a yield of 73%. Fifty-eight patients were found to have moderate CAD on CTCA with 36 referred for ICA, of which, 33 attended and 18 were found to have severe CAD. Eighteen were referred for imaging stress tests and one was positive. The total yield of severe CAD at ICA was 55%. The majority of patients had normal coronary arteries. Conclusions CTCA was an effective rule-out test for most patients. In patients that went on to have ICA, the overall yield of severe CAD was relatively high. This compares well with our previous audit applying the NICE 2010 guidelines which recommended ICA for all high probability patients wherein the yield of severe CAD was 30%.

ObjectivesMultidrug-resistant tuberculosis (MDR-TB) is a global public health priority. The advent of the World Health Organisation’s Short Course regimen for MDR-TB, which halves treatment duration, has transformed outcomes and treatment acceptability for affected patients. Bedaquiline, a cornerstone of the Short Course regimen, has unknown teratogenicity and the WHO therefore recommends reliable contraception for all female MDR-TB patients in order to secure eligibility for bedaquiline. We were concerned that low contraceptive uptake among female patients in our rural South African MDR-TB treatment programme could jeopardise their access to bedaquiline. We therefore conducted a service delivery improvement project that aimed to audit contraceptive use in female MDR-TB patients, integrate family planning services into MDR-TB care, and increase the proportion of female patients eligible for bedaquiline therapy.MethodsContraceptive use and pregnancy rates were audited in all female patients aged 13–50 years initiated on our MDR-TB treatment programme in 2016. We then implemented an intervention consisting of procurement of depot-medroxyprogesterone acetate (DMPA) for the MDR-TB unit and training of specialist MDR-TB nurses in administration of DMPA. The audit cycle was repeated for all female patients aged 13–50 years initiated on the programme in January–October 2017 (post-intervention).ResultsThe proportion of women on injectable contraceptives by the time of MDR-TB treatment initiation increased significantly in the post-intervention cohort (77.4% vs 23.9%, p<0.0001).ConclusionBy integrating contraceptive services into our MDR-TB programme we significantly increased contraceptive uptake, protecting women from the obstetric risks associated with pregnancy during MDR-TB treatment and maximising their eligibility for bedaquiline therapy.