Manchester Academic Health Science Centre Research Articles

The Unspeakable Disease: A Tale of Two Siblings

The deficiency of arylsulfatase A due to the mutations in the ARSA gene is the cause of a rare inherited lysosomal storage disease, resulting in the accumulation of sulfatides in the central nervous system (CNS) and peripheral nervous system (PNS). This, in turn, leads to progressive demyelination, neuro-inflammation, and neurodegeneration, and the accumulation in visceral organs. Affected young children gradually lose the ability to walk, stand, talk, and swallow; they lose their independence and show a steady physical and cognitive regression resulting, ultimately, in their premature death at a younger age. This condition not only devastates young patients, but it also deeply affects their families and carers, both psychologically and economically. In this interview, Simon Jones, Consultant in Paediatric Inherited Metabolic Disease at St Mary’s Hospital, Manchester, Honorary Manchester Academic Health Science Centre (MAHSC), and Professor in Paediatrics and Senior Lecturer at the University of Manchester, UK; Dipak Ram, Royal College of Paediatrics and Child Health (RCPCH) and British Paediatric Neurology Association (BPNA) National Training Advisor for Paediatric Neurology, and Consultant Paediatric Neurologist at the Royal Manchester Children’s Hospital, UK; and Ally Shaw, primary caregiver of the patients mentioned in this article, explore how the disease impacts the normal development of predominantly young patients; consider its subtle evolution; and witness the stressful diagnostic odyssey families are experiencing, often leading to the wrong diagnosis, which is compounded by the lack of a national newborn screening. Jones and Ram speak directly about the diagnosis and management of these patients. This article also includes the experience of a mother of two affected children, one of whom was diagnosed thanks to their affected older sister, who gave the younger child the chance of receiving a timely treatment. In this disease, time is of the essence; often, patients are sadly diagnosed too late, and are destined to palliative care and premature death. It is hoped that this interview and testimony will help raise awareness on this disease, and give a chance to future patients and their families.

Innovation: It's in Our DNA.

Colleen M. Kigin, PT, DPT, MS, MPA, FAPTA, the 52nd Mary McMillan Lecturer, is a consultant focused on innovation. She is a visiting clinical professor at the University of Colorado physical therapy program, University of Colorado School of Medicine, and an adjunct associate professor at the MGH Institute of Health Professions (MGH IHP). From 1998-2014, she held the positions of chief of staff and program manager for the Center of Integration of Medicine and Innovative Technology, a 12-institution consortium based in Boston, Massachusetts, developing innovative solutions to health care problems. She subsequently has served as a consultant to such efforts as the University of Manchester, Manchester Academic Health Science Centre, United Kingdom, to develop an innovation culture. In 1994, she joined the newly formed Partners HealthCare System in Boston, coordinating the system's cost reduction efforts through 1998. Kigin previously served as director of physical therapy services at Massachusetts General Hospital (MGH) (1977-1984) and as assistant professor at MGH IHP (1980-1994). While at MGH, she was responsible for the merger of 2 separate physical therapy departments, the establishment of the first nonphysician specialist position, and practice without referral for the physical therapy services. Kigin has held numerous positions within the American Physical Therapy Association (APTA), serving on the Board of Directors from 1988-1997, including as vice president; co-chair of The Physical Therapy Summit in 2007; and co-chair of FiRST, the Frontiers in Rehabilitation, Science and Technology Council. She also served as prior chair of the APTA Committee on Clinical Residencies and served on the American Board of Physical Therapy Specialties. Kigin earned a bachelor of science degree in physical therapy at the University of Colorado, a master of science degree at Boston University, a master's degree in public administration from the Harvard Kennedy School of Government, and a doctor in physical therapy degree from the MGH IHP.

Ischaemia reperfusion induces the release of donor derived Passenger Leukocytes (PLs) during normothermic machine perfusion (NMP) of the liver- a new opportunity for ex situ graft leukodepletion?

Fungai Dengu1, Tamsyn Clark1,3, Hussain Abbas1, Etohan Ann Ogbemudia1, Faysal El Gilani1,David Nasralla1, Peter Friend1, James Fildes2
 1. Oxford Organ Perfusion Lab, Nuffield Department of Surgical Sciences and Oxford Biomedical ResearchCentre, University of Oxford, Oxford, UK2. The Ex-Vivo Lab, Division of Cell Matrix Biology and Regenerative Medicine, School of BiologicalSciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester AcademicHealth Science Centre, Manchester, UK3. Institute of Biomedical Engineering, University of Oxford, Oxford, UK
 
 Background Passenger Leukocytes (PLs) are implicated in both the direct and semi-direct pathways of allorecognition which is the process that underpins acute allograft rejection1. The majority of liver-derived PLs are short lived and predominantly impact early recipient immune responses2. Removal of PLs has been shown in kidney, lung and vascularised composite allografts to reduce early allograft damage and abrogate ejection3. We aimed to assess the use normothermic machine perfusion (NMP) to investigate PL kinetics and explore PL depletion strategies in donor livers.
 Methods Porcine livers (N=4) procured in a donation after circulatory death (DCD) model were preserved with sequential static cold storage then NMP. During NMP, livers were subjected to repeated 20 min warm ischaemic hits (IH) followed by 30mins of NMP using a leukocyte depleted autologous RBC based perfusate. Leukocytes were quantified using the Sysmex® cell counter system and samples stored for flow cytometric analysis.
 Results In total, 3.4x106 PLs are effluxed into the circuit immediately after initiation of NMP, this falls rapidly to 1.35x106 by 30 mins. Following the first IH, a further efflux of occurs with a peak of 3.74x106 occurring. The second IH also induced an efflux of cells (1.61x106) with lymphocytes representing the predominant leukocyte sub-type in each efflux.
 Discussion During NMP, there is an inducible and reproducible efflux of graft derived PLs into the circuit that is composed of predominantly lymphocytes with unexpectedly low numbers of monocytes. Removal of these PLs from the perfusate during NMP may therefore be feasible using an in-line leukocyte-filter.
 
 References
 1. Alsughayyir, J., Motallebzadeh, R. & Pettigrew, G. J. Are donor lymphocytes a barrier to transplantation tolerance? Curr. Opin. Organ Transplant. 23, 90–96 (2018).2. Mastoridis, S. et al. Impact of donor extracellular vesicle release on recipient cell “cross-dressing” following clinical liver and kidney transplantation. Am. J. Transplant. ajt.16123 (2020). doi:10.1111/ajt.161233. Stone, J. P. et al. Mechanical removal of dendritic cell–generating non-classical monocytes via ex vivo lung perfusion. J. Hear. Lung Transplant. 33, 864–869 (2014).

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Prioritizing Access to Surgical Care During the Coronavirus Pandemic.

Department of Surgery, Manchester Academic Health Sciences Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom Funding/Support: None reported. Financial Disclosures: None reported. Correspondence: Gordon L. Carlson, C.B.E., M.D., F.R.C.S., F.R.C.S.Ed., Department of Colorectal Surgery, National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK. E-mail: [email protected]

Computed tomography scanning in the prone position for a critically hypoxic patient with COVID-19.

Anaesthesia ReportsVolume 8, Issue 1 p. 71-72 Multimedia Computed tomography scanning in the prone position for a critically hypoxic patient with COVID-19 B. A. McGrath, B. A. McGrath Consultant Anaesthetist, Honorary Senior Lecturer orcid.org/0000-0003-3048-3480 Manchester University Hospital NHS Foundation Trust, Manchester, UK Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UKSearch for more papers by this authorR. Lowe, R. Lowe Specialty Trainee in Anaesthesia Health Education England North West, Manchester, UKSearch for more papers by this authorW. Brady, W. Brady Consultant Anaesthetist @willbrady72 Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorA. Sharman, A. Sharman Consultant Radiologist Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorT. Felton, T. Felton Senior Lecturer, Honorary Consultant Physician orcid.org/0000-0001-6868-6633 Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorC. L. Shelton, Corresponding Author C. L. Shelton Consultant Anaesthetist, Senior Clinical Lecturer [email protected] orcid.org/0000-0002-8438-398X Manchester University Hospital NHS Foundation Trust, Manchester, UK Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK Correspondence to: C. L. Shelton Email: [email protected]Search for more papers by this author B. A. McGrath, B. A. McGrath Consultant Anaesthetist, Honorary Senior Lecturer orcid.org/0000-0003-3048-3480 Manchester University Hospital NHS Foundation Trust, Manchester, UK Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UKSearch for more papers by this authorR. Lowe, R. Lowe Specialty Trainee in Anaesthesia Health Education England North West, Manchester, UKSearch for more papers by this authorW. Brady, W. Brady Consultant Anaesthetist @willbrady72 Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorA. Sharman, A. Sharman Consultant Radiologist Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorT. Felton, T. Felton Senior Lecturer, Honorary Consultant Physician orcid.org/0000-0001-6868-6633 Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorC. L. Shelton, Corresponding Author C. L. Shelton Consultant Anaesthetist, Senior Clinical Lecturer [email protected] orcid.org/0000-0002-8438-398X Manchester University Hospital NHS Foundation Trust, Manchester, UK Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK Correspondence to: C. L. Shelton Email: [email protected]Search for more papers by this author First published: 30 June 2020 https://doi.org/10.1002/anr3.12050Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume8, Issue1January-June 2020Pages 71-72 RelatedInformation

Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial.

Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.AimsOur primary objective was to determine whether cognitive-behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide. A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline. A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.DiscussionPsychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.Declaration of interestThe trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.

Treatment of people at ultra-high risk for psychosis.

Treatment of people at ultra-high risk for psychosis.

An interview with Kevin O'Brien.

had reached a remarkable number of 48,000 reads last June. Having as his main research interests the clinical trials of the care of children with se-vere dentofacial problems, currently, he divides his professional time among the University, Manchester Academic Health Science Centre, his blog and lectures abroad. He spends his free time with his beloved and supportive family: his kind and sweet wife, Janet, his two daughters Jennifer and Claire, his son Jonathan and his lovely grandchildren, Rory and Lois. Besides his family, Kevin loves football (a passionate Manchester United supporter with his name on one of the chairs of the stadium), likes cooking (makes delicious pizzas), looking after his garden and cycling in Manchester. My acknowledgments to Professors Jose Augusto Mendes Miguel, Jonathan Sandler and Ki Beon Kim, who collaborated in the development of this interview.Klaus Barretto Lopes – interview coordinator » Manchester orthodontic specialty training in 1986.» PhD research into the effectiveness of orthodontic treatment.» Associate Professor in the School of Dental Medicine at the University of Pittsburgh, in 1991.» Professor of Orthodontics in 1996 and Dean of the School of Dentistry at The University of Manchester, from 2004 to 2007.» Associate Dean of the Faculty of Medical and Human Sciences at the University of Manchester, from 2007 to 2010.» Chair of the UK General Dental Council, from 2011 to 2013.» Over 90 scientific papers published, mostly in the AJO-DO.» Gave the

Weak Evidence Hinders the Understanding of the Benefits of Periodontal Therapy on Glycemic Control in Patients With Diabetes and Periodontitis

Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor-Ejiofor Z. Cochrane Database Syst Rev 2015;11:CD004714. This project was supported by the NIHR, via Cochrane Infrastructure funding to the Cochrane Oral Health Group, School of Dentistry, University of Manchester (UK), Manchester Academic Health Sciences Centre (UK), and the National Institute for Health Research (UK) TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Re-Examining the Role of Radiation Therapy for Diffuse Large B-Cell Lymphoma in the Modern Era.

Andrea K. Ng, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA Bouthaina Shbib Dabaja, The University of Texas MD Anderson Cancer Center, Houston, TX Richard T. Hoppe, Stanford University School of Medicine, Stanford, CA Timothy Illidge, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom Joachim Yahalom, Memorial Sloan Kettering Cancer Center, New York, NY

Integrating radiation therapy with emerging systemic therapies: Lessons from a patient with cerebral radionecrosis, spinal cord myelopathy, and radiation pneumonitis

Medical Oncology, Christie NHS Foundation Trust, Manchester, UK University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, UK The Children's Brain Tumour Research Network, University of Manchester, UK Cancer Research UK Manchester Institute, University of Manchester, the Christie NHS Foundation Trust, Manchester, UK School of Medicine, University of Queensland, Brisbane, Australia

Guidelines on the measurement of ultraviolet radiation levels in ultraviolet phototherapy: report issued by the British Association of Dermatologists and British Photodermatology Group 2015

Guidelines on the measurement of ultraviolet radiation levels in ultraviolet phototherapy: report issued by the British Association of Dermatologists and British Photodermatology Group 2015 H. Moseley, D. Allan, H. Amatiello, A. Coleman, H. du Peloux Menag e, C. Edwards, L.S. Exton, J. Ferguson, T. Garibaldinos, C. Martin and M.F. Mohd Mustapa The Photobiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, U.K. The Christie NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, U.K. Radiation Physics and Protection Group, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, U.K. Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, U.K. Lewisham and Greenwich NHS Trust, High Street, London SE13 6LH, U.K. Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, U.K. British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K. Department of Clinical Physics and Bio-Engineering, University of Glasgow, Glasgow G12 8QQ, U.K.

286. Pilot Study of Multispectral Imaging to Measure Skin Oxygenation in Healthy Controls and Patients with Systemic Sclerosis and Primary Raynaud’s Phenomenon

Ian Poxon, Jack Wilkinson, Tonia Moore, Joanne Manning, Mark Dickinson, Ariane Herrick and Andrea Murray Photon Science Institute, University of Manchester, Manchester, Research and Development, Directorate of Rheumatology, Salford Royal Hospital NHS Foundation Trust, Salford and Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

040. Combining Lifestyle and Metabolic Predictors of Incident Inflammatory Polyarthritis in the Epic-2-Noar Study

Jamie C. Sergeant, Suzanne M. M. Verstappen, Catharine Morgan, Robert N. Luben, Amit Bhaniani, Serena Anuj, RA-MAP consortium, Alex J. MacGregor, Nick Wareham, Deborah P. M. Symmons, Kay-Tee Khaw and Ian N. Bruce Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge and Norwich Medical School, University of East Anglia, Norwich, UK

041. Anti-Citrullinated Protein Antibody Status in the General Population and as a Predictor of Future Inflammatory Polyarthritis: The Epic-2-Noar Study

Suzanne M. Verstappen, Jamie C. Sergeant, Robert N. Luben, Amit Bhaniani, Serena Anuj, RA-MAP consortium, Alex J. MacGregor, Nick Wareham, Deborah P. M. Symmons, Kay-Tee Khaw and Ian N. Bruce Arthritis Research UK Centre for Epidemiology, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, Manchester, European Prospective Investigation into Cancer and Nutrition, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, Rheumatology, Norfolk and Norwich University Hospital, Manchester, UK

Systematic literature review of patient-reported outcome measures used in assessment and measurement of sleep disorders in chronic obstructive pulmonary disease.

BackgroundSleep problems are common in patients with chronic obstructive pulmonary disease (COPD), but the validity of patient-reported outcome measures (PROMs) that measure sleep dysfunction has not been evaluated. We have reviewed the literature to identify disease-specific and non-disease-specific sleep PROMs that have been validated for use in COPD patients. The review also examined the psychometric properties of identified sleep outcome measures and extracted point and variability estimates of sleep instruments used in COPD studies.MethodsThe online EMBASE, MEDLINE, PsycINFO, and SCOPUS databases for all years to May 2014 were used to source articles for the review. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Criteria from the Medical Outcomes Trust Scientific Advisory Committee guidelines were used to evaluate the psychometric properties of all sleep PROMs identified.ResultsOne COPD-specific and six non-COPD-specific sleep outcome measures were identified and 44 papers met the review selection criteria. We only identified one instrument, the COPD and Asthma Sleep Impact Scale, which was developed specifically for use in COPD populations. Ninety percent of the identified studies used one of two non-disease-specific sleep scales, ie, the Pittsburgh Sleep Quality Index and/or the Epworth Sleep Scale, although neither has been tested for reliability or validity in people with COPD.ConclusionThe results highlight a need for existing non-disease-specific instruments to be validated in COPD populations and also a need for new disease-specific measures to assess the impact of sleep problems in COPD.

Case for the wider adoption of mass spectrometry-based adrenal steroid testing, and beyond.

Department of Clinical Biochemistry (B.G.K.), University Hospital of South Manchester, Manchester M23 9LT, United Kingdom; Medical School (P.M.S.), University of Leeds, Leeds LS2 9NL, United Kingdom; The Christie Pathology Partnership (P.J.M.), Manchester, M20 4BX, UK; Department of Endocrinology (P.J.T.), The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom; and Centre for Endocrinology & Diabetes (P.J.T.), Institute of Human Development, University of Manchester, Manchester Academic Health Science Centre, United Kingdom

How Do We Classify Rheumatoid Arthritis in Established Disease — Can We Apply the 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria?

The creation of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA; Figure 1)1 sought to address some of the criticisms of the previous ACR criteria set published in 1987 (Figure 2)2 — namely that they were insensitive, particularly early in the disease course, and that this led to the exclusion of many patients with early disease from clinical trials and research studies3. As a result, there was an absence of evidence regarding the efficacy of new treatments in this group of patients, who may have had the potential to benefit the most4,5. Thus, 1 aim of the 2010 criteria was to identify those patients with early RA with the key purpose of rapid disease-modifying antirheumatic drug (DMARD) initiation. However, the ability to classify patients as having RA is important at all phases of the disease, early and late. A case definition is required as an entry criterion not only to clinical trials, but also a consensus for inclusion in longterm observational studies and the whole spectrum of research in RA. Numerous studies have tested the validity of the new criteria since their publication against various standards6, but they have generally been applied in patients with relatively short duration of symptoms, ranging from < 3 months to < 2 years. Thus, the question remains, can we extend these classification criteria to patients with established disease? Figure 1. 2010 ACR/EULAR Classification criteria for RA1. ACR: American College of Rheumatology; EULAR: European League Against Rheumatism; RF: rheumatoid factor; ACPA: anticitrullinated protein antibodies; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; RA: rheumatoid arthritis. From Aletaha, et al. Ann Rheum Dis 2010;69:1580–8; with permission. Figure 2. 1987 ACR Classification criteria for RA2. ACR: American … Address correspondence to Professor D.P.M. Symmons, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, UK. E-mail: deborah.symmons{at}manchester.ac.uk

British Association of Dermatologists' guidelines for the management of onychomycosis 2014.

British Association of Dermatologists’ guidelines for the management of onychomycosis 2014 M. Ameen, J.T. Lear, V. Madan, M.F. Mohd Mustapa and M. Richardson Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, U.K. Manchester Academic Health Science Centre (MAHSC), University of Manchester, 46 Grafton Street, Manchester M13 9NT, U.K. Salford Royal NHS Foundation Hospital, Stott Lane, Salford M6 8HD, U.K. British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K. Mycology Reference Centre Manchester, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, U.K.