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Batt NM, Rodrigues B, Bloom S, Sawhney R, George ES, Hodge A, Vootukuru N, McCrae C, Sood S, Roberts SK, Dev A, Bell S, Thompson A, Ryan MC, Kemp W, Gow PJ, Sood S, Nicoll AJ. Metabolic-associated fatty liver disease and hepatocellular carcinoma: a prospective study of characteristics and response to therapy. J Gastroenterol Hepatol 2024; 39:1048-1056. [PMID: 38369382 DOI: 10.1111/jgh.16501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND AIM The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population. METHOD Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period. RESULTS Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate. CONCLUSION Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.
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Patel P, Thomas R, Hamady M, Hague J, Raja J, Tan T, Bloom S, Richards T, Weiss C, Prechtl C, Smith C, Thiagarajah S, Fiorentino F, Markakis H, Ahmed AR. O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity? Br J Surg 2022. [DOI: 10.1093/bjs/znac242.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction
Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.
Methods
9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.
Results
N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.
Conclusion
LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.
Take-home message
Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.
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Keetarut K, Zacharopoulou-Otapasidou S, Bloom S, Majumdar A, Patel PS. An evaluation of the feasibility and validity of a patient-administered malnutrition universal screening tool ('MUST') compared to healthcare professional screening in an inflammatory bowel disease (IBD) outpatient clinic. J Hum Nutr Diet 2017; 30:737-745. [PMID: 28585266 DOI: 10.1111/jhn.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malnutrition is common in inflammatory bowel disease (IBD) and is associated with poor health outcomes. Despite this, screening for malnutrition in the outpatient-setting is not routine and research in the area is limited. The present study aimed to evaluate whether agreement between malnutrition screening completed by patients and healthcare professionals (HCPs) could be achieved by comparing patient self-administered 'MUST' ('MUST'-P) with HCP administered 'MUST' ('MUST'-HCP) in a single tertiary IBD outpatient clinic. METHODS We conducted a feasibility and validity study on adult outpatients with IBD. We collected anthropometric, nutritional and clinical data from patients. All patients completed 'MUST'-P using a self-administered questionnaire, followed by 'MUST'-HCP. 'MUST'-P was timed and feedback on ease-of-use was obtained. The risk of malnutrition was classified as low (score = 0), medium (score = 1) and high (score ≥ 2) and agreement was tested using kappa statistics (κ). RESULTS Eighty patients were recruited (Crohn's disease: n = 49, ulcerative colitis: n = 29, unclassified: n = 2), with a mean (SD) age of 39.9 (15.1) years (51.2% were males). Seventy-one (92%) of patients found 'MUST'-P either easy or very easy. The mean (SD) time to complete 'MUST'-P was 3.1 (1.8) min (range 1-10 min). Sixty-eight (85%) of patients were at low risk of malnutrition when screened by the HCP. There was moderate agreement (κ = 0.486, P < 0.001) between 'MUST'-P and 'MUST'-HCP, with 100% agreement in scoring for medium- and high-risk categories. CONCLUSIONS The results of the present study suggests that self-screening using 'MUST' could be effectively used in an IBD outpatient clinic to identify those at medium and high risk of malnutrition. The patient friendly version of 'MUST' ('MUST'-P) was considered quick and easy to use by patients. Implementation of self-screening with 'MUST' could improve the nutritional management of IBD patients.
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Philpott HL, Nandurkar S, Thien F, Bloom S, Lin E, Goldberg R, Boyapati R, Finch A, Royce SG, Gibson PR. Seasonal recurrence of food bolus obstruction in eosinophilic esophagitis. Intern Med J 2016; 45:939-43. [PMID: 25871330 DOI: 10.1111/imj.12790] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/07/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a newly recognised condition that is apparently increasing in prevalence, and the aetiology is poorly understood. The role of aeroallergens in EoE is controversial, given the success of dietary therapy. Massive aeroallergen exposure leading to food bolus obstruction events (FBOE) has been described, and the diagnosis of EoE by esophageal biopsy noted to be more common in the pollen season according to previous case series. AIM To determine if a seasonal variation and a geographical variation occurred in EoE presenting as FBOE in adults, and to track the prevalence of FBOE and EoE over time. METHOD A retrospective case-control study analysis was performed from January 2002 to January 2012 to identify all FBOE in adults presenting to five tertiary hospitals in Melbourne, Australia. Endoscopy, histopathological reports, case notes and blood tests were examined, and postcodes recorded. Records of pollen counts were obtained. Cases were defined according to esophageal biopsy and grouped based on month of diagnosis. All other causes of FBOE served as controls. RESULTS One thousand, one hundred and thirty-two FBOE were identified. Biopsies were only performed in 278 of these cases, and 85 patients were found to have EoE after biopsy. Patients with EoE were younger (mean age 38 years, range 18-72) compared with those with alternative diagnosis (mean age 64.4 range 22-92), more likely to be male (M : F = 4:1 compared with 1.68:1 ) and had a higher eosinophil count in venous blood. Overall no seasonality was demonstrated in FBOE secondary to any diagnosis, although the six cases of recurrent FBOE secondary to EoE mainly occurred in the grass pollen season in subsequent years. FBOE cases were evenly distributed throughout metropolitan Melbourne irrespective of population density. EoE as a percentage of FBOE increased over time. CONCLUSION Seasonal aeroallergens may be important for a subgroup of patients with EoE presenting as recurrent FBOE. Esophageal biopsies are performed in a minority of patients, representing a significant departure from ideal management and contributing to recurrent unnecessary FBOE. EoE is an increasingly important cause of FBOE.
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Morar PS, Faiz O, Warusavitarne J, Brown S, Cohen R, Hind D, Abercrombie J, Ragunath K, Sanders DS, Arnott I, Wilson G, Bloom S, Arebi N. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures. Aliment Pharmacol Ther 2015; 42:1137-48. [PMID: 26358739 DOI: 10.1111/apt.13388] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/16/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy can inform the design of future studies. AIM To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored. METHODS A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom-free outcome at the end of follow-up, TR as post-dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics. RESULTS Twenty-five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60-78.8%), 90.6% (95% CI: 87.8-92.8%), 6.4% (95% CI: 5.0-8.2) and 3% (95% CI: 2.2-4.0%) respectively. Cumulative surgery rate at 5 year follow-up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta-analysis. CONCLUSIONS Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow-up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long-term benefits.
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Tompkins RD, McAllister CA, Bloom S. Research Article: Ploidy Levels for Some Remnant Eastern Big Bluestem (Andropogon gerardii ) Populations: Implications for their Conservation and Restoration. ECOL RESTOR 2015. [DOI: 10.3368/er.33.3.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bloom S, Kemp W, Lubel J. Portal hypertension: pathophysiology, diagnosis and management. Intern Med J 2015; 45:16-26. [DOI: 10.1111/imj.12590] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/27/2014] [Indexed: 12/19/2022]
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Punwani S, Hafeez R, Bainbridge A, Boulos P, Halligan S, Bloom S, Taylor SA. Quantitative MRI of colonic mural enhancement: segmental differences exist in endoscopically proven normal colon. Br J Radiol 2012; 85:1314-9. [PMID: 22919009 DOI: 10.1259/bjr/30031314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Abnormal contrast enhancement on MRI is advocated as a biomarker for inflammation in colitis, although the enhancement kinetics of normal colon are poorly described. Our purpose was to quantitatively assess mural enhancement in normal colon and test for intersegmental differences. METHODS Eight patients without prior history of inflammatory bowel disease underwent standard MRI colonography followed by normal same-day colonoscopy. Acquired sequences included a volumetric interpolated breath-hold examination (VIBE) to encompass the whole colonic volume, performed at 5°, 10° and 35° flip angles for T(1) quantitation and then at a fixed 35° flip angle three times prior to and every 30 s following intravenous gadoterate meglumine for 220 s. Ascending colon, descending colon and rectal R(1) (1/T(1)) was plotted against time. Mean pre-contrast R(1), initial change of R(1) (ΔR(1)), early and late "plateau phase" enhancement and the area under the R(1)-time (AUC-R(1)) curve were compared between segments using the Student's paired t-test. RESULTS There was no significant difference of pre-contrast R(1) between segments (p=0.49 to 0.62). ΔR(1) was higher for ascending colon compared with descending colon (0.0023±0.0012 ms(-1) vs 0.0010±0.0011 ms(-1), p=0.03). There was no significant difference for early or late plateau phase R(1) between colonic segments (p=0.08 to 1.00). AUC-R(1) was greater for ascending than descending colon (0.54±0.19 vs 0.30±0.14, p=0.03). CONCLUSIONS Intersegmental differences in colonic enhancement are present and should be considered when interpreting differential segmental enhancement.
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Radhamma A, Halligan S, Bloom S, McCartney S, Taylor SA. MRI enterography: what is the clinical impact of unsuspected extra-enteric findings? Br J Radiol 2012; 85:e766-9. [PMID: 22553300 DOI: 10.1259/bjr/33344438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To define the incidence and nature of incidental extra-enteric findings on magnetic resonance enterography (MRE) following the introduction of a new clinical service, to assess the volume of additional tests generated and to gauge the potential of MRE to reduce the need for subsequent abdominal imaging. The imaging and patient records of 500 consecutive patients undergoing MRE at a single institution were reviewed. Note was made of patient demographics, any extra-enteric findings reported on the MRE, whether additional tests were recommended by the reporting radiologists to clarify or follow up extra-enteric findings and whether the patients underwent additional abdominal or pelvic imaging in the 4 months after the MRE. 64% of the cohort was male. The mean age was 45 years (range 11-80 years). Overall 190 (38%) underwent MRE for assessment of known Crohn's disease and 310 (62%) for other indications, such as abdominal pain and anaemia. 26 non-bowel-related extra-enteric abnormalities were noted on the MRE report in just 15 patients (3%), and a total of 6 additional tests were recommended by the reporting radiologist. 13 patients (2.6%) underwent some form of abdominal imaging within 4 months of the MRE. None of these additional investigations revealed any abnormality missed on the MRE. Extra-enteric findings are unlikely to have a significant impact on healthcare resources after the introduction of an MRE service.
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Abstract
The control of food intake consists of neural and hormonal signals between the gut and central nervous system (CNS). Gut hormones such as CCK, PYY and PP signal to important areas in the CNS involved in appetite regulation to terminate a meal. These hormones can act directly via the circulation and activate their respective receptors in the hypothalamus and brainstem. In addition, gut vagal afferents also exist, providing an alternative pathway through which gut hormones can communicate with higher centres through the brainstem. Animal and human studies have demonstrated that peripheral administration of certain gut hormones reduces food intake and leads to weight loss. Gut hormones are therefore potential targets in the development of novel treatments for obesity and analogue therapies are currently under investigation.
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Hafeez R, Wagner CV, Smith S, Boulos P, Halligan S, Bloom S, Taylor SA. Patient experiences of MR colonography and colonoscopy: a qualitative study. Br J Radiol 2011; 85:765-9. [PMID: 22010031 DOI: 10.1259/bjr/36231529] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to apply qualitative techniques to assimilate data on patient experience and attitudes during MR colonography (MRC) and colonoscopy (CC). METHODS 18 patients (11 male, 8 female, median age 40.5 years), 10 of whom had known colonic inflammatory bowel disease (IBD) and 8 who were under investigation for suspected colonic neoplasia (non-IBD), underwent MRC and conventional CC. Semi-structured interviews were performed to assimilate test experiences and preferences, and themes were extracted using thematic analysis. RESULTS Thematic analysis identified three main themes: (i) physical experience, (ii) information provision and (iii) overall preference. Patients expressed mixed views about the physical experience of MRC but specifically identified water filling, breath holding and lying still as problematic. Anxiety was expressed regarding potential incontinence. Scanner noise interfered with the understanding of instructions, particularly amongst non-IBD patients. Non-IBD patients expressed greater anxiety over the delay in receiving the MRC report than IBD patients. In general MRI was considered as the more informative and safer investigation. Patients reported more physical discomfort during CC (notably IBD patients) related to air insufflation and colonoscopic manipulation but were more satisfied with the feedback they received. 10 patients (56%) stated an overall preference for MRC and 5 (28%) preferred CC. Reasons for preferences stated by the patients included discomfort, speed of the test, safety, perceived diagnostic ability and the ability to take biopsies. CONCLUSION Experiences of MRC and CC are complex and influenced by clinical indication. Individuals place different weightings on the relative importance of test attributes including discomfort, noise, immobility, feedback, safety and fear of incontinence and this defines overall preference.
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Hafeez R, Punwani S, Boulos P, Bloom S, McCartney S, Halligan S, Taylor SA. Diagnostic and therapeutic impact of MR enterography in Crohn's disease. Clin Radiol 2011; 66:1148-58. [PMID: 21943719 DOI: 10.1016/j.crad.2010.12.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 12/22/2022]
Abstract
AIM To assess the impact of magnetic resonance enterography (MRE) on clinician diagnostic confidence and therapeutic strategy in patients under investigation for small bowel Crohn's disease. MATERIAL AND METHODS Gastroenterologists completed a proforma before and following MRE in 51 patients (mean age 35 years, 26 female) under investigation for small bowel Crohn's disease, indicating percentage confidence for presence/absence of small bowel involvement. In suspected disease, diagnostic confidence (using a scoring system from 1=no to 6=yes) was scored for subcategories: extent >30 cm (DE), terminal ileum (lTI), jejunal (JD), colonic disease (CoD), strictures (ST), activity (AD), extraluminal complications (EL), and surgical need (NS). Therapeutic strategy was recorded. Patients were divided into three groups: 1=suspected disease, MRE normal (n=15); 2=suspected disease, MRE abnormal (n=30); 3=no suspected disease, MRE normal (n=6). Binomial exact and paired t-tests were use to compare confidence pre and post-MRE. RESULTS Mean percentage confidence for the presence/absence of small bowel disease increased from 62 to 84% (p=0.003), 87 to 98% (p=0.0001), and 83 to 98% (p=0.005) after MRE for groups 1, 2, and 3, respectively. In suspected disease, confidence changed significantly for all of the subcategories (p<0.001) except EL in group 1. The percentage of patients with a confidence change ranged from 40% (CoD) to 87% (lTI; group 1) and from 7% (EL) to 93% (DE; group 2). Therapeutic strategy changed in 31/51 (61%, 95% CI 47-74%), 14 with a reduction in planned therapy and 17 with an increase. CONCLUSION MRE had a positive diagnostic impact in patients under investigation for small bowel Crohn's disease and this influenced therapeutic strategy in 61% of the patients.
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Hafeez R, Greenhalgh R, Rajan J, Bloom S, McCartney S, Halligan S, Taylor SA. Use of small bowel imaging for the diagnosis and staging of Crohn's disease--a survey of current UK practice. Br J Radiol 2010; 84:508-17. [PMID: 21081570 DOI: 10.1259/bjr/65972479] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study used a postal survey to assess the current use of small bowel imaging investigations for Crohn's disease within National Health Service (NHS) radiological practice and to gauge gastroenterological referral patterns. METHODS Similar questionnaires were posted to departments of radiology (n = 240) and gastroenterology (n = 254) identified, by the databases of the Royal College of Radiologists and British Society of Gastroenterologists. Questionnaires enquired about the use of small bowel imaging in the assessment of Crohn's disease. In particular, questionnaires described clinical scenarios including first diagnosis, disease staging and assessment of suspected extraluminal complications, obstruction and disease flare. The data were stratified according to patient age. RESULTS 63 (27%) departments of radiology (20 in teaching hospitals and 43 in district general hospitals (DGHs)) and 73 (29%) departments of gastroenterology replied. These departments were in 119 institutions. Of the 63 departments of radiology, 55 (90%) routinely performed barium follow-though (BaFT), 50 (80%) CT, 29 (46%) small bowel ultrasound (SbUS) and 24 (38%) small bowel MRI. BaFT was the most commonly used investigation across all age groups and indications. SbUS was used mostly for patients younger than 40 years of age with low index of clinical suspicion for Crohn's disease (in 44% of radiology departments (28/63)). MRI was most frequently used in patients under 20 years of age for staging new disease (in 27% of radiology departments (17/63)) or in whom obstruction was suspected (in 29% of radiology departments (18/63)). CT was preferred for suspected extraluminal complications or obstruction (in 73% (46/63) and 46% (29/63) of radiology departments, respectively). Gastroenterological referrals largely concurred with the imaging modalities chosen by radiologists, although gastroenterologists were less likely to request SbUS and MRI. CONCLUSION BaFT remains the mainstay investigation for luminal small bowel Crohn's disease, with CT dominating for suspected extraluminal complications. There has been only moderate dissemination of the use of MRI and SbUS.
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Abstract
A small series of pilot seminars on ethics and values in prison practice have been held over the past two years. This article outlines the background, the content and the relevance to prison staff. It concludes that a full trial of the approach for both staff and prisoners would seem to be necessary and that the seminars should be tried with public health practitioners.
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von Wagner C, Good A, Wright D, Rachet B, Obichere A, Bloom S, Wardle J. Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England. Br J Cancer 2010; 101 Suppl 2:S60-3. [PMID: 19956165 PMCID: PMC2790701 DOI: 10.1038/sj.bjc.6605392] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Introduction of organised, population-based, colorectal cancer screening in the United Kingdom using the faecal occult blood test (FOBT) has the potential to reduce overall colorectal cancer mortality. However, socio-economic variation in screening participation could exacerbate existing inequalities in mortality. METHODS This study examined FOBT uptake rates in London, England in relation to area-level socio-economic deprivation over the first 30 months of the programme during which 401 197 individuals were sent an FOBT kit. Uptake was defined as return of a completed test kit within 3 months. Area-level deprivation in each postcode sector was indexed with the Townsend Material Deprivation Index. Analyses controlled for area-level household mobility, ethnic diversity and poor health, each of which was associated with lower return rates. RESULTS The results showed a strong socio-economic gradient in FOBT uptake, which declined from 49% in the least deprived quintile of postcodes to 38% in the middle quintile and 32% in the most deprived quintile. Variation in socio-economic deprivation between sectors accounted for 62% of the variance in return rates, with little attenuation as a result of controlling for ethnic diversity, household mobility or health status. CONCLUSION These results highlight the need to understand the causes of socio-economic gradients in screening participation and address barriers that could otherwise increase disparities in colorectal cancer survival.
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Caidi H, Bloom S, Azilmaat M, Benjouad A, Reef S, El Aouad R. Rubella seroprevalence among women aged 15-39 years in Morocco. EASTERN MEDITERRANEAN HEALTH JOURNAL 2009. [DOI: 10.26719/2009.15.3.526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Caidi H, Bloom S, Azilmaat M, Benjouad A, Reef S, El Aouad R. Rubella seroprevalence among women aged 15-39 years in Morocco. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2009; 15:526-531. [PMID: 19731768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study was designed to determine the age-specific rubella seroprevalence in women of childbearing age in Morocco and to contribute to the development of a rubella vaccination strategy in the country. Of 967 women aged 15-39 years tested in 2000, 161 (16.6%) were susceptible to rubella based on absence of IgG antibodies. A significantly higher rate of susceptibility among women aged 15-19 years was observed (29.3%) compared with age 35-39 years (8.3%). An estimated 77,562 live births occur annually to rubella-susceptible women. No statistical difference in seroprevalence was seen between women in rural and urban areas (81.5% and 85.0% respectively). A substantial risk of rubella infection exists for Moroccan women of childbearing age.
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Hill CS, Khan AF, Bloom S, McCartney S, Choi D. A rare case of vomiting: fourth ventricular B-cell lymphoma. J Neurooncol 2008; 93:261-2. [PMID: 19093074 DOI: 10.1007/s11060-008-9765-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 12/08/2008] [Indexed: 11/28/2022]
Abstract
We document the case of a 69-year-old man presenting with 6 weeks of intractable vomiting. Magnetic Resonance Imaging showed a homogenously enhancing mass in the caudal fourth ventricle. Surgical exploration and biopsy was performed and pathological examination demonstrated a high-grade B-cell lymphoma. The lesion was a primary tumour in an immuno-competent patient. Despite the increasing incidence of primary central nervous system lymphomas this is believed to be only the third ever case to have occurred at this rare site. We suggest that primary B-cell lymphoma should be considered with homogenous lesions of the fourth ventricle.
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Marks DJB, Radulovic M, McCartney S, Bloom S, Segal AW. Modified skin window technique for the extended characterisation of acute inflammation in humans. Inflamm Res 2007; 56:168-74. [PMID: 17522815 PMCID: PMC2631663 DOI: 10.1007/s00011-006-6119-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To modify the skin window technique for extended analysis of acute inflammatory responses in humans, and demonstrate its applicability for investigating disease. SUBJECTS 15 healthy subjects and 5 Crohn's patients. TREATMENT Skin windows, created by dermal abrasion, were overlaid for various durations with filter papers saturated in saline, 100 ng/ml muramyl dipeptide (MDP) or 10 microg/ml interleukin-8 (IL-8). METHODS Exuded leukocytes were analyzed by microscopy, immunoblot, DNA-bound transcription factor arrays and RT-PCR. Inflammatory mediators were quantified by ELISA. RESULTS Infiltrating leukocytes were predominantly neutrophils. Numerous secreted mediators were detectable. MDP and IL-8 enhanced responses. Many signalling proteins were phosphorylated with differential patterns in Crohn's patients, notably PKC alpha/beta hyperphosphorylation (11.3 +/- 3.1 vs 1.2 +/- 0.9 units, P < 0.02). Activities of 44 transcription factors were detectable, and sufficient RNA isolated for expression analysis of over 400 genes. CONCLUSIONS The modifications enable broad characterisation of inflammatory responses and administration of exogenous immunomodulators.
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Vaschenko G, Etxarri AG, Menoni CS, Rocca JJ, Hemberg O, Bloom S, Chao W, Anderson EH, Attwood DT, Lu Y, Parkinson B. Nanometer-scale ablation with a table-top soft x-ray laser. OPTICS LETTERS 2006; 31:3615-7. [PMID: 17130921 DOI: 10.1364/ol.31.003615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Ablation of holes with diameters as small as 82 nm and very clean walls was obtained in poly(methyl methacrylate) focusing pulses from a Ne-like Ar 46.9 nm compact capillary-discharge laser with a freestanding Fresnel zone plate diffracting into third order. These results demonstrate the feasibility of using focused soft x-ray laser beams for the direct nanoscale patterning of materials and the development of new nanoprobes.
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Marks DJB, Rahman FZ, Novelli M, Yu RC, McCartney S, Bloom S, Segal AW. An exuberant inflammatory response to E coli: implications for the pathogenesis of ulcerative colitis and pyoderma gangrenosum. Gut 2006; 55:1662-3. [PMID: 17047113 PMCID: PMC1860126 DOI: 10.1136/gut.2006.104943] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Bloom S, Kiilerich S, Lassen MR, Forbes A, Leiper K, Langholz E, Irvine EJ, O'Morain C, Lowson D, Orm S. Low molecular weight heparin (tinzaparin) vs. placebo in the treatment of mild to moderately active ulcerative colitis. Aliment Pharmacol Ther 2004; 19:871-8. [PMID: 15080848 DOI: 10.1111/j.1365-2036.2004.01926.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Heparin has anti-inflammatory and immunomodulatory activity which may be of therapeutic benefit in the treatment of ulcerative colitis. AIM To test whether low molecular weight heparin, given subcutaneously, would provide a significant therapeutic response compared with placebo in the treatment of mild to moderate ulcerative colitis. STUDY DESIGN A prospective, double-blind, randomized, placebo-controlled, multi-centre trial comparing tinzaparin 175 anti-Xa IU/kg/day (innohep, LEO Pharma) subcutaneously for 14 days followed by tinzaparin 4500 anti-Xa IU/day subcutaneously for 28 days with placebo, administered subcutaneously once daily for up to 42 days. The primary outcome measure was the mean change in colitis activity from baseline to the end of study treatment assessed by the sum of scores of stool frequency, rectal bleeding, sigmoidoscopic appearance and histology. Secondary outcome measures included changes in individual activity indices and laboratory parameters. Patients were assessed at weekly intervals for 6 weeks and within 1 week of completing treatment. RESULTS One hundred patients with active ulcerative colitis (up to six bloody stools per day, no fever, no tachycardia or systemic disturbances) were randomized. Forty-eight received tinzaparin and 52 received placebo. The difference in the mean percentage change in colitis activity from baseline to end of treatment (tinzaparin-placebo) was not statistically significant (P = 0.84). There was no difference between tinzaparin and placebo in any secondary outcome measure. One major bleed (rectal), occurred in a patient receiving placebo. CONCLUSION This is the largest trial to date of heparin in ulcerative colitis. The results show no benefit of low molecular weight heparin over placebo in mild to moderately active ulcerative colitis.
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