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Nogal A, Asnicar F, Vijay A, Kouraki A, Visconti A, Louca P, Wong K, Baleanu AF, Giordano F, Wolf J, Hadjigeorgiou G, Davies R, Michelotti GA, Franks PW, Berry SE, Falchi M, Ikram A, Ollivere BJ, Zheng A, Nightingale J, Mangino M, Segata N, Bulsiewicz WJ, Spector TD, Valdes AM, Menni C. Genetic and gut microbiome determinants of SCFA circulating and fecal levels, postprandial responses and links to chronic and acute inflammation. Gut Microbes 2023; 15:2240050. [PMID: 37526398 PMCID: PMC10395212 DOI: 10.1080/19490976.2023.2240050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
Short-chain fatty acids (SCFA) are involved in immune system and inflammatory responses. We comprehensively assessed the host genetic and gut microbial contribution to a panel of eight serum and stool SCFAs in two cohorts (TwinsUK, n = 2507; ZOE PREDICT-1, n = 328), examined their postprandial changes and explored their links with chronic and acute inflammatory responses in healthy individuals and trauma patients. We report low concordance between circulating and fecal SCFAs, significant postprandial changes in most circulating SCFAs, and a heritable genetic component (average h2: serum = 14%(SD = 14%); stool = 12%(SD = 6%)). Furthermore, we find that gut microbiome can accurately predict their fecal levels (AUC>0.71) while presenting weaker associations with serum. Finally, we report different correlation patterns with inflammatory markers depending on the type of inflammatory response (chronic or acute trauma). Our results illustrate the breadth of the physiological relevance of SCFAs on human inflammatory and metabolic responses highlighting the need for a deeper understanding of this important class of molecules.
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Affiliation(s)
- Ana Nogal
- Department of Twin Research, King’s College London, London, UK
| | - Francesco Asnicar
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Amrita Vijay
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Afroditi Kouraki
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Kari Wong
- Metabolon, Metabolon, Inc. Research Triangle Park, Morrisville, NC, USA
| | | | | | | | | | | | | | - Paul W. Franks
- Lund University Diabetes Center, Lund University, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sarah E. Berry
- Department of Nutritional Sciences, King’s College London, London, UK
| | - Mario Falchi
- Department of Twin Research, King’s College London, London, UK
| | - Adeel Ikram
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Benjamin J. Ollivere
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Amy Zheng
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Jessica Nightingale
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Massimo Mangino
- Department of Twin Research, King’s College London, London, UK
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, London, UK
| | - Nicola Segata
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | | | - Tim D. Spector
- Department of Twin Research, King’s College London, London, UK
| | - Ana M. Valdes
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | - Cristina Menni
- Department of Twin Research, King’s College London, London, UK
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Fatima R, Yaqoob A, Qadeer E, Khan MA, Ghafoor A, Jamil B, Haq MU, Ahmed N, Baig S, Rehman A, Abbasi Q, Khan AW, Ikram A, Hicks JP, Walley J. Community- vs. hospital-based management of multidrug-resistant TB in Pakistan. Int J Tuberc Lung Dis 2022; 26:929-933. [PMID: 36163662 DOI: 10.5588/ijtld.21.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.
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Affiliation(s)
- R Fatima
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - A Yaqoob
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan, University of Bergen, Bergen, Norway
| | - E Qadeer
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - M A Khan
- Association for Social Development, Islamabad, Pakistan
| | - A Ghafoor
- National TB Control Program, Islamabad, Pakistan
| | - B Jamil
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - M U Haq
- University of Bergen, Bergen, Norway, National TB Control Program, Islamabad, Pakistan
| | - N Ahmed
- Ojha Institute of Chest Diseases, Karachi, Pakistan
| | - S Baig
- Ojha Institute of Chest Diseases, Karachi, Pakistan
| | - A Rehman
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - Q Abbasi
- TB Samli Sanatorium Hospital, Murree, Pakistan
| | - A W Khan
- National TB Control Program, Islamabad, Pakistan
| | - A Ikram
- National Institute of Health, Islamabad, Pakistan
| | - J P Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, UK
| | - J Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, UK
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Ikram A, Norrish AR, Marson BA, Craxford S, Gladman JRF, Ollivere BJ. Can the Clinical Frailty Scale on admission predict 30-day survival, postoperative complications, and institutionalization in patients with fragility hip fracture? : a cohort study of 1,255 patients. Bone Joint J 2022; 104-B:980-986. [PMID: 35909371 PMCID: PMC9948448 DOI: 10.1302/0301-620x.104b8.bjj-2020-1835.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture. METHODS Of 1,577 consecutive patients aged > 65 years with a fragility hip fracture admitted to one institution, for whom there were complete data, 1,255 (72%) were studied. Clinicians assigned CFS scores on admission. Audit personnel routinely prospectively completed the Standardised Audit of Hip Fracture in Europe form, including the following outcomes: 30-day survival; in-hospital complications; length of acute hospital stay; and new institutionalization. The relationship between the CFS scores and outcomes was examined graphically and the visual interpretations were tested statistically. The predictive values of the CFS and Nottingham Hip Fracture Score (NHFS) to predict 30-day mortality were compared using receiver operating characteristic area under the curve (AUC) analysis. RESULTS Significant non-linear associations between CFS and outcomes were observed. Risk of death within 30 days rose linearly for CFS 1 to 5, but plateaued for CFS > 5. The incidence of complications and length of stay rose linearly for CFS 1 to 4, but plateaued for CFS > 4. In contrast, the risk of new institutionalization rose linearly for CFS 1 to 8. The AUCs for 30-day mortality for the CFS and NHFS were very similar: CFS AUC 0.63 (95% CI 0.57 to 0.69) and NHFS AUC 0.63 (95% CI 0.57 to 0.69). CONCLUSION Use of the CFS may provide useful information on outcomes for fitter patients presenting with hip fracture, but completion of the CFS by the admitting orthopaedic team does not appear successful in distinguishing between higher CFS categories, which define patients with frailty. This makes a strong case for the role of the orthogeriatrician in the early assessment of these patients. Further work is needed to understand why patients assessed as being of mild, moderate, and severe frailty do not result in different outcomes. Cite this article: Bone Joint J 2022;104-B(8):980-986.
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Affiliation(s)
- Adeel Ikram
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - Alan R. Norrish
- Nottingham University Hospitals NHS Trust, Nottingham, UK,Queen Elizabeth Hospital, King’s Lynn, UK
| | - Ben A. Marson
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - Simon Craxford
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - John R. F. Gladman
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Unit, Nottingham, UK,NIHR Applied Research Collaboration East Midlands, Nottingham, UK
| | - Ben J. Ollivere
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Unit, Nottingham, UK,Correspondence should be sent to Ben J. Ollivere. E-mail:
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Marson BA, Ikram A, Craxford S, Lewis SR, Price KR, Ollivere BJ. Interventions for treating supracondylar elbow fractures in children. Cochrane Database Syst Rev 2022; 6:CD013609. [PMID: 35678077 PMCID: PMC9178297 DOI: 10.1002/14651858.cd013609.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Elbow supracondylar fractures are common, with treatment decisions based on fracture displacement. However, there remains controversy regarding the best treatments for this injury. OBJECTIVES To assess the effects (benefits and harms) of interventions for treating supracondylar elbow fractures in children. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase in March 2021. We also searched trial registers and reference lists. We applied no language or publication restrictions. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing different interventions for the treatment of supracondylar elbow fractures in children. We included studies investigating surgical interventions (different fixation techniques and different reduction techniques), surgical versus non-surgical treatment, traction types, methods of non-surgical intervention, and timing and location of treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data and conducted GRADE assessment for five critical outcomes: functional outcomes, treatment failure (requiring re-intervention), nerve injury, major complications (pin site infection in most studies), and cosmetic deformity (cubitus varus). MAIN RESULTS: We included 52 trials with 3594 children who had supracondylar elbow fractures; most were Gartland 2 and 3 fractures. The mean ages of children ranged from 4.9 to 8.4 years and the majority of participants were boys. Most studies (33) were conducted in countries in South-East Asia. We identified 12 different comparisons of interventions: retrograde lateral wires versus retrograde crossed wires; lateral crossed (Dorgan) wires versus retrograde crossed wires; retrograde lateral wires versus lateral crossed (Dorgan) wires; retrograde crossed wires versus posterior intrafocal wires; retrograde lateral wires in a parallel versus divergent configuration; retrograde crossed wires using a mini-open technique or inserted percutaneously; buried versus non-buried wires; external versus internal fixation; open versus closed reduction; surgical fixation versus non-surgical immobilisation; skeletal versus skin traction; and collar and cuff versus backslab. We report here the findings of four comparisons that represent the most substantial body of evidence for the most clinically relevant comparisons. All studies in these four comparisons had unclear risks of bias in at least one domain. We downgraded the certainty of all outcomes for serious risks of bias, for imprecision when evidence was derived from a small sample size or had a wide confidence interval (CI) that included the possibility of benefits or harms for both treatments, and when we detected the possibility of publication bias. Retrograde lateral wires versus retrograde crossed wires (29 studies, 2068 children) There was low-certainty evidence of less nerve injury with retrograde lateral wires (RR 0.65, 95% CI 0.46 to 0.90; 28 studies, 1653 children). In a post hoc subgroup analysis, we noted a greater difference in the number of children with nerve injuries when lateral wires were compared to crossed wires inserted with a percutaneous medial wire technique (RR 0.41, 95% CI 0.20 to 0.81, favours lateral wires; 10 studies, 552 children), but little difference when an open technique was used (RR 0.91, 95% CI 0.59 to 1.40, favours lateral wires; 11 studies, 656 children). Although we noted a statistically significant difference between these subgroups from the interaction test (P = 0.05), we could not rule out the possibility that other factors could account for this difference. We found little or no difference between the interventions in major complications, which were described as pin site infections in all studies (RR 1.08, 95% CI 0.65 to 1.79; 19 studies, 1126 children; low-certainty evidence). For functional status (1 study, 35 children), treatment failure requiring re-intervention (1 study, 60 children), and cosmetic deformity (2 studies, 95 children), there was very low-certainty evidence showing no evidence of a difference between interventions. Open reduction versus closed reduction (4 studies, 295 children) Type of reduction method may make little or no difference to nerve injuries (RR 0.30, 95% CI 0.09 to 1.01, favours open reduction; 3 studies, 163 children). However, there may be fewer major complications (pin site infections) when closed reduction is used (RR 4.15, 95% CI 1.07 to 16.20; 4 studies, 253 children). The certainty of the evidence for these outcomes is low. No studies reported functional outcome, treatment failure requiring re-intervention, or cosmetic deformity. The four studies in this comparison used direct visualisation during surgery. One additional study used a joystick technique for reduction, and we did not combine data from this study in analyses. Surgical fixation using wires versus non-surgical immobilisation using a cast (3 studies, 140 children) There was very low-certainty evidence showing little or no difference between interventions for treatment failure requiring re-intervention (1 study, 60 children), nerve injury (3 studies, 140 children), major complications (3 studies, 126 children), and cosmetic deformity (2 studies, 80 children). No studies reported functional outcome. Backslab versus sling (1 study, 50 children) No nerve injuries or major complications were experienced by children in either group; this evidence is of very low certainty. Functional outcome, treatment failure, and cosmetic deformity were not reported. AUTHORS' CONCLUSIONS: We found insufficient evidence for many treatments of supracondylar fractures. Fixation of displaced supracondylar fractures with retrograde lateral wires compared with crossed wires provided the most substantial body of evidence in this review, and our findings indicate that there may be a lower risk of nerve injury with retrograde lateral wires. In future trials of treatments, we would encourage the adoption of a core outcome set, which includes patient-reported measures. Evaluation of the effectiveness of traction compared with surgical fixation would provide a valuable addition to this clinical field.
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Affiliation(s)
- Ben A Marson
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Adeel Ikram
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Simon Craxford
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
| | - Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Kathryn R Price
- Department of Trauma and Orthopaedics, Nottingham Children's Hospital, Nottingham, UK
| | - Benjamin J Ollivere
- Department of Trauma and Orthopaedics, University of Nottingham, Nottingham, UK
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Ikram A, Norrish A, Ollivere L, Nightingale J, Valdes A, Ollivere BJ. Has a change in established care pathways during the first wave of the COVID-19 pandemic led to an excess death rate in the fragility fracture population? A longitudinal cohort study of 1846 patients. BMJ Open 2022; 12:e058526. [PMID: 35523492 PMCID: PMC9082727 DOI: 10.1136/bmjopen-2021-058526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE During the first wave of the COVID-19 pandemic, changes to established care pathways and discharge thresholds for patients with fragility fractures were made. This was to increase hospital bed capacity and minimise the inpatient risk of contracting COVID-19. This study aims to identify the excess death rate in this population during the first wave of the pandemic. DESIGN A longitudinal cohort study of patients with fragility fractures identified by specific International Classification of Diseases (ICD)-10 codes. The first wave of the pandemic was defined as the 3-month period between 1 March and 1 June 2020. The control group presented between 1 March and 1 June 2019. SETTING Two acute National Health Service hospitals within the East Midlands region of England. PARTICIPANTS 1846 patients with fragility fractures over the aforementioned two specified matched time points. PRIMARY AND SECONDARY OUTCOME MEASURES Four-month mortality of all patients with fragility fractures with a subanalysis of patients with fragility hip fractures. RESULTS 832 patients with fragility fracture were admitted during the pandemic period (104 diagnosed with COVID-19). 1014 patients presented with fragility fractures in the control group. Mortality in patients with fragility fracture without COVID-19 was significantly higher among pandemic period admissions (14.7%) than the pre-pandemic cohort (10.2%) (HR=1.86; 95% CI 1.41 to 2.45; p<0.001) adjusted for age and sex. Length of stay was shorter during the pandemic period (effect size=-4.2 days; 95% CI -5.8 to -3.1, p<0.001). Subanalysis of patients with fragility hip fracture revealed a mortality of 8.4% in the pre-pandemic cohort, and 15.48% during pandemic admissions with no COVID-19 diagnosis (HR=2.08; 95% CI 1.11 to 3.90; p=0.021). CONCLUSIONS There is a significant increase in excess death, not explained by confirmed COVID-19 infections. Altered care pathways and aggressive discharge criteria during the pandemic are likely responsible for the increase in excess deaths.
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Affiliation(s)
- Adeel Ikram
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Norrish
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Luke Ollivere
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jessica Nightingale
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ana Valdes
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Benjamin J Ollivere
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham School of Medicine, Nottingham, UK
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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FANDRI B, Toumi S, Abid H, Chaker H, Ikram A, Najla D, Kammoun K, Yaich S, Ben Hmida M. POS-614 AORTIC ARCH CALCIFICATIONS AND MORTALITY IN HEMODIALYSIS PATIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rana MS, Usman M, Raisani A, Alam MM, Umair M, Salman M, Ikram A, Zahoor Zaidi SS, Alzahrani KJ, Mehmood N. Age, sex, and comorbidities related trajectories of deceased COVID-19 patients in Balochistan, Pakistan. Eur Rev Med Pharmacol Sci 2022; 26:740-742. [PMID: 35179738 DOI: 10.26355/eurrev_202202_27980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- M S Rana
- National Institute of Health, Islamabad, Pakistan.
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FANDRI B, Ikram A, Najla D, Salma T, Soumaya Y, Hanen C, Khawla K, Mariem S, Tahya B, Mohamed B. POS-512 COMPLEMENT-MEDIATED THROMBOTIC MICROANGIOPATHY IN NEPHROLOGY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
AIMS Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited. METHODS Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year. RESULTS A total of 3,966 patients were identified. The overall rate of SSI was 1.7% (51 patients (1.3%) with deep SSI, and 18 (0.45%) with superficial SSI). In all, 50 patients underwent revision surgery for infection (43 with DAIR, and seven with excision arthroplasty). After adjustment for other variables, only concurrent urinary tract infection (odds ratio (OR) 2.78, 95% confidence interval (CI) 1.57 to 4.92; p < 0.001) and increasing delay to theatre for treatment of the fracture (OR 1.31 per day, 95% CI 1.12 to 1.52; p < 0.001) were predictors of developing a SSI, while a cemented arthroplasty was protective (OR 0.54, 95% CI 0.31 to 0.96; p = 0.031). In all, nine patients (20.9%) were alive at one year with a functioning hemiarthroplasty following DAIR, 20 (46.5%) required multiple surgical debridements after an initial DAIR, and 18 were converted to an excision arthroplasty due to persistent infection, with six were alive at one year. The culture of any gram-negative organism reduced success rates to 12.5% (no cases were successful with methicillin-resistant Staphylococcus aureus or Pseudomonas infection). Favourable organisms included Citrobacter and Proteus (100% cure rate). The all-cause mortality at one year after deep SSI was 55.87% versus 24.9% without deep infection. CONCLUSION Deep infection remains a devastating complication regardless of the treatment strategy employed. Success rates of DAIR are poor compared to total hip arthroplasty, and should be reserved for favourable organisms in patients able to tolerate multiple surgical procedures. Cite this article: Bone Jt Open 2021;2(11):958-965.
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Affiliation(s)
| | | | | | - Adeel Ikram
- The University of Nottingham, Nottingham, UK
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Wang K, Ahmadizar F, Arshi B, Kors J, Ikram A, Kavousi M. Heart rate variability and incident type 2 diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hyperglycemia and autonomic dysfunction are bidirectionally related. The implications from former cross-sectional studies regarding the association of autonomic dysfunction and diabetes are limited due to the potential reverse causation. We aimed to investigate the association of longitudinal evolution of heart rate variability (HRV) with incident type 2 diabetes mellitus (T2D) among the general population.
Methods
Using data from the prospective population-based cohort study, 7630 participants with available repeated assessments of HRV, who were free of T2D and atrial fibrillation, were included. Measurements of HRV were analyzed from standard 10-s electrocardiograms records, including heart rate and two time-domain HRV markers: the heart-rate corrected standard deviation of the normal-to-normal RR intervals (SDNNc) and heart-rate corrected root mean square of successive RR-interval differences (RMSSDc). Joint models with the Bayes approach were performed to assess the associations between longitudinal evolutions of heart rate and different HRV metrics with incident T2D during follow-up. Models were adjusted for age, sex, body mass index, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, use of blood pressure-lowering or lipid-lowering medication, and prevalent cardiovascular disease. Spearmen correlation was used to examine the associations between HRV metrics and glycemic traits (fasting blood glucose, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β)) at baseline.
Results
During a median follow-up time of 8.6 years, 871 individuals developed T2D. Based on joint models, one standard deviation (SD) increment of heart rate (hazard ratio [HR], 1.21; 95% CI, 1.09–1.34), log(SDNNc) (HR, 1.10; 95% CI, 0.94–1.27), and log(RMSSDc) (HR, 1.15; 95% CI, 1.02–1.31) was associated with the risk of developing T2D in fully-adjusted models. Subgroup analyses suggested stronger associations among men. The HRs of incident T2D per SD increment were 1.25 (1.09, 1.43) for men and 1.16 (0.99, 1.35) for women for heart rate, 1.23 (1.01, 1.51) for men and 0.97 (0.78, 1.20) for women for log(SDNNc), and 1.24 (1.05, 1.48) for men and 1.09 (0.89, 1.31) for women for log(RMSSDc). Results did not change after excluding participants who were prediabetes at baseline or after exclusion of underweight participants. Spearmen correlation indicated that heart rate was significantly associated with baseline glycemic traits, while RMSSDc was only related to fasting blood glucose.
Conclusion
Our study suggests that both higher heart rate and heart rate variability are associated with an increased risk of T2D development, especially among men.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Erasmus MC and Erasmus University Rotterdam; Netherlands Organization for Scientific Research; Netherlands Organization for Health Research and Development (ZonMw); Research Institute for Diseases in the Elderly; Netherlands Genomics Initiative; Netherlands Ministry of Education, Culture and Science; Netherlands Ministry of Health, Welfare and Sports; European Commission; and Municipality of Rotterdam. We would like to thank the China Scholarship Council for the scholarship to K.W. Forest plot
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Affiliation(s)
- K Wang
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - F Ahmadizar
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - B Arshi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - J Kors
- Erasmus University Medical Centre, Medical Informatics, Rotterdam, Netherlands (The)
| | - A Ikram
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
| | - M Kavousi
- Erasmus University Medical Centre, Epidemiology, Rotterdam, Netherlands (The)
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Urbanowicz RA, Tsoleridis T, Jackson HJ, Cusin L, Duncan JD, Chappell JG, Tarr AW, Nightingale J, Norrish AR, Ikram A, Marson B, Craxford SJ, Kelly A, Aithal GP, Vijay A, Tighe PJ, Ball JK, Valdes AM, Ollivere BJ. Two doses of the SARS-CoV-2 BNT162b2 vaccine enhance antibody responses to variants in individuals with prior SARS-CoV-2 infection. Sci Transl Med 2021; 13:eabj0847. [PMID: 34376569 PMCID: PMC9835846 DOI: 10.1126/scitranslmed.abj0847] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Understanding the impact of prior infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the response to vaccination is a priority for responding to the coronavirus disease 2019 (COVID-19) pandemic. In particular, it is necessary to understand how prior infection plus vaccination can modulate immune responses against variants of concern. To address this, we sampled 20 individuals with and 25 individuals without confirmed previous SARS-CoV-2 infection from a large cohort of health care workers followed serologically since April 2020. All 45 individuals had received two doses of the Pfizer-BioNTech BNT162b2 vaccine with a delayed booster at 10 weeks. Absolute and neutralizing antibody titers against wild-type SARS-CoV-2 and variants were measured using enzyme immunoassays and pseudotype neutralization assays. We observed antibody reactivity against lineage A, B.1.351, and P.1 variants with increasing antigenic exposure, through either vaccination or natural infection. This improvement was further confirmed in neutralization assays using fixed dilutions of serum samples. The impact of antigenic exposure was more evident in enzyme immunoassays measuring SARS-CoV-2 spike protein–specific IgG antibody concentrations. Our data show that multiple exposures to SARS-CoV-2 spike protein in the context of a delayed booster expand the neutralizing breadth of the antibody response to neutralization-resistant SARS-CoV-2 variants. This suggests that additional vaccine boosts may be beneficial in improving immune responses against future SARS-CoV-2 variants of concern.
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Affiliation(s)
- Richard A. Urbanowicz
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool Science Park IC2, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - Theocharis Tsoleridis
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Hannah J. Jackson
- School of Life Sciences, University of Nottingham, Life Sciences Building, University Park Campus, Nottingham NG7 2RD, UK
| | - Lola Cusin
- School of Life Sciences, University of Nottingham, Life Sciences Building, University Park Campus, Nottingham NG7 2RD, UK
| | - Joshua D. Duncan
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Joseph G. Chappell
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Alexander W. Tarr
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Jessica Nightingale
- Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Trauma and Orthopaedics, University Hospitals Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Alan R. Norrish
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Adeel Ikram
- Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Trauma and Orthopaedics, University Hospitals Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Ben Marson
- Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Trauma and Orthopaedics, University Hospitals Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Simon J. Craxford
- Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Trauma and Orthopaedics, University Hospitals Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Anthony Kelly
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Amrita Vijay
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Patrick J. Tighe
- School of Life Sciences, University of Nottingham, Life Sciences Building, University Park Campus, Nottingham NG7 2RD, UK
| | - Jonathan K. Ball
- Wolfson Centre for Global Virus Research, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,School of Life Sciences, University of Nottingham, A Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Corresponding author. (J.K.B.); (A.M.V.); (B.J.O.)
| | - Ana M. Valdes
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Corresponding author. (J.K.B.); (A.M.V.); (B.J.O.)
| | - Benjamin J. Ollivere
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Injury, Inflammation & Recovery Sciences, School of Medicine, University of Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Trauma and Orthopaedics, University Hospitals Nottingham, C Floor, West Block, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.,Corresponding author. (J.K.B.); (A.M.V.); (B.J.O.)
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12
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Ahmed A, Sana F, Ikram A, Yousaf S, Khan A. Reinfection or relapse of COVID-19 in health care workers; case series of 2 patients from Pakistan. New Microbes New Infect 2021; 42:100896. [PMID: 33996101 PMCID: PMC8106188 DOI: 10.1016/j.nmni.2021.100896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022] Open
Abstract
During an ongoing pandemic of severe acute respiratory syndrome coronavirus 2, main question which has arisen in everyone's mind is about the immune response that may protect from reinfection. Coronaviruses are known for short-term immunity. Their ability of mutations enables them to escape host immunity, thus increasing chances of reinfection. Here we report two cases of reinfection among health care workers who presented with symptoms of COVID-19 disease, after 3 months of first infectious course. Such documentations are necessary for epidemiological purposes and also to monitor response of virus on re-exposure.
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Affiliation(s)
- A Ahmed
- Department of Pathology, Combined Military Hospital Malir, Karachi, Pakistan
| | - F Sana
- Department of Pathology, Combined Military Hospital Malir, Karachi, Pakistan
| | - A Ikram
- National Institute of Health, Islamabad, Pakistan
| | - S Yousaf
- Department of Pathology, Combined Military Hospital Malir, Karachi, Pakistan
| | - A Khan
- Department of Pathology, Combined Military Hospital Malir, Karachi, Pakistan
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13
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Hinduja D, Ikram A, Idoye M, Bidwai A. 789 Improving Compliance of The MUST Tool Through Multiple Interventions, Improves Documentation and Assessment of Nutritional Status in Trauma and Orthopaedic Patients Undergoing Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The Malnutrition Universal Screening Tool (MUST) is a nationally validated risk tool, used to identify adults who are malnourished. 40% of surgical patients are malnourished which significantly impacts the outcomes of elderly patients. The primary aim of this study was to ascertain its utilisation in elderly patients undergoing trauma and orthopaedic surgery in a district general hospital.
Method
We completed a closed-loop audit from October2019-June2020 over two, three-week periods Inclusion criteria was age ≥65 years, and patients undergoing surgery. Data collected included MUST score, nutritional support, pre-operative fasting time, and prescription of fluids. Our intervention included departmental teaching sessions, posters, and the addition of the MUST tool to clerking proformas.
Results
We included analysis of 70 patients. Following our intervention, admission MUST score calculation improved by 8%, and providing nutritional support increased by 21%. However, there was no improvement in reducing pre-operative fasting time and prescription of pre-operative fluids.
Conclusions
Through our intervention’s documentation and assessment of nutritional status in elderly patients has improved. However further work must be completed to reduce time spent ‘nil-by-mouth’ and prescribe fluids for maintenance before surgery. This requires better pre-operative planning and communication between the surgical and ward-based teams.
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Affiliation(s)
- D Hinduja
- Kings Mill Hospital, Sutton-In-Ashfield, United Kingdom
- Nottingham University Hospital, Nottingham, United Kingdom
| | - A Ikram
- Nottingham University Hospital, Nottingham, United Kingdom
- Kings Mill Hospital, Sutton-In-Ashfield, United Kingdom
| | - M Idoye
- Kings Mill Hospital, Sutton-In-Ashfield, United Kingdom
| | - A Bidwai
- Kings Mill Hospital, Sutton-In-Ashfield, United Kingdom
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14
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Valdes AM, Moon JC, Vijay A, Chaturvedi N, Norrish A, Ikram A, Craxford S, Cusin LM, Nightingale J, Semper A, Brooks T, McKnight A, Kurdi H, Menni C, Tighe P, Noursadeghi M, Aithal G, Treibel TA, Ollivere BJ, Manisty C. Longitudinal assessment of symptoms and risk of SARS-CoV-2 infection in healthcare workers across 5 hospitals to understand ethnic differences in infection risk. EClinicalMedicine 2021; 34:100835. [PMID: 33880438 PMCID: PMC8049191 DOI: 10.1016/j.eclinm.2021.100835] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND : Healthcare workers (HCWs) have increased rates of SARS-CoV-2 infection compared with the general population. We aimed to understand ethnic differences in SARS-CoV-2 seropositivity among hospital healthcare workers depending on their hospital role, socioeconomic status, Covid-19 symptoms and basic demographics. METHODS A prospective longitudinal observational cohort study. 1364 HCWs at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals between March 20 and July 10 2020. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms. Registration number: NCT04318314. FINDINGS 272 of 1364 HCWs (mean age 40.7 years, 72% female, 74% White, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in Intensive Therapy Unit (ITU) workers (OR=0.44 95%CI 0.24, 0.77; p=0.0035). Seropositivity was higher in Black (compared to White) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen between White HCWs and other minority ethnic groups. INTERPRETATION In the UK first wave, Black ethnicity (but not other ethnicities) more than doubled HCWs likelihood of seropositivity, independent of age, sex, measured socio-economic factors and hospital role.
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Affiliation(s)
- Ana M. Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Corresponding Author: Professor Ana Valdes, University of Nottingham School of Medicine, Nottingham, United Kingdom, Tel: (+44)0115 823 1954
| | - James C. Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Amrita Vijay
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Alan Norrish
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Adeel Ikram
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Simon Craxford
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | | | - Jessica Nightingale
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Amanda Semper
- National Infection Service, Public Health England, Porton Down, UK
| | - Timothy Brooks
- National Infection Service, Public Health England, Porton Down, UK
| | - Aine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hibba Kurdi
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Patrick Tighe
- School of Life Sciences, University of Nottingham, NG7 2RB
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Guruprasad Aithal
- Nottingham Digestive Disease Centre, University of Nottingham School of Medicine, Nottingham, UK
| | - Thomas A. Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Benjamin J. Ollivere
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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15
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Marson BA, Manning JC, James M, Ikram A, Bryson DJ, Ollivere BJ. Trends in hospital admissions for childhood fractures in England. BMJ Paediatr Open 2021; 5:e001187. [PMID: 34786491 PMCID: PMC8587381 DOI: 10.1136/bmjpo-2021-001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fractures to the axial and appendicular skeleton are common in children causing loss of opportunities and disability. There are relatively few studies available to quantify the number of children who have their fractures diagnosed in the emergency department and are then admitted to hospital for ongoing management. The purpose of this study is to explore trends of frequency, types and age of children sustaining fractures who were admitted for intervention to National Health Service (NHS) hospitals. DESIGN The study uses data from the Hospital Episode Statistics and Office for National Statistics from 2012 to 2019 to calculate the annual incidence of hospital admission for limb, spine, facial and skull fractures per 100 000 children. RESULTS During 2012-2019, 368 120 children were admitted to English NHS hospitals with a fracture. 256 008 (69.5%) were upper limb fractures, 85 737 (23.3%) were lower limb fractures and 20 939 (5.7%) were skull or facial fractures. The annual incidence of upper limb fractures was highest in children aged 5-9 (348.3 per 100 000 children) and the highest incidence of lower limb fractures was in children aged 10-15 (126.5 per 100 000 children). The incidence of skull and facial fractures in preschool (age 0-4) children has been increasing at a rate of 0.629 per 100 000 children per year. IMPLICATIONS The annual incidence of hospital admission for fractures in children has been shown to be consistent for several fracture types between 2012 and 2019. An increasing trend of admissions with preschool skull fractures was observed, though the study data do not have sufficient granularity to demonstrate if this is due to changes in practice or to accidental or non-accidental causes.
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Affiliation(s)
- Ben Arthur Marson
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Clinical Trials Unit, University of Nottingham School of Medicine, Nottingham, UK
| | - Adeel Ikram
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
| | - David J Bryson
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Benjamin J Ollivere
- Orthopaedics and Trauma, University of Nottingham School of Medicine, Nottingham, UK
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16
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Khan M, Safdar R, Ishaq M, Akhtar M, Farooq U, Arif K, Rehman M, Ikram A. Experience of Cat Scratch Disease (CSD) in Rawalpindi, Pakistan – Could Physician's vigilance help in detection and case management? Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Ahad A, Salman M, Ikram A, Ashraf Z, Amir A, Saeed A, Ahmad A. Prevalence and molecular Characterization of ESBL-producing Escherichia coli in waste water samples from Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Salam A, Majooka I, Ikram A. Development of multi-drug resistance among relapsed tuberculosis drug addicts patients in Punjab Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Amir A, Ikram A, Ali Z, Rizwan M, Saeed A, Salman M. Pangenome analysis and reverse vaccinology of XDR Salmonella typhi strain from Pakistan identified novel vaccine targets. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Umair M, Salman M, Ikram A. Genetic diversity and phylogenetic analysis of Crimean Congo hemorrhagic fever virus in Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Khattak M, Ikram A, Singh K, Murray B, Shah A. Molecular typing of Enterococcus faecium from clinical specimens: Prevalence of virulence factors in correlation with biofilm formation. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Farooq H, Beveridge N, Fletcher T, Ghani E, Jamil B, Hasan Z, Ikram A, Safdar R, Salman M, Umair M, Latif M, Khan S, Pirkani G, Beeching N. A systematic review on the incidence and mortality of Crimean-Congo Haemorrhagic Fever (CCHF) in Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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23
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Khan M, Akbar N, Ahmd E, Safdar R, Ansari J, Hussain A, Ikram A. Investigation of a mysterious sking disease; Xeroderma pigmentosum, reported in a tribe in Bolan district of Pakistan, 2019. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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24
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Chaudhri M, Bashir U, Rasmussen Z, Hansen C, Ikram A. Development of a Biorisk Management (BRM) program in Pakistan: A Potential Sustainable Country Outreach Model. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Khan MA, Ikram A, Savul S, Lalani FK, Khan MA, Sarfraz M. Decontamination and Reuse of N95 Masks: A Narrative Review. Can J Infect Dis Med Microbiol 2020; 2020:8869472. [PMID: 33299504 PMCID: PMC7710392 DOI: 10.1155/2020/8869472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/01/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has presented an unprecedented strain on healthcare supplies. Currently there is a global shortage of personal protective equipment (PPE), especially N95 masks. In order to safeguard healthcare personnel in this critical time and to mitigate shortages of N95 respirators, reuse of N95 respirators has to be considered. METHODS Using PubMed and Science Direct, a literature search was conducted to find and synthesize relevant literature on decontamination of N95 respirators for their subsequent reuse. Peer-reviewed publications related to methods of decontamination from January 2007 to April 2020 in the English language are included in this narrative review. Bibliographies of articles for relevant literature were also scrutinized. Findings. A total of 19 studies are included in this narrative review. The appraised methods include ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), ethylene oxide (EtO), hydrogen peroxide vapor (HPV), microwave steam bags (MSB), microwave-generated steam (MGS), dry microwave oven irradiation, hydrogen peroxide gas plasma (HPGP), dry heat, liquid hydrogen peroxide, and bleach and alcohol. CONCLUSION In light of the COVID-19 pandemic, reuse of N95 respirators, although suboptimal, can be considered. Evidence reveals that UVGI, MHI, and HPV are amongst the safest and efficacious methods for decontamination of N95 masks. More research is needed to establish the safety and effectiveness of MGS, MSB, dry heat, EtO, liquid hydrogen peroxide, and HPGP. Alcohol, microwave irradiation, and bleach are not recommended because they damage N95 respirators.
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Affiliation(s)
- M. A. Khan
- National Institute of Health, Islamabad, Pakistan
| | - A. Ikram
- National Institute of Health, Islamabad, Pakistan
| | - S. Savul
- National Institute of Health, Islamabad, Pakistan
| | - F. K. Lalani
- National Institute of Health, Islamabad, Pakistan
| | - M. A. Khan
- National Institute of Health, Islamabad, Pakistan
| | - M. Sarfraz
- National Institute of Health, Islamabad, Pakistan
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Lloyd TD, Neal‐Smith G, Fennelly J, Claireaux H, Bretherton C, Carr AJ, Murphy M, Kendrick BJ, Palmer AJR, Wong J, Sharma P, Osei‐Bonsu PK, Ashcroft G, Baigent T, Shirland E, Espey R, Stokes M, Liew I, Dhawal A, Watchorn D, Lum J, Qureshi M, Khaled AS, Kauser S, Hodhody G, Rogers S, Haywood‐Alexander B, Sheikh G, Mahapatra P, Twaij H, Chicco M, Arnaout F, Atherton T, Mutimer J, Sinha P, Oliver E, Stedman T, Gadd R, Kutuzov V, Sattar M, Robiati L, Plastow R, Howe T, Hassan A, Lau B, Collins J, Doshi A, Tan G, Baskaran D, Hari Sunil Kumar K, Agarwal R, Horner M, Gwyn R, Masud S, Beaumont O, Pilarski A, Lebe M, Dawson‐Bowling S, Nolan D, Tsitskaris K, Beamish RE, Jordan C, Alsop S, Hibbert E, Deshpande G, Gould A, Briant‐Evans T, Kilbane L, Crowther I, Ingoe H, Naisbitt A, Gourbault L, Muscat J, Goh EL, Gill J, Elbashir M, Modi N, Archer J, Ismael S, Petrie M, O'Brien H, McCormick M, Koh NP, Lloyd T, King A, Ikram A, Peake J, Yoong A, Rye DS, Newman M, Naraen A, Myatt D, Kapur R, Sgardelis P, Kohli S, Culverhouse‐Mathews M, Haynes S, Boden H, Purmah A, Shenoy R, Raja S, Koh NP, Donovan R, Yeomans D, Ritchie D, Larkin R, Aladwan R, Hughes K, Unsworth R, Cooke R, Samra I, Barrow J, Michael K, Byrne F, Anwar R, Karatzia L, Drysdale H, Wilson H, Jones R, Dass D, Liaw F, Aujla R, Kheiran A, Bell K, Ramavath AL, Telfer R, Nachev K, Lawrence H, Garg V, Shenoy P, Lacey A, Byrom I, Simons M, Manning C, Cheyne N, Williams J. Peri‐operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study. Anaesthesia 2020; 75:1050-1058. [DOI: 10.1111/anae.15056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Affiliation(s)
- T. D. Lloyd
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - G. Neal‐Smith
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - J. Fennelly
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - H. Claireaux
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - C. Bretherton
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
- Oxford Surgical Collaborative for Audit and Research Oxford UK
| | - A. J. Carr
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - M. Murphy
- University of Oxford UK
- NHS Blood and Transplant Oxford UK
| | - B. J. Kendrick
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - A. J. R. Palmer
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
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Salam A, Majooka I, Ikram A. Development of multi-drug resistance among Relapsed Tuberculosis drug addicts patients in Punjab Pakistan. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Van Der Toorn J, Ochoa OR, Bos D, Vernooij M, Ikram A, Kavousi M. Cardiovascular Risk Profiles For Atherosclerosis In Different Vessels Among Women And Men: A Population-Based Cohort Study. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khan M, Salman M, Ansari J, Ikram A. Implementation status of international health regulations (IHR) 2005 in Pakistan. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Park C, Ikram A, Abdul-Jabar HB, Radford WJ. Sciatic nerve neuritis of no cause in primary total hip replacement: A case series. J Clin Orthop Trauma 2019; 10:121-123. [PMID: 30705545 PMCID: PMC6349595 DOI: 10.1016/j.jcot.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/17/2017] [Indexed: 11/16/2022] Open
Abstract
Neuritis of the sciatic nerve is a rare complication of total hip replacements. It is characterized by symptoms of neuropathic pain with or without motor and or sensory symptoms. Causes include direct intra-operative trauma or mechanical lengthening of the nerve. Cases of sciatic nerve neuritis without an organic cause however, are rarer still. We present two cases of sciatic nerve neuritis post total hip replacement with no identified organic cause. Whereas the reversal of the underlying cause has shown improvement in symptoms, in cases without an organic cause our experience advocates close observation and conservative management with spontaneous resolution of symptoms.
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Affiliation(s)
- Chang Park
- Corresponding author at: Stanmore Royal National Orthopaedic Hospital,Stanmore, HA7 4LP, London, United Kingdom.
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Ikram A, Singhania K, Tafazal S, Tambe A. Proximal humerus deformity, in a four-limb amputee following meningococcal septicaemia. BMJ Case Rep 2018; 2018:bcr-2018-226040. [PMID: 30366892 DOI: 10.1136/bcr-2018-226040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a challenging case of proximal humerus varus deformity in a four-limb amputee, caused by growth arrest from meningococcal septicaemia. The deformity resulted in a loss of function for our patient with inhibition of activities of daily living, requiring corrective osteotomy to help improve the range of motion of the shoulder. We describe in detail the management of our patient, highlight the importance of the orthopaedic manifestations of meningococcal septicaemia, and demonstrate the importance of monitoring potential deformities from growth arrest in these patients.
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Affiliation(s)
- Adeel Ikram
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Kriti Singhania
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Suhayl Tafazal
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
| | - Amol Tambe
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK
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Badar N, Salman M, Ansari J, Bashir U, Mushtaq N, Ahmad H, Ikram A. Chikungunya virus: A major threat to human population and its molecular epidemiology in pakistan. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Thiart M, Ikram A, Lamberts RP. How well can step-off and gap distances be reduced when treating intra-articular distal radius fractures with fragment specific fixation when using fluoroscopy. Orthop Traumatol Surg Res 2016; 102:1001-1004. [PMID: 27751844 DOI: 10.1016/j.otsr.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/30/2016] [Accepted: 09/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although fragment specific fixation has proved to be an effective treatment regime, it has not been established how successfully this treatment could be performed using fluoroscopy and what the added value of arthroscopy could be. Establish gap and step-off distances after in intra-articular distal radius fractures that have been treated with fragment specific fixation while using fluoroscopy. MATERIAL Forty-four patients with an intra-articular distal radius fracture were treated with fragment specific fixation while using fluoroscopy. METHODS After the treatment of the intra-articular distal radius fracture with fragment specific fixation and the use of fluoroscopy, but before the completion of the surgical intervention, all gap, and step-off distances were determined by using arthroscopy. In addition, the joint was checked for any other wrist pathologies. RESULTS Arthroscopy after the surgical intervention showed that in 37 patients no gap distances could be detected, while in six patients a gap distance of≤2mm was found and in one patient, a gap distance of 3mm. Similarly, arthroscopy revealed no step-off distances in 33 patients, while in 11 patients a step-off distance of≤2mm was found. Although additional wrist pathologies were found in 48% of our population, only one patient needed surgical intervention. Three months after the surgical intervention wrist flexion was 41±10°, wrist extension 51±17°, ulnar deviation 19±10°, radial deviation 32±12° while patients could pronate and supinate their wrist to 85±5° and 74±20°, respectively. CONCLUSION Intra-articular distal radius fractures can be treated successfully with fragment specific fixation and the use of fluoroscopy. As almost all gap and step-off distances could be reduced to an acceptable level, the scope for arthroscopy to further improve this treatment regime is limited. The functional outcome scores that were found 3 months after the surgical intervention were similar to what has been reported in other studies using different treatment option. These findings suggest that fragment specific fixation is a good alternative for treating intra-articular distal radius fractures. As in most cases, only fluoroscopy is needed for fragment specific fixation, this treatment technique is a good treatment option for resource-limited hospitals, setting who do not have access to arthroscopy. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- M Thiart
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - A Ikram
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa
| | - R P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, P.O. Box 19063, Tygerberg, Cape Town 7505, South Africa.
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Ikram A, Roche A. Achillon Achilles tendon suture system technical tip. Ann R Coll Surg Engl 2016; 99:337. [PMID: 27791413 DOI: 10.1308/rcsann.2016.0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Ikram
- Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust , London , UK
| | - A Roche
- Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust , London , UK
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Rizwan M, Ikram A, Zaman G, Satti L, Ahmed P. Surveillance of device-associated infections in intensive care units of a tertiary care hospital. J Hosp Infect 2016; 95:101-102. [PMID: 27837929 DOI: 10.1016/j.jhin.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022]
Affiliation(s)
- M Rizwan
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - A Ikram
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - G Zaman
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - L Satti
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan.
| | - P Ahmed
- Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan
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Ikram A, Singh J, Jagernauth S, Hambidge J. We present our experience (the first in the UK) using the Humelock hemiarthroplasty device for both primary and failed management of proximal humerus fractures. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We present a case of a 76-year-old man who underwent a corrective femoral osteotomy for a varus deformity and stress fractures. The patient was on androgen deprivation therapy (ADT) for prostate cancer and the osteotomy failed to heal. At 13 months, the ADT was stopped and bony union was achieved in 3 months. Orthopaedic surgeons treating fractures in this patient population need to aware of the problems associated with ADT and closely liaise with oncologists and urologists to stop ADT or start alternative treatment until bony union has been achieved.
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Affiliation(s)
- Adeel Ikram
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, London, Middlesex, UK
| | - Jagwant Singh
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Ahmad Ali
- Department of Trauma and Orthopaedics, Queens Hospital, London, UK
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Martin A, Imperiale B, Ravolonandriana P, Coban AY, Akgunes A, Ikram A, Satti L, Odoun M, Pandey P, Mishra M, Affolabi D, Singh U, Rasolofo V, Morcillo N, Vandamme P, Palomino JC. Prospective multicentre evaluation of the direct nitrate reductase assay for the rapid detection of extensively drug-resistant tuberculosis. J Antimicrob Chemother 2013; 69:441-4. [DOI: 10.1093/jac/dkt353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kavousi M, Leening M, Ikram A, Heeringa J, Koudstaal P, Hofman A, Steyerberg E, Franco O, Witteman J. Cardiovascular risk assessment in women: prediction of short-term and long-term risk; the Rotterdam study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Amin N, Byrne E, Johnson J, Chenevix-Trench G, Walter S, Nolte IM, Vink JM, Rawal R, Mangino M, Teumer A, Keers JC, Verwoert G, Baumeister S, Biffar R, Petersmann A, Dahmen N, Doering A, Isaacs A, Broer L, Wray NR, Montgomery GW, Levy D, Psaty BM, Gudnason V, Chakravarti A, Sulem P, Gudbjartsson DF, Kiemeney LA, Thorsteinsdottir U, Stefansson K, van Rooij FJA, Aulchenko YS, Hottenga JJ, Rivadeneira FR, Hofman A, Uitterlinden AG, Hammond CJ, Shin SY, Ikram A, Witteman JCM, Janssens ACJW, Snieder H, Tiemeier H, Wolfenbuttel BHR, Oostra BA, Heath AC, Wichmann E, Spector TD, Grabe HJ, Boomsma DI, Martin NG, van Duijn CM. Genome-wide association analysis of coffee drinking suggests association with CYP1A1/CYP1A2 and NRCAM. Mol Psychiatry 2012; 17:1116-29. [PMID: 21876539 PMCID: PMC3482684 DOI: 10.1038/mp.2011.101] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Coffee consumption is a model for addictive behavior. We performed a meta-analysis of genome-wide association studies (GWASs) on coffee intake from 8 Caucasian cohorts (N=18 176) and sought replication of our top findings in a further 7929 individuals. We also performed a gene expression analysis treating different cell lines with caffeine. Genome-wide significant association was observed for two single-nucleotide polymorphisms (SNPs) in the 15q24 region. The two SNPs rs2470893 and rs2472297 (P-values=1.6 × 10(-11) and 2.7 × 10(-11)), which were also in strong linkage disequilibrium (r(2)=0.7) with each other, lie in the 23-kb long commonly shared 5' flanking region between CYP1A1 and CYP1A2 genes. CYP1A1 was found to be downregulated in lymphoblastoid cell lines treated with caffeine. CYP1A1 is known to metabolize polycyclic aromatic hydrocarbons, which are important constituents of coffee, whereas CYP1A2 is involved in the primary metabolism of caffeine. Significant evidence of association was also detected at rs382140 (P-value=3.9 × 10(-09)) near NRCAM-a gene implicated in vulnerability to addiction, and at another independent hit rs6495122 (P-value=7.1 × 10(-09))-an SNP associated with blood pressure-in the 15q24 region near the gene ULK3, in the meta-analysis of discovery and replication cohorts. Our results from GWASs and expression analysis also strongly implicate CAB39L in coffee drinking. Pathway analysis of differentially expressed genes revealed significantly enriched ubiquitin proteasome (P-value=2.2 × 10(-05)) and Parkinson's disease pathways (P-value=3.6 × 10(-05)).
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Affiliation(s)
- N Amin
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Byrne
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - J Johnson
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - G Chenevix-Trench
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - S Walter
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I M Nolte
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - J M Vink
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - R Rawal
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Mangino
- Department of Twin Research and Genetic Epidemiology, St Thomas' Hospital Campus, King's College London, London, UK
| | - A Teumer
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University of Greifswald, Greifswald, Germany
| | - J C Keers
- LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Verwoert
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Baumeister
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - R Biffar
- Department of Prosthodontics, Gerodontology and Dental Materials, Center of Oral Health, University of Greifswald, Greifswald, Germany
| | - A Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - N Dahmen
- Department of Psychiatry, University of Mainz, Mainz, Germany
| | - A Doering
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - A Isaacs
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L Broer
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N R Wray
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - G W Montgomery
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - D Levy
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA,Center for Population Studies, NHLBI, Bethesda, MD, USA
| | - B M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA,Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland,University of Iceland, Reykjavik, Iceland
| | - A Chakravarti
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P Sulem
- deCODE Genetics, Reykjavik, Iceland
| | | | - L A Kiemeney
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands,Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands,Comprehensive Cancer Center East, BG Nijmegen, The Netherlands
| | - U Thorsteinsdottir
- deCODE Genetics, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - K Stefansson
- deCODE Genetics, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - F J A van Rooij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Y S Aulchenko
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J J Hottenga
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - F R Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C J Hammond
- Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - S-Y Shin
- Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J C M Witteman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A C J W Janssens
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Snieder
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B H R Wolfenbuttel
- LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B A Oostra
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A C Heath
- Department of Psychiatry, Washington University, St Louis, MI, USA
| | - E Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, St Thomas' Hospital Campus, King's College London, London, UK
| | - H J Grabe
- Department of Psychiatry and Psychotherapy, University of Greifswald, Stralsund, Germany
| | - D I Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - N G Martin
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - C M van Duijn
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Centre of Medical Systems Biology, Netherlands Consortium on Healthy Aging, Leiden and National Genomics Initiative, The Hague, The Netherlands,Department of Epidemiology, Erasmus Medical Center Rotterdam, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands. E-mail:
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Satti L, Ikram A, Abbasi S, Malik N, Mirza IA, Martin A. Evaluation of thin-layer agar 7H11 for the isolation of Mycobacterium tuberculosis complex. Int J Tuberc Lung Dis 2010; 14:1354-1356. [PMID: 20843431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We evaluated the thin-layer agar (TLA) method for the recovery of Mycobacterium tuberculosis complex and compared the results with the BACTEC Mycobacteria Growth Indicator Tube (MGIT) 960 system. A total of 53 mycobacterial isolates were isolated on both media. The recovery rates of mycobacteria on TLA and BACTEC MGIT 960 system were respectively 90.6% and 96.2%. Mean time to detection of mycobacteria on TLA was 12.5 compared to 11.2 days on BACTEC MGIT 960. TLA is a simple technique and can be used as an alternative to the Löwenstein-Jensen medium and BACTEC MGIT 960 for the isolation of mycobacteria in resource-poor settings.
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Affiliation(s)
- L Satti
- Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan.
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Ikram A, Rahman AA, Mostafa NA, Shamsuddin AH. Path flow study of a lab scale cyclonic combustor for coal-biomass co-combustion. 2009 3rd International Conference on Energy and Environment (ICEE) 2009. [DOI: 10.1109/iceenviron.2009.5398604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Putra EGR, Ikram A, Santoso E, Bharoto B. Performance of the 36 m small-angle neutron scattering spectrometer at BATAN, Serpong, Indonesia. J Appl Crystallogr 2007. [DOI: 10.1107/s002188980700605x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Jenkinson R, Ikram A, Horsewill A, Trommsdorff H. The quantum dynamics of proton transfer in benzoic acid measured by single crystal NMR spectroscopy and relaxometry. Chem Phys 2003. [DOI: 10.1016/j.chemphys.2003.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brougham DF, Horsewill AJ, Ikram A, Ibberson RM, McDonald PJ, Pinter‐Krainer M. The correlation between hydrogen bond tunneling dynamics and the structure of benzoic acid dimers. J Chem Phys 1996. [DOI: 10.1063/1.471940] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Al-Zahrani S, Kremli M, Saadeddin M, Ikram A, Takroni T, Zeidan H. Ultrasonography detection of radiolucent foreign bodies in soft tissue compared to computed tomography scan. Ann Saudi Med 1995; 15:110-2. [PMID: 17587917 DOI: 10.5144/0256-4947.1995.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thirty-one patients with suspected radiolucent foreign bodies (wooden splinters) in soft tissues of extremities were investigated by plain radiography, computed tomography (CT) scan and ultrasonography to the area suspected clinically. Ultrasonography detected and localized radiolucent foreign bodies in 18 of the 31 patients, while only 14 were seen on CT scan. Following surgical exploration, the presence of foreign bodies was confirmed in 20 patients; thus, the accuracy of ultrasonography was 90% while that of CT scan was 70%. The size of foreign body, the presence of infection or the delay in diagnosis had no effect on results. Ultrasonography is clearly a reliable method of detecting radiolucent foreign bodies in soft tissues of extremities.
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Affiliation(s)
- S Al-Zahrani
- Division of Orthopedics, King Khalid University Hospital, Riyadh, and Department of Radiology, Prince Abdullah Bin Abdul Aziz Hospital, Bisha
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Abstract
In this mapping study, the goal was to investigate in 10 subjects the phenomenon of the travelling waves (TW), especially of alpha activity, under conditions of (1) rest, (2) calculations, (3) emotional experience and (4) pain. The TW during wakefulness usually arose from the areas with the highest amplitude of alpha, called major peaks, for both positive (pos.) and negative (neg.) polarities. These areas were Pz (pos. and neg.) at rest, O2 (pos.) and Pz (neg.) during calculation, O1 (pos.) and O2 (neg.) during emotion and T6 (pos.) and O1 (neg.) during pain. When differences were determined between the latter 3 conditions and the resting state, a focal event-related desynchronization (ERD) became evident on T5 during math, on Pz during emotion and on both CP areas during pain. Surrounding the areas of ERD were areas of event-related synchronization (ERS). The TW were related to phase differences between the different electrode locations, seen more frequently with the pos. polarity, and more often with emotion or calculation. The direction of the TW was most often toward the midline during rest, from the right to midline (calculation), from the left to midline (emotion) and from the midline to the left (pain). Changes on one side of the head were often associated with opposite types of changes on the other side. Sleep spindles were also analyzed showing the major peaks on Fz and F4 with pos. polarities often seen anteriorly and neg. polarities posteriorly. TW were also seen with spindles, more often with the positive polarity. The direction was usually from the midline for the positive polarity and toward the midline for the neg. phase. The phenomenon of the TW is discussed, especially its possible neurophysiological significance as a means of transmitting information throughout the brain.
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Affiliation(s)
- J R Hughes
- Epilepsy Clinic, University of Illinois Medical Center, Chicago 60612
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Abstract
We report on 27 patients illustrating the use of non-vascularized single fibular strut graft, augmented with a corticocancellous bone graft to bridge bone defects. The indications were varied and included infection, fracture with bone loss, non-union, bone tumour, bone cyst and congenital pseudarthrosis. Primary union was achieved in 92 per cent. Stress fracture occurred in 26 per cent and no significant fibular graft hypertrophy occurred. The aim of this paper is to show that the non-vascularized single fibular graft, if augmented with corticocancellous bone graft along its whole length, is a simple procedure that is still valid to bridge bone defects.
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Affiliation(s)
- S al-Zahrani
- King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
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