1
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Onyeze CI, Badmus TA, Salako AA, Owojuyigbe AM, Jeje EA, Olasehinde OO, Adeyemo A, David RA. Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men. West Afr J Med 2023; 40:909-913. [PMID: 37767102] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.
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Affiliation(s)
- C I Onyeze
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
- Urology Department, Ninewells Hospital, Dundee, UK
| | - T A Badmus
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
| | - A A Salako
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
| | - A M Owojuyigbe
- Anaesthesia Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - E A Jeje
- Surgery Department, Lagos University Teaching Hospital, Lagos, Nigeria
| | - O O Olasehinde
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
| | - A Adeyemo
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
| | - R A David
- Surgery Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria.
- Urology Department, Salisbury District Hospital, Salisbury, UK
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2
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Nam HH, Martinazzi BJ, Kirchner GJ, Adeyemo A, Mansfield K, Dopke K, Ptasinski A, Bonaddio V, Aynardi MC. Vancomycin Powder Is Highly Cost-Effective in Total Ankle Arthroplasty. Foot Ankle Spec 2023; 16:283-287. [PMID: 37340880 PMCID: PMC10291110 DOI: 10.1177/19386400221136374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons apply topical vancomycin powder to minimize the risk of infection during TAA procedures. The purpose of our study was to determine the cost-effectiveness of using vancomycin powder to prevent PJI following TAA and to propose an economic model that can be applied by foot and ankle surgeons in their decision to incorporate vancomycin powder in practice. Using our institution's records of the cost of 1 g of topical vancomycin powder, we performed a break-even analysis and calculated the absolute risk reduction and number needed to treat for varying costs of vancomycin powder, PJI infection rates, and costs of TAA revision. Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in TAA if the PJI rate of 3% decreased by an absolute risk reduction of 0.02% (Number Needed to Treat = 5304). Furthermore, our results indicate that vancomycin powder can be highly cost-effective across a wide range of costs, PJI infection rates, and varying costs of TAA revision. The use of vancomycin powder remained cost-effective even when (1) the price of vancomycin powder was as low as $2.50 to as high as $100.00, (2) infection rates ranged from .05 to 3%, and (3) the cost of the TAA revision procedure ranged from $1000 to $10 000.Levels of Evidence: IV.
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Affiliation(s)
- Hannah H. Nam
- Penn State College of Medicine, Hershey, Pennsylvania
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Gregory J. Kirchner
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Adeshina Adeyemo
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Kelly Dopke
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Vincenzo Bonaddio
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael C. Aynardi
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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3
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Martinazzi BJ, Kirchner GJ, Nam HH, Mansfield K, Dopke K, Ptasinski A, Adeyemo A, Walley KC, Aynardi MC. Improving Randomized-Controlled Trials in Foot and Ankle Orthopaedics: The Need to Include Sociodemographic Patient Data. Foot Ankle Spec 2023:19386400231170965. [PMID: 37148174 DOI: 10.1177/19386400231170965] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND The representation of sociodemographic data within randomized-controlled trials (RCT) regarding foot and ankle surgery is undefined. The purpose of this study was to determine the incidence of sociodemographic data being reported in contemporary foot and ankle RCTs. METHODS Randomized-controlled trials within the PubMed database from 2016 to 2021 were searched and the full text of 40 articles was reviewed to identify sociodemographic variables reported in the manuscript. Data regarding race, ethnicity, insurance status, income, work status, and education were collected. RESULTS Race was reported in the results in 4 studies (10.0%), ethnicity in 1 (2.5%), insurance status in 0 (0%), income in 1 (2.5%), work status in 3 (7.5%) and education in 2 (5.0%). In any section other than the results, race was reported in 6 studies (15.0%), ethnicity in 1 (2.5%), insurance status in 3 (7.5%), income in 6 (15.0%), work status in 6 (15.0%), and education in 3 (7.5%). There was no difference in sociodemographic data by journal (P = .212), year of publication (P = .216), or outcome study (P = .604). CONCLUSION The overall rate of sociodemographic data reported in foot and ankle RCTs is low. There was no difference in the reporting of sociodemographic data between journal, year of publication, or outcome study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Gregory J Kirchner
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Hannah H Nam
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Kelly Dopke
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Adeshina Adeyemo
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael C Aynardi
- Penn State College of Medicine, Hershey, Pennsylvania
- Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
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4
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Chekka P, Karan A, Adeyemo A, Guo H, Reddy P. A stiff outlook-oculogyric crisis caused by anti-$$$emetics. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00596-7] [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: 01/28/2023]
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5
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Karan A, Guo H, Chekka P, Adeyemo A, Patel C. The bard’s curse: a rare cause of upper extremity weakness. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00589-x] [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: 01/28/2023]
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6
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Adeyemo A, Karan A, Chekka P, Guo H, Reddy P. Urine Trouble: Sjogren’s syndrome presenting as distal renal tubular acidosis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00491-3] [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: 01/28/2023]
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7
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Olasehinde O, Adesunkanmi A, Aaron AO, Adetoye AO, Talabi A, Olateju SOA, Ojumu TA, Adam MS, Babade RK, Mohammed TO, Aderounmu AA, Mustapha B, Ojeyemi P, Yusuf K, Adejumo OE, Badru KN, Soji-Adereti J, Adeyemo A, Olowookere AS, Amusa YB, Adegbehingbe OO, Adegbehingbe BO, Sowande OA. Addressing Unmet Surgical Needs in an Underserved Nigerian Community: Report of a 'Town and Gown' Initiative. West Afr J Med 2023; 40:25-29. [PMID: 36716240] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Access to quality and timely care prevents unnecessary deaths and morbidity from potentially curable surgical diseases. This study describes the magnitude of unmet surgical needs in a Nigerian community and describes the experiences garnered during a surgical outreach organized by a tertiary institution in an underserved community. METHODS This is a descriptive study highlighting details of a surgical outreach to a community in south-Western part of Nigeria. The project was based on a collaboration between a University Teaching Hospital (gown) and the community (town). Details of the patients' demographic and disease characteristics as well as barriers to seeking medical care were obtained. The operational workflow, treatment offered, and outcomes are highlighted. Results are presented as descriptive statistics. RESULTS Over a two-day period, 83 out of 3,056 patients who were screened had surgically treatable conditions (2.7%), predominantly hernias (37, 46.6%), goitres (13, 15.7%) and soft tissue swellings (9, 10.8%). The majority were adults (56, 67.5%) while 27 (32.5%) were in the paediatric age group. The mean duration of symptoms was 8.64 months ± 9.5 months. About half of the patients (46.9%) had never visited a medical facility on account of their index illnesses. Lack of funds was cited by many patients as the main reason for having not presented at a hospital. Sixty-three surgical operations were performed with no peri-operative adverse events. CONCLUSION Lack of financial access was the major barrier to surgical care in the sampled community. Moving from 'gown to town' helped address a significant proportion of the unmet needs over a relatively short period. Tertiary hospitals can provide surgical oversight to communities within their jurisdiction using this approach.
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Affiliation(s)
- O Olasehinde
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A Adesunkanmi
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - A O Aaron
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A O Adetoye
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A Talabi
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - S O A Olateju
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - T A Ojumu
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - M S Adam
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - R K Babade
- Department of Anaesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - T O Mohammed
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A A Aderounmu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - B Mustapha
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - P Ojeyemi
- Department of Nursing, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - K Yusuf
- Department of Nursing, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - K N Badru
- Department of Nursing, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - J Soji-Adereti
- Department of Nursing, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - A Adeyemo
- Department of Orthorhinolaryngology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - A S Olowookere
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Y B Amusa
- Department of Orthorhinolaryngology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - O O Adegbehingbe
- Department of Orthopaedic surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - B O Adegbehingbe
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - O A Sowande
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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8
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Mansfield K, Dopke K, Koroneos Z, Bonaddio V, Adeyemo A, Aynardi M. Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play. Curr Rev Musculoskelet Med 2022; 15:353-361. [PMID: 35804260 DOI: 10.1007/s12178-022-09774-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Achilles tendon ruptures (ATR) are detrimental to sports performance, and optimal treatment strategy and guidelines on return to play (RTP) remain controversial. This current review investigates the recent literature surrounding nonoperative versus operative management of ATR, clinical outcomes, and operative techniques to allow the athlete a successful return to their respective sport. RECENT FINDINGS The Achilles tendon (AT) is crucial to the athlete, as it is essential for explosive activities such as running and jumping. Athletes that sustain an ATR play in fewer games and perform at a lower level of play compared to age-matched controls. Recent studies also theorize that ATRs occur due to elongation of the tendon with fatigue failure. Biomechanical studies have focused on comparing modes of fixation under dynamic loading to recreate this mechanism. ATRs can be career-ending injuries. Fortunately, the recent incorporation of early weight-bearing and functional rehabilitation programming for non-operative and operative patients alike proves to be beneficial. Especially for those treated nonoperatively, with the incorporation of functional rehabilitation, the risk of re-rupture among non-operative patients is beginning to approach the historical lower risk of re-rupture observed among patients treated operatively. Despite this progress in decreasing risk of re-rupture particularly among non-operative patients, operative managements are associated with unique benefits that may be of particular interest for athletes and active individuals. Recent studies demonstrate that operative intervention improves strength and functional outcomes with more efficacy compared to nonoperative management with rehabilitation. The current literature supports operative intervention in elite athletes to improve performance and shorten the duration to RTP. However, we acknowledge that surgical intervention does have inherent risks. Ultimately, most if not all young and/or high-level athletes with an ATR benefit from surgical repair, but it is crucial to take a stepwise algorithmic approach and consider other factors, which may lead towards nonoperative intervention. These factors include age, chronicity of injury, gap of ATR, social factors, and medical history amongst others in this review.
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Affiliation(s)
- Kirsten Mansfield
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Kelly Dopke
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Zachary Koroneos
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Vincenzo Bonaddio
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Adeshina Adeyemo
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Michael Aynardi
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA.
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9
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Obadare T, Adejuyigbe E, Adeyemo A, Aboderin O. Characterization of Neonatal Sepsis in a Tertiary Hospital in Nigeria. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.043] [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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10
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Pan T, Adeyemo A, Armstrong DG, Petfield JL. Neurophysiological Intraoperative Monitoring in Patients with Cochlear Implant Undergoing Posterior Spinal Fusion: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00016. [PMID: 35050944 DOI: 10.2106/jbjs.cc.21.00609] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE Transcranial electric stimulation motor-evoked potentials (tcMEPs) are the most sensitive technique in multimodality intraoperative neuromonitoring (IONM) for posterior spinal fusion (PSF). The presence of a cochlear implant (CI) is considered a contraindication to IONM because of theoretical risk of implant device and local tissue damage from voltages induced by tcMEPs. We present the case of a 10-year-old girl with CI who underwent successful PSF with tcMEP and monopolar electrocautery (MoEC) without perioperative complications or CI damage. CONCLUSION With proper precautions, such as MoEC usage at a minimal voltage, motor-evoked potential monitoring can be safely performed in pediatric patients with CI undergoing PSF.
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Affiliation(s)
- Tommy Pan
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Adeshina Adeyemo
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
| | - Douglas G Armstrong
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
| | - Joseph L Petfield
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
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11
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Abstract
Proximal humerus fractures (PHF) are a common orthopedic injury; however, their treatment remains largely controversial with evidence supporting a wide array of treatments. Although many injuries can be treated nonoperatively, there has been much debate about surgical management of PHF. A detailed review of the literature was performed relative to operative management options specifically related to implant choices. Although no definitive answers are available regarding best practice, there is literature to guide operative decision-making and implant selection based on both patient- and surgeon-specific factors.
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Affiliation(s)
- Adeshina Adeyemo
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Nicholas Bertha
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Kevin J Perry
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA
| | - Gary Updegrove
- Department of Bone and Joint, Penn State Milton Hershey Medical Center, 30 Hope Drive, Building A; PO Box 859, Hershey, PA 17033, USA.
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12
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Frisby JC, Kim TWB, Schultz EM, Adeyemo A, Lo KW, Hazelton JP, Miller LS. Novel policing techniques decrease gun-violence and the cost to the healthcare system. Prev Med Rep 2019; 16:100995. [PMID: 31763160 PMCID: PMC6861592 DOI: 10.1016/j.pmedr.2019.100995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/03/2019] [Revised: 07/23/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
The objective was to investigate the effects of novel policing techniques on hospital-observed incidence, healthcare utilization, mortality and costs associated with gun violence, from the perspective of a level-1 trauma center. An eight-year retrospective review evaluating the clinical and financial effects of gunshot wound (GSW) encounters between January 1st, 2010 and December 31st, 2017. Individuals who presented to the emergency department (Level-1 trauma center in Camden, NJ) between January 1, 2010 and December 31, 2017 with GSW (995 encounters) were included; however, patients with incomplete financial or medical record data were excluded (55 encounters). Patients were subdivided into two cohorts: before and after changes in policing tactics (May 1st, 2013). 940 total firearm-related encounters were included in the study. Following the policing changes, the hospital-observed quarterly incidence of GSW encounters decreased by 22% post-policing changes, 44.3 to 34.6 (p = 0.038). Average quarterly days spent in-house for GSW treatment decreased 220.7 to 151.3 (31%) days. Hospital observed mortality increased from 13.5% of presentations to 17.3% of presentations (p = 0.106). Total cost savings associated with the policing change was roughly $254,000 per quarter (p = 0.023). In areas susceptible to high rates of gun violence, similar novel policing tactics could significantly decrease hospital-observed incidence, costs and healthcare utilization demanded by firearm-related injury.
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Affiliation(s)
- Justin C Frisby
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Thomas Jefferson University, College of Population Health, 1020 Walnut St., Philadelphia, PA 19107, United States
| | - Tae Won B Kim
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Emily M Schultz
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Adeshina Adeyemo
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Penn State Milton S. Hershey Medical Center, 500 University Drive, Hersey, PA 17033, United States
| | - Karina W Lo
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, United States
| | - Joshua P Hazelton
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Lawrence S Miller
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
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13
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Mohamed MN, Parthiban S, Adeyemo A. Formal Postoperative Care Pathways May Reduce 30 Day Unplanned General Surgical Postoperative Readmissions. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.191] [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: 10/18/2022]
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14
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Abstract
Severe chronic pain is one of the hallmarks and most debilitating manifestations of inflammatory arthritis. It represents a significant problem in the clinical management of patients with common chronic inflammatory joint conditions such as rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies. The functional links between peripheral inflammatory signals and the establishment of the neuroadaptive mechanisms acting in nociceptors and in the central nervous system in the establishment of chronic and neuropathic pain are still poorly understood, representing an area of intense study and translational priority. Several well-established inducible and spontaneous animal models are available to study the onset, progression and chronicization of inflammatory joint disease, and have been instrumental in elucidating its immunopathogenesis. However, quantitative assessment of pain in animal models is technically and conceptually challenging, and it is only in recent years that inflammatory arthritis models have begun to be utilized systematically in experimental pain studies using behavioral and neurophysiological approaches to characterize acute and chronic pain stages. This article aims primarily to provide clinical and experimental rheumatologists with an overview of current animal models of arthritis pain, and to summarize emerging findings, challenges and unanswered questions in the field.
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Affiliation(s)
- Bradford D Fischer
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, 401 S. Broadway, Camden, NJ, 08103, USA
| | - Adeshina Adeyemo
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, 401 S. Broadway, Camden, NJ, 08103, USA
| | - Michael E O'Leary
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, 401 S. Broadway, Camden, NJ, 08103, USA
| | - Andrea Bottaro
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, 401 S. Broadway, Camden, NJ, 08103, USA.
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15
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Meeks K, Freitas-Da-Silva D, Adeyemo A, Beune E, Modesti P, Stronks K, Zafarmand M, Agyemang C. Disparities in type 2 diabetes among ethnic minority groups resident in Europe - a meta-analysis. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Abstract
Takayasu arteritis is a chronic, granulomatous arteritis affecting large and medium-sized arteries. During pregnancy, maternal and foetal complications are largely as a consequence of maternal arterial hypertension. We present a case of a 35-year-old para one gravida two patient with Takayasu arteritis (group III disease) complicated by chronic hypertension and a severely dilated ascending aorta. Good blood pressure control during pregnancy is an important measure in reducing obstetric morbidity.
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Affiliation(s)
- P Soma-Pillay
- Cardiac-Obstetric Unit, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
| | - A Adeyemo
- Cardiac-Obstetric Unit, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - F E Suleman
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, South Africa
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Melville A, Jerrett I, Gallaher J, Adeyemo A, Yoong W. Intrauterine fetal death associated with maternal ketoacidosis as a first presentation of diabetes in an African woman. J OBSTET GYNAECOL 2014; 34:196-7. [PMID: 24456451 DOI: 10.3109/01443615.2013.840565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Melville
- University College London Medical School
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18
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19
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Adeyemo A, Wood C, Govind A. Kaposi's sarcoma in pregnancy after initiation of highly active antiretroviral therapy: a manifestation of immune reconstitution syndrome. Int J STD AIDS 2012; 23:905-6. [DOI: 10.1258/ijsa.2012.012141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A case of Kaposi's sarcoma (KS) presenting as an immune reconstitution inflammatory syndrome in pregnancy with conservative management is reported. Successful outcomes for mother and baby were achieved. HIV was diagnosed at antenatal booking and highly active antiretroviral therapy commenced at 20 weeks. Multiple lymphadenopathies developed two months later. Excision biopsy of a node confirmed KS. In the absence of advanced disease, she was managed conservatively until delivery. The placenta showed no evidence of KS or human herpes virus 8 (HHV-8). The baby had negative HIV and HHV-8 polymerase chain reaction tests at zero, six and 12 weeks of life. Six months postpartum, the KS had regressed and HHV-8 viral load was undetectable.
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Affiliation(s)
- A Adeyemo
- Department of Obstetrics and Gynaecology
| | - C Wood
- Department of HIV Medicine, North Middlesex University Hospital NHS Trust, Edmonton, London N18 1QX, UK
| | - A Govind
- Department of Obstetrics and Gynaecology
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20
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Liu CT, Ng MCY, Rybin D, Adeyemo A, Bielinski SJ, Boerwinkle E, Borecki I, Cade B, Chen YDI, Djousse L, Fornage M, Goodarzi MO, Grant SFA, Guo X, Harris T, Kabagambe E, Kizer JR, Liu Y, Lunetta KL, Mukamal K, Nettleton JA, Pankow JS, Patel SR, Ramos E, Rasmussen-Torvik L, Rich SS, Rotimi CN, Sarpong D, Shriner D, Sims M, Zmuda JM, Redline S, Kao WH, Siscovick D, Florez JC, Rotter JI, Dupuis J, Wilson JG, Bowden DW, Meigs JB. Transferability and fine-mapping of glucose and insulin quantitative trait loci across populations: CARe, the Candidate Gene Association Resource. Diabetologia 2012; 55:2970-84. [PMID: 22893027 PMCID: PMC3804308 DOI: 10.1007/s00125-012-2656-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 01/20/2012] [Accepted: 06/14/2012] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS Hyperglycaemia disproportionately affects African-Americans (AfAs). We tested the transferability of 18 single-nucleotide polymorphisms (SNPs) associated with glycaemic traits identified in European ancestry (EuA) populations in 5,984 non-diabetic AfAs. METHODS We meta-analysed SNP associations with fasting glucose (FG) or insulin (FI) in AfAs from five cohorts in the Candidate Gene Association Resource. We: (1) calculated allele frequency differences, variations in linkage disequilibrium (LD), fixation indices (F(st)s) and integrated haplotype scores (iHSs); (2) tested EuA SNPs in AfAs; and (3) interrogated within ± 250 kb around each EuA SNP in AfAs. RESULTS Allele frequency differences ranged from 0.6% to 54%. F(st) exceeded 0.15 at 6/16 loci, indicating modest population differentiation. All iHSs were <2, suggesting no recent positive selection. For 18 SNPs, all directions of effect were the same and 95% CIs of association overlapped when comparing EuA with AfA. For 17 of 18 loci, at least one SNP was nominally associated with FG in AfAs. Four loci were significantly associated with FG (GCK, p = 5.8 × 10(-8); MTNR1B, p = 8.5 × 10(-9); and FADS1, p = 2.2 × 10(-4)) or FI (GCKR, p = 5.9 × 10(-4)). At GCK and MTNR1B the EuA and AfA SNPs represented the same signal, while at FADS1, and GCKR, the EuA and best AfA SNPs were weakly correlated (r(2) <0.2), suggesting allelic heterogeneity for association with FG at these loci. CONCLUSIONS/INTERPRETATION Few glycaemic SNPs showed strict evidence of transferability from EuA to AfAs. Four loci were significantly associated in both AfAs and those with EuA after accounting for varying LD across ancestral groups, with new signals emerging to aid fine-mapping.
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Affiliation(s)
- C.-T. Liu
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA
| | - M. C. Y. Ng
- Center for Genomics and Personalized Medicine Research, Center for
Diabetes Research, Wake Forest University School of Medicine, Winston-Salem,
NC, USA
| | - D. Rybin
- Boston University Data Coordinating Center, Boston, MA, USA
| | - A. Adeyemo
- National Human Genome Research Institute, Bethesda, MD, USA
| | | | - E. Boerwinkle
- University of Texas Health Science Center at Houston, Houston, TX,
USA
| | - I. Borecki
- Washington University, St Louis, MO, USA
| | - B. Cade
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - L. Djousse
- Brigham and Women's Hospital, Boston, MA, USA; Department
of Medicine, Harvard Medical School, Boston, MA, USA; Boston VA Healthcare
System, Boston, MA, USA
| | - M. Fornage
- University of Texas Health Science Center at Houston, Houston, TX,
USA
| | | | - S. F. A. Grant
- Children's Hospital of Philadelphia, Philadelphia, PA,
USA
| | - X. Guo
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - T. Harris
- National Institute on Aging, Bethesda, MD, USA
| | | | | | - Y. Liu
- Center for Genomics and Personalized Medicine Research, Center for
Diabetes Research, Wake Forest University School of Medicine, Winston-Salem,
NC, USA; Department of Epidemiology and Prevention, Wake Forest University,
Winston-Salem, North Carolina, USA
| | - K. L. Lunetta
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA; National Heart, Lung, and Blood Institute'
Framingham Heart Study, Framingham, MA, USA
| | - K. Mukamal
- Department of Medicine, Harvard Medical School, Boston, MA,
USA
| | - J. A. Nettleton
- University of Texas Health Science Center at Houston, Houston, TX,
USA
| | | | - S. R. Patel
- Brigham and Women's Hospital, Boston, MA, USA
| | - E. Ramos
- National Human Genome Research Institute, Bethesda, MD, USA
| | | | - S. S. Rich
- University of Virginia, Charlottesville, VA, USA
| | - C. N. Rotimi
- National Human Genome Research Institute, Bethesda, MD, USA
| | - D. Sarpong
- Jackson State University, Jackson, MS, USA
| | - D. Shriner
- National Human Genome Research Institute, Bethesda, MD, USA
| | - M. Sims
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J. M. Zmuda
- University of Pittsburgh, Graduate School of Public Health,
Pittsburgh, PA, USA
| | - S. Redline
- Brigham and Women's Hospital, Boston, MA, USA
| | - W. H. Kao
- Johns Hopkins University, Baltimore, MD, USA
| | | | - J. C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA, USA;
Diabetes Unit and Center for Human Genetic Research, Massachusetts General
Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Broad
Institute, Cambridge, MA, USA
| | - J. I. Rotter
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - J. Dupuis
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA, USA; National Heart, Lung, and Blood Institute's
Framingham Heart Study, Framingham, MA, USA
| | - J. G. Wilson
- University of Mississippi Medical Center, Jackson, MS, USA
| | - D. W. Bowden
- Center for Genomics and Personalized Medicine Research, Center for
Diabetes Research, Wake Forest University School of Medicine, Winston-Salem,
NC, USA; Departments of Biochemistry and Internal Medicine, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
| | - J. B. Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, USA;
General Medicine Division, Massachusetts General Hospital, 50 Staniford
Street, 9th Flr, Boston, MA, USA
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21
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Ramos E, Chen G, Shriner D, Doumatey A, Gerry NP, Herbert A, Huang H, Zhou J, Christman MF, Adeyemo A, Rotimi C. Replication of genome-wide association studies (GWAS) loci for fasting plasma glucose in African-Americans. Diabetologia 2011; 54:783-8. [PMID: 21188353 PMCID: PMC3052446 DOI: 10.1007/s00125-010-2002-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [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: 07/16/2010] [Accepted: 11/08/2010] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Chronically elevated blood glucose (hyperglycaemia) is the primary indicator of type 2 diabetes, which has a prevalence that varies considerably by ethnicity in the USA, with African-Americans disproportionately affected. Genome-wide association studies (GWASs) have significantly enhanced our understanding of the genetic basis of diabetes and related traits, including fasting plasma glucose (FPG). However, the majority of GWASs have been conducted in populations of European ancestry. Thus, it is important to conduct replication analyses in populations with non-European ancestry to identify shared loci associated with FPG across populations. METHODS We used data collected from non-diabetic unrelated African-American individuals (n = 927) who participated in the Howard University Family Study to attempt to replicate previously published GWASs of FPG. Of the 29 single nucleotide polymorphisms (SNPs) previously reported, we directly tested 20 in this study. In addition to the direct test, we queried a 500 kb window centred on all 29 reported SNPs for local replication of additional markers in linkage disequilibrium (LD). RESULTS Using direct SNP and LD-based comparisons, we replicated multiple SNPs previously associated with FPG and strongly associated with type 2 diabetes in populations with European ancestry. The replicated SNPs included those in or near TCF7L2, SLC30A8, G6PC2, MTNR1B, DGKB-TMEM195 and GCKR. We also replicated additional variants in LD with the reported SNPs in ZMAT4 and adjacent to IRS1. CONCLUSIONS/INTERPRETATION We identified multiple GWAS variants for FPG in our cohort of African-Americans. Using an LD-based strategy we also identified SNPs not previously reported, demonstrating the utility of using diverse populations for replication analysis.
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Affiliation(s)
- E. Ramos
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - G. Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - D. Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - A. Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - N. P. Gerry
- Coriell Institute for Medical Research, Camden, NJ USA
| | - A. Herbert
- Department of Genetics and Genomics, Boston University School of Medicine, Boston, MA USA
| | - H. Huang
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - J. Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | | | - A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
| | - C. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, 12 South Drive, MSC 5635, Bethesda, MD 20892 USA
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22
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Adeyemo A, Adeosun A, Adedapo K. Unusual cause of thyroid abscess. Afr Health Sci 2010; 10:101-103. [PMID: 20811534 PMCID: PMC2895800] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Thyroid abscess is a rare condition of the thyroid gland. The common causative organisms responsible for thyroid abscess are Staphylococci and Streptococci species. We described a case of thyroid abscess due to Klebsiella pneumoniae in an infant. The patient was successfully treated with open surgical drainage and appropriate antimicrobial agents.
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Affiliation(s)
- A Adeyemo
- University of Ibadan, Institute of Child Health, Nigeria.
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23
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Adeyemo A, Rotimi C. Genetic variants associated with complex human diseases show wide variation across multiple populations. Public Health Genomics 2009; 13:72-9. [PMID: 19439916 DOI: 10.1159/000218711] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 03/18/2009] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The wide use of genome wide association studies (GWAS) has led to the successful identification of multiple genetic susceptibility variants to several complex human diseases. Given the limited amount of data on genetic variation at these loci in populations of non-European origin, we investigated population variation among 11 population groups for loci showing strong and consistent association from GWAS with several complex human diseases. METHODS Data from the International HapMap Project Phase 3, comprising 11 population groups, were used to estimate allele frequencies at loci showing strong and consistent association from GWAS with any of 26 complex human diseases and traits. Allele frequency summary statistics and F(ST) at each locus were used to estimate population differentiation. RESULTS There is wide variation in allele frequencies and F(ST) across the 11 population groups for susceptibility loci to these complex human diseases and traits. Allele frequencies varied widely across populations, often by as much as 20- to 40-fold. F(ST), as a measure of population differentiation, also varied widely across the loci studied (for example, 0.019 to 0.201 for type 2 diabetes, 0.022 to 0.520 for prostate cancer loci, and 0.006 to 0.520 for serum lipid levels). CONCLUSIONS The public health risk posed by any of these risk alleles is likely to show wide variation across populations simply as a function of its frequency, and this risk difference may be amplified by gene-gene and gene-environment interactions. These analyses offer compelling reasons for including multiple human populations from different parts of the world in the international effort to use genomic tools to understand disease etiology and differential distribution of diseases across ethnic groups.
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Affiliation(s)
- A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-5635, USA.
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24
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Bhatt S, Mbwana J, Adeyemo A, Sawyer A, Hailu A, Vanmeter J. Lying about facial recognition: An fMRI study. Brain Cogn 2009; 69:382-90. [PMID: 18848742 DOI: 10.1016/j.bandc.2008.08.033] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 08/25/2008] [Accepted: 08/26/2008] [Indexed: 01/12/2023]
Affiliation(s)
- S Bhatt
- ISIS Center, Georgetown University Medical Center, Box 571479, WA, DC 20057-1479, USA.
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25
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Gropman AL, Fricke ST, Seltzer RR, Hailu A, Adeyemo A, Sawyer A, van Meter J, Gaillard WD, McCarter R, Tuchman M, Batshaw M. 1H MRS identifies symptomatic and asymptomatic subjects with partial ornithine transcarbamylase deficiency. Mol Genet Metab 2008; 95:21-30. [PMID: 18662894 PMCID: PMC3724938 DOI: 10.1016/j.ymgme.2008.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [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: 04/26/2008] [Revised: 06/13/2008] [Accepted: 06/13/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate brain metabolism in subjects with partial ornithine transcarbamylase deficiency (OTCD) utilizing (1)H MRS. METHODS Single-voxel (1)H MRS was performed on 25 medically-stable adults with partial OTCD, and 22 similarly aged controls. Metabolite concentrations from frontal and parietal white matter (FWM, PWM), frontal gray matter (FGM), posterior cingulate gray matter (PCGM), and thalamus (tha) were compared with controls and IQ, plasma ammonia, glutamine, and disease severity. RESULTS Cases ranged from 19 to 59 years; average 34 years; controls ranged from 18 to 59 years; average 33 years. IQ scores were lower in cases (full scale 111 vs. 126; performance IQ 106 vs. 117). Decreased myoinositol (mI) in FWM (p=0.005), PWM (p<0.001), PCGM (p=0.003), and tha (p=0.004), identified subjects with OTCD, including asymptomatic heterozygotes. Glutamine (gln) was increased in FWM (p<0.001), PWM (p<0.001), FGM (p=0.002), and PCGM (p=0.001). Disease severity was inversely correlated with [mI] in PWM (r=-0.403; p=0.046) and directly correlated with [gln] in PCGM (r=0.548; p=0.005). N-Acetylaspartate (NAA) was elevated in PWM (p=0.002); choline was decreased in FWM (p=0.001) and tha (p=0.002). There was an inverse relationship between [mI] and [gln] in cases only. Total buffering capacity (measured by [mI/mI+gln] ratio, a measure of total osmolar capacity) was inversely correlated with disease severity in FWM (r=-0.479; p=0.018), PWM (r=-0.458; p=0.021), PCGM (r=-0.567; p=0.003), and tha (r=-0.345; p=0.037). CONCLUSION Brain metabolism is impaired in partial OTCD. Depletion of mI and total buffering capacity are inversely correlated with disease severity, and serve as biomarkers.
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Affiliation(s)
- A L Gropman
- Department of Neurology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
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26
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Lasisi AO, Adeyemo A. Improvized laryngeal cautery forcep in microsurgical treatment of laryngotracheal stenosis--experience in Nigeria, sub-Saharan Africa. Afr J Med Med Sci 2007; 36:163-167. [PMID: 19205580] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Traumatic laryngotracheal stenosis is uncommon, however it seems to be increasing due to improvement in survival after trauma and detection of injury. Surgical options include dilatation and intralesional steroid, endolaryngeal microsurgery and laryngotracheal resection and anastomosis. We report our experience with management of traumatic laryngotracheal stenosis using improvised cauterization forcep in endolaryngeal microsurgery, in the absence of supportive facility for open laryngeal surgery in resource--poor sub-Saharan Africa. This is a retrospective analysis of the outcome of endolaryngeal microsurgery in patient with laryngotracheal stenosis using our improvised laryngeal cautery forceps. Traumatic A Lindholm laryngoscope suspended by a Riecher-Kleinsasser laryngoscope holder and chest support; and Carl-Zeiss operating microscope (Op Mi 1) was used for surgery. We improvised a laryngeal cauterization forcep by using an oesophageal foreign body forcep inserted in the measured length of fluid--giving set, exposing about 1 cm of the cutting end would insulate the forcep against the laryngotracheal wall. The diathermy handle is applied to the exposed end of the forceps. All the patients had endolaryngeal microsurgery and intralesional steroid. Thirteen endolaryngeal microsurgical procedures were done on 5 patients, 4 males and 1 female. The age ranged between 19 and 62 years. Functional voice and decannulation was achieved in 2/5 patients after each had had between 2-3 procedures. The indications in all was hoarseness while there was in addition, upper airway obstruction and dependence on tracheostomy in 3. The stenosis was supraglottic in 2, combined glottic and subglottic in 1 and laryngotracheal involvement in 2. Using the circumference of the laryngeal lumen as reference for severity of stenosis, 2 patients had a 50-70% lumen obstruction while 2 had a 71-99% and 1 had 100% lumen obstruction. We found the improvisation of the laryngeal cautery forcep useful for procedures in the larynx and recommend it to resource--poor centres where appropriate facilities are yet available. However this further shows that the role of endolaryngeal microsurgery is limited in laryngotracheal stenosis. The availability of other therapeutic modalities and training of personnel will give us the opportunity of a randomized treatment comparison in future.
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Affiliation(s)
- A O Lasisi
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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27
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Fejerman L, Wu X, Adeyemo A, Luke A, Zhu X, Hicks C, Cooper RS. The effect of genetic variation in angiotensinogen on serum levels and blood pressure: a comparison of Nigerians and US blacks. J Hum Hypertens 2006; 20:882-7. [PMID: 16971959 DOI: 10.1038/sj.jhh.1002077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Molecular variants of angiotensinogen (AGT) have been associated with AGT level and hypertension (HT). However, results from reported studies vary considerably between- and within-studied populations. We performed association analysis of AGT gene variants with AGT levels and HT in samples of African descent families, including 595 Nigerians and 901 African Americans. We evaluated association using haplotypes defined by a set of single-nucleotide polymorphisms selected from a previous detailed study of the gene haplotype structure. In the sample of Nigerian families, AGT haplotype H1 was associated with high plasma level. Results were not significant for blood pressure (BP) or HT. For the African-American population, we found significant association between low plasma AGT level and haplotype H7. Furthermore, we found weak associations of H1 with hypertensive status and H7 with low systolic BP. However, no significant association between H1 and high plasma level was found. We conclude that the two distantly related haplotypes, H1 and H7, are associated, but have opposite effects on the phenotypes in two populations of African origin.
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Affiliation(s)
- L Fejerman
- Department of Biological Anthropology, University of Oxford, Oxford, UK.
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28
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Johnson L, Luke A, Adeyemo A, Deng HW, Mitchell BD, Comuzzie AG, Cole SA, Blangero J, Perola M, Teare MD. Meta-analysis of five genome-wide linkage studies for body mass index reveals significant evidence for linkage to chromosome 8p. Int J Obes (Lond) 2005; 29:413-9. [PMID: 15685251 DOI: 10.1038/sj.ijo.0802817] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To perform a meta-analysis of genome-wide linkage scans using body mass index (BMI) to identify genetic loci predisposing to obesity. DATA A total of 13 published genome scans on obesity have used BMI as their primary end point. Five of these 13 groups agreed to provide detailed results from their scans that were required for a meta-analysis. Collectively, these five studies included a total of 2814 individuals from 505 families. METHODS The results of the five studies were analysed using the GSMA (genome scans meta-analysis) method. RESULTS The analysis revealed significant evidence for linkage of the quantitative phenotype BMI to 8p (P<0.0005).
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Affiliation(s)
- L Johnson
- Mathematical Modelling and Genetic Epidemiology, Division of Genomic Medicine, University of Sheffield, UK
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29
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Luke A, Kramer H, Adeyemo A, Forrester T, Wilks R, Schoeller D, Leman C, Cooper RS. Relationship between blood pressure and physical activity assessed with stable isotopes. J Hum Hypertens 2005; 19:127-32. [PMID: 15385948 DOI: 10.1038/sj.jhh.1001790] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intrapopulation and interpopulation variation in blood pressure (BP) often reflects the joint effect of a complex set of risk factors, including lifestyle factors such as physical activity, diet, smoking and alcohol use. In this study, we set out to quantify the impact of habitual levels of physical activity on BP within and between three populations at contrasting levels of population risk of hypertension. Individuals were randomly sampled from communities in Nigeria (n=57), Jamaica (from Kingston, n=35) and the United States (from the Chicago area, n=32). Activity energy expenditure (AEE) (estimated from resting energy expenditure measured by indirect calorimetry and total expenditure measured with doubly labelled water) was used as an objective estimate of physical activity. In each of the three samples, there was a consistent negative correlation between BP and AEE. This negative association persisted after adjustment for age, sex and body fat (body mass index or percent fat mass). In multivariate models, adiposity was no longer a significant predictor of BP after accounting for low AEE. In conclusion these data suggest that habitual levels of physical activity may have a generalizable relationship with BP in populations with widely different social and environmental characteristics.
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Affiliation(s)
- A Luke
- Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, IL 60153, USA.
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30
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Forrester T, Adeyemo A, Soarres-Wynter S, Sargent L, Bennett F, Wilks R, Luke A, Prewitt E, Kramer H, Cooper RS. A randomized trial on sodium reduction in two developing countries. J Hum Hypertens 2005; 19:55-60. [PMID: 15470483 DOI: 10.1038/sj.jhh.1001782] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertension remains the most common cardiovascular risk factor in developing countries, yet the majority of patients have no access to pharmacological therapy. Population-wide preventive strategies, such as salt restriction, are an attractive alternative, but experience in resource-poor settings is limited. To address this question, we conducted a randomized crossover study of salt restriction in adults living in Nigeria and Jamaica in order to estimate the mean blood pressure (BP) response. After a 4-week run-in period to determine willingness to adhere to a low-salt diet, 56 Jamaicans and 58 Nigerians completed an 8-week crossover study of low-salt and high-salt intake. Baseline BPs were in the normotensive range (systolic=125 mmHg in Jamaica, 114 mmHg in Nigeria). Baseline urinary sodium excretion was 86.8 and 125.6 mEq/day in Nigeria and Jamaica, respectively. The mean difference between urinary sodium excretion at baseline and at the end of the 3-week low-sodium phase was 33.6 mEq/day in Nigeria and 57.5 mEq/day in Jamaica. During the high-sodium phase, mean change in urinary sodium excretion from baseline to week 3 was 35.0 and 5.5 mEq/day in Nigeria and Jamaica, respectively. The mean change in systolic BP ('high' vs 'low' sodium phase) was approximately 5 mmHg in both groups. This study suggests that the efficacy of sodium reduction in developing countries equals those noted in more affluent cultures. If promoted on a wide scale, sodium reduction could be used to treat persons with established hypertension, and more importantly, to prevent age-related increases in BP in poor communities.
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Affiliation(s)
- T Forrester
- Tropical Medical Research Institute, University of the West Indies, Kingston, Jamaica
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Obajimi MO, Ogunseyinde AO, Omigbodun A, Adeyemo A, Olayemi O, Akang EEU. Neonatal teratoma of the neck causing respiratory distress: a case report. Niger Postgrad Med J 2002; 9:102-4. [PMID: 12163871] [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: 02/26/2023]
Abstract
This is a case of a neonate with a large cervical mass and respiratory distress at birth. Radiological investigations revealed a predominantly solid mass with calcifications and multiple cysts, suggesting a teratoma. Patient died while being prepared for surgery and autopsy confirmed an immature teratoma. The clinical and pathological characteristics of paediatric cervical teratomas are discussed.
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Affiliation(s)
- M O Obajimi
- Departments of Radiology, University College Hospital, Ibadan
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Zhu X, Bouzekri N, Southam L, Cooper RS, Adeyemo A, McKenzie CA, Luke A, Chen G, Elston RC, Ward R. Linkage and association analysis of angiotensin I-converting enzyme (ACE)-gene polymorphisms with ACE concentration and blood pressure. Am J Hum Genet 2001; 68:1139-48. [PMID: 11283791 PMCID: PMC1226095 DOI: 10.1086/320104] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2000] [Accepted: 02/26/2001] [Indexed: 11/03/2022] Open
Abstract
Considerable effort has been expended to determine whether the gene for angiotensin I-converting enzyme (ACE) confers susceptibility to cardiovascular disease. In this study, we genotyped 13 polymorphisms in the ACE gene in 1,343 Nigerians from 332 families. To localize the genetic effect, we first performed linkage and association analysis of all the markers with ACE concentration. In multipoint variance-component analysis, this region was strongly linked to ACE concentration (maximum LOD score 7.5). Likewise, most of the polymorphisms in the ACE gene were significantly associated with ACE (P<.0013). The two most highly associated polymorphisms, ACE4 and ACE8, accounted for 6% and 19% of the variance in ACE, respectively. A two-locus additive model with an additive x additive interaction of these polymorphisms explained most of the ACE variation associated with this region. We next analyzed the relationship between these two polymorphisms (ACE4 and ACE8) and blood pressure (BP). Although no evidence of linkage was detected, significant association was found for both systolic and diastolic BP when a two-locus additive model developed for ACE concentration was used. Further analyses demonstrated that an epistasis model provided the best fit to the BP variation. In conclusion, we found that the two polymorphisms explaining the greatest variation in ACE concentration are significantly associated with BP, through interaction, in this African population sample. Our study also demonstrates that greater statistical power can be anticipated with association analysis versus linkage, when markers in strong linkage disequilibrium with a trait locus have been identified. Furthermore, allelic interaction may play an important role in the dissection of complex traits such as BP.
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Affiliation(s)
- X Zhu
- Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, IL 60153, USA.
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Cooper RS, Guo X, Rotimi CN, Luke A, Ward R, Adeyemo A, Danilov SM. Heritability of angiotensin-converting enzyme and angiotensinogen: A comparison of US blacks and Nigerians. Hypertension 2000; 35:1141-7. [PMID: 10818078 DOI: 10.1161/01.hyp.35.5.1141] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Angiotensinogen (AGT) and angiotensin I-converting enzyme (ACE) are heritable traits, but whether the environmental context influences heritability has not been examined. Known genetic factors explain only a portion of variation in AGT and ACE, and levels of both proteins are influenced by the environment. The African diaspora provides an opportunity to compare these traits in genetically related populations in contrasting environments. As part of a study of the genetics of hypertension, we examined families that included 1449 Nigerians and 1147 African Americans. Body mass index (weight [kg]/height [m](2)) was 21 kg/m(2) in Nigeria and 29 kg/m(2) in the United States, which is consistent with a large environmental contrast. AGT was considerably higher among African Americans (1919 versus 1396, P<0.01), whereas ACE was higher in Nigerians (630 versus 517, P<0.01). A household effect was observed among the Nigerian families (spouse correlations 0.30 for AGT, 0.18 for ACE), and correlations among first-degree relatives were large (0.42 to 0. 51 and 0.36 to 0.38 for AGT and ACE, respectively). Among African Americans, the familial aggregations of AGT and ACE were very limited, and the familial correlation for AGT was not different from zero. Heritability was 77% for AGT and 67% for ACE in Nigeria and 18% for AGT and ACE in the United States. The familial patterns of body mass index and blood pressure were similar among both family sets. In conclusion, less familial aggregation was observed for AGT and ACE in the United States than in Nigeria, most likely reflecting a greater random individual environmental effect on these traits. Variation in heritability of traits could influence the power of epidemiological studies to identify genetic effects.
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Affiliation(s)
- R S Cooper
- Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA.
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Rotimi C, Okosun I, Johnson L, Owoaje E, Lawoyin T, Asuzu M, Kaufman J, Adeyemo A, Cooper R. The distribution and mortality impact of chronic energy deficiency among adult Nigerian men and women. Eur J Clin Nutr 1999; 53:734-9. [PMID: 10509771 DOI: 10.1038/sj.ejcn.1600842] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the prevalence of chronic energy deficiency (CED) and associated mortality risk in a cohort of adult Nigerians followed from 1992 to 1997. RESEARCH METHODS AND PROCEDURES The data for this investigation were derived from an international collaborative study on chronic diseases in populations of the African diaspora. Body mass index (BMI) was used to define three grades of CED in 4061 men and women aged 25 years and older: Grade I (mild CED) as BMI 17.5-18.4, Grade II (moderate CED) as BMI 16.0-17.4, and Grade III (severe CED) as BMI < 16.0 and BMI > or = 18.5 was considered normal. The odds of mortality associated with differing grades of CED was estimated with logistic regression analysis. RESULTS The prevalence of CED (BMI < 18.5) increased from 14.3% in 1992 to 19.6% in 1997, both genders combined. The prevalence of CED was similar for both sexes in 1992 (14%) but increased to 22.4% in men and 17.4% in women by 1997. The prevalence of CED was 8.5%, 7.6 and 3.4 for Grades I, II and III, respectively. Two hundred and seven deaths occurred during the follow-up period. The mortality rate for the 5.5 y of follow-up was 5.1% (207/4061). The odds ratios (95% CIs) for all cause mortality were 1.4 (0.5, 3.8), 2.4 (1.2, 4.9) and 2.5 (1.0, 6.2), respectively, for CED grades I, II and III adjusting for age and sex. CONCLUSION Under nutrition is an increasing problem in Nigerian men and women. The economic reforms (structural adjustment program (SAP)) introduced in 1986 in combination with the continued economic woes brought on by political instability, corruption and nepotism have been advanced by several investigators as the main factors in the growing problem of inadequate calorie intake. Intervention strategies both at the government and private sectors are urgently needed to increase food availability.
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Affiliation(s)
- C Rotimi
- Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA.
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Aoki K, Hu N, Yamazaki H, Adeyemo A. Structures of thiamine thiocyanate, thiamine thiocyanate monohydrate and thiamine tetrafluoroborate monohydrate. Acta Crystallogr C 1990. [DOI: 10.1107/s0108270189012825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hambright P, Turner A, Cohen J, Lyon R, Katz A, Neta P, Adeyemo A. An iron(III) porphyrin that exhibits minimal dimerization in aqueous solution. Inorganica Chim Acta 1987. [DOI: 10.1016/s0020-1693(00)84681-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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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Bentley SJ, Andy JJ, Adeyemo A. Staphylococcal pericarditis with pyopericardium. Trop Geogr Med 1979; 31:525-9. [PMID: 542988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Seven previously well patients with acute staphylococcal pericarditis and purulent pericardial effusion are described. All had a septicaemic illness in which worsening heart failure with signs of cardiac tamponade became the major problems of management. Tropical pyomyositis was probably the predisposing illness in four patients. This number of proven cases within an 18-month period suggests that staphylococcal pyopericardium is in a tropical environment probably commoner than realised.
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Abstract
Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia. Stump pressure measurements were the principal guideline of adequacy of collateral flow and predictor of safe outcome. The safety of this concept of bilateral operations during one anesthesia can eliminate uncertainties of sequence and timing, obviate delay and indecision, and avoid the hazards of a second anesthetic-operative experience.
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Kunstadt D, Adeyemo A, Clauss RH. Aortic insufficiency. A result of intermittent migration of aortic valve prosthesis poppet. JAMA 1976; 235:2847-8. [PMID: 946993 DOI: 10.1001/jama.235.26.2847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A bizarre mechanism of aortic valve incompetence was observed when the occluder of a Braunwald-Cutter aortic valve prosthesis decreased in diameter, volume, and weight, and from time to time fell into the left ventricle. The patient's symptoms were palpitation, coughing, chocking sensations, and fright. An operation disclosed a small, smooth ball with disrupted cloth on all the struts. The residual torn mesh was removed, and the ball was replaced.
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O'Neill MF, Munda R, Adeyemo A, Clauss RH. Proceedings: Temporary by-pass grafts for aortic replacement surgery. J Cardiovasc Surg (Torino) 1976; 17:82-3. [PMID: 1245510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Forty-three patients who underwent intraperitoneal closure of colostomy are reported on. Complication rates of 4.6 per cent for wound infection and 4.6 per cent for fecal fistulas appear significantly lower than the 10 to 21 per cent complication rates reported for colostomy closure using other technics.
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Senno A, Moallem S, Quijano ER, Adeyemo A, Clauss RH. Thoracoscopy with the fiberoptic bronchoscope. A simple method in diagnosing pleuropulmonary diseases. J Thorac Cardiovasc Surg 1974; 67:606-11. [PMID: 4818537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Golding TN, Adeyemo A, Kurtz L. The incidence and surgical significance of cholelithiasis in sickle cell anemia and sickle cell trait. J Natl Med Assoc 1973; 65:410-4. [PMID: 4744054 PMCID: PMC2609227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Adeyemo A, Hoffler OW. Stab wounds of the heart. J Natl Med Assoc 1966; 58:156-8. [PMID: 5932283 PMCID: PMC2611074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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