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Hazari A, Mishra V, Kumar P, Maiya A. The accuracy of 10 g monofilament use for clinical screening of diabetes peripheral neuropathy among Indian population. PLoS One 2024; 19:e0297110. [PMID: 38394307 PMCID: PMC10890773 DOI: 10.1371/journal.pone.0297110] [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] [Received: 09/30/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The purpose of this study was to test the diagnostic accuracy of the 10g monofilament to screen for diabetic peripheral neuropathy (DPN) in India. The study further assessed the effect of physical activity, footwear use, and occupation on the outcome. METHODS Non-probabilistic purposive sampling was used to recruit patients with T2DM to assess the diagnostic utility of the 10 g monofilament. 160 participants were recruited divided into 4 groups. Each group consisted of 40 participants with 20 under each category described as "Physical Worker Vs Non- physical worker" (n = 40), "Barefoot Vs Footwear" (n = 40), "Use of Slipper at Home Vs No-slippers use at home" (n = 40), "Agriculture Vs Non- agriculture" (n = 40). 10 g monofilament was used to detect the presence of protective sensation towards screening of DPN against biothesiometer (Vibration Pressure Threshold). RESULTS The area under the ROC (receiver operating characteristic) curve was 0.6 for identifying DPN using the 10 g monofilament. Physical work (p = 0.04), footwear (p = 0.04), slipper use at home (p = 0.02) and occupation (p = 0.02) impacted on the diagnostic utility of the 10g monofilament. CONCLUSIONS This study shows that the 10 g monofilament has limited accuracy for detecting DPN in the Indian population and this is further affected by occupation, socioeconomic and religious practice.
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Affiliation(s)
| | | | - Praveen Kumar
- Gulf Medical University, Ajman, United Arab Emirates
| | - Arun Maiya
- Manipal Academy of Higher Education, Manipal, Karnataka, India
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Zohair HMA, Girish S, Hazari A. Work-related musculoskeletal disorders among United Arab Emirates schoolteachers: an examination of physical activity. BMC Musculoskelet Disord 2024; 25:134. [PMID: 38347534 PMCID: PMC10860240 DOI: 10.1186/s12891-024-07256-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To estimate the prevalence of work-related musculoskeletal disorders and their association with physical activity among schoolteachers in the United Arab Emirates. METHODS This observational cross-sectional study involved 209 schoolteachers (aged 20-60) with a minimum of two years of experience. Data, including demographics (gender, age), Nordic Musculoskeletal Questionnaire (NMQ) for WMSD prevalence and pain sites, and Global Physical Activity Questionnaire (GPAQ) for physical activity levels, were collected. Six schools were visited for data collection, with consent from school heads and participants. Schedules were tailored to participant availability, allowing up to three attempts for participation. Non-respondents were identified after three unsuccessful attempts. RESULTS Of the total 206 participants, 149 were female, while the remaining 57 were male. Age distribution analysis revealed that 18% of individuals were within the 20 to 30 years range, 26.2% fell within the 30 to 40 years, and 36.9% had 40 to 50 years age brackets. The responses were obtained in Arabic (90%) and English (10%). The study identified a high prevalence (71.4%) of work-related musculoskeletal disorders (WMSD) in UAE schoolteachers, with neck pain being the most common (74.3%). Major risk factors included age, workload, and low physical activity. The data was normally distributed, and Pearson's Correlation test revealed weak positive correlation (r: 0.14), but statistically significant (p value = 0.04) between WMSD and PA, indicating that it was a contributing factor but other factors beyond PA influenced WMSD prevalence in this cohort. The findings of the study are based on certain limitations such as cross-sectional design and convenient sampling which could have potential selection bias and affect generalizability of the results. CONCLUSION Findings suggest the need to promote physical activity and reduce workload for teachers, considering their age and gender. Additionally, there is a need to raise awareness regarding ergonomics and the importance of taking short breaks for stretching or physical movement to enhance the overall well-being of schoolteachers in the UAE and similar contexts. Diverse prevalence rates across different body areas underscore the necessity for individualized treatments.
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Affiliation(s)
| | - Srilatha Girish
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
- Department of Community Physiotherapy, MGM Institute of Physiotherapy, Chh. Sambhajinagar, India
| | - Animesh Hazari
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.
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Rashid FA, Anwar W, Malik S, Bose M, Kandakurti PK, Hazari A. Physiotherapy in Head, Neck, Lung and Breast Cancer Survivors: A Systematic Review. Gulf J Oncolog 2024; 1:54-65. [PMID: 38205574] [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] [Accepted: 12/30/2022] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. This study attempts to review the effect of physiotherapy application on head and neck, lung and breast cancer survivors on important clinical outcomes such as pain, strength, fatigability, coordination, balance, activities of daily living (ADLs), psychosocial aspects, cognitive aspects, and quality of life (QoL) Methods: A systematic review was conducted following PRISMA guidelines. Scientific articles were retrieved from electronic databases including Cochrane, Medline, EBSCO, Science Direct, Springer and Web of Science. Studies using only experimental design measuring the effectiveness of physiotherapy methods in head and neck, lung and breast cancer patients were selected for the review. Articles from 2012 till date were selected to find a piece of evidence for the latest physiotherapy practice in the last decade. RESULTS 19 articles out of 9343 records were selected (Head & Neck HN = 3, Lung LU = 5, Breast BR = 11) which demonstrated that there was a significant effect of various physiotherapeutic techniques on the selected outcomes among patients with head and neck, lung and breast cancer. CONCLUSION In this review study, we conclude that head and neck cancer patients can benefit from physiotherapy exercises and muscle awareness. However, more evidence is needed to prescribe a specific exercise regimen. It was found that a combination of fitness training along with aerobic training has the maximum gain in advanced lung cancer patients. For breast cancer patients, combined aerobic and resistance training along with stretching and relaxation is the current suggested treatment. KEY WORDS "Upper Body Cancer", "Physiotherapy", "head and neck cancer", "lung cancer", and "breast cancer".
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Affiliation(s)
- Fatima Abdul Rashid
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Wajiha Anwar
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Samiya Malik
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Meruna Bose
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Praveen Kumar Kandakurti
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Animesh Hazari
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
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Regai I, Bose M, Hazari A, Kandakueti PK. The Need for Early Screening of Diabetic Peripheral Neuropathy and Diabetic Foot in MENA Region: A Review. Curr Diabetes Rev 2024; 20:e120623217893. [PMID: 37309772 DOI: 10.2174/1573399820666230612141250] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/03/2023] [Accepted: 05/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Among all complications of DPN, diabetic foot (DF) can cause a myriad of symptoms and impact the quality of life. This study aimed to review the prevalence of DPN and DF in the Middle East and North Africa (MENA) region based on the publications available. This systematic review can be a cornerstone for further research and it summarizes the literature published on the prevalence of DPN and DF for the last two decades in the MENA region. METHODOLOGY The databases, PubMed, ResearchGate, Scopus, Web of Science, Science Direct, CINAHL, and Cochrane were searched using relevant keywords for the study. Full articles in English since 2000, including keywords "Prevalence", "Diabetic peripheral neuropathy", "Diabetic foot", and "MENA region" were reviewed in two phases. All authors screened the titles and abstracts of the articles individually, which was followed by a screening of full texts. A consensus was made among all the authors for the final selection of the articles based on the eligibility criteria. RESULTS Ten selected articles on the prevalence of DPN were reviewed in the first phase of the study, which reported varying prevalence rates among the different countries of the MENA region ranging from 9% to 61%. In the second phase, only two articles on DF prevalence were shortlisted. They reported the prevalence of DF as 4.6% and 18.1% in Jordan and Sudan, respectively. CONCLUSION The prevalence of DPN in the MENA region is varied within a short period of time and the reported prevalence of DF is limited. This study projects a strong need of establishing early screening strategies for DPN and DF to prevent further complications and decrease healthcare burden.
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Affiliation(s)
- Imen Regai
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Meruna Bose
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Animesh Hazari
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Praveen Kumar Kandakueti
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
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Hazari A, Mishra V, Agouris I. Clinical evaluation of painful diabetes peripheral neuropathy in type 2 diabetes patients: Lessons from expatriates in the United Arab Emirates. Diabetes Metab Syndr 2023; 17:102832. [PMID: 37506409 DOI: 10.1016/j.dsx.2023.102832] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The high prevalence of Type 2 Diabetes (T2D) in the United Arab Emirates makes it imperative to screen and manage diabetes peripheral neuropathy (DPN) as a priority. Considering the high number of expats from different ethnicity a more thorough approach is necessary. Unfortunately, there are very few studies addressing this issue. METHODS The study uses the chi-square test to investigate the dependence of the progression of DNP on ethnic origin. The study uses Pearson Correlation to find the association between three prevalent scales used for the measurement of painful diabetes peripheral neuropathy. Student t-test was used further to investigate the significance of the association. RESULTS With a p-value (0.004) and p-value (0.015), the study concludes that DPN risk is dependent on the ethnic origin of the residents. The study further found that there is a significant association between three scales for measuring painful diabetes peripheral neuropathy (pDNP), Douleur Neuropathique en 4 questions (DN4), Neurological Symptoms Score (NSS), and Leeds Assessment of Neuropathic Symptoms and Signs (LANNS). The p-value for all pairwise comparisons for the strength of association between scales was found significant at the level of significance 0.05. CONCLUSION The study concludes that the risk of DNP is high in Arab-origin residents in UAE and the reasons behind the finding need to be empirically tested to customize its management. The study further finds a significant association between the score of the three scales used for measuring pDNP.
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Affiliation(s)
- Animesh Hazari
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates.
| | - Ioannis Agouris
- School of Engineering, Robert Gordon University, Scotland, United Kingdom.
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Almheiri S, Hazari A, Kumar P, Kumar S, Girish S. A comprehensive survey on the beliefs, perceptions, and clinical manifestations of pre and post Covid-19 vaccinations among physiotherapy students in the United Arab Emirates. PLoS One 2023; 18:e0282385. [PMID: 37053182 PMCID: PMC10101419 DOI: 10.1371/journal.pone.0282385] [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] [Received: 02/13/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
The World Health Organization has defined Coronavirus Disease (COVID-19) as an infectious pandemic, caused by a newly discovered SARS-CoV-2 virus. Students relied heavily on the internet, social media, parents, and friends, in addition to medical advice for information on its presentation, complications, prevention, and management. It is evident from the literature that healthcare professionals including students who play an important role in the healthcare system may be lacking important information on COVID-19 vaccinations. Thus, the study aims to identify and compare the pre-post covid-19 vaccination-related essential information among Physical Therapy university students. A cross-sectional survey was conducted among physiotherapy university students in the United Arab Emirates using a self-administrated structured questionnaire. The questionnaire comprised three sections covering beliefs, perceptions, and clinical manifestations of the pre- and post-COVID- 19 vaccination. The survey was shared with more than 300 students through email and social platforms during the time between January 2022 till December 2022. Most of the physiotherapy students believed the vaccines to be safe (71.3%) due to multiple reasons while others did not believe in the effectiveness of the vaccine (28.7%). Some students did report unusual symptoms (painful periods, hair loss, forgetfulness) after the vaccine (10%). Similar findings were reported for family members as well (14%). Students had a positive perception of the vaccine and reported willingness to take it even if not mandatory (68%). Some students did believe in the safety of the vaccine due to multiple reasons while some did not due to fear of long-term side effects and personal choices. The finding of the study could be useful to create confidence as well as awareness among physiotherapy students as they are often invited to aid during medical pandemics such as Covid 19. Also, higher rates of vaccination among healthcare professionals will impart higher acceptance in the medical organization due to safety guidelines. This could also help to counsel other students against fear and apprehension towards the vaccination of such kind in the future.
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Affiliation(s)
- Shaikha Almheiri
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Animesh Hazari
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Praveen Kumar
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Sampath Kumar
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Srilatha Girish
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
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Hazari A, Maiya A, Agouris I, Monteiro A. Prediction of peak plantar pressure for diabetic foot: The regressional model. Foot (Edinb) 2019; 40:87-91. [PMID: 31212203 DOI: 10.1016/j.foot.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 11/29/2018] [Revised: 05/12/2019] [Accepted: 06/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The increase in peak plantar pressure could be the most important etiological factor for pathogenesis of a diabetic foot. Thus the fate of a diabetic foot syndrome which is a clinical triad of neurological, vascular and musculoskeletal changes could be biomechanically predictive and preventive using clinical parameters. In the presence of peripheral neuropathy, certain clinical parameters could be severely altered resulting into increased peak plantar pressure. Therefore the aim of the study was to identify the most important clinical parameters for the prediction of peak plantar pressure between neuropathy and non-neuropathy type 2 diabetes mellitus participants. METHODOLOGY A total of 380 participants were recruited under the study and divided into two groups (190 each group). The cross-sectional study was conducted at Kasturba Hosipal, Manipal, India. Multiple regression analysis was performed to find the hyperplane of best fit. Stepwise regression was performed with (α entry=0.15 and α removal=0.2) to select the best subset of predictors. RESULTS Adjusted R2 of the final model which included the predictors showed 90.8% variability for the dependent variable. CONCLUSION The findings from the regression analysis suggested model was found to be strongly significant in predicting the peak plantar pressure between neuropathy and non-neuropathy type 2 diabetes mellitus participants. Since higher values of peak plantar pressure is strongly associated with risk for future diabetic foot complications, it could be suggested that these clinical parameters could be very useful to assess and should be used in routine clinical practice very effectively.
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Affiliation(s)
- Animesh Hazari
- Faculty of Applied Medical Sciences, Lovely Professional University, Punjab, 144411, India.
| | - Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Ioannis Agouris
- Robert Gordon University, Garthdee House, Garthdee Road, Aberdeen AB10 7AQ, United Kingdom.
| | - Ashma Monteiro
- Prasanna School of Statistics, Department of Bio-statistics, Manipal Academy of Higher Education Udupi, Karnataka 576 104, India.
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Sampath Kumar A, Maiya AG, Shastry B, Vaishali K, Ravishankar N, Hazari A, Gundmi S, Jadhav R. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 62:98-103. [DOI: 10.1016/j.rehab.2018.11.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
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Hazari A, Agouris I, Wakode PS, Jadhav RA, Sharma N, Jena S, Sharma M. Head and trunk kinematics and kinetics in normal and cerebral palsy gait: a systematic review. European Journal of Physiotherapy 2019. [DOI: 10.1080/21679169.2019.1573919] [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: 10/27/2022]
Affiliation(s)
| | | | | | | | | | - Sonali Jena
- Lovely Professional University, Phagwara, India
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10
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Hazari A, Maiya AG, Shivashankara K. Foot Kinetic and Kinematic Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy A Hospital-Based Study from South India. J Am Podiatr Med Assoc 2019; 109:36-49. [PMID: 29389217 DOI: 10.7547/17-059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/03/2023]
Abstract
BACKGROUND A kinetic change in the foot such as altered plantar pressure is the most common etiological risk factor for foot ulcers in people with diabetes mellitus. Kinematic alterations in joint angle and spatiotemporal parameters of gait have also been frequently observed in participants with diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy leads to various microvascular and macrovascular complications of the foot in type 2 diabetes mellitus. There is a gap in the literature for biomechanical evaluation and assessment of type 2 diabetes mellitus with DPN in the Indian population. We sought to assess and determine the biomechanical changes, including kinetics and kinematics, of the foot in DPN. METHODS This cross-sectional study was conducted at a diabetic foot clinic in India. Using the purposive sampling method, 120 participants with type 2 diabetes mellitus and DPN were recruited. Participants with active ulceration or amputation were excluded. RESULTS The mean ± SD age, height, weight, body mass index, and diabetes duration were 57 ± 14 years, 164 ± 11 cm, 61 ± 18 kg, 24 ± 3 kg/m2, and 12 ± 7 years, respectively. There were significant changes in the overall biomechanical profile and clinical manifestations of DPN. The regression analysis showed statistical significance for dynamic maximum plantar pressure at the forefoot with age, weight, height, diabetes duration, body mass index, knee and ankle joint angle at toe-off, pinprick sensation, and ankle reflex ( R = 0.71, R2 = 0.55, F12,108 = 521.9 kPa; P = .002). CONCLUSIONS People with type 2 diabetes mellitus and DPN have significant changes in their foot kinetic and kinematic parameters. Therefore, they could be at higher risk for foot ulceration, with underlying neuropathy and biomechanically associated problems.
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Affiliation(s)
- Animesh Hazari
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Arun G. Maiya
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - K.N. Shivashankara
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Maiya AG, Kumar AS, Hazari A, Jadhav R, Ramachandra L, Hande HM, Rajgopal SK, Maiya SG, Kalkura P, Keni LG. Photobiomodulation therapy in neuroischaemic diabetic foot ulcers: a novel method of limb salvage. J Wound Care 2018; 27:837-842. [DOI: 10.12968/jowc.2018.27.12.837] [Citation(s) in RCA: 12] [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] [Indexed: 12/25/2022]
Affiliation(s)
- Arun G. Maiya
- Professor and Associate Dean, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - A. Sampath Kumar
- Scholar, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Animesh Hazari
- Scholar, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - L Ramachandra
- Professor, Head of Department, Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - H. Manjunatha Hande
- Professor, Head of Department; Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shenoy K Rajgopal
- Professor, Associate Dean (Academics), Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shubha G. Maiya
- Senior Health Educator, WDF Project, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prabath Kalkura
- Project Manager, WDF Project, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Laxmikant G. Keni
- Assistant Professor–Senior Scale, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Maiya AG, Gundmi S, Matpady P, Jadhav R, Lingadakai R, Hande M, Kamath VG, Shivashankar KN, Chinmayee P, Hazari A, Shastri N, Hande R, Loftager MM, Veluswamy SK, Jude E. Prevalence of Foot Complications in People With Type 2 Diabetes Mellitus: A Community-Based Survey in Rural Udupi. INT J LOW EXTR WOUND 2018; 17:169-175. [PMID: 30111220 DOI: 10.1177/1534734618791853] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of the study was to determine the prevalence of foot complications among people with type 2 diabetes mellitus in the rural part of Udupi district, Karnataka, India. A cross-sectional observational study design was conducted in the rural area of Udupi district. In the study, accredited social health activists were trained to screen people with type 2 diabetes mellitus for diabetic foot complications at a community level. Adults over 35 years of age were screened for the presence of type 2 diabetes mellitus by accredited social health activists who reside in the rural part of Udupi district. Participants with type 2 diabetes mellitus were included in the study. Blood glucose level was measured using a glucometer. Foot examination was done by visual inspection, monofilament, tuning fork, and pedal pulse. In the present study, 2110 among the total participants were found to have type 2 diabetes mellitus. The prevalence of musculoskeletal foot complications was 1218 (58%), vascular problem 466 (22.2%), sensory neuropathy 634 (30.2%), autonomic neuropathy 1729 (81.9%), ulcer 134 (6.38%), and infection 561 (26.7%) among people with type 2 diabetes mellitus. In the current study, we found 84.7% of people residing in rural Udupi had type 2 diabetes mellitus. Hence, there is a strong need to create awareness about diabetic foot care in these people.
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Affiliation(s)
| | - Shubha Gundmi
- 1 Manipal Academy of Higher Education, Udupi, Karnataka, India
| | | | - Radhika Jadhav
- 1 Manipal Academy of Higher Education, Udupi, Karnataka, India
| | | | | | - Veena G Kamath
- 1 Manipal Academy of Higher Education, Udupi, Karnataka, India
| | | | - P Chinmayee
- 1 Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Animesh Hazari
- 1 Manipal Academy of Higher Education, Udupi, Karnataka, India
| | | | - Rohini Hande
- 3 District Health and Family Welfare Office, Udupi, Karnataka, India
| | | | | | - Edward Jude
- 6 Tameside Hospital, NHS Foundation Trust, Ashton-under-Lyne, England, UK
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Manton RN, Molina A, Gavin N, Hazari A. Hair extensions need to be considered during preoperative assessment. J Perioper Pract 2018; 29:398-399. [PMID: 29944027 DOI: 10.1177/1750458918785265] [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: 11/15/2022]
Abstract
Hair extensions are an increasingly common hairstyling practice. Others have demonstrated these devices can lead to hair and scalp injuries. We describe a recent case where such an injury was narrowly avoided in a patient undergoing a long surgical procedure. We suggest that preoperative assessment procedures need to be aware of such devices and provide advice to patients accordingly.
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Affiliation(s)
- R N Manton
- Queen Victoria Hospital, East Grinstead, UK
| | - A Molina
- Queen Victoria Hospital, East Grinstead, UK
| | - N Gavin
- Queen Victoria Hospital, East Grinstead, UK
| | - A Hazari
- Queen Victoria Hospital, East Grinstead, UK
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Affiliation(s)
| | - S Odeyinde
- Queen Victoria Hospital, East Grinstead, UK
| | - A Hazari
- Queen Victoria Hospital, East Grinstead, UK
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Jadhav RA, Hazari A, Monterio A, Kumar S, Maiya AG. Effect of Physical Activity Intervention in Prediabetes: A Systematic Review With Meta-analysis. J Phys Act Health 2017; 14:745-755. [PMID: 28422560 DOI: 10.1123/jpah.2016-0632] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prediabetes is a strong risk factor for the development of Type2 Diabetes Mellitus (T2DM). Modification in lifestyle plays an important role to avoid the prognosis of T2DM and its complications in future. The aim of our study was to focus on the effectiveness of physical activity (PA) intervention program on different outcome measures in individuals with prediabetes. The effort of the present review was to contribute to the existing literature by strengthening the evidence pointing toward the positive impact of physical activity in individuals with prediabetes. METHODS Studies have been identified through database like PubMed, Scopus, and ProQuest. Randomized and nonrandomized controlled trials have been included. Nineteen articles have been selected for the qualitative analysis and 08 for meta-analysis. RESULTS PA intervention showed a favorable effect on improving oral glucose tolerance (Risk ratio [RR] -0.26, 95% CI -0.06 to 0.07) and fasting blood sugar (RR -0.05, 95% CI -0.14 to 0.04). It also showed the favorable effect on glycated hemoglobin (HbA1C), maximum oxygen uptake (VO2max), and body composition. CONCLUSION Present review suggests that the PA promotion and participation can help to slow down the progression of disease in individuals with prediabetes and thus reduces the morbidity and mortality associated with T2DM.
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Hazari A, K N S, K Rao K, G Maiya A. Influence of low-level laser on pain and inflammation in type 2 diabetes mellitus with diabetic dermopathy - A case report. J COSMET LASER THER 2017; 19:360-363. [PMID: 28494177 DOI: 10.1080/14764172.2017.1326611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/19/2023]
Abstract
Numerous skin lesions have been commonly observed in individuals with diabetes mellitus. The common skin manifestations of diabetes mellitus are erythrasma, xanthomatosis, xanthelasma, phycomycetes and cutaneous infections like furuncolosis, candidiasis, carbuncle, dermatophytosis, etc. Diabetic dermopathy is the most common skin lesion found in patients with diabetes. It is typically seen in men aged above 50 years. In low-level laser therapy (LLLT), the entire lower limb was illuminated with the frequency of 20 Hz and wavelength of 830 nm for 9 min, and the treatment was divided into four parts. With the continued sessions of LLLT, the skin manifestations and neuropathy conditions improved drastically. On the 21st day, the skin colour was found to be normal. Also, there were significant changes in clinical findings for diabetic peripheral neuropathy. LLLT with specific exercises can promote healing of skin manifestations in individuals with type 2 diabetes mellitus. It can be used as an effective treatment modality for treating diabetic dermopathy.
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Affiliation(s)
- Animesh Hazari
- a Kasturba Medical College (KMC), Manipal University , Manipal , India
| | - Shivashankara K N
- a Kasturba Medical College (KMC), Manipal University , Manipal , India
| | - Karthik K Rao
- a Kasturba Medical College (KMC), Manipal University , Manipal , India
| | - Arun G Maiya
- a Kasturba Medical College (KMC), Manipal University , Manipal , India
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Hazari A, Kalyana CB, Gupta R, Deokule P, Amaravadi SK. Effect of Postural Drainage Positions on Vital Parameters in Asymptomatic Healthy Individuals. International Journal of Physiotherapy 2017. [DOI: 10.15621/ijphy/2017/v4i1/136164] [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: 11/05/2022] Open
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18
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Drury P, Jones M, Hazari A. A cost-effective modification in progressive barbed suture closure of the abdominal donor site in DIEP and MS-TRAM patients: A review of surgical technique. J Plast Reconstr Aesthet Surg 2016; 70:136-138. [PMID: 27876308 DOI: 10.1016/j.bjps.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 12/01/2022]
Affiliation(s)
- P Drury
- Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, Holtye Road, East Grinstead RH19 3DZ, United Kingdom.
| | - M Jones
- Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
| | - A Hazari
- Department of Plastic Surgery, Queen Victoria Hospital NHS Trust, Holtye Road, East Grinstead RH19 3DZ, United Kingdom
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19
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Hazari A, Maiya AG, Shivashankara KN, Agouris I, Monteiro A, Jadhav R, Kumar S, Shashi Kumar CG, Mayya SS. Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis. Springerplus 2016; 5:1819. [PMID: 27812455 PMCID: PMC5071310 DOI: 10.1186/s40064-016-3405-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/28/2016] [Indexed: 12/12/2022]
Abstract
Background
Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Therefore they are prone to develop frequent and often foot problems with a relative high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. Thus the review on study of foot kinematic and kinetic in type 2 diabetes mellitus to understand the biomechanical changes is important. Methodology
Scientific articles were obtained using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection was completed after reading the full texts. Studies using experimental design with focus on biomechanics of diabetic foot were selected. Results The meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age matched participants at a high effect level (−0.09, 95 % CI −0.13 to 0.05; p < 0.0001). Regarding knee joint flexion range there was a significant difference between neuropathy and non-diabetes group (4.75, 95 % CI, −7.53 to 1.97, p = 0.0008). Conclusions The systematic review with meta-analysis reported significant difference in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetes individuals. The review also found that the sample size in some studies were not statistically significant to perform the meta-analysis and report a strong conclusion. Therefore a study with higher sample size should be done.
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Affiliation(s)
| | | | | | - Ioannis Agouris
- Sports and clinical Biomechanics, Robert Gordon University, Scotland, UK
| | - Ashma Monteiro
- Department of Statistics, Manipal University, Manipal, India
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Bhattacharya P, Frost T, Deshpande S, Baten MZ, Hazari A, Das A. Bhattacharya et al. Reply. Phys Rev Lett 2016; 117:029702. [PMID: 27447533 DOI: 10.1103/physrevlett.117.029702] [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] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 06/06/2023]
Affiliation(s)
- P Bhattacharya
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
| | - T Frost
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
| | - S Deshpande
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
| | - M Z Baten
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
| | - A Hazari
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
| | - A Das
- Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Avenue, Ann Arbor, Michigan 48109, USA
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21
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Kumar S, Rao K, Maiya AG, Hande HM, Hazari A. Need For Early Diabetic Peripheral Neuropathy Screening among Public Transport Professionals. A Case Report. Laser Ther 2016; 25:141-144. [DOI: 10.5978/islsm.16-cr-01] [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: 11/06/2022]
Affiliation(s)
- Shashi Kumar
- School of allied health sciences, Department of physiotherapy, Manipal University
| | - Karthik Rao
- Department of Medicine, Kasturba Medical College Hospital
| | - Arun G Maiya
- Department of Physiotherapy SOAHS, Manipal University
| | | | - Animesh Hazari
- School of allied health sciences, Department of physiotherapy, Manipal University
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22
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Hazari A, Warsi M. A comparative and qualitative electromyographic analysis of shoulder and wrist muscles in cricket fast bowlers during Bouncer and Yorker delivery. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.458] [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: 11/29/2022]
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23
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Molina AR, Jones ME, Hazari A, Francis I, Nduka C. Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients. Ann R Coll Surg Engl 2012; 94:493-5. [PMID: 23031768 PMCID: PMC3954245 DOI: 10.1308/003588412x13171221592050] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The deep inferior epigastric perforator (DIEP) flap is currently viewed as the gold standard in autologous breast reconstruction. We studied three-dimensional computed tomography angiography (CTA) in 145 patients undergoing free abdominal flap breast reconstruction to try to correlate deep inferior epigastric artery (DIEA) branching pattern with the type of flap performed and patient outcome. Today, reconstructive breast surgeons have become more experienced in raising DIEP flaps and operative times are becoming more acceptable. However, there remains significant interest in finding ways to aid this challenging dissection. METHODS We retrospectively evaluated consecutive patients between January 2007 and August 2008. CTAs were analysed using the Moon and Taylor (1988) classification of the DIEA branching pattern. Data gathered included pre-operative morbidity, type of abdominal wall free flap performed, length of operation, length of stay and complications. RESULTS Some 150 breast reconstructions were performed in 145 patients. There were 67 DIEP flaps, 69 MS-2 transverse rectus abdominis myocutaneous (TRAM) flaps and 14 MS-1 TRAM flaps (where MS-1 spares the lateral muscle and MS-2 spares both lateral and medial segments). Proportionally more DIEP flaps were performed in patients with a type 2 branching pattern. There was one flap loss (0.67%). CONCLUSIONS In this large CTA series, we found a type 1 (single artery) DIEA pattern most frequently, in contrast to the predominance of the type 2 bifurcating pattern observed previously. The higher proportion of DIEP flaps performed in the type 2 pattern patients is consistent with the documented shorter intramuscular course in this group. We have found CTA useful for faster selection of the best hemiabdomen for dissection and flap loss rates in our unit have reduced from 1.5% to 0.67%.
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Affiliation(s)
- A R Molina
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK.
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24
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Elliot D, Lloyd M, Hazari A, Sauerland S, Anand P. Relief of the pain of neuromas-in-continuity and scarred median and ulnar nerves in the distal forearm and wrist by neurolysis, wrapping in vascularized forearm fascial flaps and adjunctive procedures. J Hand Surg Eur Vol 2010; 35:575-82. [PMID: 20494918 DOI: 10.1177/1753193410366191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [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: 02/03/2023]
Abstract
This prospective study reports treatment by neurolysis then wrapping the nerves in vascularized forearm fascia and, when necessary, adjunctive procedures of twelve median and two ulnar nerves in continuity in the distal forearm with neurogenic pain. Preoperatively, all 14 patients had severe pain in at least one of the five modalities of pain analysed. There was complete resolution of all modalities of pain in eight of 14 patients following neurolysis and fascial nerve wrap surgery and two more patients had only mild pain in one or two modalities. After the addition of wrist pinning or arthrodesis alone or in conjunction with selective division of flexor tendons in four patients, there was complete resolution of all modalities of pain in nine of 14 patients. A further three patients had mild pain in three or less modalities and only one patient continued to have severe pain in one modality.
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Affiliation(s)
- D Elliot
- Department of Plastic Surgery, St Andrew's Centre, Broomfield Hospital, Chelmsford, UK.
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25
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See M, Hazari A. The inframammary approach for the correction of iatrogenic synmastia. J Plast Reconstr Aesthet Surg 2010; 63:e96-7. [DOI: 10.1016/j.bjps.2009.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 11/30/2008] [Accepted: 01/04/2009] [Indexed: 11/29/2022]
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26
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Pacifico M, See M, Cavale N, Collyer J, Francis I, Jones M, Hazari A, Boorman J, Smith R. Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation. J Plast Reconstr Aesthet Surg 2009; 62:1464-9. [DOI: 10.1016/j.bjps.2008.04.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 04/14/2008] [Accepted: 04/19/2008] [Indexed: 10/21/2022]
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27
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Hunter JE, Hazari A. Re: safe, tension-free stabilisation of retrieved flexor tendon ends. J Hand Surg Eur Vol 2008; 33:220-1. [PMID: 18443076 DOI: 10.1177/1753193408087113] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J. E. Hunter
- Department of Plastic and Reconstructive Surgery, Queen
Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
| | - A. Hazari
- Department of Plastic and Reconstructive Surgery, Queen
Victoria Hospital, East Grinstead, West Sussex RH19 3DZ, UK
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28
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Kelly EJ, Terenghi G, Hazari A, Wiberg M. Nerve fibre and sensory end organ density in the epidermis and papillary dermis of the human hand. ACTA ACUST UNITED AC 2005; 58:774-9. [PMID: 16086989 DOI: 10.1016/j.bjps.2004.12.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 12/09/2004] [Indexed: 11/28/2022]
Abstract
Quantification of sensory recovery after peripheral nerve surgery is difficult and no accurate techniques are available at present. Quantification of reinnervated skin has been used experimentally, and in some clinical studies, but the lack of knowledge about the normal sensory distribution has been a problem. The purpose of this study was, therefore, to map the density of sensory end organs, nerve fibres and free nerve endings in the glabrous skin of the human hand. Skin biopsies were taken from patients undergoing acute and elective hand surgery. Nerve fibres were stained in the epidermis and papillary dermis and quantified in five sites on the palm of the hand, using protein gene product 9.5 immunoreactivity-a panneuronal marker. The finger tip skin was found to have more than twice the nerve fibre density in the papillary dermis than the skin of the palm, and the number of Meissner corpuscles in the finger tip was also higher than in the palm. We found a reduction in innervation density with increasing age in the dermis, however, that was not the case for the epidermis. The innervation of the epidermis showed high interindividual variability and unlike the papillary dermis did not display any pattern of distribution in the hand.
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Affiliation(s)
- E J Kelly
- Department of Anatomy and Hand and Plastic Surgery, Umeå University, Umeå, Sweden
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Hazari A, Elliot D. Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation. ACTA ACUST UNITED AC 2004; 29:338-50. [PMID: 15234497 DOI: 10.1016/j.jhsb.2004.01.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2003] [Accepted: 01/05/2004] [Indexed: 11/30/2022]
Abstract
This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. Seven were painful as a result of tethering in scarred tissue. Eighty nerves (77%) required a single relocation and 24 (23%) required more than one operation. Ninety-eight per cent of nerve relocations achieved complete pain relief at the primary site. One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.
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Affiliation(s)
- A Hazari
- Hand Surgery Department, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Hazari A, Wiberg M, Johansson-Rudén G, Green C, Terenghi G. A resorbable nerve conduit as an alternative to nerve autograft in nerve gap repair. Br J Plast Surg 1999; 52:653-7. [PMID: 10658137 DOI: 10.1054/bjps.1999.3184] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Poly-3-hydroxybutyrate (PHB) occurs within bacterial cytoplasm as granules and is available as bioabsorbable sheets. Previously, the advantage of PHB in primary repair has been investigated while in this study the same material has been used to bridge an irreducible gap. The aim was to assess the level of regeneration in PHB conduits compared to nerve autografts. The rat sciatic nerve was exposed, a 10 mm nerve segment was resected and bridged with either an autologous nerve graft or a PHB conduit. The grafted segments were harvested up to 30 days. Immunohistochemical staining was performed and computerised quantification of penetration distance and volume of axonal regeneration was estimated by protein gene product (PGP) immunostaining and calcitonin gene-related peptide (CGRP) positive fibres. Penetration and proliferation density of Schwann cells into the conduit was measured by quantifying S-100 staining. The inflammatory response was quantified with ED-1 staining for macrophages. Antibodies to vWf provided an assessment of angiogenesis and capillary infiltration. Percentage immunostaining for PGP in autograft and PHB groups showed a progressive increase up to 30 days with a significant linear trend with time and an increase in the volume of axonal regeneration. A similar pattern of progressive increase with time was observed with CGRP immunostaining for both groups and with S-100 in the PHB group. Good angiogenesis was present at the nerve ends and through the walls of the conduit. The results demonstrate good nerve regeneration in PHB conduits in comparison with nerve grafts.
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Affiliation(s)
- A Hazari
- Blond McIndoe Centre, East Grinstead, UK
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Hazari A, Johansson-Rudén G, Junemo-Bostrom K, Ljungberg C, Terenghi G, Green C, Wiberg M. A new resorbable wrap-around implant as an alternative nerve repair technique. J Hand Surg Br 1999; 24:291-5. [PMID: 10433438 DOI: 10.1054/jhsb.1998.0001] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Poly-3-hydroxybutyrate (PHB), a bacterial storage product, is available as bioabsorbable sheets and has been used in this study for primary nerve repair. The aim was to assess axonal regeneration following such repair and determine the inflammatory response to PHB. In 20 adult cats, the transected superficial radial nerve was wrapped in PHB sheets, while primary epineural repair was carried out in the contralateral limb. At 6 and 12 months, the repair sites were assessed immunohistochemically for macrophage infiltration and myelinated axons were counted in the distal nerve. Mean macrophage counts across the whole width of the nerve in both groups at 6 and 12 months showed no statistically significant difference. Nor was there any significant difference between the two groups at both time-points in axon counts, axon diameter, myelin thickness and g-ratio. There was a statistically significant increase in fibre diameters at 12 months, indicating that fibres were undergoing continuous maturation.
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Affiliation(s)
- A Hazari
- Blond McIndoe Centre, East Grinstead, UK
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Abstract
Sternal cleft is a rare congenital deformity, with a superior cleft being the most common. Although sternal clefting is known to be associated with vascular dysplasia, to our knowledge, we report the first case of superior sternal cleft with cervicofacial hemangiomata and cardiac defects in the absence of true ectopia cordis in a neonate. Early surgery in all cases of sternal clefting is advocated, preferably within the first 4 weeks of life. However, if the child is unfit for operation at this stage, repair should be carried out as soon as the child is stable and fit. The method of choice is primary approximation with the intraoperative precaution of confirming cardiorespiratory stability. We suggest reinforcing the primary approximation with a titanium plate to achieve rigid internal fixation and to reduce the tension at the approximation site. Because titanium osseointegrates well, this procedure results in a solid bony sternum.
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Affiliation(s)
- A Hazari
- Frenchay Hospital, Bristol, United Kingdom
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