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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Matheson LM, Pitson G, Yap CH, Singh M, Collins I, Campbell P, Patrick A, Rogers MJ. Measuring the quality of cancer care in the Barwon South Western region, Victoria, Australia. Int J Qual Health Care 2021; 33:5983668. [PMID: 33196785 DOI: 10.1093/intqhc/mzaa145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The implementation of clinical quality indicators for monitoring cancer care in regional, rural and remote areas. DESIGN Retrospective data from a population-based Clinical Quality Registry for lung, colorectal and breast cancers. SETTING All major health services in the Barwon South Western region, Victoria, Australia. PARTICIPANTS All patients who were diagnosed with cancer and who presented to a health service. INTERVENTION(S) Clinical subgroups to review variations. MAIN OUTCOME MEASURES(S) Clinical quality indicators for lung, colorectal and breast cancers. RESULTS Clinical indicators included the following: discussion at multidisciplinary meetings, the timeliness of care provided and the type of care for different stages of the disease and survival outcomes. Many of the derived clinical indicator targets were reached. However, variations led to an improvement in the tumour stage being recorded in the medical record; an improved awareness of the need for adjuvant chemotherapy for colorectal cancer; a reduction in time to treatment for lung cancer and a reduced time to surgery for breast cancer, and the 30-day mortality post-treatment for all of the tumour streams was highlighted. CONCLUSIONS Clinical quality indicators allow for valuable insights into patterns of care. These indicators are easily reproduced and may be of use to other cancer centres and health services.
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Affiliation(s)
- L M Matheson
- Barwon South Western Regional Integrated Cancer Services, 70 Swanston Street, Geelong, VIC 3220, Australia
| | - G Pitson
- Andrew Love Cancer Centre, 70 Swanston Street, Geelong, VIC 3220, Australia
| | - C H Yap
- Cardiothoracic Surgery, University Hospital Geelong, Geelong, VIC 3220, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Singh
- Andrew Love Cancer Centre, 70 Swanston Street, Geelong, VIC 3220, Australia
| | - I Collins
- Dept of Oncology, South West Healthcare, Warrnambool, VIC 3280, Australia and.,School of Medicine, Deakin University, Geelong, VIC 3216, Australia
| | - P Campbell
- Andrew Love Cancer Centre, 70 Swanston Street, Geelong, VIC 3220, Australia.,School of Medicine, Deakin University, Geelong, VIC 3216, Australia
| | - A Patrick
- Barwon South Western Regional Integrated Cancer Services, 70 Swanston Street, Geelong, VIC 3220, Australia
| | - M J Rogers
- Barwon South Western Regional Integrated Cancer Services, 70 Swanston Street, Geelong, VIC 3220, Australia
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Thompson HJ, Patrick A, Liu V. Spreading violaceous neck plaques in a fatigued man. Clin Exp Dermatol 2021; 46:778-781. [PMID: 33426706 DOI: 10.1111/ced.14545] [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] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - A Patrick
- Department of Dermatology, Iowa City, IA, USA
| | - V Liu
- Department of Dermatology, Iowa City, IA, USA
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Barzilay R, White LK, Moore TM, Calkins ME, Taylor JH, Patrick A, Huque ZM, Young JF, Ruparel K, Pine DS, Gur RC, Gur RE. Association of anxiety phenotypes with risk of depression and suicidal ideation in community youth. Depress Anxiety 2020; 37:851-861. [PMID: 32500960 PMCID: PMC7484017 DOI: 10.1002/da.23060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/02/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety symptoms are common in adolescence and are often considered developmentally benign. Yet for some, anxiety presents with serious comorbid nonanxiety psychopathology. Early identification of such "malignant" anxiety presentations is a major challenge. We aimed to characterize anxiety symptoms suggestive of risk for depression and suicidal ideation (SI) in community youths. METHODS Cross-sectional associations were evaluated in community youths (n = 7,054, mean age: 15.8) who were assessed for anxiety, depression, and SI. We employed factor and latent class analyses to identify anxiety clusters and subtypes. Longitudinal risk of anxiety was evaluated in a subset of 330 youths with longitudinal data on depression and SI (with baseline mean age of 12.3 years and follow-up mean age of 16.98 years). OUTCOMES Almost all (92%) adolescents reported anxiety symptoms. Data-driven approaches revealed anxiety factors and subtypes that were differentially associated with depression and SI. Cross-sectional analyses revealed that panic and generalized anxiety symptoms show the most robust associations with depression and SI. Longitudinal, multivariate analyses revealed that panic symptoms during early adolescence, not generalized anxiety symptoms, predict depression and SI for later adolescent years, particularly in males. INTERPRETATION Anxiety is common in youths, with certain symptom clusters/subtypes predicting risk for depression and SI. Panic symptoms in early adolescence, even below disorder threshold, predict high risk for late adolescent depression and SI.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Lauren K. White
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP
| | - Tyler M. Moore
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Monica E. Calkins
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Jerome H. Taylor
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Ariana Patrick
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP
| | - Zeeshan M. Huque
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Jami F. Young
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Kosha Ruparel
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Daniel S. Pine
- Section of Developmental Affective Neuroscience, National Institute of Mental Health
| | - Ruben C. Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
| | - Raquel E. Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine; the Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania
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Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE. Association between early-life trauma and obsessive compulsive symptoms in community youth. Depress Anxiety 2019; 36:586-595. [PMID: 31066996 DOI: 10.1002/da.22907] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/27/2019] [Accepted: 04/05/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obsessive-compulsive symptoms (OCS) in youth are common, have heterogeneous manifestations, and have been shown to be associated with serious psychopathology. While early-life trauma exposure is associated with increased risk for obsessive-compulsive disorder (OCD), its association with different OCS and its clinical relevance for serious psychopathology is unclear. Here we aimed to evaluate associations among traumatic stressful events (TSE), OCS, and serious psychiatric conditions in community youth. METHODS We studied nonmental-help seeking youths from the Philadelphia Neurodevelopmental Cohort (N = 7054, aged 11-21, 54% females, 52% prepubertal), assessed for lifetime TSE exposure and OCS. Regression models investigated cross-sectional associations of TSEs with OCS, and associations with depression, suicide ideation and psychosis. Models examined sex and puberty effects, controlling for age and socioeconomic status. RESULTS Trauma exposure was associated with higher OCS rates, especially in females (Trauma × Sex interaction Wald = 7.93, p = 0.005) and prepuberty (Trauma × Puberty interaction Wald = 7.68, p = 0.006). TSEs were associated with all OCS manifestations, most prominently with bad intrusive thoughts (odds ratio [OR] = 1.63). Assaultive TSEs, especially sexual assault, showed stronger associations with OCS compared with nonassaultive TSEs. While TSEs and OCS were independently associated with depression, suicide ideation, and psychosis, a significant interaction was observed only in association with increased rates of psychosis (Trauma × OCS interaction Wald = 5.08, p = 0.024). CONCLUSION Early-life trauma is associated with OCS in a dose-response manner, more so in females and prepuberty. The trauma-OCS association varied by load, type of trauma, and by OCS subtypes. Trauma-OCS appears a detrimental combination in association with psychosis.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ariana Patrick
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Monica E Calkins
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tyler M Moore
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ruben C Gur
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Raquel E Gur
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Barzilay R, Patrick A, Calkins ME, Moore TM, Wolf DH, Benton TD, Leckman JF, Gur RC, Gur RE. Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? J Am Acad Child Adolesc Psychiatry 2019; 58:277-286.e4. [PMID: 30738554 DOI: 10.1016/j.jaac.2018.06.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 04/20/2018] [Revised: 06/13/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Obsessive-compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a "red flag" that merits psychiatric evaluation. METHOD Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N = 7,054, aged 11-21 years, 54% female). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive-compulsive disorder (OCD), depressive episode, psychosis, and suicide ideation. RESULTS OCS were common in non-mental health-seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in female participants and postpuberty. Factor analyses resulted in 4 factors: F1 - Bad Thoughts; F2 - Repeating/Checking; F3 - Symmetry; F4 - Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis, and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions. CONCLUSION OCS are common in community youth. Although for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help to identify youth at risk for serious psychopathology.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Ariana Patrick
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - Monica E Calkins
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tyler M Moore
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel H Wolf
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tami D Benton
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - James F Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Ruben C Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raquel E Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Godbout E, Masroor N, Knowlson S, Fleming M, Patrick A, Cooper K, Doll M, Stevens M, Bearman G. A Nurse-Driven Testing Protocol to Identify Community-Onset Clostridium difficile Infections in Hospitalized Patients. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4007] [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: 11/27/2022] Open
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Talari K, Anandh U, Patrick A. Lupus Nephritis with Coexistent Antiphospholipid Antibodies Associated Nephropathy: A Case Report and Literature Review. Indian J Nephrol 2018; 28:164-166. [PMID: 29861569 PMCID: PMC5952457 DOI: 10.4103/ijn.ijn_204_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antiphospholipid syndrome (APS) associated nephropathy is a distinct clinical entity and can occur in patients with systemic lupus erythematosus (SLE) independent of or associated with lupus nephritis. Associated APS nephropathy in a patient with lupus predicts poor renal outcome, especially if left untreated. Recognizing a coexistent APS nephropathy in a patient with lupus nephritis is of utmost importance. Here, we present a patient with severe lupus nephritis with antiphospholipid antibodies (aPLs) who had no thrombotic manifestations of APS clinically. On renal biopsy, she was found to have APS nephropathy. Remission was achieved after 3 months of anticoagulation and immunosuppression. This case illustrates the importance of renal biopsy in a patient of SLE with aPLs. Renal biopsy often alerts a treating rheumatologist of the presence of thrombotic involvement in such patients, thereby altering the treatment of such patients.
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Affiliation(s)
- K Talari
- Department of Rheumatology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - U Anandh
- Department of Nephrology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - A Patrick
- Department of Pathology, Yashoda Hospitals, Hyderabad, Telangana, India
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Horstmanshof D, George S, Mendenhall M, Chelikani N, El Banayosy M, Gibbs C, Jacob T, Patrick A, Duke M, Becker C, Walter T, Nelson K. Inter-facility Collaboration to Decrease Acute Care Length of Stay Post LVAD Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.687] [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: 11/30/2022] Open
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Abstract
The concept of choice, which has been inherent in the rehabilitation process since its inception, has evolved into legal mandates and ethical challenges for rehabilitation professionals during the latter part of the 20th century. This article identifies the ethical and legal issues related to choice, summarizes a pilot project on rehabilitation counselors' perceptions of choice, and provides recommendations for rehabilitation professionals in resolving ethical dilemmas related to choice.
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Affiliation(s)
- J B Patterson
- Rehabilitation Counseling Program, College of Health, University of North Florida, 4567 St. John's Bluff Rd. South, Jacksonville, FL 32224-2673, USA.
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Wang SV, Verpillat P, Rassen JA, Patrick A, Garry EM, Bartels DB. Transparency and Reproducibility of Observational Cohort Studies Using Large Healthcare Databases. Clin Pharmacol Ther 2016; 99:325-32. [PMID: 26690726 DOI: 10.1002/cpt.329] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/21/2022]
Abstract
The scientific community and decision-makers are increasingly concerned about transparency and reproducibility of epidemiologic studies using longitudinal healthcare databases. We explored the extent to which published pharmacoepidemiologic studies using commercially available databases could be reproduced by other investigators. We identified a nonsystematic sample of 38 descriptive or comparative safety/effectiveness cohort studies. Seven studies were excluded from reproduction, five because of violation of fundamental design principles, and two because of grossly inadequate reporting. In the remaining studies, >1,000 patient characteristics and measures of association were reproduced with a high degree of accuracy (median differences between original and reproduction <2% and <0.1). An essential component of transparent and reproducible research with healthcare databases is more complete reporting of study implementation. Once reproducibility is achieved, the conversation can be elevated to assess whether suboptimal design choices led to avoidable bias and whether findings are replicable in other data sources.
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Affiliation(s)
- S V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical/Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - P Verpillat
- Corporate Department Global Epidemiology, Boehringer Ingelheim, Ingelheim, Germany
| | | | - A Patrick
- Aetion, Inc., New York, New York, USA
| | - E M Garry
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - D B Bartels
- Corporate Department Global Epidemiology, Boehringer Ingelheim, Ingelheim, Germany.,Hannover Medical School, Hannover, Germany
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Bolsin S, Colson M, Patrick A, Freestone L, Creati B, Bent P. Factors contributing to successful incident reporting in anaesthesia. Br J Anaesth 2011; 107:473-4; author reply 474. [DOI: 10.1093/bja/aer243] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Patrick A, Wee A, Hedderman A, Wilson D, Weiss J, Govani M. High-dose intravenous rituximab for multifocal, monomorphic primary central nervous system posttransplant lymphoproliferative disorder. J Neurooncol 2010; 103:739-43. [PMID: 20872273 DOI: 10.1007/s11060-010-0425-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 06/11/2010] [Accepted: 09/13/2010] [Indexed: 11/25/2022]
Abstract
Primary central nervous system (CNS) posttransplant lymphoproliferative disorder (PTLD) is a well-recognized but rare complication of solid organ transplantation. Most of these disorders are B-cell in origin and generally carry poor prognosis. Rituximab, an anti-CD20 monoclonal antibody, has been used effectively in patients with systemic PTLD. However, its role in primary CNS PTLD is doubtful because it does not cross blood-brain barrier efficiently (<5%). Also, mechanisms, by which rituximab operates are not optimally effective in CNS. Here, we describe a renal transplant patient with monomorphic, multifocal, CD20-positive, primary B-cell CNS PTLD, who was treated with high-dose intravenous rituximab given in dose-escalation protocol, which has been used effectively for the patients with chronic lymphocytic leukemia. At 1-year follow-up, magnetic resonance imaging (MRI) showed complete resolution. High-dose rituximab may have a role in highly selected patients with primary CNS PTLD.
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Affiliation(s)
- A Patrick
- Department of Medicine, St. Vincent Hospital, 8333 Naab Road, Suite 300, Indianapolis, IN 46260, USA
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Solomon DH, Gleeson T, Iversen M, Avorn J, Brookhart MA, Lii J, Losina E, May F, Patrick A, Shrank WH, Katz JN. A blinded randomized controlled trial of motivational interviewing to improve adherence with osteoporosis medications: design of the OPTIMA trial. Osteoporos Int 2010; 21:137-44. [PMID: 19436935 PMCID: PMC2922963 DOI: 10.1007/s00198-009-0951-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 01/06/2009] [Accepted: 03/27/2009] [Indexed: 01/17/2023]
Abstract
UNLABELLED We have designed an innovative randomized controlled trial for improving adherence with osteoporosis medications. Recruitment and randomization have been successful. Also, the counseling intervention has been well accepted by subjects randomized to this treatment arm. INTRODUCTION While many effective treatments exist for osteoporosis, most people do not adhere to such treatments long term. No proven interventions exist to improve osteoporosis medication adherence. We report here on the design and initial enrollment in an innovative randomized controlled trial aimed at improving adherence to osteoporosis treatments. METHODS The trial represents a collaboration between academic researchers and a state-run pharmacy benefits program for low-income older adults. Beneficiaries beginning treatment with a medication for osteoporosis are targeted for recruitment. We randomize consenting individuals to receive 12 months of mailed education (control arm) or an intervention consisting of one-on-one telephone-based counseling and the mailed education. Motivational interviewing forms the basis for the counseling program which is delivered by seven trained and supervised health counselors over ten telephone calls. The counseling sessions include scripted dialog and open-ended questions about medication adherence and its barriers, as well as structured questions. The primary end point of the trial is medication adherence measured over the 12-month intervention period. Secondary end points include fractures, nursing home admissions, health care resource utilization, and mortality. RESULTS During the first 7 months of recruitment, we have screened 3,638 potentially eligible subjects. After an initial mailing, 1,115 (30.6%) opted out of telephone recruitment and 1,019 (28.0%) could not be successfully contacted. Of the remaining, 879 (24.2%) consented to participate and were randomized. Women comprise over 90% of all groups; mean ages range from 77 to 80 years old, and the majority in all groups was white. The distribution of osteoporosis medications was comparable across groups and the median number of different prescription drugs used in the prior year was eight to ten. CONCLUSIONS We have developed a novel intervention for improving osteoporosis medication adherence. The intervention is currently being tested in a large-scale randomized controlled trial. If successful, the intervention may represent a useful model for improving adherence to other chronic treatments.
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Affiliation(s)
- D H Solomon
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
BACKGROUND Gastroparesis is a chronic disorder caused by stomach pump failure and characterized by profound nausea, vomiting and epigastric pain. Most often, the cause is unapparent and of the known associations, diabetes is the most common. Diagnosis is usually made using an isotope-labelled test meal. Treatment is incremental and includes education, dietary support, prokinetic and antiemetic agents. There are novel approaches including gastric neurostimulation. AIM To review current concepts of gastric motor function, aetiology, investigation and treatment of gastroparesis. METHODS A systematic web-based review of the literature was undertaken using a lexicon of terms associated with gastroparesis. RESULTS There are few controlled studies of this condition. Little is known about causation or underlying nerve, muscle or pacemaker pathology. Idiopathic gastroparesis occurs most commonly in women and gastric emptying is often abnormal in diabetes. Isotopic gastric scintigraphy remains the gold standard investigation, but alternative tests are being developed. Treatment is multimodal and includes education, and nutritional support. There are no adequately powered controlled trials to support a particular drug regimen. In intractable gastroparesis, gastric neurostimulation appears to offer benefit. CONCLUSION Despite a significant progress in the past decade, further controlled trials are required into the therapeutic options available for treating this intriguing condition.
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Affiliation(s)
- A Patrick
- Centre for Gastroenterology, Royal Free Hampstead NHS Trust, London, UK
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19
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Abstract
We present the clinical details of four women with cardiomyopathy who required caesarean section. Two women had peripartum cardiomyopathy and two had hypertrophic obstructive cardiomyopathy, one of whom has had two caesarean sections. Those with peripartum cardiomyopathy were more compromised than those with hypertrophic obstructive cardiomyopathy. Co-operation between obstetric and cardiac anaesthetists ensured optimum experience was available. An incremental combined spinal-epidural technique with invasive monitoring was used for three women and one received general anaesthesia. The risks and benefits of different anaesthetic techniques are discussed.
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MESH Headings
- Adult
- Anesthesia, Obstetrical/methods
- Anesthesiology
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/therapy
- Cesarean Section
- Female
- Humans
- Interdisciplinary Communication
- Obstetrics
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnostic imaging
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/therapy
- Risk Factors
- Thromboembolism/prevention & control
- Ultrasonography
- United Kingdom
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Affiliation(s)
- A Pryn
- Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow, UK.
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Bolsin S, Solly R, Patrick A. The value of personal professional monitoring performance data and open disclosure policies in anaesthetic practice: a case report. Qual Saf Health Care 2003; 12:295-7. [PMID: 12897364 PMCID: PMC1743729 DOI: 10.1136/qhc.12.4.295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/04/2022]
Abstract
A case is reported in which routine detailed trainee performance monitoring data collected as part of a personal professional monitoring programme were used to help justify to a patient and relatives the unforeseeable nature of a rare complication of a procedure. The data also supported the decision to allow the trainee to undertake the procedure. The personal professional monitoring programme conforms to the highest standards of clinical governance for trainees, consultants, departments, hospitals, and professional colleges. Data from the programme are fed back to the trainees and used to guide training requirements and to provide objective evidence of trainee assessments, practical ability, and competence.
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Affiliation(s)
- S Bolsin
- Department of Perioperative Medicine, Anaesthesia & Pain Management, The Geelong Hospital, Geelong, Victoria 3220, Australia.
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Fischer MA, Patrick A. Secondary penile carcinoma from squamous cell carcinoma of the lung. Can J Urol 1999; 6:899-900. [PMID: 11180793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Secondary penile carcinoma is an unusual clinical entity that has a poor prognosis. We report a case of primary squamous cell carcinoma of the lung with a metastasis to the glans penis, which developed 8 months after treatment for the primary malignancy.
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Affiliation(s)
- M. A. Fischer
- Department of Urology, Dalhousie University, Halifax, Nova Scotia
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Abstract
OBJECTIVES There is a general consensus among physicians that the present management of chronic prostatitis is dismal. We undertook a survey of Canadian primary care physicians (PCPs) and urologists to determine the degree and source of frustration and to analyze present practice patterns in this disease. METHODS Five thousand PCPs and all 545 Canadian urologists were asked to complete a comprehensive computer-assisted telephone survey that explored practice characteristics, attitudes, and diagnostic and treatment strategies in the management of prostatitis. Randomization of attribute banks, adherence to questionnaire routing, validation by on-site monitoring, and possible bias were addressed. RESULTS Completed interviews were obtained from 10% of PCPs and 28% of urologists. PCPs see on average 3.5 (median 2) patients with prostatitis per month and urologists see on average 21.8 (median 11) patients with prostatitis per month. All physicians experience significantly more frustration in treating prostatitis than they do in treating patients with benign prostatic hyperplasia (BPH) and prostate cancer, and they perceive that prostatitis affects patients' quality of life significantly more than BPH and almost as much as prostate cancer. The degree of frustration and unhappiness in dealing with prostatitis is driven by a lack of confidence and comfort in their ability to accurately diagnose and subsequently rationalize treatment. Most PCPs and urologists continue to employ steps in addition to history and physical examination to establish a diagnosis but only a few PCPs and a third of urologists use specific lower urinary tract cultures. Physicians tend to use trimethoprim or trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone as their usual first line therapy for chronic prostatitis. The most commonly used therapeutic strategy (40%) for chronic prostatitis was TMP-SMX as first line therapy and a fluoroquinolone as second line therapy. CONCLUSIONS There is widespread frustration, discomfort, and lack of confidence in both PCPs' and urologists' perceived ability to manage prostatitis. Physicians have expressed a desire for a better understanding of this disease, simpler and clearer diagnostic guidelines, and more rational treatment strategies.
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Affiliation(s)
- J C Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada
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James KS, McGrady E, Quasim I, Patrick A. Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour. Br J Anaesth 1998; 81:507-10. [PMID: 9924221 DOI: 10.1093/bja/81.4.507] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.25% plain bupivacaine 10 ml. Analgesia provided by both techniques was similar, but women in group A retained motor power in their legs and 60% chose to get out of bed. Duration of labour and time from insertion of the epidural to delivery was similar in both groups, but in group A, duration of the second stage was significantly shorter (P = 0.0003; 95% confidence interval (CI) -1.17, -0.27 h) and the incidence of forceps delivery was lower (P = 0.032). Maternal satisfaction with epidural analgesia, as assessed by VAS, was higher in group A (P = 0.04; 95% CI -0.001, 10.001).
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Abstract
The in-hospital Utstein Style was published in April 1997. This new format is used to present the outcome of in-hospital cardiac arrest in Middlemore Hospital, Auckland, NZ, between June 1995 and June 1996. The in-hospital Utstein Style was generally easy to follow, but there were several areas where adjustments may be of benefit. The study shows that there were 140 true arrest calls during this period, with 133 attempted resuscitations. Forty-seven patients had ROSC greater than 24 h, 35 were discharged alive and 30 were alive at 1 year. Of these 30 survivors, 27 had a Cerebral Performance Category of 1.
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Affiliation(s)
- A Patrick
- Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand
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James KS, McGrady E, Patrick A. Combined spinal-extradural anaesthesia for preterm and term caesarean section: is there a difference in local anaesthetic requirements? Br J Anaesth 1997; 78:498-501. [PMID: 9175961 DOI: 10.1093/bja/78.5.498] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 02/04/2023] Open
Abstract
In a non-blinded observational study, we have tested the null hypothesis that there is no difference in local anaesthetic requirements for subarachnoid anaesthesia between women presenting for Caesarean section at term or preterm (38-42 and 28-35 weeks' gestation, respectively). Using a combined spinal-extradural technique, 2.25 ml of 0.5% hyperbaric bupivacaine was given, in the sitting position, to 50 women presenting for Caesarean section. In 21 of 25 preterm women, adequate sensory block for surgery did not develop (P < 0.001) and they required supplementary extradural local anaesthetic (median 8 ml of 2% lignocaine with 1:200,000 adrenaline (interquartile range 4-12 ml)); preterm women not requiring extradural supplementation were at the upper end of the gestational range. There was a strong linear correlation between increasing gestation and block height in the preterm group (Spearman rank correlation coefficient = 0.74; 95% confidence intervals 0.49, 0.88). All women in the term group developed adequate anaesthesia with the subarachnoid dose alone. Onset of anaesthesia was slower in the preterm group (median 15 vs 5 min) with a lower incidence of hypotension (P = 0.0005).
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Affiliation(s)
- K S James
- Directorate of Anaesthesia and Intensive Care, Glasgow Royal Maternity Hospital
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Abstract
Cigarette smoke is potentially capable of generating a high free radical load in the body and many patients with diabetes are smokers. This study was designed to investigate the relationship between long-term smoking and free radical activity in young adult insulin-dependent diabetic patients with no evidence of macrovascular disease. Eight-five patients (48 male) aged 17-40 years were studied. Mean duration of diabetes was 10.5 years (0.08-33) and 39 were cigarette smokers. All had normal serum creatinine levels. The free radical markers measured were: thiobarbituric acid reactive substances, glutathione peroxidase, and superoxide dismutase. No significant differences in thiobarbituric acid reactive substances, glutathione peroxidase, or superoxide dismutase, were found between the diabetic smokers and non-smokers. Also no difference was found comparing the diabetic patients with 40 non-diabetic control subjects (20 smokers). Persistent albuminuria was present in 16 patients (10 microalbuminuria) and free radical marker concentrations in these subjects were similar to the normoalbuminuric patients. This data suggests that any increase in free radical activity due to cigarette smoke is adequately scavenged in young adults with diabetes who are free of significant macrovascular disease.
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Affiliation(s)
- M B Leonard
- Department of Clinical Chemistry, Fazakerley Hospital, Liverpool, UK
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Hughes-Benzie RM, Tolmie JL, McNay M, Patrick A. Simpson-Golabi-Behmel syndrome: disproportionate fetal overgrowth and elevated maternal serum alpha-fetoprotein. Prenat Diagn 1994; 14:313-8. [PMID: 7520583 DOI: 10.1002/pd.1970140414] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [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: 01/25/2023]
Abstract
Simpson-Golabi-Behmel (SGB) syndrome is an X-linked condition with pre- and postnatal overgrowth, characteristic facies, and visceral and skeletal anomalies. We report an affected male who presented at 16 weeks' gestation with elevated maternal serum alpha-fetoprotein (MSAFP). Fetal measurements at 20 and 31 weeks' gestation were disproportionate, with marked macrosomia but a low head to abdominal circumference ratio and normal femur length. Fetal overgrowth with elevated MSAFP may prove to be useful markers for the prenatal diagnosis of SGB syndrome.
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Patrick A. A real headache. Aust Fam Physician 1993; 22:1854-5. [PMID: 8280014] [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: 01/29/2023]
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Michèle S, Alain B, Oliver WS, Hung OR, Hope CE, Laney G, Whynot SC, Coonan TJ, Malloy DS, Patterson S, Gelb A, Manninen P, Strum D, Glosten B, Spellman MJ, Eger EI, Craen RA, Gelb AW, Murkin JM, Chong KY, Penning DH, El-Behairy H, Brien JF, Coh JW, Arellano R, Correa J, Fedorko L, Arellano R, Liu Z, Boylan JF, Sandler AN, Nierenberg H, Sheiner PA, Greig PD, O’Leary GM, Teasdale SJ, Glynn MFX, Orser BA, Wang LY, MacDonald JF, Loomis CW, Arunachalam KD, Vyas D, Milne B, Gagnon D, Lavoie J, Dupuis JY, Miller DR, Martineau RJ, Greenway D, Olivaris L, Hull K, Tierney RNM, Wynands JE, Martineau R, St-Jean B, Kitts J, Miller D, Lindsay P, Curran M, Allen GC, Crossan ML, Wise R, Donati F, Bevan DR, Hardy JF, Desroches J, Perrault J, Carrier M, Robitaille D, Ansley DM, O’Connor JP, Dolman J, Townsend GE, Ricci D, Liepert DJ, Browne PM, Hertz T, Rooney M, Yip RW, Code W, Phillips AA, McLean RF, Devitt JH, Harrington EM, Byrick RJ, Wong PY, Wigglesworth D, Kay JC, Sinclair LA, Koch JP, Deemar KA, Christakis GK, Belo S, Angle P, Cheng D, Boylan J, Sandler A, Feindel C, Carmichael F, Boylen P, Boylen P, DeLima LGR, Nathan HJ, Hynes MS, Bourke ME, Russell GN, Seyone C, Chung F, Chartrand D, Roux L, Dain SL, Smith BD, Webster AC, Wigglesworth DF, Rose DK, Caskennette G, Mechetuk C, Doyle DJ, DeMajo W, Bosch F, Lee M, McClenaghan KM, Mazer CD, Preston R, Crosby ET, Kotarba D, Dudas H, Elliott RD, Enns J, Manninen PH, Farrar JK, Huzyka DL, Lin LP, Fossey S, Finucane BT, Stockwell M, Lozanoff S, Lang S, Hyssen J, Campbell DC, Douglas MJ, Pavy TJG, Flanagan ML, McMorland GH, Bands C, Ffaracs CB, Lipsett C, Drover D, Stafford-Smith M, Stevens S, Shields K, MacSween MJ, McAllister JD, Morley-Forster PK, White AK, Taylor MD, Vandenberghe HM, Knoppert D, Reimer H, Duke PC, Kehler CH, Kepron MW, Taraska VA, Carstoniu J, Norman P, Katz J, Hannallah M, Cooney CM, Lyons JB, Hennigan A, Blunnie WP, Moriarty DC, Dobkowski WB, Prato FS, Shannon NA, Drost DJ, Arya B, Wills JM, Bond D, Morley-Forester P, JB M, Spahr-Schopfer I, Lerman J, Cutz E, Dolovich M, Kowalski S, Ong B, Bell D, Ostryzniuk T, Serrette C, Wasylak T, Coke S, Tsuda T, Nakagawa T, Mabuchi N, Ando H, Nishida O, Azami T, Katsuya H, Goto Y, Searle N, Roy M, R. R. T., Smith CE, Pinchak AC, Hagen JF, Hancock D, Krassioukov AV, Weaver LC, Sutton IR, Mutch WAC, Teskey JM, Thomson IR, Rosenbloom M, Thiessen D, Teasdale S, Corbin H, Graham MR, Lang SA, Chang P, Gerard M, Tetzlaff JE, Walsh M, Yoon H, Warriner B, Fancourt-Smith P, McEwen J, Crane J, Badner NH, Bhandari R, Komar WE, Ganapathy S, Warriner CB, McCormack JP, Levine M, Glick N, Chan VWS, McQuestion M, Gomez M, Cruise C, Evana D, Shumka D, Smyth RJ, Graham M, Halpenny D, Goresky GV, Zaretski JE, Kavanagh B, Roger S, Davies A, Friedlander M, Cohen MM, Duncan PG, Pope WDB, Biehl D, Merchant R, Tweed WA, Tessler MJ, Angle M, Kleiman S, Kavanagh BP, Doak GJ, Li G, Hall RI, Sulliyan JA, Yee I, Halpern S, Pittini R, Huh C, Bryson GL, Gverzdys R, Perreault C, Ferland L, Gobeil F, Girard D, Smyth R, Asokumar B, Glynn M, Silveira S, Clark J, Milgram P, Splinter WM, MacNeill HB, Ménard EA, Rhine EJ, Roberts DJ, Gould GM, Johnson GG, Quance D, Wiesel S, Easdown J, Truong NT, Miller N, Sheiner N, Welborn L, Norden J, Hannallah R, Broadman L, Seiden N, Iwai M, Iwai R, Horigome H, Yamashita M, Wood CE, Klassen K, Kleinman S, Yentis S, Sikich N, Yemen TA, Mascik B, Nelson W, Ghantous H, Gandolfi J, Wood G, Ali M, Inman K, Karski JM, Carroll J, Brooks D, Oakley PA, Webster PM, Karski J, Yao T, Ivanov J, Young P, Carson S, Weisel RD, Cooper RM, Wong DT, Wagner DP, Knaus WA, Munshi CA, Kampine JP, Soutter ID, Mathieu A, Gafni A, Dauphin A, Torsher L, Tierney M, Hopkins HS, Baylon GJ, Peter EA, Bellhouse CP, Dore C, Rachwal TW, Lanigan DT, Yip R, Derdemezi JB, Britt BA, Withington DE, Reynolds F, Patrick A, Man W, Searle NR, Ste-Marie H, Kostash MA, Johnston R, Bailey RJ, Sharpe MD, Woda RP, Haug M, Slugg P, Lockrem J, Barnett G, Finegan BA, Robertson M, Taylor D, Frost G, Koshal A, Rodney GE, Reichert CC, O’Regan DN, Blackstock D, Steward DJ, Wenstone R, Harrington E, Wong A, Braude B, Fear D, Bissonnette B, Reid CW, Hull KA, Yogendran S, McGuire G, Chan V, Hartley E, Kessel K, Weisel R, Takla N, Tremblay NA, Ralley FE, Ramsay JG, Robbins GR, Salevsky FC, Gandhi S, Nimphius N, Dionne B, Jodoin C, Lorange M, Lapointe A, Hawboldt G, Volgyesi GA, Tousignant G, Barnett R, Gallant B. Erratum. Can J Anaesth 1992. [DOI: 10.1007/bf03008250] [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: 10/20/2022] Open
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Williams G, Patrick A. Human growth hormone and restoration of hypoglycaemia awareness. Lancet 1992; 339:1618; author reply 1618-9. [PMID: 1351595] [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: 03/23/2023]
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Abstract
Distal renal tubular acidosis (DRTA) is characterized by a urine of inappropriately high pH in the presence of a metabolic acidosis. Female patients with DRTA may have associated autoimmune disorders. We have described a patient with DRTA, followed by acute thyroiditis and autoimmune hemolytic anemia within 2 years. This combination of autoimmune diseases has not been described previously. These conditions are likely linked by an autoimmune pathogenesis. Clinicians are advised that some patients with DRTA may subsequently have features of any autoimmune disorder as the natural history of the disease.
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Affiliation(s)
- L Roberts
- Department of Medicine, General Hospital, Port of Spain, Trinidad
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Lie SO, Glomstein A, Slørdahl SH, Storm-Mathisen I, Albrechtsen D, Young EP, Patrick A. Bone marrow transplantation in metabolic diseases. Transplant Proc 1988; 20:499-500. [PMID: 3132771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- S O Lie
- Department of Pediatrics, Rikshospitalet, National Hospital, Oslo 1, Norway
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Abstract
We describe three male fetuses with a lethal multiple pterygium syndrome (LMPS). The family was ascertained when the first pregnancy of healthy, unrelated Scottish parents ended with a miscarriage at 23 weeks gestation. The macerated male fetus had a cystic hygroma, cleft palate, and webbing of the neck, elbows, and thighs. Radiographs showed lack of modeling of long bones, with broad ribs and clavicles, hypoplastic radii and ulnae, abnormal jaw angle, and dislocated femoral heads. Two other fetuses with similar anomalies were born to a first cousin of the propositus. These three male fetuses with a similar lethal multiple pterygium syndrome born to mothers who are second-degree relatives through the female line suggest X-linked recessive inheritance of LMPS in this family.
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Affiliation(s)
- J L Tolmie
- Duncan Guthrie Institute of Medical Genetics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
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Patrick A, Roberts L, Poon-King P, Jeelal V. Acute renal failure due to multiple stings by Africanised bees. Report of the first case in Trinidad. W INDIAN MED J 1987; 36:43-4. [PMID: 3590751] [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: 01/06/2023]
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Abstract
A 15 year old boy with profound weight loss was found to have foreign body obstruction of the lower oesophagus. Achalasia was subsequently diagnosed and there was rapid gain in weight and height after oesophagomyotomy .
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Patrick A, Cameron JS, Ogg CS. A family with a dominant form of idiopathic Fanconi syndrome leading to renal failure in adult life. Clin Nephrol 1981; 16:289-92. [PMID: 7032774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Three members of a family previously reported by Sheldon, Luder and Web in 1961 as having a benign tubular renal disease have since developed renal failure. One received a renal transplant but died following this. This form of apparently primary, dominantly-inherited Fanconi syndrome is a mild disease in childhood, but leads to renal failure in adult life.
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Patrick A. Robots in the kitchen. Dimens Health Serv 1977; 54:22-4. [PMID: 873079] [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: 12/24/2022]
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Patrick A. Spontaneous hypoglycaemia. Nurs Mirror Midwives J 1966; 122:ix-x. [PMID: 5176526] [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: 01/14/2023]
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Patrick A. Septal Rupture after Myocardial Infarction. West J Med 1961. [DOI: 10.1136/bmj.1.5236.1393-a] [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: 11/04/2022]
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Patrick A. Secondary Organisms in the Lungs in Influenza. West J Med 1944. [DOI: 10.1136/bmj.1.4330.23] [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: 11/04/2022]
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Patrick A. MENORRHAGIA OF OBSCURE ORIGIN. West J Med 1931. [DOI: 10.1136/bmj.2.3692.678-a] [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: 11/04/2022]
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