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Padhani ZA, Cichon B, Das JK, Salam RA, Stobaugh HC, Mughal M, Rutishauser-Perera A, Black RE, Bhutta ZA. Systematic Review of Management of Moderate Wasting in Children over 6 Months of Age. Nutrients 2023; 15:3781. [PMID: 37686813 PMCID: PMC10490450 DOI: 10.3390/nu15173781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The effective management of the 33 million children with moderate acute malnutrition (MAM) is key to reducing childhood morbidity and mortality. In this review, we aim to evaluate the effectiveness of specially formulated foods (SFFs) compared to non-food-based approaches to manage MAM in children >6 months old. We conducted a search on ten databases until 23 August 2021 and included five studies, covering 3387 participants. Meta-analysis of four studies comparing SFFs to counselling or standard of care showed that SFFs likely increase recovery rate, reduce non-response, and may improve weight-for-height z-score, weight-for-age z-score and time to recovery, but have little or no effect on MUAC gain. One study on a multicomponent intervention (SFFs, antibiotics and counselling provided to high-risk MAM) compared to counselling only was reported narratively. The intervention may increase weight gain after 24 weeks but may have little or no effect on weight gain after 12 weeks and on non-response and mortality after 12 and 24 weeks of enrollment. The effect of this intervention on recovery was uncertain. In conclusion, SFFs may be beneficial for children with moderate wasting in humanitarian contexts. Programmatic recommendations should consider context and cost-effectiveness.
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Affiliation(s)
- Zahra A. Padhani
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan; (J.K.D.); or (Z.A.B.)
| | | | - Jai K. Das
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan; (J.K.D.); or (Z.A.B.)
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Rehana A. Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, NSW 2006, Australia;
| | - Heather C. Stobaugh
- Action against Hunger USA, Technical Services and Innovation Department, Washington, DC 20463, USA;
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Muzna Mughal
- Action against Hunger UK, London SE10 0ER, UK; (M.M.); (A.R.-P.)
| | | | - Robert E. Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Zulfiqar A. Bhutta
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan; (J.K.D.); or (Z.A.B.)
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
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2
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Cichon B, Das JK, Salam RA, Padhani ZA, Stobaugh HC, Mughal M, Pajak P, Rutishauser-Perera A, Bhutta ZA, Black RE. Effectiveness of Dietary Management for Moderate Wasting among Children > 6 Months of Age-A Systematic Review and Meta-Analysis Exploring Different Types, Quantities, and Durations. Nutrients 2023; 15:nu15051076. [PMID: 36904076 PMCID: PMC10005276 DOI: 10.3390/nu15051076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Currently, no World Health Organization guidelines exist for the management of approximately 31.8 million moderately wasted children globally. The objective of this review was to synthesise evidence on the optimal type, quantity, and duration of dietary treatment for moderate wasting. Ten electronic databases were searched until the 23rd of August 2021. Experimental studies comparing interventions for the dietary management of moderate wasting were included. Meta-analyses were conducted and results were presented as risk ratios or mean differences with 95% confidence intervals. Seventeen studies comparing specially formulated foods were included involving 23,005 participants. Findings suggest little or no difference in recovery between Fortified Blended Foods (FBFs) with improved micronutrient and/or milk content (enhanced FBFs) and lipid-based nutrient supplements (LNS), whereas children treated with non-enhanced FBFs (locally produced FBFs or standard corn-soy blend) may have lower recovery rates than those treated with LNS. There was no difference in recovery when ready-to-use therapeutic and ready-to-use supplementary food were compared. Other outcomes mostly aligned with results for recovery. In conclusion, LNSs improve recovery compared to non-enhanced FBFs, but are comparable to enhanced FBFs. Programmatic choice of supplement should consider factors such as cost, cost-effectiveness, and acceptability. Further research is required to determine optimal dosing and duration of supplementation.
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Affiliation(s)
- Bernardette Cichon
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
- Correspondence:
| | - Jai K. Das
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Rehana A. Salam
- The Daffodil Centre, The University of Sydney, Sydney 2006, Australia
| | - Zahra A. Padhani
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
| | - Heather C. Stobaugh
- Action Against Hunger USA, Technical Services and Innovation Department, Washington, DC 20463, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Muzna Mughal
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
| | - Patrizia Pajak
- Action Against Hunger UK, Operations Department, London SE10 0ER, UK
| | | | - Zulfiqar A. Bhutta
- Institute for Global Health and Development, Aga Khan University, Karachi 74800, Pakistan
- Division of Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Robert E. Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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3
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Grewal J, Mughal M, Nnaoma C, Montgomery M, Kapoor S. Axillary IABP Migration into SMA. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1735] [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] Open
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4
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Sleiwah A, Mohanna P, AsJoe M H, Roblin P, Uppal L, Mughal M. Heads up reconstructive microsurgery: Utilisation of the three-dimensional microscope in microvascular procedures. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34844881 DOI: 10.1016/j.bjps.2021.11.036] [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] [Received: 10/16/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the earliest use of microscopes in surgery, several modifications have been made to improve the ergonomics of movement and posture, increase the resolution, and expand the visual field. The three-dimensional microscopes are latest innovation in this field. Despite the wider use of 3D microscopes in other specialities, their use in the reconstructive microsurgery in the United Kingdom is still limited. Reconstructive microsurgeons are highly skilled surgeons that are trained to operate utilising the microscope for long hours. This poses an occupational risk with a specific pattern of work-related conditions. AIMS AND METHODS We aim in this report to demonstrate our experience utilising 3D microscopes in small cohort of patients matched to a control of patients operated utilising the traditional microscopes. Patients were matched by age, comorbidities, oncologic procedures. This was complemented by a survey completed by the operating surgeons. RESULTS Nine patients were included in each group. There was no significant difference in operative or ischemia time and no significant post-operative complications in both groups. The surgeons reported better ergonomics, improved staff engagement, and a better teaching experience when utilising the 3D microscopes compared to traditional microscopes. CONCLUSION The utilisation of the 3D microscopes in reconstructive microsurgery has shown to provide comfort, improve ergonomics of movement and posture without significant clinical implications in this series.
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Affiliation(s)
- A Sleiwah
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - P Mohanna
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ho AsJoe M
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Roblin
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Uppal
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Mughal M, Kaur I, Waxman S, Gandhi H, Kakadia M, Khakwani Z, Okoh A, Shah K, Obaid A, Sirpal V, Azad S, Jaffery A, Jagdey H, Tawfik I, Alam M. Clinical outcomes in COVID-19 patients with in-hospital cardiac arrest – an insight from multi-centre data. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In general, rates of in-hospital cardiac arrest are reportedly 9 to 10 arrests per 1000 admissions, with survival rates of approximately 20–25%. Data regarding clinical characteristics and outcomes in patients with COVID-19 who received in-hospital CPR (cardiopulmonary resuscitation) are limited. This information can help guide end-of-life care conversations between families and health care workers based on real-world experience.
Purpose
To observe the outcomes (survival to discharged alive from the hospital) in critically sick COVID-19 patients who experienced in-hospital cardiac arrest.
Methods
This is a multi-centre institutional review board (IRB) approved retrospective study. The RT-PCR confirmed adult COVID-19 patients consecutively admitted from March 1st to April 30, 2020, were included. Data were extracted manually using the hospital's electronic medical record. The final date of follow-up to monitor clinical outcomes was January 2021.
Results
A total of 721 patients were admitted to the hospital. Of these, only 64 (8.87%) patients had “no CPR” orders.Cardiac arrest occurred in 141 (19.5%) patients. The mean duration of beginning of resuscitation was less than a minute and the mean duration of CPR was 19 minutes. The median age was 65 years; 62.4% were male. The most common co-morbidities were hypertension (66%) and diabetes mellitus (56%). The initial rhythm was non-shockable in 93.7% of patients [asystole in 48.4% and Pulseless Electrical Activity (PEA) in 45.3% of patients]. Only six (4.2%) patients had pulseless ventricular tachycardia and three (2.1%) patients had ventricular fibrillation. A total of eight patients (5.6%) survived and were discharged from the hospital; six (4.25%) had non-shockable and two (0.82%) had shockable initial rhythms. The median age of those who survived was 60 years (Figure 1).
Conclusions
Our study showed that critically sick patients with COVID-19 have a high rate of cardiac arrest and poor outcomes in those who received CPR. A non-shockable initial rhythm indicates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions between providers and patients' families.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - I Kaur
- Monmouth Medical Center, Long Branch, United States of America
| | - S Waxman
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Kakadia
- Monmouth Medical Center, Long Branch, United States of America
| | - Z Khakwani
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - A Okoh
- Newark Beth Israel Medical Center, The Department of Medicine, Section of Cardiology, Newark, United States of America
| | - K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - A Obaid
- Monmouth Medical Center, Long Branch, United States of America
| | - V Sirpal
- Monmouth Medical Center, Long Branch, United States of America
| | - S Azad
- Monmouth Medical Center, Long Branch, United States of America
| | - A Jaffery
- Monmouth Medical Center, Long Branch, United States of America
| | - H Jagdey
- Bronx-Lebanon Hospital Center, Bronx NY, United States of America
| | - I Tawfik
- Monmouth Medical Center, Long Branch, United States of America
| | - M Alam
- Baylor College of Medicine, The Department of Medicine, Section of Cardiology, Houston, United States of America
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Shah K, Thyagaturu H, Mughal M, Gandhi H, Harmouch F, Modi V, Kothari J, Shirani J. Impact of gastrointestinal hemorrhage on hospital outcomes of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) may be at relatively high risk of gastrointestinal hemorrhage (GIH) due to acquired von Willebrand disease (aVWD) and anticoagulation for atrial fibrillation among others factors.
Purpose
We aimed to evaluate impact of GIH on in-hospital outcomes of patients with HCM.
Methods
The National Inpatient Sample reported 45,305 admissions for adults with HCM during a two-year period (2016–2017). Among them, 1,490 patients (3.3%) also had GIH. Baseline characteristics and in-hospital outcomes of the two groups were compared. Multivariable logistic regression analysis was used to assess the independent impact of GIH on in-hospital outcomes of HCM patients.
Results
Out of 45,305 HCM patients, 1490 (3.2%) also had concomitant diagnosis of GIH. HCM patients with GIH were older (70±9 vs 66±23 years), were more often male (64% vs 61%), and had higher prevalence of prior myocardial infarction (12% vs 7%, p<0.001) and cirrhosis (7.1% vs 2.6%, p<0.001) while being less often obese (15% vs 22%, p=0.01) or having a history of congestive heart failure (30% vs 36%, p=0.03) [Table 1]. Hospital mortality was significantly higher among those with GIH (6.4% vs 3.5%, p<0.001). Multivariable logistic regression analysis identified GIH as an independent predictor of higher in-hospital mortality [adjusted odds ratio (aOR)=1.60, 95% confidence interval (CI)=1.02–2.63, p=0.001], hypovolemic shock (aOR=5.17, 95% CI=2.5–10.6, p<0.001), mean length of stay (Δ +2.4 days, p<0.001) and mean hospital cost (Δ +$21,162, p=0.004).
Conclusion
Adults with HCM and GIH are older, less often obese with higher prevalence of cirrhosis and prior myocardial infarction. Presence of GIH is an independent predictor of higher mortality, hypovolemic shock, length of stay and hospital cost in HCM adults admitted to hospital.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - F Harmouch
- St. Luke's University Hospital, Bethlehem, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Kothari
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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Shah K, Thyagaturu H, Harmouch F, Gandhi H, Mughal M, Modi V, Kothari J, Shirani J. Impact of cardiac rhythm abnormality on hospital outcomes of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Serious cardiac arrhythmias [atrial fibrillation/flutter (AFF), and ventricular tachycardia/fibrillation (VTF)] are associated with adverse outcomes in general population of patients with hypertrophic cardiomyopathy (HCM).
Purpose
We aimed to evaluate the impact of such rhythm abnormalities on in-hospital outcomes of adults with HCM.
Methods
The National Inpatient Sample reported 45,305 admissions for adults with HCM during a two-year period (2016–2017). Among them, 21,220 patients (47%) also had AFF and/or VTF. Baseline characteristics and in-hospital outcomes of the two groups were compared. Multivariable logistic regression analysis was used to assess the independent impact of rhythm abnormalities on in-hospital outcomes of HCM patients.
Results
HCM patients with arrhythmias were older (68±26 vs 64±29 years), were more often male (43% vs 36%), and had higher prevalence of congestive heart failure (45% vs 28%), chronic kidney disease (27% vs 22%), hyperlipidemia (52% vs 48%), obstructive sleep apnea (17% vs 13%), chronic obstructive pulmonary disease (22% vs 18%) and thyroid disease (19% vs 16%) [Table 1, all p<0.001]. Hospital mortality was significantly higher among those with arrhythmias (4.7% vs 2.7%, p<0.05). Multivariate logistic regression analysis identified arrhythmias as an independent predictor of in-hospital mortality (adjusted odds ratio=1.51, 95% confidence interval=1.19–1.91, p=0.001), increased mean length of stay (Δ +0.75 days, p<0.001) and increased mean total hospital cost (Δ +$18,263, p<0.001).
Conclusion
Adults with HCM and AFF and/or VTF are older and have higher prevalence of comorbid conditions. Presence of such rhythm abnormalities is an independent predictor of higher mortality, length of stay and total cost in HCM adults admitted to hospital.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Shah
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Thyagaturu
- Bassett Medical Center, Cooperstown, United States of America
| | - F Harmouch
- St. Luke's University Hospital, Bethlehem, United States of America
| | - H Gandhi
- Monmouth Medical Center, Long Branch, United States of America
| | - M Mughal
- Monmouth Medical Center, Long Branch, United States of America
| | - V Modi
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Kothari
- St. Luke's University Hospital, Bethlehem, United States of America
| | - J Shirani
- St. Luke's University Hospital, Bethlehem, United States of America
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8
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Mughal M, Sindali K, Man J, Roblin P. 'Fat chance': a review of adipose tissue engineering and its role in plastic and reconstructive surgery. Ann R Coll Surg Engl 2021; 103:245-249. [PMID: 33682428 DOI: 10.1308/rcsann.2020.7031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.
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Affiliation(s)
- M Mughal
- St Thomas' Hospital, London, UK.,University College London, London, UK
| | | | - J Man
- St Thomas' Hospital, London, UK
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Frondelius L, Jauhiainen L, Niskanen O, Mughal M, Sairanen A. Can on-farm animal welfare explain relative production differences between dairy herds? Anim Welf 2020. [DOI: 10.7120/09627286.29.4.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate factors responsible for between-herd variation in milk production, when genetic variation is controlled. Quantitative information regarding farms' production environment and animal welfare, as evaluated annually by veterinarians and health and
feeding records, were the factors studied. Principal component analysis was used to reduce the production environment variables as well as the welfare data. Two linear regression models were devised. The first model used welfare indicators and veterinary treatments to predict the difference
between herds' observed and potential milk yield. The second model explained the residual of the first model by feeding and animal-based indicator data. Together, these two models explained 62% of the variance in milk yield differences between herds. Specifically, feeding of the herd was the
most important factor, accounting for 67%, followed by the production environment/animal welfare (30%) and finally animal health, assessed through veterinary treatments, explained the remaining 3% of the variance. A poor welfare rating adversely affected milk production. Similarly, a low score
for fatness at slaughter, poor milk quality and high mortality all showed a clear negative association with production. It was found that while feeding remains a major factor, production environment and animal welfare also have significant roles to play when it comes to production. Notably,
those farms with major animal welfare problems were shown to display milk yield below the Finnish average.
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Halliday LJ, Doran SLF, Sgromo B, Viswanath YKS, Tucker O, Patel B, Jambulingam PS, Dawas K, Mercer S, Baker C, Mughal M, Hanna GB, Moorthy K. Variation in esophageal anastomosis technique-the role of collaborative learning. Dis Esophagus 2020; 33:5610077. [PMID: 31665408 DOI: 10.1093/dote/doz072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal anastomosis workshop was held to identify areas of common and differing practice within the operative technique. Surgeons showed videos of their anastomosis technique by open and minimally invasive surgery. Each video was followed by a discussion. Surgeons from 10 different EG cancer centers attended. Eight key technical differences and learning points were identified and discussed: the optimum diameter of the gastric conduit; avoiding ischemia in the gastric conduit; minimizing esophageal trauma; the use of an esophageal mucosal collar; omental wrapping; intraoperative leak testing; ideal diameter of the circular stapler and the growing use of linear stapled anastomoses. The workshop received positive feedback from participants and on 2 years follow-up, 40% stated that they believed that the learning of tips and techniques during the workshop has contributed to lowering their anastomotic leak rate. Many differences exist in surgical technique. The reasons for, and crucially the significance of, these differences must be discussed and examined. Workshops provide a forum for peer-to-peer collaborative learning to reflect on one's own practice and improve surgical technique. These changes can, in turn, generate incremental improvements in patient care and postoperative outcomes.
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Affiliation(s)
- L J Halliday
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S L F Doran
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - B Sgromo
- Oxford Oesophago Gastric Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Y K S Viswanath
- Department of Surgery, James Cook University Hospital, Middlesborough, UK
| | - O Tucker
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - B Patel
- Upper GI Surgery Unit, The Royal London Hospital, London, UK
| | - P S Jambulingam
- Department of Upper GI Surgery, Luton and Dunstable Hospital, Luton, UK
| | - K Dawas
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - S Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Baker
- Upper GI Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Mughal
- Upper Gastrointestinal Surgery, University College London, London, UK
| | - G B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - K Moorthy
- Department of Surgery and Cancer, Imperial College London, London, UK
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Abstract
Topical negative pressure is widely used in the management of superficial wounds. The use of this technology in the management of oesophageal perforations is becoming increasingly common. This systematic review aims to capture available evidence about its use in this setting. Medline and Embase were searched using MeSH terms and free text: esophageal perforation; esophageal injury; vacuum assisted closure; vacuum therapy device; esophagus; wounds penetrating; esophageal perforation; wound healing; negative pressure wound therapy. Searches were carried out between April and November 2015. Case series, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Eleven studies met the inclusion criteria with 180 patients. Nine of the studies were case series and two were retrospective comparisons of negative pressure with stents or clips. Healing of the perforation occurred in 163/179 patients and the overall mortality was 12.8%. Compared with published data on mortality from oesophageal perforation, the application of negative pressure appears to be beneficial. The studies are, however, limited to case series and retrospective cohort studies. The number of patients in each study is small and in the absence of randomized trials demonstrating a lack of bias firm conclusions cannot be made.
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Affiliation(s)
- N J Newton
- Gastrointestinal Services, University College Hospital, London
| | - A Sharrock
- Centre for Blast Injury Studies Imperial College, London
| | - R Rickard
- Academic Department of Military Surgery and Trauma Royal Centre for Defence Medicine, Birmingham, UK
| | - M Mughal
- Gastrointestinal Services, University College Hospital, London
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Markar S, Wiggins T, Antonowicz S, Lagergren J, Mughal M, Hanna G. Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30095-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Buissink C, Thompson J, Voet M, Sanderud A, Kamping L, Savary L, Mughal M, Rocha C, Hart G, Parreiral R, Martin G, Hogg P. The influence of experience and training in a group of novice observers: A jackknife alternative free-response receiver operating characteristic analysis. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.06.016] [Citation(s) in RCA: 4] [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] [Indexed: 11/26/2022]
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Mughal M, Chang C, Southern SJ. Re: Lee HJ, Kim PT, Jeon IH, et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur. 2014, 39: 258-61. J Hand Surg Eur Vol 2014; 39:906-7. [PMID: 25236534 DOI: 10.1177/1753193414546443] [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)
- M Mughal
- Pinderfield's General Hospital, Wakefield, UK
| | - C Chang
- Pinderfield's General Hospital, Wakefield, UK
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15
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Grenader T, Plotkin Y, Mohammadi B, Dawas K, Hashemi M, Mughal M, Bridgewater J. Predictive Value of the Neutrophil Lymphocyte Ratio in Peritoneal and/or Metastatic Disease at Staging Laparoscopy for Gastric and Oesophageal Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.12] [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: 11/13/2022] Open
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16
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Soldin M, Mughal M, Al-Hadithy N. National Commissioning Guidelines: Body contouring surgery after massive weight loss. J Plast Reconstr Aesthet Surg 2014; 67:1076-81. [DOI: 10.1016/j.bjps.2014.04.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
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17
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Mughal M, Ching D, Soldin M. External traction sutures to facilitate exposure in abdominoplasty: a novel technique. J Plast Reconstr Aesthet Surg 2014; 67:1306-7. [PMID: 24934100 DOI: 10.1016/j.bjps.2014.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/30/2014] [Indexed: 11/15/2022]
Affiliation(s)
- M Mughal
- Department of Plastic Surgery, St. George's Hospital, London, UK.
| | - D Ching
- St Georges Medical School, St. George's Hospital, London, UK
| | - M Soldin
- Department of Plastic Surgery, St. George's Hospital, London, UK; Department of Plastic Surgery Kingston Hospital, London, UK
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18
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Abstract
INTRODUCTION Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier's gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. METHODS A literature search was performed using PubMed and MEDLINE ® . The search terms included 'perineal defects', 'perineal reconstruction', 'perforator flaps for perineum', 'vulval flaps', 'secondary healing of wound' and 'vacuum assisted closure'. Backward chaining of reference lists from retrieved papers was also used to expand the search. FINDINGS Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK; Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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19
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Mughal M, Mathew P, Hastings H. Ulnar nerve compression at the cubital tunnel in a tetraplegic patient after biceps-to-triceps transfer via the medial route. J Hand Surg Eur Vol 2013; 38:1010-1. [PMID: 23719173 DOI: 10.1177/1753193413491704] [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)
- M Mughal
- Indiana Hand to Shoulder Center Indiana, USA
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20
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Abstract
Introduction Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier’s gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. Methods A literature search was performed using PubMed and MEDLINE®. The search terms included ‘perineal defects’, ‘perineal reconstruction’, ‘perforator flaps for perineum’, ‘vulval flaps’, ‘secondary healing of wound’ and ‘vacuum assisted closure’. Backward chaining of reference lists from retrieved papers was also used to expand the search. Findings Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK
| | - RJ Baker
- Royal Free London NHS Foundation Trust, UK
| | - A Muneer
- University College London Hospitals NHS Foundation Trust, UK
| | - A Mosahebi
- Royal Free London NHS Foundation Trust, UK
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21
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Abstract
INTRODUCTION Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier's gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. METHODS A literature search was performed using PubMed and MEDLINE ® . The search terms included 'perineal defects', 'perineal reconstruction', 'perforator flaps for perineum', 'vulval flaps', 'secondary healing of wound' and 'vacuum assisted closure'. Backward chaining of reference lists from retrieved papers was also used to expand the search. FINDINGS Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.
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Affiliation(s)
- M Mughal
- Royal Free London NHS Foundation Trust, UK; Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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22
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Mughal M, Mathew P, Hastings H. Iatrogenic injury to the ulnar nerve during primary repair of medial ulnar collateral ligament in complex elbow fracture dislocations. J Hand Surg Eur Vol 2013; 38:686-7. [PMID: 22719013 DOI: 10.1177/1753193412449579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. Mughal
- Indiana Hand to Shoulder Center, Indiana, USA
| | - P. Mathew
- Indiana Hand to Shoulder Center, Indiana, USA
| | - H. Hastings
- Indiana Hand to Shoulder Center, Indiana, USA
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23
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24
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Soni M, Mughal M, Kirkby G. The subluxated lens: a patient's perspective. Eye (Lond) 2006; 20:1308-10. [PMID: 16410817 DOI: 10.1038/sj.eye.6702161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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25
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Leaper DJ, Irving M, Bancewicz J, Mughal M. Server abdominal sepsis. Br J Surg 2005. [DOI: 10.1002/bjs.1800730839] [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: 11/11/2022]
Affiliation(s)
- D J Leaper
- Department of Surgery, University of Bristol, Bristol, UK
| | - M Irving
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
| | - J Bancewicz
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
| | - M Mughal
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
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Zar T, Sharar Z, Mughal M, McClintock C. Severe hepatitis due to HBV-HDV coinfection. Conn Med 2001; 65:649-52. [PMID: 11766551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Quadruple hepatic infections are not uncommon in human immunodeficiency virus (HIV) infected patients. Hepatotropic viruses behave differently in immunocompromised patients resulting in varied clinical and serological outcomes. Delta hepatitis, an important cause of acute hepatitis in intravenous drug abusers (IVDAs) and HIV-infected patients, can present as coinfection or superinfection clinically, which influences the prognosis. Prevention of hepatitis D virus (HDV) coinfection is possible with hepatitis B virus (HBV) vaccination. No definitive medical treatment for HDV infection is known to be successful. Interestingly, liver transplantation carries a higher success rate in HDV/HBV infection then in HBV infection alone.
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Affiliation(s)
- T Zar
- University of Connecticut, Primary Care Internal Medicine Program, Farmington, USA
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27
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Shah M, Moogerfeld MS, Ahmed J, Mughal M, Aziz K. Metastatic cervical cancer with unusual presentation: a case report. Conn Med 2001; 65:523-5. [PMID: 11678057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Carcinoma of the cervix is rare in the United States thanks to widespread use of screening Pap smears. A 60-year-old female with right upper quadrant pain, diarrhea, and urinary incontinence was found to have stage IV B cervical cancer. Computerized tomography (CT) was of value in diagnosis. Like mammography, which improves survival by detecting malignant disease at an early stage, the Pap test is central in preventing the development of invasive cervical cancer.
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Affiliation(s)
- M Shah
- Integrated Internal Medicine/Primary Care Program, University of Connecticut, Farmington, USA
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28
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Abstract
Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1-6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2-10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
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Affiliation(s)
- D J DeFriend
- Department of Surgery, University Hospital of South Manchester, Chorley Hospital, Lancs, England
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30
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Carlson GL, Gray P, Barber D, Shaffer JL, Mughal M, Irving MH. Total parenteral nutrition modifies the acute phase response to Crohn's disease. J R Coll Surg Edinb 1994; 39:360-4. [PMID: 7532715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Measurements of the acute phase proteins, C-reactive protein (CRP) and orosomucoid are widely used to monitor the activity of Crohn's disease. The effect of TPN upon the levels of acute phase proteins is unknown. Serum levels of CRP and orosomucoid were measured simultaneously over a four year period in 13 patients receiving TPN for Crohn's disease, nine patients with noninflammatory causes of intestinal failure, and 16 patients with Crohn's disease treated without TPN. An acute phase response was found with a similar frequency in both groups of patients with Crohn's disease (73.6% and 83.9% for Crohn's with and without TPN respectively), but was less prevalent in patients receiving TPN for non-inflammatory causes of intestinal failure (56.1%, P < 0.01). In this latter group, the acute phase response consisted primarily of an isolated elevation of orosomucoid (78.4%), compared with patients with Crohn's disease alone (21.1%, P < 0.001) and with Crohn's disease and TPN (46.6%, P < 0.05). Liver function abnormalities were seen on 68.8% of occasions in patients with noninflammatory causes of intestinal failure who had elevated levels of orosomucoid, compared with 34.9% of occasions on which orosomucoid levels were normal (P < 0.001). TPN may lead to isolated elevation of serum levels of orosomucoid, reducing the value of this acute phase protein in monitoring the activity of Crohn's disease in patients receiving TPN.
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Affiliation(s)
- G L Carlson
- Department of Surgery, University of Manchester, Hope Hospital, Salford, UK
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31
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Mughal M. A cheap laparoscopic surgery trainer. Ann R Coll Surg Engl 1992; 74:256-7. [PMID: 1416677 PMCID: PMC2497604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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32
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Abstract
To investigate extraesophageal anomalies in infants with esophageal atresia, preoperative plasma gastrin was measured in 12 infants. The median plasma gastrin was 32 ng/L (interquartile range, 24 to 44). There was significant correlation with birth weight (rs = .73, P less than .05) and gestational age (rs = .74, P less than .05). Within this group 9 infants of greater than 36 weeks' gestation were matched to a group of 20 control infants without esophageal atresia. Infants with esophageal atresia had a significantly lower median plasma gastrin (38 ng/L v 55 ng/L, P less than .05). This may indicate preexisting vagal abnormalities in esophageal atresia unrelated to surgical intervention.
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Affiliation(s)
- M Davenport
- Sub Department of Paediatric Surgery, St Mary's Hospital, Manchester, England
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Abstract
Two commercially available kits have been used to create 25 percutaneous tracheostomies, 20 using the Cook system and five using the Rapitrac system. The operation time and complication rates of these tracheostomies have been compared with those for 16 conventional tracheostomies performed for similar indications. Median operating times were 60 (range 30-105) min for conventional tracheostomy, 15 (range 8-70) min for Cook and 5 (range 3-15) min for Rapitrac systems (P less than 0.001). A significantly higher proportion of patients in the Rapitrac group had complications compared with the other two groups (P less than 0.05). The complication rate for the Cook group compared favourably with that for the conventional tracheostomy group. The Cook system of percutaneous tracheostomy is a simple, rapid and safe alternative to conventional tracheostomy.
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Affiliation(s)
- D J Leinhardt
- University Department of Surgery, Hope Hospital, Salford, UK
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Leinhardt DJ, Ragavan C, O'Hanrahan T, Mughal M. Endocarditis complicating parenteral nutrition: the value of repeated echocardiography. JPEN J Parenter Enteral Nutr 1992; 16:168-70. [PMID: 1556815 DOI: 10.1177/0148607192016002168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cardiac complications of parenteral nutrition are well recognized but the diagnosis of such complications may be difficult. Two-dimensional echocardiography has been shown to be of value in establishing the diagnosis of valvular vegetations and right atrial thrombus. We describe two patients who developed endocarditis while receiving parenteral nutrition via central venous catheters. In both cases initial echocardiography was normal and the tricuspid valvular vegetations were only picked up after one or more additional echocardiograms. This highlights the necessity for repeated echocardiography in patients receiving parenteral nutrition in whom infective central venous catheter complications fail to resolve quickly after appropriate treatment.
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Affiliation(s)
- D J Leinhardt
- Department of Surgery, University of Manchester School of Medicine, Hope Hospital, Salford, United Kingdom
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35
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Abstract
The pressure and intra-abdominal length of the lower oesophageal sphincter (LOS) were measured by oesophageal manometry before and after floppy Nissen fundoplication (FNP) for intractable gastrooesophageal reflux. Control of reflux was assessed by 24 h pH recording and endoscopy. It was complete in 67 cases (84.8 per cent) in this non-consecutive series. In the group as a whole LOS pressure increased significantly after FNP, but the intra-abdominal length did not. LOS pressure decreased in 21 cases of whom 16 (76.2 per cent) still had perfect reflux control. Likewise, intra-abdominal length decreased in 41 cases of whom 36 (87.8 per cent) had good reflux control. There was no evidence of a compensatory increase in length to account for reflux control when LOS pressure decreased. When a length-pressure diagram was plotted for the postoperative measurements no clear separation of those with persistent reflux could be seen. These results suggest that the measured changes in LOS pressure and length following FNP are an artefact of surgery rather than the means by which the operation controls gastro-oesophageal reflux.
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Abstract
Between January, 1977, and March, 1986, 200 patients were registered as receiving home parenteral nutrition (HPN) in the UK and the Republic of Ireland. Although 28 centres contributed case-reports, 75% of the cases were registered by 7 centres. Most patients started treatment between the ages of 10 and 40 years, a reflection of the high incidence of Crohn's disease during these decades. The three main indications for HPN were Crohn's disease (90 patients), mesenteric vascular disease (27), and extensive small-bowel resection for volvulus or other benign enteric disease (14). 85 patients required treatment for less than 1 year and 17 have been on treatment for more than 2 years. Patients whose indication for HPN was a primary intestinal disease had a better quality of life than did those in whom the intestinal failure was secondary to a systemic disorder. Of the 108 patients who have completed treatment 56 have been able to resume enteral nutrition through adaptation of the remaining bowel, or closure of a fistula. 34 have died, 19 as a consequence of the underlying disease and 10 of complications of treatment. The incidence of catheter-related sepsis varied between 0.2 and 0.9 episodes per year of treatment (overall 0.35) depending on the length of experience of the supervising centre.
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38
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Abstract
A case is reported of a 16-year-old girl who accidentally swallowed a toothbrush, which was safely extracted under local anaesthesia using a fibre-optic endoscope. The technique described is safe, and can be adapted for the extraction of a variety of foreign bodies from the oesophagus and the stomach. Guidelines are presented for the management of ingested foreign bodies, based on a review of the literature.
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