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Emami-Naeini P, Garmo V, Boucher N, Fernando R, Menezes A. Maintenance of Vision Needed to Drive after Intravitreal Anti-VEGF Therapy in Patients with Neovascular Age-related Macular Degeneration and Diabetic Macular Edema. Ophthalmol Retina 2024; 8:388-398. [PMID: 37866681 DOI: 10.1016/j.oret.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To evaluate the association between intravitreal anti-VEGF therapy and visual acuity (VA)/driving vision maintenance over 4 years in patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME). DESIGN Retrospective, observational, clinical practice cohort study using data from the Vestrum Health database. PARTICIPANTS Initial diagnosis (January 1, 2014 to June 30, 2019) of nAMD or DME and ≥ 1 year of treatment/follow-up history. The VA analysis required 4 years of treatment/follow-up history. For the driving vision maintenance analysis, patients required Snellen VA of 20/40 or better at baseline and for ≥ 6 months during year 1 after index intravitreal anti-VEGF treatment in the better-seeing eye. METHODS A loss-of-driving event was the first clinic visit with VA worse than 20/40 sustained for ≥ 6 consecutive months. Kaplan-Meier analyses estimated the probability of maintaining driving vision over 4 years stratified by year-1 injection number. Cox proportional hazard models examined associations between baseline clinical characteristics and year-1 injection frequency and the risk of losing driving vision. MAIN OUTCOME MEASURES Mean change in VA over time and by baseline VA, driving vision maintenance probability over time and stratified by anti-VEGF injection frequency, and baseline factors predictive of driving vision maintenance. RESULTS In year 1, the nAMD and DME cohorts gained 8.5 and 9.5 ETDRS letters, respectively. Between years 1 and 4, patients with nAMD and DME lost 6.6 and 2.7 ETDRS letters, respectively. The probability of maintaining driving vision over 4 years was 56% (nAMD) and 72% (DME); among patients who received 1 to 5, 6 to 7, and ≥ 8 anti-VEGF injections in year 1, corresponding probabilities were 50%, 56%, and 65% (nAMD; P < 0.001) and 63%, 72%, and 77% (DME; P < 0.001). Baseline factors associated with driving vision loss included older age, worse index VA, geographic atrophy (nAMD), and worsening baseline diabetic retinopathy (DME). CONCLUSIONS Older age and worse index VA were risk factors for driving vision loss, whereas a greater year-1 injection number was associated with driving vision maintenance through year 4, supporting early initiation and frequent anti-VEGF injections for maintaining driving vision in nAMD or DME. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Parisa Emami-Naeini
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, California.
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Wagstaff DT, Bulamba F, Fernando R. Obstetric anaesthesia over the next 10 years: Africa and Middle East. Int J Obstet Anesth 2023; 55:103877. [PMID: 37076357 DOI: 10.1016/j.ijoa.2023.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
Maternal and neonatal health outcomes vary within Africa and the Middle East. Despite substantial improvements over the past 20 years, there are persisting inequities in access to, and the quality of, obstetric anaesthetic care. These are most noticeable in Sub-Saharan Africa which has only 3% of the world's healthcare workforce but approximately two-thirds of global maternal deaths. Improvements are being made by: improving access; increasing numbers of trained staff; delivering accessible training; gathering data; conducting research and quality improvement activities; using innovative technologies; and forming productive collaborations. Further improvements will be needed to cope with increasing demand, the impacts of climate change and potential future pandemics.
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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Soares RR, Huang C, Boucher N, Aggarwal N, Fernando R, Hinkle J, DeSimone J, Cai L, Patel SN, Xu D, Kuriyan AE, Yonekawa Y. REGIONAL POPULATION MOBILITY AND OUTPATIENT RETINA VISITS IN THE UNITED STATES DURING THE COVID-19 PANDEMIC. Retina 2022; 42:607-615. [PMID: 35174800 DOI: 10.1097/iae.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize how community mobility patterns across the United States correlate with local changes in retina visits during the pandemic. METHODS Outpatient retina clinic visits were linked to population mobility by combining multiple public data sets, including the Google Community Mobility Reports and data from the Centers for Disease Control and Infection. Percentage change from baseline in daily-average number of retina visits by county and mobility were measured by county. RESULTS A total of 2,159,689 patient visits were examined across 332 counties. Daily-average retina visits decreased by 7.0%, 19.0%, 5.0%, and 4.0% from Quarter 1 to 4 of 2020. This decrease was negatively correlated with increased incident of COVID-19 deaths for Quarters 1 to 3 (r = -0.13, r = -0.16, and r = -0.15, respectively, P < 0.001) and increased incident cases for Quarters 1 and 2 (r = -0.18, r = -0.13, respectively, P < 0.001). Daily-average retina visits relative to baseline were significantly lower for metropolitan counties in Quarters 1 and 2, compared with urban and rural (P < 0.001). The decline in retina visits had greatest association with decline in workplace visits in Quarters 1 to 3 (r = 0.27, r = 0.09, r = 0.12, respectively, P < 0.001 for all). CONCLUSION This study provides insight into how regional mobility patterns may help to explain and predict patient behaviors and retina outpatient visit responses during the COVID-19 pandemic.
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Affiliation(s)
- Rebecca R Soares
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Charles Huang
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | | | | | - John Hinkle
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Joseph DeSimone
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Louis Cai
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Samir N Patel
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - David Xu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
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Al-Moujahed A, Boucher N, Fernando R, Saroj N, Vail D, Rosenblatt TR, Moshfeghi DM. Incidence of Retinal Artery and Vein Occlusions During the COVID-19 Pandemic. Ophthalmic Surg Lasers Imaging Retina 2022; 53:22-30. [PMID: 34982005 PMCID: PMC10699281 DOI: 10.3928/23258160-20211209-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To examine whether new cases of retinal artery occlusion (RAO) or retinal vein occlusion (RVO) increased during the coronavirus 209 (COVID-19) pandemic. PATIENTS AND METHODS This was a retrospective cohort study of patients visiting retina clinics with a new diagnosis in two time periods: between January 1, 2019, and February 29, 2020 (the pre-COVID-19 period), and between March 1, 2020, and December 31, 2020 (the COVID-19 period). The key outcome was the percentage of newly diagnosed central RAO (CRAO), branch RAO (BRAO), central RVO (CRVO), and branch RVO (BRVO) seen in each period. RESULTS The study population included 285,759 new patients in the pre-COVID-19 period and 156,427 new patients in the COVID-19 period. The overall number of new patients dropped dramatically during the first few months of the COVID-19 pandemic (24%, 66%, and 51% less new patients in March, April, and May 2020 than in the same months in 2019; P < .0001 for all 3 months). However, the decrease in the number of newly diagnosed patients with CRAO, CRVO, and BRAO during these months was less dramatic. As most states reopened in June and the number of patients in retina clinics started to increase, the newly diagnosed patients with these conditions as a percentage of all new diagnoses returned to similar trends as seen in the pre-COVID-19 period. CONCLUSIONS The percentage of new cases of RAO and RVO with respect to all new diagnoses in retina clinics remained stable for the majority of the COVID-19 period. There was an increase in these percentages during the first few months of the COVID-19 pandemic, particularly for CRAO, CRVO, and BRAO, which may have led to the presumption that more patients presented with these conditions during the COVID-19 period evaluated in this study. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:22-30.
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Peacock S, Briggs D, Barnardo M, Battle R, Brookes P, Callaghan C, Clark B, Collins C, Day S, Diaz Burlinson N, Dunn P, Fernando R, Fuggle S, Harmer A, Kallon D, Keegan D, Key T, Lawson E, Lloyd S, Martin J, McCaughan J, Middleton D, Partheniou F, Poles A, Rees T, Sage D, Santos-Nunez E, Shaw O, Willicombe M, Worthington J. BSHI/BTS guidance on crossmatching before deceased donor kidney transplantation. Int J Immunogenet 2021; 49:22-29. [PMID: 34555264 PMCID: PMC9292213 DOI: 10.1111/iji.12558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
All UK H&I laboratories and transplant units operate under a single national kidney offering policy, but there have been variations in approach regarding when to undertake the pre‐transplant crossmatch test. In order to minimize cold ischaemia times for deceased donor kidney transplantation we sought to find ways to be able to report a crossmatch result as early as possible in the donation process. A panel of experts in transplant surgery, nephrology, specialist nursing in organ donation and H&I (all relevant UK laboratories represented) assessed evidence and opinion concerning five factors that relate to the effectiveness of the crossmatch process, as follows: when the result should be ready for reporting; what level of donor HLA typing is needed; crossmatch sample type and availability; fairness and equity; risks and patient safety. Guidelines aimed at improving practice based on these issues are presented, and we expect that following these will allow H&I laboratories to contribute to reducing CIT in deceased donor kidney transplantation.
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Affiliation(s)
- S Peacock
- Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Briggs
- H&I Laboratory, NHSBT Birmingham Vincent Drive, Birmingham, UK
| | - M Barnardo
- Clinical Transplant Immunology, Churchill Hospital, Oxford, UK
| | - R Battle
- H&I Laboratory, SNBTS, Edinburgh, UK
| | - P Brookes
- H&I Laboratory, Harefield Hospital, Harefield, UK
| | - C Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
| | - B Clark
- H&I Laboratory, Leeds Teaching Hospitals NHS Trust, UK
| | - C Collins
- H&I Laboratory, NHSBT Birmingham Vincent Drive, Birmingham, UK
| | - S Day
- H&I Laboratory, Southmead Hospital, Bristol, UK
| | - N Diaz Burlinson
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - P Dunn
- Transplant Laboratory, Leicester General Hospital, Leicester, UK
| | - R Fernando
- H&I Laboratory, The Anthony Nolan Laboratories, Royal Free Hospital, UK
| | - S Fuggle
- Organ Donation & Transplantation, NHSBT, Stoke Gifford, Bristol, UK
| | - A Harmer
- H&I Laboratory, NHSBT Barnsley Centre, Barnsley, UK
| | - D Kallon
- H & I Laboratory, Royal London Hospital, London, UK
| | - D Keegan
- Department of H&I, Beaumont Hospital, Dublin, UK
| | - T Key
- H&I Laboratory, NHSBT Barnsley Centre, Barnsley, UK
| | - E Lawson
- Organ Donation and Transplantation, NHSBT, Birmingham, UK
| | - S Lloyd
- Welsh Transplantation & Immunogenetics Laboratory, Cardiff, UK
| | - J Martin
- H&I Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - J McCaughan
- H&I Laboratory, Belfast Health and Social Care Trust, Belfast, UK
| | - D Middleton
- H&I Laboratory, Liverpool Foundation Trust, Liverpool, UK
| | - F Partheniou
- H&I Laboratory, Liverpool Foundation Trust, Liverpool, UK
| | - A Poles
- H&I Laboratory, University Hospitals Plymouth, Plymouth, UK.,H&I Laboratory, NHSBT Filton, Bristol, UK
| | - T Rees
- Welsh Transplantation & Immunogenetics Laboratory, Cardiff, UK
| | - D Sage
- H&I Laboratory, NHSBT Tooting Centre, London, UK
| | - E Santos-Nunez
- H&I Laboratory, Imperial College Healthcare NHS Trust, London, UK
| | - O Shaw
- H&I Laboratory, Viapath, Guys & St Thomas, London, UK
| | - M Willicombe
- Department of Immunology and Inflammation, Imperial College London, UK
| | - J Worthington
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester, UK
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Samanta BR, Fernando R, Rösch D, Reisler H, Osborn DL. Primary photodissociation mechanisms of pyruvic acid on S1: observation of methylhydroxycarbene and its chemical reaction in the gas phase. Phys Chem Chem Phys 2021; 23:4107-4119. [DOI: 10.1039/d0cp06424f] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Following S1 ← S0 excitation at 351 nm, pyruvic acid dissociates mainly into methylhydroxycarbene (MHC) and CO2. Some MHC molecules isomerize to more stable acetaldehyde and vinyl alcohol; the remaining MHC is stabilized and reacts bimolecularly.
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Affiliation(s)
- B. R. Samanta
- Department of Chemistry
- University of Southern California
- Los Angeles
- USA
| | - R. Fernando
- Department of Chemistry
- University of Southern California
- Los Angeles
- USA
| | - D. Rösch
- Combustion Research Facility
- Sandia National Laboratories
- Livermore
- USA
| | - H. Reisler
- Department of Chemistry
- University of Southern California
- Los Angeles
- USA
| | - D. L. Osborn
- Combustion Research Facility
- Sandia National Laboratories
- Livermore
- USA
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Al-Sulttan S, Bampoe S, Howle R, Setty T, Columb M, Patel A, Fernando R, Husain T, Sultan P. A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women. Int J Obstet Anesth 2020; 45:28-33. [PMID: 33129656 DOI: 10.1016/j.ijoa.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of high flow nasal oxygenation (HFNO) for pre-oxygenation before obstetric general anaesthesia remains unclear. This study aimed to determine the number of vital capacity breaths using HFNO required to pre-oxygenate 90% of parturients to an end-tidal oxygen concentration fraction (FETO2) of ≥0.90 (termed EN90). METHODS Using up-down, sequential allocation trial design, volunteer term parturients undergoing caesarean delivery were investigated with HFNO with their mouth closed, followed by mouth open, and if FETO2 ≥0.90 was not achieved after a maximum of 20 vital capacity breaths, pre-oxygenation was attempted with a face mask. The primary outcome was the number of vital capacity breaths required using HFNO (mouth open and closed) to achieve EN90. Secondary outcomes included assessment of EN90 using mouth open versus mouth closed and face mask pre-oxygenation, maternal satisfaction and evaluation of fetal cardiotocography. RESULTS Twenty women at term were recruited. Successful pre-oxygenation occurred in 4 (20%), 3 (15%) and 14 (70%) women with HFNO mouth closed, HFNO mouth open, and via face mask respectively. At up to 20 vital capacity breaths, face mask pre-oxygenation was more successful at achieving EN90 compared with both HFNO with a closed (P=0.006) or open (P=0.001) mouth. Closed mouth HFNO did not outperform open mouth pre-oxygenation. CONCLUSION Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.
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Affiliation(s)
- S Al-Sulttan
- Department of Anaesthesia, University College London NHS Trust, London, UK
| | - S Bampoe
- Department of Anaesthesia, University College London NHS Trust, London, UK; University College London, UK.
| | - R Howle
- Department of Anaesthesia, University College London NHS Trust, London, UK
| | - T Setty
- Anaesthesia, Queens Medical Centre, Nottingham, UK
| | - M Columb
- Anaesthesia & Intensive Care Medicine, University of Manchester Hospitals NHS Foundation Trust, Wythenshawe Hospital, UK
| | - A Patel
- University College London, UK
| | - R Fernando
- The Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - T Husain
- Anaesthesia, Ashford & St Peters NHS Foundation Trust, UK
| | - P Sultan
- Stanford University School of Medicine, CA, USA
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Samanta BR, Fernando R, Rösch D, Reisler H, Osborn DL. Looking at the bigger picture: Identifying the photoproducts of pyruvic acid at 193 nm. J Chem Phys 2020; 153:074307. [DOI: 10.1063/5.0018582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B. R. Samanta
- Department of Chemistry, University of Southern California, Los Angeles, California 90089-0482, USA
| | - R. Fernando
- Department of Chemistry, University of Southern California, Los Angeles, California 90089-0482, USA
| | - D. Rösch
- Combustion Research Facility, Sandia National Laboratories, Livermore, California 94551-0969, USA
| | - H. Reisler
- Department of Chemistry, University of Southern California, Los Angeles, California 90089-0482, USA
| | - D. L. Osborn
- Combustion Research Facility, Sandia National Laboratories, Livermore, California 94551-0969, USA
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Swanger AM, Fesmire JE, Fernando R. Oxygen storage module with physisorption technology for closed-circuit respirators. IOP Conf Ser Mater Sci Eng 2020; 755:10.1088/1757-899x/755/1/012106. [PMID: 37206896 PMCID: PMC10193508 DOI: 10.1088/1757-899x/755/1/012106] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The new Cryogenic Flux Capacitor (CFC) technology employs nano-porous aerogel composites to store large quantities of fluid molecules in a physisorbed solid-state condition at moderate pressures and cryogenic temperatures. By its design architecture, a CFC device can be "charged" and "discharged" quickly and on demand according to standby/usage requirements. One of three main application areas is the CFC-Life for breathing air or oxygen supply to meet new demands in life support systems. Through the Liquid Oxygen Storage Module (LOXSM) Project, the National Institute for Occupational Safety and Health, and Cryogenics Test Laboratory have partnered to test the feasibility of applying the CFC technology to Closed-Circuit Escape Respirators (CCER), or respirators operating on the closed-circuit principle in general. The envisioned Cryogenic Oxygen Storage Module (COSM) is an innovative concept to store oxygen in solid-state form, according to physisorption processes at any cryogenic temperature, and deliver it as a gas using the CFC as the core storage element. Gaseous oxygen would be admitted into the breathing loop of the CCER by introducing heat into the storage module. Potentially replacing the gaseous or chemical based oxygen supply used in today's closed-circuit respirators, the COSM is a high capacity, conformal, small-size solution for future life support equipment of all kinds. In particular, are the CCER devices that must to be carried on the person, ready to be quickly deployed and used for escape in an emergency. Initial test data for physisorption of oxygen in aerogel materials and CFC core modules are presented. The basic operational parameters for charging and discharging are summarized through prototype testing of the cryogenic oxygen storage module.
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Affiliation(s)
- A M Swanger
- NASA Kennedy Space Center, Cryogenics Test Laboratory, Kennedy Space Center, FL 32899 USA
| | - J E Fesmire
- NASA Kennedy Space Center, Cryogenics Test Laboratory, Kennedy Space Center, FL 32899 USA
| | - R Fernando
- National Institute for Occupational Safety and Health, Pittsburgh, PA 15236 USA
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del Arroyo A, Sanchez J, Patel S, Phillips S, Reyes A, Cubillos C, Fernando R, David A, Sultan P, Ackland G, Reeve A, Sodha S, Ciechanowicz S, Olearo E, Dick J, Stewart A. Role of leucocyte caspase-1 activity in epidural-related maternal fever: a single-centre, observational, mechanistic cohort study. Br J Anaesth 2019; 122:92-102. [DOI: 10.1016/j.bja.2018.09.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
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Fernando R. TECHNOLOGIES FOR THE NEXT GENERATION CLOSED-CIRCUIT ESCAPE RESPIRATORS. Trans Soc Min Metall Explor Inc 2018; 2018:469-471. [PMID: 37020536 PMCID: PMC10071403] [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: 04/07/2023]
Abstract
The National Institute for Occupational Safety and Health (NIOSH) National Personal Protective Technology Laboratory (NPPTL) is leading an effort to develop the next generation of self-escape breathing apparatus for egress from confined spaces in emergency scenarios. A backpack style closed-circuit mine escape respirator design was one configuration explored as part of the research imperative directed by the 2006 MINER Act. Stakeholder feedback from MSHA and at the NIOSH Breathing Air Supply Partnership Meeting indicated a smaller belt worn unit that does not sacrifice performance is desirable. This paper outlines some further technology advancements that may be investigated toward developing such a small-sized respirator. Technologies being considered are novel chemicals for improved carbon dioxide (CO2) absorption and oxygen (O2) production, eliminating a dedicated CO2 scrubber by incorporating its function in the spaces of the respirator's breathing loop and storing O2 in a liquid form with long standby capabilities. When these technologies are applied to a future design, there is the possibility of having an escape respirator that can be belt worn and capable of being certified to 42 Code of Federal Regulations (CFR) Part 84 standards, including sub-part O for escape purposes including mine escape.
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Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia 2017; 73:71-92. [DOI: 10.1111/anae.14080] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Kinsella
- Department of Anaesthesia; St Michael's Hospital; Bristol UK
| | - B. Carvalho
- Department of Anesthesiology; Stanford University School of Medicine; Stanford CA USA
| | - R. A. Dyer
- Department of Anaesthesia and Perioperative Medicine; University of Cape Town; South Africa
| | - R. Fernando
- Department of Anaesthesia; Hamad Women's Hospital; Doha Qatar
| | - N. McDonnell
- Department of Anaesthesia and Pain Medicine; King Edward Memorial Hospital for Women; Subiaco Australia
| | - F. J. Mercier
- Département d'Anesthésie-Réanimation; Hôpital Antoine Béclère; Clamart France
| | - A. Palanisamy
- Department of Anesthesiology; Washington University School of Medicine; St. Louis MO USA
| | - A. T. H. Sia
- Department of Women's Anaesthesia; KK Women's and Children's Hospital; Singapore
| | - M. Van de Velde
- Department of Anesthesiology; UZ Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; KU Leuven; Leuven Belgium
| | - A. Vercueil
- Department of Anaesthesia and Intensive Care Medicine; King's College Hospital NHS Foundation Trust; London UK
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Fernando R, Munasinghe D, Gunasena A, Abeynayake P. Determination of nitrofuran metabolites in shrimp muscle by liquid chromatography-photo diode array detection. Food Control 2017. [DOI: 10.1016/j.foodcont.2015.08.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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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Mon W, Stewart A, Fernando R, Ashpole K, El-Wahab N, MacDonald S, Tamilselvan P, Columb M, Liu YM. Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. J Clin Anesth 2016; 37:43-48. [PMID: 28235526 DOI: 10.1016/j.jclinane.2016.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05].
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Affiliation(s)
- W Mon
- University College London Hospitals NHS Foundation Trust, London, UK
| | - A Stewart
- University College London Hospitals NHS Foundation Trust, London, UK
| | - R Fernando
- University College London Hospitals NHS Foundation Trust, London, UK
| | - K Ashpole
- St.Richard's Hospital, Chichester, UK
| | - N El-Wahab
- University College London Hospitals NHS Foundation Trust, London, UK
| | - S MacDonald
- Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - M Columb
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK
| | - Y M Liu
- University College London Hospitals NHS Foundation Trust, London, UK
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Rosado C, Antunes F, Barbosa R, Fernando R, Estudante M, Silva HN, Rodrigues LM. About the in vivo quantitation of skin anisotropy. Skin Res Technol 2016; 23:429-436. [PMID: 27882608 DOI: 10.1111/srt.12353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE Human skin anisotropy is difficult to quantify. The Cutiscan® , is allegedly, the first biometrical system to provide information on the elastic and viscoelastic properties, as well as on anisotropy and directionality of the human skin in vivo. Thus, this study aims to contribute to characterize this new device and its applicability, and to compare its behavior with two other well-known devices-the Cutometer® and the Reviscometer® . METHODS Measurements were conducted with each device in three different anatomical sites (forehead, forearm and leg) of 20 female volunteers engaged after informed consent. The participants in the study were aged 19-73 years (mean age 37 ± 18.7 years old), and were divided in two groups (n = 10), based on their age - Group I, mean age 22 ± 1.3 years; Group II, mean age 52 ± 13.7 years. RESULTS All devices were useful tools to explore the anatomical and the age dependant changes in biomechanical terms, showing different discriminative capacities. Interesting correlations were established between the variables provided by the equipment. CONCLUSION The Cutiscan® descriptors delivered excellent relationships with those from Cutometer® and Reviscometer® , while providing more detailed information about skin anisotropy through a full 360° analysis.
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Affiliation(s)
- C Rosado
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - F Antunes
- Pharmacological Sciences Department, School of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - R Barbosa
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - R Fernando
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - M Estudante
- iMed.ULisboa - Research Institute for Medicines, School of Pharmacy, Lisbon, Portugal
| | - H N Silva
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal.,Pharmacological Sciences Department, School of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - L M Rodrigues
- CBIOS - Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal.,Pharmacological Sciences Department, School of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
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Patel S, Fernando R. Opioids should be given before cord clamping for caesarean delivery under general anaesthesia. Int J Obstet Anesth 2016; 28:76-80. [PMID: 27720615 DOI: 10.1016/j.ijoa.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- S Patel
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK.
| | - R Fernando
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, UK
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Blanchart A, Fernando R, Häring M, Assaife-Lopes N, Romanov RA, Andäng M, Harkany T, Ernfors P. Endogenous GAB AA receptor activity suppresses glioma growth. Oncogene 2016; 36:777-786. [PMID: 27375015 DOI: 10.1038/onc.2016.245] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 12/23/2022]
Abstract
Although genome alterations driving glioma by fueling cell malignancy have largely been resolved, less is known of the impact of tumor environment on disease progression. Here, we demonstrate functional GABAA receptor-activated currents in human glioblastoma cells and show the existence of a continuous GABA signaling within the tumor cell mass that significantly affects tumor growth and survival expectancy in mouse models. Endogenous GABA released by tumor cells, attenuates proliferation of the glioma cells with enriched expression of stem/progenitor markers and with competence to seed growth of new tumors. Our results suggest that GABA levels rapidly increase in tumors impeding further growth. Thus, shunting chloride ions by a maintained local GABAA receptor activity within glioma cells has a significant impact on tumor development by attenuating proliferation, reducing tumor growth and prolonging survival, a mechanism that may have important impact on therapy resistance and recurrence following tumor resection.
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Affiliation(s)
- A Blanchart
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - R Fernando
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - M Häring
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - N Assaife-Lopes
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - R A Romanov
- Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - M Andäng
- Department of Physiology and Pharmacology, Biophysics of Stem Cell and Tissue Growth, Karolinska Institutet, Stockholm, Sweden
| | - T Harkany
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Neurosciences, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - P Ernfors
- Department of Medical Biochemistry and Biophysics, Division of Molecular Neurobiology, Karolinska Institutet, Stockholm, Sweden
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Jeewandara K, Gomez L, Paranavitane S, Jayarathne M, Tantirimudalige M, Fernando S, Fernando R, Prathapan S, Ogg G, Malavige G. Obesity and the presence of asthma are associated with hospitalization due to dengue infection. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Heesen M, Stewart A, Fernando R. Vasopressors for the treatment of maternal hypotension following spinal anaesthesia for elective caesarean section: past, present and future. Anaesthesia 2015; 70:252-7. [DOI: 10.1111/anae.13007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - A. Stewart
- Department of Anaesthesia; University College London Hospitals NHS Foundation Trust; London UK
| | - R. Fernando
- Department of Anaesthesia; University College London Hospitals NHS Foundation Trust; London UK
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21
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Etheridge FS, Fernando R, Golen JA, Rheingold AL, Sauve G. Tuning the optoelectronic properties of core-substituted naphthalene diimides by the selective conversion of imides to monothioimides. RSC Adv 2015. [DOI: 10.1039/c5ra05920h] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Molecules with a low optical gap and high electron affinity were obtained via selective thionation of the distal carbonyls of 2,6-dialkylamino core-substituted naphthalene diimide.
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Affiliation(s)
- F. S. Etheridge
- Department of Chemistry
- Case Western Reserve University
- Cleveland
- USA
| | - R. Fernando
- Department of Chemistry
- Case Western Reserve University
- Cleveland
- USA
| | - J. A. Golen
- Department of Chemistry and Biochemistry
- UMass Dartmouth
- Dartmouth
- USA
| | - A. L. Rheingold
- Department of Chemistry and Biochemistry
- University of California at San Diego
- La Jolla
- USA
| | - G. Sauve
- Department of Chemistry
- Case Western Reserve University
- Cleveland
- USA
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Armstrong S, Fernando R, Tamilselvan P, Stewart A, Columb M. The effect of serial in vitro haemodilution with maternal cerebrospinal fluid and crystalloid on thromboelastographic (TEG®) blood coagulation parameters, and the implications for epidural blood patching. Anaesthesia 2014; 70:135-41. [DOI: 10.1111/anae.12911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. Armstrong
- Department of Anaesthesia; Frimley Health NHS Foundation Trust; Frimley UK
| | - R. Fernando
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - P. Tamilselvan
- Department of Anaesthesia; The Princess Alexandra Hospital; Harlow UK
| | - A. Stewart
- Department of Anaesthesia; University College London Hospitals NHS Trust; London UK
| | - M. Columb
- Department of Anaesthesia; South Manchester University Hospitals NHS Trust; Wythenshawe UK
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El-Wahab N, Fernando R, Columb MO. A reply. Anaesthesia 2014; 69:1291-2. [PMID: 25302972 DOI: 10.1111/anae.12874] [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: 11/29/2022]
Affiliation(s)
- N El-Wahab
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Patel NP, El-Wahab N, Fernando R, Wilson S, Robson SC, Columb MO, Lyons GR. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia 2014; 69:458-67. [PMID: 24738803 DOI: 10.1111/anae.12602] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 02/02/2023]
Abstract
We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population.
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Affiliation(s)
- N P Patel
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK
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Polf J, Jackson I, Ranjan A, Zheng Y, Fernando R. SU-E-T-211: Induced Release of Nanocarrier Encapsulated Chemotherapeutic Drugs Using Proton Radiotherapy Beams. Med Phys 2014. [DOI: 10.1118/1.4888541] [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: 11/07/2022] Open
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Fernando R, Maples D, Senavirathna LK, Zheng Y, Polf JC, Benton ER, Bartels KE, Piao D, Ranjan A. Hyperthermia Sensitization and Proton Beam Triggered Liposomal Drug Release for Targeted Tumor Therapy. Pharm Res 2014; 31:3120-6. [DOI: 10.1007/s11095-014-1404-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/28/2014] [Indexed: 12/25/2022]
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Husain T, Liu Y, Fernando R, Nagaratnam V, Sodhi M, Tamilselvan P, Venkatesh S, England A, Columb M. How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: National surveys of practice conducted in 2004 and 2010. Int J Obstet Anesth 2013; 22:298-302. [DOI: 10.1016/j.ijoa.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/26/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
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Wolc A, Arango J, Settar P, Fulton JE, O'Sullivan NP, Preisinger R, Fernando R, Garrick DJ, Dekkers JCM. Analysis of egg production in layer chickens using a random regression model with genomic relationships. Poult Sci 2013; 92:1486-91. [PMID: 23687143 DOI: 10.3382/ps.2012-02882] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Random regression models allow for analysis of longitudinal data, which together with the use of genomic information are expected to increase accuracy of selection, when compared with analyzing average or total production with pedigree information. The objective of this study was to estimate variance components for egg production over time in a commercial brown egg layer population using genomic relationship information. A random regression reduced animal model with a marker-based relationship matrix was used to estimate genomic breeding values of 3,908 genotyped animals from 6 generations. The first 5 generations were used for training, and predictions were validated in generation 6. Daily egg production up to 46 wk in lay was accumulated into 85,462 biweekly (every 2 wk) records for training, of which 17,570 were recorded on genotyped hens and the remaining on their nongenotyped progeny. The effect of adding additional egg production data of 2,167 nongenotyped sibs of selection candidates [16,037 biweekly (every 2 wk) records] to the training data was also investigated. The model included a 5th order Legendre polynomial nested within hatch-week as fixed effects and random terms for coefficients of quadratic polynomials for genetic and permanent environmental components. Residual variance was assumed heterogeneous among 2-wk periods. Models using pedigree and genomic relationships were compared. Estimates of residual variance were very similar under both models, but the model with genomic relationships resulted in a larger estimate of genetic variance. Heritability estimates increased with age up to mid production and decreased afterward, resulting in an average heritability of 0.20 and 0.33 for pedigree and genomic models. Prediction of total egg number was more accurate with the genomic than with the pedigree-based random regression model (correlation in validation 0.26 vs. 0.16). The genomic model outperformed the pedigree model in most of the 2-wk periods. Thus, results of this study show that random regression reduced animal models can be used in breeding programs using genomic information and can result in substantial improvements in the accuracy of selection for trajectory traits.
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Affiliation(s)
- A Wolc
- Department of Genetics and Animal Breeding, Poznan University of Life Sciences, Poland.
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Alempijevic D, Beriashvili R, Beynon J, Duque M, Duterte P, Fernando R, Fincanci S, Hansen S, Hardi L, Hougen H, Iacopino V, Mendonça M, Modvig J, Mendez M, Özkalipci Ö, Payne-James J, Peel M, Rasmussen O, Reyes H, Rogde S, Sajantila A, Treue F, Vanezis P, Vieira D. Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment. J Forensic Leg Med 2013; 20:158-63. [PMID: 23472795 DOI: 10.1016/j.jflm.2012.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.
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Vijaya G, Cartwright R, Derpapas A, Gallo P, Fernando R, Khullar V. Changes in nerve growth factor level and symptom severity following antibiotic treatment for refractory overactive bladder. Int Urogynecol J 2013; 24:1523-8. [PMID: 23376905 DOI: 10.1007/s00192-012-2038-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/29/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Overactive bladder (OAB) has a multifactorial aetiology, and for some women symptoms may be associated with chronic urothelial inflammation secondary to bacterial colonisation. One marker of such inflammation may be urinary nerve growth factor (NGF). We hypothesised that for women with OAB and urothelial inflammation, urinary NGF would be reduced following antibiotic therapy. METHODS Women with overactive bladder and urodynamic diagnosis of detrusor overactivity who were refractory to anticholinergics, and had histological evidence of urothelial inflammation were treated with a 6-week course of rotating antibiotics. Urinary NGF was measured by ELISA before and after treatment. Three-day bladder diaries, the Patients' Perception of Intensity of Urgency Scale, the King's Health Questionnaire and the Patients' Perception of Bladder Condition questionnaire were used to assess subjective and objective outcomes of therapy. RESULTS Thirty-nine women with refractory DO were recruited. The NGF levels decreased significantly after antibiotic therapy (Wilcoxon signed rank test; p = 0.015). There were significant improvements in daytime frequency, nocturia and urgency (p < 0.05), and 74 % of women reported improvement in perception of their bladder condition. CONCLUSIONS Urinary NGF is responsive to antibiotic therapy. Women with refractory overactive bladder and elevated NGF may benefit from antibiotic treatment.
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Affiliation(s)
- G Vijaya
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK.
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Spurlock DM, Dekkers JCM, Fernando R, Koltes DA, Wolc A. Genetic parameters for energy balance, feed efficiency, and related traits in Holstein cattle. J Dairy Sci 2013; 95:5393-5402. [PMID: 22916946 DOI: 10.3168/jds.2012-5407] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/27/2012] [Indexed: 01/21/2023]
Abstract
Objectives of the current study were to estimate genetic parameters in Holstein cows for energy balance (EB) and related traits including dry matter intake (DMI), body weight (BW), body condition score (BCS), energy-corrected milk (ECM) production, and gross feed efficiency (GFE), defined as the ratio of total ECM yield to total DMI over the first 150 d of lactation. Data were recorded for the first half of lactation on 227 and 175 cows in their first or later lactation, respectively. Random regression models were fitted to longitudinal data. Also, each trait was averaged over monthly intervals and analyzed by single and multivariate animal models. Heritability estimates ranged from 0.27 to 0.63, 0.12 to 0.62, 0.12 to 0.49, 0.63 to 0.72, and 0.49 to 0.53 for DMI, ECM yield, EB, BW, and BCS, respectively, averaged over monthly intervals. Daily heritability estimates ranged from 0.18 to 0.30, 0.10 to 0.26, 0.07 to 0.22, 0.43 to 0.67, and 0.25 to 0.38 for DMI, ECM yield, EB, BW, and BCS, respectively. Estimated heritability for GFE was 0.32. The genetic correlation of EB at 10d in milk (DIM) with EB at 150 DIM was -0.19, suggesting the genetic regulation of this trait differs by stage of lactation. Positive genetic correlations were found among DMI, ECM yield, and BW averaged over monthly intervals, whereas correlations of these traits with BCS depended upon stage of lactation. Total ECM yield for the lactation was positively correlated with DMI, but a negative genetic correlation between total ECM yield and EB was found. However, the genetic correlation between total ECM yield and EB in the first month of lactation was -0.02, indicating that total production is not genetically correlated with EB during the first month of lactation, when negative EB is most closely associated with diminished fitness. The genetic correlation between GFE and EB ranged from -0.73 to -0.99, indicating that selection for more efficient cows would favor a lower energy status. However, the genetic correlation between EB in the first month of lactation and GFE calculated from 75 to 150 DIM was not significant, indicating that the unfavorable correlation between GFE and EB in early lactation may be minimized with alternative definitions of efficiency. Thus, EB, GFE and related traits will likely respond to genetic selection in Holstein cows. However, the impact of selection for improved feed efficiency on EB must be carefully considered to avoid potential negative consequences of further reductions in EB at the onset of lactation.
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Affiliation(s)
- D M Spurlock
- Department of Animal Science, Iowa State University, Ames 50011.
| | - J C M Dekkers
- Department of Animal Science, Iowa State University, Ames 50011
| | - R Fernando
- Department of Animal Science, Iowa State University, Ames 50011
| | - D A Koltes
- Department of Animal Science, Iowa State University, Ames 50011
| | - A Wolc
- Department of Animal Science, Iowa State University, Ames 50011; Department of Genetics and Animal Breeding, Poznan University of Life Sciences, Poland
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Fernando R. I112 CURRENT MANAGEMENT OF PERINEAL TRAUMA AFTER VAGINAL DELIVERY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60142-8] [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]
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Armstrong S, Fernando R, Columb M. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07284.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wolc A, Arango J, Settar P, Fulton JE, O’Sullivan NP, Preisinger R, Habier D, Fernando R, Garrick DJ, Hill WG, Dekkers JCM. Genome-wide association analysis and genetic architecture of egg weight and egg uniformity in layer chickens. Anim Genet 2012; 43 Suppl 1:87-96. [DOI: 10.1111/j.1365-2052.2012.02381.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Patel NP, Armstrong SL, Fernando R, Columb MO, Bray JK, Sodhi V, Lyons GR. Combined spinal epidural vs epidural labour analgesia: does initial intrathecal analgesia reduce the subsequent minimum local analgesic concentration of epidural bupivacaine? Anaesthesia 2012; 67:584-93. [DOI: 10.1111/j.1365-2044.2011.07045.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cekanova M, Fernando R, Wimalasena J. P1-02-11: The BCL2 Antagonist of Death, BAD Is Down-Regulated in Breast Cancer and Inhibits Cancer Cell Invasion. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-02-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent clinical evidence suggest that expression of BCL2 and its antagonist BAD are good prognosticators for survival in breast cancer patients. BAD protein was previously shown by us to inhibit cyclin D1 expression and cJun activation, both may enhance invasiveness of tumor cells(Fernando et al JBC 07). However, the role of BAD and other BCL2 family proteins in invasion/metastasis of breast cancer is poorly characterized.
Methods: By immunohistochemistry nuclear and cytoplasmic staining of several proteins including BAD in normal epithelial was compared to that of cancer cells in human specimens. Western blotting and ELISA methods were used to compare BAD overexpressing MCF7 breast cancer cells with control cells for the expression of variety of signaling molecules, proteins that take part in metastasis and invasion and ability of cells to invade was measured. PCR was used to measure m RNA levels and reporter constructs utilized for transcriptional factor activity studies.
Results: Grade II breast cancer specimens express less total and phosphorylated forms of BAD in nuclei and cytoplasm compared to normals. BAD expression decreased Sp1, β-catenin and STAT proteins, which may increase cyclin D1 in vitro. BAD inhibited activation of the CRE and AP1 elements, and phosphorylation of BAD on S112 and S136 is required for this activity. BAD inhibited the Ras/MEK/ERK pathway and JNK, which may underlie inactivation of c Jun. BAD, like BCL2, may decrease metastasis,therefore, ability of BAD to modulate the expression of metastasis related proteins were measured and MMP10, VEGF, SNAIL, CXCR4, E-cadherin, and ***TlMP2 were regulated by BAD with a concomitant reduction in cell invasion.
Conclusion: Higher expression of BAD in breast cancer and a role in metastasis and proliferation suggests that BAD is valuable prognostic marker in breast cancer and a multi functional protein. Further given the overwhelming clinical evidence that BCL2 prolongs survival, a reevaluation of the role of BCL2 family proteins in metastasis is urgently required.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-11.
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Affiliation(s)
- M Cekanova
- 1University of Tennessee, Knoxville, TN; NIH, NCI, Bethesda, MD
| | - R Fernando
- 1University of Tennessee, Knoxville, TN; NIH, NCI, Bethesda, MD
| | - J Wimalasena
- 1University of Tennessee, Knoxville, TN; NIH, NCI, Bethesda, MD
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Armstrong S, Fernando R, Ashpole K, Simons R, Columb M. Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry. Int J Obstet Anesth 2011; 20:293-8. [DOI: 10.1016/j.ijoa.2011.05.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 05/10/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022]
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Abstract
INTRODUCTION Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.
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Affiliation(s)
- A P Malalasekera
- Department of Surgery, Faculty of Medicine, University of Kelaniya.
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Fernando K, Fernando R, Kandasami A, Jude R, Fernando N, Tennakoon S. SP6-3 Fermented sap of spiky Palmyra toddy (borassus flabellifer) suggested as a vehicle of transportation of amoebiasis in the district of mannar, Sri Lanka: 50 cases of amoebic liver abscess within 15 months. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Loubert C, O’Brien PJ, Fernando R, Walton N, Philip S, Addei T, Columb MO, Hallworth S. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial. Anaesthesia 2011; 66:341-7. [DOI: 10.1111/j.1365-2044.2011.06662.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Panayi D, Khullar V, Digesu G, Spiteri M, Hendricken C, Fernando R. Rectal distension: The effect on bladder function. Neurourol Urodyn 2011; 30:344-7. [DOI: 10.1002/nau.20944] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/13/2010] [Indexed: 12/11/2022]
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Fernando R, Chandrasinghe PC, Bandara M. Hypocalcemia and Hoarseness Following Total Thyroidectomy for Benign Disease: Relationship of Incidence to the Size of the Gland. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10002-1046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Introduction
Total thyroidectomy is considered as the standard surgical procedure for most malignancies and benign disease involving both lobes of the thyroid gland. Postoperative complications are likely to be commoner when the thyroid gland is large in size due to the alteration of structural anatomy.
Methods
Postoperative complications of 102 patients who underwent total thyroidectomy for benign disease, by the same surgeon, were analyzed. Patients were prospectively followed up and presence of hoarseness and hypocalcemia, both transient and temporary, were compared with the weight of the gland.
Results
Fourteen patients developed hypocalcemia of which 12 (11.7%) had transient and 2 (1.96%) had permanent deficiencies. Eight patients developed hoarseness following surgery of which seven (6.86%) had transient and only one (0.98%) had permanent hoarseness. A mean thyroid weight of 91.78 gm was observed in the uncomplicated group. Those who developed postoperative hypocalcemia and transient hoarseness had a mean thyroid weight over 100 gm. One patient, who had a thyroid weighing 195 gm developed permanent hoarseness due to RLN injury.
Conclusion
There is no statistically significant difference in the incidence of transient RLN and transient or permanent hypocalcemia. With increased size of the thyroid gland increased rate of complications was observed with a mean thyroid weight above 100 gm. There may be a significant risk of permanent RLN injury when the thyroid gland is enlarged over 10 times (closer to 200 gm) its normal size.
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Wilks M, Fernando R, Ariyananda P, Berry D, Tomenson J, Buckley N, Gawarammana I, Jayamanne S, Gunnell D, Dawson A. Time trends and factors influencing survival following paraquat ingestion in Sri Lanka. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Panayi D, Tekkis P, Fernando R, Hendricken C, Khullar V. Ultrasound measurement of bladder wall thickness is associated with the overactive bladder syndrome. Neurourol Urodyn 2010; 29:1295-8. [DOI: 10.1002/nau.20871] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
We report the identification of two novel major histocompatibility complex (MHC) class I-related chain A (MICA) alleles. MICA*054 has a nucleotide substitution of A to G at position 871 (codon 268), encoding an amino acid change of serine to glycine in the alpha-3 domain. MICA*056 has a nucleotide substitution at position 758 of G to C resulting in the substitution of tryptophan for serine at codon 230, also in the alpha-3 domain.
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Affiliation(s)
- S T Cox
- The Anthony Nolan Research Institute and Trust, The Royal Free Hospital, London, UK.
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Wortley A, Mckinley K, Whittle R, Calvert A, Shaw O, Fernando R, Pearse A, Hopkins K, Clark B. Investigations into the lack of consensus in the reporting of HLA antibody specificities in the UK. J Clin Pathol 2009; 62:270-4. [DOI: 10.1136/jcp.2008.061259] [Citation(s) in RCA: 3] [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: 11/03/2022]
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Abstract
BACKGROUND Between 1950 and 1995 suicide rates in Sri Lanka increased 8-fold to a peak of 47 per 100,000 in 1995. By 2005, rates had halved. We investigated whether Sri Lanka's regulatory controls on the import and sale of pesticides that are particularly toxic to humans were responsible for these changes in the incidence of suicide. METHODS Ecological analysis using graphical and descriptive approaches to identify time trends in suicide and risk factors for suicide in Sri Lanka, 1975-2005. RESULTS Restrictions on the import and sales of WHO Class I toxicity pesticides in 1995 and endosulfan in 1998, coincided with reductions in suicide in both men and women of all ages. 19,769 fewer suicides occurred in 1996-2005 as compared with 1986-95. Secular trends in unemployment, alcohol misuse, divorce, pesticide use and the years associated with Sri Lanka's Civil war did not appear to be associated with these declines. CONCLUSION These data indicate that in countries where pesticides are commonly used in acts of self-poisoning, import controls on the most toxic pesticides may have a favourable impact on suicide. In Asia, there are an estimated 300,000 deaths from pesticide self-poisoning annually. National and international policies restricting the sale of pesticides that are most toxic to humans may have a major impact on suicides in the region.
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Affiliation(s)
- D Gunnell
- Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
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