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Narula P, Gasparetto M, Wong C, Branchflower J, Sebastian S, McLaughlin J, Rao A, Wakeman R, Ainley R, Smith PJ, Kammermeier J, Younge L, Randall S, Bukhari S, Manson J, Ellis P, Arebi N. Top 10 research priorities for digital technology for adolescents and young persons with inflammatory bowel disease: Results of a James Lind Alliance Priority Setting Partnership. J Pediatr Gastroenterol Nutr 2024; 78:670-676. [PMID: 38504402 DOI: 10.1002/jpn3.12105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/06/2023] [Accepted: 12/10/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Priority Setting Partnerships (PSP's) using the James Lind Alliance (JLA) methodology, bring together health professionals, patients and parents/carers to identify and prioritise unanswered questions that can be addressed by future research projects. To identify and prioritise the top 10 unanswered research priorities in digital technology for adolescents and young people (AYP) with inflammatory bowel disease (IBD). METHODS A steering group (SG) consisting of AYP with IBD, their parents/carers, representatives from two charities (Crohn's & Colitis UK, Crohn's in Childhood Research Association), patient information forum and paediatric and adult and primary care healthcare professionals was established in 2021. The SG agreed the protocol, and scope of the PSP and oversaw all aspects. SG meetings were chaired by a JLA advisor and followed the established JLA methodology. RESULTS The initial survey generated 414 in-scope questions from 156 respondents, thematically categorised into 10 themes and consolidated into 92 summary questions by the SG. A comprehensive literature review followed by SG deliberation narrowed the unanswered summary questions to 45, for the interim prioritising survey. One hundred and two respondents ranked their top 10 research questions. Outputs generated top 18 research priorities presented at a final virtual prioritisation workshop, facilitated by JLA advisors and attended by key stakeholders, ranked into top 10 research priorities. DISCUSSION The top 10 research priorities will encourage researchers to undertake research that addresses these areas of unmet need for AYP living with IBD, their parents/carers and their healthcare professionals, thereby facilitating improved patient care.
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Affiliation(s)
- Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS FT, Sheffield, UK
| | - Marco Gasparetto
- Paediatric Gastroenterology Unit, Jenny Lind Children's Hospital, University of East Anglia (UEA), Norwich, UK
| | - Charlotte Wong
- Department of IBD, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion & Reproduction Imperial College, London, UK
| | - Jacob Branchflower
- Sheffield CRF, NIHR MedTech & In Vitro diagnostics Co-operatives (MICs), Sheffield
| | | | - John McLaughlin
- Division of Diabetes, Endocrinology & Gastroenterology, Manchester and Salford Royal Hospital, University of Manchester, London, UK
| | - Arati Rao
- Department of Paediatrics, Royal Free Hospital, London, UK
| | | | | | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jochen Kammermeier
- Paediatric Gastroenterology Department, Evelina London Children's Hospital, London, UK
| | - Lisa Younge
- Department of IBD, St Mark's National Bowel Hospital, London, UK
| | - Sophie Randall
- Crohn's & Colitis UK Representative Patient Information Forum, Hatfield, UK
| | | | | | | | - Naila Arebi
- Department of IBD, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion & Reproduction Imperial College, London, UK
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Maagaard M, Plambech MZ, Funder KS, Schou NK, Mølgaard AK, Stormholt ER, Leth MF, Bukhari S, Mortensen A, Lunn TH, Tryggedsson I, Nørskov AK, Zamany C, Toquer P, Jaeger P, Andersen JH, Mathiesen O. The effect of oral dexamethasone on duration of analgesia after upper limb surgery under infraclavicular brachial plexus block: a randomised controlled trial. Anaesthesia 2023; 78:1465-1471. [PMID: 37864459 DOI: 10.1111/anae.16149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/22/2023]
Abstract
The effects of oral dexamethasone on peripheral nerve blocks have not been investigated. We randomly allocated adults scheduled for forearm or hand surgery to oral placebo (n = 61), dexamethasone 12 mg (n = 61) or dexamethasone 24 mg (n = 57) about 45 min before lateral infraclavicular block. Mean (SD) time until first pain after block were: 841 (327) min; 1171 (318) min; and 1256 (395) min, respectively. Mean (98.3%CI) differences in time until first postoperative pain for dexamethasone 24 mg vs. placebo and vs. dexamethasone 12 mg were: 412 (248-577) min, p < 0.001; and 85 (-78 to 249) min, p = 0.21, respectively. Mean (98.3%CI) difference in time until first postoperative pain for dexamethasone 12 mg vs. placebo was 330 (186-474) min, p < 0.001. Both 24 mg and 12 mg of oral dexamethasone increased the time until first postoperative pain compared with placebo in patients having upper limb surgery under infraclavicular brachial plexus block.
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Affiliation(s)
- M Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - M Z Plambech
- Department of Anaesthesiology, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - K S Funder
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Denmark
| | - N K Schou
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - A K Mølgaard
- Department of Anaesthesiology, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - E R Stormholt
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - M F Leth
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - S Bukhari
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - A Mortensen
- Department of Anaesthesiology, Naestved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - T H Lunn
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Denmark
| | - I Tryggedsson
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Denmark
| | - A K Nørskov
- Department of Anaesthesiology, Copenhagen University Hospital, North Zealand Hospital, Hillerød, Denmark
| | - C Zamany
- Department of Orthopaedic Surgery, Trauma Unit, Zealand University Hospital, Køge, Denmark
| | - P Toquer
- Department of Orthopaedic Surgery, Trauma Unit, Zealand University Hospital, Køge, Denmark
| | - P Jaeger
- Department of Anaesthesia, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J H Andersen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - O Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
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Ibrahim J, Bukhari S, Nieves R, Barakat A, Shpilsky D, Hynal K, Soman P. DSPECT-specific normal limits for LV measurements: a new approach to derivation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.040] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Differences in spatial resolution and image filtering between the solid-state DSPECT and traditional Anger SPECT (A-SPECT) cameras are likely to result in differences in LV measurements. However, DSPECT- specific normal values have not been systematically derived. We used healthy organ-donor subjects from our high-volume solid organ transplant center for derivation of normal values.
Purpose
To report DSPECT-specific LV measurements normal limits derived from a unique cohort of donor subjects.
Methods
Subjects were 92 consecutive kidney or liver donors who underwent single day rest (5 mCi)- stress (15mCi) Tc-99m sestamibi gated SPECT myocardial perfusion imaging (MPI) on the DSPECT for pre-operative evaluation. Exclusion criteria included any cardiac disease or medications. LV measurements were made on the post-stress supine stress images using QGS®.
Results
Of 92 subjects (mean age 54.4 ± 15.0 and 39% men), mean EF for women and men were 77.2 ± 14.1% and 70.0 ± 14.7%, respectively. Mean end-diastolic volume for women and men were 67.0 ± 32.2 ml and 99.6 ± 51.6 ml (indexed 38.3 ± 17.2 ml/m2 and 48.1 ± 25.9 ml/m2), respectively. Mean LV wall volume for women and men were 95.9 ± 26.0 ml and 112.0 ± 48.8 ml (indexed 55.0 ± 13.8 ml/m2 and 54.1 ± 24.6 ml/m2), respectively.
Conclusion
We report DSPECT-specific LV measurements from normal subjects from which limits of normality can be derived for clinic use. Organ-donors who undergo pre-operative MPI are a suitable cohort for the derivation of normal values.
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Affiliation(s)
- J Ibrahim
- University Of Pittsburgh Medical Centre, Department of Internal Medicine, Pittsburgh, United States of America
| | - S Bukhari
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
| | - R Nieves
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
| | - A Barakat
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
| | - D Shpilsky
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
| | - K Hynal
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
| | - P Soman
- University Of Pittsburgh Medical Centre, Division of Cardiology, Pittsburgh, United States of America
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Khan NN, Ganai N, Alam S, Shanaz S, Hamadani A, Rather MA, Bukhari S, Shah R, Jalal H, Wani N. Genetic evaluation of growth performance in Corriedale sheep in J&K, India. Small Rumin Res 2020. [DOI: 10.1016/j.smallrumres.2020.106197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Broomfield A, Zuberi K, Mercer J, Moss G, Finnegan N, Hensman P, Walker R, Bukhari S, Wright NB, Stewart F, Jones SA, Ramirez R. Outcomes from 18 years of cervical spine surgery in MPS IVA: a single centre's experience. Childs Nerv Syst 2018; 34:1705-1716. [PMID: 29946810 DOI: 10.1007/s00381-018-3823-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/04/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE This study examines the long-term outcomes of paediatric Morquio (MPS IVA) patients undergoing cervical spine surgery and evaluates the factors that impacting this. METHODS A retrospective review was performed on all MPS IVA patients undergoing cervical spine surgery, since the introduction of standardised neuroradiological screening. The impact of preoperative neurological status, growth, genotype and radiological status on outcome is assessed, whilst long-term surgical, radiological and neurological outcomes are documented. RESULTS Twenty-six of the eighty-two MPS IVA patients (31%) reviewed underwent cervical spine surgery at a median age of 6.1 years (range, 1.45 to 15.24). Preoperatively, cord signal change was seen in 11 patients with 5 being myelopathic; however, 6 clinically manifesting patients had no overt cord signal change. Postoperatively, none of the 14 preoperatively clinically asymptomatic patients followed long term progressed neurologically during a median follow-up of 77.5 months (range = 18-161). Of the ten preoperatively clinically symptomatic patients who were followed up for the same duration, seven continued to deteriorate, two initially improved and one remained stable. Radiological follow-up performed for a median duration of 7 years (range = 0.5-16) has shown a degree of stenosis at the level immediately caudal to the termination of the graft in 76% of patients, though only one has become clinically symptomatic and required revision. CONCLUSIONS Once clinically elicitable neurological signs become evident in patients with MPS IVA, they tend to progress despite surgical intervention. Referring clinicians should also not be falsely reassured by the lack of T2 spinal cord signal change but should consider surgical intervention in the face of new clinical symptomology or radiological signs of progressive canal stenosis or instability.
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Affiliation(s)
- A Broomfield
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK.
| | - K Zuberi
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - J Mercer
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - G Moss
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - N Finnegan
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - P Hensman
- Department of Physiotherapy, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - R Walker
- Department of Paediatric Anaesthetics, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - S Bukhari
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - N B Wright
- Department of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - F Stewart
- N.I Regional Genetics Service, Level A, Belfast City Hospital, Lisburn Rd, Belfast, BT9 7AB, UK
| | - S A Jones
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
| | - R Ramirez
- Department of Paediatric Neurosurgery, Royal Manchester Children's Hospital, Central Manchester Foundation Trust, Manchester, M13 9WL, UK
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Al-Sulaiti H, Al Mugren K, Bradley D, Regan P, Santawamaitre T, Malain D, Habib A, Nasir T, Alkhomashi N, Al-Dahan N, Al-Dosari M, Bukhari S. An assessment of the natural radioactivity distribution and radiation hazard in soil samples from Qatar using high-resolution gamma-ray spectrometry. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Marshall C, Talboys MA, Bukhari S, Evans WD. Quantification of the activity of tritium produced during the routine synthesis of (18)F fluorodeoxyglucose for positron emission tomography. J Radiol Prot 2014; 34:435-444. [PMID: 24894021 DOI: 10.1088/0952-4746/34/2/435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gamma emitting radioactive by-products generated during the cyclotron irradiation of (18)O labelled water by protons to produce (18)FDG (fluorodeoxyglucose) for positron emission tomography are well characterised. However, the production of tritium ((3)H) through the (18)O(p,t)(16)O nuclear reaction has not been investigated in detail. The aim of this study was to measure tritium activity produced during a large number of (18)FDG production runs in order to obtain a better perspective on its impact on radioactive waste management, particularly as regards storage and disposal. Tritium was assayed by liquid scintillation counting in recovered (18)O water from 24 separate production runs. The mean (SD) values of activity and activity concentration were 170 (20) kBq and 81 (8) kBq ml(-1) respectively. Both quantities were positively correlated with the activity of (18)F. Tritium was detected in much lower concentration in water used to rinse the target vessel. The activity of tritium is such that it is exempt from regulatory control and may be combined with bulk non-active waste for disposal as Very Low Level Waste. However, variations in the irradiation conditions or the procedures for the collection of recovered water might result in its classification as Low Level Waste, necessitating a more complex disposal regime.
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Affiliation(s)
- C Marshall
- Wales Research and Diagnostic Positron Emission Tomography Imaging Centre (PETIC), School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK
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8
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Lang J, Amato-Watkins A, Amarasinghe S, Goetz P, Bukhari S, Leach P. One year failure rate for de-novo ventriculo-peritoneal shunts in children from a small volume paediatric neurosurgical unit. Br J Neurosurg 2013; 27:503-4. [DOI: 10.3109/02688697.2012.761674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J Lang
- Department of Paediatric Neurosurgery, University Hospital of Wales , Cardiff , UK
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9
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Al-Sulaiti H, Nasir T, Al Mugren K, Alkhomashi N, Al-Dahan N, Al-Dosari M, Bradley D, Bukhari S, Matthews M, Regan P, Santawamaitre T, Malain D, Habib A. Determination of the natural radioactivity levels in north west of Dukhan, Qatar using high-resolution gamma-ray spectrometry. Appl Radiat Isot 2012; 70:1344-50. [DOI: 10.1016/j.apradiso.2011.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022]
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10
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Balamurali G, Bukhari S, Carter J, Sofat A. Improvement of persistent developmental stuttering after surgical excision of a left perisylvian meningioma. Br J Neurosurg 2010; 24:485-7. [PMID: 20726757 DOI: 10.3109/02688697.2010.489654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Persistent developmental stuttering (PDS) has been treated by speech and language and psychotherapy with limited success. We report the case of a 69-year-old with PDS since the age of five. A left perisylvian meningioma was successfully resected following investigation for generalised seizure. Spontaneous significant improvement in stuttering after surgery in the perisylvian area to the best of our knowledge has not been reported.
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Affiliation(s)
- G Balamurali
- Department of Neurosurgery, Greater Manchester Neurosciences Centre, Hope Hospital, Salford M6 8HD, UK.
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11
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Parakh R, Kapadia S, Agarwal S, Grover T, Bukhari S, Yadav A, Sen I, Pankaj P. Assessment of total thrombus load in symptomatic patients with venous thromboembolism. Clin Appl Thromb Hemost 2006; 12:369-72. [PMID: 16959693 DOI: 10.1177/1076029606291408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pulmonary embolism (PE) and Deep vein thrombosis (DVT) are separate but related aspects of the same dynamic process termed as venous thrombembolism (VTE). The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from the Indian subcontinent. Between January 2001 and July 2004, 1,552 patients with clinically suspected lower limb DVT underwent a combined ascending radionuclide venogram and lung perfusion scan for assessment of the total thrombus burden. Of 744 patients with radionuclide venography proven DVT, 294 (40%) had a high probability lung scan. Nearly half of these patients were asymptomatic for pulmonary embolism. The high prevalence of PE in patients with DVT suggests the need for evaluation of thrombus load in the venous as well as pulmonary circulation. A combination radionuclide ascending venography with lung perfusion scan is a useful and reliable single test for this purpose.
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Affiliation(s)
- R Parakh
- Department of Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, New Delhi, India.
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12
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Bukhari AS, Bukhari S. Vaginal fibroid--a case report. J OBSTET GYNAECOL 2005; 25:83-4. [PMID: 16147714 DOI: 10.1080/01443610400025580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bukhari AS, Bukhari S. Heterotopic pregnancy--a report of 2 cases in women without risk factors. J Ayub Med Coll Abbottabad 2001; 13:45-8. [PMID: 11732223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Two cases of heterotopic pregnancy are reported. The cases emphasize that co incident pregnancies may occur in women who are without risk of ectopic pregnancy or multiple gestation. The cases describe the complexities of diagnosis and management.
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Hardy MJ, Nascimento L, Ragbeer S, Bukhari S, Kashgari A. Effect of acute renal failure on free thyroid hormone levels in a thyrotoxic patient. Nephron Clin Pract 1989; 52:360-2. [PMID: 2770952 DOI: 10.1159/000185678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Acute renal failure in a previously undiagnosed case of thyrotoxicosis was accompanied by a rapid and spontaneous decline in thyroid hormone levels. Over a 2-week period, free triiodothyronine and thyroxine fell to the low levels seen in euthyroid patients with end-stage renal disease. Thyrotropin levels remained undetectable throughout, suggesting impairment of the pituitary-thyroid axis at the level of the thyroid gland. This may represent an important beneficial adaptation to severe illness and could explain the virtual absence of hyperthyroidism in renal failure patients.
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Affiliation(s)
- M J Hardy
- Department of Laboratory Medicine, King Fahd Armed Forces Hospital, Jedda, Saudi Arabia
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