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de Cates C, Guéroult AM, Narantsolmon GE. Sustainable equipment donation in otolaryngology in low-resource settings. Curr Opin Otolaryngol Head Neck Surg 2024; 32:193-199. [PMID: 38547365 DOI: 10.1097/moo.0000000000000972] [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: 05/02/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs. RECENT FINDINGS LMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding. SUMMARY Sustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.
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Affiliation(s)
- Catherine de Cates
- Department of Otolaryngology, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage
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Guéroult AM, Bashir A, Azhar B, Budge J, Roy I, Loftus I, Holt P. Long Term Outcomes and Durability of Fenestrated Endovascular Aneurysm Repair: A Meta-analysis of Time to Event Data. Eur J Vasc Endovasc Surg 2024; 67:119-129. [PMID: 37572869 DOI: 10.1016/j.ejvs.2023.08.012] [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: 03/29/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Despite widespread use, long term outcomes for fenestrated endovascular aneurysm repair (FEVAR) are uncertain. This meta-analysis reports long term survival, freedom from re-intervention, target vessel patency, and one year sac regression after FEVAR. DATA SOURCES Systematic review and meta-analysis to pool time to event data according to PRISMA guidelines. The study was registered with the international prospective register of systematic reviews (PROSPERO) (ID: CRD42023401468). REVIEW METHODS Medline, Embase, and Cochrane databases were searched from 1992 - 2023; articles were independently screened by two authors. Publication of complete time to event data for any outcome of interest was an inclusion criterion. Raw Kaplan-Meier probabilities were directly extracted from published curves and pooled by random effects. Risk of bias was assessed using ROBINS I and certainty with GRADE. RESULTS A total of 3 569 records were retrieved, 2 869 screened after duplicate removal, yielding 37 included studies (n = 4 371). The pooled mean age was 73.2 years (interquartile range [IQR] 72.2, 73.7) and 87.4% were male (95% confidence interval [CI] 85.8 - 88.9). Pooled Kaplan-Meier estimated probabilities of survival (n = 34 studies, n = 4 192 patients) at one, three, and five years were 91.6% (95% CI 90.2 - 92.9), 80.8% (95% CI 78.0 - 83.2), and 65.1% (95% CI 60.9 - 69.1). For freedom from re-intervention (n = 24, n = 3 211 patients) at one, three, and five years these were 90.2% (95% CI 87.3 - 92.7), 80.9% (95% CI 76.5 - 84.9), and 73.8% (95% CI 67.1 - 79.6). For target vessel patency (n = 13, n = 5805 target vessels) at one, three, and five years, these were 96.6% (95% CI 94.9 - 98.0), 94.5% (95% CI 91.7 - 96.7), and 93.1% (95% CI 89.3 - 96.0). Pooled estimate of sac regression (n = 8, n = 560) at one year was 40.2% (95% CI 28.9 - 52.7). Risk of bias was judged as moderate in 11 studies and low for the remaining 26. CONCLUSION There are moderate to low certainty data supporting reasonable long term outcome estimates following fenestrated endovascular aneurysm repair. Beyond five years there is a lack of data in the literature.
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Affiliation(s)
| | - Aisha Bashir
- St George's Vascular Institute; St George's, University of London, UK
| | - Bilal Azhar
- St George's Vascular Institute; St George's, University of London, UK
| | - James Budge
- St George's Vascular Institute; St George's, University of London, UK
| | - Iain Roy
- St George's Vascular Institute; St George's, University of London, UK
| | - Ian Loftus
- St George's Vascular Institute; St George's, University of London, UK
| | - Peter Holt
- St George's Vascular Institute; St George's, University of London, UK
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Guéroult AM, Al-Balah A, Davies AH, Shalhoub J. Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis. Heart 2021; 108:1707-1715. [PMID: 34702756 DOI: 10.1136/heartjnl-2021-319940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Nickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-containing endovascular device. METHODS Inclusion criteria were: endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology involving nickel-allergic patients. All adverse outcomes were included as defined by included studies. A systematic review and meta-analysis were undertaken using a random-effects model. Searches of MEDLINE and EMBASE were conducted for articles published 1947-2019. RESULTS 190 records were identified, 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. Patch-test confirmed nickel allergy was associated with an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (n=14 articles, 1740 patients; OR 2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary (n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI 1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33 patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI 0.23 to 19.70). CONCLUSIONS Patch-tested nickel allergy is associated with an increased risk of adverse outcomes following endovascular device implantation and alternative treatment options should be considered. Specialists faced with patients' self-reporting nickel allergy should consider proceeding to diagnostic patch-testing.
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Affiliation(s)
- Aurélien M Guéroult
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, London, UK .,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Amer Al-Balah
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Machin M, Younan HC, Guéroult AM, Onida S, Shalhoub J, Davies AH. Systematic review of inframalleolar endovascular interventions and rates of limb salvage, wound healing, restenosis, rest pain, reintervention and complications. Vascular 2021; 30:105-114. [PMID: 33789557 PMCID: PMC8862126 DOI: 10.1177/17085381211004246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Peripheral artery disease is estimated to affect 237 million individuals worldwide. Critical limb ischaemia, also known as chronic limb threatening ischaemia is a consequence of the progression of peripheral artery disease which occurs in ∼21% of patients over a five-year period. The aim of this systematic review is to assess the use of additional below-the-ankle angioplasty in comparison to the use of above-the-ankle angioplasty alone, and the subsequent rates of amputation, wound healing, restenosis, rest pain, reintervention and complications. Methods This systematic review was undertaken in accordance with PRISMA guidelines following a registered protocol (CRD42019154893). Online databases were searched using a search strategy of 20 keywords. Included articles reported the outcome for inframalleolar (pedal artery, pedal arch, plantar arteries) angioplasty with additional proximal angioplasty in comparison to proximal angioplasty alone. GRADE assessment was applied to assess the quality of the evidence. Results After screening 1089 articles, 10 articles met the inclusion criteria. Comparative performance assessment of below-the-ankle with above-the-ankle versus above-the-ankle angioplasty alone was undertaken in 3 articles, with the remaining 7 articles reporting outcomes of below-the-ankle with above-the-ankle angioplasty with no distinct comparator group. Significant decrease in major lower limb amputation at the last follow-up in the below-the-ankle group when compared with the above-the-ankle angioplasty alone group was observed in a single study (3.45% vs. 14.9%, p < 0.05). Improved wound healing rate at follow-up in the below-the-ankle group versus above-the-ankle angioplasty alone group was also reported in a single study (59.3% vs. 38.1%, p < 0.05). Subsequent rate of amputation after below-the-ankle angioplasty has been estimated as 23.5%. Conclusion To date, there is a lack of studies assessing inframalleolar interventions and their use in improving limb salvage, wound healing and symptomatology. Prospective RCTs should be undertaken with adequate participant numbers to be sufficiently powered and report clinically important end-points.
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Affiliation(s)
- M Machin
- Academic section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- M Machin, 4 East, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - HC Younan
- Department of Public Health, Imperial College London, London, UK
| | - AM Guéroult
- Academic section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Onida
- Academic section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Shalhoub
- Academic section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - AH Davies
- Academic section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- AH Davies, 4 East, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
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Affiliation(s)
- Aurélien M Guéroult
- Department of Surgery & Cancer, Academic Section of Vascular Surgery, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Machin
- Department of Surgery & Cancer, Academic Section of Vascular Surgery, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Rebecca Lawton
- Department of Surgery & Cancer, Academic Section of Vascular Surgery, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Alun H Davies
- Department of Surgery & Cancer, Academic Section of Vascular Surgery, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Department of Surgery & Cancer, Academic Section of Vascular Surgery, 4615Imperial College London, London, UK.,Imperial Vascular Unit, 8946Imperial College Healthcare NHS Trust, London, UK
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Guéroult AM, Khan FA, Stather PW, Harrison SC, Boyle JR. Long-term Outcomes Following Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms. J Endovasc Ther 2020; 27:428-435. [PMID: 32517557 DOI: 10.1177/1526602820919901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose: To investigate the long-term outcomes of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) from a single center over an 11-year period. Materials and Methods: A retrospective analysis was conducted of 121 patients (median age 78 years; 100 men) with rAAA who underwent emergency EVAR at a single tertiary vascular center from January 2006 to December 2016. The study included only ruptures confirmed by evidence of hematoma on preoperative computed tomography; both iliac and aortic aneurysm ruptures were eligible. The primary outcome measures included mortality and reintervention rates. Kaplan-Meier estimates of survival and freedom from reintervention are reported with the 95% confidence interval (CI). Results: In-hospital and 30-day mortality rates for emergency EVAR were 16.5%; 90-day mortality was 24.0%. The mortality estimates were 27.3% (95% CI 20% to 36%) at 1 year and 61.7% (95% CI 51% to 72%) at 5 years. In the observation period to 2017, 63 reinterventions were performed on 37 patients (30.6%). Median time to the first reintervention was 3.2 years. Freedom from reintervention in surviving patients at 1 year was 86% (95% CI 72% to 94%) and 51% (95% CI 26% to 71%) at 5 years. Four patients (3.3%) had a secondary sac rupture over the study period. Conclusion: Emergency EVAR for ruptured AAA can be performed with acceptable short-term outcomes; however, long-term surveillance is necessary, and reintervention is common.
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Affiliation(s)
- Aurélien M Guéroult
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Farhaan A Khan
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Philip W Stather
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Seamus C Harrison
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK
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Guéroult AM, Cameron M. Rare brown tumour of the mandible secondary to tertiary hyperparathyroidism in a renal transplant recipient. BMJ Case Rep 2019; 12:e231231. [PMID: 31551320 PMCID: PMC6768332 DOI: 10.1136/bcr-2019-231231] [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] [Accepted: 09/08/2019] [Indexed: 11/04/2022] Open
Abstract
Brown tumours are rare osteolytic lesions that occur secondary to hyperparathyroidism (HPT). In 2% of all cases, the craniofacial bones are affected, most frequently the mandible. HPT is classified according to aetiology into three types, of which tertiary HPT is the rarest. Here we present the case of a 42-year-old man who had received a renal transplant 16 years previously and was referred due to swelling on the right side of his jaw. An orthopantomogram revealed a multilocular radiolucency in the right body of the mandible. The bony lesion was treated by surgical enucleation. After histopathological examination of the lesion, the diagnosis of brown tumour of the mandible secondary to tertiary HPT was reached. The patient's recovery was uneventful and follow-up radiography showed good bone healing.
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Affiliation(s)
| | - Malcolm Cameron
- Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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