64 results found
Vali S, Jones BP, Saso S, et al., 2021, Uterine transplantation: Legal and regulatory implications in England., BJOG
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein.
Patel V, Levy S, Malik I, et al., 2021, Takotsubo cardiomyopathy in elderly female trauma patients - a case series and mini-review, Journal of Medical Case Reports, Vol: 15, Pages: 1-7, ISSN: 1752-1947
Takotsubo cardiomyopathy is a syndrome characterised by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality. Here we describe three cases of Takotsubo cardiomyopathy occurring in three elderly trauma patients and the impact on their clinical course.
Park C, Sugand K, Aframian A, et al., 2021, Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative, Irish Journal of Medical Science, ISSN: 0021-1265
Introduction:COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals.Materials and methodsA multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019.Results:A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years.Conclusion:The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.
van der Kruk E, Silverman AK, Koizia L, et al., 2021, Age-related compensation: Neuromusculoskeletal capacity, reserve & movement objectives, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290
Kelani T, Lee A, Walker M, et al., 2021, The influence of cervical spine angulation on symptoms associated with wearing a rigid neck collar, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 12, Pages: 1-7, ISSN: 2151-4585
Introduction:Rigid cervical spine collars can be used to maintain the position of the cervical spine following injury or surgery. However, they have been associated with difficulty swallowing, pressure sores and pain, particularly in older patients. We aimed to investigate the relationship between cervical spine angulation, a rigid neck collar and neck pain in healthy young and older adults.Methods:Twenty healthy young adults aged 25 ± 3 years and 17 healthy older adults aged 80 ± 8 years were tested. Magnetic resonance imaging scans of their cervical spines were taken before and after the rigid neck collar was worn for 1 hour. Measurement of vertebral angulation involved digitization of the scans and joint angle calculations using image processing software. Pain was quantified before and after the collar was worn, using a visual analogue scale.Results:Pain scores increased in the young group after the collar was worn (p = 0.001). The older group showed no difference in pain score after the collar was worn. Statistical tests showed no significant correlations between the change in cervical angles and the change in pain scores after the collar was worn.Discussion:The aging process may contribute to the changing distribution of subcutaneous tissue and increase risk of symptoms associated with wearing a collar. Oesophageal compression is not a result of collar use.Conclusion:There is no correlation between cervical spine vertebrae angulation and symptoms associated with wearing a neck collar. Generally, older individuals have greater cervical lordosis angles, and more straight and lordotic neck shapes. Older individuals may be more prone to skin-interface pressures from the neck collar than younger individuals.
Rosa A, Pye VE, Graham C, et al., 2021, SARS-CoV-2 can recruit a heme metabolite to evade antibody immunity, SCIENCE ADVANCES, Vol: 7, ISSN: 2375-2548
Pereira C, Harris B, Di Giovannantonio M, et al., 2021, Antibody response to SARS-CoV-2 infection is not associated with Post-COVID-19 Syndrome in healthcare workers, Journal of Infectious Diseases, Vol: 223, Pages: 1671-1676, ISSN: 0022-1899
It is currently unknown how Post-COVID-19 Syndrome (PCS) may affect those infected with SARS-CoV-2. This longitudinal study reports on healthcare staff who tested positive for SARS-CoV-2 between March-April 2020 and follows their antibody titres and symptomatology. Over half (n=21/38) had PCS at 7-8 months. There was no statistically significant difference between initial RT-PCR viral titres or serial antibody levels between those who did and did not develop PCS. This study highlights the relative commonality of PCS in healthcare workers and this should be considered in vaccination scheduling and workforce planning to allow adequate frontline staffing numbers.
Vali S, Jones B, Saso S, et al., 2021, Uterine transplantation: Legal and regulatory implications in the UK, BJOG: an International Journal of Obstetrics and Gynaecology, ISSN: 1470-0328
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world’s first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. Public funding of fertility treatments pertaining to UTx remains variable and warrants review.
Oleribe O, Olawepo O, Ezechi O, et al., 2021, Describing the epidemiology of COVID-19 in Nigeria: an analysis of the first year of the pandemic, Journal of Health Care for the Poor and Underserved, ISSN: 1049-2089
We report the COVID-19 experience across Nigeria from March 2020 to March 2021.Demographics were obtained from Nigerian Center for Disease Control. By 21 March 2021,161,737 people were confirmed positive for SARS-COV-2. Overall, testing rates were 0.8% ofthe population, with positivity rates of 9.6%, complete recovery rates without long-termsequelae of 91.4%, and case fatality rates of 1.3%. Most Nigerian regions contributed to figuresfor recent cases and deaths in 2021. The picture may change as testing is scaled-up to includecommunity testing. Given so-called “pandemic fatigue” among the general population, variousconspiracy theories being prevalent, and the recent introduction of COVID-19 vaccines inNigeria, we assume that Nigeria is at a pivotal stage of the outbreak. Effort must be made bygovernment to learn successful strategies in other countries to adapt to prevent a rise in casenumbers and deaths.
Koizia L, Dani M, Brown H, et al., 2021, Does the weather contribute to admissions of neck of femur fractures?, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 12, Pages: 1-6, ISSN: 2151-4585
Background: The effects of weather on overall mortality are well documented. Anecdotally, icy conditions are perceived to result in more falls and admissions for neck of femur (NOF) fractures. The aim of this pilot study was to determine whether relationships could be extracted or at least not ruled out by analysing a small dataset, and so give impetus to a larger project. Methods: Seven trauma units across North West London were identified and NOF fracture data extracted for five years. Visual inspection of the time series, consideration of the weather on specific days and correlation analysis were used to assess associations between fracture numbers and a variety of weather parameters (temperature, rainfall, wind and ice risk). Results: Overall, 10929 individuals with hip fractures were admitted over the five-year period. The highest number of admissions in a day was 14. No clear association was found between a weather parameter and daily admissions. However, when accumulated to a weekly timescale, a negative relationship with maximum temperature was found. No seasonal cycle was detected.Conclusion: The lack of a daily relationship and presence of a weekly relationship points to a possible delayed response to weather or insufficient daily data to extract a signal. The inconclusive results also indicate a larger data sample is required in future studies. In addition, even in cold weather an urban environment may not create icy conditions, being ameliorated by the heat island effect and gritting.
Koizia LJ, Dani M, Brown H, et al., 2021, DOES THE WEATHER CONTRIBUTE TO ADMISSIONS OF NECK OF FEMUR FRACTURES?, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729
Rosa A, Pye VE, Graham C, et al., 2021, SARS-CoV-2 recruits a haem metabolite to evade antibody immunity., medRxiv
The coronaviral spike is the dominant viral antigen and the target of neutralizing antibodies. We show that SARS-CoV-2 spike binds biliverdin and bilirubin, the tetrapyrrole products of haem metabolism, with nanomolar affinity. Using cryo-electron microscopy and X-ray crystallography we mapped the tetrapyrrole interaction pocket to a deep cleft on the spike N-terminal domain (NTD). At physiological concentrations, biliverdin significantly dampened the reactivity of SARS-CoV-2 spike with immune sera and inhibited a subset of neutralizing antibodies. Access to the tetrapyrrole-sensitive epitope is gated by a flexible loop on the distal face of the NTD. Accompanied by profound conformational changes in the NTD, antibody binding requires relocation of the gating loop, which folds into the cleft vacated by the metabolite. Our results indicate that the virus co-opts the haem metabolite for the evasion of humoral immunity via allosteric shielding of a sensitive epitope and demonstrate the remarkable structural plasticity of the NTD.
Harris BHL, Zuhair M, Di Giovannantonio M, et al., 2021, Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a rehabilitation facility: evolution of the presence of nasopharyngeal SARS-CoV-2 and serological antibody responses., Journal of Infectious Diseases, Vol: 223, Pages: 192-196, ISSN: 0022-1899
At the start of the UK coronavirus disease 2019 epidemic, this rare point prevalence study revealed that one-third of patients (15 of 45) in a London inpatient rehabilitation unit were found to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but asymptomatic. We report on 8 patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral reverse-transcription polymerase chain reaction (RT-PCR) burden, and their antibody levels over time, revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS-CoV-2 showed that 100% of our asymptomatic cohort remained seropositive 3-6 weeks after diagnosis.
Radia U, Malietzis G, Dani M, et al., 2021, The difficulty of managing recurrent sigmoid volvulus in a frailpatient, Journal of Surgery, Vol: 6, Pages: 1-4, ISSN: 2575-9760
Abdominal pain is a common cause for presentation of the older patient to healthcare services. Sigmoid volvulus is one of the leading causes of acute large bowel obstruction in adults. It affects older, comorbid, frailer and institutionalized patients.In this report, we highlight some of the clinical and ethical dilemmas clinicians face when caring for patients with recurrent sigmoid volvulus. We endorse early involvement of geriatricians and palliative care services in these individuals to ensure maximum patient comfort, quality of life and dignity.
Harris BHL, Zuhair M, di Giovannantonio M, et al., 2021, Asymptomatic COVID-19 in a rehabilitation facility: evolution of the presence of nasopharyngeal SARS-CoV-2 and serological antibody responses, The Journal of Infectious Diseases, Vol: 223, Pages: 192-196, ISSN: 0022-1899
At the start of the UK COVID-19 epidemic, this rare point prevalence study reveals ⅓ of patients in a London inpatient rehabilitation unit were found to be infected with SARS-CoV 2, but asymptomatic (n=15/45). We report on eight patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral RT-PCR burden and their antibody levels over time revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS40 CoV-2 (anti-RBD) showed 100% of our asymptomatic cohort remained seropositive between 3 to 6 weeks post-diagnosis.
Chauhan D, Varma S, Dani M, et al., 2021, Nasogastric tube feeding in older patients: a review of current practice and challenges faced, Current Gerontology and Geriatrics Research, Vol: 2021, ISSN: 1687-7063
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in olderinpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events”related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, whichsubsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way.Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updatedreview on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correctplacement, and innovative solutions for improving safety and outcomes in older patients.v
Moledina S, Maini A, Gargan A, et al., 2020, Clinical characteristics and predictors of mortality in patients with COVID-19 infection outside intensive care, International Journal of General Medicine, Vol: 2020, Pages: 1157-1165, ISSN: 1178-7074
Background/introductionThe Coronavirus Disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from Level 1 (general medical wards) through to Level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome. MethodsThis was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March – 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded. Results229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality. ConclusionUrea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.
Oleribe O, Ezechi O, Osita-Oliberi P, et al., 2020, Public perception of COVID-19 management and response in Nigeria: a cross-sectional survey, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055
Objectives: A study designed to assess the public perception of the response of government and its institutions to the COVID-19 pandemic in Nigeria. Setting: Self-selecting participants throughout Nigeria completed a self-administered questionnaire through an online cross-sectional survey. Participants: 495 Results: The majority of respondents were married (76.6%), were males (61.8%), had tertiary level education (91.0%), were public servants (36.8%), Christians (82.6%), and resident either in the Federal Capital Territory (Abuja) (49.1%) or in the South-East Region of Nigeria (36.6%). Over 95% of the respondents had heard of COVID-19 (98.8%) and knew it is a viral disease (95.4%). The government and its institutions response to the pandemic were rated as poor, with the largest rating as poor for Federal President’s Office (57.5%). Communication (50.0%) and prevention messages (43.7%) received the highest perception good rating. Female respondents and those less than 40 years generally rated the governmental responses as poor. Conclusions/Recommendations: It is recommended that as a public-private partnership approached was efficiently used to more effectively disseminate public health communication and prevention messages, the Nigerian Government should expand this collaboration to improve the quality of services provided in other areas of COVID-19 outbreak management.
Koizia LJ, Dani M, Sritharan G, et al., 2020, Collaborative working on a 7-day rota reduces length of stay., Future Healthc J, Vol: 7, ISSN: 2514-6645
A 7-day consultant-geriatrician-led service across five surgical wards, with integrated working among surgeons and physicians, was implemented in response to the COVID-19 pandemic. Our model has shown to increase discharge rates and improve MDT wellbeing. Embedded physician working with surgeons could be key in the recovery to COVID-19.
Fertleman M, Glickstein B, Philip H, 2020, Medical law and ethics, Medicine for MRCP, Editors: Besant, Birns, Charlotte, Oxford, Publisher: Oxford Specialty Training: Revision Texts, ISBN: 9780198779506
Medicine for MRCP provides a comprehensive review of the material that you need to pass the MRCP Parts 1 and 2 written papers. The twenty-seven chapters mapped out to the RCP syllabus, cover all areas from molecular medicine and genetics, through to medical law and ethics. Written by specialist contributors and educational experts, the content is carefully crafted to build your understanding for both papers. Each chapter begins with the basic science required for Part 1, before covering clinical medicine for Part 1, Part 2 and the PACES examinations.To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes. Over 150 drawings and photos illustrate key principles and clinical topics making them easier to retain. References to evidence-based protocols and directions to further reading allow for deeper understanding. Candidates can review their progress via the 180 end-of chapter self-assessment questions.Drawing on the authors' expertise, Medicine for MRCP is the ideal companion for the MRCP as well as a useful reference guide for practicing medical doctors.
Oleribe O, Osita-Oleribe P, Salako B, et al., 2020, COVID-19 Experience: Taking the right steps at the right time to prevent avoidable morbidity and mortality in Nigeria and other nations of the world, International Journal of General Medicine, Vol: 2020, Pages: 491-195, ISSN: 1178-7074
The 2020 Coronavirus pandemic has caused countless governmental and societal challenges around the world. Nigeria, Africa’s most populous nation, has been exposed in recent years to a series of epidemics including Ebola and Lassa Fever. In this paper we document our perception of the national response to COVID-19 in Nigeria. The response to the pandemic is with a healthcare system that has changed as a result of previous infectious disease outbreaks but in the context of scarce resources typical of many low-middle income countries. We make recommendations regarding what measures should be in place for future epidemics.
Varma S, Wilson MSJ, Naik M, et al., 2020, Sarcopenia in elderly major trauma; A single centre retrospective analysis of psoas and masseter muscle groups, Preprints
Lee A, Koizia L, Dani M, et al., 2020, 'Nipples to knees' in the 'Me Too' era (vol 20, pg 235, 2020), CLINICAL MEDICINE, Vol: 20, Pages: 379-379, ISSN: 1470-2118
Koizia L, Naik M, Peck G, et al., 2020, The utility of psoas muscle assessment in predicting frailty in patients undergoing transcatheter aortic valve replacement, Current Gerontology and Geriatrics Research, Vol: 2020, Pages: 1-7, ISSN: 1687-7063
Background. The rise in an ageing population has resulted in an increase in the prevalence of aortic stenosis. With the advent and rapid expansion in the use of transcatheter aortic valve replacements (TAVRs), patients with severe aortic stenosis, traditionally thought too high risk for surgical intervention, are now being treated with generally favourable results. Frailty is an important factor in determining outcome after a TAVR, and an assessment of frailty is fundamental in the identification of appropriate patients to treat. Objective. The objective of the study was to identify if the psoas muscle area is associated with frailty in TAVR patients and outcome after intervention. Method. In this prospective study, we measured outcomes of 62 patients who underwent TAVR procedures against the psoas muscle area and the Reported Edmonton Frail Scale (REFS). Our aim was to assess if psoas muscle assessment can be used as a simple method to predict frailty in our population group. Results. A total of 60 patients met the study criteria. Mean psoas-lumbar vertebral index was 0.61, with a lower value in the frail group. There was not a statistically significant correlation between the psoas measures, REFS score (indicative of frailty), and mortality. However, there was a statistically significant relationship between the psoas size and REFS score (). Conclusion. Psoas assessment can be useful in providing additional information when planning for patients to undergo a TAVR and can be used as a screening tool to help identify frail patients within this high-risk group.
Davies A, Heaton T, Sabharwal S, et al., 2020, Consent for surgery during the COVID-19 pandemic, Transient Journal of Trauma, Orthopaedics and the Coronavirus
Bassendine M, Taylor-Robinson S, Fertleman M, et al., 2020, Is Alzheimer's Disease a liver disease of the brain?, Journal of Alzheimer's Disease, Vol: 75, Pages: 1-14, ISSN: 1387-2877
Clinical specialization is not only a force for progress, but it has also led to the fragmentation of medical knowledge. The focus of research in the field of Alzheimer’s disease (AD) is neurobiology, while hepatologists focus on liver diseases and lipid specialists on atherosclerosis. This article on AD focuses on the role of the liver and lipid homeostasis in the development of AD. Amyloid-β (Aβ) deposits accumulate as plaques in the brain of an AD patient long before cognitive decline is evident. Aβ generation is a normal physiological process; the steady-state level of Aβ in the brain is determined by balance between Aβ production and its clearance. We present evidence suggesting that the liver is the origin of brain Aβ deposits and that it is involved in peripheral clearance of circulating Aβ in the blood. Hence the liver could be targeted to decrease Aβ production or increase peripheral clearance.
van der Kruk E, Silverman A, Koizia L, et al., 2020, CaReMoOC: Capacity, Reserve, Movement Objectives, and Compensation. A New Framework to Describe Mechanisms of Movement Limitations, Demonstrated for Ageing, Preprints
Ahmad Y, Vendrik J, Eftekhari A, et al., 2019, Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow, Circulation: Cardiovascular Interventions, Vol: 12, ISSN: 1941-7640
Background:Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.Methods:Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2).Results:Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s−1 versus post-TAVI 3.04±1.6 mm Hg·cm·s−1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74.Conclusions:TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider us
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.