Publications
181 results found
Moussa OM, Ardissino M, Kulatilake P, et al., 2019, Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition, Clinical Obesity, Vol: 9, ISSN: 1758-8103
With obesity levels increasing, it is important to consider the mental health risks associated with this condition to optimize patient care. Links between depression and obesity have been explored, but few studies focus on the risk profiles of patients across stratified body mass index (BMI) classes above 30 kg/m2 . This study aims to determine the impact of BMI on depression risk in patients with obesity and to investigate trends of depression in a large cohort of British patients with BMI > 30 kg/m2 . A nationwide primary care database, the Clinical Practice Research Datalink (CPRD), was analysed for diagnoses of obesity (BMI > 30 kg/m2 ). Obese patients were then sub-classified into seven BMI categories. Primary health care-based records of patients entered in the CPRD were analysed. A total of 363 037 patients had a BMI ≥ 30 kg/m2 ; of these patients 97 392 (26.8%) also had a diagnosis of depression. Absolute event rates over time and hazard risk of depression were analysed by BMI category. On Cox regression analysis of time to development of depression, the cumulative hazard increased significantly and linearly across BMI groups (P < 0.001). Compared to those with BMI 30 to 35 kg/m2 , patients with BMI 35 to 40 kg/m2 had a 20% higher risk of depression (hazard ratio [HR] 1.206, confidence interval [CI] 1.170-1.424), and those with BMI > 60 kg/m2 had a 98% higher risk (HR 1.988, CI 1.513-2.612). This study identified the prevalence and time course of depression in a cohort of obese patients in the United Kingdom. Findings suggest the risk of depression is directly proportional to BMI above 30 kg/m2 . Therefore, clinicians should note higher BMI levels confer increased risk of depression.
Markar SR, Chin S-T, Romano A, et al., 2019, Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-Tube Mass Spectrometry., Annals of Surgery, Vol: 269, Pages: 903-910, ISSN: 0003-4932
OBJECTIVE: BACKGROUND:: Breath VOCs have the potential to noninvasively diagnose cancer. METHODS: Exhaled breath samples were collected using 2-L double-layered Nalophan bags, and were analyzed using selected-ion-flow-tube mass-spectrometry. Gold-standard test for comparison was endoscopy for luminal inspection and computed tomography (CT) to confirm cancer recurrence. Three studies were conducted: RESULTS:: CONCLUSION:: This study suggests the association of a single breath biomarker with the primary presence and recurrence of CRCa. Further multicenter validation studies are required to validate these findings.
Arhi CS, Burns EM, Bouras G, et al., 2019, Complications after discharge and delays in adjuvant chemotherapy following colonic resection: a cohort study of linked primary and secondary care data, Colorectal Disease, Vol: 21, Pages: 307-314, ISSN: 1462-8910
AIM: By understanding the reasons for delays in adjuvant chemotherapy (AC) after colonic resection, there is the potential to improve patient outcome. The aim of this study is to determine the extent and impact of complications after hospital discharge on delays to AC. METHOD: The study cohort included patients from Hospital Episode Statistics (HES) who had a colorectal cancer resection; linkage to primary care data was provided by the Clinical Practice Research Datalink (CPRD). Complications during the index hospital stay (from HES) and after discharge (from CPRD) were compared. The risk of late AC treatment (8 weeks or later) following a complication, stoma at the index procedure or emergency admission was described after accounting for age and Charlson score. A Cox hazards model determined the association of these factors with overall survival (OS). RESULTS: A total of 1266 patients underwent AC following colon cancer resection, of whom 598 (47.2%) received treatment within 8 weeks. Patients receiving late AC had a significantly higher proportion of re-operations (7.0% vs 3.3% P < 0.005) and wound infections (5.5% vs 3.7% P = 0.042), with 96% of the latter only being noted in CPRD. In multivariate analysis, the risk of AC delay significantly increased following a complication (OR 1.53, 95% CI 1.16-2.03, P = 0.003) or a stoma at the index operation. AC delay was associated with worse OS [hazard ratio (HR) 1.44, 95% CI 1.16-1.79, P = 0.001], as was an emergency admission (HR 1.59, 95% CI 1.21-1.98, P < 0.0005). However, the presence of a complication did not independently reduce OS (HR 1.15, 95%CI 0.89-1.48, P = 0.295). CONCLUSION: The true extent and impact of complications following colonic resection is underestimated when only secondary care data are used.
Ardissino M, Moussa O, Tang A, et al., 2019, Idiopathic intracranial hypertension in the British population with obesity, Acta Neurochirurgica: the European journal of neurosurgery, Vol: 161, Pages: 239-246, ISSN: 0001-6268
PurposeIdiopathic intracranial hypertension (IIH) is a syndrome that is characterized by persistently high intracranial pressure and associated with high rates of morbidity and visual loss. Its exact etiology and clinical picture is poorly understood, but it is known to be associated with obesity. The aim of this study was to investigate the prevalence and clinical manifestations of IIH using a large nationwide database of British subjects.Materials and methodsThe anonymized healthcare records of patients with a BMI of ≥ 30 kg/m2 were extracted from the Clinical Practice Research Datalink (CPRD), and analyzed.ResultsThe patients with IIH were older and more likely to have peripheral vascular disease, ischemic heart disease, and anemia; to have had a previous myocardial infarction; and have used non-steroidal anti-inflammatory drugs (NSAIDs) and steroids. Multivariate analysis with adjustment for confounders showed that anemia (p = 0.033) and the use of NSAIDs (p = 0.011) were the only factors independently associated with IIH. Increases in BMI beyond the threshold of obesity did not independently increase risk of IIH.ConclusionsIIH is a multifactorial disease; the risk of which is increased in patients with a background of anemia, and those who use NSAIDs. Across BMI categories beyond the threshold for obesity (BMI ≥ 30 kg/m2), there is no continuation of the previously described “dose-response” relationship between BMI and IIH.Ethical approvalScientific approval for the study was granted from the Regulatory Agency’s Independent Scientific Advisory Committee and ethical approval by the Health Research Authority IRAS Project ID: 203143. ISAC approval registration number 16_140R2.
Griffiths EA, Hodson J, Vohra RS, et al., 2019, Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy (vol 33, pg 110, 2019), SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 33, Pages: 122-125, ISSN: 0930-2794
Griffiths EA, Hodson J, Vohra RS, et al., 2019, Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy, 20th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: SPRINGER, Pages: 110-121, ISSN: 0930-2794
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- Citations: 63
Arhi CS, Bottle A, Burns EM, et al., 2018, Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics, Cancer Epidemiology, Vol: 57, Pages: 148-157, ISSN: 0361-090X
IntroductionThe Clinical Practice Research Datalink (CPRD) is a large electronic dataset of primary care medical records. For the purpose of epidemiological studies, it is necessary to ensure accuracy and completeness of cancer diagnoses in CPRD.MethodCases included had a colorectal, oesophagogastric (OG), breast, prostate or lung cancer diagnosis recorded in a least one of CPRD, Cancer Registry (CR) or Hospital Episodes Statistics(HES) between 2000 and 2013. Agreement in diagnosis between the datasets, difference in dates, survival at one and five-years, and whether patient characteristics differed according to the dataset or the timing of diagnosis were investigated.Results116,769 patients were included. For each cancer, approximately 10% of cases identified from CPRD or HES were not confirmed in the CR. 25.5% colorectal, 26.0% OG, 8.9% breast, 32.0% lung and 18.6% prostate cases identified from the CR were missing in CPRD. The diagnosis date was recorded later in CPRD compared with CR for each cancer, ranging from 81.1% for prostate to 59.6% for colorectal, especially if the diagnosis was an emergency. Compared with the CR and HES, the adjusted risk of a missing diagnosis in CPRD was significantly higher if the patient was older, had more co-morbidities or was diagnosed as an emergency. Survival at one and five-years was highest for CPRD.ConclusionPatient demographics and the route of diagnosis impact the accuracy of cancer diagnosis in CPRD. Although CPRD provides invaluable primary care data, patients should ideally be identified from the CR to reduce bias.
Arhi C, Ziprin P, Bottle A, et al., 2018, Young colorectal cancer patients experience referral delays in primary care leading to emergency diagnoses, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: NATURE PUBLISHING GROUP, Pages: 4-4, ISSN: 0007-0920
Arhi C, Burns E, Bottle A, et al., 2018, Delays in primary care are associated with a late stage and worse prognosis for colorectal cancer patients: A population based study, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: NATURE PUBLISHING GROUP, Pages: 4-4, ISSN: 0007-0920
Arhi C, Markar S, Moussa O, et al., 2018, Obesity and the risk of late stage colorectal cancer, 23rd World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: Springer Verlag, Pages: 100-100, ISSN: 0960-8923
Moussa O, Arhi C, Ziprin P, et al., 2018, THE OUTCOME OF BARIATRIC SURGERY ON THE METABOLICALLY HEALTHY OBESE; A CLINICAL PRACTICE RESEARCH DATALINK (CPRD) STUDY, 23rd World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: 139-139, ISSN: 0960-8923
Arhi C, Moussa O, Aylin P, et al., 2018, SYMPTOM AT PRESENATION FOR OBESITY PATIENTS WITH COLORECTAL CANCER, 23rd World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: 329-329, ISSN: 0960-8923
Moussa O, Ardissiano M, Ziprin P, et al., 2018, OVERVIEW OF BARIATRIC SURGERY IN THE UNITED KINGDOM, 23rd World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: 141-141, ISSN: 0960-8923
Shipway D, Koizia L, Winterkorn N, et al., 2018, Embedded geriatric surgical liaison is associated with reduced inpatient length of stay in older patients admitted for gastrointestinal surgery, Future Healthcare Journal, Vol: 5 (2)
Moussa O, Arhi C, Ziprin P, et al., 2018, Fate of the metabolically healthy obese-is this term a misnomer? A study from the Clinical Practice Research Datalink, International Journal of Obesity, Vol: 43, Pages: 1093-1101, ISSN: 0307-0565
INTRODUCTION: The metabolically healthy obese (MHO) phenotype may express typical characteristics on long-term follow-up. Little is known about the initiation of this phenotypes and its future stability. AIM: The Clinical Practice Research Datalink (CPRD) is a large-scale primary care database. The aim of this study was to assess the stability of, and evaluate the factors associated with a transition into an unhealthy outcome in, a MHO population in the UK. METHODS: The CPRD was interrogated for a diagnosis of 'obesity' and cross-referenced with a body mass index (BMI) ≥35 kg/m2; participants were further classified as MH using a clinical diagnostic code or a relative therapeutic code. A hazard cox regression univariate and multivariate analysis evaluated the time to transition for independent variables. RESULTS: There were 231,399 patients with a recorded BMI of 35 kg/m2 or greater. Incomplete records were eliminated and follow-up limited to 300 months, the cohort was reduced to 180,560 patients. The prevalence of MHO within the obese population from the CPRD was 128,191/180,560 (71%). MHO individuals, who were of male gender (hazard ratio (HR) 1.23 (1.21-1.25), p = < 0.01), older age group (HR 3.93 (3.82-4.04), p = < 0.01), BMI of 50-60 kg/m2 at baseline (HR 1.32(1.26-1.38), p = 0.01), smokers (HR 1.07(1.05-1.09), p = < 0.01) and regionally from North West England (HR 1.15(1.09-1.21), p = < 0.01) were more prone to an unhealthy transition (to develop comorbidities). Overall, of those MH at baseline, 71,485/128,191(55.8%) remained healthy on follow-up, with a mean follow-up of 113.5 (standard deviations (SD) 78.6) months or 9.4 (SD 6.6) years. CONCLUSIONS: From this unique large data set, there is a greater prevalence of MHO individuals in the UK population than in published literature elsewhere. Female gender, younger age group
Chicco M, Filobbos G, Francis N, et al., 2018, A mysterious postoperative rash., BMJ Case Rep, Vol: 2018
This case report describes the development of a rash in a patient admitted with large bowel obstruction secondary to carcinoma of the sigmoid colon. The patient underwent a Hartmann's procedure and right hemicolectomy for a metastatic deposit at the terminal ileum. On postoperative day 3, the patient developed a bullous haemorrhagic rash on the thighs, flanks and abdomen, associated with a sharp drop in platelet count. Suspicion of heparin-induced skin necrosis was raised, and prophylactic enoxaparin was switched to fondaparinux. Skin biopsy results later confirmed the diagnosis. Clinical suspicion of heparin-induced skin necrosis is essential and should prompt a switch between prophylactic agents, in order to prevent potentiation of this life-threatening side effect.
Erridge S, Moussa O, Ziprin P, et al., 2018, Risk of GERD-related disorders in obese patients on PPI therapy: a population analysis, Obesity Surgery, Vol: 105, Pages: 1-8, ISSN: 0960-8923
BackgroundIncreasing prevalence of obesity has shown an associated increase in gastroesophageal reflux disease (GERD)-related diseases. Proton pump inhibitor (PPI) therapy has been demonstrated to reduce the incidence of such diseases. The study’s aim was to analyze the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on PPIs to develop Barrett’s esophagus (BE) and esophageal carcinoma.MethodA case-control population study was carried out, including patients from the CPRD. Clinicopathological factors were extracted for each patient alongside clinical endpoints of GERD, BE, and esophageal carcinoma. Multivariate analysis was utilized to identify factors that increase the propensity to develop BE and esophageal carcinoma. Statistical significance was p < 0.050.ResultsOne hundred sixty five thousand nine hundred twenty nine obese patients on PPI treatment were identified up until July 2017. Median follow-up time was 119.0 months (range 11.3–1397.9 months). In patients with GERD, the following were associated with increased BE risk: age ≥ 60 years (OR = 1.197; p = 0.039), male (OR = 2.209; p < 0.001), H2 antagonists (OR = 1.377; p < 0.001), D2 antagonists (OR = 1.241; p = 0.008), and hiatus hernias (OR = 6.772; p = 0.017). The following were associated with increased risk of esophageal carcinoma: age (OR = 2.831; p = 0.031), male sex (OR = 3.954; p = 0.003), and hiatus hernias (OR = 12.170; p < 0.001). Only D2 antagonists (OR = 2.588; p = 0.002) were associated with increased risk of developing esophageal carcinoma in BE patients.ConclusionsIn obese patients on PPI therapy for reflux, higher BMIs were not associated with increased risk of BE or esophageal carcinoma. Male
Moussa O, Erridge S, Chidambaram S, et al., 2018, BARIATRIC SURGERY ASSOCIATED WITH REDUCED MORTALITY IN THEMORBIDLY OBESE: A CLINICAL PRACTICE RESEARCH DATALINK STUDY, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: WILEY, Pages: 25-25, ISSN: 0007-1323
Moussa O, Ziprin P, Purkayastha S, 2017, PPI USE AFTER ANTI-REFLUX SURGERY IN THE OBESE; IS IT LIFELONG? Primary care and the bariatric surgery patient, Publisher: SPRINGER, Pages: 836-836, ISSN: 0960-8923
Moussa O, Arhi C, Ziprin P, et al., 2017, IS IRON DEFICIENCY IDENTIFIED AFTER BARIATRIC SURGERY IN THE COMMUNITY? Post-operative complications, Publisher: SPRINGER, Pages: 734-734, ISSN: 0960-8923
Moussa O, Ziprin P, Purkayastha S, 2017, VALIDITY OF CLINICAL DIAGNOSIS IN THE MORBIDLY OBESE FROM THE CLINICAL PRACTICE RESEARCH DATALINK Primary care and the bariatric surgery patient, Publisher: SPRINGER, Pages: 834-834, ISSN: 0960-8923
Moussa O, Arhi C, Fakih N, et al., 2017, LONG TERM WEIGHT LOSS AFTER BARIATRIC SURGERY FROM THE COMMUNITY; FROM THE CLINICAL PRACTICE RESEARCH DATALINK Bariatric registries, Publisher: SPRINGER, Pages: 406-406, ISSN: 0960-8923
Beyer-Berjot L, Pucher P, Patel V, et al., 2017, Colorectal surgery and enhanced recovery: Impact of a simulation-based care pathway training curriculum, Journal of Visceral Surgery, Vol: 154, Pages: 313-320, ISSN: 1878-7886
BACKGROUND: The aim was to determine whether a simulation-based care pathway approach (CPA) curriculum could improve compliance for enhanced recovery programs (ERP), and residents' participation in laparoscopic colorectal surgery (LCS). Indeed, trainee surgeons have limited access to LCS as primary operator, and ERP have improved patients' outcomes in colorectal surgery (CS). METHODS: All residents of our department were trained in a simulation-based CPA: perioperative training consisted in virtual patients built according to guidelines in both ERP and CS, whilst intraoperative training involved a virtual reality simulator curriculum. Twenty consecutive patients undergoing CS were prospectively included before (n=10) and after (n=10) the training. All demographic and perioperative data were prospectively collected, including compliance for ERP. Residents' participation as primary operator in LCS was measured. RESULTS: Five residents (PGY 4-7) were enrolled. None had performed LCS as primary operator. Overall satisfaction and usefulness were both rated 4.5/5, usefulness of pre-, post- and intraoperative training was rated 5/5, 4.5/5 and 4/5, respectively. Residents' participation in LCS significantly improved after the training (0% (0-100) vs. 82.5% (10-100); P=0.006). Pre- and intraoperative data were comparable between groups. Postoperative morbidity was also comparable. Compliance for ERP improved at Day 2 in post-training patients (3 (30%) vs. 8 (80%); P=0.035). Length of stay was not modified. CONCLUSIONS: A simulated CPA curriculum to training in LCS and ERP was correctly implemented. It seemed to improve compliance for ERP, and promoted residents participation as primary operator without adversely altering patients' outcomes.
Pathiraja A, Ziprin P, Shiraz A, et al., 2017, Detecting colorectal cancer using electrical impedance spectroscopy: an <i>ex vivo</i> feasibility study, PHYSIOLOGICAL MEASUREMENT, Vol: 38, Pages: 1278-1288, ISSN: 0967-3334
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- Citations: 17
Scott A, Lewis M, Gomez-Romero M, et al., 2017, LONGITUDINAL ANALYSIS OF URINARY METABOLIC PHENOTYPE AFTER COLORECTAL RESECTION DEMONSTRATE TEMPORAL EVOLUTION., Annual Scientific Meeting of the American-Society-of-Colon-and-Rectal-Surgeons, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E121-E121, ISSN: 0012-3706
Zhang L, Herrera C, Coburn J, et al., 2017, Stabilization and Sustained Release of HIV Inhibitors by Encapsulation in Silk Fibroin Disks, ACS BIOMATERIALS SCIENCE & ENGINEERING, Vol: 3, Pages: 1654-1665, ISSN: 2373-9878
Topical microbicides have the potential to provide effective protection against sexual transmission of HIV. Challenges in developing microbicides include their application in resource-poor settings with high temperatures and a lack of refrigeration, and low user adherence to a rigorous daily regimen. Several protein-based HIV inhibitors show great promise as microbicides, being highly specific and not expected to lead to resistance that would affect the efficacy of current antiretroviral treatments. We show that four potent protein HIV inhibitors, 5P12-RANTES, 5P12-RANTES-L-C37, Grft, and Grft-L-C37 can be formulated into silk fibroin (SF) disks and remain functional for 14 months at 25, 37, and 50 °C. These HIV inhibitor-encapsulated SF disks show excellent inhibition properties in PBMC and in human colorectal and cervical tissue explants, and do not induce inflammatory cytokine secretion. Further, the SF provides a mechanically robust matrix with versatile material formats for this type of application. Finally, a formulation was developed to allow sustained release of functional Grft for 4 weeks at levels sufficient to inhibit HIV transmission. This work establishes the suitability of HIV inhibitor-encapsulated SF disks as topical HIV microbicides that can be further developed to allow easy insertion for extended protection.
Ravikumar R, Bartlett D, Morton DG, et al., 2017, Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial), BMJ-BRITISH MEDICAL JOURNAL, Vol: 357, ISSN: 0959-535X
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- Citations: 76
Drake TM, Nepogodiev D, Chapman SJ, et al., 2017, Safety of Nonsteroidal Anti-inflammatory Drugs in Major Gastrointestinal Surgery: A Prospective, Multicenter Cohort Study, WORLD JOURNAL OF SURGERY, Vol: 41, Pages: 47-55, ISSN: 0364-2313
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- Citations: 14
Vohra RS, Pasquali S, Kirkham AJ, et al., 2016, Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases, BRITISH JOURNAL OF SURGERY, Vol: 103, Pages: 1716-1726, ISSN: 0007-1323
Vohra RS, Pasquali S, Kirkham AJ, et al., 2016, Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases, BRITISH JOURNAL OF SURGERY, Vol: 103, Pages: 1704-1715, ISSN: 0007-1323
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