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Ashraf F, Mustafa MS, Shafique MA, Haseeb A, Mussarat A, Noorani A, Sohail Rangwala B, Kashif Rasool F, Siddiq MA, Iqbal J. Association between depression and stroke risk in adults: a systematic review and meta-analysis. Front Neurol 2024; 15:1331300. [PMID: 38725648 PMCID: PMC11079212 DOI: 10.3389/fneur.2024.1331300] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Stroke is a significant global health concern, and numerous studies have established a link between depression and an increased risk of stroke. While many investigations explore this link, some overlook its long-term effects. Depression may elevate stroke risk through physiological pathways involving nervous system changes and inflammation. This systematic review and meta-analysis aimed to assess the association between depression and stroke. Methodology We conducted a comprehensive search of electronic databases (PubMed, Embase, Scopus, and PsycINFO) from inception to 9 April 2023, following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We included all articles assessing the association between different stroke types and depression, excluding post-stroke depression. Two investigators independently extracted data and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, utilizing a random-effects model for data synthesis. The primary outcome was the association of depression with stroke, with a secondary focus on the association of antidepressants with stroke. Results The initial search yielded 10,091 articles, and 44 studies were included in the meta-analysis. The pooled analysis revealed a significant association between depression and stroke risk, with an overall hazard ratio of 1.41 (95% CI 1.32, 1.50; p < 0.00001), indicating a moderately positive effect size. Subgroup analyses showed consistent associations with ischemic stroke (HR = 1.30, 95% CI 1.13, 1.50; p = 0.007), fatal stroke (HR = 1.39, 95% CI 1.24, 1.55; p < 0.000001), and hemorrhagic stroke (HR = 1.33, 95% CI 1.01, 1.76; p = 0.04). The use of antidepressants was associated with an elevated risk of stroke (HR = 1.28, 95% CI 1.05, 1.55; p = 0.01). Conclusion and relevance This meta-analysis indicates that depression moderately raises the risk of stroke. Given the severe consequences of stroke in individuals with depression, early detection and intervention should be prioritized to prevent it. Systematic review registration Prospero (CRD42023472136).
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Affiliation(s)
- Farheen Ashraf
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Amber Noorani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | | | - Javed Iqbal
- Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
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2
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Alsubai AK, Ahmad M, Chang R, Asghar MA, Siddiqui A, Khan HN, Ashraf MH, Javaid MD, Kalwar A, Asad M, Memon K, Khan LA, Noorani A, Siddiqi AK. Effect of preterm birth on blood pressure in later life: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2805-2826. [PMID: 38186804 PMCID: PMC10771170 DOI: 10.4103/jfmpc.jfmpc_684_23] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Preterm birth is linked to various complications in both infancy and adulthood. We assessed the association between preterm birth and hypertension in adulthood. Materials and Methods PubMed, EMBASE, and Cochrane CENTRAL Register were searched for randomized controlled trials (RCT) comparing systolic and diastolic blood pressures in individuals born preterm and those born full-term, from inception till April 11th, 2022. Data were extracted, pooled, and analyzed. Forest plots were created for a visual demonstration. Results Twenty-eight studies were included in our meta-analysis. SBP and DBP across all categories (Mean, Ambulatory, Daytime, and Nighttime) were higher in the preterm group compared to the term group. Mean SBP, mean ambulatory SBP, mean daytime SBP and mean nighttime SBP were 4.26 mmHg [95% CI: 3.09-5.43; P < 0.00001], 4.53 mmHg [95% CI: 1.82-7.24; P = 0.001], 4.51 mmHg [95% CI: 2.56-6.74; P < 0.00001], and 3.06 mmHg [95% CI: 1.32-4.80; P = 0.0006] higher in the preterm group, respectively. Mean DBP, mean ambulatory DBP, mean daytime DBP, and mean nighttime DBP were 2.32 mmHg [95% CI: 1.35-3.29; P < 0.00001], 1.54 mmHg [95% CI 0.68-2.39; P = 0.0004], 1.74 mmHg [95% CI: 0.92-2.56; P < 0.0001], and 1.58 mmHg [95% CI: 0.34-2.81; P = 0.01] higher in the preterm group, respectively. Conclusion Our observations suggest that individuals who were born preterm may have higher blood pressures as compared to those who were born full-term.
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Affiliation(s)
| | - Mushtaq Ahmad
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Rabia Chang
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa A. Asghar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Amna Siddiqui
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Hamza N. Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad H. Ashraf
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asifa Kalwar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mahnoor Asad
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kainat Memon
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Laibah A. Khan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Amber Noorani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Fatima K, Asad D, Shaikh N, Ansari SA, Kumar G, Rehman HA, Azam F, Khan SA, Ahmed S, Shah A, Bawani AM, Noorani A, Rashid AM. A Systematic Review and Meta-Analysis on Effectiveness of Mineralocorticoid Receptor Antagonists in Reducing the Risk of Atrial Fibrillation. Am J Cardiol 2023; 199:85-91. [PMID: 37269781 DOI: 10.1016/j.amjcard.2023.04.038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 06/05/2023]
Abstract
Mineralocorticoid receptor antagonists (MRAs) are known to improve clinical outcomes in heart failure, particularly heart failure with reduced ejection fraction. However, the effect of MRAs on the incidence of and recurrence of atrial fibrillation (AF) is not well established. Therefore, databases, such as PubMed, EMBASE, and Cochrane Central, were searched from inception to September 2021 for randomized controlled trials of MRAs with AF as an outcome. Risk ratios (RRs) with 95% confidence interval (CIs) were combined using the random-effects model. A total of 10 randomized controlled trials (n = 11,356) were included. Our pooled analysis demonstrates that MRAs reduce the risk of AF occurrence by 23% compared with the control therapy (RR 0.77, 95% CI 0.65 to 0.91, p = 0.003, I2 = 40%). Subgroup analysis demonstrated that MRAs reduced the risk of both new-onset AF (RR 0.84, 95% CI 0.61 to 1.16, p = 0.28, I2 = 43%) and recurrent AF (RR 0.73, 95% CI 0.59 to 0.90, p = 0.004, I2 = 26%) similarly; p interaction = 0.48. Our meta-analysis concludes that MRAs reduce the risk of development of AF overall, with consistent effects in new-onset and recurrent AF.
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Affiliation(s)
- Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Dayab Asad
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Nafhat Shaikh
- Department of Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan.
| | - Saad Ali Ansari
- Department of Medicine, University of California, Riverside School of Medicine. Riverside, California
| | - Ganesh Kumar
- Department of Medicine, Chandka Medical College, Larkana, Pakistan
| | | | - Fatima Azam
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Shabitul Aisha Khan
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sehar Ahmed
- Department of Medicine, Ziauddin Medical College, Karachi, Pakistan
| | - Arhama Shah
- Department of Medicine, Ziauddin Medical College, Karachi, Pakistan
| | | | - Amber Noorani
- Department of Biochemistry, Jinnah Sindh Medical University, Karachi, Pakistan
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Siddiqui Z, Hagare D, Liu MH, Panatta O, Hussain T, Memon S, Noorani A, Chen ZH. A Food Waste-Derived Organic Liquid Fertiliser for Sustainable Hydroponic Cultivation of Lettuce, Cucumber and Cherry Tomato. Foods 2023; 12:foods12040719. [PMID: 36832794 PMCID: PMC9956311 DOI: 10.3390/foods12040719] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
We previously reported a sustainable food waste management approach to produce an acceptable organic liquid fertiliser for recycling food waste called "FoodLift." This study follows our previous work to evaluate the macronutrients and cation concentrations in harvested structural parts of lettuce, cucumber, and cherry tomatoes produced using food waste-derived liquid fertiliser (FoodLift) and compare them against commercial liquid fertiliser (CLF) under hydroponic conditions. N and P concentrations in the structural parts of lettuce and the fruit and plant structural parts of cucumber appear to be similar between FoodLift and CLF (p > 0.05), with significantly different N concentrations in the various parts of cherry tomato plants (p < 0.05). For lettuce, N and P content varied from 50 to 260 g/kg and 11 to 88 g/kg, respectively. For cucumber and cherry tomato plants, N and P concentrations ranged from 1 to 36 g/kg and 4 to 33 g/kg, respectively. FoodLift was not effective as a nutrient source for growing cherry tomatoes. Moreover, the cation (K, Ca, and Mg) concentrations appear to significantly differ between FoodLift and CLF grown plants (p < 0.05). For example, for cucumber, Ca content varied from 2 to 18 g/kg for FoodLift grown plants while Ca in CLF-grown cucumber plants ranged from 2 to 28 g/kg. Overall, as suggested in our previous work, FoodLift has the potential to replace CLF in hydroponic systems for lettuce and cucumber. This will lead to sustainable food production, recycling of food waste to produce liquid fertiliser, and will promote a circular economy in nutrient management.
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Affiliation(s)
- Zuhaib Siddiqui
- School of Engineering, Design and Built Environment, Western Sydney University, Penrith, NSW 2751, Australia
| | - Dharmappa Hagare
- School of Engineering, Design and Built Environment, Western Sydney University, Penrith, NSW 2751, Australia
- Correspondence:
| | - Min-Hang Liu
- School of Engineering, Design and Built Environment, Western Sydney University, Penrith, NSW 2751, Australia
| | - Orousa Panatta
- School of Engineering, Design and Built Environment, Western Sydney University, Penrith, NSW 2751, Australia
| | - Tanveer Hussain
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2350, Australia
| | - Sheeraz Memon
- Institute of Environmental Engineering, Mehran University of Engineering and Technology, Jamshoro 76062, Pakistan
| | - Amber Noorani
- Department of Biochemistry, Faculty of Basic Medical Science, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | - Zhong-Hua Chen
- School of Science, Western Sydney University, Richmond, NSW 2753, Australia
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Aminian O, Noorani A, Sadeghniiat-Haghighi K, Najafi A. Evaluation of psychomotor performance in patients with obstructive sleep apnea syndrome. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rollins K, Noorani A, Janeckova L, Jones T, Griffiths M, Baker MP, Boyle JR. Ascorbic acid ameliorates renal injury in a murine model of contrast-induced nephropathy. BMC Nephrol 2017; 18:101. [PMID: 28340561 PMCID: PMC5366137 DOI: 10.1186/s12882-017-0498-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 03/02/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Contrast induced nephropathy (CIN) is the commonest cause of iatrogenic renal injury and its incidence has increased with the advent of complex endovascular procedures. Evidence suggests that ascorbic acid (AA) has a nephroprotective effect in percutaneous coronary interventions when contrast media are used. A variety of biomarkers (NGAL, NGAL:creatinine, mononuclear cell infiltration, apoptosis and RBP-4) in both the urine and kidney were assayed using a mouse model of CIN in order to determine whether AA can reduce the incidence and/or severity of renal injury. METHODS Twenty-four BALB/c mice were divided into 4 groups. Three groups were exposed to high doses of contrast media (omnipaque) in a well-established model of CIN, and then treated with low or high dose AA or placebo (saline). CIN severity was determined by measurement of urinary neutrophil gelatinase-associated lipocalin (NGAL):creatinine at specific time intervals. Histological analysis was performed to determine the level of mononuclear inflammatory infiltration as well as immunohistochemistry to determine apoptosis in the glomeruli by staining for activated caspase-3 and DNA nicking (TUNEL assays). Reverse transcriptase PCR (rtPCR) of mRNA transcripts prepared from mRNA extracted from mouse kidneys was also performed for both lipocalin-2 (Lcn2) encoding NGAL and retinol binding protein-6 (RBP4) genes. NGAL protein expression was also confirmed by ELISA analysis of kidney lysates. RESULTS Urinary NGAL:creatinine ratio was significantly lower at 48 h with a 44% and 62% (204.3μg/mmol versus 533.6μg/mmol, p = 0.049) reduction in the low and high dose AA groups, respectively. The reduced urinary NGAL:creatinine ratio remained low throughout the time period assessed (up to 96 h) in the high dose AA group. In support of the urinary analysis ELISA analysis of NGAL in kidney lysates also showed a 57% reduction (12,576 ng/ml versus 29,393 ng/ml) reduction in the low dose AA group. Immunohistochemistry for apoptosis demonstrated decreased TUNEL and caspase-3 expression in both low and high dose AA groups. CONCLUSIONS Ascorbic acid reduced the frequency and severity of renal injury in this murine model of CIN. Further work is required to establish whether AA can reduce the incidence of CIN in humans undergoing endovascular procedures.
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Affiliation(s)
- K. Rollins
- National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
| | - A. Noorani
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge, UK
| | - L. Janeckova
- Antitope Ltd, Babraham Research Campus, Cambridge, UK
| | - T. Jones
- Antitope Ltd, Babraham Research Campus, Cambridge, UK
| | - M. Griffiths
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - M. P. Baker
- Antitope Ltd, Babraham Research Campus, Cambridge, UK
| | - J. R. Boyle
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge, UK
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Williams D, Singh J, Heidari N, Ahmad M, Noorani A, Di Mascio L. Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study. Ann R Coll Surg Engl 2016; 98:138-42. [PMID: 26829667 DOI: 10.1308/rcsann.2016.0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/22/2022] Open
Abstract
INTRODUCTION Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal screws continues to be a problem in volar plating of the distal radius. Ultrasound is a well recognised, readily available, diagnostic tool used to assess soft-tissue impingement by orthopaedic hardware. In this cadaveric study, we wished to ascertain the sensitivity and specificity of ultrasound for identification of protrusion of dorsal screws after volar plating of the distal radius. METHODS Four adult, unpaired phenol-embalmed cadaveric distal radii were used. A VariAx™ Distal Radius Volar Locking Plate system (Stryker, Kalamazoo, MI, USA) was employed for instrumented fixation. A portable SIUI CTS 900 ultrasound machine (Providian Medical, Eastlake, OH, USA) was used to image the dorsal cortex to ascertain screw penetration. RESULTS Specificity and sensitivity of ultrasound for detection of screw protrusion through the dorsal cortex was 100%. CONCLUSIONS Ultrasound was found to be a safe and accurate method for assessment of dorsal-screw penetration through the dorsal cortex of the radius after volar plating of the distal radius. It also aids diagnosis of associated tendon disorders (eg tenosynovitis) that might cause pain and limit wrist function.
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Affiliation(s)
- D Williams
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - J Singh
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - N Heidari
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - M Ahmad
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - A Noorani
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
| | - L Di Mascio
- The Royal London Hospital , Barts Health NHS Trust & Queen Mary University of London , UK
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Noorani A, Rangelova E, Del Chiaro M, Lundell LR, Ansorge C. Delayed Gastric Emptying after Pancreatic Surgery: Analysis of Factors Determinant for the Short-term Outcome. Front Surg 2016; 3:25. [PMID: 27200357 PMCID: PMC4843166 DOI: 10.3389/fsurg.2016.00025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/11/2016] [Indexed: 01/04/2023] Open
Abstract
Background Delayed gastric emptying (DGE) frequently complicates pancreatoduodenectomy (PD). Mainly DGE develops as consequence of postoperative intra-abdominal complications (secondary), while the incidence of primary DGE (i.e., not related to surgical complications) has rarely been studied. Moreover, the pathogenesis of DGE is complex and needs to be further elucidated. The present study aimed at highlighting potential mechanisms behind primary and above all secondary DGE by studying a variety of different pancreatic surgical procedures. Patients and methods During the time period 2008–2011, 327 patients underwent pancreatic resective procedures at Karolinska University Hospital. Of these, 242 were PD and 56 tail resections, 17 had a duodenal preserving pancreatectomy for chronic pancreatitis, and 15 patients with familial duodenal polyposis had a pancreas preserving duodenectomy. All postoperative courses were assessed and scored according to Clavien–Dindo. The presence of DGE was evaluated and recorded according to the definition launched by the International Study Group for Pancreatic Surgery (ISGPS). Crude associations were studied in a univariate model, followed by a multivariate analysis of the respective factors. The associations were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results In total DGE emerged during the postoperative course in about 40% of the PD cases. About half of those (n = 47) were scored as being primary. The majority of the primary DGEs were classified as A (n = 26) and only four as grade C, whereas among the secondary cases significantly more patients were scored as grade C (p < 0.01). In those submitted to a pancreatic body and tail resection 25% reported DGE. The distribution of the different grades of DGE in patients with a tail resection followed the same pattern with a predominance of Grade A cases with an equal distribution between those being scored as primary and secondary. Duodenal preservation, as well as keeping the pancreas intact following duodenectomy, was not followed by primary DGE. Multivariate risk factor analyses for the development of primary GE revealed no specific risk profile except for high age. Conclusion DGE is frequently seen after different surgical procedures directed toward the pancreatic gland. DGE is most commonly seen after PD, and half of these cases are scored as primary DGE. Primary and secondary DGE are seen in one-quarter of the cases even after pancreatic tail resection emphasizing the complex nature of the pathogenesis. Resection of the duodenum as an important mechanism behind DGE is not supported by the present results.
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Affiliation(s)
- A Noorani
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Elena Rangelova
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Lars Ragnar Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Christoph Ansorge
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Center for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Shah TT, Chin KF, Noorani A, Nairn D. Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique. Ann R Coll Surg Engl 2012; 94:e51-4. [PMID: 22391348 DOI: 10.1308/003588412x13171221502022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Brodie's abscess is a form of subacute osteomyelitis characterised by a low grade pyogenic abscess found most commonly in the metaphysis. One rare form found in children crosses the physeal growth plate and into the epiphysis. Due to the rarity of this subtype and apprehension associated with treatment of the transphyseal abscess, no clear guidance exists on its management. CASE HISTORY We present a case of delayed diagnosis of Brodie's abscess crossing the physis in a 14-year-old boy. He gave a one-year history of pain in the right knee and early x-rays had shown lucent areas in the tibia. However, these were only noted to be significant at presentation one year later. We also describe an improvised minimally invasive and atraumatic technique of modifying a laminar suction catheter for accessing and draining the abscess. CONCLUSIONS From our experience and reports in the literature it is clear that antibiotic treatment is generally advocated with varying degrees of surgical intervention. Outcomes are largely favourable. Nevertheless, initial drainage allows samples to be sent for microbiological and histological assessment to aid subsequent management and may prevent subsequent leg length discrepancy from failed conservative treatment. We believe that management of a transphyseal abscess must include early drainage and a prolonged course of antibiotics. The antibiotic choice and duration will be governed by culture results and local policy but is commonly given for up to six weeks in the literature and must include one antistaphylococcal drug.
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Affiliation(s)
- T T Shah
- Princess Alexandra Hospital NHS Trust, UK.
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10
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Noorani A, Page A, Walsh S, Varty K, Hayes P, Boyle J. Mid-term Outcomes following Emergency Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Noorani A, Walsh SR, Boyle JR. Long-term effects of EVAR. Suprarenal versus infrarenal fixation. J Cardiovasc Surg (Torino) 2011; 52:199-203. [PMID: 21460770] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Endovascular aortic aneurysm repair (EVAR) is the first line management of abdominal aortic aneurysms in many institutions. The relationship between EVAR and renal impairment, especially in the longer term remains unclear. Suprarenal graft fixation is widely used in order to achieve stable graft anchorage. Numerous studies have tried to answer the question about whether suprarenal fixation affects renal outcome. We reviewed the literature to investigate the relationship between endograft fixation and post-operative renal function.
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Affiliation(s)
- A Noorani
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK
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Walsh S, Noorani A, Rabey N, Davies RJ. Authors' reply: Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone–iodine in clean- contaminated surgery (Br J Surg 2010; 97: 1614–1620). Br J Surg 2011. [DOI: 10.1002/bjs.7448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S Walsh
- Addenbrooke's Hospital, Cambridge, UK
| | - A Noorani
- Addenbrooke's Hospital, Cambridge, UK
| | - N Rabey
- Broomfields Hospital, Chelmsford, UK
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Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone–iodine in clean-contaminated surgery. Br J Surg 2010; 97:1614-20. [DOI: 10.1002/bjs.7214] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Surgical-site infection increases morbidity, mortality and financial burden. The preferred topical antiseptic agent (chlorhexidine or povidone–iodine) for preoperative skin cleansing is unclear.
Methods
A meta-analysis of clinical trials was conducted to determine whether preoperative antisepsis with chlorhexidine or povidone–iodine reduced surgical-site infection in clean-contaminated surgery.
Results
The systematic review identified six eligible studies, containing 5031 patients. Chlorhexidine reduced postoperative surgical-site infection compared with povidone–iodine (pooled odds ratio 0·68, 95 per cent confidence interval 0·50 to 0·94; P = 0·019).
Conclusion
Chlorhexidine should be used preferentially for preoperative antisepsis in clean-contaminated surgery.
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Affiliation(s)
- A Noorani
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Rabey
- Department of Plastic and Reconstructive Surgery, St Andrew's Centre, Broomfields Hospital, Chelmsford, UK
| | - S R Walsh
- Department of Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Karthikesalingam A, Holt PJE, Nordon I, Noorani A, Thompson M, Boyle J. The accuracy of non-nephrotoxic surveillance after EVAR and the role of surveillance in directing post-operative re-intervention. Acta Chir Belg 2009; 109:681-3. [PMID: 20184049 DOI: 10.1080/00015458.2009.11680517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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16
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Nikolic M, Noorani A, Park G. Interaction between clonidine and escitalopram. Br J Anaesth 2008. [DOI: 10.1093/bja/el_3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Abstract
Entrapment syndromes represent a pathological process that vascular specialists encounter infrequently. However symptomatic patients are often young with impaired quality of life and successful treatment can produce great benefit, making knowledge of these conditions essential. The purpose of this review was to bring together the entrapment syndromes to understand and gain consensus on the aetiology, pathogenesis, diagnosis and modern management of these rare and interesting vascular disorders. This includes entrapment syndromes of the popliteal artery, superior mesenteric artery, coeliac artery, renal vein and iliac vein.
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Affiliation(s)
- A Noorani
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
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18
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Abstract
INTRODUCTION Non-attendance in the out-patient department has financial costs for the NHS and clinical implications to the non-attender and those awaiting an appointment. The aim of this audit was to quantify the percentage of non-attenders at colorectal clinics in a UK teaching hospital, assess which factors affected attendance, establish why individuals fail to attend and to implement appropriate change. PATIENTS AND METHODS The number of 'did-not-attend' patients was recorded initially for 686 appointments. Non-attenders were contacted by post or telephone to ask why this was so. The study was then repeated following telephone reminders to 391 patients due to attend clinic. The 'did-not-attend' rates in the two limbs of the completed audit cycle were then compared. RESULTS The initial study revealed a 'did-not-attend' rate of 21%, with significantly more males than females failing to attend (males, 28.6%; females, 16.9%; P = 0.001). The 'did-not-attend' rate was not significantly affected by the day of the week, time of appointment or by the weather. There were 51.7% responses to either the postal or telephone questionnaire regarding non-attendance. Of these, 27.7% did not receive an appointment letter or received it after the appointment. Hospital administration problems were cited as accounting for 34.2% of 'did-not-attends'. In the post-intervention limb, 87 patients (22%) replied to the reminder telephone call, of whom 9 (10%) cancelled their appointment and 78 (90%) confirmed that they would attend. The 'did-not-attend' rate fell to 19.7% although this was not a significant reduction. CONCLUSIONS Telephoning patients before their appointments is labour intensive and did not significantly improve the 'did-not-attend' rate. Although hospital administration errors account for a significant number of the 'did-not-attends', patients also have a responsibility to notify the hospital if they are unable to attend.
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19
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Ghosh R, Walsh SR, Tang TY, Noorani A, Hayes PD. Gene therapy as a novel therapeutic option in the treatment of peripheral vascular disease: systematic review and meta-analysis. Int J Clin Pract 2008; 62:1383-90. [PMID: 18657197 DOI: 10.1111/j.1742-1241.2008.01842.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stimulation of therapeutic angiogenesis using gene therapy is a novel intervention for peripheral vascular disease (PVD). Despite encouraging outcomes from animal studies and phase 1 trials, results from larger trials in this area have been conflicting. We undertook a systematic review and meta-analysis of randomised controlled trials in this field, to clarify the current situation. METHODS Medline, Embase, trial registries, the American Heart Association (AHA) abstract database and article reference lists were searched to identify randomised controlled trials of gene therapy for treatment of PVD. The outcomes were change in peak walking time and claudication onset time at 90 and 180 days post-treatment, and change in ankle-brachial pressure index (ABPI) at 90 days. Weighted mean differences (WMD) were calculated for these outcomes. RESULTS Five eligible randomised clinical trials were identified, containing 508 patients. There were no significant differences between control and intervention groups for any outcomes, irrespective of whether low-dose or high-dose gene therapy was tried. CONCLUSION The available data suggests that gene therapy confers no benefit on patients with PVD. Closer examination of the individual trials shows that several have an excessive placebo response, which may go some way to explaining our result. Further research in this area in needed.
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Affiliation(s)
- R Ghosh
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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20
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Abstract
This meta-analysis of the three RCTs that have compared topical negative pressure with conventional treatment in patients with lower limb ulcers found that it significantly reduced healing times and increased the number of healed wounds.
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Affiliation(s)
- U Sadat
- CambridgeVascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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21
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Noorani A, Minakaran N, Mokbel K. Late results of skin-sparing mastectomy followed by immediate breast reconstruction (Br J Surg 2007; 94: 1220-1225). Br J Surg 2008; 95:260; author reply 260-1. [PMID: 18196562 DOI: 10.1002/bjs.6146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Chana R, Noorani A, Ashwood N, Chatterji U, Healy J, Baird P. The role of MRI in the diagnosis of proximal femoral fractures in the elderly. Injury 2006; 37:185-9. [PMID: 16249001 DOI: 10.1016/j.injury.2005.07.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Revised: 07/13/2005] [Accepted: 07/14/2005] [Indexed: 02/02/2023]
Abstract
The diagnosis of an undisplaced hip fracture cannot always be made on plain radiographs alone. The use of MRI scanning in detecting occult hip fractures is well documented. However, no previous studies have suggested which specific patient group would benefit most from this investigation. Thirty-five patients with hip pain and normal plain radiographs underwent MRI scanning. Pathology was detected in 29 of the patients, of which 21 involved a neck of femur fracture. Patients were divided into two groups based on age. In patients over 70 years, pathology detected resulted in surgical intervention in 13 cases. This is in contrast with those below the age of 70 years, in whom no neck of femur fractures were found and no surgical intervention was indicated (p<0.001). We recommend that an MRI scan be performed on such patients, above 70 years of age. These are the patients in whom management is significantly altered due to the imaging process used.
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Affiliation(s)
- R Chana
- Department of Orthopaedics and Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea SW10 9NH, UK.
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Bottomley N, Williams A, Birch R, Noorani A, Lewis A, Lavelle J. Displacement of the common peroneal nerve in posterolateral corner injuries of the knee. ACTA ACUST UNITED AC 2005; 87:1225-6. [PMID: 16129747 DOI: 10.1302/0301-620x.87b9.16122] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [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: 01/13/2023]
Abstract
We reviewed the relationship between the pattern of damage to the posterolateral corner of the knee and the position of the common peroneal nerve in 54 consecutive patients with posterolateral corner disruption requiring surgery. We found that 16 of the 18 patients with biceps avulsions or avulsion-fracture of the fibular head had a displaced common peroneal nerve. The nerve was pulled anteriorly with the biceps tendon. None of the 34 proximal injuries resulted in an abnormal nerve position. Whenever bone or soft-tissue avulsion from the fibular head is suspected, the surgeon should expect an abnormal position of the common peroneal nerve and appreciate the increased risk of iatrogenic damage.
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Affiliation(s)
- N Bottomley
- Department of Orthopaedics Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, England, UK
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Affiliation(s)
- F De Lorenzo
- Thrombosis Research Institute, 1B Manresa Road, Chelsea, London SW3 6LR, UK
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Jasir A, Tanna A, Noorani A, Mirsalehian A, Efstratiou A, Schalen C. High rate of tetracycline resistance in Streptococcus pyogenes in Iran: an epidemiological study. J Clin Microbiol 2000; 38:2103-7. [PMID: 10834960 PMCID: PMC86737 DOI: 10.1128/jcm.38.6.2103-2107.2000] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2000] [Accepted: 03/14/2000] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pyogenes, a major human pathogen, is still considered susceptible to beta-lactams, but for other relevant antibiotics, highly variable resistance rates have been reported. Since no data were available from Iran, we tested 1,335 throat isolates from two different regions of the country for their antibiotic susceptibilities and, for comparison, a collection of 80 strains isolated from 1989 to 1991. Erythromycin resistance was uncommon (0.6%), whereas an overall high rate of tetracycline resistance was found, increasing between 1989-1991 and 1995-1997 from 23 to 42%. The tetracycline-resistant strains belonged to more than 10 different T types, the majority being types 4, 11, and B3264. By conventional M typing of 406 tetracycline-resistant isolates, more than 20 different M types were found. Approximately 50% of the strains were nontypeable by T agglutination as well as serological M typing; however, by genotyping by a combined PCR-capture-enzyme-linked immunosorbent assay, many of these strains were successfully emm typed. We conclude that the high rate of tetracycline resistance among Iranian S. pyogenes isolates is due to multiclonal dissemination of resistance within the streptococcal population rather than epidemic spread of single clones.
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Affiliation(s)
- A Jasir
- Department of Infectious Diseases and Medical Microbiology, University of Lund, Lund, Sweden
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Jasir A, Noorani A, Mirsalehian A, Schalen C. Isolation rates of Streptococcus pyogenes in patients with acute pharyngotonsillitis and among healthy school children in Iran. Epidemiol Infect 2000; 124:47-51. [PMID: 10722129 PMCID: PMC2810882 DOI: 10.1017/s0950268899003088] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/07/2022] Open
Abstract
We examined three populations from the Tehran region and the North part of Iran (Gilan), in all more than 5000 individuals, for carriage of Streptococcus pyogenes (group A streptococci; GAS). Children or adults with acute pharyngotonsillitis and healthy school children harboured GAS in 34-1, 20.0 and 21.0%, respectively. Typing of 421 randomly selected isolates showed a predominance of M-types M4, M5, M11, M12, as well as the provisional type 4245; however, many of the isolates were T and M non-typable. Forty-three percent of all strains were opacity factor (OF) negative. The type distribution differed markedly from that reported in 1973-4, when M types 1 and 12 were predominant.
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Affiliation(s)
- A Jasir
- Department of Medical Microbiology, University of Lund, Sweden
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