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Abstract
Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996–1999 in the three district hospitals of North Wales. 40 cases of CSDH were identified in patients > 65 years, the incidence in this population being 8.2/100000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%). Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.
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Affiliation(s)
| | - Vedamurthy Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd District General Hospital, Rhyl, Denbighshire LL18 5UJ
| | - M W Greenway
- Department of Geriatric Medicine, Glan Clwyd District General Hospital, Rhyl, Denbighshire LL18 5UJ
| | - Bhimal K Bhowmick
- Department of Geriatric Medicine, Glan Clwyd District General Hospital, Rhyl, Denbighshire LL18 5UJ
| | - A Bates
- Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK
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Bhowmick BK, Takahata N, Watanabe M, Satta Y. Comparative analysis of human masculinity. Genet Mol Res 2006; 5:696-712. [PMID: 17183480] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
To study rapidly evolving male specific Y (MSY) genes we retrieved and analyzed nine such genes. VCY, HSFY and RBMY were found to have functional X gametologs, but the rest did not. Using chimpanzee orthologs for XKRY, CDY, HSFY, PRY, and TSPY, the average silent substitution is estimated as 0.017 +/- 0.006/site and the substitution rate is 1.42 x 10(-9)/site/year. Except for VCY, all other loci possess two or more pseudogenes on the Y chromosome. Sequence differences from functional genes show that BPY2, DAZ, XKRY, and RBMY each have one pseudogene for each one that is human specific, while others were generated well before the human-chimpanzee split, by means of duplication, retro-transposition or translocation. Some functional MSY gene duplication of VCY, CDY and HSFY, as well as X-linked VCX and HSFX duplication, occurred in the lineage leading to humans; these duplicates have accumulated nucleotide substitutions that permit their identification.
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Affiliation(s)
- B K Bhowmick
- School of Advanced Sciences, The Graduate University for Advanced Studies, Kanagawa, Japan.
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Abdelgabar AM, Bhowmick BK. The return of the leech. Int J Clin Pract 2003; 57:103-5. [PMID: 12661792] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Medicinal leeches (Hirudo medicinalis) have been used in medicine for thousands of years to treat a wide range of ailments. Nowadays, leeches are used successfully for only a few conditions, notably in the field of reconstructive or microsurgery, to salvage tissue flaps and skin grafts whose viability is threatened by venous congestion. The anticoagulant properties of hirudin, contained in leech saliva, may lead to wider therapeutic applications in the prevention and treatment of thromboembolic disease. Optimal care is needed when applying leeches, because their use can be complicated by serious bacterial infections.
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Affiliation(s)
- A M Abdelgabar
- Department of Elderly Medicine, Princess of Wales Hospital, Grimsby, Humberside
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Abstract
Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996-1999 in the three district hospitals of North Wales. 40 cases of CSDH were identified in patients >65 years, the incidence in this population being 8.2/100,000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%). Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.
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Abstract
Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half the cases. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.
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Affiliation(s)
- V Adhiyaman
- Department of Geriatric Medicine, Glan Clwyd District General Hospital, Rhyl.
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Abstract
OBJECTIVES to study the diagnostic accuracy for parkinsonism and Parkinson's disease in a community-based sample of subjects on anti-parkinsonian medication. METHODS computerized prescribing records in general practice were used to create a community-based disease register for Parkinson's disease. Subjects were examined to establish the likely diagnosis using recommended clinical diagnostic criteria. RESULTS of 402 cases, parkinsonism was confirmed in 74% and clinically probable Parkinson's disease in 53%. The commonest causes of misdiagnosis were essential tremor, Alzheimer's disease and vascular pseudo-parkinsonism. Over one-quarter of subjects did not benefit from anti-parkinsonian medication. CONCLUSIONS there is difficulty in diagnosing parkinsonism and Parkinson's disease in elderly subjects and we suggest early referral of those suspected of having parkinsonism for specialist assessment.
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Affiliation(s)
- J Meara
- University Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, North Wales, UK
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Coyle JM, Bhowmick BK, Hobson JP, Meara RJ. Cardiovascular Reflexes in Parkinson's Disease. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_2.38-b] [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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Abstract
OBJECTIVE to determine what practising geriatricians in Wales do to continue their education; what they would prefer to do; and what their views are on study leave, resources and funding. DESIGN questionnaire survey. SETTING the principality of Wales. PARTICIPANTS hospital-based, career-grade geriatricians. RESULTS the overall response rate from a total of 56 questionnaires was 87%. More than half [26 (53%)] of the respondents stated they were able to take only half of their study leave entitlement of 10 days a year. Twenty-five (51%) considered this to be due to service commitment. Geriatricians regarded attendance at routine hospital meetings [47 (96%)] and specialist society meetings [45 (92%)], reading books and journals [49 (100%)] and discussion with colleagues [44 (90%)] as their preferred methods of keeping up to date. Most respondents [44 (90%)] said that the resources and funding required to underpin the system of continuing medical education (CME) should be provided by the employing authority. CONCLUSIONS the many barriers to the continuing education of geriatricians in Wales include service commitments and funding constraints. Geriatricians placed great emphasis on the traditional CME methods such as reading books and journals, attending meetings and conferences and discussion with colleagues and were reluctant to use technology-based educational methods. The results of this study have implications for the way in which geriatricians fulfil CME obligations in the future and provide directions for the planners of CME.
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Affiliation(s)
- M Hasan
- Academic Department of Geriatric Medicine, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Cardiff, UK
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Coyle J, Hatch M, Bhowmick BK, Meara J. Risk Factor Management in Cerebrovascular Disease. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_3.p28-b] [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: 11/14/2022] Open
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11
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Abstract
We investigated the quality of diagnostic coding in relation to cerebrovascular disease (CVD) in a computerized clinical information system by comparing the codes on the computer printout, obtained from casemix database on 166 patients with a diagnosis of cerebrovascular disease, with the codes allocated by the investigators after examining the case notes. Overall, the diagnostic coding was incorrect in 44 (26%) cases. These inaccuracies included 9 (5%) patients who did not have CVD and 35 (21%) patients who were incorrectly coded as "acute but ill-defined stroke". The inadequacy of information in discharge letters was the main reason for such discrepancies (21 cases). There is a need for adequate education and training of doctors and coding clerks and for a constant dialogue between them if the deficiencies in coding are to be rectified and the value of hospital information system in the audit, costing and health care planning is to be improved.
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Affiliation(s)
- M Hasan
- University Department of Geriatric Medicine, Glan Clwyd Hospital, Bodelwyddan, Rhyl, Wales, UK
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Hasan M, Meara J, Bhowmick BK, Woodhouse KW. Review: Binswanger's disease, leukoaraiosis and dementia. Age Ageing 1995; 24:454. [PMID: 8669355 DOI: 10.1093/ageing/24.5.454] [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: 02/01/2023] Open
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Hasan M, Meara RJ, Bhowmick BK, Woodhouse K. Percutaneous endoscopic gastrostomy in geriatric patients: attitudes of health care professionals. Gerontology 1995; 41:326-31. [PMID: 8586289 DOI: 10.1159/000213704] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 01/31/2023] Open
Abstract
This study investigated, by questionnaire, the attitudes of geriatricians, speech therapists, dieticians, and nurses towards feeding by percutaneous endoscopic gastrostomy (PEG). The final response rate from a total of 199 questionnaires sent to this group was 75%. According to 95 (64%) of the respondents, the decision to use PEG feeding was reached by a multidisciplinary team approach and commonly involved carers as well as the patients. The quality of life was the single most important factor influencing this decision. PEG feeding was felt to be indicated in non-dysphagia-related malnutrition by 98 (66%) and in dementia with rejection of oral feeding by 69 (47%) of the respondents. It was felt by 39 (55%) of the nurses and by 32 (42%) of the other professionals that patients with dementia in long-term care who are established on nasogastric feeding should be converted to PEG feeding. This raises several ethical and resource issues.
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Affiliation(s)
- M Hasan
- University Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, North Wales, UK
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Bhowmick BK. Watermelon stomach treated with oral corticosteroid. J R Soc Med 1993; 86:52. [PMID: 8423582 PMCID: PMC1293829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- B K Bhowmick
- Department of Health Care of the Elderly, HM Stanley Hospital, St Asaph, Clwyd
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Affiliation(s)
- B K Bhowmick
- Department for Health Care of the Elderly, HM Stanley Hospital, St Asaph
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Griffiths A, Bhowmick BK. Sick role status and the elderly discharged from hospital. Practitioner 1978; 221:926-8. [PMID: 219424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bhowmick BK. Generalized melanosis in malignant melanoma. Br J Clin Pract 1977; 31:36. [PMID: 871363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
A patient with secondary syphilis presenting with jaundice is reported. Hepatic histology showed evidence of non-specific granuloma and active hepatitis but no cholestasis. This has been treated successfully with antisyphilitic therapy. The possibility of syphilitic pancreatitis and diabetes mellitus is discussed. The importance of serological tests for syphilis in jaundice of obscure origin is emphasized.
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Bhowmick BK, Kubik MM. Bisalbuminaemia in an Indian family. Practitioner 1974; 213:691-2. [PMID: 4457840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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