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Ahmad N, Ahmad A, Siddique I. Responsible Tourism and Hospitality: The Intersection of Altruistic Values, Human Emotions, and Corporate Social Responsibility. Administrative Sciences 2023. [DOI: 10.3390/admsci13040105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
The burgeoning tourism and hospitality industry is plagued by numerous challenges that pose significant hurdles to its long-term success and sustainability. These challenges encompass a range of factors, including fierce competitive convergence, rapid obsolescence of innovative strategies, and the relentless pursuit of ever-greater competitiveness in the marketplace. In such a service-oriented industry, where customer satisfaction is the sine qua non of success, the role of corporate social responsibility (CSR) in shaping consumer attitudes and behavior cannot be overstated. Despite this, the empirical evidence on the impact of CSR on brand advocacy behavior among hospitality consumers (BADB) remains somewhat underdeveloped and incomplete. In light of this knowledge gap, the basic objective of our study is to examine the complex interplay between CSR and BADB in the context of a developing country’s hospitality sector. The authors place a particular emphasis on the mediating role of consumer emotions and the moderating influence of altruistic values (ALVS) in shaping this relationship. Through rigorous empirical analysis, the authors demonstrate that CSR positively and significantly impacts BADB, with consumer engagement (CENG) serving as a crucial mediating variable that facilitates this relationship. These findings have significant theoretical and practical implications for the tourism and hospitality industry. Specifically, the authors show that the judicious deployment of CSR initiatives in a hospitality context can foster a positive behavioral psychology among consumers and, in turn, enhance their advocacy intentions towards the brand. This underscores the importance of carefully crafted CSR strategies to secure a competitive advantage in this dynamic and rapidly evolving sector.
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Affiliation(s)
- Naveed Ahmad
- Faculty of Management Sciences, University of Central Punjab, Lahore 54000, Pakistan
| | - Aqeel Ahmad
- Faculty of Management Sciences, University of Central Punjab, Lahore 54000, Pakistan
| | - Irfan Siddique
- Faculty of Management Sciences, University of Central Punjab, Lahore 54000, Pakistan
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Mohammed R, Carrasco R, Verma R, Siddique I, Mohammad S, Elmalky M. Does Instrumentation of the Fractured Level in Thoracolumbar Fixation Affect the Functional and Radiological Outcome? Global Spine J 2023; 13:53-59. [PMID: 33530726 PMCID: PMC9837517 DOI: 10.1177/2192568221991106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). METHODS 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. RESULTS Back pain score was significantly lower in the FL group (P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb's angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay. CONCLUSION The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction.
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Affiliation(s)
- Riaz Mohammed
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom,Riaz Mohammed, Department of Complex Spine
Surgery, Salford Royal Hospital, Manchester M6 8HD, United Kingdom.
| | - Roberto Carrasco
- Division of Population Health, Health
Sciences Research and Primary Care, University of Manchester, Manchester, United
Kingdom
| | - Rajat Verma
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Irfan Siddique
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Saeed Mohammad
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom
| | - Mahmoud Elmalky
- Salford Royal NHS Foundation Trust,
Salford, United Kingdom,Faculty of Medicine, Menoufia
University, Egypt
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Ali A, Hamid TA, Naveed RT, Siddique I, Ryu HB, Han H. Preparing for the “black swan”: Reducing employee burnout in the hospitality sector through ethical leadership. Front Psychol 2022; 13:1009785. [PMID: 36312154 PMCID: PMC9597687 DOI: 10.3389/fpsyg.2022.1009785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Hospitality is at a crossroads. While the growth and developmental indicators in this sector show economic potential, the rising employee burnout rate is a serious challenge to hospitality management. Literature suggests that an ethical leader can reduce employee burnout significantly. Although hospitality employees face a higher risk of burnout than other service segments, shockingly, past leadership studies did not focus on how ethical leaders in a hospitality organization may reduce the risk of burnout. Therefore, we conducted this research to explore ethical leadership-burnout relationships in the hospitality sector with the mediating effects of subjective wellbeing and employee resilience. A questionnaire was provided to employees in different hotel organizations (n = 346). Structural equation modeling was employed for hypothesis testing. The statistical evidence supported the theoretical assumptions that ethical leadership negatively predicts employee burnout, and subjective wellbeing and resilience mediate this relationship. The outcomes of this study suggest different theoretical and social implications. For example, the findings indicate the effectiveness of ethical leadership in reducing employee burnout in the hospitality sector. Several other implications have been discussed in detail.
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Affiliation(s)
- Anis Ali
- Department of Management, College of Business Administration, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Tasawar Abdul Hamid
- OUS Royal Academy of Economics and Technology in Switzerland, Zurich, Switzerland
| | - Rana Tahir Naveed
- Division of Management and Administrative Sciences, University of Education (UE) Business School, University of Education, Lahore, Pakistan
| | - Irfan Siddique
- Faculty of Management Studies, University of Central Punjab, Lahore, Pakistan
| | - Hyungseo Bobby Ryu
- Food Franchise Department, College of Health Sciences, Kyungnam University, Changwon, South Korea
- *Correspondence: Hyungseo Bobby Ryu
| | - Heesup Han
- College of Hospitality and Tourism Management, Sejong University, Seoul, South Korea
- Heesup Han
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Al-Naseem AO, Gonnah AR, Al-Ali H, Al-Naseem AO, Siddique I. Robot-Assisted Versus Conventional Freehand Fluoroscopy-Guided Percutaneous Screw Fixation in Femoral Neck Fractures: A Systematic Review and Meta-analysis. Cureus 2022; 14:e24258. [PMID: 35607578 PMCID: PMC9123337 DOI: 10.7759/cureus.24258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
Abstract
Robotic-assisted navigation for percutaneous femoral neck fracture fixation is a new technology that has shown enhanced intraoperative and postoperative outcomes compared to the conventional freehand fluoroscopy-guided technique. The authors aim to compare robot-assisted femoral neck fracture fixation to conventional freehand fluoroscopy-guided repair. Electronic databases were searched, identifying all observational studies comparing outcomes of both groups. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted. The primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure, and frequency of intraoperative drilling. The secondary outcomes included Harris scores, healing rate and time, screw accuracy, and postoperative complications. Seven observational studies were identified, enrolling 506 patients. There was a significant difference between the robot-assisted and conventional groups in terms of intraoperative blood loss (mean difference (MD) = -18.83, p ≤ 0.05), fluoroscopy exposure (MD = -1.81, p ≤ 0.05), and intraoperative drilling frequency (MD = -7.35, p < 0.05). There was no significant difference in operative duration between the groups (MD = -0.21, p = 0.66). Most secondary outcomes were improved in the robot-assisted group. Overall, robot-assisted fixation was superior in terms of safety and efficacy.
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Affiliation(s)
| | - Ahmed R Gonnah
- School of Medicine, University of Liverpool, Liverpool, GBR
| | - Hussain Al-Ali
- Orthopaedic Surgery Department, McGill University Health Centre, Quebec, CAN
| | | | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal National Health Services (NHS) Foundation Trust, Manchester, GBR
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Lopez CC, Berg A, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. 787 Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Emerg Med J 2022. [DOI: 10.1136/emermed-2022-rcem.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aims/Objectives/BackgroundCauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre.Methods/DesignConsecutive patients with suspected CES presenting over a three-year period to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI).Results/ConclusionsOut of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI +ve CES). 35% of MRI +ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI +ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI +ve CES in patients ≤ 42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed.The prevalence of MRI +ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
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Curtis Lopez C, Berg AJ, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Br J Neurosurg 2021:1-5. [PMID: 34796788 DOI: 10.1080/02688697.2021.2005775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Cauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time-sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre. MATERIALS AND METHODS Consecutive patients with suspected CES presenting over three years to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI). RESULTS Out of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI + ve CES). 35% of MRI + ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI + ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI + ve CES in patients ≤42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed. CONCLUSION The prevalence of MRI + ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
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Affiliation(s)
- Carlos Curtis Lopez
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Bethan Clayton
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Roberto Carrasco
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Daniel Horner
- Division of Population Health, Health Services Research & Primary Care, School of Biological Sciences, The University of Manchester, Manchester, UK
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Angus M, Curtis-Lopez CM, Carrasco R, Currie V, Siddique I, Horner DE. Determination of potential risk characteristics for cauda equina compression in emergency department patients presenting with atraumatic back pain: a 4-year retrospective cohort analysis within a tertiary referral neurosciences centre. Emerg Med J 2021; 39:emermed-2020-210540. [PMID: 34642235 DOI: 10.1136/emermed-2020-210540] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/02/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Atraumatic back pain is an increasingly common presentation to the ED. A minority of these cases will have significant structural pathology, resulting in acute cauda equina compression (CEC). Although clinicians often look for 'red flags' to identify potential CEC, the prognostic accuracy of these presenting symptoms and clinical examination findings is unclear. We sought to evaluate the accuracy of individual clinical features in a large cohort of ED patients with atraumatic backpain and reference standard imaging, for the diagnosis of CEC. METHODS A retrospective case note review from 2014 to 2018 within an established ED atraumatic back pain pathway, undertaken at the largest tertiary spinal referral centre in the UK. We analysed routine data, collected prospectively by treating clinicians within a structured electronic health record clinical proforma. Data on signs and symptoms in 996 patients with suspected CEC referred for definitive MRI over a 4-year study period were extracted and compared against a final reference standard diagnosis. RESULTS We identified 111 patients with radiological evidence of CEC within the cohort referred for definitive imaging (111/996, 11.1%), of whom 109 (98.2%) underwent operative intervention. Patients with CEC were more likely to present with bilateral leg pain (OR=2.2), dermatomal sensory loss (OR 1.8) and bilateral absent ankle or ankle and knee jerks (OR=2.9). Subjective weakness was found to be associated with CEC on univariate but not multivariate analysis. We found no relationship between digital rectal examination findings and the diagnosis of CEC. CONCLUSIONS In our cohort, factors independently associated with CEC diagnosis on MRI included bilateral leg pain, dermatomal sensory loss. Loss of lower limb reflexes was strongly suggestive of CES (likelihood ratio 3.4 on multivariate logistic regression). Our findings raise questions about the diagnostic utility of invasive digital rectal examination.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Roberto Carrasco
- School of Medicine, The University of Manchester, Manchester, UK
| | - Vicki Currie
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Irfan Siddique
- Complex Spines, Salford Royal NHS Foundation Trust, Salford, UK
| | - Daniel E Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
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Lea MA, Elmalky M, Sabou S, Siddique I, Verma R, Mohammad S. Revision pedicle screws with impaction bone grafting: a case series. J Spine Surg 2021; 7:344-353. [PMID: 34734139 PMCID: PMC8511565 DOI: 10.21037/jss-20-684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pedicle screw fixation in spinal constructs can be subject to failure requiring revision surgery. In cases of aseptic loosening various salvage techniques have been described. Revision screws augmented with cement have become popular but are not without risks. Larger diameter screws are often used but result in reducing bone stock or expanding the pedicles. We present a novel technique of pedicle screw revision by impaction bone allografting and a case series. METHODS The failed screws are removed. The screw track is probed to check its integrity. Milled bone allograft is funneled into the screw hole and sequentially impacted, before insertion of a replacement screw. We report a case series and describe a single case where this method has been used. Information was gathered from the electronic patient record in our hospital. RESULTS Ten screws were revised in 7 patients. Mean age at first surgery was 60.86 (48-76) years. Average time between first surgery and revision was 12.6 (4.7-49.9) months. Average follow-up was 26.2 (5.7-62.2) months and no screws showed any signs of loosening. CONCLUSIONS Impaction grafting with bone allograft is a technique for pedicle screw salvage that can be used safely and effectively as an alternative to cemented screws, when pedicle screws have failed by aseptic loosening. It avoids the risks associated with cemented screws and in our series was successful.
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Affiliation(s)
- Matthew Alexander Lea
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Mahmoud Elmalky
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
- Faculty of Medicine, Menoufia University, Al Minufiyah, Egypt
| | - Silviu Sabou
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Irfan Siddique
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Rajat Verma
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Saeed Mohammad
- Department of Orthopaedic Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
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Laurente R, Yates J, Siddique I. 116 Patient Long Stay in the Manchester Centre for Clinical Neurosciences Complex Spines Department: Numbers, Reasons, and Recommendations. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Patient long-stay is one of the main causes of inefficient resource management in the National Health Service. Similarly, delays in treatment and access to social care contributes to the trust’s economic burden but also causes a significant delay in care for society's most vulnerable.
A single-centre evaluation of patient long stay was performed in a tertiary spinal unit in Greater Manchester. The top 50 patients who stayed the longest in an acute spinal bed between 2018 and 2019 were selected for analysis. Demographics, indication for transfer from another trust, overall length of stay, and the main reasons for such were evaluated.
Of the 50 assessed, there was an average length of stay of 46.9 days and the majority were comprised of patients with metastatic spinal cord compression. 74% had delays to surgery due to poor medical optimisation pre-transfer.
41% remained as an inpatient longer than necessary due to non-medical concerns. The main reasons included awaiting placement in a rehabilitation facility, social care issues and delays in repatriation back to their referring trust for ongoing care.
Delays in treatment and length of stay were found to be increased in patients who were poorly optimised pre-operatively and who required complex social and medical care post-operatively.
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Affiliation(s)
- R Laurente
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - J Yates
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - I Siddique
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Angus ML, Dickens V, Yasin N, Greenwood J, Siddique I. The value of a consultant physiotherapist within a primary care musculoskeletal interface service: part of the spinal multidisciplinary team. International Journal of Therapy and Rehabilitation 2021. [DOI: 10.12968/ijtr.2019.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Background/aims The national low back pain pathway in the UK suggests practitioners managing patients with spinal pathology should be specifically trained to do so and have the ability to link with tertiary spinal services when required. The aim of this study was to ensure referrals through to a tertiary spinal surgical centre are appropriate and patients get the correct advice early in their management pathway. Methods A retrospective review of 700 cases were discussed at a spinal case-based discussion meeting in a primary care interface service, compared to services without this model. A convenience sample of cases were analysed with the consultant physiotherapist and those referred from other allied health professionals into the tertiary spinal surgical centre. Case-based team discussion took place before every referral into the tertiary spinal service, with spinal surgical discussion where required. Results Patients referred from other interface services were more likely to require further work-up such as investigations, or be discharged from clinic on their first attendance than those who had been through the case-based discussion. Conclusions A consultant physiotherapist working as part of the spinal team of a tertiary referral centre can help advanced practitioners with their clinical decision making to help prevent unnecessary referrals to spinal surgical services.
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Affiliation(s)
- Michelle L Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Victoria Dickens
- Musculoskeletal Clinical Assessment and Treatment Service, Salford Royal NHS Foundation Trust, Salford, UK
| | - Naveed Yasin
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - James Greenwood
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
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Khan R, Naz I, Hussain S, Khan RAA, Ullah S, Rashid MU, Siddique I. Phytochemical management of root knot nematode (Meloidogyne incognita) kofoid and white chitwood by Artemisia spp. in tomato (Lycopersicon esculentum L.). BRAZ J BIOL 2020; 80:829-838. [PMID: 31800766 DOI: 10.1590/1519-6984.222040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022] Open
Abstract
In vitro and screen house experiments were conducted to investigate the effectiveness of thirteen phytochemicals from Artemisia elegantissimia and A. incisa on root knot nematode, Meloidogyne incognita in tomato (Lycopersicon esculentum L.) cv. Rio Grande. A positive control (Carbofuran) and negative control (H2O) were also used for comparison. Effectiveness of phytochemicals against juveniles (J2s) mortality and egg hatch inhibition were evaluated after 24, 48 and 72 hours of incubation at three concentrations viz; 0.1, 0.2 and 0.3 mg/mL in vitro conditions. Amongst thirteen phytochemicals, Isoscopletin (Coumarin), Carbofuran and Apigenin (Flavonoid) showed the highest mortality and egg hatch inhibition of M. incognita at all intervals. Inhibition of eggs and J2s mortality were the greatest (90.0%) and (96.0%) at 0.3 mg/mL concentration. Application of phytochemicals caused reduction in number of galls, galling index, and egg masses on tomato plant and enhanced plant growth parameters under screen house conditions. Gall numbers (1.50), galling index (1.00), number of juveniles (4.83) and egg masses (4.00) were greatly reduced and plant growth parameters such as; plant height (28.48 cm), fresh (72.13 g) and dry shoot weights (35.99 g), and root fresh (6.58 g) and dry weights (1.43 g) were increased significantly by using Isoscopletin. In structure activity relationship, juveniles of M. incognita, exhibited variations in their shape and postures upon death when exposed to different concentrations of phytochemicals of Artemisia spp. The present study suggests that Artemisia based phytochemicals possess strong nematicidal effects and can be used effectively in an integrated disease management program against root knot nematodes.
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Affiliation(s)
- R Khan
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - I Naz
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S Hussain
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - R A A Khan
- Institute of Vegetable and Flowers, Graduate School of Chinese Academy of Agricultural Sciences, Beijing, P.R. China
| | - S Ullah
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M U Rashid
- Department of Chemistry, Faculty of Arts & Basic Sciences, Balochistan University of Information Technology, Engineering and Management Sciences, Pakistan
| | - I Siddique
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Carrasco R, Elmalky M, Sabou S, Leach J, Verma R, Mohammad S, Siddique I. Concomitant back and leg pain as predictors for trajectories of poor outcome after single level lumbar micro-decompression alone and with micro-discectomy: a study of 3,308 patients. J Spine Surg 2020; 6:688-702. [PMID: 33447671 PMCID: PMC7797806 DOI: 10.21037/jss-19-462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Lumbar decompression is the commonest spinal intervention. One in four patients have suboptimal outcome postoperatively, however no large studies identified clear poor outcome predictors. The aim of this study was to study low back pain (LBP) as a predictor of poor outcome following lumbar micro-decompression. METHODS Prospectively collected spinal registry data was analysed for patients who underwent primary, single-level, decompression with or without discectomy at single spinal centre (2011-2017). Based on the response to the Likert global outcome question, we had two outcome groups (good & poor). Percentage of achievement of minimum clinically relevant change (MCRC) for Core Outcome Measures Index (COMI) score, LBP and leg pain (LP) was examined. A two-step approach was adopted. First, COMI score, LBP and LP visual analogue scales (VAS) trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories. RESULTS We included 3,308 patients with mean follow up (1.4 y). MCRC was achieved in COMI score in 63% of cases, 42% in LBP and 62% in LP. A three-group trajectory model was identified: large-improvement (LI) (n=980), moderate-improvement (MI) (n=1,364) and no-improvement (NI) (n=966) with 99.5%, 84.5% and 31.5% of patients presenting good outcome, respectively. Higher pre-operative LBP and COMI score and smoking were strongly associated with MI and NI. In addition, higher LP, post-operative surgical complications, previous surgery at same level, conservative treatment >6 months and anxiety/depression were associated with NI. CONCLUSIONS This is the first large-scale study reporting preoperative LBP severity, spinal stenosis and smoking as predictors for poor functional outcomes post lumbar decompression with or without discectomy. This is very useful while counselling patients for surgery to meet realistic expectations.
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Affiliation(s)
- Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Mahmoud Elmalky
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
- Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - John Leach
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Greater Manchester, UK
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Angus M, Dickens V, Greenwood J, Yasin N, Siddique I. The value of a consultant physiotherapist within a primary care musculoskeletal interface services: part of the spinal multi-disciplinary team. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.295] [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: 11/25/2022]
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Abbott C, Watt T, Oxborrow N, Siddique I, Verma R, Angus M. Implementation of a virtual spinal clinic (VSC) for patient́s with acute spinal pathology providing timely management and reducing face-to-face follow-up. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.247] [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: 10/24/2022]
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Abstract
Purpose: The purpose of this study was to validate the cauda scale (TCS) in an external population. TCS was proposed as a tool to be used to predict the likelihood of cauda equina compression.Methods: We analysed the presenting condition of consecutive patients attending the emergency department undergoing a magnetic resonance scan with a clinical suspicion of cauda equina syndrome (CES). The findings were graded according to TCS for those with and without radiological compression of the cauda equina. Logistic regression was applied to the data in accordance with the original paper.Results: Patients were included over a 14 month period (n = 313), subsequent imaging revealed CES compression in 34 cases and no CES compression in 279. The TCS proposed that small values meant a more likely diagnosis of CES, the data showed the opposite of this with the highest number of patients with CES scoring a maximal 9 on TCS (mildest symptoms).Conclusions: Our data suggests that TCS has potential limitations in identifying patients with CES and needs further work prior to implementation.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Andrew Berg
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford, UK
| | - Daniel Horner
- Emergency Medicine Department, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - John Leach
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, UK
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Mahmood H, Siddique I, McKechnie A. Antiplatelet drugs: a review of pharmacology and the perioperative management of patients in oral and maxillofacial surgery. Ann R Coll Surg Engl 2020; 102:9-13. [PMID: 31755732 PMCID: PMC6937600 DOI: 10.1308/rcsann.2019.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION An increasing number of patients are taking oral antiplatelet agents. As a result, there is an important patient safety concern in relation to the potential risk of bleeding complications following major oral and maxillofacial surgery. Surgeons are increasingly likely to be faced with a dilemma of either continuing antiplatelet therapy and risking serious haemorrhage or withholding therapy and risking fatal thromboembolic complications. While there are national recommendations for patients taking oral antiplatelet drugs undergoing invasive minor oral surgery, there are still no evidence-based guidelines for the management of these patients undergoing major oral and maxillofacial surgery. METHODS MEDLINE and EMBASE databases were searched to retrieve all relevant articles published to 31 December 2017. FINDINGS A brief outline of the commonly used antiplatelet agents including their pharmacology and therapeutic indications is discussed, together with the haemorrhagic and thromboembolic risks of continuing or altering the antiplatelet regimen in the perioperative period. Finally, a protocol for the management of oral and maxillofacial patients on antiplatelet agents is presented. CONCLUSIONS Most current evidence to guide decision making is based upon non-randomised observational studies, which attempts to provide the safest possible management of patients on antiplatelet therapy. Large randomised clinical trials are lacking.
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Affiliation(s)
- H Mahmood
- Department of Oral & Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - I Siddique
- Department of Oral & Maxillofacial Surgery, Bradford Royal Infirmary, Bradford, UK
| | - A McKechnie
- Department of Oral & Maxillofacial Surgery, Leeds Dental Institute, Leeds, UK
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Sabou S, Carrasco R, Verma R, Siddique I, Mohammad S. The clinical and radiological outcomes of multilevel posterior lumbar interbody fusion in the treatment of degenerative scoliosis: a consecutive case series with minimum 2 years follow up. J Spine Surg 2019; 5:520-528. [PMID: 32043002 DOI: 10.21037/jss.2019.12.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical treatment for adult degenerative scoliosis (ADS) is a complex undertaking and is associated with a high complication rate. Our aim was to evaluate the clinical and radiological outcomes, mortality and morbidity of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment in ADS based on the experience of a single tertiary referral center for spinal surgery. Methods We performed a retrospective analysis of prospectively collected data of consecutive patients who had undergone multi-level posterior interbody fusion for degenerative scoliosis. We prospectively recorded patients' demographics, co-morbidities; coronal and sagittal plane deformity assessment and surgical details: number of instrumented levels, and intra-operative and postoperative complications. Functional outcomes and patient-reported complications were entered in our local spine surgery database (part of the Eurospine Spine Tango Registry) and used to collect data on functional scores and patient-reported complications preoperatively and at 6, 12 and 24 months' follow-up. Results Our study involved 13 males and 51 females with a mean age of 70.26 (range 49-90, SD 8.9). MPLIF was performed at five levels in one patient, four levels in 29 patients, three levels in 20 patients, and two levels in 14 patients. There were a total of 14 (21.87%) major, minor and mechanical complications. There were no procedure-related mortalities. The average COMI and Eq5d scores improved significantly post-surgery, and this improvement was maintained at a mean follow-up of up to two years. Conclusions Multilevel posterior interbody fusion is a safe procedure, and in selected cases can result in good clinical and radiological outcomes with improvement in patient quality of life.
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Affiliation(s)
- Silviu Sabou
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research & Primary Care, Manchester, UK.,Biology, Medicine and Health (BMH), The University of Manchester, Manchester, UK
| | - Rajat Verma
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Irfan Siddique
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Lancashire, UK
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Sethi G, Aljawadi A, Choudhry MN, Fischer B, Divecha HM, Leach J, Arnall F, Verma R, Yasin N, Mohammad S, Siddique I. Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery - A study of 995 patients. J Orthop 2019; 16:478-482. [PMID: 31680735 DOI: 10.1016/j.jor.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To determine if preoperative leg pain and low back pain severity affected postoperative outcome. Method Prospectively collected Spine-Tango data was analysed for 995 consecutive patients who underwent a primary, single level, lumbar micro-decompression/microdiscectomy at a single tertiary spinal centre. Result At 3 months, 72% of patients were satisfied with the outcome of surgery. Pre-operative low back pain was a significant predictor of poor outcome (P < 0.01). Conclusion Our study has shown that patients with a low back pain VAS of 6 or more have a significantly greater chance of a poor outcome following primary lumbar microdecompressive/microdiscectomy surgery.
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Affiliation(s)
- G Sethi
- Trauma and Orthopaedics- Spinal, University of Salford, Salford, Manchester, UK.,School of Health Sciences Allerton Building, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | - A Aljawadi
- Trauma and Orthopaedics, University of Salford, Salford, Fredrick Road Campus, M6 6PU, UK
| | - M N Choudhry
- Spinal Registrar, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | | | - H M Divecha
- StR Trauma & Orthopaedics, North Western Deanery, UK
| | - J Leach
- Consultant Neurosurgeon, Department of Neutosurgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - F Arnall
- Consultant Physiotherapist. Lecturer Fellow Higher Education Academy, MSc Trauma & Orthopaedics Academic Module Lead, School of Health Sciences Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | - R Verma
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - N Yasin
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - S Mohammad
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - I Siddique
- Consultant Spinal Surgeon, Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
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Abstract
Purpose
Socioemotional wealth (SEW) has emerged as the most differentiating aspect in family firms and has become the focal issue in family firm decision making. Family firms have to face the jeopardy of financial gains and socioemotional. The purpose of this paper is to investigate the different dimensions of SEW in developing the firm as corporate entrepreneurial and which dimensions engage stakeholders.
Design/methodology/approach
The authors designed a survey questionnaire to obtain primary data for the study using purposive sampling method. The study conducted on the family firm using the questionnaire to investigate for corporate entrepreneurship (CE), and stakeholder engagement (SE) depended on family control and influence, family identity, binding social ties, emotional attachment and renewal of family bonds.
Findings
The study identified different SEW factors affecting CE and SE. The authors found that binding social ties and renewal of family bonds has a statistically significant impact on SE, whereas family identity and social ties have a statistically significant impact on CE.
Research limitations/implications
The authors receive data from the CEOs with low response rate and expected to have better results with more observations. The same study been conducted in different parts of the world may give different results and a cultural bias may restrict the findings.
Practical implications
From the research, family firms can take twofold benefits. In short term, a family firm with better SE can generate satisfied employees with lesser turnover intentions. For long-term objectives with respect to CE, a firm can get a result in terms of market innovations through for better firm’s performance.
Social implications
Since her inception, Pakistan has emerged as a society of commodity traders and technology importers. This society can easily generate an import-driven business. Nonetheless this import-driven economy always remains under great economic distress due to limited potential for actual innovations and market disruptions. The family businesses of any emerging market like Pakistan need to learn CE and SE while safeguarding social-emotional wealth, thereby being successful as firm to become export-driven economy at large.
Originality/value
The study identifies different SEW factors that help in developing a firm as corporate entrepreneurial and stakeholder’s engagement. Findings of the study are valuable for managing the family firms in developing economies where the family structures are very vibrant and businesses have a clear dependency on family formations.
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Sabou S, Lagaras A, Verma R, Siddique I, Mohammad S. Comparative study of multilevel posterior interbody fusion plus anterior longitudinal ligament release versus classic multilevel posterior interbody fusion in the treatment of adult spinal deformities. J Neurosurg Spine 2019; 31:46-52. [DOI: 10.3171/2019.1.spine18754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVESagittal imbalance and loss of lumbar lordosis are the main drivers of functional disability in adult degenerative scoliosis. The main limitations of the classic posterior lumbar interbody fusion technique are increased risk of neurological injury and suboptimal correction of the segmental lordosis. Here, the authors describe the radiological results of a modified posterior lumbar interbody fusion and compare the results with a historical cohort of patients.METHODSEighty-two consecutive patients underwent surgical treatment for degenerative scoliosis/kyphosis in a single tertiary referral center for complex spinal surgery. Fifty-five patients were treated using the classic multilevel posterior lumbar interbody fusion (MPLIF) technique and 27 were treated using the modified MPLIF technique to include a release of the anterior longitudinal ligament (ALL) and the annulus. A radiographic review of both series of patients was performed by two independent observers. Functional outcomes were obtained, and patients were registered in the European Spine Tango registry.RESULTSThe mean L4–5 disc angle increased by 3.14° in the classic MPLIF group and by 12.83° in MPLIF plus ALL and annulus release group. The mean lumbar lordosis increased by 15.23° in the first group and by 25.17° in the second group. The L4–S1 lordosis increased on average by 4.92° in the classic MPLIF group and increased by a mean of 23.7° in the MPLIF plus ALL release group when both L4–5 and L5–S1 segments were addressed. There were significant improvements in the Core Outcome Measures Index and EQ-5D score in both groups (p < 0.001). There were no vascular or neurological injuries observed in either group.CONCLUSIONSThe authors’ preliminary results suggest that more correction can be achieved at the disc level using posterior-based ALL and annulus release in conjunction with posterior lumbar interbody fusion. They demonstrate that ALL and annulus release can be performed safely using a posterior-only approach with minimal risk of vascular injury. However, the authors recommend that this approach should only be used by surgeons with considerable experience in anterior and posterior spinal surgery.
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Aljawadi A, Sethi G, Imo E, Arnall F, Choudhry MN, George KJ, Tambe A, Verma R, Yasin MN, Mohammed S, Siddique I. Medium-term outcome of posterior surgery in the treatment of non-tuberculous bacterial spinal infection. J Orthop 2019; 16:569-575. [PMID: 31680747 DOI: 10.1016/j.jor.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/16/2019] [Indexed: 12/17/2022] Open
Abstract
Objective to evaluate the outcome of posterior spinal stabilization surgery for the management of bacterial spinal infection. Methods 21 patients with bacterial infection were managed surgically with posterior stabilization. Outcome measures included neurological status. Follow-up data collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D. Results The mean improvement in neurological deficits was 0.91 Frankel grade. Residual symptoms of pain had no or minor effect on the work or usual activities in 52% of subjects, with 88% reported having either no or mid problems with mobility. Conclusion Posterior surgery can improve neurological outcome in approximately half of the patients.
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Affiliation(s)
- Ahmed Aljawadi
- Trauma and Orthopaedics, University of Salford, Salford, Manchester, M5 4WT, UK
| | - Gagan Sethi
- Trauma and Orthopaedics - Spinal, University of Salford, Manchester, UK
| | - Eze Imo
- Trauma and Orthopaedics, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Merseyside, CH49 5PE, UK
| | - Frances Arnall
- School of Health Sciences, Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | | | | | - Anant Tambe
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Mohammed Naveed Yasin
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Saeed Mohammed
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
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Angus M, Jackson K, Smurthwaite G, Carrasco R, Mohammad S, Verma R, Siddique I. The implementation of enhanced recovery after surgery (ERAS) in complex spinal surgery. J Spine Surg 2019; 5:116-123. [PMID: 31032446 DOI: 10.21037/jss.2019.01.07] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background This paper aims to review the introduction of an enhanced recovery after surgery (ERAS) service within complex spinal surgery, with an aim to assess if this is a cost effective way to improve the overall experience of such complex surgery. Methods The ERAS model was defined and followed within a regional centre for complex spinal surgery in the UK. Outcomes such as length of stay (LOS) and satisfaction were measured before and after implementation of the service. Results LOS was reduced and both patient and staff satisfaction improved following the implementation of the ERAS service. Conclusions The ERAS model can successfully be implemented within complex spinal surgery, to help improve satisfaction and reduce cost.
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Affiliation(s)
- Michelle Angus
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kelly Jackson
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Glyn Smurthwaite
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Roberto Carrasco
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Saeed Mohammad
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
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Panikkar S, Tol G, Siddique I. Iatrogenic bilateral hypoglossal palsy following spinal surgery. Eur Spine J 2017; 27:314-317. [PMID: 28698964 DOI: 10.1007/s00586-017-5214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bilateral hypoglossal palsy is a rare complication during airway management in surgery. CASE PRESENTATION Isolated bilateral hypoglossal palsy was noted post-operatively in a patient who underwent multiple spinal surgeries associated with prone anaesthesia. DISCUSSION Risk factors include difficult, multiple intubations, prolonged surgical time, throat pack, and hyperextension of the neck during intubation. CONCLUSION We aim to create awareness about this complication which has a significant morbidity and negative effect on patient outcomes.
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Affiliation(s)
- Shrijit Panikkar
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
| | - Govind Tol
- Department of Anaesthesia, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK
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Rushton PRP, Siddique I, Crawford R, Birch N, Gibson MJ, Hutton MJ. Magnetically controlled growing rods in the treatment of early-onset scoliosis. Bone Joint J 2017; 99-B:708-713. [DOI: 10.1302/0301-620x.99b6.bjj-2016-1102.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/20/2017] [Indexed: 11/05/2022]
Abstract
The MAGnetic Expansion Control (MAGEC) system is used increasingly in the management of early-onset scoliosis. Good results have been published, but there have been recent reports identifying implant failures that may be associated with significant metallosis surrounding the implants. This article aims to present the current knowledge regarding the performance of this implant, and the potential implications and strategies that may be employed to identify and limit any problems. We urge surgeons to apply caution to patient and construct selection; engage in prospective patient registration using a spine registry; ensure close clinical monitoring until growth has ceased; and send all explanted MAGEC rods for independent analysis. The MAGEC system may be a good instrumentation system for the treatment of early-onset scoliosis. However, it is innovative and like all new technology, especially when deployed in a paediatric population, robust systems to assess long-term outcome are required to ensure that patient safety is maintained. Cite this article: Bone Joint J 2017;99-B:708–13.
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Affiliation(s)
| | - I. Siddique
- Salford Royal NHS Foundation Trust, Salford, UK
| | - R. Crawford
- Norfolk and Norwich University Hospitals
NHS Foundation Trust, Norwich, Norfolk, UK
| | - N. Birch
- The Chris Moody Centre, Gate
4 Moulton College, Pitsford Road, Moulton, Northamptonshire, UK
| | - M. J. Gibson
- Royal Victoria Infirmary, Newcastle
Upon Tyne, UK
| | - M. J. Hutton
- Royal Devon and Exeter NHS Foundation
Trust, Exeter, Devon, UK
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Leavy P, Siddique I, Mohammed-Ali R. Occupational exposure to bodily fluids in oral and maxillofacial surgery: an evaluation of reporting practices and attitudes among staff at a major teaching hospital in the UK. Br J Oral Maxillofac Surg 2016; 55:e7-e11. [PMID: 27876546 DOI: 10.1016/j.bjoms.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022]
Abstract
Our aim was to evaluate experience, practice, and beliefs about reporting of occupational exposures to blood and other body fluids among a sample of 88 healthcare providers working in oral and maxillofacial surgery at Sheffield Teaching Hospitals. We used a cross-sectional survey to evaluate awareness of the Trust's policy for reporting occupational exposure, recent incidence of exposure, and current reporting practices. Beliefs were measured using questions derived from the theory of planned behaviour. Fifty-five people responded, 14 of whom had been exposed to bodily fluids in the previous 12 months. Of those, 10 did not report it. Fifty-three respondents were certain that the Trust had a protocol in place for reporting sharps injuries to staff. Most (n=51) said the Trust had a protocol for reporting mucocutaneous exposure to blood. Respondents placed equal importance on reporting exposures that affected both themselves and patients, but intention to report exposure of patients was significantly higher than for themselves (z score -3.18, p<0.0001). We conclude that OMFS healthcare workers generally think that occupational exposures should be reported, but there are shortcomings in practice.
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Affiliation(s)
- P Leavy
- Department of Oral & Maxillofacial Surgery, Charles Clifford Dental Hospital, Sheffield S10 2SZ, UK.
| | - I Siddique
- Department of Oral & Maxillofacial Surgery, Charles Clifford Dental Hospital, Sheffield S10 2SZ, UK.
| | - R Mohammed-Ali
- Department of Oral & Maxillofacial Surgery, Charles Clifford Dental Hospital, Sheffield S10 2SZ, UK.
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26
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Chaudhry B, Siddique I. The surgical management of metastatic spinal cord compression: A proposed cost-utility analysis. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.404] [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: 12/01/2022]
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Sabou S, Tseng THJ, Stephenson J, Siddique I, Verma R, Mohammad S. Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for mild degenerative scoliosis. Eur Spine J 2015; 25:2520-6. [PMID: 26626083 DOI: 10.1007/s00586-015-4338-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/26/2022]
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Siddique I, Oktseloglou V, Srinivasan D, McCahon R. The effect of maxillary repositioning on nasal airflow function - a provisional report. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.167] [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: 11/30/2022]
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Whitehouse S, Stephenson J, Sinclair V, Gregory J, Tambe A, Verma R, Siddique I, Saeed M. A validation of the Oswestry Spinal Risk Index. Eur Spine J 2014; 25:247-251. [PMID: 25391625 DOI: 10.1007/s00586-014-3665-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.
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Affiliation(s)
- S Whitehouse
- ST7 Orthopaedics, North West Deanery, Manchester, UK.
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - V Sinclair
- ST7 Orthopaedics, North West Deanery, Manchester, UK
| | - J Gregory
- University of Manchester, Manchester, UK
| | - A Tambe
- Salford Royal Foundation Trust, Salford, UK
| | - R Verma
- Salford Royal Foundation Trust, Salford, UK
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Siddique I, Abdullwahab Bukhari N, Perveen K, Siddiqui I, Anis M. Pre-culturing of nodal explants in thidiazuron supplemented liquid medium improves in vitro shoot multiplication of Cassia angustifolia. Acta Biol Hung 2013; 64:377-84. [PMID: 24013898 DOI: 10.1556/abiol.64.2013.3.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/19/2022]
Abstract
An in vitro propagation system for Cassia angustifolia Vahl. has been developed. Due to the presence of sennosides, the demand of this plant has increased manyfold in global market. Multiple shoots were induced by culturing nodal explants excised from mature plants on a liquid Murashige and Skoog [8] medium supplemented with 5-100 μM of thidiazuron (TDZ) for different treatment duration (4, 8, 12 and 16 d). The optimal level of TDZ supplemented to the culture medium was 75 μM for 12 d induction period followed by subculturing in MS medium devoid of TDZ as it produced maximum regeneration frequency (87%), mean number of shoots (9.6 ± 0.33) and shoot length (4.4 ± 0.46 cm) per explant. A culture period longer than 12 d with TDZ resulted in the formation of fasciated or distorted shoots. Ex vitro rooting was achieved when the basal cut end of regenerated shoots was dipped in 200 μM indole-3-butyric acid (IBA) for half an hour followed by their transplantation in plastic pots filled with sterile soilrite where 85% plantlets grew well and all exhibited normal development. The present findings describe an efficient and rapid plant regeneration protocol that can further be used for genetic transformation studies.
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Affiliation(s)
- I Siddique
- King Saud University Department of Botany and Microbiology, College of Science, Female Centre for Scientific and Medical Colleges P.O. Box 22452 Riyadh 11495 Saudi Arabia
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Siddique I, Patel K. Paracetamol overdose cases secondary to dental pain requiring acute medical admissions: a retrospective case series. Br J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.bjoms.2012.04.131] [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: 12/01/2022]
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Charalambous CP, Mosey C, Johnstone E, Akimau P, Gullett TK, Siddique I, Wilkes RA. Improving osteoporosis assessment in the fracture clinic. Ann R Coll Surg Engl 2009; 91:596-8. [PMID: 19558771 DOI: 10.1308/003588409x432400] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of different ways of referring patients to an osteoporosis assessment service at an orthopaedic fracture clinic of a hospital in the UK. PATIENTS AND METHODS Three methods of identifying and referring to an osteoporosis assessment service were evaluated. RESULTS Relying on doctors for such a referral gave a catchment rate of only 1.6%. Involving patients themselves, asking them to self-refer, increased the catchment rate to 63% (P < 0.0001). Having a specialist osteoporosis and fracture liaison nurse present in clinic and reviewing the notes of patients checking in, to see if they match criteria for osteoporosis assessment, further increased catchment to 77% (P = 0.036). CONCLUSIONS Simply having an osteoporosis assessment service and strict criteria to identify which patients should be referred to such a service will not necessarily increase catchment rate for osteoporosis patients. A nurse physically present in the clinic provided the best result, and supports the need of investing in an osteoporosis and fracture liaison nurse.
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Affiliation(s)
- C P Charalambous
- Department of Trauma and Orthopaedics, Hope Hospital, University of Manchester, Salford, UK
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Charalambous CP, Stanley JK, Siddique I, Aster A, Gagey O. Posterolateral rotatory laxity following surgery to the head of the radius: biomechanical comparison of two surgical approaches. ACTA ACUST UNITED AC 2009; 91:82-7. [PMID: 19092009 DOI: 10.1302/0301-620x.91b1.21039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The lateral ligament complex is the primary constraint to posterolateral rotatory laxity of the elbow, and if it is disrupted during surgery, posterolateral instability may ensue. The Wrightington approach to the head of the radius involves osteotomising the ulnar insertion of this ligament, rather than incising through it as in the classic posterolateral (Kocher) approach. In this biomechanical study of 17 human cadaver elbows, we demonstrate that the surgical approach to the head can influence posterolateral laxity, with the Wrightington approach producing less posterolateral rotatory laxity than the posterolateral approach.
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Affiliation(s)
- C P Charalambous
- Department of Upper Limb Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, UK.
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Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, Marynissen H. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 2007; 127:205-10. [PMID: 17186293 DOI: 10.1007/s00402-006-0256-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [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: 10/18/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to describe early results of a new internal locking system, PHILOS, used for the treatment of proximal humeral fractures. MATERIALS AND METHODS A chart and radiographic review of 25 cases that had proximal humeral internal locking system (PHILOS) plate for the treatment of proximal humeral fractures was performed. RESULTS Of the 25 cases, 20 went to union with a mean neck/shaft angle of 127.2 degrees . Five cases required or were considered for revision surgery for non-union or implant failure. Of the 25 implants, 4 had screw protrusion into the gleno-humeral joint, 4 had screw loosening and backing out, and 1 plate broke without further trauma. CONCLUSIONS Our results suggest that PHILOS is an effective system for providing fracture stabilisation to bony union but awareness of potential hardware complications is essential.
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Affiliation(s)
- C P Charalambous
- Department of Trauma and Orthopaedics, Burnley General Hospital, Burnley, UK.
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Charalambous CP, Alvi F, Siddique I, Zenios M, Hirst P, Marshall P. Casting versus surgical fixation for grade IIIA open tibial diaphysial fractures in children: effect on the rate of infection and the need for secondary surgical procedures to promote bone union. Int Orthop 2005; 29:392-5. [PMID: 16091949 PMCID: PMC2231577 DOI: 10.1007/s00264-005-0009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 06/02/2005] [Accepted: 06/13/2005] [Indexed: 11/26/2022]
Abstract
We evaluated 39 grade IIIA open tibial fractures presenting in children younger than 13 years of age, to determine if the mode of fracture stabilization (casting vs. surgical fixation) was related to the rate of infection or the need for secondary surgical procedures to promote bone union. All fractures had wound debridement in the operating room. Thirty patients had manipulation and casting, and nine surgical internal or external fixation. There were two cases of infection in the cast-treated group and two in the surgical fixation group (P=0.17). None of the fractures required a secondary surgical procedure to promote bone union. Three of the fractures treated by manipulation and casting displaced; two required re-manipulation and casting and one was converted to external fixation. In two cases the applied external fixator had to be re-aligned. Our results suggest that manipulation and casting is a reliable treatment for open tibial fractures in children.
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Affiliation(s)
- C P Charalambous
- Department of Trauma & Orthopaedics, Manchester Royal Infirmary, Manchester, UK.
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Charalambous CP, Siddique I, Zenios M, Roberts S, Samarji R, Paul A, Hirst P. Early versus delayed surgical treatment of open tibial fractures: effect on the rates of infection and need of secondary surgical procedures to promote bone union. Injury 2005; 36:656-61. [PMID: 15826628 DOI: 10.1016/j.injury.2004.10.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [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: 12/16/2003] [Accepted: 10/04/2004] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate whether there was any significant difference in the rates of infection and of secondary surgical procedures to promote bone union, between early(6 h or less after arrival to hospital) and delayed(more than 6 h) surgical treatment of open tibial fractures. Three hundred and eighty-three open tibial fractures were evaluated. 184 fractures had early and 199 had delayed surgical treatment. The rates of infection and secondary surgical procedures to promote bone union of the two groups were compared with univariate and multivariate statistical methods. There was no statistically significant difference between early and delayed treatment groups with respect to overall infection (53/184 versus 51/199 infection rates, P = 0.96), deep infection (8/184 versus 8/199 infection rates, P = 1.0), and rates of secondary surgical procedures to promote bone union (24/184 versus 20/198, P = 0.77). We were unable to demonstrate any significant difference in infection rates or need of secondary procedures to promote bone union, between early and delayed surgical treatment of open tibial fractures.
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Affiliation(s)
- C P Charalambous
- Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, UK.
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Malik RA, Tesfaye S, Newrick PG, Walker D, Rajbhandari SM, Siddique I, Sharma AK, Boulton AJM, King RHM, Thomas PK, Ward JD. Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetologia 2005; 48:578-85. [PMID: 15729579 DOI: 10.1007/s00125-004-1663-5] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [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: 06/24/2004] [Accepted: 11/17/2004] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS The early pathological features of human diabetic neuropathy are not clearly defined. Therefore we quantified nerve fibre and microvascular pathology in sural nerve biopsies from diabetic patients with minimal neuropathy. METHODS Twelve diabetic patients underwent detailed assessment of neuropathy and fascicular sural nerve biopsy at baseline, with repeat assessment of neuropathy 8.7+/-0.6 years later. RESULTS At baseline, neuropathic symptoms, neurological deficits, quantitative sensory testing, cardiac autonomic function and peripheral nerve electrophysiology showed minimal abnormality, which deteriorated at follow-up. Myelinated fibre density, fibre and axonal area, and g-ratio were normal but teased fibre studies showed paranodal abnormalities (p<0.001), segmental demyelination (p<0.01) and remyelination (p<0.01) without axonal degeneration. Unassociated Schwann cell profile density (p<0.04) and unmyelinated axon density (p<0.001) were increased and axon diameter was decreased (p<0.007). Endoneurial capillaries demonstrated basement membrane thickening (p<0.006), endothelial cell hyperplasia (p<0.004) and a reduction in luminal area (p<0.007). CONCLUSIONS/INTERPRETATION The early pathological features of human diabetic neuropathy include an abnormality of the myelinated fibre Schwann cell and unmyelinated fibre degeneration with regeneration. These changes are accompanied by a significant endoneurial microangiopathy.
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Affiliation(s)
- R A Malik
- Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
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Abstract
There is considerable geographical variation in the distribution of allelic types of Helicobacter pylori. This first study from Kuwait determined the prevalence of cagA and vacA genotypes among 117 unselected patients attending a gastroenterology center. We found that whereas vacA s1 and s2 types were equally likely to be present in biopsies obtained from patients of Middle-Eastern origin, African Arabs were predominantly infected with s2 type and South-Asians the s1 type. South Asians most frequently carried the cagA positive genotype with Bangladeshis showing the highest prevalence rate of 87%.
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Affiliation(s)
- Asmaa Al Qabandi
- Department of Pathology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
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Harrison JWK, Siddique I, Powell ES, Shaaban H, Stanley JK. Does the orientation of the distal radioulnar joint influence the force in the joint and the tension in the interosseous membrane? Clin Biomech (Bristol, Avon) 2005; 20:57-62. [PMID: 15567537 DOI: 10.1016/j.clinbiomech.2004.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 03/19/2004] [Accepted: 07/28/2004] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of change in the orientation of the distal radioulnar joint on the force in the joint and the strain in the interosseous membrane. DESIGN Biomechanical study in fresh frozen cadavers. BACKGROUND The articular surfaces of the distal radioulnar joint may be orientated in parallel with the long axis of the forearm (a Type I joint) or at an oblique angle opening distally to the ulnar side (a Type II joint). METHODS Three cadaveric upper limbs were held on a custom built frame allowing measured rotation and axial loading across the wrist. Measurements of force in the distal radioulnar joint and strain in the interosseous membrane were taken and repeated after replacement of the distal radioulnar joint with prosthetic Type I and Type II joints. FINDINGS The force in the joint and the strain in the interosseous membrane increased with increasing load across the wrist (P < 0.0001). The force in the Type I joint was reduced compared to the normal or Type II joint. This difference was greater with increasing load and was significant at 8 kg (P < 0.001). The strain in the interosseous membrane was maximal at neutral forearm rotation and decreased with increasing pronation and supination. INTERPRETATION The force in the joint is greater with the Type II distal radioulnar joint. We believe this compressive force increases joint stability and this orientation of the articular surfaces should be considered in the design of a total distal radioulnar joint arthroplasty.
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Affiliation(s)
- J W K Harrison
- Centre for Hand and Upper Limb Surgery, Wrightington Hospital, Appleby Bridge, UK.
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Abstract
Na/H exchanger-1 (NHE-1) isoform regulates intracellular pH and protects the esophageal mucosa. These functions are compromised in gastroesophageal reflux disease (GERD); however, the role and the underlying mechanism of NHE-1 regulation are obscure. To address this issue, NHE-1 protein and mRNA levels were measured by ECL western blot analysis and a semiquantitative RT-PCR using alpha-actin as an internal control. Ouabain-sensitive and K-stimulated p-nitrophenylphosphatase activity was measured as a marker of the sodium pump. The level of NHE-1 protein and mRNA and sodium pump activity was increased in GERD patients with or without esophagitis. Interestingly, myeloperoxidase (MPO) activity and infiltration of inflammatory cells were significantly increased in the GERD patients with esophagitis as compared to the GERD without esophagitis and the normal controls. This induction of NHE-1 and sodium pump was reversed in the GERD patients taking an H2 blocker, but not in those taking antacids. The internal control alpha-actin did not change under these conditions. Yield of total RNA and crude microsomal proteins was also statistically similar in all the test groups. These findings demonstrate that induction of NHE-1 is regulated posttranscriptionally through a possible interaction of histamine receptor. Induction of NHE-1 and sodium pump activity together might be a mechanism underlying the GERD pathogenesis and suggests a significance of NHE-1 inhibition in the treatment of GERD.
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Affiliation(s)
- I Siddique
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
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Abstract
Published guidelines recommend early transfer of patients with hip fractures to hospital wards and avoidance of unnecessary delays in A&E. We describe a protocol whereby the liaison of an orthopaedic trauma co-ordinator with A&E reduced A&E-to-ward transfer times by 43%. Following introduction of the new protocol, 39% of hip fracture patients were in a ward bed within 3 h of admission to A&E compared to 4% previously. The new protocol also reduces administrative workload for the on-call orthopaedic SHOs.
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Affiliation(s)
- C P Charalambous
- University Department of Trauma and Orthopaedic Surgery, Manchester Royal Infirmary, Manchester, UK.
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Abstract
BACKGROUND Sampling variability on liver biopsy has been demonstrated in a variety of liver diseases. The objective of this study was to determine whether sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection. METHODS Two separate tissue samples were obtained from the right lobe of the liver, through a single skin puncture, in 29 patients (22 M, mean age 43.4 +/- 8.1 years) with chronic HCV infection. The biopsies were assessed using a descriptive histological reporting system and Knodell's Histological Activity Index (HAI) and compared for differences in necroinflammatory activity (grade) and fibrosis (stage). RESULTS Thirteen (44.8%) patients had a difference of > or = 1 grade between the 2 biopsies on the descriptive system and 13 differed by > or = 1 stage. On the HAI, 20 (69.0%) patients had a difference of > or = 2 in the necroinflammatory activity score and 10 (34.5%) had a difference of > or = 4; whereas, 11 (38.0%) patients had a difference of > or = 1 in the fibrosis score and 6 (20.7%) had a difference of > or = 2. The mean difference between the two sets of biopsies was 2.4 +/- 2.1 (range 0-7) for the necroinflammatory activity and 0.6 +/- 0.9 (range 0-3) for fibrosis. Spearman's correlation coefficient (r) was moderate for both necroinflammatory activity (r = 0.53, P < 0.01) and fibrosis (r = 0.62, P < 0.0001). CONCLUSIONS Sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection and should be taken into consideration when decisions regarding prognosis and therapy are made based on biopsy, and when defining histological response to antiviral regimens.
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Affiliation(s)
- I Siddique
- Dept. of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
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Charalambous CP, Yarwood S, Paschalides C, Siddique I, Hirst P, Paul A. Factors delaying surgical treatment of hip fractures in elderly patients. Ann R Coll Surg Engl 2003; 85:117-9. [PMID: 12648344 PMCID: PMC1963705 DOI: 10.1308/003588403321219911] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [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: 11/22/2022] Open
Abstract
BACKGROUND Published guidelines recommend early surgical treatment of hip fractures in elderly patients. Understanding the factors that delay surgical intervention is essential in order to introduce changes that will facilitate early treatment. AIM To determine the factors delaying surgical treatment of hip fractures in elderly patients for more than 24 h. PATIENTS AND METHODS Assessment of 163 consecutive patients undergoing surgery for hip fractures at the trauma unit of Manchester Royal Infirmary. RESULTS Only 72/163 (44.2%) patients had their operation within 24 h of presenting to hospital. The remaining 91 patients had a total of 239 days delay (in excess of the initial 24 h) for surgical treatment. Active medical problems (56.5%) and a wait for medical investigations (19.7%) caused most delays. Lack of operating theatre time and Sunday trauma lists caused 23.8% of delays. CONCLUSIONS Medical problems account for most delays of surgical treatment of hip fractures. A multidisciplinary approach, with early input by medical and anaesthetic teams, is essential in managing such patients. Established protocols may reduce waiting times for essential investigations.
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Affiliation(s)
- C P Charalambous
- University Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, UK.
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Charalambous C, Barker TA, Zipitis CS, Siddique I, Swindell R, Jackson R, Benson J. Comparison of peripheral and central venous pressures in critically Ill patients. Anaesth Intensive Care 2003; 31:34-9. [PMID: 12635392 DOI: 10.1177/0310057x0303100106] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [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: 11/15/2022]
Abstract
We conducted a prospective study to determine the relationship between central (CVP) and peripheral (PVP) venous pressures in critically ill patients. CVP and PVP were measured on five different occasions in 20 critically ill patients in the intensive care unit. Results showed that the mean difference between PVP and CVP was 4.4 mmHg (95% CI = 3.7 to 5.0). However, PVP might be 1.9 mmHg below (95% CI = 0.7 to 3.1) or 10.6 mmHg above (95% CI = 9.4 to 11.8) the CVP. The mean difference between changes in PVP and corresponding changes in CVP was 0.3 mmHg (95% CI = -0.1 to 0.7). The actual change in PVP could be 3.0 mmHg below (95% CI = 2.3 to 3.7) or 3.6 mmHg above (95% CI = 2.9 to 4.3) the change in CVP. Overall, the direction of change in PVP (rise or drop) predicted a same direction of change in CVP with an accuracy of 78%. Changes in PVP > or = 2 mmHg predicted a change in same direction of CVP with an accuracy of 90%. The direction of changes in CVP > or = 2 mmHg were predicted by the direction of change in PVP with an accuracy of 91%. We conclude that PVP measurement does not give an accurate estimate of the absolute value of CVP in individual patients. However, as changes in PVP parallel, in direction, changes in CVP, serial measurements of PVP may have a value in determining volume status and guiding fluid therapy in critically ill patients.
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Affiliation(s)
- C Charalambous
- Intensive Care Unit, Manchester Royal Infirmary, Manchester, United Kingdom
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Abstract
The purpose of this study was to define pathological abnormalities in the peripheral nerve of a large animal model of long-duration type 1 diabetes and also to determine the effects of treatment with sulindac. Detailed morphometric studies were performed to define nerve fiber and endoneurial capillary pathology in 6 control dogs, 6 type 1 diabetic dogs treated with insulin, and 6 type 1 diabetic dogs treated with insulin and sulindac for 4 years. Myelinated fiber and regenerative cluster density showed a non-significant trend toward a reduction in diabetic compared to control animals, which was prevented by treatment with sulindac. Unmyelinated fiber density did not differ among groups. However, diabetic animals showed a non-significant trend toward an increase in axon diameter (p < 0.07), with a shift of the size frequency distribution towards larger axons, which was not prevented by treatment with sulindac. Endoneurial capillary density and luminal area showed a non-significant trend toward an increase in diabetic animals, which was prevented with sulindac treatment. Endoneurial capillary basement membrane area was significantly increased (p < 0.05) in diabetic animals, but was not prevented with sulindac treatment. We conclude that the type 1 diabetic dog demonstrates minor structural abnormalities in the nerve fibers and endoneurial capillaries of the sciatic nerve, and treatment with sulindac ameliorates some but not all of these abnormalities.
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Affiliation(s)
- D Walker
- Department of Medicine, Manchester Royal Infirmary, UK
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Malik RA, Veves A, Walker D, Siddique I, Lye RH, Schady W, Boulton AJ. Sural nerve fibre pathology in diabetic patients with mild neuropathy: relationship to pain, quantitative sensory testing and peripheral nerve electrophysiology. Acta Neuropathol 2001; 101:367-74. [PMID: 11355308 DOI: 10.1007/s004010000287] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [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: 10/25/2022]
Abstract
Nerve fibre pathology is poorly described in diabetic patients with mild neuropathy and has not been adequately related to clinical evaluation, quantitative sensory examination and neurophysiology. Sural nerve myelinated and unmyelinated fibre pathology was morphometrically quantified and related to the presence of pain and conventional measures of neuropathic severity in 15 diabetic patients with mild neuropathy and 14 control subjects. Diabetic patients demonstrated a significant (P < 0.01) reduction in myelinated fibre density, but no change in fibre/axonal area, or g-ratio, compared to control subjects. Unmyelinated fibre degeneration was evidenced by an increase in the percentage of unassociated Schwann cell profiles (P < 0.0001) and a reduction in axon density (P < 0.0008) in diabetic patients. This was associated with a significant reduction in unmyelinated axon diameter (P < 0.001) with a shift of the size frequency distribution to the left (P < 0.02). Neurophysiology, quantitative sensory testing and nerve fibre pathology failed to differentiate diabetic patients with painful and painless neuropathy and failed to correlate with any measure of unmyelinated fibre pathology.
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Affiliation(s)
- R A Malik
- University Department of Medicine, Manchester Royal Infirmary, Oxford Road, M13 9WL, UK.
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Mésangeau D, Laroche S, Laude D, Elghozi J, Malik R, Walker D, Siddique I, Tomlinson D. Early Detection Of Autonomic Neuropathy In Diabetic Minipigs By Blood Pressure And Heart Rate Variability: Relationship With Changes In Vagus Nerve Morphometry. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000abstracts-15.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - D Laude
- CNRS UMR 8604, Paris, France,
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Mésangeau D, Laroche S, Laude D, Elghozi J, Malik R, Walker D, Siddique I, Tomlinson D. Early Detection Of Autonomic Neuropathy In Diabetic Minipigs By Blood Pressure And Heart Rate Variability: Relationship With Changes In Vagus Nerve Morphometry. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.abstracts-15.x] [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: 11/20/2022]
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Malik R, Tesfaye S, Walker D, Newrick P, Bandhari R, Siddique I, Boulton A, Ward J. Sural Nerve Pathology In Asymptomatic Minimally Neuropathic Diabetic Patients. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000.005003177.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ra Malik
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - S Tesfaye
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - D Walker
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - Pg Newrick
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - R Bandhari
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - I Siddique
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - Ajm Boulton
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
| | - Jd Ward
- Manchester Royal Infirmary 1, Royal Hallamshire Hospital, 2 UK
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Wesley IV, Wells SJ, Harmon KM, Green A, Schroeder-Tucker L, Glover M, Siddique I. Fecal shedding of Campylobacter and Arcobacter spp. in dairy cattle. Appl Environ Microbiol 2000; 66:1994-2000. [PMID: 10788372 PMCID: PMC101445 DOI: 10.1128/aem.66.5.1994-2000.2000] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.4] [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: 10/12/1999] [Accepted: 02/01/2000] [Indexed: 11/20/2022] Open
Abstract
Campylobacter jejuni, Campylobacter coli, and Arcobacter spp. were detected in feces of healthy dairy cows by highly specific multiplex-PCR assays. For C. jejuni, at this one-time sampling, cows from 80.6% of farm operations (n = 31) and 37.7% of individual dairy cattle fecal samples (n = 2,085) were positive. Farm management factors were correlated with prevalence in herds in which >25% of cows were positive for C. jejuni. Statistical significance was set at a P of 0.20. Using these criteria, application of manure with broadcast spreaders (P = 0.17), feeding of whole cottonseed or hulls (P = 0.17) or alfalfa (P = 0.15), and accessibility of feed to birds (P = 0.17) were identified as possible risk factors for C. jejuni infection. C. coli was detected in at least one animal in 19.4% of operations and 1.8% of individual cows (n = 2,085). At the herd level, use of broadcaster spreaders was not a risk factor for C. coli infection. For Arcobacter, cows from 71% of dairy operations (n = 31) and 14.3% of individual dairy cattle fecal samples (n = 1,682) were positive. At the herd level, for Arcobacter spp., feeding of alfalfa (P = 0.11) and use of individual waterers (P = 0.19) were protective. This is the first description of Arcobacter spp. in clinically healthy dairy cattle and the first attempt to correlate their presence with C. jejuni.
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Affiliation(s)
- I V Wesley
- Pre-Harvest Food Safety and Enteric Diseases Research Unit, National Animal Disease Center, Agricultural Research Service, U.S. Department of Agriculture, Ames, Iowa 50010, USA.
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