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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Hatter M, Abdelwahab M, Holsinger FC, Capasso R, Nayak JV, Hwang PH, Patel ZM, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The burden of olfactory dysfunction during the COVID-19 pandemic in the United Kingdom. Rhinology 2023; 61:93-96. [PMID: 36286227 DOI: 10.4193/rhin22.232] [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: 02/02/2023]
Affiliation(s)
- M Lechner
- Division of Surgery and Interventional Science, University College London, London, UK; UCL Cancer Institute, University College London, London, UK; ENT Department, Barts Health NHS Trust, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | - D Chandrasekharan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - R Gupta
- Division of Surgery and Interventional Science, University College London, London, UK
| | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - M Hatter
- Medical University of South Carolina, Charleston, SC, USA
| | - M Abdelwahab
- Medical University of South Carolina, Charleston, SC, USA
| | - F C Holsinger
- Medical University of South Carolina, Charleston, SC, USA
| | - R Capasso
- Medical University of South Carolina, Charleston, SC, USA
| | - J V Nayak
- Medical University of South Carolina, Charleston, SC, USA
| | - P H Hwang
- Medical University of South Carolina, Charleston, SC, USA
| | - Z M Patel
- Medical University of South Carolina, Charleston, SC, USA
| | - S Paun
- Division of Surgery and Interventional Science, University College London, London, UK
| | - N Eynon-Lewis
- Division of Surgery and Interventional Science, University College London, London, UK
| | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- Division of Surgery and Interventional Science, University College London, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospitals NHS Trust, London, UK
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Tan BKJ, Han R, Zhao JJ, Tan NKW, Quah ESH, Tan CJW, Chan YH, Teo NWY, Charn TC, See A, Xu S, Chapurin N, Chandra RK, Chowdhury N, Butowt R, von Bartheld CS, Kumar BN, Hopkins C, Toh ST. Prognosis and persistence of smell and taste dysfunction in patients with covid-19: meta-analysis with parametric cure modelling of recovery curves. BMJ 2022; 378:e069503. [PMID: 35896188 PMCID: PMC9326326 DOI: 10.1136/bmj-2021-069503] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To clarify in patients with covid-19 the recovery rate of smell and taste, proportion with persistent dysfunction of smell and taste, and prognostic factors associated with recovery of smell and taste. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Scopus, Cochrane Library, and medRxiv from inception to 3 October 2021. REVIEW METHODS Two blinded reviewers selected observational studies of adults (≥18 years) with covid-19 related dysfunction of smell or taste. Descriptive prognosis studies with time-to-event curves and prognostic association studies of any prognostic factor were included. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data, evaluated study bias using QUIPS, and appraised evidence quality using GRADE, following PRISMA and MOOSE reporting guidelines. Using iterative numerical algorithms, time-to-event individual patient data (IPD) were reconstructed and pooled to retrieve distribution-free summary survival curves, with recovery rates reported at 30 day intervals for participants who remained alive. To estimate the proportion with persistent smell and taste dysfunction, cure fractions from Weibull non-mixture cure models of plateaued survival curves were logit transformed and pooled in a two stage meta-analysis. Conventional aggregate data meta-analysis was performed to explore unadjusted associations of prognostic factors with recovery. MAIN OUTCOME MEASURES The primary outcomes were the proportions of patients remaining with smell or taste dysfunction. Secondary outcomes were the odds ratios of prognostic variables associated with recovery of smell and taste. RESULTS 18 studies (3699 patients) from 4180 records were included in reconstructed IPD meta-analyses. Risk of bias was low to moderate; conclusions remained unaltered after exclusion of four high risk studies. Evidence quality was moderate to high. Based on parametric cure modelling, persistent self-reported smell and taste dysfunction could develop in an estimated 5.6% (95% confidence interval 2.7% to 11.0%, I2=70%, τ2=0.756, 95% prediction interval 0.7% to 33.5%) and 4.4% (1.2% to 14.6%, I2=67%, τ2=0.684, 95% prediction interval 0.0% to 49.0%) of patients, respectively. Sensitivity analyses suggest these could be underestimates. At 30, 60, 90, and 180 days, respectively, 74.1% (95% confidence interval 64.0% to 81.3%), 85.8% (77.6% to 90.9%), 90.0% (83.3% to 94.0%), and 95.7% (89.5% to 98.3%) of patients recovered their sense of smell (I2=0.0-77.2%, τ2=0.006-0.050) and 78.8% (70.5% to 84.7%), 87.7% (82.0% to 91.6%), 90.3% (83.5% to 94.3%), and 98.0% (92.2% to 95.5%) recovered their sense of taste (range of I2=0.0-72.1%, τ2=0.000-0.015). Women were less likely to recover their sense of smell (odds ratio 0.52, 95% confidence interval 0.37 to 0.72, seven studies, I2=20%, τ2=0.0224) and taste (0.31, 0.13 to 0.72, seven studies, I2=78%, τ2=0.5121) than men, and patients with greater initial severity of dysfunction (0.48, 0.31 to 0.73, five studies, I2=10%, τ2<0.001) or nasal congestion (0.42, 0.18 to 0.97, three studies, I2=0%, τ2<0.001) were less likely to recover their sense of smell. CONCLUSIONS A substantial proportion of patients with covid-19 might develop long lasting change in their sense of smell or taste. This could contribute to the growing burden of long covid. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021283922.
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Affiliation(s)
| | - Ruobing Han
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Kye Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emrick Sen Hui Quah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Claire Jing-Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Neville Wei Yang Teo
- Surgery Academic Clinical Program, SingHealth, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Tze Choong Charn
- Surgery Academic Clinical Program, SingHealth, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital, Singapore
| | - Anna See
- Surgery Academic Clinical Program, SingHealth, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Sengkang General Hospital, Singapore
| | - Shuhui Xu
- Surgery Academic Clinical Program, SingHealth, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Nikita Chapurin
- Department of Otorhinolaryngology-Head and Neck Surgery, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Rakesh K Chandra
- Department of Otorhinolaryngology-Head and Neck Surgery, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Naweed Chowdhury
- Department of Otorhinolaryngology-Head and Neck Surgery, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Rafal Butowt
- Department of Molecular Cell Genetics, L Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - B Nirmal Kumar
- Wigan and Leigh Teaching NHS Foundation Trust, Wrightington, UK
- Edge Hill University Medical School, Orsmkirk, UK
| | - Claire Hopkins
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospitals, London, UK
- King's College, London, UK
| | - Song Tar Toh
- Surgery Academic Clinical Program, SingHealth, Singapore
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
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Hardman JC, Harrington K, Roques T, Sood S, Jose J, Lester S, Pracy P, Simo R, Repanos C, Stafford F, Jennings C, Winter SC, Wheatly H, Homer J, Kumar BN, Paleri V. Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative. BMC Med Res Methodol 2022; 22:189. [PMID: 35818027 PMCID: PMC9275134 DOI: 10.1186/s12874-022-01667-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. METHODS A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. RESULTS Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached 'strong agreement' (n = 25, 2, 0 for each round, respectively), a single statement achieved 'agreement' only (round 3), and 'no agreement' could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. CONCLUSIONS The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sanjai Sood
- Department of Otolaryngology, Head and Neck Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jemy Jose
- Department of Otolaryngology, Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Shane Lester
- Department of Otolaryngology, Head and Neck Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Paul Pracy
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ricard Simo
- Department of Otolaryngology, Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Costa Repanos
- Department of Otolaryngology, Head and Neck Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Frank Stafford
- Department of Otolaryngology, Head and Neck Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Chris Jennings
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stuart C Winter
- Department of Otolaryngology, Head and Neck Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Wheatly
- Department of Otolaryngology, Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jarrod Homer
- Department of Otolaryngology, Head and Neck Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - B Nirmal Kumar
- Department of Otolaryngology, Head and Neck Surgery, Wrightington Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
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Lechner M, Liu J, Counsell N, Gillespie D, Chandrasekharan D, Ta NH, Jumani K, Gupta R, Rao-Merugumala S, Rocke J, Williams C, Tetteh A, Amnolsingh R, Khwaja S, Batterham RL, Yan CH, Treibel TA, Moon JC, Woods J, Brunton R, Boardman J, Paun S, Eynon-Lewis N, Kumar BN, Jayaraj S, Hopkins C, Philpott C, Lund VJ. The COVANOS trial - insight into post-COVID olfactory dysfunction and the role of smell training. Rhinology 2022; 60:188-199. [PMID: 35901492 DOI: 10.4193/rhin21.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. METHODOLOGY We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. RESULTS 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. CONCLUSIONS Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.
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Affiliation(s)
- M Lechner
- ENT Department, Barts Health NHS Trust, London, UK; UCL Cancer Institute, University College London, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - J Liu
- UCL Cancer Institute, University College London, London, UK
| | - N Counsell
- CRUK and UCL Cancer Trials Centre, University College London, London, UK
| | - D Gillespie
- UCL Cancer Institute, University College London, London, UK
| | | | - N H Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Jumani
- ENT Department, Barts Health NHS Trust, London, UK
| | - R Gupta
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - J Rocke
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - C Williams
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - A Tetteh
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - R Amnolsingh
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, UK
| | - R L Batterham
- Centre for Obesity Research, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research, UCLH Biomedical Research Centre, London, UK
| | - C H Yan
- Department of Otolaryngology-Head and Neck Surgery, University of San Diego School of Medicine, San Diego, USA
| | - T A Treibel
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J C Moon
- National Institute for Health Research, UCLH Biomedical Research Centre, London, UK; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Sciences, University College London, UK
| | - J Woods
- The Norfolk Smell and Taste Clinic, Norfolk
| | - R Brunton
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Paun
- ENT Department, Barts Health NHS Trust, London, UK
| | | | - B N Kumar
- ENT Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - S Jayaraj
- ENT Department, Barts Health NHS Trust, London, UK
| | - C Hopkins
- ENT Department, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, UK
| | - V J Lund
- Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK
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Chu M, Gopikrishna D, Rocke J, Kumar BN. Implementing a COVID-19 specialist smell clinic: experience at the Wrightington, Wigan and Leigh Teaching Hospitals (WWL), NHS Foundation Trust, United Kingdom. Med J Malaysia 2021; 76:9-13. [PMID: 34558550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION It is clear that a proportion of patients continue to suffer long-lasting symptoms following acute infection with coronavirus disease 2019 (COVID-19). Persistent olfactory dysfunction is one of the commonest complaints reported in the condition colloquially known as long COVID (now known as post-acute sequelae of SARS-CoV-2 infection (PASC)). The prevalence, risk factors and clinical course of long COVID olfactory dysfunction are not yet well understood. At present, the main stay of treatment is olfactory training. Quantitative olfactory testing and impacts on patient quality of life have not been widely studied. This study describes our experiences at Wrightington, Wigan and Leigh Teaching Hospitals, UK (WWL) of establishing a COVID-19 smell clinic, along with preliminary data on patient demographics, baseline smell test scores and quality of life questionnaire scores before olfactory training. METHODS We piloted a COVID-19 smell clinic. We recorded patient demographics and clinical characteristics then performed clinical assessment of each patient. Quantitative measurements of olfactory dysfunction were recorded using the University of Pennsylvania Smell Identification Test (UPSIT). We measured the impact of olfactory dysfunction on patient quality of life using the validated English Olfactory Disorders Questionnaire (eODQ). RESULTS 20 patients participated in the clinic. 4 patients were excluded from analysis due to missing data. Median age was 35 years. 81% (n=13) of the participants were female. 50% (n=8) of patients suffered with a combination of anosmia/ageusia and parosmia, whilst 43% (n=7) of patients suffered with anosmia/ageusia without parosmia. Almost all the patients registered UPSIT scores in keeping with impaired olfaction. Patient scores ranged from 22 to 35, with the median score at 30. All patients reported that their olfactory dysfunction had an impact on their quality of life. The median eODQ score reported was 90, with scores ranging from 42 to 169 out of a maximum of 180. CONCLUSION We have demonstrated that it is simple and feasible to set up a COVID-19 smell clinic. The materials are inexpensive, but supervised completion of the UPSIT and eODQ is time-consuming. Patients demonstrate reduced olfaction on quantitative testing and experience significant impacts on their quality of life as a result. More research is needed to demonstrate if olfactory training results in measurable improvements in smell test scores and quality of life.
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Affiliation(s)
- M Chu
- Teaching Hospitals, Department of Otolaryngology, United Kingdom
| | - D Gopikrishna
- eaching Hospitals, Department of Otolaryngology, United Kingdom
| | - J Rocke
- eaching Hospitals, Department of Otolaryngology, United Kingdom
| | - B N Kumar
- eaching Hospitals, Department of Otolaryngology, United Kingdom.
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Rocke J, Evans C, Kumar BN. Teaching and training in Otorhinolaryngology (ORL) during the pandemic and beyond, in the United Kingdom. Med J Malaysia 2021; 76:27-30. [PMID: 34558554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
No abstract provided.
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Affiliation(s)
- J Rocke
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom
| | - C Evans
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom
| | - B N Kumar
- Health Education England & Wrightington, Wigan and Leigh Teaching NHS Foundation Trust, United Kingdom.
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8
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Kumar A, Rocke JPJ, Kumar BN. Evolving treatments in high-risk neuroblastoma. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1865918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Abhinav Kumar
- Division of Medicine, University College London Medical School, London, UK
| | - John P J Rocke
- ENT Department, Royal Albert Edward Infirmary, Wigan, UK
| | - B Nirmal Kumar
- ENT Department, Wrightington, Wigan & Leigh Teaching NHS, Wigan, UK
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Lechner M, Liu J, Counsell N, Ta NH, Rocke J, Anmolsingh R, Eynon-Lewis N, Paun S, Hopkins C, Khwaja S, Kumar BN, Jayaraj S, Lund VJ, Philpott C. Course of symptoms for loss of sense of smell and taste over time in one thousand forty-one healthcare workers during the Covid-19 pandemic: Our experience. Clin Otolaryngol 2020; 46:451-457. [PMID: 33283459 PMCID: PMC8240100 DOI: 10.1111/coa.13683] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Matt Lechner
- Barts Health NHS Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer, Trials Centre, University College London, London, UK
| | - Ngan Hong Ta
- The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - John Rocke
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Sadie Khwaja
- Manchester University NHS Foundation Trust, London, UK
| | - B Nirmal Kumar
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, London, UK
| | | | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK
| | - Carl Philpott
- The Norfolk Smell & Taste Clinic, Norfolk & Waveney ENT Service, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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Hopkins C, Alanin M, Philpott C, Harries P, Whitcroft K, Qureishi A, Anari S, Ramakrishnan Y, Sama A, Davies E, Stew B, Gane S, Carrie S, Hathorn I, Bhalla R, Kelly C, Hill N, Boak D, Nirmal Kumar B. Management of new onset loss of sense of smell during the COVID-19 pandemic - BRS Consensus Guidelines. Clin Otolaryngol 2020; 46:16-22. [PMID: 32854169 PMCID: PMC7461026 DOI: 10.1111/coa.13636] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 08/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset loss of sense of smell during the COVID-19 pandemic. DESIGN After undertaking a literature review, we used the RAND/UCLA methodology with a multi-step process to reach consensus about treatment options, onward referral, and imaging. SETTING AND PARTICIPANTS An expert panel consisting of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. MAIN OUTCOME MEASURES The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset loss of sense of smell during the COVID-19 pandemic. Using a 9-point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. RESULTS Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A drops. Alpha-lipoic acid was not recommended, olfactory training was recommended for all patients with persistent loss of sense of smell of more than 2 weeks duration, and oral steroids, steroid rinses, and omega 3 supplements may be considered on an individual basis. Recommendations regarding the need for referral and investigation have been made. CONCLUSION This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID-19-related loss of sense of smell. The guideline may evolve as our experience of COVID-19 develops.
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Affiliation(s)
| | | | | | - Phil Harries
- University Hospital Southampton, Southampton, UK
| | | | | | - Shahram Anari
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | | | - Anshul Sama
- Nottingham University Hospital, Nottingham, UK
| | | | - Ben Stew
- University Hospital Wales, Cardiff, UK
| | - Simon Gane
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - Sean Carrie
- The Freeman Hospital and University of Newcastle, Newcastle upon Tyne, UK
| | | | - Raj Bhalla
- Central Manchester & Manchester Children's Foundation Trust, Manchester, UK
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11
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Cherry G, Rocke J, Chu M, Liu J, Lechner M, Lund VJ, Kumar BN. Loss of smell and taste: a new marker of COVID-19? Tracking reduced sense of smell during the coronavirus pandemic using search trends. Expert Rev Anti Infect Ther 2020; 18:1165-1170. [PMID: 32673122 PMCID: PMC7441792 DOI: 10.1080/14787210.2020.1792289] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives It has been demonstrated that reduction in smell and/or taste is the most predictive symptom in SARS-CoV-2/Covid-19 infection. We used Google Trends to analyze regional searches relating to loss of smell and taste across Italy, Spain, France, Brazil, and the United States of America and determined the association with reported Covid-19 cases. Methods In order to retrieve the data, we built a Python software program that provides access to Google Trends data via an application program interface. Daily COVID-19 case data for subregions of the five countries selected were retrieved from respective national health authorities. We sought to assess the association between raw search interest data and COVID-19 new daily cases per million for all regions individually. Results In total, we yielded 2188 sets of Google Trends data which included 548 time series of 4 anosmia and ageusia search concepts over the study period for 137 regions. These data indicated that differences in search interest for terms relating to anosmia and ageusia, between regions, is associated with geographical trends in new Covid-19 cases. Conclusions We feel that Google search trends relating to loss of smell can be utilized to identify potential Covid-19 outbreaks on a national and regional basis.
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Affiliation(s)
| | - John Rocke
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
| | - Michael Chu
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London , London, UK
| | - Matt Lechner
- UCL Cancer Institute, University College London , London, UK.,Barts Health NHS Trust, Royal London Hospital and Whipps Cross University Hospital , UK
| | - Valerie J Lund
- Royal National Throat Nose and Ear Hospital, UCLH Foundation Trust , UK
| | - B Nirmal Kumar
- Wigan and Leigh Teaching Hospitals NHS Foundation Trust , Wrightington, UK
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12
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Hopkins C, Surda P, Whitehead E, Kumar BN. Early recovery following new onset anosmia during the COVID-19 pandemic - an observational cohort study. J Otolaryngol Head Neck Surg 2020; 49:26. [PMID: 32366299 PMCID: PMC7196882 DOI: 10.1186/s40463-020-00423-8] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A rapidly evolving evidence suggests that smell and taste disturbance are common symptoms in COVID-19 infection. As yet there are no reports on duration and recovery rates. We set out to characterise patients reporting new onset smell and taste disturbance during the COVID-19 pandemic and report on early recovery rates. METHODS Online Survey of patients reporting self-diagnosed new onset smell and taste disturbance during the COVID-19 pandemic, with 1 week follow-up. RESULTS Three hundred eighty-two patents completed bot an initial and follow-up survey. 86.4% reported complete anosmia and a further 11.5% a very severe loss of smell at the time of completing the first survey. At follow-up 1 week later, there is already significant improvement in self-rating of severity of olfactory loss. 80.1% report lower severity scores at follow-up, 17.6% are unchanged and 1.9% are worse. 11.5% already report compete resolution at follow up, while 17.3% report persistent complete loss of smell, with reported duration being 1 to over 4 weeks. This is reflected in the overall cumulative improvement rate of 79% patients overall in the interval between surveys. CONCLUSIONS A review of the growing evidence base supports the likelihood that out cohort have suffered olfactory loss as part of COVID-19 infection. While early recovery rates are encouraging, long term rates will need to be further investigated and there may be an increase in patients with persistent post-viral loss as a result of the pandemic. We further call for loss of sense of smell to be formerly recognised as a marker of COVID-19 infection.
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Affiliation(s)
- Claire Hopkins
- Guy's and St Thomas' Hospitals, London, SE1 9RT, UK.
- King's College, London, UK.
| | - Pavol Surda
- Guy's and St Thomas' Hospitals, London, SE1 9RT, UK
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13
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Edmiston R, Anmolsingh R, Khwaja S, Kumar BN. ENT Quality Improvement Program as a tool to improve the collection of morbidity and mortality data: a multisite audit carried out over 6 months. BMJ Open Qual 2019; 8:e000501. [PMID: 31523728 PMCID: PMC6711441 DOI: 10.1136/bmjoq-2018-000501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 07/06/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022] Open
Abstract
Objective This project aims to assess the role of a standardised process of data collection to improve morbidity and mortality data across the region. Design Six hospitals within the North West (UK) were recruited and adopted the ENT Quality Improvement Program (QIP) into their daily practice. Monthly anonymous data were sent back to the reviewer for trend analysis. Outcome measures Four outcome measures were defined: (1) number of cases recorded within the region each month; (2) assessment of the severity of cases and trends; (3) assessment of action plans reviewing any changes in practice made as a result of using this tool; (4) long-term use of the tool and qualitative feedback from units. Results 162 patients over the 6 months were included with 180 case discussions. 170 of these were morbidities and 10 were mortalities. Mortality was more frequent in patients with a diagnosis of head and neck cancer. Of the 162 patients, 133 encountered postoperative complications. Post-tonsillectomy (62/133 47%) and post-thyroid surgery (19/133 14%) complications were the most frequently encountered. 66% of the complications were low grade with 18% requiring management under general anaesthetic. Actions plans included four policy reviews with the introduction of three new policies. All sites found the tool user-friendly and are continuing to use it beyond the data collection period. Conclusions The ENT QIP has been found to be a simple, user-friendly tool which has improved the quality of data over the six sites and resulted in improvements in practice. Implementation of the tool allows clinicians to critically appraise their practice and to reflect as well as to demonstrate how complications have resulted in change.
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Affiliation(s)
| | | | - Sadie Khwaja
- ENT department, Stepping hill hospital, Manchester, UK
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14
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Jahan N, Bano H, Ahmed Makbul S, Kumar BN, Mushir A. Effect of hydroalcoholic extract of Cyperus rotundus L. Rhizome against ethylene glycol and ammonium chloride-induced urolithiasis in male sprague-dawley rats. Urol Sci 2019. [DOI: 10.4103/uros.uros_136_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Htun HM, Edmiston R, Kaimal K, Kumar BN. Variable management of postoperative hypoparathyroidism at nine NHS trusts in north-west England: The need for a universal protocol. Clin Otolaryngol 2018; 43:1583-1587. [PMID: 30063291 DOI: 10.1111/coa.13205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/11/2018] [Accepted: 06/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Hay Mar Htun
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Rachel Edmiston
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Krishna Kaimal
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - B N Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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16
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Bano H, Jahan N, Makbul SAA, Kumar BN, Husain S, Sayed A. Effect of Piper cubeba L. fruit on ethylene glycol and ammonium chloride induced urolithiasis in male Sprague Dawley rats. Integr Med Res 2018; 7:358-365. [PMID: 30591890 PMCID: PMC6303358 DOI: 10.1016/j.imr.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022] Open
Abstract
Background To investigate the antilithiatic effect of hydroalcoholic extract of Kabab Chini (Piper cubeba L.) fruit in male Sprague Dawley rats. Methods Rats were divided into six groups of six each. Group I received regular rat food and drinking water ad libitum. Groups II to VI were administered with ethylene glycol (EG) 0.75% (V/V) and ammonium chloride (AC) 1% (W/V) in drinking water for 7 days to induce urolithiasis. From 8th day Group I received 1 mL of 5% gum acacia. Group IV was treated with Cystone; V and VI groups with the hydro-alcoholic extract of Piper cubeba L. Treatment was continued for further 14 days, thereafter animals sacrificed. While Group II animals were sacrificed just after 7 days treatment with EG and AC. Group III was left untreated until 14 days and sacrificed on 22nd day. Crystalluria was analyzed on 8th and 22nd day while, urinary calcium, phosphorus, creatinine, sodium and magnesium on 22nd day. Biochemistry and histopathological studies of kidney were also carried out. Results Test groups showed significant reduction (p < 0.001) of crystals in urine. Serum creatinine and urea (p < 0.01) were also decreased significantly. Urine analysis showed significant increase in magnesium while calcium, sodium, chloride and phosphorus significantly decreased along with histopathological improvement in kidney tissue in treated groups. Conclusion From the above results it can be concluded that hydroalcoholic extract of P. cubeba L. fruit has significant inhibitory effect in calcium oxalate urolithiasis.
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Affiliation(s)
- Humaira Bano
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India
| | - Nasreen Jahan
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India
| | - Shaikh Ajij Ahmed Makbul
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India
| | - B N Kumar
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India
| | - Sadique Husain
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India
| | - Atiya Sayed
- Department of Obstetrics and Gynecology, National Institute of Unani Medicine, Bangalore, India
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17
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Papadopoulos I, Zorba A, Koulouglioti C, Ali S, Aagard M, Akman O, Alpers LM, Apostolara P, Biles J, Martín-García Á, González-Gil T, Kouta C, Krepinska R, Kumar BN, Lesińska-Sawicka M, Lopez L, Malliarou M, Nagórska M, Nissim S, Nortvedt L, Oter-Quintana C, Ozturk C, Pangilinan SB, Papp K, Eldar Regev O, Rubiano FO, Tolentino Diaz MY, Tóthová V, Vasiliou M. International study on nurses' views and experiences of compassion. Int Nurs Rev 2018; 63:395-405. [PMID: 27557745 DOI: 10.1111/inr.12298] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics. AIM The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses. METHODS An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire. RESULTS The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion. CONCLUSION Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers. LIMITATIONS Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses. IMPLICATIONS FOR NURSING POLICY Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff).
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Affiliation(s)
- I Papadopoulos
- Research Centre for Transcultural Studies in Health, Middlesex University, London, UK
| | - A Zorba
- Middlesex University, London, UK
| | - C Koulouglioti
- Research and Innovation Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - S Ali
- Research Centre for Transcultural Studies in Health, Middlesex University, London, UK
| | - M Aagard
- Walden University, Minneapolis, MN, USA
| | - O Akman
- Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - L-M Alpers
- Lovisenberg Diaconal Hospital/Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - P Apostolara
- National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - J Biles
- Charles Sturt University, Abury, NSW, Australia
| | - Á Martín-García
- Centro de San Blas, Servicio Madrileño de Salud, Madrid, Spain
| | - T González-Gil
- Nursing Section Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - C Kouta
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - R Krepinska
- School of Nursing, Havlíčkův Brod, Czech Republic
| | - B N Kumar
- Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | | | - L Lopez
- Universidad Nacional de Colombia - Bogotá - Facultad de Enfermería., Colombia
| | - M Malliarou
- Technological Institution of Thessaly, Larisa, Greece
| | | | - S Nissim
- Wolfson Academic Nursing School, Tel Aviv University, Tel Aviv, Israel
| | - L Nortvedt
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - C Oter-Quintana
- Nursing Section Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - C Ozturk
- Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | | | - K Papp
- Faculty of Health, University of Debrecen, Debrecen, Hungary
| | - O Eldar Regev
- The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - F O Rubiano
- Bataan Peninsula State University, Balanga, Philippines
| | | | - V Tóthová
- Faculty of Health and Social Studies, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - M Vasiliou
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
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18
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Abstract
We present a simple method of preparing a smart phone based ENT endoscopy for OPD clinic and for on call ENT to provide emergency ENT care in Accident and Emergency department when required. In our experience, this method is efficient, economical and ensures mobility and flexibility of remote visual inspection and documentation. This aids in better care for patients especially where there is no easy access to traditional ENT treatment room facility. This provides a fast and cost-effective solution to simultaneously view capture and save photos and videos with a smartphone and, if required, send these pictures to oncall Consultant. This enables quicker identification, documentation and support regardless of location.
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Hellings PW, Akdis CA, Bachert C, Bousquet J, Pugin B, Adriaensen G, Advani R, Agache I, Anjo C, Anmolsingh R, Annoni E, Bieber T, Bizaki A, Braverman I, Callebaut I, Castillo Vizuete JA, Chalermwatanachai T, Chmielewski R, Cingi C, Cools L, Coppije C, Cornet ME, De Boeck I, De Corso E, De Greve G, Doulaptsi M, Edmiston R, Erskine S, Gevaert E, Gevaert P, Golebski K, Hopkins C, Hox V, Jaeggi C, Joos G, Khwaja S, Kjeldsen A, Klimek L, Koennecke M, Kortekaas Krohn I, Krysko O, Kumar BN, Langdon C, Lange B, Lekakis G, Levie P, Lourijsen E, Lund VJ, Martens K, Mő Sges R, Mullol J, Nyembue TD, Palkonen S, Philpott C, Pimentel J, Poirrier A, Pratas AC, Prokopakis E, Pujols L, Rombaux P, Schmidt-Weber C, Segboer C, Spacova I, Staikuniene J, Steelant B, Steinsvik EA, Teufelberger A, Van Gerven L, Van Gool K, Verbrugge R, Verhaeghe B, Virkkula P, Vlaminck S, Vries-Uss E, Wagenmann M, Zuberbier T, Seys SF, Fokkens WJ. EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis. Rhinology 2017; 55:202-210. [PMID: 28501885 DOI: 10.4193/rhin17.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.
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Affiliation(s)
- P W Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Christine-Kuhne Center for Allergy Research and Education, Davos, Switzerland
| | - C Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - J Bousquet
- Department of Respiratory Disease, University Hospital Arnaud de Villeneuve, Montpellier, France
| | - B Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - G Adriaensen
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Advani
- Health Education North West, Manchester, UK
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - C Anjo
- Department of Otorhinolaryngology, Hospital Sao Jose, Hospital Centre of Central Lisbon, Lisbon, Portugal
| | - R Anmolsingh
- Department of Otorhinolaryngology, Wigan Wrightington and Leigh NHS Foundation Trust, Wigan, UK
| | | | - T Bieber
- Department of Dermatology and Allergy, Christine Kuhne-Center for Allergy Research and Education, Friedrich-Wilhelms-University, Bonn, Germany
| | | | - I Braverman
- Hillel Yaffe Medical Center, Hadera Technion Faculty of Medicine, Haifa, Israel
| | - I Callebaut
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | | | - T Chalermwatanachai
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - R Chmielewski
- Department of Otolaryngology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - C Cingi
- Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, Eskisehir, Turkey
| | - L Cools
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - C Coppije
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - M E Cornet
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - I De Boeck
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - E De Corso
- Agostino Gemelli Hospital Foundation, Catholic University of the Sacred Heart, Head and Neck Surgery Area, Institute of Otorhinolaryngology, Rome, Italy
| | - G De Greve
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - M Doulaptsi
- Laboratory of Clinical Immunology, KU Leuven, Belgium
| | - R Edmiston
- Health Education North West, Manchester, UK
| | - S Erskine
- Norwich Medical School, University of East Anglia, UK
| | - E Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - P Gevaert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - K Golebski
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands
| | - C Hopkins
- ENT Departments, Guys and St Thomas Hospitals NHS Trust, London and James Paget University Hospital, Gorieston, United Kingdom
| | - V Hox
- Departement Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium
| | - C Jaeggi
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - G Joos
- Department of Respiratory Medicine, Ghent University, Belgium
| | - S Khwaja
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK
| | - A Kjeldsen
- Department Of Otorhinolaryngology, Odense University Hospital, Denmark
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M Koennecke
- University Hospital Schleswig-Holstein, Campus Lubeck, Department of Otorhinolaryngology, Lubeck, Germany
| | | | - O Krysko
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - B N Kumar
- Department of Otolaryngology-Head and Neck, WWL NHS Foundation Trust and NIHR CRN, Greater Manchester, UK
| | - C Langdon
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Clinical and Experimental Respiratory Immunology, IDIBAPS, Barcelona, Spain
| | - B Lange
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK
| | - G Lekakis
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | - P Levie
- ENT Clinic Messidor, Brussels, Belgium
| | - E Lourijsen
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, United Kingdom
| | - K Martens
- Laboratory of Clinical Immunology, KU Leuven, Belgium
| | - R Mő Sges
- Faculty of Medicine, Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Mullol
- Clinical and Experimental Respiratory Allergy, IDIBAPS, CIBERES. Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - T D Nyembue
- Department of OtoRhinoLaryngology, University of Kinshasa, Congo
| | - S Palkonen
- European Federation of Allergy and Airways Diseases Patients Associations (EFA), Brussels, Belgium
| | - C Philpott
- Norwich Medical School, University of East Anglia, UK
| | - J Pimentel
- Hospital de Egas Moniz and Hospital da Luz, Lisbon, Portugal
| | - A Poirrier
- ENT department, University Hospital of Liege, Belgium
| | - A C Pratas
- Norwich Medical School, University of East Anglia, UK
| | - E Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Greece
| | - L Pujols
- Clinical and Experimental Respiratory Allergy, IDIBAPS, CIBERES. Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - P Rombaux
- Departement d Otorhinolaryngologie, Cliniques Universitaires Saint-Luc, Belgium
| | - C Schmidt-Weber
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany
| | - C Segboer
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - I Spacova
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - J Staikuniene
- Lithuanian Universitys of health sciences, Department of Immunology and allergology, Kaunas, Lithuania
| | - B Steelant
- Laboratory of Clinical Immunology, KU Leuven, Belgium
| | - E A Steinsvik
- Department of Otorhinolaryngology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - A Teufelberger
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Belgium
| | - L Van Gerven
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Belgium
| | | | | | - B Verhaeghe
- Department of Otorhinolaryngology, Sint-Jozefskliniek, Izegem, Belgium
| | - P Virkkula
- Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - S Vlaminck
- Department of Otorhinolaryngology, AZ St. Johns Hospital, Bruges, Belgium
| | | | - M Wagenmann
- Department of Otorhinolaryngology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - T Zuberbier
- Comprehensive Allergy-Centre-Charite, Department of Dermatology and Allergy, Charite-Universitatsmedizin Berlin, Germany
| | - S F Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
BACKGROUND Allergic fungal rhinosinusitis (AFS) is considered to part of the disease spectrum of chronic rhinosinusitis, which affects between five to fifteen per cent of the population. Currently, there is uncertainty relating to the pathological process and therefore optimal management of AFS. Studies assessing antifungal use have shown mixed results. The aim of this review is to assess the effect of antifungals on patients with AFS. METHODS A systematic review of the literature to include all published trials searching Pubmed, Medline (Ovid), CINAHL (EBSCO) and the Cochrane central register of controlled trials (CENTRAL) databases. RESULTS Sixteen studies (two systematic reviews, two meta-analysis, four randomised controlled trials, five prospective cohort studies and three retrospective studies) were included in this review. There was found to be no overall benefit of topical or oral antifungals upon endoscopic findings or patient reported outcome measures in AFS. There were no statistically significant differences in adverse effect profiles between treatment and control groups. CONCLUSION There is limited evidence to support the use of topical or oral antifungal agents in patients with AFS. Future research recommendations include large multicentre randomised trials with better matched patient groups and appropriate dosage and timing of antifungals.
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Kumar BN, Wadud A, Jahan N, Sofi G, Bano H, Makbul SAA, Husain S. Antilithiatic effect of Peucedanum grande C. B. Clarke in chemically induced urolithiasis in rats. J Ethnopharmacol 2016; 194:1122-1129. [PMID: 27825989 DOI: 10.1016/j.jep.2016.10.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/18/2016] [Revised: 10/01/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Duqu (Peucedanum grande C. B. Clarke) has been used by Unani physicians since ancient times in retention of urine, renal and bladder calculi, nephritis and other associated disorders in different dosage forms. AIM OF THE STUDY The aim of the study was to evaluate the antiurolithiatic activity of Peucedanum grande C. B. Clarke in experimental model. MATERIALS AND METHODS The experiment was carried out in male Sprague Dawley rats divided into 5 groups of 8 animals each. Animals of negative control received 1ml of 5% Gum acacia throughout the study. Remaining four groups received Ethylene glycol 0.75% and Ammonium chloride 1% by adding in their drinking water for first seven days to induce urolithiasis. From 8th day, positive control received 1ml of 5% Gum acacia, standard control received Cystone in the dose of 750mg/kg while test groups A and B were treated with hydroalcoholic extract of test drug in the dose of 56mg/kg and 97mg/kg respectively up to 21 days, thereafter the animals were sacrificed. Number of CaOx crystals in urine, levels of serum calcium, phosphorus, creatinine, urea, urinary calcium and sodium were observed. Kidney homogenate analysis and histopathology were also carried out. RESULTS Test drug reduced number of CaOx crystals in urine (p<0.001); levels of serum calcium, phosphorus, creatinine, (p<0.001) urea, (p<0.05); urinary calcium (p<0.001) and sodium decreased significantly in standard and test groups. The urine volume increased significantly (p<0.05, 0.01) in both the test groups. Histopathology of kidney showed no CaOx crystal deposition in both the test groups. CONCLUSION On the basis of above findings, it can be concluded that the test drug possesses significant antiurolithiatic activity.
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Affiliation(s)
- B N Kumar
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
| | - Abdul Wadud
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
| | - Nasreen Jahan
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
| | - Ghulamuddin Sofi
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
| | - Humaira Bano
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
| | | | - Sadique Husain
- Department of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Bangalore, India.
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Stobbs N, Kumar BN. What is the current evidence for the use of virtual reality simulation in ENT training? Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.156] [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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Killick N, Cameron C, Malik V, Kumar BN. A low cost low fidelity trainer for tracheostomy care. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.183] [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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Abstract
We present the case of a 5-year-old boy with no personal or family history of bleeding disorders, who suffered from recurrent post-tonsillectomy bleeds. The patient required multiple separate emergency visits to theatre in the 2-week postoperative period to achieve haemostasis. Initial baseline coagulation tests were found to be normal. However more extensive clotting studies revealed that the patient had an undiagnosed 'mild' haemophilia A.
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Affiliation(s)
| | | | - B N Kumar
- Department of ENT, RAEI Hospital, Wigan, UK
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Abstract
Recurrent croup is a distinct clinical entity from viral croup. It is not a specific diagnosis and its presence should alert the clinician to explore the underlying cause. We discuss an evidence-based structured approach to management of a child with recurrent croup.
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Affiliation(s)
- Vineeta Joshi
- Department of Paediatrics, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - Vikas Malik
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - Omar Mirza
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
| | - B Nirmal Kumar
- Department of Otolaryngology Otolaryngology and Head and Neck Surgery, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, Lancashire, UK
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Affiliation(s)
- Neil Killick
- Clinical Research Fellow, Department of Otolaryngology, Royal Albert Edward Infirmary, Wigan WN1 2NN
| | - Vikas Malik
- Consultant Otolaryngologist/Head and Neck Surgeon, Department of Otolaryngology, Royal Albert Edward Infirmary, Wigan WN1 2NN
| | - B Nirmal Kumar
- Consultant Otolaryngologist/Head and Neck Surgeon in the Department of Otolaryngology, Royal Albert Edward Infirmary, Wigan WN1 2NN
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Achar P, Kumar BN. Can apneagraphy change our approach in management of snoring and sleep apnoea? Indian J Otolaryngol Head Neck Surg 2014; 66:110-4. [PMID: 24533368 DOI: 10.1007/s12070-011-0344-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/14/2011] [Accepted: 11/09/2011] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED To evaluate role of overnight domiciliary apneagraph in diagnosing severity of sleep apnoea. Prospective audit of 37 patients with Epworth sleepiness score over ten and all patients with history of sleep apnoea presenting to ENT outpatient clinic investigated with apneagraph. Data analysed initially with pulse oximetry findings alone followed by analysis with full apneagraph findings. RESULTS Data analysed with pulse oximetry alone showed 31 patients to be simple snorers, but on analysis with apneagraph, 11 of these were shown to be suffering from moderate and one with severe sleep apnoea. There was no correlation between Epworth sleepiness score and severity of sleep apnoea. CONCLUSION Management plan can be more evidence based by using apneagraph as a mini sleep study in investigating patients with history of obstructive sleep apnoea. Apneagraph could also be used in diagnosing the level of obstruction in snorers; however, this aspect needs further studying.
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Affiliation(s)
- Priya Achar
- Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK ; 10 Holme Avenue, Wigan, WN1 2EH UK
| | - B N Kumar
- Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan lane, Wigan, WN1 2NN UK
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Charaklias N, Mamais C, Pothula V, Kumar BN. Laryngopharyngeal reflux and primary snoring: a pilot case-control study. B-ENT 2013; 9:89-93. [PMID: 23909114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
STUDY OBJECTIVES Laryngopharyngeal reflux has been implicated as a causative factor in the aetiology of sleep related breathing disorders. However there are no reports on the association of this disorder and primary snoring in the absence of obstructive sleep apnoea. This study was undertaken to investigate any link between primary snoring and the presence of laryngopharyngeal reflux. METHODS A matched case-control study was performed in a district general Ear Nose Throat outpatient population in the United Kingdom. Twenty six patients referred for snoring without sleep apnoea (cases) were individually matched for gender, body mass index and age, to 26 patients referred for other otorhinolaryngological complaints (controls). Snoring was not an exclusion criterion for the controls. Exclusion criteria for both groups were previous referral or treatment for snoring and/or sleep apnoea, nasal obstruction symptoms (as a potential cause of snoring), and known history of gastrooesophageal reflux with medical treatment longer than two months. The main outcome measure was prevalence of laryngopharyngeal reflux based on the Reflux Symptom Index score. RESULTS Patients seeking medical advice for primary snoring are fourteen times more likely to report Reflux Symptom Index scores of more than 13 than controls. CONCLUSIONS Laryngopharyngeal reflux may also be implicated in the pathogenesis of primary snoring in the absence of sleep apnoea. This constitutes 3b level of evidence.
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Affiliation(s)
- N Charaklias
- Otolaryngology Department, Wrightington Wigan and Leigh NHS Trust, Wigan WN1 2NN, United Kingdom
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Abstract
BACKGROUND Acid reflux into the oesophagus, larynx, pharynx or nasopharynx has been suggested as a causal factor in chronic rhino-sinusitis (CRS), which can then be refractory to nasal treatments. The aim of this review was to conclude on the strength of the link between GORD, LPR, nasopharyngeal reflux, nasal symptoms and CRS. METHOD Medline and Embase search. RESULTS Nineteen papers describing varying studies on CRS, GORD, LPR and PPI therapy were found. Four adult case-controlled studies showed more acid reflux events/symptoms in refractory CRS patients. Paediatric cohort studies showed more reflux events in rhinosinusitis patients than the general paediatric population, but they are not conclusive. Many papers do not use robust CRS diagnostic criteria for inclusion into studies and take no confounding factors into consideration. CONCLUSION The evidence of a link is poor with no good randomised controlled trials available. The few adult studies that show any link between acid reflux and nasal symptoms are small case-controlled studies with moderate levels of potential bias. There is not enough evidence to consider anti-reflux therapy for adult refractory CRS and there is no evidence that acid reflux is a significant causal factor in CRS.
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Affiliation(s)
- E P Flook
- ENT Registrar North Western Deanery, Hope Hospital, Salford Royal Foundation NHS Trust, United Kingdom.
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Affiliation(s)
- C Mamais
- East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK.
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Mamais C, Charaklias N, Pothula V, Dias A, Hawthorne M, Nirmal Kumar B. Introduction of a new surgical technique: minimally invasive video-assisted thyroid surgery. Clin Otolaryngol 2011; 36:51-6. [DOI: 10.1111/j.1749-4486.2011.02254.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Tonsillectomy is one of the commonest ear, nose, and throat procedures performed in the United Kingdom. In the drive to reduce complication rates and improve patients' satisfaction, numerous adaptations to the traditional technique have evolved. In this article, the authors explore the changes that have been happening in the United Kingdom during the past 100 years and conclude that revisiting the traditional techniques may still be the answer to a successful procedure.
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Affiliation(s)
- Napoleon Charaklias
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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Affiliation(s)
- Priya Achar
- ENT Department, Royal Albert Edward Infirmary, WWL NHS Trust, Wigan, UK.
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Singh H, Dulhani N, Kumar BN, Singh P, Tewari P, Nayak K. A pharmacovigilance study in medicine department of tertiary care hospital in chhattisgarh (jagdalpur), India. J Young Pharm 2010; 2:95-100. [PMID: 21331200 PMCID: PMC3035895 DOI: 10.4103/0975-1483.62222] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to observe adverse drug reactions (ADRs) with respect to polypharmacy at tertiary care centre at Bastar, Jagdalpur (Government Medical College, Jagdalpur). A prospective, observational evaluation of the ADRs conducted over a period of 6 months in Department of Medicine in Government Medical College, Jagdalpur. During the study period, a total of about 4850 patients visited the OPD and inpatient ward of medicine department, and 154 ADRs events were reported. Out of 154 reports that were identified, a higher percentage of ADRs in females (51.29%) was observed as compared to males (48.7%). Of the 154 ADRs, 76 (49.35%) were found to be mild, 55 moderate (35.71%), and 23 severe (14.93%). A total of 99 (64.28%) ADRs were observed in patients receiving four or more medications concurrently. Conversely 55 (35.71%) ADRs were detected in patients using three or less medicines. The largest number of reports was associated with antimicrobial therapy (28.57%), followed by antihypertensive (24.02%) and antidiabetics (14.28%). Among the affected organ systems, gastrointestinal ADRs constituted a major component (39.61%) followed by skin reactions (28.57%). On causality assessment, nearly 36.36% ADRs were considered as probable, 31.16% possible, and 9.74% could not be categorized and were placed under unassessable. Expected, limited ADR are permissible in normal clinical setting, but the present study focuses on the result showing increased and amplified ADR associated with the polypharmacy practices, which may be curtailed with rational drug prescribing habit.
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Affiliation(s)
- H Singh
- Department of Pharmacology, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - N Dulhani
- Department of Medicine, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - BN Kumar
- Department of Pharmacology, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - P Singh
- Department of Pharmacology, Government Medical College, Rewa, MP, India
| | - P Tewari
- Department of Anatomy, Government Medical College, Jagdalpur, Chhattisgarh, India
| | - K Nayak
- Department of Pharmacology, Government Medical College, Jagdalpur, Chhattisgarh, India
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Abstract
BACKGROUND The Internet is a rich source of medical information and the general opinion among doctors is that the number of patients attending clinics with information from a web search is increasing. The purpose of this study was to assess the demographics of those who access the Internet and their attitudes towards the quality and usefulness of information provided by the Internet. This study also looked at the various sources of health information and the satisfaction rates. DESIGN Cross-sectional observational study. The study group consisted of a cohort of women attending the gynaecology outpatient clinic at a district general hospital in the United Kingdom. In total, 484 patients attending the gynaecology outpatient clinic completed a questionnaire which included 13 structured questions regarding access to and attitudes towards the Internet and other health sources of information. SETTING Questionnaires were distributed to 564 women attending gynaecology outpatient clinics for 3 months from 1 June 2005. RESULTS A total of 484 patients (85.6%) completed the questionnaire. Age range was 41-65 years and the median education level was completion of General Certificate of Secondary Education (GCSE). In total, 360/484 (74%) had sought health information about their condition from a variety of sources before attending the outpatient clinic. In total, 399/484 (82.4%) respondents had access to the Internet. Of 399 with access, 107 (26.8%) of the patients used the Internet to find information about their condition before their appointment. General practitioners remain as the primary source of health information, mainly to improve the knowledge of the condition. A total of 78/107 (73.3%) who had used the Internet before their appointment would like to continue using the Internet as a health information resource. CONCLUSION A significant proportion of patients had access to the Internet to find health information. The widespread availability and increased usage of medical websites by patients raises important issues regarding the need for quality control and impacts on the doctor-patient relationship.
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Affiliation(s)
- Padmaja Neelapala
- Wrightington, Wigan and Leigh NHS Trust, Royal Albert and Edward Infirmary, Wigan, UK.
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Furness DN, Katori Y, Nirmal Kumar B, Hackney CM. The dimensions and structural attachments of tip links in mammalian cochlear hair cells and the effects of exposure to different levels of extracellular calcium. Neuroscience 2008; 154:10-21. [PMID: 18384968 DOI: 10.1016/j.neuroscience.2008.02.010] [Citation(s) in RCA: 55] [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] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Revised: 01/23/2008] [Accepted: 02/12/2008] [Indexed: 11/25/2022]
Abstract
The tip links between stereocilia of acousticolateral hair cells have been suggested to contain cadherin 23 (CDH23) comprising an upper branched portion that is bound to a lower portion composed of protocadherin 15 (PCDH15). The molecular conformation of CDH23, its binding to PCDH15, the tip links, and mechanoelectrical transduction have all been shown previously to be sensitive to exposure to low levels of calcium. The aim of this study was to compare the characteristics of tip links in guinea-pig cochlear hair cells with reported features of the CDH23-PCDH15 complex. Tip links were examined using field emission scanning electron microscopy and transmission electron microscopy in conventional preparations and after treatment with the detergent Triton-X-100 or varying calcium concentrations in the extracellular solution. The results showed that tip links have a twisted double-stranded appearance with a branched upper region. They survived demembranation of the stereocilia by detergent suggesting that they have transmembrane domains at both ends. Their lengths, when fixed in the presence of 2 mM extracellular calcium, were approximately 150 nm. With prior exposure to 1 mM calcium their lengths were approximately 164 nm. The lengths in 50 microM calcium are similar ( approximately 185 nm) to those reported for CDH23-PCDH15 complexes in 100 microM calcium ( approximately 180 nm). Exposure to 1 microM calcium caused loss of tip links and an increased distance between the residual attachment sites. The data indicate that extracellular calcium concentration affects tip-link length. One model compatible with the recently proposed tip-link structure is that the CDH23 double strand undergoes calcium-dependent unfolding, changing the length of the links. The bundle may also tilt in the direction of the tallest row of stereocilia as the tip link lengthens and then is lost. Overall, our data are consistent with a tip link composed of complexes of CDH23 and PCDH15 but do not rule out other possibilities.
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Affiliation(s)
- D N Furness
- Institute of Science and Technology in Medicine, School of Life Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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Duvvi S, Walker T, Kumar BN. Masters degrees for ENT trainees. Clin Otolaryngol 2007; 32:493. [PMID: 18076444 DOI: 10.1111/j.1749-4486.2007.01527.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Younis F, Duvvi S, Walker T, Kumar BN. Sino-nasal assessment questionnaire: a specific outcome measure for rhinosinusitis, but what is the range in the asymptomatic population? J Laryngol Otol 2006; 121:650-2. [PMID: 17140459 DOI: 10.1017/s0022215106004531] [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] [Accepted: 09/08/2006] [Indexed: 11/07/2022]
Abstract
The sino-nasal assessment questionnaire is a system used for scoring the symptoms of chronic rhinosinusitis. However, the range of scores for this questionnaire in the healthy adult population is unknown. We aimed to establish this by recruiting 100 healthy volunteers and comparing their sino-nasal assessment questionnaire scores with those of 100 individuals who had undergone sinus surgery for rhinosinusitis. The difference in mean scores in the symptomatic group (44.62) and the asymptomatic group (8.46) was statistically significant. However, there was substantial overlap between the scores of the two groups. Factors such as age, gender and smoking did not have a statistically significant impact on the eventual score in the asymptomatic group. We believe that symptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast.
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Affiliation(s)
- F Younis
- Department of Otolaryngology, Royal Albert Edward Infirmary, Wigan, UK.
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Duvvi S, Gollapalli R, Sankar V, Walker T, Kumar BN, Reddy KTV. How we do it: Evaluation of nurse-led ENT services in the UK: a preliminary descriptive postal questionnaire survey. Clin Otolaryngol 2006; 31:552-5. [PMID: 17184468 DOI: 10.1111/j.1365-2273.2006.01270.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There has been a steady growth in the volume and range of nurse led services in ENT practise in the UK. There was very little consistency in the titles of the nurses providing nurse led services but those nurses working in advanced practice roles now require courses, diplomas, degrees and study days related to ENT. Locally or nationally agreed practice guidelines can define nursing practice boundaries and ensure accountability. Monitoring and evaluation of nurse led services also requires attention.
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Lien N, Kumar BN, Holmboe-Ottesen G, Klepp KI, Wandel M. Assessing social differences in overweight among 15- to 16-year-old ethnic Norwegians from Oslo by register data and adolescent self-reported measures of socio-economic status. Int J Obes (Lond) 2006; 31:30-8. [PMID: 16788570 DOI: 10.1038/sj.ijo.0803415] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine to what extent self-reported and objective data on socio-economic status (SES) are associated with overweight/obesity among 15 to 16-year-old ethnic Norwegians. DESIGN A cross-sectional questionnaire study on health and health-related behaviors. SUBJECTS All school children aged 15-16 years old in 2000 and 2001 in Oslo, Norway. Response rate 88% (n=7343). This article is based on the data from the 5498 ethnic Norwegians. MEASUREMENTS Self-reported height and weight were used to measure overweight (including obesity) as defined by the International Obesity Task Force cutoffs at the nearest half-year intervals. SES was determined by register data from Statistics Norway on residential area, parental education and income and by adolescent self-reported measures on parental occupation and adolescents' educational plans. RESULTS The prevalence of overweight/obesity was low, but higher among boys (11%) than among girls (6%). Parental education (four levels) showed the clearest inverse gradients with overweight/obesity (boys: 18, 13, 10 and 7%; girls: 11, 6, 6 and 4%). Parental education remained significantly associated with overweight/obesity when adding occupation and income to the model for the boys, whereas there were no significant associations in the final model for the girls. Overweight/obesity was associated with a lower odds ratio of planning for higher education (college/university) among boys only. CONCLUSION For the boys, parental education was most strongly associated with overweight/obesity, and the association between overweight/obesity and educational plans appears to imply downward social mobility. The relationships between the various SES measures and overweight/obesity appeared more interrelated for the girls.
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Affiliation(s)
- N Lien
- Department of Nutrition, University of Oslo, Blindern, Oslo, Norway.
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Abstract
The aim of this study was to find out whether there is a consensus of opinion among healthcare providers and different sections of the public on the relative prioritization of common otolaryngological conditions for outpatient consultations and inpatient treatment. ENT consultants, general practitioners, administrators, NHS employees, non-ENT patients and members of the general public were given common scenarios of otolaryngological conditions and asked to prioritize them in order of importance. All the groups gave top priority for patients with suspected cancer of the larynx (outpatients) and for surgical treatment of cancer. Children with hearing problems were more commonly ranked in the top three categories than children requiring treatment for sore throats. All groups assigned those requiring rhinoplasty, treatment for snoring or hearing aids to the last three ranks. This study shows that there is a remarkable uniformity of opinion in determining clinical priorities which is similar to the traditional policies practised by UK ENT consultants.
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Affiliation(s)
- S Prasad
- Department of Otolaryngology-Head and Neck Surgery, North Cheshire Hospitals NHS Trust, Warrington, UK
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Abstract
STUDY DESIGN Two case reports of male football players who sustained injury to cervical spinal cord as a direct result of the sport. OBJECTIVE To raise the awareness that playing football (soccer), a very popular sport, may cause injury to the cervical spinal cord with dire consequences, albeit rarely. SETTING North West Regional Spinal Injuries Centre, Southport, UK. CASE REPORT We report two male football players, who sustained injury to the cervical spine and developed tetraplegia as a direct result of the sport. Case 1: A 21-year-old football player was tackled from behind while running with the football, he lost his balance and landed on his head resulting in burst fracture dislocation of C5/C6 associated with immediate onset of complete tetraplegia (ASIA-A). Case 2: A 24-year-old football player collided, head first, with his own team goalkeeper, causing a hyperextension of neck. He developed motor complete tetraplegia at C5 level, with some sensation sparing below the level of injury (ASIA-B). CONCLUSION Injury to the cervical spinal cord is known to occur in some team contact sports such as rugby and American football. Over time the laws and the preparation of the athletes for these games have been changed in order to minimize the neck injuries. What might not be appreciated is that playing football (soccer), a very popular sport worldwide, may cause injury to cervical spinal cord with dire consequences.
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Affiliation(s)
- P Silva
- North West Regional Spinal Injuries Centre, Southport, Merseyside, UK
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Nagarajarao HS, Kumar BN, Watt JWH, Wiredu E, Bhamidimarri K. Bedside assessment of sympathetic skin response after spinal cord injury: a brief report comparing inspiratory gasp and visual stimulus. Spinal Cord 2005; 44:217-21. [PMID: 16172628 DOI: 10.1038/sj.sc.3101821] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/08/2022]
Abstract
STUDY DESIGN A case control study in five controls, and 20 tetraplegic and paraplegic patients, complete and incomplete. OBJECTIVE The aim was to assess the feasibility of a simple test for sympathetic system preservation after spinal cord damage in a pain-free manner and which could be undertaken worldwide without specialist equipment or manpower. SETTINGS Patients were attending the Southport Regional Spinal Injuries Centre, England, either as outpatients or as in-patients during rehabilitation. METHODS The sympathetic skin response (SSR) was recorded on a single-channel ECG recorder from the right hand and right foot in turn after inspiratory gasp (IG) or visual stimulation. RESULTS Unlike the visually evoked SSR, the gasp-evoked SSR was reliable, albeit of variable amplitude, and there was little difference between the hand and foot. Paraplegics had similar SSRs in the hands as the controls. There was minor insignificant habituation of response for the gasp reflex. There was occasional unexpected SSR distally in patients with complete lesions, and in patients with incomplete lesions the responses could not have been predicted from the sensory motor pattern. CONCLUSIONS Trained IG induces an SSR which is sufficient to elucidate sympathetic loss following spinal cord injury. It is superior to visual stimulation in this respect. Habituation is not a problem with at least 1 min between tests, and high doses of anticholinergics agents may impair the response.
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47
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Abstract
OBJECTIVES To compare ethnic and gender differences in generalized and central obesity and to investigate whether these differences persisted after adjusting for socio-demographic and lifestyle factors. DESIGN In 2002, the population-based cross-sectional, Oslo Immigrant Health study was conducted. SUBJECTS A total of 7890 Oslo residents, born between 1942 and 1971 in Turkey, Iran, Pakistan, Sri Lanka and Vietnam, were invited and 3019 attended. MEASUREMENTS Participants completed a health questionnaire and attended a clinical screening that included height, weight, waist and hip measurements. RESULTS Generalized obesity (BMI> or =30 kg/m2) was greatest among women from Turkey (51.0%) and least among men from Vietnam (2.7%). The highest proportions of central obesity (waist hip ratio (WHR)>or =0.85) were observed among women from Sri Lanka (54.3%) and Pakistan (52.4%). For any given value of BMI, Sri Lankans and Pakistanis had higher WHR compared to the other groups. Despite a high mean BMI, Turkish men (27.9 kg/m2) and women (30.7 kg/m2) did not have a corresponding high WHR. Ethnic differences in BMI, waist circumference and WHR persisted despite adjusting for socio-demographic and lifestyle factors. CONCLUSION We found large differences in generalized and central obesity between immigrant groups from developing countries. Our data find high proportions of overweight and obese subjects from Pakistan and Turkey, but low proportions among those from Vietnam. Subjects from Sri Lanka and Pakistan had the highest WHR for any given value of BMI. Our findings, in light of the burgeoning obesity epidemic, warrant close monitoring of these groups.
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Affiliation(s)
- B N Kumar
- Section of Preventive Medicine and Epidemiology, Department of Community Medicine and General Practice, University of Oslo, Oslo, Norway.
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Shi Z, Lien N, Kumar BN, Holmboe-Ottesen G. Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China. Eur J Clin Nutr 2005; 59:1439-48. [PMID: 16118652 DOI: 10.1038/sj.ejcn.1602259] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [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: 11/09/2022]
Abstract
OBJECTIVE To identify the differences in food habits and preferences among the adolescents according to socio-demographic characteristics. DESIGN Cross-sectional, cluster design survey in 2002. SETTING Eight middle schools in two distinct socio-economic areas of the Jiangsu province, China. SUBJECTS Some 824 young adolescents (12-14 y) attending public schools with a response rate of 99%. METHODS A self-administered questionnaire containing questions on food and meal frequencies, food preferences and socio-demographic characteristics was used. RESULTS High socio-economic status (SES) and urban residence was positively associated with intake of high-energy foods, such as foods of animal origin, Western style foods and dairy products. In all, 76% of the students had three meals a day regularly , but 8.1% urban students vs 3.4% rural students had breakfast only 1-3 times per week or less often. Daily fruit consumption was fairly common, but with clear differences by SES. Only about 42% of the boys and 55% of the girls from low SES families ate fruit daily, compared with 66% and 72%, respectively in the high SES families. Urban boys had the lowest proportion of daily consumers of vegetables (67.0%). More urban students drank milk daily than the rural students (68.7 vs 38.5%). The frequency of milk drinking also showed a strong positive association with SES. About 10% of the high SES boys consumed hamburgers daily compared with 2.8% of the low SES boys. More than half of the students reported a liking for Western style fast foods including hamburgers, soft drinks and chocolate. Among high SES boys, 21.5% consumed soft drinks on a daily basis; however, as many as 72.3% wanted to drink soft drinks more often if they could afford it. CONCLUSIONS SES and urban location were positively associated with frequency of intake of high-energy foods. Reported food preferences may enforce this trend. Nutrition education for adolescents and parents is needed to promote healthy eating. Health Authorities should strengthen the monitoring of food intake and its association with overweight/obesity. SPONSORSHIP This study was funded by the Norwegian Directorate of Health and Social affairs under the auspices of the Norway-China Health Agreement.
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Affiliation(s)
- Z Shi
- Department of Nutrition and Food Hygiene, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China.
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Kumar BN, Holmboe-Ottesen G, Lien N, Wandel M. Ethnic differences in body mass index and associated factors of adolescents from minorities in Oslo, Norway: a cross-sectional study. Public Health Nutr 2005; 7:999-1008. [PMID: 15555201 DOI: 10.1079/phn2004644] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [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: 11/11/2022]
Abstract
OBJECTIVES To examine ethnic differences in body mass index (BMI), food habits and physical activity, and determine the factors contributing to differences in BMI. DESIGN AND METHOD In 2000-2001, 7343 (response rate 88%) 15- and 16-year-old students, enrolled in lower secondary schools in Oslo, participated in the cross-sectional Oslo Health Study. Of these participants, 1719 were defined as ethnic minorities. RESULTS Significant gender and ethnic differences in mean BMI were observed. Of the ethnic minority adolescents, 5.8% were underweight (<5th percentile of the US Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS) reference distribution) and 9.1% were overweight (>85th percentile of the US CDC/NCHS reference distribution). BMI was not significantly associated with either socio-economic factors or physical activity. Food habits and physical activity differed with ethnicity but not with socio-economic factors. An ordinal regression showed that girls from East Asia (odds ratio (OR) 0.4) and boys from sub-Saharan Africa (OR 0.4) had lower BMI than the Western group. Among girls, higher BMI was associated with less frequent consumption of chocolates and sweets, full-fat milk and breakfast (OR 2.4, 1.7 and 1.7, respectively). Higher BMI, for both boys and girls, was associated with current and past dieting (OR 3.7 and 4.2, respectively). CONCLUSIONS Adolescent food habits and physical activity varied by gender and ethnicity but not with socio-economic factors. BMI was associated with ethnicity, gender and food habits, but no significant relationship was observed with socio-economic factors or physical activity. Ethnicity, in addition to gender, should be taken into consideration when studying BMI and associated factors among adolescents.
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Affiliation(s)
- B N Kumar
- Section of Preventive Medicine and Epidemiology, Department Group for Community Medicine and General Practice, University of Oslo, Norway.
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Abstract
Autoimmune inner ear disease is a well described entity. We report a case of sudden-onset sensorineural hearing loss in association with psoriatic arthritis, which has not been reported in the literature. The case satisfies the criteria for the presumptive diagnosis of autoimmune hearing loss. A high index of suspicion, with early diagnosis and aggressive treatment with steroids and/or immunosuppressive agents, is essential to prevent irreversible hearing loss. The condition of psoriatic arthritis must be added to the pantheon of autoimmune diseases that can lead to sensorineural hearing loss.
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Affiliation(s)
- S Srikumar
- Department of Otolaryngology, Royal Albert Edward Infirmary, Wrightington Wigan & Leigh NHS Trust, Wigan WN1 2NN, UK
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