Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta-analysis.
Authors Mousavizadeh M.; Daliri M.; Aljadayel H.A.; Mohammed I.; Rezaei Y.; Bashir M.
Source Journal of cardiac surgery; Sep 2021; Vol. 36(9)
Abstract The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.
Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives.
Authors Rogers J.P.; Watson C.J.; Badenoch J.; Cross B. et al.
Source Journal of neurology, neurosurgery, and psychiatry; Sep 2021; Vol. 92 (9)
Abstract There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.
Out-patient physiotherapy service delivery post COVID-19: opportunity for a re-set and a new normal?
Author(s) Rawlinson G.; Connell L.
Source Physiotherapy; Jun 2021; vol. 111 ; p. 1-3
Author(s) Conti I.; Cross B.; Rooney A.G.; Nicholson T.R.
Source Journal of the Neurological Sciences; Jul 2021; vol. 426
Author(s) Harrison R.; Mckenzie C.
Source BJOG: An International Journal of Obstetrics and Gynaecology; Jun 2021; vol. 128 ; p. 221
AbstractObjective Women from Black, Asian or Minority ethnic backgrounds have significantly worse health outcomes, with 66% increased risk of neonatal death and stillbirth in Asian ethnicity women compared to white ethnicity women. A document produced by Maternity Action, exploring maternal health inequalities, highlighted language barriers as a key component leading to suboptimal care. The aim of this quality improvement project was to address these inequalities by producing a multi-lingual audio-visual information video for maternity services. Design Semi-structured interviews were conducted with new mothers to assess how patient information in maternity services could be improved. Feedback from this was analysed and a quality improvement project was conducted involving producing a video following a patients experience when seeking advice for reduced fetal movements. Method New mothers, who had recently accessed maternity services, were interviewed about their experience of seeking help for reduced fetal movements and expectations of attending hospital with reduced fetal movements. They were asked about what information would have made a difference to their experience. Content for a patient information video was then written based upon this. Funding for video equipment and backfill for time to develop the project, was funded by the 'Digital Pioneer Scheme' run by Healthier Lancashire and South Cumbria, a partnership between NHS and council organisations. Feedback regarding the video content was sought from healthcare professionals involved in maternity services. A video was produced in the most common languages spoken in the area and published for women and their families to access. Results Positive feedback from semi-structured interviews regarding the use of digital technology to convey patient information was received, with new mothers reporting that this information would have been useful in their pregnancies and lessened anxieties about attending hospital. The group expressed that they felt information was lacking about what to expect when they reported reduced fetal movements and the process followed in hospital when attending an appointment with reduced fetal movements. Positive feedback was received regarding the use of digital technologies in improving patient information from both healthcare professionals and patients. Conclusion The use of digital technology to produce multi- lingual audio-visual patient information leaflets, is a useful tool for addressing inequalities experienced by Black, Asian and Minority Ethnic women, allowing them to access important information and reduced anxieties of seeking medical attention.
Author(s) Eden J.K.; Gawne S.; Dobrashian R.
Source Breast Cancer Research; 2021; vol. 23
The injectable breast filler Polyacrylamide hydrogel (PAAG) was widely used in China since the 1980s with as many as 300,000 women subjected for cosmesis and reconstruction following cancer. The procedure requires no anaesthesia, often injected by nonmedical professionals. No safety clinical trials were conducted and in 2006 the Chinese State Food and Drug Administration prohibited the clinical application following significant evidence of neurotoxic and teratogenic monomers residual in the synthesis of PAAG. Although now withdrawn, many patients are developing on-going associated complications of PAAG and presenting worldwide to surgeons unfamiliar with the treatment, necessitating complex surgery. Management of PAAG is not standardised and often directed by the radiological appearances. A case study is reported discussing the associated challenges of PAAG with recommendations gathered from the literature. Radiological imaging can mimic malignancy with inflammatory appearances, whilst simulating silicone implants and the features of Breast Implant Associated-Anaplastic Large Cell Lymphoma. Glandular atrophy and encapsulation can develop potentially delaying cancer diagnosis. Surgically, migration of the gel almost always prevents complete removal and often requires extensive reconstructive techniques. Considering PAAG may have potential toxicity and radiological interpretation is significantly compromised, careful assessment is required to understand how best to manage this group of patients often presenting with multiple complications; the long term implications are yet unknown.
Combination fixed-dose beta agonist and steroid inhaler as required for adults or children with mild asthma: A Cochrane systematic review
Author(s) Crossingham I.; Turner S.; Richardson R.; Webb P.; Ramakrishnan S. et al.
Source BMJ Evidence-Based Medicine; 2021
Background: In people with mild asthma poor adherence to regular therapy is common and increases the risk of exacerbations, morbidity and mortality. The use of fixed-dose combination inhalers containing an inhaled corticosteroid (ICS) and a fast-acting beta2-agonist (FABA) is established in moderate asthma, but they may also have potential utility in mild asthma. Objective(s): To evaluate the efficacy and safety of single combined FABA/ICS inhaler only used as needed in people with mild asthma. Design and setting: Cochrane meta-analysis of available trial data. Participant(s): Children aged 12+ and adults with mild asthma.
Internal jugular vein duplication: Clinical significance for head and neck cancer ablative and reconstructive surgery
Author(s) Hedayat F. (Fatemehhedayat97@gmail.com); Kyzas P. (Panayiotis.Kyzas@elht.nhs.uk); Vassiliou L.V. (Leandros.Vassiliou@elht.nhs.uk); Lauder J.J. (Joshua.Lauder@elht.nhs.uk)
Source Journal of Surgical Case Reports; Jul 2021; vol. 2021 (no. 7)
AbstractWe present the case of a 75-year-old patient with a T2N0Mo oral cancer, who underwent surgery for cancer ablation and reconstruction. Intraoperatively, a duplicate internal jugular vein (IJV) was identified. Both segments were preserved. The veins of the free radial forearm flap that was used to reconstruct the defect were anastomosed to tributaries of the anterior IJV segment. In this rare anatomical variation, the anterior segment of IJV lies medially/anteriorly to the sternocleidomastoid muscle which poses a risk of inadvertent injury during the early steps of the neck dissection (ND). The posterior segment is at risk of injury during developing levels II-III-IV of ND. It is important to preserve the anterior IJV segment as this receives all tributaries that can be used for end-to-end anastomosis for the free flap. Preoperative contrast computed tomography scan can aid in recognition of IJV duplication and help prepare the surgeon to adjust certain operative steps. Copyright © 2021 Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved.
Author(s) Kirby L. (firstname.lastname@example.org); Gran S.; Simpson R.; Orekoya F.; Owen C.
Source British Journal of Dermatology; 2021
Management of oral and maxillofacial trauma during the first wave of the COVID-19 pandemic in the United Kingdom
Author(s) Puglia F.A.; Hills A.; Dawoud B.; Magennis P.; Chiu G.A. et al.
Source British Journal of Oral and Maxillofacial Surgery; 2021
We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient's care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients' treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care.Copyright © 2021 The British Association of Oral and Maxillofacial Surgeons
Author(s) Meharban N. (Drmobashir@outlook.com); Munir W.; Idhrees M.; Bashir A.; Bashir M.
Source Asian Cardiovascular and Thoracic Annals; 2021
AbstractPenetrating atherosclerotic ulcers present with an insidious onset with a reported mortality of 9%, varying across populations. With vast arrays of risk factors and potentially ominous complications, it is vital to efficiently provide optimum strategies for management. There exists controversy in the literature regarding management, especially for Type B penetrating atherosclerotic ulcers; the decision-making framework encompasses numerous factors in considerations for medical management versus invasive intervention and choice of endovascular versus open repair in the latter. The concomitant presence of intramural haematoma adds further complexity to the already intricate decision-making for management. We performed searches through PubMed and SCOPUS analysing studies reporting outcomes for management strategies for penetrating atherosclerotic ulcers treatment, focusing on Type B, further seeking to analyse studies reporting their experiences of PAU patients with concomitant intramural haematoma. Our review highlights the ambiguity and controversy existing in the literature, comprising studies burdened by their inherent hindering limitations of their single-centre retrospective experiences. Endovascular therapy has come to the forefront of penetrating atherosclerotic ulcers management, often considered first line therapy. In the case of penetrating atherosclerotic ulcers alongside intramural haematoma, there have been reports of potential hybrid surgical approaches to management. Studies further show misdiagnosis of penetrating atherosclerotic ulcers in earlier data sets further complicates management. However, it is clear we must progress on the journey towards precision medicine, allowing delivery of optimum care to our patients.Copyright © The Author(s) 2021.
Author(s) Yap Z.J.; Sharif M.; Bashir M. (email@example.com)
Source Journal of Cardiac Surgery; Apr 2021; vol. 36 (no. 4); p. 1520-1530
AbstractBackground and Aim: Aortic aneurysms most commonly occur in the infra-renal and proximal thoracic regions. While generally asymptomatic, progressive aneurysmal dilation can become rapidly lethal when dissection or ruptures occurs, highlighting the need for more robust screening. Abdominal aortic aneurysm (AAA) is more prevalent compared to thoracic aortic aneurysm (TAA). The true incidence of TAA is underreported due to the absence of population screening and the silent nature of TAA. To achieve the optimum survival rate in aortic aneurysms, knowledge of natural course, genetic association, and surgical results are needed to be applied with adequate medical treatment and careful selection of patients for operation. The purpose of this paper is to provide a comprehensive review of the literature on natural history, immunology, and genetic differences between thoracic and AAAs. Method(s): The literature was collected from OVID, SCOPUS, and PubMed. Result(s): (1) AAA expands faster than TAA. AAA expands at approximately 0.3-0.45 cm annually, depending on various factors (advancing age, diameter of aorta, smoking etc.). TAA expands up to 0.3 cm annually in a non-bicuspid aortic valve patient. (2) An increase in Matrix metallopeptidase 1, 2, 9, 12, 14 led to degrading extracellular matrix of the aortic vessel wall. This significantly contributed to the pathogenesis in AAA, whereas overactive Transforming growth factor-beta played a major role in the pathogenesis of TAA. Conclusion(s): In the future, genetic testing may be the gold standard for tackling the geneticheterogeneity of aneurysms, therefore, identifying at-risk individuals developing TAA andAAA earlier.Copyright © 2021 Wiley Periodicals LLC
Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease
Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M.; Hara H.; Wijns W.; Onuma Y.; Serruys P.W. (firstname.lastname@example.org); van Geuns R.-J.; Garg S.; Morice M.-C.; Davierwala P.M.; Kappetein A.P.; Holmes D.R.
AbstractAims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not available: see fulltext.]Copyright © 2021, The Author(s).
Author(s) Patel T.; Umeh K.; Poole H.; Vaja I.; Newson L. et al.
Source Psychology & health; Aug 2021 ; p. 1-19
OBJECTIVE: This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN: Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES: Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULT(S): A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSION(S): The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
When is extra-anatomical bypass for the left subclavian artery required to prevent ischaemia after thoracic endovascular stent grafting?
Author(s) Moore K.; Gordon A.; Thomas R.; Wood A.; White R.D.; Bailey D.M.; Lewis M.H.; Bashir M.; Williams I.M. (Ian.Williams5@wales.nhs.uk)
AbstractIntroduction: Thoracic endovascular aortic repair (TEVAR) has become an accepted treatment for thoracic aortic disease. However, the principal complications relate to coverage of the thoracic aortic wall and deliberate occlusion of aortic branches over a potentially long segment. Complications include risk of stroke, spinal cord ischaemia (SCI) and arterial insufficiency to the left arm (left arm ischaemia (LAI)). This study specifically scrutinised the development of SCI and LAI after TEVAR for interventions for thoracic aortic disease from 1999 to 2020. In particular, those who underwent extra-anatomical bypass (both immediate and late) were compared to the length of thoracic aortic coverage by the stent graft.
Author(s) Lopuszko; Patrick Tan, Sven Zhen Cian; Munir, Wahaj; Bashir, Mohamad
Source Journal of Cardiac Surgery; Jul 2021; vol. 36 (no. 7); p. 2496-2501
Publication Date Jul 2021
AbstractBackground: Aortic aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. Eight in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies, AA is thought to be subject to chronobiological patterns of varying incidence.Methods: We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology.Results: The incidence of AA is found to peak in the early morning (6-11 a.m.) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other cerebrovascular pathologies, such as myocardial infarcts, or cerebrovascular strokes.Conclusion: Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6-11 a.m.), and during colder months (December-January). This is more pronounced in patients with Marfan syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.
Author(s) Pramanik; Webb, Philip; Hamid, RanaShoaib
Source BMJ Case Reports; Jul 2021; vol. 14 ; p. 1-3
Publication Date Jul 2021
AbstractWe present to you a case of life-threatening haemoptysis secondary to non-cystic fibrosis bronchiectasis complicated by bronchial artery pseudoaneurysms. We discuss this patient’s emergency medical management using intravenous tranexamic acid, which resulted in successful resuscitation and eventual survival, and evaluate the need for urgent anaesthetic and interventional radiology input in such a case.
BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiativ
Author(s) Ho M.W. (email@example.com); Puglia F. (BAOMSprojectmanager@baoms.org.uk); Tighe D. (firstname.lastname@example.org); Chiu G.A. (email@example.com); Ridout F. (firstname.lastname@example.org); Hutchison I. (email@example.com); Mason M. (firstname.lastname@example.org); McMahon J.M. (email@example.com)
Source British Journal of Oral and Maxillofacial Surgery; Sep 2021; vol. 59 (no. 7); p. 831-836
AbstractThe BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though not all units offered the full range of service audited. Users suggest the skin and ODA audits were sufficiently clear, but improvement is required in the oncology and reconstruction questionnaire particularly. The pilot was successful in aiding the project team identify areas of weaknesses and strength in the design of the REDCap registry and implementation of the next phase of the initiative. The information and experience gained has to date enabled a successful application for section 251 approval from the HRA and progress for the next phase of national data collection.Copyright © 2021
Neurological complications following frozen elephant trunk for aortic dissection: What's truly to blame?
Author(s) Tan ; El Santawy, Hazem; Abdelhaliem, Amr
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3352-3353
Hypothermic circulatory arrest time affects neurological outcomes of frozen elephant trunk for acute type A aortic dissection: A systematic review and meta-analysis
Author(s) Mousavizadeh; Daliri, Mahdi; Aljadayel, Hadi Abo; Mohammed, Idhrees; Rezaei, Yousef; Bashir, Mohamad; Hosseini, Saeid
Source Journal of Cardiac Surgery; Sep 2021; vol. 36 (no. 9); p. 3337-3351
A prospective multicenter validation study for a novel angiography-derived physiological assessment software: Rationale and design of the radiographic imaging validation and evaluation for Angio-iFR (ReVEAL iFR) study.
Author(s) Ono; Serruys, Patrick W.; Patel, Manesh R.; Escaned, Javier; Akasaka, Takashi; Lavieren, Martijn A. van; Haase, Christian; Grass, Michael; Kogame, Norihiro; Hara, Hironori; Kawashima, Hideyuki; Wykrzykowska, Joanna J.; Piek, Jan J.; Garg, Scot; O'Leary, Neil; Inderbitzen, Becky; Onuma, Yoshinobu
Source American Heart Journal; Sep 2021; vol. 239 ; p. 19-26
AbstractAngiography-derived physiological assessment of coronary lesions has emerged as an alternative to wire-based assessment aiming at less-invasiveness and shorter procedural time as well as cost effectiveness in physiology-guided decision making. However, current available image-derived physiology software have limitations including the requirement of multiple projections and are time consuming.
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