London Bridge Hospital

About: London Bridge Hospital is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Antiphospholipid syndrome & Systemic lupus erythematosus. The organization has 107 authors who have published 122 publications receiving 4523 citations.

Lupus around the world

Abstract: Back in 1970, when I was a post-doc fellow in the unit of Dr Charles Christian in New York, I remember seeing a fairly primitive ‘world map’ of units which had published 200 lupus cases or more. As I recall, there were few ‘dots’ on the map—indeed there were huge swathes of the globe where lupus failed to ‘light up’. So much has changed, with lupus becoming an increasingly common diagnosis worldwide. In some countries, for example in the Far East, lupus may well have overtaken rheumatoid arthritis in prevalence. In 1995, we launched, in this journal, a series called ‘Lupus around the world’, in order firstly to compare prevalence and disease patterns in different regions, and secondly to facilitate publication of data from centres with solid experience of the disease, but with little international publishing success. A trawl through the 100 or so articles in this series does seem to underscore this trend. The numbers are striking, including a series of 2684 patients from China, 9349 from Taiwan, (also from Taiwan a staggering series of 2870 admitted to intensive care over a period of nine years),1521 from Korea, 841 from Singapore, and 428 from two centres in Turkey. There were of course, similarities—the almost universal 9:1 female to male ratio—and differences between the series. Ethnic differences were frequently reported, such as the higher prevalence in Kazakhstan (predominantly ethnic Asian) in the large Russian survey. An Australian survey found a prevalence of 95 per 100,000 in the indigenous peoples compared with 45 per 100,000 in the non-indigenous population. In addition, with this higher prevalence in certain ethnic groups, there was frequent evidence of more serious disease. For example, in a study of patients attending two hospitals in New Zealand, 60% of the Maori patients developed renal disease compared with 19% of Caucasians. A number of studies addressed possible lifestyle and local factors. In Kuwait, where up to 44.8% of marriages are consanguineous, ‘we found that familial and sporadic cases of SLE [systemic lupus erythematosus] are broadly similar . . .’. There is a report from Brazil of a high incidence of lupus in Natal City—also known as ‘sun city’ with up to 288 hours of sun a month. In addition, there are interesting studies of Malaviya and colleagues who found a similar prevalence of antiphospholipid antibodies in New Delhi Indians and Arab Kuwaitis, but with a far higher incidence of thrombotic antiphospholipid syndrome in the Kuwaitis. Many of the studies reported clinical differences—the highest incidence of infections were in the Brazilian and Saudi populations. Another Saudi report documented a high percentage (82%) of haematological abnormalities, and Edwards in Singapore noted the frequency of gastro-intestinal problems in that particular series. Two of the studies reported on the lack of association between lupus and cancer. 20 There were some laboratory associations of interest: Uthman et al. in Beirut found 25% of their series with false positive VDRL tests, and pulmonary hypertension strongly associated with positive anti-Beta2 GP1 antibodies in a report from Tunisia. Perhaps the most recurring epidemiological observation is the seeming rarity of lupus in Africans living in Africa, compared with its high prevalence in African–Americans and West Indians. In our own studies in Jamaica, back in 1975, lupus was the second most common rheumatological hospital admission (after rheumatic fever). 24 The studies of Gilkeson et al. and Barnado et al. comparing genetics and disease manifestations in the ‘Gullah Indians’ of South Carolina, and their close relatives in Sierra Correspondence to: GRV Hughes, London Lupus Centre, London Bridge Hospital, Tooley Street, London SE1 2PR, UK. Email: Graham.Hughes@HCAConsultant.co.uk Received 30 April 2015; accepted 30 April 2015

Are the Outcomes of Minimally Invasive Transforaminal/Posterior Lumbar Fusion Influenced by the Patient's Age or BMI?

Abstract: Study design A retrospective subgroup analysis of a prospective observational study was carried out. Summary of background data Patients' baseline characteristics may influence the clinical outcomes after minimally invasive lumbar interbody fusion (MILIF). Objective This study aimed to investigate the influence of patient's age and body mass index (BMI) on the clinical outcomes of MILIF for degenerative lumbar disorder. Materials and methods A total of 252 patients underwent MILIF. The clinical outcomes, including time to first ambulation, time to postsurgical recovery, back/leg pain in visual analog scale, Oswestry Disability Index, and EuroQol-5 Dimension, were collected at baseline, 4 weeks, 6, and 12 months. Patients were subgrouped by age (50 y and below: N=102; 51-64 y: N=102; 65 y and above: N=48) and BMI (≤25.0: N=79; 25.1-29.9: N=104; ≥30.0: N=69). Data from baseline to 12 months were compared for all clinical outcomes within age/BMI subgroups. Adverse events (AEs) and serious adverse events (SAEs) were summarized by age and BMI subgroups. Results All age and BMI subgroups showed significant improvements in clinical outcomes at 12 months compared with the baseline. The median time to first ambulation was similar for all subgroups (age groups: P=0.8707; BMI: P=0.1013); older people show a trend of having longer time to postsurgical recovery (age groups: P=0.0662; BMI: P=0.1591). Oswestry Disability Index, back, and leg pain visual analog scale, and EuroQol-5 Dimension were similar in all subgroups at every timepoint. A total of 50 AEs (N=39) were reported, 9 of which were SAEs; 3 AEs and 1 SAE were considered to be related to surgical procedure. No differences were observed in safety by age groups and BMI groups. Conclusion MILIF appears to be safe and effective, independent of age or weight in the treatment of degenerative lumbar disorder. Level of evidence Level II.

Let's talk about sex.

Abstract: Giving sexual advice to cardiac patients is an important aspect of their overall management, no matter the cardiovascular disease (CVD) condition [1]. Sexual health is an integral component of human (male and female) well being. The World Health Organisation made it clear that all individuals have a fundamental right to sexual health, including ‘‘freedom from...factors inhibiting sexual response and impairing sexual relations...[and] organic disorders, disease and deficiencies that interfere with reproductive function’’ [2]. In 1978 I concluded ‘‘It should be routine policy to advise patients and their spouses (update this to partners) on sexual activity, whether they have had an infarction or are regularly attending with angina pectoris. Most patients with ischaemic heart disease can enjoy normal sexual relations without risk’’ [3]. Unfortunately 35 years later, though sexual counselling of patients with CVD and their partners is recognised to be an important part of recovery, advice is still not routinely provided [1–4]. The bold paper in this issue from the Netherlands depressingly confirms we have hardly moved on [5]. Of 980 members of the Netherlands Society of Cardiology mailed 53.9 % responded—were the rest too embarrassed to answer?—and only 16 % said they discussed sexual function routinely with 2 % referring for specialised advice. 54 % hid behind ‘‘lack of initiative of the patient’’ and 43 % could not make time, whilst 35 % admitted to a lack of training. The importance of initiating the enquiry has been emphasised repeatedly in several key-note publications with sample questions provided [6, 7]. Lack of time is simply a pathetic excuse whilst lack of training or understanding is recognising an honest need for further education which should be made available [8, 9]. Indeed, most studies of CVD patients and their partners suggest health care professionals provide inadequate advice about sexual activity and wish more information was provided— in other words the health care professional needs to ask pro-actively [10, 11]. Studies have clearly shown that sexual counselling improves knowledge about CVD and sex, helps relieve anxiety, increases confidence and alleviates the fear of sexual activity [12]. The cardiovascular responses to sexual activity including intercourse is similar to mild to moderate non-sexual effort—walking 1 mile (1.6 km) in 20 min on the flat or briskly climbing two flights of stairs in 10 s [13]. In longstanding (not casual) relationships the heart rate and blood pressure response is similar to that experienced during other aspects of normal daily life. Coital death is rare (±1 % of sudden deaths) and occurs usually as a result of casual sex with an age mismatch, following too much to eat and drink [14]. The need for cardiologists to be actively involved in providing sexual advice is increasing as the link between erectile dysfunction (ED) and CVD has identified endothelial dysfunction as the common denominator, with ED predicting cardiovascular events and mortality in asymptomatic men and also frequently being a problem after a CV event [6, 12]. It is also becoming a problematic area in grown up congenital heart disease [15]. There is no doubt that sexual activity is a concern for patients with CVD and their partners (it may be one person’s problem but it is a couple’s concern) and some cardiologists looking after them [8]. Because counselling is such an important component of treatment, cardiologists need to understand the physiological aspects of sex, the risks involved, and the therapy available. The Dutch have G. Jackson (&) London Bridge Hospital, Tooley Street, London SE1 2PR, UK e-mail: gjcardiol@talk21.com

Use of the wide-awake local anaesthetic no tourniquet in the management of distal radius fractures.

Abstract: Objective To evaluate the Wide-Awake Local Anaesthesia with No Tourniquet (WALANT) method in fixation of distal radial fractures. Methods Forty patients admitted to the Jinnah Postgraduate Medical Centre, Karachi, Pakistan were recruited from March 2017 to December 2018. All patients had a distal radial fracture which was appropriate for internal fixation with a locked volar distal radial plate. The surgical site was infiltrated to achieve tumescent local anaesthesia using a solution of 0.9% normal saline and 1% lidocaine with 1:1,000,000 epinephrine. The patients were followed up until fracture union and were evaluated clinically, with goniometry, radiologically and with standard outcome scores (Mayo and qDASH). Results The patients were marginally more male than female (55% versus 45%), and mostly the dominant hand was injured (65%). The mean time to union was just over 3 months (15.2 weeks). All were united by 11 months. Good outcomes were achieved at final review with mean qDASH and Mayo scores of 13.3 and 81.6 respectively. The mean flexion and extension range at finalreview was 64 and 53 degrees respectively, and the mean grip strength was 73% when compared with the opposite side. Conclusions The WALANT technique seems to be an acceptable and safe technique for fixation of distal radial fractures. There seem to be added benefits in terms of costs, reduced disposables, and intra-operative assessment of active movement.