Showing papers by "Wishaw General Hospital published in 2006"
TL;DR: This study confirms that in patients with established osteoporosis, there is also a distinct group with a low vitamin D and a blunted PTH level and that Mg deficiency (as measured by the Mg loading test) is an important contributing factor.
Abstract: Introduction
Vitamin D insufficiency is common, however within individuals, not all manifest the biochemical effects of PTH excess. This further extends to patients with established osteoporosis. The mechanism underlying the blunted PTH response is unclear but may be related to magnesium (Mg) deficiency. The aims of this study were to compare in patients with established osteoporosis and differing degrees of vitamin D and PTH status : (1) the presence of Mg deficiency using the standard Mg loading test (2) evaluate the effects of Mg loading on the calcium-PTH endocrine axis (3) determine the effects of oral, short term Mg supplementation on the calcium-PTH endocrine axis and bone turnover.
148 citations
TL;DR: In this “true-to-life” study, an inexpensive combination of DMARDs proved more effective than monotherapy in patients with rheumatoid arthritis with a suboptimal response to SASP.
Abstract: Background: Optimal use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis is vital if progression of disease is to be reduced. Methotrexate (MTX) and sulfasalazine (SASP) are widely used inexpensive DMARDs, recently often combined despite no firm evidence of benefit from previous studies. Aim: To establish whether a combination of SASP and MTX is superior to either drug alone in patients with rheumatoid arthritis with a suboptimal response to 6 months of SASP. Methods: A randomised controlled study of step-up DMARD treatment in early rheumatoid arthritis. In phase I, 687 patients received SASP for 6 months. Those with a disease activity score (DAS) ⩾2.4 were offered additional treatment in phase II (SASP alone, MTX alone or a combination of the two). The primary outcome measure was change in DAS. Results: At 6 months, 191 (28%) patients had a DAS Conclusions: In this “true-to-life” study, an inexpensive combination of DMARDs proved more effective than monotherapy in patients with rheumatoid arthritis with a suboptimal response to SASP. There was no increase in toxicity. These results provide an evidence base for the use of this combination as a component of tight control strategies.
113 citations
Journal Article•
TL;DR: The aim of this study was to ascertain the incidence of acute mountain sickness at different altitudes in the Solu-Khumbu and to assess the region's suitability for a future study.
Abstract: Introduction: The aim of this study was to ascertain the incidence of acute mountain sickness (AMS) at different altitudes in the Solu-Khumbu. This was a pilot to examine the feasibility of investigating demographic, behavioral, and physiological factors related to the etiology of AMS and to assess the region's suitability for a future study. Methods: A convenience sample of 150 recreational trekkers staying in teahouses was interviewed at altitudes above 2500 m. Two interviews were performed, firstly in the evening and then the subsequent morning. Trekker's age, gender, ascent profile, and use of acetazolamide were noted. A Lake Louise score was calculated to determine the presence of AMS. Results: The incidence of AMS was 0% at 2500-3000 m, 10% between 3000-4000 m, 15% between 4000-4500 m, 51% between 4500-5000 m, and 34% over 5000 m. There was no significant association between age or gender and the altitude studied or incidence of AMS. Subjects with AMS ascended significantly further in the preceding 72 h than subjects without AMS, with a mean altitude gained of 846 m vs. 722 m. Discussion: We concur with the literature that incidence of AMS increases with altitude. We found an abrupt increase in incidence over 4500 m. This appears to be a new finding. A future study examining factors predisposing to AMS would be most effectively performed above 4500 m. No association was found between age or gender and AMS. Mean vertical ascent gained in the previous 72 h was significantly higher among the trekkers with AMS but remained within recommended guidelines.
66 citations
TL;DR: It is stated that serum creatinine concentration, and therefore eGFR, may only be slightly affected by ingestion of meat, and that samples for serum creat inine concentration and eG FR are generally used in situations …
Abstract: Traynor et al state that serum creatinine concentration, and therefore eGFR, may only be slightly affected by ingestion of meat.1 In the data from the modification of diet in renal disease study that were used to generate the eGFR equations,2 samples were taken from predominantly fasting subjects (AS Levey, personal communication). In clinical practice, however, samples for serum creatinine concentration and eGFR are generally used in situations …
59 citations
TL;DR: Phlebotomy tourniquets may be potential vectors for transferring bacteria, including MRSA, and contamination rates can be reduced if hand decontamination is performed, suggesting that contamination of tournique is via phlebotomists' hands, not directly from patients' skin.
28 citations
TL;DR: The increase in serum ionized calcium in the AS group was small and, therefore, unlikely to be of clinical significance, and biochemical parameters in these individuals were not statistically different from the wild type.
Abstract: Background: Recent studies have suggested a correlation between the A986S polymorphism of the calcium sensing receptor (CASR), and serum total and ionized calcium. This study aimed to assess the pr...
18 citations
TL;DR: A case of lateral swivel dislocation of the talo-navicular joint treated by closed reduction and percutaneous wire fixation is reported, and excellent clinical and functional outcome were achieved.
8 citations
TL;DR: This work attempts to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients.
Abstract: Background: The ionizing radiations (Medical Exposure) Regulation 2000 has made it mandatory to establish diagnostic reference levels (DRLs) for all typical radiological examinations. Objectives: We attempt to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients. Materials and methods: The dose area product (DAP) in 865 paediatric trauma examinations was analysed. Median DAP values and screening times for each procedure type along with quartile values for each range are presented. Results: In the upper limb, elbow examinations had maximum exposure with a median DAP value of 1.21 cGy cm 2 . Median DAP values for forearm and wrist examinations were 0.708 and 0.538 cGy cm 2 , respectively. In lower limb, tibia and fibula examinations had a median DAP value of 3.23 cGy cm 2 followed by ankle examinations with a median DAP of 3.10 cGy cm 2 . The rounded third quartile DAP value for each distribution can be used as a provisional DRL for the specific procedure type.
6 citations
TL;DR: How exposure of samples to lower temperatures leads to an increase in in vitro potassium concentration and underlines the importance of correct sample storage is shown.
Abstract: Hyperkalaemia is well recognized as a potentially serious condition. However, pre-analytical factors such as delay in separation, haemolysis and contamination (particularly EDTA) commonly lead to false elevations in potassium concentrations. This may lead to repeated sampling, unnecessary investigation and inappropriate therapies. A potentially signi¢cant hypokalaemia may also be masked. Less well recognized is the e¡ect of ambient temperature prior to centrifugation on in vitro potassium concentration. Exposure of samples to lower temperatures is associated with a rise in potassium concentration and high temperatures with a fall in serum potassium due to the e¡ect on the transmembrane Naþ--Kþ pump. An example of this has recently become evident at our laboratory. During winter 2005--06, an unusually high number of elevated potassium results were found to originate from a local general practitioner (GP) surgery (surgeryA). Potassium results from an equivalent surgery (surgery B) were compared retrospectively over periods of two months (summer 2005, winter 2006) and reasons for any potential di¡erence sought. Details of the number of samples sent, mean potassium concentrations, temperatures and time to centrifugation are provided in Table 1. Potassium concentrations over 5.1mmol/l were de¢ned as abnormal. Mean seasonal potassium concentration rose by 0.59mmol/l at surgery A between summer 2005 and winter 2006 compared with 0.10mmol/l at surgery B. The mean winter 2006 temperature was 101C colder than that of summer 2005. The proportion of samples with hyperkalaemia remained stable at surgery B over both time periods, unlike the marked increase seen in surgery A’s results (Figure1). In fact, the only sample with hyperkalaemia from surgeryA in summer 2005 had a creatinine concentration of over 400 mmol/L. All other creatinine concentrations from both surgeries over both time periods had creatinine concentrations less than 200 mmol/L. Potassium assay performance was adequate, as indicated by internal and external quality control. Discussion with the surgeries revealed a major di¡erence in sample handling: surgery Awas hanging the samples on an outside door handle for collection, exposing them to potentially cold temperatures for variable lengths of time. Our study shows how exposure of samples to lower temperatures leads to an increase in in vitro potassium concentration and underlines the importance of correct sample storage. GP surgeries can limit the e¡ects of pre-analytical factors. Time between sampling and delivery to the laboratory for centrifugation should be limited as far as possible. To deal with this, numerous GP surgeries in our area have installed centrifuges. This not only minimizes the time to centrifugation but also negates the possible e¡ects of ambient temperature Table 1 Details of the samples sent for surgeries A and B
5 citations
TL;DR: Loss of protective sensation due to neuropathy, a reduction in arterial perfusion caused by ischaemia, and infection all contribute to the underlying aetiology of diabetic foot ulceration.
Abstract: A non-pressurised boot dressing keeps wounds moist, warm and humid, stimulating healing and providing a barrier against wound odour. Its use in the management of problematic neuroischaemic diabetic foot ulcers is reported.
3 citations
TL;DR: A 37-year-old Caucasian woman had a long-standing history of infertility secondary to severe endometriosis and failed to conceive using her embryos frozen from previous IVF cycles but conceived following IVF with donor oocytes in January 2003, when she developed pre-eclampsia with associated uteroplacental insufficiency.
Abstract: A 37-year-old Caucasian woman had a long-standing history of infertility secondary to severe endometriosis. Complex surgery had previously been undertaken in 1994 at the age of 28 years, to remove ...
TL;DR: A prospective 1-year audit was carried out on consecutive patients admitted to a district general hospital of the UK with ankle fractures needing open reduction internal fixation in order to analyse the factors affecting infection.
Abstract: A prospective 1-year audit was carried out on consecutive patients admitted to a district general hospital of the UK with ankle fractures needing open reduction internal fixation in order to analyse the factors affecting infection. Ninety seven percent patients had had their operative procedure within 24 h from the time of injury. Eighty four percent patients were discharged in less than 7 days period from the day of admission. All but one patient received antibiotic prophylaxis in accordance with local microbiology policy guidelines. Four out of 32 patients received therapeutic antibiotics for wound cellulitis/superficial infection. No patient had a deep infection, osteomyelitis or septic arthritis. Complex ankle trauma, post-radiography preliminary reduction of ankle fracture-dislocation in the emergency department, prolonged operating time, delayed surgery, persistent ankle swelling and unsupervised operation were common denominators in four cases with infection in ankle fracture fixation.