Collier A.,Ayr Hospital |
Ghosh S.,AMRI Institute of Diabetes and Hormonal Disorders |
Hair M.,NHS Ayrshire and Arran
Diabetic Medicine | Year: 2015
Aim: To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes. Methods: Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients. Results: In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.007) and significantly lower total cholesterol (P = 0.005), HDL-cholesterol (P = 2.5*10-17) and HbA1c levels (P = 0.003) than women. By contrast, men had higher blood pressure, both systolic (P = 0.034) and diastolic (P = 0.0003), and higher non-fasting triglyceride levels (P = 0.001). Men with Type 1 diabetes had a higher prevalence of neuropathy (P = 0.021). Among people with Type 2 diabetes, men had a significantly lower BMI (P = 4.26*10-37), and significantly lower total cholesterol (P = 2.96*10-62) and HDL-cholesterol levels (P = 8.25*10-141) but higher non-fasting triglyceride levels (P = 0.0002). In Type 2 diabetes, men had a higher prevalence of ischaemic heart disease (P = 1.66*10-25), stroke (P = 0.002) and peripheral vascular disease (P = 1.68*10-12), while women were older (P = 4.83*10-23), heavier and had a higher prevalence of hypertension (P = 5.32*10-12). More people with Type 2 diabetes were on lipid-lowering treatment (84.7 vs 52.4%; P = 5.51*10-8) than were those with Type 1 diabetes. The prevalence of retinopathy was higher among non-smokers thank smokers in people with both Type 1 and Type 2 diabetes (Type 1, P = 0.016; Type 2, P = 0.001). Conclusions: The study shows gender differences between Type 1 and 2 diabetes that are of clinical significance and require further investigation. Follow-up of the patients included in the present study should give us much greater understanding of the importance of gender in the development of metabolic abnormalities and diabetes complications. © 2014 The Authors.
Collier A.,Ayr Hospital |
Ghosh S.,Ayr Hospital |
McGlynn B.,Ayr Hospital |
Hollins G.,Ayr Hospital
American Journal of Clinical Oncology: Cancer Clinical Trials | Year: 2012
Prostate cancer is the most frequently diagnosed malignancy among UK men and accounts for 12% of male deaths. Androgen deprivation therapy (ADT) is commonly used as part of the treatment for prostate cancer. It is effective at suppressing prostate-specific antigen, stabilizing disease, alleviating symptoms in advanced disease, and potentially prolonging survival. However ADT, presumably at least in part owing to low testosterone levels is associated with insulin resistance, the development of metabolic syndrome plus increased overall and cardiovascular disease mortality. We have reviewed the relationship between prostate cancer, ADT, metabolic syndrome, type 2 diabetes, and cardiovascular disease. We have not reviewed other potential medical problems such as osteoporosis. We suggest that there should be a baseline assessment of patients' risk for cardiovascular disease before starting ADT. Consideration should be given to starting appropriate therapies including lifestyle advice, antihypertensive and lipid-lowering agents, insulin sensitizer, plus possibly aspirin. Having started ADT, the patients should have a regular (possibly annual) assessment of their cardiovascular risk factors. Copyright © 2011 by Lippincott Williams & Wilkins.
Ting D.S.J.,Ayr Hospital |
Sau C.Y.,University of Glasgow |
Srinivasan S.,Ayr Hospital |
Ramaesh K.,Gartnavel General Hospital |
And 2 more authors.
British Journal of Ophthalmology | Year: 2012
Background/aims: To review the indications and types of keratoplasty performed in the West of Scotland between 2001 and 2010. Methods: A retrospective analysis of the histopathological diagnoses of all corneal buttons submitted to the regional Ocular Pathology Laboratory (Glasgow, UK) between January 2001 and December 2010 was performed. Results: Between 2001 and 2010, a total of 921 keratoplasties were performed in the West of Scotland. These included 646 (70.1%) penetrating keratoplasties and 275 (29.9%) lamellar keratoplasties (LK). Keratoconus (n=264, 28.7%) was the leading indication for keratoplasty, followed by graft failure (n=177, 19.2%), Fuch's endothelial dystrophy (n=124, 13.5%), keratitis (n=106, 11.5%), pseudophakic/aphakic bullous keratopathy (n=88, 9.6%), endothelial failure (n=67, 7.3%), non-Fuch's corneal dystrophies (n=21, 2.3%), trauma (n=19, 2.0%), autoimmune/inflammatory diseases (n=16, 1.7%) and others (n=39, 4.2%). A significant increase in the proportion of LK over penetrating keratoplasty was observed during this 10-year period: from 14.1% LK (2001-2005) to 40.4% LK (χ 2=71.78, p value<0.001). Conclusion: Keratoconus was the leading indication for keratoplasty in the West of Scotland. Both anterior LK and endothelial keratoplasty seemed to show an emerging trend as the procedures of choice for dealing with anterior and posterior corneal pathologies, respectively.
Cowie A.,Ayr Hospital |
Thow M.K.,Glasgow Caledonian University |
Granat M.H.,Glasgow Caledonian University |
Mitchell S.L.,Scottish Government
European Journal of Cardiovascular Prevention and Rehabilitation | Year: 2011
Background: In heart failure, reduced physical activity level can adversely affect physical and psychosocial functioning. No previous heart failure research has compared effects of home and hospital-based exercise training upon physical activity level, or has objectively assessed their long-term effects upon physical activity. This study used an activPAL™ monitor to examine immediate and long-term effects of home and hospital-based aerobic exercise training upon physical activity level. Design: Randomized controlled trial. Methods: Sixty patients with heart failure (mean age 66 years; NYHA class II/III; 51 male/9 female) were randomized to home training, hospital training or control. Both programmes consisted of aerobic circuit training, undertaken twice a week for one hour, for eight weeks. All participants wore the activPAL™ at baseline, and after eight weeks, for one week. Six months after cessation of training, a subgroup of participants from the home and hospital training groups (n = 10 from each group) wore the activPAL™ for a further week. Results: Hospital-based training significantly increased steps taken per day during 'extra long' (P = 0.04) and 'long' (P = 0.01) walks. Neither programme had any immediate effect upon physical activity level otherwise. Though daily upright duration for the home group significantly improved six months after cessation of training (P = 0.02), generally physical activity level was maintained in the long term for both training groups. Conclusions: Hospital-based training enabled participants to walk for longer periods. It is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period. © The European Society of Cardiology 2011.
Masterton R.G.,Ayr Hospital
International Journal of Antimicrobial Agents | Year: 2010
In modern sepsis management, long-held concerns about the inexorable rise of antimicrobial resistance have led to a key focus on antibiotic stewardship. Among the many strands that come together to provide a complete picture of stewardship is the issue of how antibiotic classes are deployed. Based on consistent results from mathematical modelling studies, the concept of a structured approach to such class use has evolved over the last decade. Whereas antibiotic cycling was initially perceived to be the strongest candidate for investigation in this field, over recent years the focus has shifted to antibiotic heterogeneity. Although there is presently little clinical work available on antibiotic heterogeneity, the available data demonstrate that this is an attractive option for enabling clinicians to make the most of their existing pool of antimicrobial classes by holding at bay, as much as possible, the emergence of resistance. © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Smart C.M.,Ayr Hospital |
Primrose C.W.,University of Glasgow |
Peters A.L.,University of Glasgow |
Speirits E.J.,University of Glasgow
Anaesthesia | Year: 2014
To maximise the effect of a small fluid load, it is occasionally desirable to bolus manually with multiple depressions of a large-capacity syringe. This is usually achieved by placing the syringe on the side port of a three-way tap. We modified this technique by placing two-one-way valves in line with the three-way tap, effectively creating a piston pump, the infusion rates via which we compared with those achieved by an inflatable pressure-infuser in a simulated resuscitation. Fluid flow was faster using the piston pump than with the pressure-infuser (mean (SD) time to infuse 2000 ml saline 0.9% via a 16-G cannula 352 (10) s vs 495 (19) s, respectively, p < 0.0001). The piston pump appears to have potential for both tight control of fluid delivery and major high-volume resuscitation. The lightweight nature of the pump and its lack of reliance on gravity may also make it suitable for the pre-hospital setting. © 2014 The Association of Anaesthetists of Great Britain and Ireland.
A novel technique of tangential, circumferential, scleral tunnel in 20-gauge transconjunctival sutureless vitrectomy: Optical coherence tomography-aided analysis of wound integrity and clinical outcome
Awan M.A.,Gartnavel General Hospital |
Lyall D.A.M.,Gartnavel General Hospital |
Koshy Z.R.,Ayr Hospital
British Journal of Ophthalmology | Year: 2012
Aim: To describe a novel technique of sclerotomy construction to facilitate 20-gauge transconjunctical sutureless vitrectomy (TSV) along with the evaluation of the wound integrity. Methods: The surgical technique is described. One hundred consecutive patients who underwent TSV were evaluated for wound leaks, postoperative hypotony, endophthalmitis and any other complication related to surgery. The sclerotomies of eight patients (24 ports) were analysed by imaging with anterior segment optical coherence tomography immediately after surgery, and on the first postoperative day and after the first postoperative month. Results: 104 eyes of 100 patients were evaluated with a mean follow-up of 9.6 months. All cases underwent surgery with standard 20-gauge instrumentation and vitrectomy techniques. Five sclerotomies were found to leak at the end of surgery, requiring a suture. Anterior segment optical coherence tomography images were obtained from eight eyes with good apposition of the tunnel noted in all the cases. Mean intraocular pressure was 18.7 mm Hg on the first postoperative day. One patient had hypotony without leak and this patient had pre-existing hypotony due to chronic panuveitis. There was no instance of postoperative endophthalmitis. Conclusions: This technique of 20-gauge TSV achieves good wound apposition with a low incidence of complications while using standard 20-gauge instrumentation and vitrectomy techniques.
Lyall D.,Ayr Hospital |
Srinivasan S.,Ayr Hospital |
Roberts F.,Western Infirmary
Clinical and Experimental Ophthalmology | Year: 2011
A 7-year-old Caucasian girl presented with a pigmented lesion on the left bulbar conjunctiva that increased in size from 1mm to 4mm over a 12-month period. She underwent excision biopsy and reconstruction of the ocular surface with amniotic membrane graft. Histopathology showed the naevus was composed of somewhat swollen naevus cells with clear cytoplasm and central nucleus. These vacuolated naevus cells were approximately 40μm in diameter. Over 90% of the cells in the naevus were composed of these swollen cells. Immunohistochemical staining was positive for S100 and Melan-A. This case illustrates that balloon cells may be observed in conjunctival naevi at a previously unreported pre-pubescent age. Awareness of ballon cell naevus is important to avoid clinical and histological pitfalls in diagnosis. © 2010 The Authors. Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists.
Srinivasan S.,Ayr Hospital |
Srinivasan S.,University of Glasgow |
Hanumanthu S.,Ayr Hospital |
Varikkara M.,Ayr Hospital
Journal of Cataract and Refractive Surgery | Year: 2013
A 78-year-old man had uneventful cataract surgery with implantation of a 1-piece plate-haptic intraocular lens in the capsular bag. Seven weeks later, he presented as an emergency with intense fibrinous uveitis and increased intraocular pressure (IOP). Examination revealed an inflammatory capsular block syndrome (CBS) causing fibrinous anterior uveitis and secondary angle-closure glaucoma. The glaucoma resolved and the patient's vision improved following neodymium:YAG laser posterior capsulotomy. Inflammatory CBS should be considered in pseudophakic patients presenting with fibrinous anterior uveitis, increased IOP, and secondary angle closure. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2012 ASCRS and ESCRS Published by Elsevier Inc.
McArthur C.,Ayr Hospital |
McLaughlin G.,Ayr Hospital |
Meddings R.N.,Ayr Hospital
British Journal of Radiology | Year: 2012
Objectives: The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA <20 in well-moderately differentiated tumours. Methods: We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. Results: Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p<0.01. None of the 357 patients with a PSA level of <20 and a Gleason score of <8 had a positive bone scan. Conclusion: Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of <20 and a Gleason score of <8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series. © 2012 The British Institute of Radiology.