Bashir W.A.,Ealing Hospital NHS Trust
Seminars in musculoskeletal radiology | Year: 2010
The entities encompassing the syndromes collectively known as myopathies and myositis are composed of numerous separate and distinct disorders with a vast spectrum of clinical signs, symptoms, immunopathology, genetic and environmental influences, as well as overall clinical outcome. Classification of the myositides (diseases of skeletal muscle) remains a rather controversial subject due to our lack of complete understanding of this divergent group of disorders. The mainstay of achieving diagnosis of a myopathy has until relatively recently been with a combination of clinical acumen, laboratory assessment, electromyography, and muscle biopsy. The use of modern high-resolution cross-sectional imaging studies is of particular value in confirming the physical findings and identifying suitable sites for biopsy. Imaging is fast becoming an established part of the overall evaluation of myopathies and myositis, helping to delineate the location and extent of the disease process, and it is being recognized as central to a prompt and accurate diagnosis in some cases. Although radiology has mainly been seen to have a subsidiary role in the diagnosis of myositides, newer imaging techniques following recent determined research interests have began to spark a renewed interest in the complex field of skeletal muscle imaging.
Mehta S.R.,Ealing Hospital NHS Trust
Therapeutic Advances in Endocrinology and Metabolism | Year: 2010
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the Western world, and its prevalence is predicted to rise in the future in parallel with rising levels of obesity and type 2 diabetes mellitus. It is commonly associated with insulin resistance. Many patients have coexisting obesity, hypertension, dyslipidaemia or hyperglycaemia, and are at increased risk of developing cardiovascular disease. Although patients with simple steatosis have a good prognosis, a significant percentage will develop nonalcoholic steatohepatitis which may progress to cirrhosis, end-stage liver failure and hepatocellular carcinoma. Despite promising results from several pilot studies and small to medium randomized controlled trials, there is currently no pharmacological agent that is licensed for the treatment of NAFLD. At present the mainstay of treatment for all patients is lifestyle modification using a combination of diet, exercise and behavioural therapy. With recent advances in the understanding of the pathogenesis of NAFLD, the goal of treatment has shifted from simply trying to clear fat from the liver and prevent progressive liver damage to addressing and treating the metabolic risk factors for the condition. To reduce liver-related and cardiovascular morbidity and mortality, all patients with NAFLD should be invited to enrol in adequately powered, randomized controlled studies testing novel therapies, many of which are targeted at reducing insulin resistance or preventing progressive liver disease. Coexisting obesity, hypertension, dyslipidaemia or hyperglycaemia should be treated aggressively. Orlistat, bariatric surgery, angiotensin receptor blockers, statins, fibrates, metformin and thiazolidinediones should all be considered, but treatments should be carefully tailored to meet the specific requirements of each patient. The efficacy and safety of any new treatment, as well as its cost-effectiveness, will need to be carefully evaluated before it can be advocated for widespread clinical use. © The Author(s), 2010.
Crook J.,Ealing Hospital NHS Trust
Paediatric nursing | Year: 2010
Paracetamol and ibuprofen are safe and effective medications for reducing a fever in children and young people and they are often administered together with a view to reducing a temperature quickly. National Institute for Health and Clinical Excellence guidelines dictate that only one of these drugs should be given at a time because there is no evidence to suggest that simultaneous use is more effective. This article summarises a literature search of randomised controlled trials carried out to identify which, if either, of these drugs is faster at reducing a fever. In the studies examined, ibuprofen was found to be marginally more effective. However, the maximum dose of paracetamol was not administered. There is a need for more methodologically sound research that uses equivalent doses of both drugs.
Sharma R.,Ealing Hospital NHS Trust
Journal of Renal Care | Year: 2010
Cardiovascular disease remains the major cause of mortality and morbidity in patients with advanced chronic kidney disease (CKD) and after renal transplantation. The mechanisms for cardiotoxicity are multiple. Identifying high-risk patients remains a challenge. Given, the poor long-term outcome of dialysis patients who do not receive renal transplantation and the lower supply of donor kidneys relative to demand, optimal selection of renal transplantation candidates is crucial. This requires a clear understanding of the validity of cardiac tests in this patient group. This paper explores the strengths and weaknesses of currently available diagnostic tools in patients with advanced CKD. Echocardiography is very useful for the detection of cardiomyopathy and prognosis. Stress echocardiography, myocardial perfusion imaging and coronary angiography are the best tools for the assessment of coronary artery disease. All predict outcome. No single gold standard investigation exists. At present, there is not an optimal technique for predicting sudden cardiac death in this patient group. Ultimately, the choice of cardiac test will always be determined by patient preference, local expertise and availability. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Agency: Cordis | Branch: H2020 | Program: RIA | Phase: HCO-05-2014 | Award Amount: 3.61M | Year: 2015
South Asians, who represent one-quarter of the worlds population, are at high risk of type-2 diabetes (T2D). Intensive lifestyle modification (healthy diet and physical activity) is effective at preventing T2D amongst South Asians with impaired glucose tolerance, but this approach is limited by high-cost, poor scalability and low impact on T2D burden. We will complete a cluster-randomised clinical trial at 120 locations across India, Pakistan, Sri Lanka and the UK. We will compare family-based intensive lifestyle modification (22 health promotion sessions from a community health worker, active group, N=60 sites) vs usual care (1 session, control group, N=60 sites) for prevention of T2D, amongst 3,600 non-diabetic South Asian men and women with central obesity (waist100cm) and/or prediabetes (HbA1c6.0%). Participants will be followed annually for 3 years. The primary endpoint will be new-onset T2D (physician diagnosis on treatment or HbA1c6.0%, predicted N~734 over 3 years). Secondary endpoints will include waist and weight in the index case and family members. Our study has 80% power to identify a reduction in T2D risk with family-based intervention vs usual care of: 30% in South Asians with central obesity; 24% in South Asians with prediabetes; and 24% overall. Health economic evaluation will determine cost-effectiveness of family based lifestyle modification for prevention of T2D amongst South Asians with central obesity and / or prediabetes. The impact of gender and socio-economic factors on clinical utility and cost-effectiveness will be investigated. Our results will determine whether screening by waist circumference and/or HbA1c, coupled with intervention by family-based lifestyle modification, is an efficient, effective and equitable strategy for prevention of T2D in South Asians. Our findings will thereby provide a robust evidence base for scalable community-wide approaches to reverse the epidemic of T2D amongst the >1.5 billion South Asians worldwide.