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Mandalos A.,Sandwell and West Birmingham Hospitals NHS Trust | Sung V.,Sandwell and West Birmingham Hospitals NHS Trust
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2017

Purpose: To compare the postoperative outcomes and complications of glaucoma drainage device (GDD) surgery in pediatric (<18 years old) and adult patients. Methods: Retrospective, comparative study including all patients who underwent Baervedlt or Molteno device surgery by the same surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 21 mmHg and a 20% reduction from baseline. Results: Fifty-two children (69 eyes) and 130 adults (145 eyes) were included. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall failure rate was similar in children and adults. However, GDD failed earlier in adults than in children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later on, bleb encapsulation was more frequent in children, while corneal decompensation tended to be more frequent and occurred earlier in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults. Conclusions: GDD surgery presents different postoperative challenges in children and adults, and the surgeon should remain vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in pediatric patients. On the other hand, adults may be more prone to early corneal decompensation. © 2017 The Author(s)


Ewies A.A.A.,Sandwell and West Birmingham Hospitals NHS Trust | Alfhaily F.,University of Essex
Obstetrical and Gynecological Survey | Year: 2012

Endometrial hyperplasia is a commonly seen gynecological condition that affects women of all age groups. Whereas hysterectomy is the most preferred treatment option for complex endometrial hyperplasia with atypia, there is no consensus regarding the first-line management of women with hyperplasia without cytological atypia. Oral progestogen therapy was used with some success. Nonetheless, it may be plausible to argue that women with endometrial hyperplasia need continuous treatment and high level of compliance to ensure complete regression, which may not be guaranteed with oral therapy. Observational studies suggested that levonorgestrel-releasing intrauterine system (LNG-IUS) has been successfully used to treat endometrial hyperplasia without cytological atypia and selected cases of atypical endometrial hyperplasia. Furthermore, there is strong evidence from randomized controlled trials that LNG-IUS prevents the development of endometrial hyperplasia in exogenous estrogen users; however, its protective role and safety in tamoxifen-treated breast cancer survivors remain uncertain. This article evaluates the current evidence for the use of LNG-IUS, releasing 20 μg of LNG per day, in the prevention and treatment of endometrial hyperplasia.Target Audience: Obstetricians and gynecologists, family physiciansLearning Objectives: After completing this CME activity, phsicians should be better able to evaluate the current evidence for the use of LNG-IUS in the prevention and treatment of endometrial hyperlasia, and assess the current evidence as it relates to the endometrial protective role of LNG-IUS as an adjunct to tamoxifen in breast cancer survivors and as an adjunct to estrogen replacement therapy. Copyright © 2012 Lippincott Williams & Wilkins.


Smith P.P.,University of Birmingham | Gordon C.,Sandwell and West Birmingham Hospitals NHS Trust
Autoimmunity Reviews | Year: 2010

Systemic lupus erythematosus is a complex multisystem autoimmune disease that affects 1 in 2000 adult women in the United Kingdom. Lupus affects Afrocaribbeans and South Asians more frequently and more severely than white British. The disease can affect almost any part of the body and is characterised by remission and relapses. It is most common in women of reproductive age but can present at any age from 1 to 90. years and in men, but the diagnosis is probably missed in some men. It is important to distinguish active lupus features due to inflammatory and thrombotic mechanisms from chronic damage and to be aware that infection is an important trigger that may co-exist or mimic lupus activity. The disease is associated with a variety of autoantibodies that can help in making the diagnosis. Monitoring the disease is usually done using a clinical disease activity index such as the BILAG index, anti-dsDNA antibodies, C3 and C4 levels. Anti-C1q antibodies may have a role in monitoring the disease and in predicting those at risk of renal involvement or flare. The prognosis depends on the organs involved. There is an increased risk of premature atherosclerosis as a complication of lupus and this and infection are the most common causes of death in lupus patients. © 2010 Elsevier B.V.


Tomlinson C.L.,University of Birmingham | Stowe R.,University of Birmingham | Patel S.,University of Birmingham | Rick C.,University of Birmingham | And 3 more authors.
Movement Disorders | Year: 2010

Interpretation of clinical trials comparing different drug regimens for Parkinson's disease (PD) is complicated by the different dose intensities used: higher doses of levodopa and, possibly, other drugs produce better symptomatic control but more late complications. To address this problem, conversion factors have been calculated for antiparkinsonian drugs that yield a total daily levodopa equivalent dose (LED). LED estimates vary, so we undertook a systematic review of studies reporting LEDs to provide standardized formulae. Electronic database and hand searching of references identified 56 primary reports of LED estimates. Data were extracted and the mean and modal LEDs calculated. This yielded a standardized LED for each drug, providing a useful tool to express dose intensity of different antiparkinsonian drug regimens on a single scale. Using these conversion formulae to report LEDs would improve the consistency of reporting and assist the interpretation of clinical trials comparing different PD medications. © 2010 Movement Disorder Society.


Patel R.,Sandwell and West Birmingham Hospitals NHS Trust | Ispoglou S.,Sandwell and West Birmingham Hospitals NHS Trust | Apostolakis S.,University of Birmingham
Expert Opinion on Investigational Drugs | Year: 2014

Introduction: Desmoteplase is an investigational plasminogen activator found in the saliva of the vampire bat, Desmodus rotundus. It has been of scientific interest for over 25 years as it exhibits pharmacological properties that have led to the hypothesis that desmoteplase may be safer and more effective than recombinant tissue plasminogen activator (rtPA) in arterial thromboembolic disease, and in particular, acute ischaemic stroke (AIS). Areas covered: In this review, the authors cover the pharmacological properties of desmoteplase, focussing on how this translates into a theoretical advantage over rtPA in AIS. The authors further present preclinical studies and clinical data on the use of desmoteplase in AIS. Expert opinion: In contrast to rtPA, and despite a similar structure, desmoteplase has demonstrated high selectivity for fibrin and an absence of neurotoxicity in experimental models. Demonstrating such properties in animal models, one would have expected an ambitious clinical study future. Phase II and Phase III clinical studies in patients with AIS demonstrated an excellent safety profile with low risk of symptomatic intracranial haemorrhage compared to rtPA. However, data on clinical and radiological efficacy end points of desmoteplase in AIS are inconclusive. Further Phase III trials are currently underway and their results are eagerly awaited. © 2014 Informa UK, Ltd.


Hickman R.A.,University of Birmingham | Gordon C.,University of Birmingham | Gordon C.,Sandwell and West Birmingham Hospitals NHS Trust
Rheumatology | Year: 2011

SLE is a multi-system, autoimmune condition that can influence both male and female fertility. Inability to conceive may be attributed to several factors that may act singly or in combination: (i) older age in patients with SLE compared with healthy controls; (ii) disease-related infertility; and (iii) infertility through gonadotoxic treatments. In addition, psychosocial factors related to the disease may lower fecundity and may be associated with apparent infertility. Many therapeutic avenues are open to counteract reproductive damage in the management of SLE and to assist conception once infertility is diagnosed. These treatments can include the administration of gonadotrophin-receptor hormone analogues while receiving CYC treatment, the use of assisted reproductive technologies, such as in vitro fertilization and psychosocial intervention to promote a healthier relationship with their partner. Knowledge of how these reproductive problems occur and its prevention/treatment in SLE patients should avert irreversible infertility as well as give hope to SLE patients with infertility. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.


Kumar K.,Sandwell and West Birmingham Hospitals NHS Trust
Rheumatology (Oxford, England) | Year: 2010

Delay in assessment by rheumatologists of patients with new-onset RA is an important determinant of delay in treatment initiation. The influence of ethnicity on delay in assessment has not been addressed. We studied the extent of delay in patients of South Asian origin compared with other patients and the reasons underlying this delay. Data were collected from 272 patients with RA at the time of assessment by a rheumatologist; 43 were of South Asian origin. Delays were recorded at the level of the patient seeking advice from the general practitioner (GP), the GP referring to secondary care and the rheumatologist seeing the patient after the referral had been made. In addition, using qualitative methods, we assessed the reasons underlying delay in help-seeking behaviour in 10 patients of South Asian origin. Patient delay was significantly longer in patients of South Asian origin than in other patients. Delays at the level of primary and secondary care were not different. Four interlinking themes influenced how rapidly early RA patients of South Asian origin consulted their GPs: symptom experience, symptom evaluation, existing ideas, and knowledge of RA and influence of friends and family. Patient-dependent factors leading to delays in GP consultation, are the principal reason for the considerable delay in RA patients of South Asian origin being seen by rheumatologists. An understanding of the reasons underlying this delay will inform the development of interventions to reduce it in this population.


Sinha A.,Sandwell and West Birmingham Hospitals NHS Trust | Ewies A.A.A.,Sandwell and West Birmingham Hospitals NHS Trust
Climacteric | Year: 2013

Vulvovaginal atrophy-related symptoms exert a negative impact on the quality of life of up to 50% of postmenopausal women. Many of them decline to use topical vaginal estrogen, which is the standard effective therapy, due to the adverse publicity over recent years, and seek for alternatives. Further, there are no safety studies to support the use of topical vaginal estrogen in breast cancer survivors, and it is considered as contraindicated by many health-care professionals. Vaginal moisturizers and lubricants as well as regular sexual activity may be helpful to such women. Vaginal moisturizers may have an equivalent efficacy to topical vaginal estrogen and should be offered to women wishing to avoid the use of hormonal therapy. Lubricants are usually used during sexual intercourse to provide temporary relief from vaginal dryness and dyspareunia; however, they have no long-term therapeutic effects. We provide in this systematic review up-to-date information, for women and health-care professionals, about the use, safety and efficacy of the available vaginal moisturizers and lubricants. © 2013 International Menopause Society.


Berg J.,Pathology Harmony Lead | Berg J.,Sandwell and West Birmingham Hospitals NHS Trust
Clinica Chimica Acta | Year: 2014

The United Kingdom Pathology Harmony project commenced in 2007 and has been widely mirrored around the world. This initiative evolved through three separate phases of work. Fundamental to the project has been the ability to question variation in the work of the pathology laboratory that has been in place sometimes for a very long time, and yet appears to have little scientific foundation. Work has been undertaken on a methodological approach to studying variation in reference intervals and then moving forward with consensus values. On a wider level there is much else in pathology that can be harmonised from test names and units, through to the clinical guidance we offer for using our tests and work has been undertaken in several of these areas. © 2013 Elsevier B.V.


Mehta P.,Sandwell and West Birmingham Hospitals NHS Trust | Durrani O.M.,Sandwell and West Birmingham Hospitals NHS Trust
Orbit | Year: 2011

Purpose: To describe a new technique for deep lateral (single) wall orbital decompression surgery, developed by Mr. Geoffrey Rose, for proptosis in patients with thyroid-associated orbitopathy and to analyse the results achieved in our series. Methods: The study is an interventional, retrospective, non-comparative case series. Twenty-one eyes of seventeen patients underwent the described technique of deep lateral wall orbital decompression for thyroid-associated orbitopathy. All patients had controlled thyroid functions and underwent surgery for cosmetic rehabilitation, with analysis of the reduction in proptosis, changes in visual acuity and post-operative complications. The surgery involved removing the lateral orbital wall whilst preserving the lateral rim, the lateral wall being approached through a horizontal skin incision placed lateral to the lateral canthus. After reflecting the periosteum, most of the bone (deep lateral wall) between the skull base and inferior orbital fissure is removed. Results: A mean reduction in proptosis of 4.81mm ±1.23 (SD) (p<0.0001) with a median of 5.0mm (range 37mm) was achieved and the best-corrected visual acuity was maintained in all patients. There were no complications during surgery, and post-operative complications included worsening of pre-existing diplopia in one patient (6%) and transient cheek/temple numbness seen in three patients (18%). Conclusions: This technique of deep lateral wall orbital decompression developed by Mr. Rose is a safe and effective procedure for patients with mild to moderate proptosis. It carries a low risk of morbidity and avoids complications associated with decompressing the floor and medial wall, including new onset of motility disorders. © 2011 Informa Healthcare USA, Inc.

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