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Liverpool, United Kingdom

Ruff L.M.,Walton Center Foundation Trust | Mendelow A.D.,Newcastle General Hospital | Lecky F.E.,TARN
British Journal of Neurosurgery | Year: 2013

Introduction. Head injury is an important cause of death and disability in young people, with 1.4 million presentations each year in the UK. Extradural haematoma (EDH) is a potentially fatal head injury, which is easily remedied surgically. Several factors influence the mortality of EDH. The mortality of isolated EDH ranges from 1.2 to 33%.12,16,19,28 EDH outcome within the UK has not been recently described. Materials and methods. The Trauma Audit and Research Network (TARN) database was used to collate data on patients in England and Wales, with 'isolated' EDH between 1997 and 2003. Age, gender, GCS at 1st emergency department (ED), haematoma size, presence of a skull fracture, outcome (alive or dead) and injury-to-operation time were required. Where this time was unavailable, an estimation could be made using another time collected for the patient. Data co-ordinators at several hospitals were contacted in order to collect extra information missing from the database. The mortality for this group was then calculated and comparisons between this and previous series were made. Results. A total of four-hundred and eighty four (484) patients with isolated EDH were identified. One-hundred and ninety-seven (197) patients were operated on in England and Wales in this TARN dataset, between 1997 and 2003 for 'isolated' EDH. The mortality rate for this operative series was 2% (4 patients) (95% CI 0.1-4%). The non-operative mortality rate was 3% (95% CI 0.9-5.0%). Conclusion. This study has found a low EDH operative mortality rate of 2%. This is lower than that of previous studies on isolated EDH in the UK. This is likely to be valid as TARN is the largest European trauma registry, although we acknowledge that this first EDH sample derived from UK EDs may represent a selected series. © 2013 The Neurosurgical Foundation. Source

Nurmikko T.J.,Neuroscience Research Unit | Gupta S.,Walton Center Foundation Trust | Maclver K.,University of Liverpool
Current Pain and Headache Reports | Year: 2010

Central neuropathic pain is common in multiple sclerosis (MS), and its prevalence increases with physical disability. Sufficient evidence links dysesthetic pain, trigeminal neuralgia, Lhermitte's sign, and painful tonics spasms to plaque formation in the spinal cord and brain, whereas the association with headache and back pain remains unclear. Management varies according to the pain in question. For dysesthetic pain, drugs in use for neuropathic pain in general are recommended as first-line treatment, and emerging evidence suggests some benefit from cannabinoids and levetiracetam. Because of unique characteristics of MS-related trigeminal neuralgia, ganglion and root level neuroablative procedures are worth considering before microvascular decompression. Overall, the lack of controlled clinical trials, together with our limited understanding of the pathophysiological mechanisms involved, form a hindrance to a systematic and rational management of MS-related pain. © Springer Science+Business Media, LLC 2010. Source

Solomon T.,University of Liverpool | Solomon T.,Walton Center Foundation Trust | Lewthwaite P.,University of Liverpool | Perera D.,University Malaysia Sarawak | And 3 more authors.
The Lancet Infectious Diseases | Year: 2010

First isolated in California, USA, in 1969, enterovirus 71 (EV71) is a major public health issue across the Asia-Pacific region and beyond. The virus, which is closely related to polioviruses, mostly affects children and causes hand, foot, and mouth disease with neurological and systemic complications. Specific receptors for this virus are found on white blood cells, cells in the respiratory and gastrointestinal tract, and dendritic cells. Being an RNA virus, EV71 lacks a proofreading mechanism and is evolving rapidly, with new outbreaks occurring across Asia in regular cycles, and virus gene subgroups seem to differ in clinical epidemiological properties. The pathogenesis of the severe cardiopulmonary manifestations and the relative contributions of neurogenic pulmonary oedema, cardiac dysfunction, increased vascular permeability, and cytokine storm are controversial. Public health interventions to control outbreaks involve social distancing measures, but their effectiveness has not been fully assessed. Vaccines being developed include inactivated whole-virus, live attenuated, subviral particle, and DNA vaccines. © 2010 Elsevier Ltd. Source

Sathasivam S.,Walton Center Foundation Trust
European Journal of Internal Medicine | Year: 2012

Statins are an effective treatment for the prevention of cardiovascular diseases and used extensively worldwide. However, myotoxicity induced by statins is a common adverse event and a major barrier to maximising cardiovascular risk reduction. The clinical spectrum of statin induced myotoxicity includes asymptomatic rise in creatine kinase concentration, myalgia, myositis and rhabdomyolysis. In certain cases, the cessation of statin therapy does not result in the resolution of muscular symptoms or the normalization of creatine kinase, raising the possibility of necrotizing autoimmune myopathy. There is increasing understanding and recognition of the pathophysiology and risk factors of statin induced myotoxicity. Careful history and physical examination in conjunction with selected investigations such as creatine kinase measurement, electromyography and muscle biopsy in appropriate clinical scenario help diagnose the condition. The management of statin induced myotoxicity involves statin cessation, the use of alternative lipid lowering agents or treatment regimes, and in the case of necrotizing autoimmune myopathy, immunosuppression. © 2012 European Federation of Internal Medicine. Source

Mutch K.,Walton Center Foundation Trust
British Journal of Nursing | Year: 2010

Background People are not expected to die from multiple sclerosis although, as the condition progresses over a period of time, some people become increasingly disabled and will require assistance with all activities of daily living. Their partners invariably carry out these tasks. Objective To gain a deeper understanding of the experiences of the partner living with and caring for a spouse disabled by multiple sclerosis. Methodology In a qualitative study, eight partners who live and care for a person with multiple sclerosis were interviewed using a semi-structured questionnaire to explore their experience of their role. Results The interview transcripts were analyzed using a thematic framework approach. Codes, themes and five categories were identified, which were worry, planning, frustrations, commitment to marriage and coping strategies. These categories were examined using quotes from the transcripts as evidence. Conclusion This qualitative study identified that these couples had been married for at least 20 years before disability of the spouse significantly affected their lifestyle. Partners felt obliged to continue in their caring role due to a sense of duty and commitment of marriage.Partners felt a sense of loss as they prioritized the health and needs of their spouse above their own and, finally, partners lost their identity as husband/wife as they were called 'the carer'. Partners felt out of control due to the unpredictable and progressive nature of MS and because it consumed their life 24 hours every day. Partners often felt guilty at not being satisfied with their life and wanting some independence. Source

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