Dhillon P.S.,Imperial College London |
Gray R.,Whittington Hospital |
Kojodjojo P.,Imperial College London |
Jabr R.,University of Surrey |
And 3 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2013
Background-Gap junction resistivity, Rj, has been proposed as a key determinant of conduction velocity (CV). However, studies in connexin-gene knockout mice demonstrated significant CV slowing only with near-complete connexin deletion, and these findings led to the concept of a significant redundancy of myocardial gap junctions. We challenged this prevailing concept and addressed the hypothesis that there is a continuous relationship between Rj and CV, each independently measured in human and guinea-pig myocardium. Methods and Results-Rj and CV were directly measured by oil-gap impedance and microelectrode techniques in human left ventricular myocardium from patients with hypertrophic cardiomyopathy and in guinea-pig atrial and ventricular myocardium before and during pharmacological uncoupling with 20-μmol/L carbenoxolone. There was a continuous relationship between Rj and CV in human and guinea-pig myocardium, pre- and post-carbenoxolone (r2=0.946; P<0.01). In guinea-pig left ventricle, left atrium, and right atrium, carbenoxolone increased Rj by 28±9%, 26±16%, and 25±14% and slowed CV by 17±3%, 23±8%, and 11±4% respectively (all P<0.05 versus control). As a clinically accessible measure of local microscopic myocardial conduction slowing in vivo in the intact human heart, carbenoxolone prolonged electrogram duration in the right atrium (39.7±4.2 to 42.3±4.3 ms; P=0.01) and right ventricle (48.1±2.5 to 53.3±5.3 ms; P<0.01). Conclusions-There is a continuous relationship between Rj and CV that is consistent between cardiac chambers and across species, indicating that naturally occurring variations in cellular coupling can account for variations in CV, and that the concept that there is massive redundancy of coupling is not tenable. © 2013 American Heart Association, Inc.
Lawton L.,Whittington Hospital
Nursing children and young people | Year: 2012
Guidelines were developed at the Whittington Hospital paediatric emergency department for a nurse-led discharge pathway, initially for children presenting to the department having accidentally ingested a substance that was potentially toxic. The pathway led to cuts in average time in hospital, time to treatment, and costs. Patients' experience of the emergency service was reported to be improved.
Congi L.,Whittington Hospital |
Roussou E.,Rheumatology and Rehabilitation
Clinical and Experimental Rheumatology | Year: 2010
Objective: Psoriatic arthritis (PsA) has been defined as a systemic, chronic, inflammatory arthritis, usually seronegative for rheumatoid factor (RF), associated with cutaneous psoriasis. The exact prevalence of PsA is unknown and its estimation has been difficult, partly due to the lack of a widely accepted classification criteria. Agreed and validated criteria will facilitate comparison between centres and different countries in the areas of epidemiology, outcome studies and therapeutic trials. A number of classification criteria have been published by Moll & Wright (M&W), Bennett's, Vasey and Espinoza (V&E), Fournié's, European Spondyloarthropathy Study Group (ESSG), McGonagle, Gladman and most recently, the CASPAR Study Group. In this paper, we present an audit aiming to assess which of these criteria performs better in clinical practice. Methods: Sixty-nine (69) patients with evidence of PsA were seen in the clinic as regular outpatients and were assessed as to whether they fulfil any of the 6 existing criteria for PsA: M&W, Bennett's, V&E, Fournié's, ESSG and CASPAR criteria. All items included in the 6 sets of criteria were recorded for each patient based on interview, clinical examination and scrutiny of clinical medical records. By comparing the criteria between themselves as well as the items used in each one of them we tried to assess which one of the criteria was performing best. Results: A total of 69 patients (M/F=24/45; mean age 46.4 years (±20.3), and delay in diagnosis of 3.4 years (±4.1) was assessed. From those, 9 patients did not fulfil any criteria and excluded from the analysis. From the remaining 60 patients [M/F=21/39; (age 48±15.3)], 21 patients (35%) fulfilled all 6 sets of criteria. The remaining 39 patients (M/F=41/59 %; age 47±14.9) were further analysed with regards to the feature that did not enable concordance. From those 39 patients, Bennett's criteria were positive in only 4139 (10.2%), M&W criteria were positive in 12/39 (30.7%), ESSG criteria in 17/39 (435%), V&E criteria were positive in 18/39 (46.1%), Fournié's criteria were positive in 31139 (79.4%) and CASPAR criteria in 35/39 (89.7%). By including family history of psoriasis in the criteria, 11/39 patients (28.2%), who did not fulfil M& W or V&E due to lack of family history of psoriasis as item, met the CASPAR criteria. In addition, some patients who did not fulfil the M&W criteria, since RF positive (7139; 17.9%), were able to satisfy the CASPAR criteria. Conclusion: Family history of psoriasis is the main advantage of the new CASPAR Criteria over M&W and V&E. In addition, using the CASPAR criteria, it is possible to make a diagnosis of PsA in a patient who develops inflammatory articular disease even if with RF positive and polyarticular symmetrical arthritis. It is also important to have these classification criteria for the development of recommendations for the optimal treatment of patients with PsA. We believe that the CASPAR criteria, which are simple and easy to use, have high potential to be introduced as the universal classification criteria for PsA. However, further study of the validation of these new criteria is required. © Copyright Clinical and Experimental Rheumatology 2010.
Steward M.J.,Whittington Hospital |
Taylor S.A.,University College London |
Halligan S.,University College London
Colorectal Disease | Year: 2014
Aim: Abdominal computed tomography (CT) improves the accuracy of clinical diagnosis and facilitates patient management. Radiation exposure must be considered by requesting clinicians and is especially relevant owing to the increasing use of CT colonography for diagnosis and screening of colorectal disorders. This review describes the radiation dose of abdominopelvic CT and colonography and attempts to quantify the risk for the clinician. Method: Articles were searched in the PubMed and Medline databases using combinations of the MeSH terms 'radiation', 'abdominal computed tomography' and 'colonography'. Electronic English language abstracts were read by two reviewers and the full article was retrieved if relevant to the review. Results: Abdominopelvic CT and CT colonography convey significant radiation dose to the patient but also have considerable diagnostic potential. In the right clinical context, the radiation risk should not be overestimated. Techniques to reduce the dose should be used. Repeated imaging in certain patients is a concern and should be monitored. Conclusion: Radiation risk can be quantified and presented simply in a manner that both patients and doctors can comprehend and evaluate. This approach will diminish misconceptions and allow a rational choice of diagnostic test. © 2014 The Association of Coloproctology of Great Britain and Ireland.
Ahmad O.F.,Whittington Hospital |
Akbar A.,St. Marks Hospital
British Medical Bulletin | Year: 2015
Introduction Food is a recognized trigger for most patients with irritable bowel syndrome (IBS). In recent years, an emerging evidence base has identified dietary manipulation as an important therapeutic approach in IBS. Sources of data Original and review articles were identified through selective searches performed on PubMed and Google Scholar. Areas of agreement Randomized controlled trials have supported the use of a diet that restricts a group of short-chain carbohydrates known collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). There is evidence that specific probiotics may improve symptoms in IBS. Areas of controversy The role of a high-fibre diet remains subject to ongoing debate with a lack of high-quality evidence. The long-term durability and safety of a low FODMAP diet are unclear. Growing points A paradigm shift has led to a focus on the relationship between diet and pathophysiological mechanisms in IBS such as effects on intestinal microbiota, inflammation, motility, permeability and visceral hypersensitivity. Areas timely for developing research Future large, randomized controlled trials with rigorous end points are required. In addition, predictors of response need to be identified to offer personalized therapy. © 2014 The Author.