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2. Idiopathic intracranial hypertension presenting as iron deficiency anemia: a case report

Author

Ione O. C. Woollacott, Desmond Kidd, Priyal Taribagil, Safina Rashid, and Peng Yong Sim

Subjects
Adult, Pediatrics, medicine.medical_specialty, Blood transfusion, Anemia, medicine.medical_treatment, lcsh:Medicine, Context (language use), Case Report, Optic neuropathy, Spinal Puncture, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Vision loss, 030225 pediatrics, hemic and lymphatic diseases, medicine, Humans, Papilledema, Pseudotumor Cerebri, medicine.diagnostic_test, Anemia, Iron-Deficiency, business.industry, Lumbar puncture, lcsh:R, General Medicine, medicine.disease, Idiopathic intracranial hypertension, Iron-deficiency anemia, Iron deficiency anemia, Female, medicine.symptom, Intracranial Hypertension, business, 030217 neurology & neurosurgery
Abstract

Background The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare. Case presentation This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits. Conclusion The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.

Published
2020

3. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Author

T. Yang, T. Pitts-Tucker, Daron Smith, S. Suresh, A.A. Khetarpal, C. Brathwaite-Shirley, Justine Davies, Sayinthen Vivekanantham, A. A. Adebayo, T. Sorah, N. Yim, H.R. Jackson, Salim Tayeh, R.H. Bremner, A. Piquet, L. Higgs, R. Yuen, P. Fergurson, N.K. Sim, A. Hibberd, A. Mehdi, N. Moody, D. Maru, C. Joyner, I. Hindle Fisher, Vartan Balian, N. Wetherall, Siyin Liu, P.N. Phan, S. Mallick, C. Lek, B. Oremule, S. Nelaj, M. Williams, Maqsood Qamar, A. Menon, M. Mohamud, H. Cheema, C. Chan, H.M. Omer, S.J. Cole, E. Craig, K.E. Leslie, S.S. Talukdar, R.B.S. Holliday, J. Heskin, A. Cody, Syed Shumon, S. McAleer, S. Abburu, P. Deekonda, S.F. Ashraf, R. Bose, AE Cotton, C. McGowan, S. Rashid, K. Theodoropoulou, A. MacAskill, Vishal Narwani, R. Maamari, S. Stokes, L.N. Harris, Peng Yong Sim, Evie Gardner, Leo Ng, N. Chandan, J.W. Lockey, M. Acres, H. Jhala, M.L. Kwan, A. Abdulmajid, A.E. Cardwell, P. Buakuma, C.P. Keane, M. Ahmed, N.J. Chilvers, E. Semple, J. Meek, A.K. Clarke, K. Koysombat, A. Hague, E.J.H. Turner, N. Keelty, P. Karunakaran, K.D. Clement, Mansoor Khan, Y. Cao, O. Prys-Jones, S.L. Walsh, C.N. McKerr, Sanjay Shah, S. Peroos, A. Dhanji, Joseph M. Norris, Neil Smith, M. Lakhani, M. Wijesekera, M. Bhatti, Midhun Mohan, C.Y. Luk, M. Elkawafi, S. Wadanamby, Jameel Mushtaq, Jonathan C. M. Wan, A. Ghaffar, M. Siddiqui, S. Naqib, Michaeline Kelly, J.W. Duncumb, F. Hughes, H.E.M. Jordan, R. Callan, G. Hung, C.F. Brewer, E.M. Ruiz, A. Higgins, C. Horst, C. Roberts, S. Kanabar, C. Wall, A.M. Buchan, A. Luhishi, R.P. Watson, D. Xylas, A. McBride, A. Bell, G. Heppenstall-Harris, A. Pericleous, Akanksha Chhabra, N. Hitchen, P. Raut, Shahzada Ahmed, M. Mirza, C.H. Archer, G. Russell, C.T. Francescon, D.T. Robertson, N. Gardiner, K. Cheng, A. Mishra, E. Webb, L. Rothwell, Dee A. Carter, V. Gupta, M. Johnstone, M.E. Kelly, R.D.C. Moon, E. Woin, K. Nadanakumaran, U. White, J. Empey, F. Bulley, R. Morley, G. Charalambous, L. Turner, S. Angelov, D. Coffey, S. Hartley, S. Pronin, E. Seager, R.K. Varma, Sharifullah Khan, S.B. Husnoo, R.K. Sethi, H.M. Chang, A. Duffy, Hew D.T. Torrance, P. Cunha, L. Kimani, W. Din, E.G. Heywood, C. O'Connell, D. Wylam, L. Anderson, N. Ahern, A.J. Trist, D. Burke, A. He, M. Sundar-Singh, A. Odeleye, G. Kumaran, N.L. Salloum, T.M. Brooks, A.S. Lynch, R. Debenham, Howard Gardner, M. Nielsen, M. Das, G. Bingham, S. Qureshi, Aditya Borakati, J. Wylie, Z. Kazmi, J.H. Park, P. Gill, A.R. Craig, M. Chen, Jonathan Wild, S.J. Lim, K.P. Choo, G. Culleton, G. Deas, E.Y. Chua, D. Vanniasegaram, A.H. Amphlett, N. Rajan, J.H. Chen, M. Hameed, Paul Ziprin, C. Toale, D. Gold, N. Keane, Jacob H Matthews, E. Palkhi, Nick Watson, C.M. Hewitt, A. Yousif, Faheem Ahmed, D. Wilkinson, John Mason, C. Reeder, R. Sagar, Deirdre A. Collins, S. Sandhu, S. Singh, J. Herron, A.Y.L. Ng, K. Brennan, K.A. Hoban, V. Navayogaarajah, A.S. Jawad, J.Y.L. Low, Julian R. Johnston, J. Wye, Inge Bernstein, John Parkin, A.D. Henson, Y.H. Soo, C. Topham, M. Steel, Priyank Patel, C.M. Lankage, U. Ashfaq, E.J. Brown, N.L. Foster, C.W. Rookes, R.J. Greig, K.L. McKevitt, N. Jathanna, J.M. Geraghty, M. Karia, S. Cumming, H. Holyoak, S. Parthiban, R.B. Karsan, V.C. Wing, T.E. Glover, R.D. Adams, B.H. Miranda, S. Gaffney, S. Rogers, G.E. Torlot, J.J. Filby, S. Sii, N.M. Rafiq, M. Shoa, S. Singagireson, N. Ungcharoen, Jennie Parker, B.F. Chong, N.M. Shafiq, V. Wong, E. Shakweh, A. Al-Mousawi, J. Pearce, S. Botchey, L. Horne, L. Fletcher, B. Singh, E.A. Whatling, K. Duke, A. Mastan, A.L. Frank, S. Verma, Humaira Shaheen, W. Liew, J. Turner, R. Rampal, T. Filipescu, R.M. Markham, B.A. Patel, S. Lim, A. Atayi, S. Yoganathan, N. Ramsay, M. Khattak, O. Amin, E. McAleer, K. Gohil, H. Shufflebotham, George S Bethell, M. Dhar, J.E. Davies, A.F. Carroll, E. Cornish, S. Omara, J. Bartlett, D. Loughran, A. Iqbal, L.R. Springford, D.R. McCormack, S. Leong, R. Ingham, D. Tan, A. Khajuria, M. Tonkins, M. Petrarca, A.M. Bucko, L.L. McKelvey, C. Gill, C.E. Thakker, K. Mohan, J. Turnbull, G. Cuthbert, W. Dean, R.D.J. Whitham, D.M. Lees, N. Chan, D. Osei-Kuffour, A. Sahathevan, K. Ng, L.B. Anderson, J. Eraifej, A. O'Connor, O.J. Cundy, C. Kong, R.K. Hughes, Bryan Paul Traynor, P. Keane, C. Liu, E. Canning, E.D. Mills, C. Gouldthrope, S. Patel, M.J.V. Holmes, C. Cullen, Lisa McNamee, Alberto Pizzolato, P. Harries, M. Elseedawy, R. Varley, C. Whacha, S.G. Ratu, A. Wright, S. Parsons, Pishoy Gouda, A. Mian, R. Bhudia, R. Adams, N. Bell, Talisa Ross, R. Reid, J.P. Shah, Sarah Dean, C. Neophytou, Alex Ward, J.D. Thompson, M. Seedat, A. Ramnarine, R.T. Harris, A. Qureshi, C. Major, Y. Sinha, A.S. Rocke, C.S. Yong, P. Kwang, David Neil Cooper, L. Aildasani, R.W. Goh, A.R. Dyal, L. Braganza, L. Healy, N. Davies, T. Reakes, N. Patel, S. Sng, C. Brennan, Z.R. Bakewell, S.L. Jenkin, Ahmed Daoub, I.A. Rhema, R.A. Walford, O. Spence, L. Yow, E.J. Roberts, W. Cymes, Y. Liew, E. Segall, June A. Sullivan, K.K. Sandhu, L. Satterthwaite, G.X. Xu, R.M. Waldron, S. McGarvie, D. Brown, M. Alizadeh, J.A. Syeed, H.F. Roberts, P. Dawson, H.R. Abdikadir, S. O'Connor, Y. Maheswaran, B.A. Hughes, B.A. Atraszkiewicz, K. Singh, C. Mcgenity, A.D. Wood, Ewan D. Kennedy, S.X. Poo, S. Mitrasinovic, Max Marsden, A. Ibrahim, Daniel F. McAuley, M. Attalla, S. Govinden, Siti Asma' Hassan, T. Raghvani, T. Bloomfield, R. Heminway, M. Ali, K.L. Robertson, P. Lalor, T. Dogra, I. Antoniou, A. Tahmina, Markus L. Sagmeister, Ronan McMullan, J. Matthams, Richard J. Egan, Elspeth Cumber, M. Dolaghan, P. Sritharan, S. Sarwar, E.S.M. Tan, S.E. Murray, S. Morris, S. Mansoor, M. King, Randall V. Martin, P. Williams, G. Brent, N.B. Reid, S. Collinson, T. Sarvanandan, R. Ratnakumaran, R.E. Keeling, M.A. Sherif, D. Thomas, I.J. Clark, R. Coulson, T.P. Bemand, A. Abid, A.L. Martin, J.C.K. Ng, P. Avery, Y. Narang, R. Manson, H. Petra, J.E. Giles, A.E. Lim, N.A. Vithanage, S. Osman, D. Elf, Panagis M. Lykoudis, A. Ang, Debra Salmon, A. Croall, T. Sale, S. Bonsu, Y.P. Mogan, G.E. Cooper, J. Lamont, S.T. Marchal, P. Naran, A.N. Kumar, R. Owasil, F. Koumpa, J.Q. Ng, P.N. Nesargikar, J. Boyle, Ryan Preece, E. Sewart, S. Lee, S. Kosasih, N. Jamal, Stephen J Chapman, N.A. Redgrave, C. Holmes, A.E. Barthorpe, S. Mistry, J.A. Yates, Robin Wilson, E. Prakash, J.Y. Kee, S.M. Anderson, R.S. Suresh, N. Hussain, S. Gentry, S. Darr, H. Heneghan, H.D. McRobbie, S. Assadullah, Shivam Bhanderi, C. Weston, A. Delport, A. Winarski, M.M. Li, T. Tharmachandirar, N. Canning, P.R. Forrest, Adam J Boulton, A. Ponweera, G.E. Stewart, J.S. Ahn, J. Hartley, A. Isaac, J.L.Y. Allen, R. Carr, S. Gokani, J. Zhao, C. Player, D. Sim, W. English, R.J. McGalliard, S. Cullen, R. Thethi, A. Livesey, K.N. Lwin, M. K. Abd Ghaffar, C.L. Knight, P.C. Hurst, A.Y. Tay, Devender Mittapalli, F. Winslow, G. Bhaskaran, L. Gauntlett, W. Leung, D.M. Golding, A. Wali, D.C. Marshall, H. Ross, K.P. Raman, P.J. Teoh, C. Allan, I. Nehikhare, C.M. Ventre, M. Venn, J.A. Crewdson, A. Shukla, N. Ramjeeawon, S. Shahid, P. Mithrakumar, J. Fern, Y. Tan, H. Haq, S. Turaga, U. Hayat, C. Palmer, H. Goradia, T. Ramtoola, J. Bloomer, C. Chhina, Z. Momoh, W.M. Wynell-Mayow, N. Jayakody, M. Bravo, J. Gabriel, R. Khanijau, L. Esteve, A. Malik, R.D. Obute, S. Sheth, S. Lunawat, U. Qureshi, C. Rees, A. Kerai, M. Peters, A.Y. Tsui, K. Kow, M. Trail, A. Coates, F. Long, V. Paraoan, M.T. Stoddart, N. Li, M. Bright, W.W. Chaudhry, M.K. Malys, S. Owczarek, C.L. Jubainville, E. Brennan, M. Hanrahan, A. Wang, A. Burgess, S. Dutt, N. Varma, R.P. Williams, A. Ledsam, R.T. Buckle, W. Ho, U. Sajjad, B. Goh, M.R. Hardy, E. Lim, L.J. Burney, C.S.D. Roy, Thomas M Drake, Harry J. Gilbert, A. Yener, A. Trimble, Archana Shah, H. Ahmed, E.C. Barton, K. Eparh, C. McCrann, F. Harding, J. Mah, D. Kotecha, A. Al-Robeye, J. MacDonald, S. Kim, Andrew Logan, C. McLaughin, H. Collier, O. Brewster, J. Loveday, L. Tung, S. Dindyal, O. Al-Obaedi, A. Simpson, M. Sirakaya, F. Morgan, G.S. Ng, S. Mahboob, D. FitzPatrick, A. Jindal, O. O'Carroll, Y. Devabalan, T. Axelson, D. Rojoa, K. Sasapu, Kirsty Davies, J. Moradzadeh, Ewen M Harrison, K. Gandhi, S. Beecroft, G. McCabe, C.P. Chilima, T. Goldsmith, H.Z. Bazeer, N. Kalra, P. Morrison, T.C. Hoskins, J.J. Wiltshire, A. Narain, D. Joshi, D. Horth, H.C.P. Wilson, Y.F. Dennis, M. Mills, C. Diaper, J.A. Sanders, S.M. Chiu, J. Coffin, V. Elangovan, K.S. Dolbec, H.L. Warwick, R.H. Shuttleworth, T. Patel, R. Goodson, F.S. Brown, Jane Lim, O. Ziff, M. Rashid, V. Mirdavoudi, K.G. Reid, A. Broyd, E. Woon, M. Zuhair, A.D. Greenhalgh, L.R. Wingfield, S. Stevens, O. Hussain, G. Pandey, A. Bakhsh, I.B. Ptacek, J. Dobson, L. Bolton, A.L. Kerr, T.M.P. Fung, P. Narayan, T. Ward, Ruth Lyons, C. Robinson, Buket Gundogan, S. Akhtar, P. Vanmali, L. Austreng, N. Kelly, M. Kadicheeni, H Ali, P. Holton, H. Turley, C.J. Morrison, L. Hu, M. Sukkari, D.A. O'Sullivan, J. Brecher, C.J. White, M.A. Charalambos, William Bolton, M. Tahir, L. Grundy, T.P. Pezas, Ewan Brown, Nicholas Bullock, A.M.A. Shafi, A. Aslanyan, Michael F. Bath, H. Wilson, P.C. Copley, S.E. Scotcher, Heather Kennedy, N. Bassam, A. Omar, G.D. Stott, S. Ashraf, E. Galloway, R.D. Bartlett, H. Amin, Y.N. Neo, W.C. Soon, S. Rabinthiran, C. Phillips, L.A. Henderson, K. Whitehurst, A. Kahar, S. Sukumar, M.R. Williams, W.A. Gatfield, C. Ntala, K. Dear, A.R. Chitnis, M. Eragat, H.C. Huang, K. O'Sullivan, N. Yong, J. Robson, A. Valli, A. Mohite, G.J. Salam, F. Tongo, S. Lopes, R.A. O'Loughlin, S.L. Hickling, J. Fong, A. Chung, Kathy Nicholls, H. Abid, S. Balaji, J. Hardie, T. Reeves, H.R. Paine, M. Hayat, H. Nayee, Y.N. Suleman, S. Tan, M. Sharifpour, X. Chen, I. Barai, A. Yan, M.A. Gillies, T.W. Tilston, A. Kreibich, Y.H. Tan, A. Murtaza, Chris Dunn, P. Jull, J.W. Kim, A.D. Semana, N. Abuhussein, P. Shepherd, L. Derbyshire, P.M. McEnhill, J.B. Patel, C. Toh, T. Arif, B.W. Matthews, D. Shanahan, N. Seneviratne, L. Carr, A. Curran, A. Batho, L.D. O'Flynn, R. McAllister, A. Durr, Rahul Bhome, S. Mackin, K. Ahmad, R. Shaunak, S. Bassiony, H.A. Khokhar, R. Chin, R. Priestland, G.X.J. Sherliker, J.H. Entwisle, C. Anandarajah, H. Aziz, M. Chaudhary, A. Kishore, H. Adjei, M. Minhas, S.W. McLure, T. Kane, E. Ingram, T. Fautz, D. Chrastek, R. Singh, B.N. Shurovi, A. Asmadi, N. Ansari, J. Mahmood, K. Patel, A.N. Street, A. Thacoor, C. Girling, L. Cheskes, V. Shatkar, B. Ali, A. McGrath, Shaun Trecarten, J.D. Farmer, R. Dean, R.C. McLean, P.L.M. Harrison, S. Iqbal, S. Hirani, R. Fleck, S. Pope, C.Y. Kong, A.M. Demetri, H. Selvachandran, M. Malaj, H.K. Blege, B.D. Mistry, C.M. Grossart, R. Slade, S.A. Stanger, A.J. Dhutia, A. Amajuoyi, Ased Ali, M. Robinson, R. Punj, Jane Dickson, J. Lucas de Carvalho, Jessica Harvey, L.M. Bullman, D Nepogodiev, H.L. Joyce, Catrin Morgan, J. Paul, R. Vaughan, A. Prabhudesai, C. Egerton, A. Sheldon, C. Holloway, K. Brzyska, J. Ashwood, Christine McGarrigle, S. Pal, H. Rosen O'Sullivan, A. Rangedara, A. Hill, A. Szczap, S. Hudson-Phillips, J. Lavery, Harriet Mitchell, J.D.B. Hayes, M. Salem, F.A. Bamgbose, J. Bassett, V. Raghuvir, R. Dennis, S.E. Cox, C.J. Dewdney, N. Mitha, A.W. Roberts, Brij Patel, J. Wills, R. Goodier, R.M. Koshy, D. Weinberg, E.J. Griffin, Harriet L. Mills, A. Marsh, Z. Khonat, Kenneth A. McLean, E. Hester, T. Spencer, A.H.Y. Lee, J. Chong, L.R. Bookless, Michael J. Raphael, P. Sangal, M. McMenamin, H. Khalid, G.S. Harbhajan Singh, F.I. Chaudhry, N. Favero, J.E.F. Fitzgerald, Chetan Khatri, J. Remedios, A. Charania, Daniel J. George, S. Jackson, C. Murkin, R. Dawar, I. Kisyov, E. Wong, R.J. Pearse, A.N. Baker, L. Carthew, N. Warren, I. Adeleja, M. McCann, C. Drislane, R. Tan, S. Ho, K. Hulley, L. Doan, E.M. O'Neill, R. Gratton, M. Srikantharajah, C. Henderson, L. Puan, H. Whittingham, A. Johnston, E. Mckean, A.K. Tear, D. Varma, H. McFarlane, C.N. Lou, E.M. Cumber, Aneel Bhangu, Z.H. Siddiqui, J. Cleere, M. Chamberlain, James Glasbey, Sarah Ali, M. Masood, A. Linton, G. Chillarge, M. Davis-Hall, A. Anilkumar, U. Khan, A. Tai, R. Shepherd, Joshua Burke, W. Loke, M. Edison, A. Mortimer, N. Anim-Addo, R.S. Reehal, R. Blessed, Daniyal J. Jafree, M.S. Sait, H.C. Copley, N. Ward, M. Wells, K. Raji, J. Gulati, H. Keevil, C.A. Asbjoernsen, A. White, Nikita R. Bhatt, J. Barnes, S. Wang, F. Cheung, Clive Graham, K. Dynes, C. Dorman, E. Strange, A. Radotra, A. Reed, R. Nachiappan, I. Ibrahim, F. Acquaah, P. Jalota, S. Stezaker, J.E. Rogers, MI Perera, R. Kiff, T. Rangan, R. Weaver, E. Mazumdar, J. Beckett, Rowena McGregor, E.V. Wright, N. Punjabi, V. Charavanamuttu, Stephen O'Neill, S. Majid, Zulfiqarali G. Abbas, S.M. Lakhani, G. Rattan, J. Lua Boon Xuan, K. Joshi, HE Whewell, M. Patel, T.M. Schulz, O.K. Vernon, L.F. McClymont, N. Woodcock, L. Gray, Reena Shah, H. Thakur, F.S. Peck, P. Karia, L. Ashken, S. Rinkoff, M. McDowell, L. Chew, C.D. Blore, A.C.D. Smith, E. Auyoung, L.M. Sabine, O. Parker, S.M. Choi, V. Thirumal, J. Pickard, L. Murphy, C.J. Coffey, P. Dube, M.H. Abul, T. Khan, J. Campbell, M.T. Turner, Adam Gwozdz, K.K. Ong, B. Durrani, A. O'Kane, A.S. North, Najeeb Ahmed, C. Xiao, D. Maclennan, Nora Abdul Aziz, S.A. Semnani, L. Bell, Amy Ashton, L. Crozier, V. Teng, M. O'Bryan, K. Clesham, Vanisha Patel, L. Kretzmer, T. Lo, G.H. Stanley, M.D. Theodoreson, J.K. Mehta, F. Morris, L. Howells, R. Pinto, T. Bergara, J. Matheson, E. Devlin, E.T. Tan, E. Toner, L. Jacob, Sher Ahmad, J. Sellathurai, Catherine Doherty, J. Norton, C. Maxwell-Armstrong, S. Ng, T.R. Barrow, N. Boxall, A.A. Thevathasan, M. Ryan, E. Uppal, C. Jenvey, G.E. Aidoo-Micah, Karan Verma, U. Datta, F. Hirst, H. Woodward, J. Khangura, J. Chervenkoff, F. Edozie, E. Burke, M.G. Rasiah, A. Jaitley, Thomas L. Lewis, D. Lazenby, A. Lotfallah, A. Khan, E. McCance, Henry A. Claireaux, A.S. Fawaz, P.D. Jewell, R.G. Tharakan, R. Narramore, E. Heathcote, G. Nixon, H. Chin, E. Sun, L.S. Chew, K. Lim, G. Lakshmipathy, R. Telfer, B.A. Shuker, H. Kitt, O.D. Thompson, N. Behar, H. Naveed, R. Allot, E. Batt, E.J. Stone, J.M. Aithie, I. Henderson, Rakesh Heer, C. Deall, C.J. McIntyre, L. Dinsmore, S. Milne, Bhavik Anil Patel, N. Cody, A. Pandey, A. Kaushal, M.C. Sykes, N. Maple, R. Simpson, S. Lynne, S. Shahidi, M.I. Zegeye, B. Forte, P. Khonsari, G. Thomas, O. Sitta, V. Robertson, K. Mazan, J. Prest-Smith, D. O'Reilly, A. Sreh, A.E. Salih, Anna Craig-Mcquaide, Vandana Agarwal, E.G. Chisholm, Z. Afzal, G.L. de Bernier, P.W. Stather, Lucy Elliott, A. Collins, D. Lim, M. Abdelhadi, Q. Lu, and J. Stein

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Critical Care, medicine.medical_treatment, Patient Care Planning, Young Adult, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, 030202 anesthesiology, Laparotomy, Intensive care, medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, Aged, 80 and over, Postoperative Care, business.industry, Patient Selection, Professional Practice, Odds ratio, Middle Aged, United Kingdom, Confidence interval, Anesthesiology and Pain Medicine, Cohort, Emergency medicine, Female, Observational study, Emergencies, business, Ireland, Abdominal surgery
Abstract

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Published
2019
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4. Safety of nonsteroidal anti-inflammatory drugs in major gastrointestinal surgery: a prospective, multicenter cohort study

Author

Denise Osei-Kuffour, Rahul Bhome, Charn Gill, Oliver Ziff, Ali Bakhsh, Damien Brown, DEVENDER MITTAPALLI, Hayden McRobbie, Dafydd Loughran, Roshni Bhudia, Christopher Graham, John Bassett, Dermot Burke, Guy Stanley, Richard Egan, Michael Stoddart, James Fitzgerald, Thomas Lorchan Lewis, Bryan Traynor, Robert Whitham, Hannah Charlotte Copley, Shaine Morris, Fraser Peck, Chetan Khatri, Rupert Pearse, Christine McGarrigle, Charlotte Holmes, Nicholas Bullock, Adam Boulton, Shyam Gokani, Nicholas John Sebastian Chilvers, Peng Yong Sim, Siyin Liu, Dominic Marshall, Laura Wingfield, Darren Mc Cormack, Angeline Lee, Inge Bernstein, Marie Edison, Babatunde Oremule, Daniel McAuley, STARSurg Collaborative, Joshua Burke, James Glasbey, DR DEVINA MARU, Rebecca Reid, Michael Greshan Rasiah, Ossama Al-Obaedi, Catrin Morgan, Laurie Rigueros Springford, Mary Venn, Sarah Gentry, Chia Yew Kong, Jonathan Wan, Abhishek Chitnis, Nicholas Sim, Justine Davies, Alistair JM Reed, George Bethell, Michael Kelly, Alex Elizabeth Ward, Philip Stather, Shershah Assadullah, Helen Heneghan, Stephen Chapman, Talisa Ross, Renol M Koshy, Paul McEnhill, Alice Buchan, Syed Shumon, Conor Toale, Ewan Kennedy, John Hayes, Amrita Dhutia, Joseph Duncumb, Sarah Hudson-Phillips, Daniyal Jafree, Shujing Jane Lim, Richard Adams, Adam Gwozdz, Kirtan Patel, Olivia Cundy, Richard Moon, Syed Faaz Ashraf, and Claireaux, H

Subjects
Adult, Male, medicine.medical_specialty, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, business.industry, Anti-Inflammatory Agents, Non-Steroidal, Odds ratio, Middle Aged, Confidence interval, Colorectal surgery, Surgery, Logistic Models, 030220 oncology & carcinogenesis, Propensity score matching, Female, business, Cohort study, Abdominal surgery
Abstract

Background Significant safety concerns remain surrounding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) following gastrointestinal surgery, leading to wide variation in their use. This study aimed to determine the safety profile of NSAIDs after major gastrointestinal surgery. Methods Consecutive patients undergoing elective or emergency abdominal surgery with a minimum one-night stay during a 3-month study period were eligible for inclusion. The administration of any NSAID within 3 days following surgery was the main independent variable. The primary outcome measure was the 30-day postoperative major complication rate, as defined by the Clavien–Dindo classification (Clavien–Dindo III–V). Propensity matching with multivariable logistic regression was used to produce odds ratios (OR) and 95 % confidence intervals. Results From 9264 patients, 23.9 % (n = 2212) received postoperative NSAIDs. The overall major complication rate was 11.5 % (n = 1067). Following propensity matching and adjustment, use of NSAIDs were not significantly associated with any increase in major complications (OR 0.90, 0.60–1.34, p = 0.560). Conclusions Early use of postoperative NSAIDs was not associated with an increase in major complications following gastrointestinal surgery.

Published
2020
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5. Gastric banding clip in the urinary bladder

Author

Peng Yong Sim, Kean Hin Tung, and Joshua Yi Min Tung

Subjects
Adult, medicine.medical_specialty, Urinary bladder, Gastroplasty, business.industry, Gastric banding, Urinary Bladder, Perforation (oil well), General Medicine, Case presentation, Anatomic region, Surgical Instruments, medicine.disease, Surgery, medicine.anatomical_structure, Foreign-Body Migration, Lower urinary tract symptoms, Humans, Medicine, Female, Foreign body, business, Foreign Bodies
Abstract

Background and aim: A wide variety of foreign bodies have been found in the urinary bladder, most often due to self-introduction and autoerotism, or iatrogenically introduced during surgery in the anatomic region. We report the first case of a gastric banding clip found in the urinary bladder. Case presentation: We describe the case of a 33-year-old Chinese female who had previously undergone gastric banding and subsequent removal of the band. She presented with lower urinary tract symptoms which followed a diurnal pattern, and investigations revealed a portion of a gastric banding clip in the urinary bladder. There was no sign of perforation or erosion of the bladder. The clip was surgically removed and the patient recovered without complications. Discussion and conclusion: This is the first reported case of an intraperitoneal gastric banding clip migrating extraperitoneally into the urinary bladder. The use of the urinary bladder to expel foreign bodies has been documented in other vertebrates, and the mechanism by which this occurs without perforation or erosion of the urinary bladder warrants further investigation.

Published
2019
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6. Enhanced Depth Imaging Optical Coherence Tomography of Optic Nerve Head Drusen in Children

Author

Peng Yong Sim, Michael Karampelas, Faye Barampouti, and Hibba Soomro

Subjects
Male, Retinal Ganglion Cells, medicine.medical_specialty, genetic structures, Adolescent, Optic Disk, Visual Acuity, Drusen, 03 medical and health sciences, 0302 clinical medicine, Nerve Fibers, Optical coherence tomography, Ophthalmology, medicine, Humans, Child, Retrospective Studies, medicine.diagnostic_test, Adult patients, business.industry, Optic Disk Drusen, Automated perimetry, Ultrasound, medicine.disease, eye diseases, Cross-Sectional Studies, 030221 ophthalmology & optometry, Optic nerve, Female, sense organs, Neurology (clinical), Enhanced depth imaging, Visual Fields, business, Monitoring tool, 030217 neurology & neurosurgery, Tomography, Optical Coherence
Abstract

BACKGROUND To assess the utility of enhanced depth imaging optical coherence tomography (EDI-OCT), compared with other conventional imaging modalities, for detecting and characterizing optic nerve head drusen (ONHD) in children. METHODS We report a retrospective cross-sectional case series of consecutive pediatric patients (age ≤16 years) with ONHD confirmed using B-scan ultrasonography. All eyes were evaluated using spectral-domain OCT of the optic nerve head in conventional (non-EDI) and EDI modes, fundus autofluorescence (FAF), and standard automated perimetry. Detection rates and the capacity to characterize ONHD were compared between EDI-OCT, non-EDI-OCT, and FAF. RESULTS Twenty-eight eyes of 15 patients (mean age 11 years; 60% female) were identified with definite ONHD that were confirmed by B-scan ultrasound. Among the technologies, EDI-OCT, non-EDI-OCT, FAF, and automated perimetry had findings consistent with ONHD in 24, 21, 18, and 4 eyes, respectively. EDI-OCT had a significantly better detection capability (86% of eyes) compared with FAF (P = 0.04) but not with non-EDI-OCT (P = 0.15). Similar to results previously reported in adult patients, EDI-OCT detected ONHD at different levels of depth; most were located anterior to the lamina cribrosa. ONHD detected by EDI-OCT appeared as hypo-reflective ovoid regions bordered by hyper-reflective material or as isolated hyper-reflective bands without a hypo-reflective core. The mean greatest diameter of ONHD seen on EDI-OCT was 449.7 (SD ±114.1) μm. CONCLUSIONS EDI-OCT detects ONHD in most eyes identified as having drusen on B-scan ultrasonography. This technique has the potential to be an effective alternative first-line diagnostic and monitoring tool for ONHD, particularly for detecting buried drusen in children.

Published
2019

7. National survey of the management of eye emergencies in the accident and emergency department by foundation doctors: has anything changed over the past 15 years?

Author

Chuiki Jasmine La, Jonathan Than, Jason Ho, and Peng Yong Sim

Subjects
business.industry, Accident and emergency, education, Workload, medicine.disease, Confidence interval, Article, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Surveys and Questionnaires, 030221 ophthalmology & optometry, medicine, Medical Staff, Hospital, Humans, Medical emergency, Prospective Studies, Emergencies, business, Emergency Service, Hospital, 030217 neurology & neurosurgery
Abstract

BACKGROUND: Ophthalmic emergencies comprise a significant portion of junior doctors’ workload in accident and emergency (A&E). However, previous studies have demonstrated a lack of training and confidence in the management of such emergencies. This study assessed changes in basic ophthalmic training that A&E junior doctors received in dealing with eye emergencies, their perceived level of confidence and the availability of appropriate ophthalmic equipment in A&E over the last 15 years. METHODS: A prospective, national, combined online and telephone survey using a previously published questionnaire was performed. Foundation year two doctors (FY2s) from each A&E department in the UK listed on the official NHS directory were contacted for participation. RESULTS: Two hundred and ten A&E departments were contacted and 202 responded (response rate of 96.2%). There was no significant change in the number of A&E departments equipped with slit lamps (82.5% in 2003 vs 79.7% in 2018; p = 0.26). However, the prevalence of training in its use has decreased significantly (68.4% in 2003 vs 52% in 2018; p = 0.005). There was also a significant reduction in the prevalence of training in the management of eye emergencies (77.4% in 2003 vs 45.5% in 2018; p

Published
2019

8. Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

Author

Cheng Yi Loo, Flora Elwes, A M Armbrecht, Peter Cackett, Shyamanga Borooah, Peter Aspinall, Baljean Dhillon, and Peng Yong Sim

Subjects
Male, medicine.medical_specialty, Time Factors, Visual acuity, genetic structures, Recombinant Fusion Proteins, Visual Acuity, Angiogenesis Inhibitors, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, lcsh:Ophthalmology, Pro re nata, Ranibizumab, Ophthalmology, Journal Article, medicine, Humans, In patient, 030212 general & internal medicine, Dosing, Retrospective Studies, Aflibercept, Aged, 80 and over, Drug Substitution, business.industry, Treatment regimen, Age-related macular degeneration, Anti-VEGF, General Medicine, Macular degeneration, medicine.disease, Receptors, Vascular Endothelial Growth Factor, Treatment Outcome, lcsh:RE1-994, Intravitreal Injections, Wet Macular Degeneration, 030221 ophthalmology & optometry, Female, medicine.symptom, business, Tomography, Optical Coherence, Research Article, Follow-Up Studies, medicine.drug
Abstract

Background To assess the effect of switching patients previously incompletely treated with ranibizumab (RBZ) to aflibercept (AFL) using a pro re nata (PRN) treatment strategy in neovascular age-related macular degeneration (nvAMD). Methods A retrospective case series was conducted on patients who had persistent or recurrent intra- and/or sub-retinal fluid treated initially with RBZ and subsequently switched to AFL. The main outcome measures were best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at different stages of the study. Friedman analysis of variance and Wilcoxon test were used to examine differences in BCVA and CRT. Results Two hundred and seven eyes from 182 patients were included. BCVA and CRT improved significantly initially following 3 RBZ injections with a mean gain of 3.7 letters (p

Published
2018
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9. Is there a relationship between surgical success defined by motor and health-related quality of life criteria in adult strabismic patients?

Author

Peng Yong Sim and Saurabh Jain

Subjects
0301 basic medicine, Health related quality of life, medicine.medical_specialty, Vision, Binocular, Eye Movements, business.industry, Eye movement, Strabismus, 03 medical and health sciences, Ophthalmology, Oculomotor Muscle, 030104 developmental biology, 0302 clinical medicine, Physical medicine and rehabilitation, Quality of life (healthcare), Oculomotor Muscles, Correspondence, 030221 ophthalmology & optometry, medicine, Quality of Life, Humans, business, Binocular vision
Published
2017

10. Investigation of factors associated with the success of adult strabismus surgery from the patient's perspective

Author

Charles Cleland, Peng Yong Sim, Saurabh Jain, and Jonathan Dominic

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Visual acuity, Adolescent, Health Status, Visual Acuity, Ophthalmologic Surgical Procedures, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Quality of life, Risk Factors, Medicine, Humans, Young adult, Strabismus, Socioeconomic status, Aged, Diplopia, Aged, 80 and over, business.industry, Middle Aged, Ophthalmology, Logistic Models, Socioeconomic Factors, Oculomotor Muscles, Pediatrics, Perinatology and Child Health, 030221 ophthalmology & optometry, Quality of Life, Female, medicine.symptom, business, Psychosocial, 030217 neurology & neurosurgery, Strabismus surgery
Abstract

Purpose To explore factors that influence the success of adult strabismus surgery based on health-related quality of life (HRQOL) criteria. Methods The HRQOL aspect of strabismus surgery was assessed using the Adult Strabismus 20 (AS-20) questionnaire. Adult patients (≥16 years of age) undergoing strabismus surgery between 2014 and 2016 were identified using a treatment register. Pre- and postoperative AS-20 scores were calculated. HRQOL surgical success was defined as a pre- to postoperative change in AS-20 score exceeding previously published 95% limits of agreement. Any relationship between demographic factors (sex, age, and socioeconomic status), presence or absence of diplopia, type and magnitude of deviation, and change in deviation size with HRQOL success was investigated. Results A total of 87 patients were included (mean age, 47 years; 53% female). Nondiplopic patients showed significantly lower pre- and postoperative scores on the AS-20 psychosocial subscale compared to diplopic patients. Of 87 surgeries, 54 (62%) were classified as successful based on HRQOL criteria. Multiple logistic regression analysis showed only lower socioeconomic status to be significantly associated with a higher rate of HRQOL success (P = 0.04). Conclusions Strabismic patients with a lower socioeconomic status are more likely to achieve HRQOL success following surgery. We also show that nondiplopic patients have more psychosocial concerns than those with diplopia and that this disparity persists even after strabismus surgery.

Published
2017

11. How to pass the Part 1 FRCOphth in foundation training

Author

Peng Yong Sim

Subjects
Medical education, business.industry, education, Medical school, Internship and Residency, Foundation (evidence), Pass rate, General Medicine, Certificate, Syllabus, Ophthalmology, England, Education, Medical, Graduate, Humans, Medicine, Educational Measurement, business, Curriculum
Abstract

The Part 1 FRCOphth (hereafter referred to as Part 1) is the first of four examinations required for a Fellowship in Ophthalmology (FRCOphth) awarded by the Royal College of Ophthalmologists (RCOphth). It is considered to be one of the toughest exams in ophthalmology training, with an average pass rate of 44% in 2017 (cf. 62% for the Refraction Certificate, 62% for the Part 2 FRCOphth written and 60% for the Part 2 FRCOphth oral).1 It also has the lowest pass rate (39%) and is the most expensive (table 1) of any entry-level postgraduate exams undertaken by foundation doctors in 2017.2 Unlike other popular entry-level postgraduate exams (eg, MRCP Part 1) where the syllabus directly extends from medical school curricula, the knowledge required for the Part 1 is mostly non-transferrable. View this table: Table 1 Comparison of cost between popular UK entry-level postgraduate exams* At present, foundation trainees in the UK are only permitted to sit the Part 1 following full General Medical Council registration (ie, after completion of foundation year 1).3 The exam is not a mandatory requirement prior to commencing Ophthalmic Specialist Training but ophthalmic trainees are required to pass it before entering into the third year of their training. Part 1 aims to assess a candidate’s ‘understanding of patient investigations and knowledge of basic and clinical sciences relevant to ophthalmology’.4 Consequently, there is …

Published
2018
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