Publications (83) View all
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Article: Advanced age influences the dynamic changes in circulating C-reactive protein following injury.
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ABSTRACT: BACKGROUND: The concentration of C-reactive protein (CRP), a biomarker of systemic inflammation, is determined by genetic, clinical and demographic factors including gender, smoking and body mass index (BMI). The influence of age on CRP dynamic changes following insult has, however, been poorly characterised. METHODS: We used unilateral hernia repair as a model of standardised insult to investigate the influence of baseline demographic and clinico-pathological factors affecting the dynamic changes in CRP, interleukin (IL) 6 and tumour necrosis factor-α over a time course of 48 h following injury. RESULTS: We derived CRP negativisation kinetics on 100 prospectively enrolled male subjects with mean age of 60.6 years (range 24-90 years) and mean BMI of 25.7 kg/m(2) (range 17.9-37 kg/m(2)). Patients who failed to normalise CRP to<10 mg/l at 48 h (n=74) were significantly older (p<0.001), had longer surgical times (p=0.05), higher waist/hip ratio (p=0.02). Multiple regression analysis confirmed age as the only independent predictor of delayed CRP normalisation (p=0.03). Persistent CRP elevation was associated with higher peak CRP values (p<0.001), higher IL-6 concentrations at 24 (p=0.01) and 48 h (p=0.03). CONCLUSIONS: CRP decline following insult is delayed in elderly patients as a result of unopposed IL-6 release. Age should be routinely incorporated in the assessment of CRP response to avoid misinterpretation of age-related delay in CRP clearance with ongoing systemic inflammation.Journal of clinical pathology 03/2013; · 2.43 Impact Factor -
Article: Abdominal adiposity is the main determinant of the C-reactive response to injury in subjects undergoing inguinal hernia repair.
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ABSTRACT: BACKGROUND: Obesity and serum C-reactive protein (CRP) (a sensitive marker of inflammatory activity) are associated with most chronic diseases. Abdominal adiposity along with age is the strongest determinant of baseline CRP levels in healthy subjects. The mechanism of the association of serum CRP with disease is uncertain. We hypothesized that baseline serum CRP is a marker of inflammatory responsiveness to injury and that abdominal adiposity is the main determinant of this responsiveness. We studied the effect of abdominal adiposity, age and other environmental risk factors for chronic disease on the CRP response to a standardised surgical insult, unilateral hernia repair to not only test this hypothesis but to inform the factors which must be taken into account when assessing systemic inflammatory responses to surgery. METHODS: 102 male subjects aged 24-94 underwent unilateral hernia repair by a single operator. CRP was measured at 0, 6, 24 and 48 hrs. Response was defined as the peak CRP adjusted for baseline CRP. RESULTS: Age and waist:hip ratio (WHR) were associated both with basal CRP and CRP response with similar effect sizes after adjustment for a wide-range of covariates. The adjusted proportional difference in CRP response per 10% increase in WHR was 1.50(1.17-1.91) p = 0.0014 and 1.15(1.00-1.31) p = 0.05 per decade increase in age. There was no evidence of important effects of other environmental cardiovascular risk factors on CRP response. CONCLUSION: Waist:hip ratio and age need to be considered when studying the inflammatory response to surgery. The finding that age and waist:hip ratio influence baseline and post-operative CRP levels to a similar extent suggests that baseline CRP is a measure of inflammatory responsiveness to casual stimuli and that higher age and obesity modulate the generic excitability of the inflammatory system leading to both higher baseline CRP and higher CRP response to surgery. The mechanism for the association of baseline CRP and waist:hip ratio to chronic disease outcomes could be through this increase in inflammatory system excitability.Journal of Inflammation 02/2013; 10(1):5. · 2.26 Impact Factor -
Article: Ethnicity in relation to incidence of oesophageal and gastric cancer in England.
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ABSTRACT: Background:This study investigated the variation in incidence of all, and six subgroups of, oesophageal and gastric cancer between ethnic groups.Methods:Data on all oesophageal and gastric cancer patients diagnosed between 2001 and 2007 in England were analysed. Self-assigned ethnicity from the Hospital Episode Statistics dataset was used. Male and female age-standardised incidence rate ratios (IRRs) were calculated for each ethnic group, using White groups as the references.Results:Ethnicity information was available for 83% of patients (76 130/92 205). White men had a higher incidence of oesophageal cancer, with IRR for the other ethnic groups ranging from 0.17 95% confidence interval (CI) (0.15-0.20) (Pakistani men) to 0.58 95% CI (0.50-0.67) (Black Caribbean men). Compared with White women, Bangladeshi women (IRR 2.02 (1.24-3.29)) had a higher incidence of oesophageal cancer. For gastric cancer, Black Caribbean men (1.39 (1.22-1.60)) and women (1.57 (1.28-1.92)) had a higher incidence compared with their White counterparts. In the subgroup analysis, White men had a higher incidence of lower oesophageal and gastric cardia cancer compared with the other ethnic groups studied. Bangladeshi women (3.10 (1.60-6.00)) had a higher incidence of upper and middle oesophageal cancer compared with White women.Conclusion:Substantial ethnic differences in the incidence of oesophageal and gastric cancer were found. Further research into differences in exposures to risk factors between ethnic groups could elucidate why the observed variation in incidence exists.British Journal of Cancer advance online publication, 11 October 2012; doi:10.1038/bjc.2012.465 www.bjcancer.com.British Journal of Cancer 10/2012; · 5.04 Impact Factor -
Article: Pancreatic cystic neoplasm presenting as a large gastric ulcer.
Endoscopy 10/2011; 43 Suppl 2 UCTN:E363. · 5.21 Impact Factor -
Article: Diagnosing gastroenteritis and travellers' diarrhoea.
The Practitioner 04/2001; 245(1620):192-4, 199-200, 204.
