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QJM: monthly journal of the Association of Physicians 02/2009; 102(4):293-6. · 2.33 Impact Factor
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ABSTRACT: Clostridium difficile is the most common infectious cause of colitis and has been increasingly diagnosed in hospitalized patients. The number of prescriptions for proton pump inhibitors (PPIs) has also increased significantly over time. Few studies have reported an association between C. difficile-associated disease (CDAD) and PPI use.
To assess the extent and appropriateness of PPI prescribing in patients diagnosed with C. difficile infection.
We prospectively studied PPI prescriptions in 138 hospitalized patients diagnosed with C. difficile infection over a 4-month period. Clostridium difficile infections were diagnosed by the presence of C. difficile toxin in the stools. The appropriateness of prescriptions and relevant investigations were assessed by interview of patients and review of patient records.
Sixty-four percent (88 of 138) of all patients who developed C. difficile infections were on PPIs. A valid indication for PPIs therapy was not apparent in 63% of the patients.
There appears to be a widespread and inappropriate use of PPIs in hospital practice. Reduction of unnecessary PPIs use may be an additional strategy to reduce the incidence of this infection.
QJM: monthly journal of the Association of Physicians 07/2008; 101(6):445-8. · 2.33 Impact Factor
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ABSTRACT: To determine independent risk factors for recurrence of atrial fibrillation (AF) after a successful direct current (DC) cardioversion in patients with and without diabetes.
We retrospectively analysed the outcome in patients recently diagnosed with persistent AF.
Of 364 patients included, 289 had a successful direct current (DC) cardioversion. We compared 42 (14.5%) patients known to have diabetes to 247 (85.5%) without. Patients were reviewed in outpatient clinic with assessment of heart rhythm clinically and by electrocardiogram. Median follow-up after DC cardioversion was 74 days [interquartile range (IQR) 69-78 days].
When reviewed in outpatient clinic, only 63.7% (185 of 289) were still in sinus rhythm (SR). Of the group without diabetes, 66.8% (165 of 247) remained in SR vs. 45.2% (19 of 42) of the group with diabetes (P = 0.005). Binary logistic regression analysis showed duration of AF (P < 0.0001) and the presence of diabetes (P = 0.019) have been independent risk factors for recurrence of AF.
Presence of diabetes and the longer duration of AF were independent risk factors for the recurrence of AF after a successful DC cardioversion.
QJM: monthly journal of the Association of Physicians 03/2008; 101(3):181-7. · 2.33 Impact Factor
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QJM: monthly journal of the Association of Physicians 11/2007; 100(10):659-63. · 2.33 Impact Factor
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ABSTRACT: A 72-year-old lady presented with recurrent hypoglycaemia and a large pelvic mass. Hypoglycaemia was accompanied by undetectable serum insulin and c-peptide and high insulin-like growth factor II (IGFII) to IGFI ratio. She had undergone successful resection of a large bladder haemangiopericytoma 7 years earlier. A core biopsy was performed, and histology confirmed the recurrence of the haemangiopericytoma. Local palliative radiotherapy resulted in the reduction of IGFII level and IGFII to IGFI ratio and increased insulin, c-peptide and growth hormone (GH) level with long-term amelioration of hypoglycaemic episodes. Clinically and biochemically, radiotherapy was more effective than GH therapy.
International Journal of Clinical Practice 11/2006; 60(10):1319-22. · 2.41 Impact Factor
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QJM: monthly journal of the Association of Physicians 10/2006; 99(9):635-7. · 2.33 Impact Factor
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ABSTRACT: Erectile dysfunction (ED) is one of the commonest disorders of male sexual function. Penile erection depends on a complex interaction of psychological, neural, vascular and endocrine factors. Testosterone has an important role in both central and peripheral domains of this process. In this article we discuss the role of testosterone in male sexual function and endocrine causes of ED.
International Journal of Andrology 01/2006; 28 Suppl 2:28-34. · 3.59 Impact Factor
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QJM: monthly journal of the Association of Physicians 09/2005; 98(8):620-1. · 2.33 Impact Factor
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ABSTRACT: Diabetes is a major public health problem that is approaching epidemic proportions globally. There is an urgent need for strategies to curb the rising prevalence of this disease, and prevention appears a logical approach. Lifestyle modifications with weight loss and moderate exercise can reduce the incidence of diabetes by >50% in patients with impaired glucose tolerance (IGT). The use of metformin, acarbose and other agents have been shown in randomized prospective trials to prevent type 2 diabetes in high-risk subjects with IGT. Other pharmacological interventions are currently being examined in large prospective studies. It is likely that one or a combination of these approaches could make diabetes prevention a reality in the near future.
QJM: monthly journal of the Association of Physicians 07/2004; 97(7):451-5. · 2.33 Impact Factor
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International Journal of Obesity 02/2004; 28(1):183. · 4.69 Impact Factor
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QJM: monthly journal of the Association of Physicians 12/2002; 95(11):757-61. · 2.33 Impact Factor
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ABSTRACT: A case of bleeding from angiodysplasia in association with aortic stenosis is presented. The particular interest in this patient is that the bleeding ceased immediately after the insertion of a bioprosthetic valve and recurred when the valve restenosed. Furthermore, the bleeding again promptly resolved when the valve was exchanged for a metallic prosthesis despite long-term anticoagulation. The implications of these observations are discussed.
International Journal of Clinical Practice 04/2002; 56(2):155-6. · 2.41 Impact Factor
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QJM: monthly journal of the Association of Physicians 03/2002; 95(2):125-6. · 2.33 Impact Factor
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QJM: monthly journal of the Association of Physicians 01/2002; 94(12):721-2. · 2.33 Impact Factor
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ABSTRACT: Inflammatory pseudotumours of the liver are rare benign tumours of unknown origin, usually mistaken for malignant lesions. Two patients with Type 2 diabetes presented separately, unwell with fever, weight loss and hepatomegaly. Ultrasonography revealed 3-4 cm multiple lesions in the liver of the first case and a solitary 5 cm mass in the right lobe of the liver in the second. Biopsies revealed inflammatory pseudotumours in both cases. Both patients were treated with intravenous antibiotics and fluids. The clinical outcome was good and both patients had an uneventful recovery. We believe these to be the first two cases of inflammatory liver pseudotumours to be described in patients with diabetes mellitus.
International Journal of Clinical Practice 01/2002; 55(10):717-9. · 2.41 Impact Factor
