Farhad Huwez

Barts Health NHS Trust

Background: Contrast induced nephropathy (CIN) could be high in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). CIN risk prediction scores often involved the use of contrast volume in score calculations that limits their application in identifying patients who might benefit from peri-procedural nephroprotective strategies. W...

Background: Matched hydration and forced diuresis (MHFD) using the RenalGuard device has been shown to reduce contrast induced nephropathy (CIN) following coronary interventions. Aim: To evaluate the potential benefits of a non-automated MHFD protocol compared to current hydration protocol in prevention of CIN in patients with CKD. Methods: A total...

https://eposter.europa-organisation.com/2021/europcr/index/slide/abstract/154

Hankey and Blacker’s article provides a practical approach to the diagnosis and management of stroke.1 However, an important issue is the failure of the FAST (face, arm, speech, and time) tool to detect posterior fossa strokes in some patients, who might then not be triaged to stroke physicians and neurologists in hyperacute centres.Although I have...

Introduction and objectives NICE guidelines highlight the importance of adequate inhaler technique to ensure sufficient drug delivery in asthma and C. O. P. D. Whilst adequate inhaler technique can be a problem for patients of any age, the delivery of inhaled medication continues to be a particular problem for elderly patients. Despite the existenc...

The demand for memory assessment is increasing due to the dementia CQUIN and increased public awareness of dementia. Drs Huwez, Perera and Ewins describe an innovative approach of pre-clinic imaging and investigation which removed the need for a follow-up appointment, and also resulted in increased availability of clinic slots.

An 82 year old man presented with a six day history of watery diarrhoea, vomiting, abdominal cramps, and confusion. He had a history of hypertension, gout, and prostate cancer, which was well controlled on hormonal therapy. He was independent and lived alone. He had not travelled or used antibiotics within the past two months. On examination he ap...

79·6 years (range 58‐99). The presenting features included limb weakness (48·5%), speech abnormality (45·7%), facial weakness (22·8%), disturbed consciousness (11·4%), collapse (11·4%), visual disturbance (8·6%), dizziness (8·6%), confusion (5·7%), incoordination/ataxia (5·7%), and paraesthesia (2·9%). The FAST screening was documented for 85·7% of...

A 74-year-old man developed sudden onset of painless persistent partial loss of vision in the right eye 3 days after right total knee replacement. The initial investigation was for amaurosis fugax with a normal CT scan of the brain but the carotid Doppler confirmed >90% stenosis of the right internal carotid artery. Urgent ophthalmological review c...

Covering the wide range of knowledge and skills needed to tackle problems that may lead up to, or follow on from a stroke, this resource follows the course of a patient's journey from diagnosis to life at home, incorporating recent changes in the field of stroke medicine including the latest clinical trials.

A 64 year old man was admitted with sudden onset of pain in his right eye, blurred vision, and double vision on looking to the right. His medical history included hypertension, myocardial infarction, and a stroke from which there was no residual deficit. Neurological examination identified intention tremor in both arms, horizontal nystagmus, and...

Postural hypotension is a side effect of many antihypertensive drugs and a well recognised cause of acute or repeated falls.1 2 Measuring standing blood pressure in elderly hypertensive patients is recommended by the …

The editorial on herbal medicines warning about the possibility of serious side effects from some herbal medicines is welcome.1 The message was quite clear: “always ask your patient about herbal medicines”. It was prompted by the case report in the same issue by Fong and Kinnear on a patient with retrobulbar haemorrhage associated with chronic Gink...

The influence of Q wave acute anteroseptal myocardial infarction (Ml) on the sensitivity of the voltage electrocardiographic criteria of left ventricular hypertrophy (LVH) was assessed in this study. Patients with Q wave acute anteroseptal myocardial infarction but without echocardiographic (echo) LVH, showed augmentation of QS deflections in leads...

The effect of left ventricular volume (LVV) in relation to the left ventricular mass (LVM) was studied on the voltage electrocardiography (ECG) criteria of left ventricular hypertrophy (LVH). For this purpose, the sensitivity of numerous voltage criteria were assessed in patients with documented echocardiographic (echo) LVH with or without left ven...

This is a case report of a lady who presented with pupil-sparing Weber's syndrome. She had left oculomotor nerve palsy with normal pupil and right hemiparesis. The patient subsequently made a good recovery. An ischemic lesion of the lower mid-brain was demonstrated on the MRI scan of the brain, which corresponds to the motor nucleus of the oculomot...

We read with interest the case report by Courtney et al. 1 It demonstrates the need to consider hyperhomocysteinemia as a risk fac-tor in vascular occlusive disease, and also the importance of reducing homocysteine levels in such patients. In addition, a meta-analysis of 10 case-control studies on patients with a raised concentration of homocystein...

To the Editor: Even low doses of mastic gum — 1 mg per day for two weeks — can cure peptic ulcers very rapidly, but the mechanism responsible has not been clear. We have found that mastic is active against Helicobacter pylori, which could explain its therapeutic effect in patients with peptic ulcers. Mastic is a resinous exudate obtained from the s...

We reviewed the drug therapy of 83 patients who underwent cardiac transplantation for chronic left ventricular cardiac failure in Scotland from 1992-1996. Digoxin had been prescribed to 52% of patients in sinus rhythm, and 82% of those in atrial fibrillation (P=NS). This audit confirms that, in line with the clinical practice in the period between...

Avascular necrosis affects 3% of transplant recipients. In the lower limb, the femoral heads or condyles may be involved. We report the hitherto unrecorded complication of avascular necrosis of the calcaneum. Conservative management resulted in resolution without long-term complications.

The role of Helicobacter pylori in the pathogenesis of nonautoimmune gastritis and peptic ulceration is well recognized. H. pylori is widely prevalent in the general population, but the incidence among heart transplant recipients has not been reported. Furthermore, the natural history of this infection may be modified by immunosuppression. Gastric...

We report the coexistence of symptomatic viral, bacterial, and fungal infection of the upper gastrointestinal tract in a heart transplant recipient. Endoscopic findings were normal at all levels but, because of severe symptoms and recent conversion to positive serology for Cytomegalovirus, biopsies were taken. These showed esophageal candidiasis an...

A 43-year-old orthotopic heart transplant recipient had coagulase-negative staphylococcus endocarditis 26 weeks after the operation. A diagnosis of endocarditis was confirmed and followed up by serial transoesophageal echocardiography. Treatment with intravenous gentamycin and vancomycin cured her endocarditis, and a 2.5 cm vegetation regressed sig...

M Mode echocardiograms can be measured by two different conventions. In addition, normal limits of echocardiographic measurements have customarily been stratified according to age or body surface area. There is therefore a need to develop a more easily managed approach to calculating normal limits of measurements for the two conventions, one of whi...

M-mode echocardiograms of 202 cardiac patients were studied with respect to the pattern of left ventricular (LV) geometry. Patients with normal LV mass and volume were separated from those who had LV hypertrophy or enlargement on the basis of LV mass and volume indexed to body surface area. The relative wall thickness that is currently used to clas...

Classically, the ST-T configuration in the electrocardiogram of patients with left ventricular hypertrophy is said to have a typical pattern of ST depression together with asymmetrical T wave inversion (the so-called left ventricular strain pattern). However, many patients with left ventricular hypertrophy may also have ischaemic heart disease. To...

Left ventricular dimensions were measured on M-mode echocardiograms, both by the Penn Convention and the Recommendations of the American Society of Echocardiographers in a sample cardiac population. The measurements of interventricular septum and the posterior wall of the left ventricle were significantly larger (P less than 0.001) using American S...

SUMMARY1. A double-blind clinical trial was carried out on thirty-eight patients with symptomatic and endoscopically proven duodenal ulcer to compare the therapeutic responses to mastic (1 g daily, twenty patients) and placebo (lactose, 1 g daily, eighteen patients) given orally over a period of 2 weeks.2. Symptomatic relief was obtained in sixteen...