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  1. Article: Therapeutic anticoagulation in patients with acute pancreatitis and splanchnic vein thrombosis: a best evidence topic.

    Redman, Ishtar / Panahi, Pedram / Bananis, Kyriakos / Drymousis, Panagiotis

    Annals of medicine and surgery (2012)

    2023  Volume 86, Issue 1, Page(s) 271–278

    Abstract: A best evidence topic in general surgery was written according to a structured protocol. The clinical question addressed was: in adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be ... ...

    Abstract A best evidence topic in general surgery was written according to a structured protocol. The clinical question addressed was: in adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be advisable considering the rates of vessel recanalization and bleeding complications? Four hundred twenty-four papers were found on Ovid Embase and Medline whilst 222 were found on PubMed using the reported literature search. From these, five articles represented the best evidence to the clinical question. The authors, publication dates, countries, patient groups, study outcomes, and results of these papers were tabulated. There were three systematic reviews with meta-analyses, one systematic review without meta-analysis and one randomized, retrospective study. The authors conclude that among patients with splanchnic vein thrombosis in the context of acute pancreatitis, therapeutic anticoagulation improved the rates of recanalization without increasing the risk of bleeding complications. However, there remains a need for randomized studies to address this clinical dilemma to further increase the quality of available evidence.
    Language English
    Publishing date 2023-11-16
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1097/MS9.0000000000001440
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Postoperative packing of perianal abscesses following incision and drainage.

    Redman, Ishtar A / Panahi, Pedram / Gill, Moneet / Drymousis, Panagiotis

    British journal of hospital medicine (London, England : 2005)

    2023  Volume 84, Issue 11, Page(s) 1–6

    Abstract: A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound ...

    Abstract A best evidence topic in general surgery was written according to a structured protocol, to address the question: in adult patients with perianal abscesses, should postoperative wound packing be undertaken considering the rates of pain experienced, wound healing and abscess recurrence? The literature search identified 159 papers on Ovid, Embase and Medline and 48 on PubMed. These were independently screened, and three articles were included in this review as these offered the best information to answer the question. One was a systematic review without meta-analysis, one was a randomised controlled trial and one was a multicentre observational study. Review of these articles led the authors to conclude that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain and confers no protection against recurrence of abscesses or formation of fistulae.
    MeSH term(s) Adult ; Humans ; Abscess/surgery ; Drainage ; Multicenter Studies as Topic ; Observational Studies as Topic ; Pain ; Postoperative Period ; Randomized Controlled Trials as Topic ; Skin Diseases
    Language English
    Publishing date 2023-11-27
    Publishing country England
    Document type Journal Article ; Review
    ISSN 1750-8460
    ISSN 1750-8460
    DOI 10.12968/hmed.2023.0308
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Best evidence topic: Can acute appendicitis manifest with normal inflammatory markers?

    Ibrahim, Rashid / Veeralakshmanan, Pushpa / Ackah, James / Panahi, Pedram

    Annals of medicine and surgery (2012)

    2020  Volume 58, Page(s) 147–150

    Abstract: A best evidence topic has been constructed using a described protocol. The three-part question addressed was: for patients with suspected acute appendicitis can normal inflammatory markers rule out the diagnosis? Altogether 151 papers were found using ... ...

    Abstract A best evidence topic has been constructed using a described protocol. The three-part question addressed was: for patients with suspected acute appendicitis can normal inflammatory markers rule out the diagnosis? Altogether 151 papers were found using the search strategy reported below. Seven were identified to provide the best evidence to answer the question. The author, journal, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. In conclusion, six out of seven papers are more in favour with the concept that normal inflammatory markers cannot effectively rule out the diagnosis of acute appendicitis.
    Language English
    Publishing date 2020-09-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1016/j.amsu.2020.09.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: The impact of COVID-19 prevention measures on surgical wound infection rates post-cardiac surgery.

    Bashir, Aladdin / Holmes, Matthew / Suresh, Nebumathew / Panahi, Pedram / Atta, Sameh / Perkins, Hannah T / Lloyd, Clinton / Asopa, Sanjay

    Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

    2023  

    Abstract: The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post- ... ...

    Abstract The COVID-19 pandemic had a huge impact on medical services. Several measures have been implemented to reduce the risk of viral transmission. In this paper, we assessed the impact of these measures on surgical wound infection rates in patients post-cardiac surgery. Hypothesis testing was used to compare post-cardiac operation infection rates between the year prior to the COVID-19 pandemic being declared and the first 13 months of the pandemic. The infection rates in 969 patients with operations between 01/03/2019 and 29/02/2020 were compared to those of 925 patients with cardiac surgery between 01/03/2020 and 31/03/2021. Infection rates for various operative urgencies and infection types were analysed. To compare infection rates, a two-tailed pooled z-test using the difference in infection proportions was performed. A 5% significance level was used and only categories with at least 10 patients in both the pre-covid and covid populations were tested. For leg infections, only operations involving coronary artery bypass grafting were included. To ensure that any differences in outcomes were not due to differences in patient demographics resulting in unequal operative risks, Euroscore II values, a measure of cardiac operative risk, were compared between the pre-covid and post-covid cohorts. The Mann-Whitney U-test was used to determine whether the distributions of Euroscore II values were likely to be drawn from the same population. A significance level of 5% was used. A total of 1901 patients (932 during the COVID-19 pandemic) were included in this study. Significant reduction in post-operative infections for all patients undergoing cardiac surgery from 4.3% of patients before COVID to 1.5% during the pandemic. During the pandemic, fewer elective and more urgent operations were performed. This study suggests a significant role of iatrogenic causes in wound infections prior to the pandemic. The implementation of COVID-19 prevention measures in healthcare providers can reduce surgical infection rates. As COVID-19-related restrictions have been eased, we suggest maintaining them in healthcare providers to reduce the incidence of surgical wound infections.
    Language English
    Publishing date 2023-10-12
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 1160940-0
    ISSN 1122-0643 ; 1120-0391
    ISSN 1122-0643 ; 1120-0391
    DOI 10.4081/monaldi.2023.2604
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Appendiceal phlegmon in adults: Do we know how to manage it yet?

    Panahi, Pedram / Ibrahim, Rashid / Veeralakshmanan, Pushpa / Ackah, James / Coleman, Mark

    Annals of medicine and surgery (2012)

    2020  Volume 59, Page(s) 274–277

    Abstract: A Best Evidence Topic in general surgery was written according to a structured protocol. The question addressed was 'Appendiceal phlegmon in adults: Do we know how to manage it yet?'. Altogether 217 papers were found on Ovid Embase and Medline, 334 on ... ...

    Abstract A Best Evidence Topic in general surgery was written according to a structured protocol. The question addressed was 'Appendiceal phlegmon in adults: Do we know how to manage it yet?'. Altogether 217 papers were found on Ovid Embase and Medline, 334 on PubMed and 13 on the Cochrane database using the reported search. From the screened articles, 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best management method is conservative only treatment without interval appendicectomy. These patients must be followed up, including colonoscopy and/or CT imaging as indicated, to investigate for conditions such as inflammatory bowel disease or malignancy masquerading as appendicitis.
    Language English
    Publishing date 2020-08-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1016/j.amsu.2020.08.033
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Early versus interval appendicectomy for localised perforated appendicitis in children: A best evidence review.

    Veeralakshmanan, Pushpa / Ackah, James / Panahi, Pedram / Ibrahim, Rashid / Coleman, Mark

    Annals of medicine and surgery (2012)

    2020  Volume 59, Page(s) 161–164

    Abstract: A best evidence topic in general surgery was written according to a structured protocol. The question addressed was whether early or interval appendicectomy provides a superior clinical outcome for children presenting with localised perforated appendix. ... ...

    Abstract A best evidence topic in general surgery was written according to a structured protocol. The question addressed was whether early or interval appendicectomy provides a superior clinical outcome for children presenting with localised perforated appendix. Altogether 204 papers were found using the search strategy reported below; of which 5 were identified to provide the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We concluded that for children presenting with localised perforated appendix without abscess formation, early appendicectomy provides better clinical outcome in terms of lower complication and re-admission rate and shorter length of hospital stay.
    Language English
    Publishing date 2020-09-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1016/j.amsu.2020.09.028
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: A review of the best method of leg wound closure following open harvesting of the long saphenous vein for coronary artery bypass grafting.

    Panahi, Pedram / Ilyas, Ali Adeeb / Lloyd, Clinton / Marchbank, Adrian / Unsworth-White, Jonathan

    Annals of medicine and surgery (2012)

    2021  Volume 70, Page(s) 102855

    Abstract: Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. ... ...

    Abstract Uncertainty exists around the optimal method of leg wound closure following open long saphenous vein harvesting in adults undergoing coronary artery bypass graft surgery (CABG). Such is evident from the variety observed in the closure approach utilised. Consequently, a best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'following open long saphenous vein harvesting in adults undergoing CABG, is single-layer leg wound closure superior to multiple-layer closure in terms of post-operative complications encountered? '. Altogether 382 papers on Ovid Embase and Ovid Medline, 301 papers on PubMed and 11 papers on the Cochrane database were found using the reported search. From the screened articles, 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best method of leg closure following open saphenous vein harvesting for CABG is single-layer cutaneous closure. The use of a suction drain to eliminate the dead space should be considered on a case-to-case basis by the lead operating surgeon with the patient's characteristics and their own expertise in mind.
    Language English
    Publishing date 2021-09-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2745440-X
    ISSN 2049-0801
    ISSN 2049-0801
    DOI 10.1016/j.amsu.2021.102855
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  8. Article: Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland.

    Ackah, James Kofi / Neal, Louise / Marshall, Neil R / Panahi, Pedram / Lloyd, Clinton / Rogers, Luke J

    Journal of infection prevention

    2020  Volume 22, Issue 2, Page(s) 83–90

    Abstract: Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection ... ...

    Abstract Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection significantly. In 2018, the European Association for CardioThoracic Surgery (EACTS) provided clear guidance advising that third-generation cephalosporins are the first-line prophylactic antimicrobial of choice for cardiac surgery via median sternotomy as a result of their broad spectrum of activity and association with reduced postoperative mortality. Despite this guidance, it was believed that UK practice differed from this as a consequence of national concerns surrounding cephalosporins use and
    Methods: A survey was developed and distributed to all UK and Republic of Ireland (ROI) cardiac surgery centres in January 2019 to quantify this variation.
    Results: Of the 38 centres, 34 responded. Variation existed between the antimicrobial agent used, as well as the dosage, frequency and duration of suggested regimens even among centres using the same antimicrobial agent. The most common antimicrobial prophylaxis prescribed was a combination of flucloxacillin and gentamicin (16, 47%). Followed by cefuroxime (6, 17.6%) and cefuroxime combined with a glycopeptide (4, 11.7%). In patients colonised with methicillin-resistant
    Discussion: This variation in antimicrobial agents and regimens may well contribute to the varying incidence of surgical site infection seen across the UK and ROI.
    Language English
    Publishing date 2020-11-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2595000-9
    ISSN 1757-1782 ; 1757-1774
    ISSN (online) 1757-1782
    ISSN 1757-1774
    DOI 10.1177/1757177420971850
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Overcoming Heparin-Associated RT-qPCR Inhibition and Normalization Issues for microRNA Quantification in Patients with Acute Myocardial Infarction.

    Coelho-Lima, Jose / Mohammed, Ashfaq / Cormack, Suzanne / Jones, Samuel / Das, Rajiv / Egred, Mohaned / Panahi, Pedram / Ali, Simi / Spyridopoulos, Ioakim

    Thrombosis and haemostasis

    2018  Volume 118, Issue 7, Page(s) 1257–1269

    Abstract: Background:  Cardiac-enriched micro ribonucleic acids (miRNAs) are released into the circulation following ST-elevation myocardial infarction (STEMI). Lack of standardized approaches for reverse transcription quantitative real-time polymerase chain ... ...

    Abstract Background:  Cardiac-enriched micro ribonucleic acids (miRNAs) are released into the circulation following ST-elevation myocardial infarction (STEMI). Lack of standardized approaches for reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) data normalization and presence of RT-qPCR inhibitors (e.g. heparin) in patient blood samples have prevented reproducible miRNA quantification in this cohort and subsequent translation of these biomarkers to clinical practice.
    Materials and methods:  Using a RT-qPCR miRNA screening platform, we identified and validated an endogenous circulating miRNA as a normalization control. In addition, we assessed the effects of in vivo and in vitro anticoagulant drugs administration (heparin and bivalirudin) on three RT-qPCR normalization strategies (global miRNA mean, exogenous spike-in control [cel-miR-39] and endogenous miRNA control). Finally, we evaluated the effect of heparin and its in vitro inhibition with heparinase on the quantification of cardiac-enriched miRNAs in STEMI patients.
    Results:  miR-425-5p was validated as an endogenous miRNA control. Heparin administration in vitro and in vivo inhibited all RT-qPCR normalization strategies. In contrast, bivalirudin had no effects on cel-miR-39 or miR-425-5p quantification. In vitro RNA sample treatment with 0.3 U of heparinase overcame heparin-induced over-estimation of cardiac-enriched miRNA levels and improved their correlation with high-sensitivity troponin T.
    Conclusion:  miRNA quantification in STEMI patients receiving heparin is jeopardized by its effect on all RT-qPCR normalization approaches. Use of samples from bivalirudin-treated patients or in vitro treatment of heparin-contaminated samples with heparinase are suitable alternatives for miRNA quantification in this cohort. Finally, we reinforce the evidence that cardiac-enriched miRNAs early after myocardial reperfusion reflect the severity of cardiac injury.
    MeSH term(s) Aged ; Anticoagulants/adverse effects ; Anticoagulants/blood ; Circulating MicroRNA/blood ; Circulating MicroRNA/genetics ; Female ; Genetic Markers ; Heparin/adverse effects ; Heparin/blood ; Heparin Lyase/metabolism ; Hirudins/blood ; Humans ; Male ; Middle Aged ; Peptide Fragments/blood ; Percutaneous Coronary Intervention ; Real-Time Polymerase Chain Reaction/standards ; Recombinant Proteins/blood ; Reproducibility of Results ; Reverse Transcriptase Polymerase Chain Reaction/standards ; ST Elevation Myocardial Infarction/blood ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/genetics ; ST Elevation Myocardial Infarction/therapy ; Time Factors ; Treatment Outcome
    Chemical Substances Anticoagulants ; Circulating MicroRNA ; Genetic Markers ; Hirudins ; Peptide Fragments ; Recombinant Proteins ; Heparin (9005-49-6) ; Heparin Lyase (EC 4.2.2.7) ; bivalirudin (TN9BEX005G)
    Language English
    Publishing date 2018-06-11
    Publishing country Germany
    Document type Journal Article ; Validation Study
    ZDB-ID 518294-3
    ISSN 2567-689X ; 0340-6245
    ISSN (online) 2567-689X
    ISSN 0340-6245
    DOI 10.1055/s-0038-1660437
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Effect of ciclosporin on safety, lymphocyte kinetics and left ventricular remodelling in acute myocardial infarction.

    Cormack, Suzanne / Mohammed, Ashfaq / Panahi, Pedram / Das, Rajiv / Steel, Alison J / Chadwick, Thomas / Bryant, Andrew / Egred, Mohaned / Stellos, Konstantinos / Spyridopoulos, Ioakim

    British journal of clinical pharmacology

    2020  Volume 86, Issue 7, Page(s) 1387–1397

    Abstract: Aims: Following a favourable pilot trial using a single bolus of ciclosporin, it has been unclear why 2 large studies (CYCLE and CIRCUS) failed to prevent reperfusion injury and reduce infarct size in STEMI (ST elevation myocardial infarction). The ... ...

    Abstract Aims: Following a favourable pilot trial using a single bolus of ciclosporin, it has been unclear why 2 large studies (CYCLE and CIRCUS) failed to prevent reperfusion injury and reduce infarct size in STEMI (ST elevation myocardial infarction). The purpose of this study was to assess the effect of ciclosporin on myocardial injury, left ventricular remodelling and lymphocyte kinetics in patients with acute STEMI undergoing primary percutaneous coronary intervention.
    Methods: In this double-blind, single centre trial, we randomly assigned 52 acute STEMI patients with an onset of pain of <6 hours and blocked culprit artery to a single bolus of ciclosporin (n = 26) or placebo (n = 26, control group) prior to reperfusion by stent percutaneous coronary intervention. The primary endpoint was infarct size at 12 weeks.
    Results: Mean infarct size at 12 weeks was identical in both groups (9.1% [standard deviation= 7.0] vs 9.1% [standard deviation = 7.0], P = .99; 95% confidence interval for difference: -4.0 to 4.1). CD3 T-lymphocytes dropped to similar levels at 90 minutes (867 vs 852 cells/μL, control vs ciclosporin) and increased to 1454 vs 1650 cells/μL at 24 hours.
    Conclusion: In our pilot trial, a single ciclosporin bolus did not affect infarct size or left ventricular remodelling, matching the results from CYCLE and CIRCUS. Our study suggests that ciclosporin does either not reach ischaemic cardiomyocytes, or requires earlier application during first medical contact. Finally, 1 bolus of ciclosporin is not sufficient to inhibit CD4 T-lymphocyte proliferation during remodelling. We therefore believe that further studies are warranted. (Evaluating the effectiveness of intravenous Ciclosporin on reducing reperfusion injury in pAtients undergoing PRImary percutaneous coronary intervention [CAPRI]; NCT02390674).
    MeSH term(s) Cyclosporine/therapeutic use ; Double-Blind Method ; Humans ; Kinetics ; Lymphocytes ; Magnetic Resonance Imaging ; Myocardial Infarction/drug therapy ; Treatment Outcome ; Ventricular Remodeling
    Chemical Substances Cyclosporine (83HN0GTJ6D)
    Language English
    Publishing date 2020-03-11
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 188974-6
    ISSN 1365-2125 ; 0306-5251 ; 0264-3774
    ISSN (online) 1365-2125
    ISSN 0306-5251 ; 0264-3774
    DOI 10.1111/bcp.14252
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