Sherif Sultan | National University of Ireland, Galway (original) (raw)

Papers by Sherif Sultan

Research paper thumbnail of Minimally Invasive Posterior Full Crown Competitors : Onlays , Occlusal Veneers , Vonlays and Endocrowns : A Review and Proposed Classification

The main disadvantage of the posterior full crown (PFC) is excessive loss of sound tooth structur... more The main disadvantage of the posterior full crown (PFC) is excessive loss of sound tooth structure. A new group of posterior minimally invasive (PMI) restorations have evolved that can be used for the same indications of PFC with the added advantage of tooth structure preservation, so they can compete PFC. The purpose of this article is to a) summarize and suggest a classification of this new group of restorations b) compile different names for the same PMI restoration described in the literature. MEDLINE search was conducted using the following key words: “endocrowns”, “occlusal veneers”, “indirect onlays”, “bonded onlays”, “occlusal onlays”, “ceramic overlays”, “partial ceramic crowns”, “tabletop restorations”, “full crown alternatives”, and “indirect minimally invasive restorations”. English language articles were included within the last 10 years. 179 articles were finally selected after evaluation of the identified articles for eligibility. The conclusion is “When a posterior t...

Research paper thumbnail of A comprehensive review of vascular complications in COVID-19

Journal of Thrombosis and Thrombolysis, 2021

This study aims to review the available literature pertinent to vascular complications in COVID-1... more This study aims to review the available literature pertinent to vascular complications in COVID-19. A systematic search was performed using PubMed and Google Scholar to identify all relevant studies based on our study objective. Multiple studies have reported widespread systemic inflammation and procoagulant/hypercoagulable state in COVID-19, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis. However, large specialised studies on vascular complications are lacking despite current evidence indicating dysfunctional coagulation pathways. Furthermore, there are no clear and definitive recommendations regarding thromboprophylaxis or full therapeutic anticoagulation in COVID-19. Several studies have reported hypercoagulability and vascular complications as important predictors of patient outcome in COVID-19. Therefore, it is important to understand the pathogenesis, epidemiology, management, and outcomes of patients who develop venous or arterial thrombosis and those with a pre-existing thrombotic disease who contract COVID-19 for risk stratification, thromboprophylaxis, optimal antithrombotic therapy during active infection and long-term anticoagulation following discharge or recovery. Keywords COVID-19 • Vascular complications • Blood coagulation disorders, review Highlights • SARS-CoV-2 induces proinflammatory cytokines and/ or procoagulant factors that could activate coagulation cascades, leading to thrombosis, atherosclerotic plaque rupture, and ischemia. • Noting changes in coagulation profile in critically ill COVID-19 patients are of utmost importance, as studies have shown that hypercoagulability and vascular complications are important predictors of optimal patient outcomes. • Despite current evidence indicating dysfunctional coagulation pathways, specific studies concerning vascular complications in COVID-19 are lacking. • It is crucial to have large-scale multicentre studies to establish and ascertain the vascular complications in COVID-19 and formulate management strategies.

Research paper thumbnail of A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity

Annals of Translational Medicine, 2020

An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in isc... more An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90-99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.

Research paper thumbnail of Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned

Vascular, 2020

Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-1... more Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. Methods A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the “TrialsTracker” project. Results We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic micro...

Research paper thumbnail of COVID-19 cytokine storm and novel truth

Medical Hypotheses, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Topical Wound Oxygen Versus Conventional Compression Dressings in the Management of Refractory Venous Ulcers

Wound Healing - New insights into Ancient Challenges, Oct 12, 2016

Topical wound oxygen (TWO 2) proposes an innovative therapy option in the management of refractor... more Topical wound oxygen (TWO 2) proposes an innovative therapy option in the management of refractory non-healing venous ulcers (RVU) that aims to accelerate wound healing. TWO 2 accelerates epithelialisation. This leads to the development of a higher tensile strength collagen, which lessens scarring and the risk of recurrence. Sixty-seven limbs with 67 ulcers were managed using TWO 2 therapy, and 65 limbs with 65 ulcers were managed using conventional compression dressings (CCD). The proportion of ulcers completely healed by 12 weeks was 76% in patients managed with TWO 2 , compared to 46% in patients managed with CCD (p < 0.0001). The mean reduction in ulcer surface area at 12 weeks was 96% in the TWO 2 therapy group, compared to 61% in patients managed with CCD. The median time to full ulcer healing was 57 days in the TWO 2 group, in contrast to 107 days in patients managed with CCD (p < 0.0001). TWO 2 patients had a significantly improved Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of treatment (Q-TWiST) compared to CCD patients, denoting an improved outcome (p < 0.0001). TWO 2 reduces the time needed for RVU healing and is successful in pain alleviation and MRSA elimination. TWO 2 therapy radically degrades recurrence rates. Utilising diffused oxygen raises the capillary partial pressure of oxygen (Po 2) levels at the wound site, stimulating epithelialisation, and granulation of new healthy tissue. Taking the social and individual aspects of chronic venous ulceration into account, the use of TWO 2 can provide an overwhelmingly improved quality of life for long-time sufferers of this debilitating disease.

Research paper thumbnail of LDL-C Does Not Cause Cardiovascular Disease: a comprehensive review of current literature

Expert review of clinical pharmacology, Jan 10, 2018

Introduction For half a century, a high level of total cholesterol (TC) or low-density-lipoprotei... more Introduction For half a century, a high level of total cholesterol (TC) or low-density-lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated, and that statin treatment, in particular when used as primary prevention, is of doubtful benefit. Areas covered The authors of three large reviews recently published by statin advocates have attempted to validate the current dogma. This paper delineates the serious errors in these three reviews as well as other obvious falsifications of the cholesterol hypothesis. Expert commentary Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality, and that the conclusions of the authors of the three reviews are based on misleading s...

Research paper thumbnail of Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

Vascular, 2017

Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed init... more Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetat...

Research paper thumbnail of Serious bias in 20 year follow-up study of statin trial

BMJ (Clinical research ed.), Oct 31, 2017

Research paper thumbnail of Survival of Ruptured Abdominal Aortic Aneurysms in the West of Ireland: Do Prognostic Indicators of Outcome Exist?

Vascular and Endovascular Surgery, 2004

Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause ... more Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause of significant morbidity and mortality. The aim of this study was to identify prognostic factors that influence outcome. Over 6 years, 42 ruptured abdominal aortic aneurysms were operated on with a mean diameter of 7.2 cm. RAAA was defined as free intraperitoneal rupture. Data were collected retrospectively from hospital medical records. The male:female ratio was 8:1 and the mean age was 74 years (range 55–89). Fifteen were in hypovolemic shock and 27 patients were clinically stable. The perioperative mortality rate for the 15 shocked patients was 60% (9 patients) and the 1-year cumulative survival rate was 33%. The perioperative mortality rate for the 27 clinically stable patients was 40% (11 patients) and the 1-year cumulative survival rate was 56%. Survival curves were constructed for these groups to compare male versus female, age =70 versus age <70, shocked versus stable, and pre...

Research paper thumbnail of Stem Cell Smart Technology, where are we now and how far we have to go?

Vascular, 2017

Approximately eight million people in the United States have peripheral arterial disease, which i... more Approximately eight million people in the United States have peripheral arterial disease, which increases exponentially with age. There have been a plethora of available treatments including surgery, angioplasty, atherectomy, laser technology, and cell-based therapies. Cell-based therapies were developed in the hope of translating laboratory-based technology into clinical successes. However, clinical results have been disappointing. Infusion or injection for stem cell therapy is still considered experimental and investigational, and major questions on safety and durability have arisen. In no option patients, how can they be treated safely and successfully? In this article, we review contemporary practice for cell therapy, its pitfalls and breakthroughs, and look at the future ahead. We introduce a novel smart system for minimally invasive delivery of cell therapies, which exemplifies the next generation of endovascular solutions to stem cell technology and promises safety, efficacy,...

Research paper thumbnail of PS160. Management of Median Arcuate Ligament Syndrome (MALS) with Decompression and Coeliac Ganglion Sympathectomy (CGS) for Chronic Mesenteric Ischaemia (CMI). Procedural, Clinical and Enduring Results With Quality-Adjusted Time Spent Without Symptoms of Disease and Toxicity of Treatment (Q-TWiST)

Research paper thumbnail of Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

BMJ open, Jun 12, 2016

It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause... more It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue. We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population. We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the ...

Research paper thumbnail of SS15. Sustained 5 Years Performance Analysis of Sequential Compression Biomechanical Device (SCBD) in Critical Limb Ischaemia (CLI) Patients with Un-reconstructable Peripheral Vascular Disease (PVD) vs Primary Amputation in a Tertiary Referral Vascular Centre With Quality of Time Without the Symp...

Research paper thumbnail of Contemporary management of critical Lower Limb Ischaemia in TASC D lesions with subintimal angioplasty in femoro-popliteal lesions, tibial angioplasty and sequential compression biomechanical device for Infra-inguinal arterial occlusion. Experience and quality of life outcome learned over 25 years

Research paper thumbnail of PS130. The 6L Irish Pivotal Trial Comparing Three-Year Outcomes of Cool Excimer Laser Assisted Angioplasty (CELA) and Tibial Balloon Angioplasty (TBA) in Management of Infragenicular Tibial Arterial Occlusion in Critical Lower Limb Ischaemia (CLI) TASC D E

Research paper thumbnail of Vein stripping device

Research paper thumbnail of An observational parallel group comparative study with and without the “Magic Bullet” (MB: Aspirin, cardio selective beta-blocker, Pravastatin and Clopidogrel) in the peri-operative and postoperative period for Abdominal Aortic aneurysms Surgery and femoral-popliteal segment revascularisation. Do...

British Journal of Surgery

Research paper thumbnail of The impact of Expression of Extracellular Matrix Metalloproteinase inducer (EMMPRIN), Matrix Metalloproteinase-2 (MMP-2), Tissue inhibitors of Matrix Metalloproteinases (TIMP-2) on the chronicity of venous leg ulcers. Does Matrix Metalloproteinase Alter healing?

British Journal of Surgery

Research paper thumbnail of Does single Supra-renal Artery clamping alter outcome in Juxta-Renal Aortic Aneurysm Repair(JRAR)? A parallel group observational study of the technical and clinical outcome of Infrarenal Aortic Aneurysm Repair (IRAR) and Supra-renal Aortic Aneurysm Repair (SRAR)

Irish Journal of Medical Science

Research paper thumbnail of Minimally Invasive Posterior Full Crown Competitors : Onlays , Occlusal Veneers , Vonlays and Endocrowns : A Review and Proposed Classification

The main disadvantage of the posterior full crown (PFC) is excessive loss of sound tooth structur... more The main disadvantage of the posterior full crown (PFC) is excessive loss of sound tooth structure. A new group of posterior minimally invasive (PMI) restorations have evolved that can be used for the same indications of PFC with the added advantage of tooth structure preservation, so they can compete PFC. The purpose of this article is to a) summarize and suggest a classification of this new group of restorations b) compile different names for the same PMI restoration described in the literature. MEDLINE search was conducted using the following key words: “endocrowns”, “occlusal veneers”, “indirect onlays”, “bonded onlays”, “occlusal onlays”, “ceramic overlays”, “partial ceramic crowns”, “tabletop restorations”, “full crown alternatives”, and “indirect minimally invasive restorations”. English language articles were included within the last 10 years. 179 articles were finally selected after evaluation of the identified articles for eligibility. The conclusion is “When a posterior t...

Research paper thumbnail of A comprehensive review of vascular complications in COVID-19

Journal of Thrombosis and Thrombolysis, 2021

This study aims to review the available literature pertinent to vascular complications in COVID-1... more This study aims to review the available literature pertinent to vascular complications in COVID-19. A systematic search was performed using PubMed and Google Scholar to identify all relevant studies based on our study objective. Multiple studies have reported widespread systemic inflammation and procoagulant/hypercoagulable state in COVID-19, including thrombotic microangiopathy, endothelial dysfunction, bleeding disorder, and thrombosis. However, large specialised studies on vascular complications are lacking despite current evidence indicating dysfunctional coagulation pathways. Furthermore, there are no clear and definitive recommendations regarding thromboprophylaxis or full therapeutic anticoagulation in COVID-19. Several studies have reported hypercoagulability and vascular complications as important predictors of patient outcome in COVID-19. Therefore, it is important to understand the pathogenesis, epidemiology, management, and outcomes of patients who develop venous or arterial thrombosis and those with a pre-existing thrombotic disease who contract COVID-19 for risk stratification, thromboprophylaxis, optimal antithrombotic therapy during active infection and long-term anticoagulation following discharge or recovery. Keywords COVID-19 • Vascular complications • Blood coagulation disorders, review Highlights • SARS-CoV-2 induces proinflammatory cytokines and/ or procoagulant factors that could activate coagulation cascades, leading to thrombosis, atherosclerotic plaque rupture, and ischemia. • Noting changes in coagulation profile in critically ill COVID-19 patients are of utmost importance, as studies have shown that hypercoagulability and vascular complications are important predictors of optimal patient outcomes. • Despite current evidence indicating dysfunctional coagulation pathways, specific studies concerning vascular complications in COVID-19 are lacking. • It is crucial to have large-scale multicentre studies to establish and ascertain the vascular complications in COVID-19 and formulate management strategies.

Research paper thumbnail of A pilot protocol and review of triple neuroprotection with targeted hypothermia, controlled induced hypertension, and barbiturate infusion during emergency carotid endarterectomy for acute stroke after failed tPA or beyond 24-hour window of opportunity

Annals of Translational Medicine, 2020

An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in isc... more An alternative to tissue plasminogen activator (tPA) failure has been a daunting challenge in ischemic stroke management. As tPA is time-dependent, delays can occur in definitive treatment while passively waiting to observe a clinical response to intravenous thrombolysis. Until today, uncertainty exists in the management strategy of wake-up stroke patients or those presenting beyond the therapeutic tPA window. Clinical dilemmas in these situations can prolong the transitional period of inertia, resulting in an adverse neurological outcome. We propose and review an innovative approach called triple neuro-protection (TNP), which encompasses three technical domains-targeted hypothermia, systemic induced hypertension, and barbiturates infusion, to protect the brain during carotid endarterectomy after failed tPA and/or beyond the 24-hour therapeutic mechanical thrombectomy window. This proposal assimilates discussion on the clinical evidence of the individual domains of TNP with our own clinical experience with TNP. Our first TNP was successfully employed in a 55-year-old man in 2015 while performing emergency carotid endarterectomy after he was referred to us 72 hours post tPA failure. The patient had a successful clinical outcome despite being in therapeutic inertia with 90-99% ipsilateral carotid stenosis and contralateral occlusion on presentation. In the last five years, we have safely used TNP in 25 selected cases with favourable clinical outcomes.

Research paper thumbnail of Antimalarial and cytotoxic drugs on COVID-19 and the cardiovascular burden: Literature review and lessons to be learned

Vascular, 2020

Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-1... more Background The world is witnessing an unprecedented crisis with Coronavirus disease 2019 (COVID-19). It is important to accurately analyze the available evidence to provide correct clinical guidance for optimal patient care. We aim to discuss current clinical evidence regarding chloroquine, hydroxychloroquine, azithromycin, remdesivir, and the cardiovascular burden of COVID-19. Methods A literature review was performed using PubMed and Google Scholar. Additional clinical trials were identified through the “TrialsTracker” project. Results We found conflicting evidence of chloroquine, hydroxychloroquine plus azithromycin, and remdesivir in COVID-19 despite promising early reports of in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2. Some of the current studies have demonstrated adverse drug reactions to chloroquine and hydroxychloroquine + azithromycin. Widespread systemic inflammation and procoagulant/hypercoagulable state, including thrombotic micro...

Research paper thumbnail of COVID-19 cytokine storm and novel truth

Medical Hypotheses, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Topical Wound Oxygen Versus Conventional Compression Dressings in the Management of Refractory Venous Ulcers

Wound Healing - New insights into Ancient Challenges, Oct 12, 2016

Topical wound oxygen (TWO 2) proposes an innovative therapy option in the management of refractor... more Topical wound oxygen (TWO 2) proposes an innovative therapy option in the management of refractory non-healing venous ulcers (RVU) that aims to accelerate wound healing. TWO 2 accelerates epithelialisation. This leads to the development of a higher tensile strength collagen, which lessens scarring and the risk of recurrence. Sixty-seven limbs with 67 ulcers were managed using TWO 2 therapy, and 65 limbs with 65 ulcers were managed using conventional compression dressings (CCD). The proportion of ulcers completely healed by 12 weeks was 76% in patients managed with TWO 2 , compared to 46% in patients managed with CCD (p < 0.0001). The mean reduction in ulcer surface area at 12 weeks was 96% in the TWO 2 therapy group, compared to 61% in patients managed with CCD. The median time to full ulcer healing was 57 days in the TWO 2 group, in contrast to 107 days in patients managed with CCD (p < 0.0001). TWO 2 patients had a significantly improved Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of treatment (Q-TWiST) compared to CCD patients, denoting an improved outcome (p < 0.0001). TWO 2 reduces the time needed for RVU healing and is successful in pain alleviation and MRSA elimination. TWO 2 therapy radically degrades recurrence rates. Utilising diffused oxygen raises the capillary partial pressure of oxygen (Po 2) levels at the wound site, stimulating epithelialisation, and granulation of new healthy tissue. Taking the social and individual aspects of chronic venous ulceration into account, the use of TWO 2 can provide an overwhelmingly improved quality of life for long-time sufferers of this debilitating disease.

Research paper thumbnail of LDL-C Does Not Cause Cardiovascular Disease: a comprehensive review of current literature

Expert review of clinical pharmacology, Jan 10, 2018

Introduction For half a century, a high level of total cholesterol (TC) or low-density-lipoprotei... more Introduction For half a century, a high level of total cholesterol (TC) or low-density-lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated, and that statin treatment, in particular when used as primary prevention, is of doubtful benefit. Areas covered The authors of three large reviews recently published by statin advocates have attempted to validate the current dogma. This paper delineates the serious errors in these three reviews as well as other obvious falsifications of the cholesterol hypothesis. Expert commentary Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality, and that the conclusions of the authors of the three reviews are based on misleading s...

Research paper thumbnail of Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene

Vascular, 2017

Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed init... more Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetat...

Research paper thumbnail of Serious bias in 20 year follow-up study of statin trial

BMJ (Clinical research ed.), Oct 31, 2017

Research paper thumbnail of Survival of Ruptured Abdominal Aortic Aneurysms in the West of Ireland: Do Prognostic Indicators of Outcome Exist?

Vascular and Endovascular Surgery, 2004

Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause ... more Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause of significant morbidity and mortality. The aim of this study was to identify prognostic factors that influence outcome. Over 6 years, 42 ruptured abdominal aortic aneurysms were operated on with a mean diameter of 7.2 cm. RAAA was defined as free intraperitoneal rupture. Data were collected retrospectively from hospital medical records. The male:female ratio was 8:1 and the mean age was 74 years (range 55–89). Fifteen were in hypovolemic shock and 27 patients were clinically stable. The perioperative mortality rate for the 15 shocked patients was 60% (9 patients) and the 1-year cumulative survival rate was 33%. The perioperative mortality rate for the 27 clinically stable patients was 40% (11 patients) and the 1-year cumulative survival rate was 56%. Survival curves were constructed for these groups to compare male versus female, age =70 versus age <70, shocked versus stable, and pre...

Research paper thumbnail of Stem Cell Smart Technology, where are we now and how far we have to go?

Vascular, 2017

Approximately eight million people in the United States have peripheral arterial disease, which i... more Approximately eight million people in the United States have peripheral arterial disease, which increases exponentially with age. There have been a plethora of available treatments including surgery, angioplasty, atherectomy, laser technology, and cell-based therapies. Cell-based therapies were developed in the hope of translating laboratory-based technology into clinical successes. However, clinical results have been disappointing. Infusion or injection for stem cell therapy is still considered experimental and investigational, and major questions on safety and durability have arisen. In no option patients, how can they be treated safely and successfully? In this article, we review contemporary practice for cell therapy, its pitfalls and breakthroughs, and look at the future ahead. We introduce a novel smart system for minimally invasive delivery of cell therapies, which exemplifies the next generation of endovascular solutions to stem cell technology and promises safety, efficacy,...

Research paper thumbnail of PS160. Management of Median Arcuate Ligament Syndrome (MALS) with Decompression and Coeliac Ganglion Sympathectomy (CGS) for Chronic Mesenteric Ischaemia (CMI). Procedural, Clinical and Enduring Results With Quality-Adjusted Time Spent Without Symptoms of Disease and Toxicity of Treatment (Q-TWiST)

Research paper thumbnail of Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

BMJ open, Jun 12, 2016

It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause... more It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue. We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population. We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the ...

Research paper thumbnail of SS15. Sustained 5 Years Performance Analysis of Sequential Compression Biomechanical Device (SCBD) in Critical Limb Ischaemia (CLI) Patients with Un-reconstructable Peripheral Vascular Disease (PVD) vs Primary Amputation in a Tertiary Referral Vascular Centre With Quality of Time Without the Symp...

Research paper thumbnail of Contemporary management of critical Lower Limb Ischaemia in TASC D lesions with subintimal angioplasty in femoro-popliteal lesions, tibial angioplasty and sequential compression biomechanical device for Infra-inguinal arterial occlusion. Experience and quality of life outcome learned over 25 years

Research paper thumbnail of PS130. The 6L Irish Pivotal Trial Comparing Three-Year Outcomes of Cool Excimer Laser Assisted Angioplasty (CELA) and Tibial Balloon Angioplasty (TBA) in Management of Infragenicular Tibial Arterial Occlusion in Critical Lower Limb Ischaemia (CLI) TASC D E

Research paper thumbnail of Vein stripping device

Research paper thumbnail of An observational parallel group comparative study with and without the “Magic Bullet” (MB: Aspirin, cardio selective beta-blocker, Pravastatin and Clopidogrel) in the peri-operative and postoperative period for Abdominal Aortic aneurysms Surgery and femoral-popliteal segment revascularisation. Do...

British Journal of Surgery

Research paper thumbnail of The impact of Expression of Extracellular Matrix Metalloproteinase inducer (EMMPRIN), Matrix Metalloproteinase-2 (MMP-2), Tissue inhibitors of Matrix Metalloproteinases (TIMP-2) on the chronicity of venous leg ulcers. Does Matrix Metalloproteinase Alter healing?

British Journal of Surgery

Research paper thumbnail of Does single Supra-renal Artery clamping alter outcome in Juxta-Renal Aortic Aneurysm Repair(JRAR)? A parallel group observational study of the technical and clinical outcome of Infrarenal Aortic Aneurysm Repair (IRAR) and Supra-renal Aortic Aneurysm Repair (SRAR)

Irish Journal of Medical Science