Podiatry

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An overview of AVF maturation and endothelial dysfunction in an advanced renal failure
(BioMed Central, 2017-10-02) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Carline, Tom
Development of a prognostic model for fistula maturation in patients with advanced renal failure
(2012-05-24) Siddiqui, Muhammad A.; Raza, Zahid; Santos, Derek; Ashraff, Suhel; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone fistula creation between 2006 and 2009. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Results Three variables were identified which influenced fistula maturation. Gender - Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio [OR] 0.514; 95% confidence interval [CI] 0.308 to 0.857). Peripheral Vascular Disease - Patients with no evidence of PVD were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596 to 6.177). Vein Size - A pre operative vein diameter > 2.5mm resulted in a five fold increase in fistula maturation compared to a vein size less than 2.5mm (OR 4.532; 95% CI 2.063 to 9.958). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.79) and the c-index was 0.677. Conclusion Gender, PVD and vein size are useful predictors of arteriovenous fistulae maturation. The clinical utility of these risk categories in the maturation of arteriovenous fistulae requires further clinical evaluation in a prospective study.
Development of a prognostic model for stump healing in patients with advanced atherosclerosis
(2012-05-24) Ashraff, Suhel; Raza, Zahid; Santos, Derek; Siddiqui, Muhammad A.; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the stump healing in patients who underwent lower extremity amputation surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone lower extremity amputation surgery between 2006 and 2010. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Result Three variables were identified which influenced stump healing. Serum Sodium - The lower limb stump healing was 75% likely in patients with normal serum sodium compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048-2.942) Serum Creatinine- Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946) Serum High Density Lipoproteins - A normal serum HDL resulted in a 75% more likely chance of healing compared to those with abnormal serum HDL (OR 1.753; 95% CI 1.061 to 2.895). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.879) and the c-index was 0.612. Conclusion Serum Sodium, Serum High Density Lipids and Serum creatinine are useful predictors of lower limb stump. The clinical utility of these risk categories in the healing of a lower limb stump requires further clinical evaluation in a prospective study.
Development of prognostic model for fistula maturation in patients with advanced renal failure
(BioMed Central, 2018-03-07) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, Zahid
Background: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.
Effect of Exercise and Muscle Contraction on Insulin Action, Transportation and Sensitivity and Muscle Fibres in type II Diabetes Mellitus
(Scientific & Academic Publishing, 2012-11) Rehman, A. U.; Siddiqui, Muhammad A.; Ashraff, Suhel
This review will critically evaluate the role of exercise in increasing the insulin action, transportation and sensitivity in skeletal muscles. The review will also, try to explore the relationship between the insulin stimulation and glucose transporter type 4 (GLUT-4) protein after the exercise The secondary purpose of this review is to explore whether the exercise induced sensitivity of glucose transport activation is mediated by translocation of greater number of GLUT-4 to the cell surface, and the role of different types of exercise in increasing insulin sensitivity. The review concluded that the stimulation of insulin and exercise is relevant to the physiological developed process of GLUT-4, isoform gene expression is precise and associated with the exercise only. While performing the endurance exercise as well as resistance training we can maintain the muscle bulk and prevent the atrophy in DM. Furthermore, it was proved that the resistance training puts direct effects on the muscles glycogen uptake intracellular and extra cellular signalling pathway and GLUT4, when the subject fed the rich diet of carbohydrate and participates in the exercise. These effects also found in the non-diabetes and healthy subjects.
Haemodialysis and Vascular Access in the End Stage Kidney Disease
(SciencePG, 2017-01-12) Siddiqui, Muhammad A.; Santos, Derek; Ashraff, Suhel; Carline, Tom
The efficiency of haemodialysis treatment relies on a functional status of vascular access. A vascular access makes life-saving haemodialysis treatments possible. The efficiency of haemodialysis treatment relies on a functional status of vascular access. The purpose of this review was to discuss the role of haemodialysis and vascular access in end stage kidney disease. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Vascular access can be divided into three categories: arteriovenous fistula, central venous catheter and arteriovenous graft. Central venous catheter has a number of disadvantages, including a considerable risk of infection and mortality. It also has negative implications for the use of a fistula for dialysis. In contrast, arteriovenous fistula is the most beneficial method, as it has a low risk of infection and mortality, and can ensure long-term functional access. Furthermore, there are three configurations of native arteriovenous fistula that can be used for haemodialysis providing flexibility of approach depending on risk factors of the individual patient.
Obesity and insulin resistance: Management in diabetes
(2013-09) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, Tom
Obesity today, is a major public health problem across the world. The rapid increase in the incidence of obesity and associated co-morbidities presents a major challenge to health care globally. Insulin resistance is commonly associated with obesity and other life style diseases. However, much uncertainty remains about the mechanism regarding the association between insulin resistance and human disease mainly because of the difficulties of defining insulin resistance in clinical terms and of quantifying insulin action in humans. This review looks at the available literature concerning the link between obesity and insulin resistance and discusses the various approaches of their management.
The psychosocial impact of diabetes in adolescents: A review
(2013-05) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, Tom
Type 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus. OMSB, 2013.
The role of haematological markers and factors in predicting leg amputation success in diabetic subjects with advanced atherosclerosis
(2009) Ashraff, Suhel; Carline, Tom; Santos, Derek; Raza, J.; McKnight, John