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Publication Sex differences in the radiographic and symptomatic prevalence of knee and hip osteoarthritis(Frontiers Media, 2024-10-04) Faber, Benjamin; Macrae, Fiona; Jung, Mijin; Zucker, Benjamin; Beynon, Rhona; Tobias, Jonathan; Macrae, Fiona; Medical and DentalRecognising sex differences in disease prevalence can lead to clues as to its pathogenesis, for example the role of hormonal factors and related influences such as body composition, as well as forming the basis for new treatments. However, if different methods are used to define the disorder it can be difficult to explore differences in prevalence, making it necessary to draw on multiple sources of evidence. This narrative review addresses sex differences in the prevalence of knee and hip osteoarthritis, which are the most common forms of large joint osteoarthritis. Females appear to have a higher prevalence of knee osteoarthritis across a wide range of disease definitions, while findings for the hip vary depending on how the disease is defined. Clinically or symptomatically defined hip osteoarthritis is more common in females, whereas radiographically defined hip osteoarthritis is more common in males. Therefore, understanding sex differences in large joint arthritis requires consideration that osteoarthritis, as defined structurally, more commonly affects females at the knee, whereas the opposite is true at the hip. Furthermore, despite structural changes in hip osteoarthritis being more common in males, symptomatic hip osteoarthritis is more common in females. The basis for these disparities is currently unclear, but may reflect a combination of hormonal, biomechanical and behavioural factors.Publication Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts(Elmer Press, 2024-04-15) Farooq, Omer; Ghani, Usman; Friedman, Harvey; Akbar, Muhammad Sikander; Saudye, Hammad; Alam, Sundus; Khan, Muhammad Junaid; Mutti, Sumeet; Alam, Sundus; Khan, Muhammad Junaid; Medical and DentalBackground: Atrial septal defects can allow right to left shunting of venous blood which presents clinically as platypnea-orthodeoxia syndrome. It is believed that concomitant presence of aortic root pathologies increases the likelihood of shunting. Methods: The study included a review of 510 articles listed in PubMed of patients with platypnea-orthodeoxia syndrome. Case reports of patients with extra-cardiac etiologies of platypnea-orthodeoxia were excluded. Results: We reviewed 191 case reports, and 98 cases (51.3%) had evidence of concomitant aortic root pathology. Furthermore, of the remaining 93 case reports, 69 ones excluded any mention of the nature of the aortic root altogether, further suggesting that this is an underreported number. Conclusions: There is a high prevalence of aortic root pathologies in patients with platypnea-orthodeoxia syndrome secondary to intra-cardiac shunts. In patients with unexplained hypoxemia and incidental finding of aortic root pathology, it may be worthwhile to obtain postural oxygen saturation measurements to exclude intra-cardiac shunts as the potential cause.Publication Dual Chamber Pacemaker Implant in Coronary Sinus Leading to Several Complications(MDPI, 2024-11-05) Wassef, Nancy; Ibrahim, Mina; Botrous, Christine; Anos, Amr; Hogrefe, Kai; Pathiraja, Janaka; Wassef, Nancy; Botrous, Christine; Anos, Amr; Pathiraja, Janaka; Medical and DentalPermanent pacemaker implantation is a low-risk procedure. However, complications may occur at a rate of around 4-8%. We present a case where initial implantation resulted in complications that could have been avoided by meticulous assessment of lead position in different projections and early post-procedure X-ray that would have delineated other serious complications. We present a case where the right ventricular lead was placed in the coronary sinus, which resulted in the loss of pacing capture with further syncope after the pacemaker implant. This was apparent in the post-procedure electrocardiogram (ECG) with right bundle branch pacing and the lead was repositioned in the right ventricular apex the following day. Furthermore, the patient was discharged home without a chest X-ray (CXR), and she represented a week later with a haemo-pneumothorax and pericardial effusion. A chest drain was placed and was discharged after a slow recovery following several complications that could have been avoidable.