Publications by authors named "R A Armstrong"

1,769 Publications

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Neonatal presentation of PHACE syndrome.

BMJ Case Rep 2021 Jul 12;14(7). Epub 2021 Jul 12.

Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1136/bcr-2021-244183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276169PMC
July 2021

Extubation generates lung volume inhomogeneity in preterm infants.

Arch Dis Child Fetal Neonatal Ed 2021 Jun 23. Epub 2021 Jun 23.

Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.

Objective: To evaluate the feasibility of electrical impedance tomography (EIT) to describe the regional tidal ventilation (V) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process of extubation from invasive to non-invasive respiratory support.

Design: Prospective observational study.

Setting: Single-centre tertiary neonatal intensive care unit.

Patients: Preterm infants born <32 weeks' gestation who were being extubated to nasal continuous positive airway pressure as per clinician discretion.

Interventions: EIT measurements were taken in supine infants during elective extubation from synchronised positive pressure ventilation (SIPPV) before extubation, during and then at 2 and 20 min after commencing nasal continuous positive applied pressure (nCPAP). Extubation and pressure settings were determined by clinicians.

Main Outcome Measures: Global and regional ΔEELV and ΔV, heart rate, respiratory rate and oxygen saturation were measured throughout.

Results: Thirty infants of median (range) 2 (1, 21) days were extubated to a median (range) CPAP 7 (6, 8) cm HO. SpO/FiO ratio was a mean (95% CI) 50 (35, 65) lower 20 min after nCPAP compared with SIPPV. EELV was lower at all points after extubation compared with SIPPV, and EELV loss was primarily in the ventral lung (p=0.04). V was increased immediately after extubation, especially in the central and ventral regions of the lung, but the application of nCPAP returned V to pre-extubation patterns.

Conclusions: EIT was able to describe the complex lung conditions occurring during extubation to nCPAP, specifically lung volume loss and greater use of the dorsal lung. EIT may have a role in guiding peri-extubation respiratory support.
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http://dx.doi.org/10.1136/archdischild-2021-321788DOI Listing
June 2021

Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents.

Med Hypotheses 2021 Jun 5;153:110622. Epub 2021 Jun 5.

Concerned Ontario Doctors, Toronto, ON, Canada. Electronic address:

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about 'early' treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.
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http://dx.doi.org/10.1016/j.mehy.2021.110622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178530PMC
June 2021

India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward.

Indian J Orthop 2021 May 16;55(Suppl 1):46-55. Epub 2020 Sep 16.

HBT Medical College and Dr RN Cooper Hospital, Mumbai, 400056 India.

Background: The number of joint replacements in India is set to grow at the highest rate in the world from 2020 to 2026. It is high time for India to have an efficient and credible registry to help curtail the clinical impact of implant failure at a very early stage by prompt reporting.

Methods: Indian Joint Registry has been established by ISHKS with new data forms for reporting. These new detailed forms record, in addition to previous form, component-wise details of implants. Additional useful features include Linking with unique ID like PAN or Aadhaar, thromboprophylaxis, untoward intra-operative event, IJR consent and type of anaesthesia.

Results: There were 712 registered surgeons in IJR database till June 2020. Total TKRs being reported to registry increased from 1019 in 2006 to 27,000 in 2019. Majority of the patients (98.5%) were diagnosed with osteoarthritis knee. Company-wise distribution unveils that Johnson & Johnson DePuy represents the highest implant usage at over 37%. There has been increased utilisation of uncemented THR over cemented THR from 2006 to 2019. Dual-mobility THRs have gained ground as surgeon preference for the choice of implant.

Conclusion: Effective use of quality registries can lead to better health outcomes at a lower cost for the society. An effective, responsive and sustainable registry in India offers many benefits and should be considered as a key objective. Making the registry function in India successfully will undoubtedly require multi-pronged efforts, but can deliver many benefits both to the patient and to the nation as a whole.
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http://dx.doi.org/10.1007/s43465-020-00251-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149501PMC
May 2021

Effect of Kinesiology Tape on Tri-Axial Accelerometry During the Dance Aerobic Fitness Test.

J Dance Med Sci 2021 Jun 3. Epub 2021 Jun 3.

Objectives: Kinesiology tape (KT) is thought to provide greater mechanical support during physical activity, however, there is a paucity of research investigating its application in dance. The study aimed to determine whether KT reduces PlayerLoad (PL) during the Dance Aerobic Fitness Test (DAFT) in addition to examining the relative sensitivity of accelerometer site locations.

Methods: University-level dancers (N = 11; age 18 ± 0.45 years, height 168.17 ± 12.25 cm, body mass 57.50 ± 9.91 kg) participated in two trials of the DAFT protocol in two conditions: no tape (NT) and kinesiology tape (KT). Global positioning systems (GPS) and accelerometer units were attached onto the seventh vertebra (C7) at the mid-scapula region and lower limb (LL) located at the mid-gastrocnemius of the dominant leg calculating measurements of triaxial (PLTotal) and uniaxial measures (anteroposterior [PLAP], mediolateral [PLML], and vertical [PLV]) measures of PlayerLoad during the DAFT.

Results: No significant main effect was observed for the taping condition in all measures of PlayerLoad (P > 0.10). A significant main effect (p < 0.01) was observed for unit location and time, with greater loading at the LL compared to C7 and during each consequent stage of the DAFT. No significant (p > 0.52) location*taping, nor location*taping*time (p > 0.36) interactions were observed for all variables measured.

Conclusions: Kinesiology tape does not reduce loading patterns in healthy dancers during a fatigue protocol. However, triaxial accelerometers provide adequate sensitivity when detecting changes in loading, suggesting the LL may be deemed as a more relevant method of monitoring training load in dancers.
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http://dx.doi.org/10.12678/1089-313X.091521dDOI Listing
June 2021
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