Author: Jason Curtis

The Effect of Colesevelam on the Microbiome in Postoperative Crohn's (2024)

Posted on by

Type of publication:

Journal article

Author(s):

Kumar, Aditi; Quraishi, Mohammed Nabil; Al-Hassi, Hafid O; Elasrag, Mohammed; Segal, Jonathan P; Jain, Manushri; Steed, Helen; *Butterworth, Jeffrey; Farmer, Adam; Mclaughlin, John; Beggs, Andrew D; Brookes, Matthew J.

Citation:

Inflammatory Bowel Diseases. 2024 Oct 18.

Abstract:

BACKGROUND: While surgery plays a pivotal role in the management of ileal Crohn's disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn's disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn's disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence. METHODS: Patients with Crohn's disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT <= 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert's score, with disease remission defined as Rutgeert's score <i2 and disease recurrence >=i2. 16S ribosomal RNA gene analysis was undertaken for the collected fecal and mucosal samples to assess alpha/beta-diversity and microbial composition. RESULTS: A total of 14 patients who completed the study, 10 of whom had a   75SeHCAT positive diagnosis of bile acid diarrhea and were started on   treatment with colesevelam. Four patients did not require treatment as 3 were asymptomatic and 1 had a negative 75SeHCAT scan. Three of the fourteen patients had disease recurrence at their 6-12 month postoperative colonoscopy assessment, of which 1 patient was taking colesevelam and 2 patients were not taking colesevelam. A total of 44 fecal samples and 44 mucosal biopsies underwent 16S ribosomal RNA gene analysis to assess alpha/beta-diversity and microbial composition. In the colesevelam treated patients there was no significant difference in alpha/beta-diversity pre- and posttreatment. Pretreatment, the 3 most abundant bacterial classes in all patients were Bacteroidia, Clostridia, and Gammaproteobacteria. Following 6-12 months of treatment, out of the 9 patients on colesevelam, 5/9 (55.6%) had a reduction in Bacteroidia, 9/9 (100%) had an increase in Clostridia, and 7/9 (77.8%) had a reduction in Gammaproteobacteria. Of the 2 patients not given colesevelam, one showed a reduction in Bacteroidia, increase in Clostridia and a reduction in Gammaproteobacteria. CONCLUSIONS: This small pilot study demonstrated that patients who were given colesevelam, were more likely to be in disease remission at their 6-12 months colonoscopy review compared with those not treated. Furthermore, treatment with colesevelam may have a role in altering the microbiome to help maintain remission states in postoperative Crohn's disease. Larger mechanistic studies are now needed to confirm these findings and demonstrate statistical significance as well as investigate whether this benefit may be present even in those patients with 75SeHCAT negative disease. 

Altmetrics:

A literature review assessing the perioperative efficacy and safety of tranexamic acid in elective total hip and knee arthroplasty in UK practice (2024)

Posted on by

Type of publication:

Journal article

Author(s):

*Patel R.; Golding S.; Nandra R.; Banerjee R.;

Citation:

Journal of perioperative practice. (pp 17504589241278478), 2024. Date of Publication: 20 Sep 2024 [epub ahead of print]

Abstract:

Hip and knee arthroplasty are frequently associated with significant blood loss, often necessitating blood transfusions. A variety of methods are employed to minimise blood loss and consequently mitigate the necessity for transfusions. This review explores the incidence of blood loss in hip and knee arthroplasty alongside perioperative strategies aimed at its reduction in UK practice. Given the increasing prevalence of tranexamic acid utilisation, we systematically examine the extant literature concerning its application in patients undergoing hip and knee arthroplasty. Our analysis discerns a prevailing consensus within published studies favouring the implementation of tranexamic acid as a safe and efficacious measure for reducing blood loss during hip and knee arthroplasty procedures.

Patient with Pneumomediastinum and Pneumoperitoneum-Importance of Human Factors (2024)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.R.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Belfast United Kingdom. 111(Supplement 8) (pp viii119), 2024. Date of Publication: September 2024.

Abstract:

Clinical assessment: 70-year-old lady presents with one-day history of dyspnoea, chest and abdominal pain. She was recently discharged following a three-week hospital admission with fall related traumatic rib fractures and hospital acquired pneumonia. Her abdomen was soft and non-tender. CT scan with oral and IV contrast demonstrates pneumomediastinum and pneumoperitoneum with connection at diaphragmatic crura. Management: Patient was managed conservatively however two days after admission her CRP climbed to 150 and clinical suspicion remained high. Repeat CT scan over the weekend demonstrated increase in the pneumoperitoneum and decrease in the pneumomediastinum with a collection around sigmoid colon. Trainee raised concern to consultant and a laparotomy was done. Operative findings showed perforated sigmoid colon with faeculent peritonitis of unclear cause. Hartmann's procedure was done and patient continued post recovery in ITU. Discussion(s): This case demonstrates the complex varying presentations of our elderly co-morbid population. The presence of air in thoracic and abdominal cavities with unknown cause weeks after the fall was suspicious. Hence, the team communicated well from top-down and likewise from weekday to weekend. Low threshold for escalation and high index of suspicion enabled a re-scan which proved to be life-saving for this patient. Identifying complicated cases where errors can occur is a critical first step. Clear communication among staff, accurate documentation and addressing the patient concerns enabled the surgical team to navigate the complex disease process and ensure safe patient care.

Link to full-text [no password required]

The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research (2024)

Posted on by

Type of publication:

Journal article

Author(s):

*Elsmore, Amy; Rai, Tanvi; Pallmann, Philip; Townson, Julia; Kotecha, Sarah; Black, Mairead; Sanders, Julia; Collis, Rachel; Collins, Peter; Karunakaran, Bala; Wu, Pensee; Bell, Sarah; *Parry-Smith, William

Citation:

Trials. 25(1):629, 2024 Sep 27.

Abstract:

BACKGROUND: Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. traditionally, decisions regarding site selection are based on desire to complete trials on target in 'tried and tested' research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK. METHOD: Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard. RESULTS: The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented. CONCLUSION: The NIHR equality, diversity and inclusion strategy states studies must widen

Link to full-text [open access - no password required]

Altmetrics:

BTS Position Statement on Sustainability and the Environment: Climate Change and Lung Health (2024)

Posted on by

Type of publication:

National guidance

Author(s):

Laura-Jane Smith, Henry Marshall, Thomas Medveczky, *Jennifer Nixon, Gerrard Phillips, Ravijyot Saggu, Lewis Standing, Ruth Wiggans, Alexander Wilkinson

Citation:

British Thoracic Society 2024

Link to full-text [no password required]

LBA70 Adding metformin to androgen deprivation therapy (ADT) for patients (pts) with metastatic hormone sensitive prostate cancer (mHSPC): Overall survival (OS) results from the multi-arm, multi-stage randomised platform trial STAMPEDE (2024)

Posted on by

Type of publication:

Conference abstract

Author(s):

Gillessen S.; Murphy L.R.; James N.D.; Sachdeva A.; Attard G.; Jones R.J.; Adler A.; El-Taji O.; Varughese M.; Gale J.; Brown S.J.; Srihari N.N.; Millman R.; Matheson D.; Amos C.L.; Murphy C.; McAlpine C.; Parmar M.K.; Brown L.C.; Clarke N.

Citation:

Annals of Oncology. Conference: ESMO Congress 2024. Barcelona Spain. 35(Supplement 2) (pp S1258-S1259), 2024. Date of Publication: September 2024.

Abstract:

Background: Metformin is a widely used, well tolerated anti-diabetic agent. Several studies suggest metformin has anti-cancer activity in different malignancies, including prostate cancer. We hypothesised that metformin also reduces the development of ADT-induced metabolic adverse effects, possibly improving OS via these mechanisms. Method(s): Non-diabetic pts with mHSPC were randomly allocated 1:1 to standard of care (SOC) or SOC+metformin within STAMPEDE. SOC included ADT +/- radiotherapy +/- docetaxel +/- androgen receptor pathway inhibitor (ARPI). The primary outcome was OS. Target hazard ratio (HR) 0.8 (92% power, 2.5% 1-sided significance). 7 subgroup analyses were pre-specified but not pre-powered. Result(s): 1874 pts with mHSPC were randomised Sep2016-Mar2023. Arms were well balanced: median age 69 years, IQR 63-73; median PSA 84ng/ml, IQR 24-352; de novo 1758 (94%) vs relapsed 116 (6%). Planned SOC included 82% Docetaxel and 3% ARPI. After a median follow-up of 60 months, the HR for OS between arms was 0.91 (p=0.148; 95% CI 0.80-1.03). The median (95%CI) OS was 63 (58-69) and 69 (63-73) months in the SOC and SOC+metformin arms respectively. In patients with high versus low volume disease (CHAARTED def), HR was 0.79 (p=0.006; 0.66-0.93) and 1.0 (p=0.992; 0.79-1.26) respectively. The interaction p-value = 0.086. For progression-free survival: Overall HR was 0.92 (p=0.164; 0.81-1.04) with HRs of 0.76 (p=0.001; 0.64-0.89) and 1.10 (p=0.401; 0.88-1.37) in the high and low volume subgroups respectively, interaction p-value = 0.006. Metabolic parameters that improved significantly with metformin included reduced weight gain, fasting glucose, HbA1c and total and LDL cholesterol. Fewer patients developed a metabolic syndrome. Adverse events (AE) >=grade 3 were reported in 52% and 57% in the SOC and SOC+metformin arms, respectively; Gastrointestinal AEs increased with metformin. Conclusion(s): Metformin does not improve survival in unselected metastati

Link to full-text

Interpretable Machine Learning for Predicting Multiple Sclerosis Conversion from Clinically Isolated Syndrome (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Daniel E.C.; Tirunagari S.; Batth K.; Windridge D.; *Balla Y.

Citation:
medRxiv. (no pagination), 2024. Date of Publication: 19 Jul 2024. [preprint]

Abstract:
Background: Machine learning (ML) prediction of clinically isolated syndrome (CIS) conversion to multiple sclerosis (MS) could be used as a remote, preliminary tool by clinicians to identify high-risk patients that would benefit from early treatment. Objective(s): This study evaluates ML models to predict CIS to MS conversion and identifies key predictors. Method(s): Five supervised learning techniques (Naive Bayes, Logistic Regression, Decision Trees, Random Forests and Support Vector Machines) were applied to clinical data from 138 Lithuanian and 273 Mexican CIS patients. Seven different feature combinations were evaluated to determine the most effective models and predictors. Result(s): Key predictors common to both datasets included sex, presence of oligoclonal bands in CSF, MRI spinal lesions, abnormal visual evoked potentials and brainstem auditory evoked potentials. The Lithuanian dataset confirmed predictors identified by previous clinical research, while the Mexican dataset partially validated them. The highest F1 score of 1.0 was achieved using Random Forests on all features for the Mexican dataset and Logistic Regression with SMOTE Upsampling on all features for the Lithuanian dataset. Conclusion(s): Applying the identified high-performing ML models to the CIS patient datasets shows potential in assisting clinicians to identify high-risk patients.

Link to full-text [open access - no password required]

Clinical decision support systems for maternity care: a systematic review and meta-analysis (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Cockburn N.; Osborne C.; Withana S.; *Elsmore A.; *Nanjappa R.; South M.; *Parry-Smith W.; Taylor B.; Chandan J.S.; Nirantharakumar K.

Citation:
eClinicalMedicine. 76 (no pagination), 2024. Article Number: 102822. Date of Publication: October 2024.

Abstract:
Background: The use of Clinical Decision Support Systems (CDSS) is increasing throughout healthcare and may be able to improve safety and outcomes in maternity care, but maternity care has key differences to other disciplines that complicate the use of CDSS. We aimed to identify evaluated CDSS and synthesise evidence of their impact on maternity care. Method(s): We conducted a systematic review for articles published before 24th May 2024 that described i) CDSS that ii) investigated the impact of their use iii) in maternity settings. Medline, CINAHL, CENTRAL and HMIC were searched for articles relating to evaluations of CDSS in maternity settings, with forward- and backward-citation tracing conducted for included articles. Risk of bias was assessed using the Mixed Methods Assessment Tool, and CDSS were described according to the clinical problem, purpose, design, and technical environment. Quantitative results from articles reporting appropriate data were meta-analysed to estimate odds of a CDSS achieving its desired outcome using a multi-level random effects model, first by individual CDSS and then across all CDSS. PROSPERO ID: CRD42022348157. Finding(s): We screened 12,039 papers and included 87 articles describing 47 unique CDSS. 24 articles (28%) described randomised controlled trials, 30 (34%) described non-randomised interventional studies, 10 (11%) described mixed methods studies, 10 (11%) described qualitative studies, 7 (8%) described quantitative descriptive studies, and 7 (8%) described economic evaluations. 49 (56%) were in High-Income Countries and 38 (44%) in Low- and Middle-Income countries, with no CDSS trialled in both income categories. Meta-analysis of 35 included studies found an odds ratio for improved outcomes of 1.69 (95% confidence interval 1.24-2.30). There was substantial variation in effects, aims, CDSS types, context, study designs, and outcomes. Interpretation(s): Most CDSS evaluations showed improvements in outcomes, but there was heterogeneity in all aspects of design and evaluation of systems. CDSS are increasingly important in delivering healthcare, and Electronic Health Records and mHealth will increase their availability, but traditional epidemiological methods may be limited in guiding design and demonstrating effectiveness due to rapid CDSS development lifecycles and the complex systems in which they are embedded. Development methods that are attentive to context, such as Human Centred Design, will help to meet this need.

Link to full-text [open access - no password required]

Altmetrics:

To study morbidity and mortality related to ileostomy/colostomy closure at tertiary care hospital (2024)

Posted on by

Type of publication:
Journal article

Author(s):
Gilani S.S.; *Shahzeb M.; Salman D.M.; Nadeem M.; Khan S.; Thomas J.J.; Almesri A.

Citation:
Journal of Population Therapeutics and Clinical Pharmacology. 31(8) (pp 853-858), 2024. Date of Publication: 01 Aug 2024.

Abstract:
Background and Aim: Gastrointestinal stomas main function is to divert the flow away from a difficult anastomoses or intestinal obstruction. There is now a trend toward avoiding permanent stomas, and temporary loop stomas often used to protect anastomotic or distal bowel segments in high-risk patients. The present study aimed to determine the morbidity-mortality after ileostomy or colostomy closure. Patients and Methods: This comparative observational study investigated 42 cases of ileostomy and colostomy closure in the Surgical Unit of Jinnah Hospital, Lahore from January 2020 to January 2024. Patients were divided into two groups; Group-I (Ileostomy closure) and Group-II (Colostomy closure). Demographic details such as age and gender, Clinical details such as indications, types of stoma technique used, and operative times, length of hospital stay, morbidity, and mortality recorded. SPSS version 26 was used for data analysis. Result(s): The overall mean age was 46.8+/-6.52 years (15-75 years). Out of 42 cases, 28 (66.7%) underwent ileostomy and 14 (33.3%) underwent colostomy closure. The most prevalent indication for closure was protection of anastomosis in both stoma groups. The interval between creation and closure of stoma was shorter (117.8 days) in Group-I than Group-II (162.4 days). The incidence of hand sewing sutures and stapled technique was 32 (76.2%) and 10 (23.8%), respectively. The Group-II patients took 107.9+/-5.24 minutes as operative time which was significantly higher than 82.96+/-8.84 minutes in Group-I. The prevalence of morbidity in Group-I and Group-II was 10.7% (n=3) and 14.3% (n=2), respectively. Prolong hospital stay was required in Group-II. No mortality case reported in both stoma groups. Conclusion(s): The present study observed that Stomatal closure well tolerated procedure, with low morbidity and mortality. The results suggest that ileostomy closure is a relatively simple procedure.

Link to full-text [open access - no password required]

Does tranexamic acid really matter in reducing blood loss? A critical evaluation of its efficacy in orthognathic surgery through a comprehensive systematic review and meta-analysis (2024)

Posted on by

Type of publication:
Systematic Review

Author(s):
Mortada, Hatan; Hussain, Samar Ali; Liyanage, Dinithi Dilruvi; Zou, Yutong; Subbiah, Praveen; *George, Jefferson; Mansour, Hamid Reza Khademi; Khajuria, Ankur.

Citation:
British Journal of Oral & Maxillofacial Surgery. 2024 Jul 09.

Abstract:
Tranexamic acid (TXA) is acknowledged for reducing blood loss and transfusion requirements in various surgical specialties, yet its role in orthognathic procedures is less defined. Our study seeks to fill this knowledge gap by reviewing the available data and summarising the efficacy and clinical outcomes of TXA in orthognathic surgery. We performed a systematic review and meta-analysis, searching five databases for studies until 16 April, 2023. Our key outcome measures were intraoperative blood loss, postoperative bleeding, and transfusion rate. Previous weaknesses in systematic review and meta-analyses (SRMA) were identified using Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). The risk of bias was evaluated with the RoB-2 tool. A total of 15 studies were included, involving a combined total of 1060 patients. Compared with the control, the TXA group demonstrated significant reductions in intraoperative blood loss (mean difference -135.60 mL; p < 0.00001; 95% CI, -177.51 to -93.70 mL), Hb level drop (mean difference: 2.67 [-0.63, 5.98]), and improved surgical field visibility [p < 0.00001. (MD -0.99) (CI -1.11 to -0.86)]. No significant differences were observed in postoperative haematocrit levels (mean difference: -0.42 [-2.19, 1.35]; p = 0.003; I2 = 75%), operation duration (p = 0.21), or duration of hospital stay (p = 0.63) between TXA and control groups. In orthognathic surgery, TXA effectively minimises blood loss, demonstrating both safety and efficiency. Well-designed, larger studies and comparisons with other haemostatic agents could solidify TXA evidence.