Author: Jason Curtis

The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope (2024)

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Type of publication:
Journal article

Author(s):
Hannah, Jennifer; Rodziewicz, Mia; Mehta, Puja; Heenan, Kerri-Marie; Ball, Elizabeth; Barratt, Shaney; Carty, Sara; Conway, Richard; Cotton, Caroline V; Cox, Sarah; Crawshaw, Anjali; Dawson, Julie; Desai, Sujal; Fahim, Ahmed; Fielding, Carol; *Garton, Mark; George, Peter; Gunawardena, Harsha; Kelly, Clive; Khan, Fasihul; Koduri, Gouri; Morris, Helen; Naqvi, Marium; Perry, Elizabeth; Riddell, Claire; Sieiro Santos, Cristiana; Spencer, Lisa G; Chaudhuri, Nazia; Nisar, Muhammad K.

Citation:
Rheumatology Advances in Practice. 8(2):rkae056, 2024.

Abstract:
Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.

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Persistent sweet taste dysgeusia diagnosed with probable SIADH: Unmasking underlying lung cancer in a high-risk individual: A case report (2024)

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Type of publication:
Journal article

Author(s):
*Praveenkumar Katarki, *Lyudmyla Nod, *Nawaid Ahmad

Citation:
Clinical Medicine 2024. Volume 24, Supplement, April 2024

Abstract:
Introduction: The timely identification of lung cancer is critical but difficult due to its broad and often nonspecific symptoms. This case report highlights the importance of taking into consideration unusual manifestations, especially in persons at high risk, and emphasises the necessity of a thorough diagnostic approach. Case presentation: A 66-year-old female referred from the general practitioner (GP)to the same day emergency care (SDEC) with persistent sweet taste dysgeusia, headache and hyponatraemia (118). Notably, her chest X-ray was unremarkable (image 1) despite a 30-pack-year smoking history. Initial suspicion was on drug-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) potentially due to her long-term use of gabapentin (for 25 years), as reported in a retrospective study conducted in Sweden.1 However, an inadequate response to treatment prompted further investigation, CT thorax (image 2) revealing primary lung malignancy with liver metastases. A histological evidence is awaited, the radiological diagnosis of the lung cancer was considered after discussion at Lung cancer at the multidisciplinary team. Discussion: This case further strengthens the growing body of evidence suggesting sweet taste dysgeusia as a rare paraneoplastic symptom of small cell lung cancer (SCLC), as documented in previous studies.2–5 The potential mechanisms underlying this phenomenon remain unclear, but possibilities include ectopic antidiuretic hormone (ADH) production4, tumour-derived substances affecting taste pathways5 or metabolic disturbances associated with the malignancy itself.4,5 This case underscores the critical need for heightened suspicion for malignancy, especially in high-risk individuals like smokers, even when presenting with seemingly common diagnoses like SIADH. Additionally, it highlights the limitations of solely relying on initial symptoms and investigations. Notably, the patient had an unremarkable chest X-ray (image 1) despite a significant 40-pack-year smoking history, emphasising the importance of employing a comprehensive diagnostic approach. This approach should encompass a detailed medical history and risk factor evaluation, thorough physical examination for potential malignancy signs, targeted laboratory investigations including electrolytes, renal function, and tumour markers, and appropriate imaging studies based on clinical suspicion and initial findings (chest X-ray, CT scan). While this case showcases the potential of sweet taste dysgeusia as a paraneoplastic sign, several limitations must be acknowledged. First, this symptom remains rare and its specificity for SCLC is uncertain; Second, potential selection bias towards atypical presentations could overestimate its prevalence.7 Finally, confounding factors like hyponatraemia itself can affect taste perception.4. Conclusion: This case contributes to the growing evidence suggesting sweet taste dysgeusia could be an atypical early warning sign of lung cancer, particularly in high-risk individuals. While limitations exist and further research is warranted, this association necessitates further investigation due to its potential implications for earlier detection and improved patient outcomes. Recognising limitations, advocating for further research, and emphasising potential clinical impact contribute to ongoing efforts in improving lung cancer diagnosis and management.

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COVID Recovery Laparoscopic Simulation Program for Gynaecological Registrars-Trainee Perceptions of Regional Model (2024)

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Type of publication:
Journal article

Author(s):
Azeem, Zahra; Odendaal, Joshua; Ghosh, Donna; *Tapp, Andrew; Hassan, Ismail

Citation:
Journal of Minimally Invasive Gynecology. 2024 May 11.

Abstract:
STUDY OBJECTIVE: The acquisition of gynaecological operating skills can be challenging for trainees given the conflicting demands of clinical work. Alternative models of surgical skill training such as laparoscopic simulation is, therefore, required. This study demonstrates the development of a regional gynaecological surgery laparoscopic simulation program and trainee perceptions of such an approach. DESIGN: An intervention-based cohort study. SETTING: A regional model based in West Midlands training region. PATIENTS/PARTICIPANTS: Responses from sixty-four trainees in the training region who participated in his regional program were included. INTERVENTION: A three-stream curriculum was developed to deliver key training outcomes as required by the Royal College of Obstetricians and Gynaecologists (RCOG) core curriculum as a component of a Covid Recovery Program. Courses were held in seven teaching hospitals. Courses consisted of both theory and practical teaching. MEASUREMENTS: A structured feedback tool was used to collect trainee perceptions of the programme. Trainee satisfaction was measured on the Likert scale of 1-3. A qualitative thematic analysis was conducted with rank-order analysis of coded free-text responses. MAIN RESULTS: Overall, the majority of trainees 92% (n=58/64) were very satisfied with the course. Rank-order analysis demonstrated hands-on-practice to be the key perceived benefit of laparoscopic simulation amongst basic and intermediate trainees whilst feedback on procedural skills was felt most useful amongst advanced trainees. CONCLUSION: A regional approach to laparoscopic simulation training is both achievable and acceptable. Trainee perceptions of usefulness are altered by seniority and experience. This should be accounted for in the development of laparoscopic simulation programmes.

Reflector-guided localisation of non-palpable breast lesions: A prospective evaluation of the SAVI SCOUT system on 137 patients (2024)

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Type of publication:
Conference abstract

Author(s):
Taj S.; Han S.; *Lefroy R.; Hajiesmaeili H.; Alamgir C.F.; Rahman E.; Khosla M.; Bowen N.; Troman P.; Vidya R.; Verma R.; Mylvaganam S.; Clarke D.; Ingle H.; Sircar T.

Citation:
European Journal of Surgical Oncology. Conference: The Association of Breast Surgery Conference 2024. Bournemouth International Centre, Bournemouth United Kingdom. 50(Supplement 1) (no pagination), 2024. Article Number: 108190. Date of Publication: May 2024.

Abstract:
Introduction: Traditionally, wire-guided localisation has been the gold-standard for localising non-palpable breast lesions. However, this method has some limitations, including patient discomfort, wire migration and scheduling radiology appointments on the day of surgery, causing delay in start of theatre list. Various wire-less alternatives have been developed. Therefore, the aim of this study was to evaluate the safety and effectiveness of the SAVI SCOUT localisation technique. Method(s): This was a prospective study of 137 consecutive patients with SAVI SCOUT reflector, deployed between December 2020 and November 2023. We studied the rate of successful localisation and retrieval of SCOUT, imaging modality used for localisation, re-excision rate, pathology, median weight of specimen and SCOUT-related complications. Result(s): A total of 137 SAVI SCOUT reflectors were deployed in 137 consecutive patients undergoing breast conserving surgery for non-palpable lesions which included malignancy 97% (n=133), high risk lesions 2.18% (n=3) and benign lesion in 0.72% (n=1). The rate of radiological localisation and retrieval of the reflector at surgery was 97.8% (n=134) and 100% (n=137) respectively. The most common modality for localisation was ultrasound 97% (n=133). The median specimen weight was 21.5gm. The mean duration between deployment day and surgery was 2 days (range 0-30). The re-excision rate was 8% (n=11). There was no specific technique-related surgical complication. Conclusion(s): Our study demonstrates that the SAVI SCOUT localisation system is a safe, effective, and reliable localization modality for non-palpable breast lesions with low re-excision rate.

Statins As Anti-Hypertensive Therapy: A Systematic Review and Meta-Analysis (2024)

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Type of publication:
Systematic Review

Author(s):
Khan, Zahid; Gul, Amresh; Mlawa, Gideon; Bhattacharjee, Priyadarshini; Muhammad, Syed Aun; Carpio, Jonard; *Yera, Hassan; Wahinya, Maureen; Kazeza, Axel P; Amin, Mehul S; Gupta, Animesh.

Citation:
Cureus. 16(4):e57825, 2024 Apr.

Abstract:
Hypertension is the most prevalent condition in clinical practice. Hypertension, diabetes, and hypercholesterolaemia are major contributing factors to cardiovascular diseases. They commonly coexist in a single patient. Statins have been used as prominent medicines for the reduction of cardiovascular events. Statins have been shown to reduce blood pressure in patients with hypertension and have lipid-lowering properties in recent articles. Statins reduce blood pressure because of their impact on endothelial function, their interactions with the renin-angiotensin system, and their influence on major artery compliance. This meta-analysis aimed to ascertain the effectiveness and efficacy of statins for managing hypertension in patients with hypertension. Systematic searches were conducted on PubMed, Science Direct, Embase, Cochrane Library, and Google Scholar. Randomized controlled trials, systematic trials, and cohort studies were retrieved using keywords on statins and their use in patients with hypertension. Exclusion criteria included studies that were not in the English language, studies that did not include patients on statins with hypertension, studies that did not provide enough information, technical reports, opinions, or editorials, and studies involving patients < 18 years old. The inclusion criteria were randomized controlled trials, meta-analyses, adult patients aged > 18 years old, and studies that were freely available or through institutional login. This meta-analysis scrutinized 9361 randomized controlled trials, clinical trials, meta-analyses, and systematic reviews, of which 32 articles including 25 randomized controlled trials and seven meta-analyses were included in the final analysis. This meta-analysis of the role of statins in hypertensive patients aimed to determine the outcome of hypertension control along with antihypertensive medication. Our study showed that statins are useful in reducing both systolic and diastolic blood pressure. We used a heterogeneous model for analysis due to variations in the study characteristics. The I2 value was 0.33 (0.76, 0.10) for systolic blood pressure and 0/88 (0.86, 0.90) for diastolic blood pressure. The I2 value for the seven meta-analyses included in the study was 1.79 (2.88, 0.69).

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Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome (2024)

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Type of publication:
Journal article

Author(s):
Anjum, Ihtisham; Ullah, Ubaid; *Fazli Maula, Aimen; Haroon, Hamza; Ahmad, Yaseen; Hassan, Rao E; Shahid, Kashan; Hussain, Saddam; Haider, Waseem; Ullah, Rizwan

Citation:
Cureus. 16(3):e57270, 2024 Mar.

Abstract:
Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93+/-5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

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Is SPECT/CT a useful imaging tool for the identification of knee cartilage lesions: a systematic review (2024)

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Type of publication:
Journal article

Author(s):
Rix L.; *Tushingham S.; Wright K.T.; Snow M.

Citation:
Osteoarthritis and Cartilage. Conference: 2024 OARSI World Congress on Osteoarthritis. Vienna Austria. 32(Supplement 1) (pp S353), 2024. Date of Publication: April 2024.

Abstract:
Purpose (the aim of the study): Anterior knee pain (AKP) is a common orthopaedic pain which affects individuals from the young and active to the elderly and sedentary. Though multifactorial in nature, the disorder is believed to occur through muscular imbalance, structural malalignment, overuse, and trauma. Subsequently, as time passes, this can cause damage to the cartilage, resulting in chondral lesions. Currently, magnetic resonance imaging (MRI) is defined as the gold standard imaging tool for chondral lesion detection. However, MRI mis-diagnoses around 20% of chondral lesions, and therefore is not a highly sensitive tool. An emerging imaging tool is single-photon emission computerised tomography with conventional computer tomography (SPECT/CT). Important diagnostic information may be provided from SPECT/CT for AKP patients who exhibit absence of structural change on other imaging modalities, and thus holds clinical value for the detection of knee chondral lesions. This review systematically assessed the utility of SPECT/CT as an imaging modality for knee pain, and its ability to diagnose chondral lesions for those patients who present clinically with knee pain. Method(s): Under PRISMA guidelines, a systematic search of databases was conducted in PubMed, Science Direct, and Web of Knowledge, CINAHL, AMED, Ovid Emcare and Embase. Inclusion criteria comprised of any English language article which focused on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Further, any articles which focused on animal or cadaver studies, comparator technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded from the study. Articles that were deemed relevant underwent QUADAS-2 bias assessment. Result(s): After database search, manuscripts were identified, and 11,982 titles were screened for relevance. Seven studies were identified as suitable for inclusion based on eligibility criteria and were subjected to QUADAS-2 assessment. All 7 articles scored low for bias. Two papers found that ICRS score at intraoperative assessment correlated with SPECT/CT tracer uptake. Two studies concluded that whilst SPECT/CT tracer uptake significantly correlated with MRI, for some patients SPECT/CT identified more chondral lesions than MRI. Two papers compared bone scintigraphy (BS) to SPECT/CT, and found that SPECT/CT was able to identify, localise and characterise more chondral lesions in the knee than BS. Conclusion(s): The evidence found in this review suggests that SPECT/CT may be a useful imaging tool to detect and localise cartilage lesions of the knee. Particularly in those patients with conflicting cases whereby there is an absence of lesions on other imaging modalities, or a lack of resemblance with patients' symptoms. More studies would be of value to strengthen the conclusions of this review.

Frequency of CLAR and JAK2 mutations in Sudanese chronic myeloid leukemia patients with Philadelphia-positive disease (2024)

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Type of publication:
Journal article

Author(s):
Yasin E.B.; *Yasin A.

Citation:
Asian Journal of Pharmaceutical and Clinical Research. 16(8) (pp 133-137), 2023. Date of Publication: August 2023.

Abstract:
Objective: It is well-established that myeloproliferative diseases coexist with CLAR and JAK2. In Ph+ chronic myeloid leukemia (CML), only a few case reports indicate the existence of CLAR, JAK2V617F, and JAK2 exon 12 mutations. Method(s): This study examined CALR and JAK2 mutation profiles in Sudanese Chronic Myeloid Leukemia patients with Philadelphia-positive patients. Blood samples were collected from 100 patients with Ph+ CML chromosomes. Results for the JAK2V617F mutation were confirmed using the TaqMan Mutation Detection Assay, and the four common mutations on exon 12 and CLAR mutations were confirmed using allele-specific PCR (AS-PCR) and Sanger sequencing. Result(s): CML patients with CALR frameshift mutations were detected in two patients (2%), patients with JAK2 exon 12 mutations were found in two patients (2%), and patients with JAK2V617F mutations made up 4 (4%) of the total CML patients. No significant relationships existed between mutations and age, WBC, RBC, Hb, HCT, or platelet parameters. Patients with CLAR, JAK2 exon 12, and JAK2V617F mutations have normal leukocyte counts and lower values compared to triple-negative Ph+ CML, but these differences are not statistically significant (p values for each 0.084, 0.173, and 0.072). Conclusion(s): It is conceivable for Ph+ CML and all mutations to coexist.

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Lung Ultrasound for Diagnosis of Primary Graft Dysfunction in Lung Transplantation Recipients (2024)

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Type of publication:
Conference abstract

Author(s):
O'Brien E.; Curry S.; Rubino A.; Barker A.; *Miller A.; Parmar J.

Citation:
Journal of Heart and Lung Transplantation. Conference: ISHLT 44th Annual Meeting and Scientific Sessions Prague Congress Centre. Prague Czechia. 43(4 Supplement) (pp S345), 2024. Date of Publication: April 2024.

Abstract:
Purpose: To determine if lung aeration scores calculated using LUS correlate with the identification and grading of PGD in lung transplantation recipients identified on bedside chest radiography (CXR) and PaO2/FiO2 as the reference standard. Method(s): This is a two-year, single-centre, prospective observational study investigating lung transplantation patients admitted post-operatively to Critical Care at Royal Papworth Hospital (RPH). LUS assessments to examine 12-lung regions were conducted at specified timepoints and scored retrospectively. Differences between LUS aeration scores for PGD and non-PGD were tested for and correlation of LUS score and PGD grading was assessed. Result(s): To date, data has been collected from 29 consecutive adult patients in 12 months. A total of 816 lung ultrasound clips have been collected for analysis. The mean aeration scores in PGD patients was higher than non-PGD (t(42) = 4.58, p < 0.001). PGD severity grading and LUS score shows a moderate positive linear association r(42) =.67, p < 0.01. Conclusion(s): This interim data analysis demonstrates exciting potential of LUS as an imaging modality in this cohort for PGD. This study is set to continue for a further 12 months, to allow for a larger sample size and further analysis of the utilisation of LUS in this cohort.