Open access

A UK prospective multicentre decision impact, decision conflict and economic evaluation of the 21-gene assay in women with node+ve, hormone receptor+ve, HER2-ve breast cancer (2024)

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Type of publication:
Journal article

Author(s):
Holt, Simon; Verrill, Mark; *Pettit, Laura; Rigg, Anna; Hickish, Tamas; Archer, Caroline; Dent, Jo; Dillon, Marianne; Nathan, Mark; Barthelmes, Ludger; Rehman, Shazza; Sharaiha, Yousef; Innis, Paige; Sai-Giridhar, Priya; Khawaja, Saira.

Citation:
British Journal of Cancer. 2024 Feb 02.

Abstract:
BACKGROUND: For a tumour profiling test to be of value, it needs to demonstrate that it is changing clinical decisions, improving clinical confidence, and of economic benefit. This trial evaluated the use of the Oncotype DX Breast Recurrence Score R assay against these criteria in 680 women with hormone receptor-positive (HR+), HER2-negative early breast cancer with 1-3 lymph nodes positive (LN+) in the UK National Health Service (NHS). METHODS: Prior to receipt of the Recurrence Score (RS) result, both the physician and the patient were asked to state their preference for or against chemotherapy and their level of confidence on a scale of 1-5. Following receipt of the RS result, the physician and patient were asked to make a final decision regarding chemotherapy and record their post-test level of confidence. RESULTS: Receipt of the RS result led to a 51.5% (95% CI, 47.2-55.8%) reduction in chemotherapy, significantly increased the relative and absolute confidence for both physicians and patients and led to an estimated saving to the NHS of 787 per patient. CONCLUSION: The use of the Oncotype DX assay fulfils the criteria of changing clinical decisions, improving confidence and saving money.

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Low Risk Meets High Stakes: Unraveling the Mystery of Low D-dimer Pulmonary Embolism (2023)

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Type of publication:
Journal article

Author(s):
Kasanga, Sadat; Khashan, Abdallah; Salik, Ahsan; *Aboshehata, Ahmed M; Casillas, Sebastian; Islam, Mohammed

Citation:
Cureus. 15(12):e51045, 2023 Dec.

Abstract:
Pulmonary embolisms (PEs) are potentially life-threatening emergencies that carry significant morbidity and mortality. Advances in treatment options and the safety of existing procedures have effectively reduced the long-term and short-term effects of the condition. Therefore, it is important to make an early diagnosis so that treatment options can be thoroughly explored. The D-dimer is an important tool in the early diagnosis of PEs. It is especially useful in ruling out the diagnosis in patients with a low to moderate suspicion of the disease. We present a case of a 22-year-old male who presented with exertional dyspnea, congestion, and rhinorrhea for one day and was noted to have persistent hypoxia and tachycardia. The influenza test was positive, and he was started on oseltamivir. Due to persistent hypoxia, a CT pulmonary angiogram was ordered and revealed filling defects in the left lower lobe segmental vessels suggestive of PE, as well as multifocal multilobar bilateral ground-glass opacities. He was initially treated with a heparin drip and subsequently switched to eliquis. After a significant improvement in his hypoxia, he was discharged home for outpatient follow-up, includinga hypercoagulable workup. This case demonstrates that despite the usefulness of the D-dimer as a diagnostic tool for PEs, it cannot solely or fully replace the full gamut of screening tools used to determine the risk of PE. Although rare, false-negative scores do occur; therefore, the tool should always be used in conjunction with other scoring systems, physician gestalt, and within the specific clinical context.

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A Survey on the Type and Prevalence of Medical Interventions during Labor and Childbirth in Greek Pregnant Women (2023)

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Type of publication:
Journal article

Author(s):
*Papoutsis D.; Chatzipanagiotidou N.

Citation:
Clinical and Experimental Obstetrics and Gynecology. 50(12) (no pagination), 2023. Article Number: 258. Date of Publication: December 2023.

Abstract:
Background: The purpose of this study was to identify the type and prevalence of medical interventions during labor and birth in Greek pregnant women. Method(s): We constructed a 49-item web-based questionnaire to capture demographic data, obstetric data and the medical interventions performed during the most recent childbirth of participants. The questionnaire was posted on nationwide electronic media between November 2022 to January 2023. All women who had given birth at least once were eligible for the study, and results were stratified by the timing of their last birth. Result(s): There was a total of 954 women participating in the survey, with 809 women giving birth within the last 10 years and 145 women giving birth between 10 to 20 years ago. In those that gave birth within the past 10 years, the majority had a low-risk pregnancy (78.8%) and the overall cesarean section rate was 42.8%. During labor, women were allowed to change positions and to mobilize in about half of cases, whereas the lithotomy position at birth was reported by 81.4%. Almost 2 in 3 women reported a vaginal examination every hour or even more frequently, with approximately 30% sustaining more than 5 examinations intrapartum. Oxytocin use was reported in 36.9%, epidural use in 69.6%, and episiotomy in 47.3% of women. Women who had their last birth 10-20 years ago when compared to those who gave birth within the last 10 years seem to have experienced higher rates of medical interventions during labor and birth. Conclusion(s): The survey results demonstrate the medicalization of childbirth in Greek pregnant women over the past 20 years. These findings may serve as a benchmark against which to compare and identify possible changes in future birthing practices and to determine which measures to promote normality at birth should be implemented.

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Musculotendinous ruptures of the achilles tendon had greater heel-rise height index compared with mid-substance rupture with non-operative management: A retrospective cohort study (2024)

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Type of publication:
Journal article

Author(s):
*Carmont, Michael R; Gunnarsson, Baldvin; Brorsson, Annelie; Nilsson-Helander, Katarina.

Citation:
Journal of Isakos. 9(2):148-152, 2024 Apr.

Abstract:
INTRODUCTION: Achilles tendon ruptures (ATRs) may occur at varying locations with ruptures at the mid-substance (MS) of the tendon most common, followed tears at the musculotendinous (MT) junction. There is scant literature about the outcome of MT ATR. This study compared the outcome of patients with a MT ATR with patients following a MS ATR. METHODS: The diagnostic features and clinical outcome of 37 patients with a MT ATR were compared with a cohort of 19 patients with a MS ATR. Patients in both groups were managed non-operatively and received the same rehabilitation protocol with weight-bearing rehabilitation in protective functional brace. RESULTS: From February 2009 to August 2023, 556 patients presented with an ATR. Of these, 37 (6.7 %) patients were diagnosed with a MT tear. At final follow-up, at 12 months following injury, the MT group reported an Achilles tendon total rupture score (ATRS) of mean (standard deviation (SD)) of 83.6 (3.5) (95 % confidence interval (CI) 81.8, 85.4) and median (inter-quartile range (IQR)) ATRS of 86 points (78-95.5) and the MS group mean (SD) of 80.3 (8.5) (95%CI) 76.1, 80.5) and median (IQR) of 87 points (59-95) (p = 0.673). Functional evaluation, however, revealed statistically significant differences in mean (SD) heel-rise height index MT group 79 % (25) (95%CI 65.9, 92.1) and MS group 59 % (13) (95%CI 51.9, 67.1) (p = 0.019). In the MT rupture group, there were considerably less complications than the MS rupture group. CONCLUSIONS: When managed non-operatively, with only a 6 weeks period of brace protection, patients have little limitation although have some residual reduction of single heel-rise at the one-year following MT ATR. LEVEL OF EVIDENCE: IV.

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Mastering the Art of Dermatosurgery: Aesthetic Alchemy in Medical Excellence (2023)

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Type of publication:
Journal article

Author(s):
*Ekomwereren, Osatohanmwen; Shehryar, Abdullah; Abdullah Yahya, Noor; Rehman, Abdur; Affaf, Maryam; Chilla, Srikar P; Kumar, Uday; Faran, Nuzhat; I K H Almadhoun, Mohammed Khaleel; Quinn, Maria; Ekhator, Chukwuyem

Citation:
Cureus. 15(11):e49659, 2023 Nov.

Abstract:
Dermatosurgery, a specialized branch within dermatology, has traversed an extraordinary journey through time, shaped by ancient practices, technological leaps, and shifting societal perceptions. This review explores the evolution of dermatosurgery, highlighting its profound transformation from addressing solely medical concerns to seamlessly integrating aesthetics. From its roots in ancient civilizations, where cultural traditions laid the foundation for modern techniques, to the twentieth-century technological renaissance, marked by innovative tools and enhanced understanding of skin anatomy, dermatosurgery has emerged as a dynamic field. Societal notions of beauty and health have significantly influenced dermatosurgery, blurring the lines between medical necessity and elective aesthetic procedures. The delicate balance between satisfying aesthetic desires and upholding medical ethics is a central challenge that
dermatosurgeons face today. Open dialogue between practitioners and patients as well as psychological support plays a pivotal role in navigating this terrain. The training and ethics associated with dermatosurgery have evolved to meet the increasing demand for specialized procedures. Maintaining a focus on patient safety and satisfaction remains paramount as commercial pressures and disparities in access to care loom. Upholding best practices and standards in the field is essential for ensuring consistent, high-quality care for all patients. Looking ahead, dermatosurgery stands on the brink of a transformative era, marked by non-invasive techniques, artificial intelligence (AI) integration, and personalized medicine. The field's ability to harmonize medical science with aesthetic artistry is evident in various case studies, showcasing the intricate balance dermatosurgeons strike between addressing medical concerns and fulfilling aesthetic desires. As dermatosurgery continues to evolve, it promises to provide patients with even more precise, tailored treatments that enhance both their physical well-being and aesthetic satisfaction.

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Vesical Haemangioma in Klippel-Trenaunay-Weber Syndrome: A Clinical Case (2023)

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Type of publication:
Journal article

Author(s):
Mohamed, Ahmed; *Chin, Yew Fung; Farah, Mohamed; Mahmalji, Wasim

Citation:
Cureus. 15(12):e49952, 2023 Dec.

Abstract:
Klippel-Trenaunay-Weber (KTW) syndrome, a rare vascular disorder, often presents with cutaneous capillary malformations and soft tissue hypertrophy. However, urinary tract involvement in the form of vesical haemangiomas is a seldom-encountered clinical condition. We present a case of a 37-year-old male with KTW syndrome who exhibited recurrent gross haematuria, prompting clinical evaluation. Initial diagnostic assessments revealed erythematous changes in the bladder, consistent with haemangiomas. Despite an initial biopsy and diathermy, the patient's symptoms recurred, leading to a subsequent management strategy involving laser fulguration. This case underscores the significance of recognizing cutaneous haemangiomas as potential indicators of urinary tract involvement in KTW syndrome and highlights the challenges in managing vesical haemangiomas, where a multidisciplinary approach is essential for optimal care.

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Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial (2024)

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Type of publication:
Randomised controlled trial

Author(s):
Zahed, Ghazal; Fatahi, Somaye; Tabatabaee, Leila; Imanzadeh, Negar; *Seraj, Shaikh Sanjid; Wolters, Benjamin Hernandez; Hosseini, Amirhossein

Citation:
BMC Pediatrics. 24(1):7, 2024 Jan 03.

Abstract:
OBJECTIVES: Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS: In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS: 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 +/- 2.4 years and 8.0 +/- 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION: Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.

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Transregional Study Highlighting the Increasing Burden of Urology Cancer Multidisciplinary Team Meetings Around the UK (2023)

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Type of publication:
Journal article

Author(s):
Kasmani, Zain; Mohamed, Wail; Siddiqui, Zain; Boksh, Saddek; Ganapathi, Shaswath; Saidani, Zakaria; Wijayasuriya, Don S; Donati-Bourne, Jack.

Citation:
Cureus. 15(11):e48501, 2023 Nov.

Abstract:
Introduction: The urology multidisciplinary team meeting (MDT) is the key weekly meeting that allows the opportunity to review results and discuss management plans for all urological cancers within a department. As populations age and cancer detection and management improve, the demand for the MDT will increase. We conducted a collaborative transregional study within the UK to evaluate the current workload on the urology MDT. Methods: The study was divided into two parts: a multicenter retrospective audit and a snapshot survey. Three UK hospitals in Birmingham, Liverpool, and Cardiff were recruited into the multicenter study. Each hospital provided full MDT lists for all weekly meetings between August 2017 and 2022. Retrospective data gathered included the number of patients discussed per week, the average age of patients per week, the time allocated to their weekly MDT, and the total number of consultants in the department. The second part of the study involved the distribution of an online questionnaire to urologists across the UK to obtain a snapshot picture with the above parameters. Results Snapshot data from 34 different UK hospitals showed MDT length ranged from 1-6 hours, patients discussed ranged from 10-90 per week, and the maximum average discussion time was 3.8 minutes per case. Furthermore, 76% (N = 28/37) of respondents said unnecessary cases were discussed. Varied suggestions were provided on how the MDT could be improved. Multicenter five-year data showed a rise in mean total numbers of patients discussed per week in all centers: a 34.8% increase in Birmingham (from 34.5 patients to 46.5 patients), a 23.5% increase in Liverpool (27.2 patients to 33.6 patients), and a 38.8% increase in Cardiff (22.7 patients to 31.5 patients). Hours per meeting were Birmingham (2), Liverpool (3), and Cardiff (4), which meant the average minutes per patient discussion were Birmingham (2.6), Liverpool (5.4), and Cardiff (7.6). Conclusion There is a rapidly rising trend across UK regions for the number of patients being discussed in the urology MDT meeting. The MDT structure and function across the country are highly variable. There is consensus that the MDT discusses cases that are unnecessary, and this has been recognized for many years. Widespread implementation of the latest MDT management guidelines is urgently required to ensure MDT meetings are able to function effectively and efficiently into the future.

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Radiological and Imaging Evidence in the Diagnosis and Management of Microbial Infections: An Update (2023)

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Type of publication:
Journal article

Author(s):
Vaishnav, Aditya; *Gurukiran, Gurukiran; Ighodaro, Osazuwa; Kandi, Venkataramana

Citation:
Cureus. 15(11):e48756, 2023 Nov.

Abstract:
Microbial infections are extremely prevalent throughout the world. Bacteria, fungi, parasites, and viruses generally cause them. Most microbial infections spread from humans to humans and from animals to humans. A vast majority of microbial infections are self-limiting. However, some microbial infections result in severe morbidity and mortality. The diagnosis of microbial infections generally depends on the direct demonstration of microbes in human clinical specimens through microscopy followed by culture. Some microbes are uncultivable, and among those that are cultivable, some take a very long time to grow in the laboratory. This causes delays in the diagnosis that may result in poor patient outcomes. Serological and molecular methods like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively, have been extensively used to diagnose infectious diseases. However, these require costly infrastructure and adequate personnel training. In this context, alternative, more efficient, and rapid detection methods for the diagnosis of microbial infections are warranted. In this review, we comprehensively discuss the role played by radiological investigations in the diagnosis and management of infectious diseases.

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Orbital Onset: The Intricate Journey From Ear Abscess to Cavernous Sinus Thrombosis in a Diabetic Male (2023)

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Type of publication:Journal article

Author(s):*Ekomwereren, Osatohanmwen; Sunkara, Vyshnavidevi; Grezenko, Han; Hamid, Yusra H; Faran, Nuzhat; Abubakar, Muhammad.

Citation:Cureus. 15(11):e48922, 2023 Nov.

Abstract:Cavernous sinus thrombosis (CST) is a rare, yet severe condition often linked to infections in the nasal and facial areas. We present a case of a 43-year-old male farmer with diabetes who initially showed ear abscess symptoms that progressed to vision loss and CST-like symptoms. Self-treatment and an unidentified medication regimen may have worsened his condition. Advanced diagnostic evaluations, particularly magnetic resonance imaging with magnetic resonance venography, confirmed CST, likely originating from the ear infection spreading to the eyes, causing bilateral orbital cellulitis. Treatment with antibiotics, anticoagulants, and supportive therapy stabilized the patient's condition. This case emphasizes the importance of early detection and intervention in CST, especially in atypical presentations, and the need for comprehensive diagnostic and therapeutic approaches.

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