Staff Publication

Effectiveness of weight loss interventions in breast cancer survivors: a systematic review of reviews (2022)

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Type of publication:Systematic Review

Author(s):*Lake B; Damery S; Jolly K

Citation:BMJ Open, 2022 Oct 07; Vol. 12 (10), pp. e062288

Abstract:Background: Elevated body mass index (BMI) in breast cancer survivors (BCS) is associated with cancer recurrence and poorer treatment response. Guidelines recommend 5%-10% weight loss for overweight or obese BCS.Objectives: To assess effectiveness of lifestyle interventions for female BCS on weight loss, BMI, body composition, health-related quality of life (HRQoL), physical functioning, psychosocial measures, biomarkers.Design: Systematic review of reviews and meta-analyses.Setting: All clinical settings.Participants: Adult female BCS (active treatment or post-treatment).Methods: Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including Database of Abstracts of Reviews of Effects) were searched for systematic reviews published in English between 1990 and 2022, with weight, BMI or body fat as primary outcome. Narrative reviews, editorials, letters, conference abstracts were excluded. Review quality was assessed using the Joanna Briggs Institute quality assessment tool.Results: 17 reviews were included. Twelve reported significant reductions in one or more anthropometric outcomes: weight -1.36 kg (95% CI:-2.51 to -0.21) to -3.8 kg (95% CI: -5.6 to -1.9); BMI -0.89 kg/m 2 (95% CI: -0.15 to -0.28) to -3.59 kg/m 2 (95% CI: -6.29 to 0.89) or body fat -1.6% (95% CI: -2.31 to -0.88) to -2.6% (95% CI not reported). Significant reductions in two or more anthropometric outcomes were reported in 7/12 reviews, with effective interventions comprising aerobic exercise/aerobic exercise plus resistance training (n=5), or diet and exercise with or without counselling (n=2). Significant improvements were also reported for HRQoL (8/11 reviews), mental health (4/7) and physical functioning (2/3). Group interventions comprising aerobic exercise or aerobic exercise plus resistance training were most likely to improve outcomes.Conclusions: Lifestyle interventions can significantly improve outcomes for BCS. Multimodal interventions are likely to have the greatest impact in reducing weight, BMI and body fat. Further research must define the optimal combination, intensity and duration of effective interventions.

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Clinical outcomes after using patient specific instrumentation: is it worth the effort? A minimum 5-year retrospective review of 298 PSI knees (2023)

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Type of publication:Journal article

Author(s):Rammohan R; *Nugent L; Kasture S; Ganapathi M

Citation:Archives of Orthopaedic & Trauma Surgery, Jun 2023; 143(6): 3409-3422.

Abstract:Introduction: Use of patient specific instrumentation (PSI) for performing total knee arthroplasty (TKA) has been shown to improve component positioning but there is dearth of evidence regarding clinical outcomes. The aim of our study was to report patient satisfaction and functional outcome scores of patients who underwent PSI TKAs at minimum 5 year follow up.Methods: This is a retrospective study of a prospectively collected data of patients who underwent PSI TKAs between January 2012 and October 2015 under a single surgeon. Patient Reported Outcome Measures (PROMs), patient satisfaction questionnaires, surgeon directed 3D planning changes and intra-operative changes were collected and analysed.Results: The cohort included 298 consecutive PSI TKAs performed on 249 patients at a mean age of 71 years (range: 49-93 years). On an average 4 changes were made for each knee during 3D planning compared to preliminary plan. Intra-operative implant size change was required only in 3% (10 knees). The PROM scores were collected at a mean follow-up period of 6.8 years (range: 5.0-8.6 years) for 224 knees. Oxford Knee Score improved from median pre-operative score of 18 (IQR: 13-24) to median post-operative score of 44 (IQR: 40-47) with a median gain of 23 (IQR: 16-30). The median modified Forgotten Joint Score was 87.5 (IQR: 54.4-98.1). For the Beverland questionnaire, 75% (n = 166) reported being "Very Happy" and only 4% (n = 9/222) were 'Never Happy'.Conclusion: Excellent patient satisfaction and functional scores at mid-term can be achieve d using PSI technique to perform TKA with careful surgeon directed pre-operative planning.

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Unilateral Testicular Tuberculosis: An Extra-Pulmonary Manifestation (2021)

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Type of publication:Journal article

Author(s):*Al-Hashimi KA; Said UN

Citation:Cureus, 2021 Oct 19; Vol. 13 (10), pp. e18896

Abstract:The pathogenicity of Mycobacterium tuberculosis (M. tuberculosis) causes it to most commonly manifest within the respiratory system (pulmonary tuberculosis); however, 15% of cases undergo extra-pulmonary spread to various organs. Genitourinary tuberculosis (GUTB) is a rare form of tuberculosis infection which has a propensity to affect the genitourinary tract, primarily affecting the kidneys, epididymis, seminal vesicles and prostate; however, 0.5% of cases result in infection of the testicles. This may present unilaterally or bilaterally with varying atypical presentations, thus misleading physicians in diagnosis. We present a case in a 48-year-old patient admitted to the surgical assessment unit in our hospital presenting with a unilateral painful testicular lesion and scrotal changes. He was admitted nine weeks prior for unexplainable constitutional symptoms however presented again whilst awaiting follow up in an outpatient clinic. Ultrasound guidance and fine-needle aspiration & culture (FNAC) of the lesion resulted in a positive diagnosis for M. tuberculosis. He underwent anti-tuberculous chemotherapy treatment for six months as per clinical guidance with adequate clinical response.

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A Brief Clinical Study: The Use of a Custom Guide for Scapula Free Flap Harvest and Mandibular Reconstruction (2022)

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Type of publication:Journal article

Author(s):*Chundoo S; *Naredla P; *Thomas S

Citation:Journal of Craniofacial Surgery, 2022 Oct 01; Vol. 33 (7), pp. 2142-2145.

Abstract:Head and neck cancer can leave patients with significant defects requiring major reconstruction. The scapula free flap remains a relatively underused flap choice. This article examines the novel use of a custom guide for a scapula free flap in mandibular reconstruction following resection. A case file was created involving a consultant surgeon, KLS advisor, and technical team based in Belgium. A computed tomography scan of the mandible was sent electronically to render a 3-dimensional model. Custom cutting guides for resection and scapula graft harvest were fabricated. A custom plate for fixation was also developed. The scapula free flap was successfully placed using custom guides. In this case, the use of a custom guide enabled easier harvest, manipulation, and handling of the scapula free flap into the defect. The use of new technology and computer-generated guides represents a considerable shift forward into improving precision in complex surgical procedures and reducing intraoperative time. The use of a custom guide can provide an easier means to handle and manipulate one of the largest free flaps in surgery, the scapula free flap.

Systematic Review of Focal and Salvage Cryotherapy for Prostate Cancer (2022)

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Type of publication:Systematic Review

Author(s):Chin YF; *Lynn N

Citation:Cureus, 2022 Jun 28; Vol. 14 (6), pp. e26400

Abstract:Cryotherapy is one of the recognised ablative modalities for both primary and salvage therapy for prostate cancer. It presents an alternative, less invasive treatment for an organ-confined disease, improved preservation of surrounding tissue and a more suitable option for patients who are unfit for radical prostatectomy. Nevertheless, the currently available literature is relatively too scarce to provide definite conclusions regarding the treatment outcomes in cryotherapy. The present study aimed to review current oncological and survival outcomes in cryotherapy for primary and recurrent prostate cancer. Furthermore, this study aimed to establish the complications and functional outcomes of cryotherapy for prostate cancer. A literature search was performed on the PubMed, Cochrane and Google Scholar databases. Current guidelines and recommendations from the European Association of Urology were also reviewed. The search keywords used included 'Cryotherapy, Prostate Cancer', 'Cryoablation, Prostate Cancer' and 'Cryosurgery, Focal Prostate Cancer'. Truncations and Boolean operators were used with the keywords. All relevant studies from after 2015, including abstracts and non-English research assessing oncological and functional outcomes and complications, were included. Twenty-six studies consisting of 11,228 patients were reviewed. Fifteen studies assessed the outcomes of primary cryotherapy, whereas 11 studies reported the outcomes in salvage therapy. The patient's age ranged 55-85 years, and the pre-procedural prostate-specific antigen (PSA) ranged 0.01-49.33 ng/mL. A total of 2031 patients were classified to be at low risk, 2,995 were at moderate risk and 253 were at high risk on the D'Amico prostate cancer risk classification system. Follow-ups ranged from 9.0 to 297.6 months. The disease-specific survival rate was 65.5%-100.0%, overall survival was 61.3%-99.1%, the PSA nadir was 0.01-2.63 ng/mL and the overall biochemical recurrence rate was 15.4%-62.0%. The complications included erectile dysfunction (3.7%-88.0%), urinary retention (2.13%-25.30%) and bladder neck stricture/stenosis (3.0%-16.7%). The functional assessment showed a mixture of improved, unchanged or worsened post-procedural outcomes in primary therapy. This systematic review did not find significant differences in the cancer-specific, overall and biochemical-free survival rate between the primary and salvage cryotherapy cohorts. The most common complications encountered in both cohorts were erectile dysfunction, urinary incontinence, lower urinary tract/bladder neck stricture and infection. More prospective and double-arm studies are critically needed to provide guidance on the careful selection of patient cohorts for cryotherapy, whether for curative or salvage intent.

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Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study (2022)

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Type of publication:Journal article

Author(s):Mullins E; Perry A; Banerjee J; Townson J; Grozeva D; Milton R; Kirby N; Playle R; Bourne T; Lees C; PAN-COVID Investigators (including *Millward, H.)

Citation:European Journal of Obstetrics, Gynecology, and Reproductive Biology, 2022 Sep; Vol. 276, pp. 161-167.

Abstract:Objective: To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection.Methods: Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant.Results: Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2.Conclusions: Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.

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Sex differences in patients' recovery following an acute Achilles tendon rupture - a large cohort study (2022)

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Type of publication:
Journal article

Author(s):
Larsson, Elin; Brorsson, Annelie; Carling, Malin; Johansson, Christer; *Carmont, Michael R; Nilsson Helander, Katarina

Citation:
BMC Musculoskeletal Disorders, October 2022, 23(1): 913-913.

Abstract:
Introduction: The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders. Aims: The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients. Methods: Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men. Results: A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS. Conclusion: To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.

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Retrograde tibiotalocalcaneal nailing for the treatment of acute ankle fractures in the elderly: a systematic review and meta-analysis (2022)

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Type of publication:Systematic Review

Author(s):Lu V.; Tennyson M.; Zhou A.; *Patel R.; Fortune M.D.; Thahir A.; Krkovic M.

Citation:EFORT Open Reviews. 7(9) (pp 628-643), 2022. Date of Publication: 2022.

Abstract:Introduction: Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures. Methods: A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893). Results: A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06-0.16), deep infection 8% (95% CI: 0.06-0.11), implant failure 11% (95% CI: 0.07-0.15), malunion 11% (95% CI: 0.06-0.18), and all-cause mortality 27% (95% CI: 0.20-0.34). The pooled mean post-operative Olerud-Molander ankle score was 54.07 (95% CI: 48.98-59.16). Egger's test (P = 0.56) showed no significant publication bias. *Conclusion(s): TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.

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Recurrence of a second trimester fundal uterine rupture at the old scar site: A case report (2022)

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Type of publication:Journal article

Author(s):*Panesar H.; *Patel R.; Dhaliwal H.

Citation:Radiology Case Reports. 17(11) (pp 4445-4448), 2022. Date of Publication: November 2022.

Abstract:Uterine rupture is a rare life-threatening complication. It can occur in all 3 trimesters with the first and the second being a rarity. It mainly occurs in the third trimester or during labor in a previously scarred uterus. It is rare in an unscarred uterus. The risk fold is further enhanced by the induction and augmentation with prostaglandins and oxytocin. The clinical diagnosis at this early gestation can be a dilemma to the attending physician as in this case. (1) The patient was a holidaymaker with no documented evidence of a dating scan to suggest any evidence of an ovarian/placental pathology at that stage. (2) The ultrasound findings in our department did suggest a viable intrauterine pregnancy with free fluid within both the adnexa. A 6 cm solid homogenous mass in the midline/right adnexa suggested an ovarian torsion or bowel pathology. The differentials in this particular case were that of a ruptured hemorrhagic cyst, ovarian torsion and even a heterotrophic pregnancy as there had been a few documented cases in the department. Ultrasound diagnosis of an intrauterine pregnancy together with a fluid collection does not suggest by any means that the uterus is intact or there is no ectopic pregnancy.

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Airway management, intensive care requirement, and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study (2022)

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Type of publication:Journal article

Author(s):Exley R.; Logan G.; Kent S.; McDonald C.; Hennedige A.; Henry A.; Dawoud B.; Kulkarni R.; Kyzas P.; Morrison R.; McCaul J.; Brandsma D.S.; Cashman H.; Swain A.; Java K.; Vithlani G.; Watson M.; Christopher M.; Murray S.; Baniulyte G.; Grant J.; Wareing S.; Kawalec A.; Ng T.; Reedy N.; Tavakoli M.; Underwood C.; Gowrishankar S.; Collins T.; Davies R.; Uppal S.; Elledge R.; Shaheen S.; O'Connor R.; King H.; Tudor-Green B.; Garg M.; Wareing J.; Wicks C.; Mitchell O.; Maarouf M.; Chohan P.; *Otukoya R.; Wu E.; Farooq S.; Brewer E.; King S.; Nandra B.; Stevenson S.; Stiles E.; Davies L.; Madattigowda R.; Mohindra A.; Gilbert K.; Young D.

Citation:British Journal of Oral and Maxillofacial Surgery, 2022 Nov; Vol. 60 (9), pp. 1228-1233.

Abstract:Cervicofacial infection (CFI) is a frequently encountered presentation to Oral and Maxillofacial Departments (OMFS). The United Kingdom has recently seen cessation of all routine community dental treatment due to the Coronavirus (COVID-19) pandemic and consequently an initial modification of treatment received in secondary care. Subsequent airway difficulties and the need for level 2 High Dependency Unit (HDU) or level 3 Intensive Care Unit (ICU) is a concern to surgeons and anaesthetists alike. The availability of skilled staff and appropriate facilities can be variable. It is imperative to understand the resource implications of CFI with respect to airway management and critical care utilisation. Adequate provision is fundamental for optimal care. A national, multicentre, trainee-led audit was carried out across 17 hospitals in the UK from May to September 2017. Information recorded included demographic features, presentation, airway management, medical and surgical treatment, and steroid administration. One thousand and two presentations (1002) were recorded. Forty-five percent were female, with a mean (range) age of 37.5 years (0-94). Regarding surgical airway management, 63.4% had a standard intubation (oral 42%, nasal 21.4%). Awake fibreoptic intubation (AFOI) was performed in 28% and surgical airway required in 0.9%. Impending airway compromise at the time of presentation was 1.7%. Following surgical incision and drainage, 96.1% of patients returned to a general ward, 2.7% to Level 3, and 1.1% to Level 2 care. The return to theatre was 2.8%, and 0.7% required reintubation. There was an association between corticosteroid administration and duration of intubation. Those who received steroids were more likely to remain intubated postoperatively (p = 0.006), require a higher level of postoperative care (p < 0.001), and require a return to theatre (p = 0.019). Postoperatively, patients who received steroids were less likely to be extubated at the close of the procedure. Intubated patients who received multiple steroid doses postoperatively were extubated with less frequency those that received a single dose. To our knowledge, this dataset is the largest ever recorded for CFI. Our results showed a high requirement for advanced airway management in this cohort. The requirement for surgical airway was low, but the significance of this situation should not be underestimated. The relatively frequent need for care at levels 2 or 3 within this cohort also placed a significant demand on already overburdened resources. Knowledge of care requirements for these patients will inform resource planning.