Type of publication:
Journal article
Author(s):
Silva S.; Amarasena R.; Rajakulenthiran T.; Singh R.; *Moorcroft J.
Citation:
Clinical medicine (London, England); Mar 2020; vol. 20, p. S57
Abstract:
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Staff Publication
Thyrotoxicosis and the consumption of bovine thyroid tissue (2021)
Type of publication:
Journal article
Author(s):
S Senthilkumaran, *F Benita, P Thirumalaikolundusubramanian, K Swaminathan
Citation:
QJM : monthly journal of the Association of Physicians; Jul 2021; vol. 114 (no. 4); p. 253-254
Abstract:
Thyrotoxicosis due to consumption of bovine thyroid tissue is called hamburger thyroiditis. Despite bovine meat consumption in India and Asia, it is surprising to note that very few thyrotoxicosis from food contamination has been reported from Asia. We report a case of exogenous thyrotoxicosis due to bovine thyroid tissue consumption probably for the first time from Asia, to create an awareness of this entity among physicians and practitioners and others to consider this entity while handling patients with features of thyrotoxicosis of recent onset.
DRESS syndrome: an important differential for eosinophilia with systemic organ dysfunction (2020)
Type of publication:
Journal article
Author(s):
*Whoasif Mukit, *Richard Cooper, *Harmesh Moudgil, *Nawaid Ahmad
Citation:
BMJ Case Reports, 2020 Vol. 13(5)
Abstract:
Drug rash occurring with eosinophilia and systemic symptoms syndrome is a potentially fatal adverse drug reaction that requires immediate action in order to minimise patient harm. Initially implicated with the use of anticonvulsants, it has also been shown to be caused by many other medications but less frequently with vancomycin. Patients typically present with fever, lymphadenopathy, eosinophilia and systemic organ dysfunction. Diagnosis is aided using probability calculators such as RegiSCAR (Registry of Severe Cutaneous Adverse Reaction), as well as clinical response on removing the responsible medication. Here, we present a case without any systemic organ dysfunction that improved with withdrawal of the offending drug vancomycin.
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Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection (2020)
Type of publication:
Journal article
Author(s):
*Po Fung Wong, *Sam Craik, *Piers Newman, *Annabel Makan, *Koottalai Srinivasan, *Emma Crawford, *Devapriya Dev, *Harmesh Moudgil and *Nawaid Ahmad
Citation:
Clinical Medicine 2020 Vol 20, No 3, p. 293-294
Abstract:
A 40-year-old man developed acute brainstem dysfunction 3 days after hospital admission with symptoms of the novel SARS-CoV-2 infection (COVID-19). Magnetic resonance imaging showed changes in keeping with inflammation of the brainstem and the upper cervical cord, leading to a diagnosis of rhombencephalitis. No other cause explained the patient’s abnormal neurological findings. He was managed conservatively with rapid spontaneous improvement in some of his neurological signs and was discharged home with continued neurology follow up.
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Point-of-care lung ultrasound in patients with COVID-19 - a narrative review (2020)
Type of publication:
Journal article
Author(s):
Smith, M J; Hayward, S A; Innes, S M; *Miller, A S C 
Citation:
Anaesthesia; Aug 2020, vol. 75 (no. 8); p. 1096-1104
Abstract:
Ultrasound imaging of the lung and associated tissues may play an important role in the management of patients with COVID-19-associated lung injury. Compared with other monitoring modalities, such as auscultation or radiographic imaging, we argue lung ultrasound has high diagnostic accuracy, is ergonomically favourable and has fewer infection control implications. By informing the initiation, escalation, titration and weaning of respiratory support, lung ultrasound can be integrated into COVID-19 care pathways for patients with respiratory failure. Given the unprecedented pressure on healthcare services currently, supporting and educating clinicians is a key enabler of the wider implementation of lung ultrasound. This narrative review provides a summary of evidence and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID-19-associated lung injury. Mechanisms by which the potential lung ultrasound workforce can be deployed are explored, including a pragmatic approach to training, governance, imaging, interpretation of images and implementation of lung ultrasound into routine clinical practice.
Link to full-text [NHS OpenAthens account required]
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Adult cavernous haemangioma of the vocal cords with a unique presentation of acute respiratory distress: a case report (2020)
Type of publication:
Journal article
Author(s):
*Rafie, A; Jolly, K; Darr, A; *Thompson, S
Citation:
Annals of the Royal College of Surgeons of England; Sep 2020; vol. 102 (no. 7); p. e152
Abstract:
Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition – with this being the only published adult case presenting with acute respiratory distress – the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis – and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15 mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.
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Comprehensive geriatric assessment in the emergency department (2020)
Type of publication:
Journal article
Author(s):
*Harding, Siobhan
Citation:
Age & Ageing; Nov 2020; vol. 49 (no. 6); p. 936-938
Abstract:
Completing comprehensive geriatric assessments (CGA) for frail patients admitted to acute hospitals has well-established benefits and is advocated by national guidelines. There is high-quality evidence demonstrating an association between inpatient CGAs and the patient being alive and community-dwelling at 12-month follow-up. However, less well-known is the effectiveness of CGAs conducted within the emergency department (ED), with the primary purpose of facilitating admission avoidance, on reducing 30-day reattendance or readmission. This commentary provides an overview of five studies that measure the impact of conducting an ED-CGA on subsequent secondary care attendance. Two randomised-controlled trials, one case-matched cohort study and two quasi-experimental pre- and post-intervention studies were reviewed. The studies reported variable success in preventing subsequent secondary care use. No studies meeting the criteria had been conducted within the UK, affecting generalisability of the findings. There is no clear evidence that conducting a CGA within ED reduced reattendances or admissions 30 days post-discharge. The existing evidence base is methodologically and clinically heterogeneous and is vulnerable to multiple sources of bias. Further research is needed to understand whether screening to identify target populations or whether increased intensity of interventions delivered improves outcomes. ED-CGA may not have a beneficial effect on cost improvement or service delivery metrics, but it may have positive outcomes that are of high importance to the patients. This warrants further study.
No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture (2020)
Type of publication:
Journal article
Author(s):
*Carmont, Michael R; Zellers, Jennifer A; Brorsson, Annelie; Silbernagel, Karin Grävare; Karlsson, Jón; Nilsson-Helander, Katarina
Citation:
Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA; May 2020; vol. 28 (no. 5); p. 1587-1594
Abstract:
PURPOSE This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients.
METHODS Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation.
RESULTS Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: – 6.9° (5.5), acute: – 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury.
CONCLUSIONS Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair. LEVEL OF EVIDENCE III.
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'You have got a foreign body in there': Renal transplantation, unexpected mild-to-moderate distress and patients' support needs: A qualitative study (2020)
Type of publication:
Journal article
Author(s):
Jones J.; Damery S.; Combes G.; Allen K.; *Nicholas J. ; Baharani J.
Citation:
BMJ Open; Mar 2020; vol. 10 (no. 3)
Abstract:
Objective: To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need.
Design: Qualitative study using individual in-depth interviews. Setting Four National Health Service (NHS) Trusts in the Midlands, UK. Participants Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. Main outcome measures Identification of the reasons for distress and support options acceptable to renal transplant patients.
Results: Three themes were interpreted from the data: I am living with a "foreign body" inside me', why am I distressed?' and different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist.
Conclusions: Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
Link to full-text [open access - no password required]
Improving our departmental reporting of thyroid cytology specimens against national guidelines: a two-cycle retrospective audit (2020)
Type of publication:
Journal article
Author(s):
*Halliday E.; *Ahsan S.F.; *Harrison E.; *Harrison K.; *Sansom H.
Citation:
Cytopathology : official journal of the British Society for Clinical Cytology; November 2020, Volume31, Issue6, Pages 514-524
Abstract:
OBJECTIVE: In the United Kingdom, guidelines from the Royal College of Pathologists (RCPath) facilitate consistent and reproducible reporting and classification of fine needle aspiration cytology (FNAC) thyroid specimens. The aim was to audit our department against RCPath guidelines to refine and improve our reporting process.
METHOD(S): Two-cycle retrospective observational audit of all patients undergoing thyroid FNAC over a two-year period (one year for each cycle). Final histology was correlated. The positive predictive value (PPV) for malignant neoplastic lesions was calculated; for Thy1, Thy1c, Thy2 and Thy2c all cases without final histology were assumed to be benign, while for Thy3a, Thy3f, Thy4 and Thy5 samples the PPV calculation was based only on those cytology samples with corresponding histology. 'False positive' and 'false negative' cases were reviewed.
RESULT(S): 288 cytology samples were included in the first cycle; 96 (33.3%) had corresponding histology. 287 samples were included in the second cycle; 119 (41.5%) had follow-up histology. The rate of non-diagnostic samples (Thy1/1c) decreased from 39.6% to 30.0%. The PPV for malignant neoplastic lesions was Thy1/1c 2.6%, Thy2/2c 0.0%, Thy3a 40.0%, Thy3f 19.4%, Thy4 75.0%, Thy5 100.0% (first cycle); Thy1/1c 4.7%, Thy2/2c 0.7%, Thy3a 13.3%, Thy3f, 7.7%, Thy4, 50.0%, Thy5 100.0% (second cycle).
CONCLUSION(S): Our department was able to reduce the rate of non-diagnostic FNAC samples and improve the diagnostic accuracy of FNAC. Auditing local outcomes helps refine and improve the reporting process. Review of 'false positive' and 'false negative' cases helps examine potential pitfalls of cytology.