Staff Publication

Assessing opinion on lower LDL-cholesterol lowering, and the role of newer lipid-reducing treatment options (2023)

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Type of publication:
Journal article

Author(s):
Connolly, Derek L; Zaman, Azfar; *Capps, Nigel E; Bain, Steve C; Fernando, Kevin.

Citation:
British Journal of Cardiology. 30(2):14, 2023.

Abstract:
While statins are the gold standard for lipid-lowering therapies, newer therapies, such as PCSK9 inhibitors, have also demonstrated low-density lipoprotein cholesterol (LDL-C) reduction, but with a similar or better
safety profile. Conflicting guidance has contributed to a low uptake. More up-to-date, evidence-led guidance supports greater use of newer therapies, particularly in combination with statins, to reduce LDL-C to levels shown to be effective in trials. The aim of this study was to determine how such guidance can be implemented more effectively in the UK. Using a modified Delphi approach, a panel of healthcare professionals with an interest in the management of dyslipidaemia developed 27 statements across four key themes. These were used to form an online survey that was distributed to healthcare professionals working in cardiovascular care across the UK. Stopping criteria included 100 responses received, a seven-month window for response (September 2021 to March 2022), and 90% of statements passing the predefined consensus threshold of 75%. A total of 109 responses were analysed with 23 statements achieving consensus (four statements <75%). Variance was observed across respondent role, and by UK region. From the high degree of consensus, seven recommendations were established as to how evidence-based guidance can be delivered, including a call for personalised therapy strategies and simplification of LDL-C goals, which should be achieved within as short a time as possible.

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Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study (2024)

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Type of publication:
Journal article

Author(s):
Abouelazayem, Mohamed; Jain, Rajesh; Wilson, Michael S J; Martinino, Alessandro; Balasubaramaniam, Vignesh; Biffl, Walter; Coccolini, Federico; *Riera, Manel; Wadhawan, Himanshu; Wazir, Ishaan; Abderaouf, Bettahar; Abramov, Daniil; Abu Jayyab, Mustafa A; Al-Shami, Khayry; Alfarwan, Ahmad; Alhajami, Faris M; Alkaseek, Akram; Alozairi, Ous; Ammar, Ahmed Siddique; Atar, Burak; Baatarjav, Gan-Erdene; Bains, Lovenish; Bakri, Ashraf; Bayramov, Nuru; Bhojwani, Rajesh; Brachini, Gioia; Calini, Giacomo; Campanelli, Michela; Cheng, Shi Yu; Choudhary, Charan Singh; Chowdhury, Sharfuddin; Colak, Elif; Das, Jayanta Kumar; Dawani, Surrendar; Donmez, Turgut; Elzayat, Ibrahim; Erdene, Sarnai; Faizi, Tashaba Qaiser; Frountzas, Maximos; Gafsi, Besma; Gentileschi, Paolo; Guler, Mert; Gupta, Gaurav; Harkati, Nour Elhouda; Harris, Matthew; Hasan, Doaa M; Irowa, Omorodion Omoruyi; Jafferi, Salman; Jain, Sumita Agarwal; Jun Han, Lai; Kandiboyina, Satyanarayana Murthy; Karabulut, Mehmetu; Khamees, Almu'atasim; Khan, Shahzeb; Khan, Madiha Masood; Khaw, Cheng Jing; Kisielewski, Michal; Klib, Mohamad; Kosir, Jurij A; Krawczyk, Wiktor Jan; Lisi, Giorgio; Makama, Jerry Godfrey; Maqbool, Baila; Marques, Claudia Neves; Meric, Serhat; Mietla, Mateusz Przemyslaw; Ads, Alaa Mohamed; Muhumuza, Joshua; Mulita, Francesk; Mustafayeva, Matanat; Omar, Mohammed A; Omarov, Taryel; Pathak, Akshant Anil; Paul, Ratnadeep; Pavone, Giovanna; Podda, Mauro; Raja Ram, Novinth Kumar; Rauf, Fatima; Rauf, Sidra; Safy, Ahmed Mohamed; Sandag, Erdene; Sanli, Ahmet Necati; Siddiqui, Adeela Z; Sotiropoulou, Maria; Talib, Vikash; Tatar, Cihad; Thota, Anuroop; Tokocin, Merve; Tolat, Aditya; Uchikov, Petar Angelov; Valenzuela, Jose I; Venkatappa, Sunil Kumar; Verras, Georgios-Ioannis; Vlahovic, Ivan; Zreeg, Dafer Abdulhakim S; Cardoso, Victor Roth; Gkoutos, Georgios V; Singhal, Rishi; Mahawar, Kamal.

Citation:
Surgical Endoscopy. 2024 Jun 17.

Abstract:
BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients
undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (>= 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (<= 50 and > 50 years) and time from onset of symptoms to hospital presentation (<= 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS: 1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female
gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI
2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Five historical innovations that have shaped modern otolaryngological surgery (2024)

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Type of publication:
Journal article

Author(s):
*Patel R; Acharya R; *Shah S; Desai C; Raveshia D; *Panesar H; Patel N; Mcconaghie G; Cain DC; *Parmar D; Banerjee R; Singh R

Citation:
Journal of Perioperative Practice. 17504589241244996, 2024 Jun 03.

Abstract:
Throughout history, many innovations have contributed to the development of modern otolaryngological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern otolaryngological surgery: Operative Microscope, Hopkins Rigid Endoscope, Laryngeal Nerve monitoring, Cochlear implants and Laser surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of otolaryngological surgery and their ongoing relevance in contemporary and perioperative practice.

A Systemic Review of Primary Malignant Long Bone Tumors in Children and Adolescents (2024)

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Type of publication:
Systematic Review

Author(s):
Khan, M; *Patel, R; *Youssef, M; Banerjee, R; Pardiwala, A; Belen, C.

Citation:
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(2):77-87, 2024.

Abstract:
PURPOSE OF THE STUDY: Managing bone tumours is complex, relying on limited evidence, expert opinions, and retrospective reviews. Multidisciplinary approaches and early diagnosis are crucial for better outcomes, especially in young patients with growing skeletons. The aim of this systemic review and meta-analysis is to give a comprehensive review of common malignant tumors affecting long bones in children and adolescents. MATERIAL AND METHODS: A PubMed/Medline search for "primary malignant long bone tumours in children" initially retrieved 1120 papers, which were subsequently narrowed down to 110 articles based on inclusion and exclusion criteria. These articles were reviewed, focusing on clinical presentation, diagnostic workup, treatment options, surgical planning, and variations in presentation, including rare tumours. The two most commonly reported tumours were osteosarcoma and Ewing sarcoma, leading to the division of studies into five groups. The inclusion criteria encompassed malignancies in patients aged 2-25 years, work-up, imaging, surgical treatment, rare tumour case reports, and surgical management principles, resulting in a heterogeneous group of articles. To enhance categorisation, it was clarified that studies with 10 or more cases were considered retrospective reviews. RESULTS: Reviewing of results thus demonstrate that the two likely tumours in children under consideration were osteosarcoma and Ewing sarcoma. Their presentation findings and clinical features were discussed in detail in the review. It is worth noting here that in case of differential diagnosis this should be the first on the list. DISCUSSION AND CONCLUSIONS: Although focus of literature is more on the two most common tumours. However, rare tumours should be considered as they can mimic these common tumors.

Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: a Systematic Review and Meta-Analysis of Randomised Control Trials of the Efficacy on Pain, Functional Disability, and the Occurrence of Adverse Events (2024)

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Type of publication:
Systematic Review

Author(s):
*Patel, R; Orfanos, G; Gibson, W; Banks, T; McConaghie, G; Banerjee, R.

Citation:
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(2):109-119, 2024.

Abstract:
PURPOSE OF THE STUDY: Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis. MATERIAL AND METHODS: We conducted a comprehensive search across PubMed, Google Scholar, and the Cochrane Library for randomised trials investigating the effectiveness of high molecular weight hyaluronic acid (HMWHA) in the treatment of hip osteoarthritis. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. To synthesise the data, we utilised the Standardised Mean Difference (SMD) for assessing pain relief through the Visual Analogue Scale (VAS) and the Lequesne index (LI) for evaluating functional outcomes. Risk Ratio (RR) was calculated to assess the occurrence of complications. RESULTS: A total of four studies involving HMWHA and control groups were included. The standardised mean difference (SMD) for the Visual Analogue Scale (VAS) (SMD -0.056; 95% CI; -0.351, 0.239; p = 0.709) and the Lequesne index (SMD -0.114; 95% CI; -0.524, 0.296; p = 0.585) were not statistically significant. Analysis for complications demonstrated an overall relative risk ratio (RR) of 0.879 (95% CI; 0.527, 1.466; p = 0.622), and was not statistically significant. DISCUSSION AND CONCLUSIONS: Intra-articular HMWHA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there is no significant difference between HMWHA, or saline, or other therapeutic treatments. Currently, available evidence indicates that intra-articular HMWHA in hip OA would not increase the risk of adverse events.

Re-induction of intravenous ustekinumab to maintain drug persistence. A UK experience (2024)

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Type of publication:
Conference abstract

Author(s):
*Muir J.; *Hazir Y.; *Butterworth J.

Citation:
Journal of Crohn's and Colitis. Conference: 19th Congress of the European Crohn's and Colitis Organisation, ECCO 2024. Stockholm Sweden. 18(Supplement 1) (pp i1034), 2024. Date of Publication: January 2024.

Abstract:
Background: In this study we seek to add to the body of knowledge on the practical use of ustekinumab in patients with Crohns and Colitis. Patients commencing ustekinumab will mostly have failed, or are intolerant to, conventional biologic agents and therefore have a limited number of medical options available to manage their disease. Results from the IM-UNITI long-term extension study have shown that a proportion of patients will lose response to maintenance dose therapy, and a small number of studies have suggested that repeated induction doses of this therapy can prolong its effective use and allow patients a greater period of disease free remission. Shrewsbury and Telford hospital NHS trust is a multi-site UK hospital serving a large population in the west-midlands region which has established the routine use of usetkinumab therapy over 5 years ago and by reviewing data on our patient cohort we aimed to identify characteristics amongst patients who have required reinduction doses and how effective they have been in maintaining remission. Method(s): In this retrospective, interventional study two researchers gathered data including baseline characteristics, disease type and distribution, previous surgical and medical therapies and time from diagnosis on all patients who had received ustekinumab therapy over the past five years. We used biochemical and endoscopic data, as well as clinical records, to determine the efficacy of ustekinumab on the disease course. We identified the subgroup of patients requiring reinduction doses and noted whether this was a successful intervention and sought to describe similarities which could help identify patients at risk of failing maintenance therapy in future. Result(s): Data from 213 patients was gathered (Crohns: 150, UC: 61, IBDU: 2) and of which 87 (Crohns: 63, UC: 24) received reinduction doses. Average time to reinduction from therapy commencement was 19.5 months (Crohns) and 16.3 months (UC) respectively. Of the reinduction group 63% showed improvement in their disease control and a variety of characteristics were noted amongst the successful patients for discussion including disease location, presence of perianal disease and time from diagnosis. Conclusion(s): Ustekinumab reinduction is an important area for further research as it allows patients to prolong their successful therapy and delay the need for surgical intervention for difficult to manage disease. This study suggests characteristics which could inform further trials and establish protocols to aid clinicians when making decisions about switching biologic therapies.

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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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