2021

An evaluation of the current assessment methods used within a district general NHS trust spasticity service (2021)

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Type of publication:Journal article

Author(s):*Fitzgerald, A. ; Pandyan, P.A.

Citation:Physiotherapy, December 2021. Vol 113, Supplement 1, p. E21-E22

Abstract:The management of spasticity in specialist clinic has not been evaluated objectively. One of the barriers to conducting an audit is the lack of a robust patient-centred assessment framework. The aim of this study was to audit the existing patient notes and from this develop a patient-centred assessment framework that provides objective data that can be used to audit the service.

Cerebrospinal fluid leak following a COVID-19 nasopharyngeal swab (2021)

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Type of publication:Journal article

Author(s):*Hill, Thomas ; *Sivapatham, Stefan; *Metcalfe, Christopher; *Tzortzis, Sevina

Citation:British Journal of Hospital Medicine (17508460); Nov 2022; vol. 82 (no. 11); p. 398-400

Abstract:The article describes the case of an adult who developed cerebrospinal fluid leak after taking a COVID-19 nasopharyngeal swab.

Successful diagnosis of gout with use of dual energy CT in a patient presenting with atypical symptoms and negative aspiration (2021)

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Type of publication:Conference abstract

Author(s):*Goel N.; *Amarasena R.

Citation:International Journal of Rheumatic Diseases; Sep 2021; vol. 24 ; p. 177

Abstract:A 42 year old Caucasian gentleman presents with acute left knee swelling, developed over 3 days without preceding trauma. He was referred to Trauma and Orthopaedics who aspirated the knee, finding no organisms or crystals. Following readmission 4 days later with the same complaint, re-aspiration again showed no crystals or organisms. MRI of the left knee showed femoral condyle oedema, initially suggesting Osteomyelitis, but on re-discussion with the radiologist seemed unlikely. The patient was started on Indomethacin and referred to Rheumatology. Despite having some symptomatic relief, he developed progressive swelling in the left calf, ankle and foot. Blood tests confirmed raised D-Dimer and rising CRP: 142 (ref range 0-5). Ultrasound Doppler of the left leg revealed no evidence of DVT, but did show pockets of fluid in the lower thigh, which were noted on previous MRI. X-rays of the knee and ankle did not show any pathological changes. Following Rheumatology review, it was postulated that he could have myofasciitis or infection. RF and CCP were found to be negative with normal complement levels and CK. Further MRI of the left leg showed progressive persistent oedema in the lateral femur. He was commenced on Intravenous flucloxacillin and diclofenac for suspected infection. Following 10 weeks of investigations and management, an MDT discussion opted for Dual Energy CT scan to look for evidence of gout. The Dual Energy CT scan showed extensive gout crystal deposition in the left knee, as well as affecting the popliteus tendon. He was commenced on Prednisolone, counselled on lifestyle factors and later started on Allopurinol that was up-titrated with bridging Colchicine, with excellent response. This case highlights the advances in Dual Energy CT scanning in helping to diagnose gout in those patients with atypical presentation and negative results on needle aspiration.

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The largest transcriptomic resource for radiotherapy-treated high-risk prostate cancer: paving the way for companion diagnostic biomarkers (2021)

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Type of publication:Conference abstract

Author(s):Thiruthaneeswaran N.; Bibby B.; Pereira R.; More E.; Hoskin P.; Bristow R.; Choudhury A.; West C.; Wylie J.; *Denley H.; Henry A.

Citation:Journal of Medical Imaging and Radiation Oncology; Sep 2021; vol. 65 ; p. 252

Abstract:Purpose: The Cancer Genome Atlas (TCGA) is a valuable resource for developing and validating gene signatures for personalising treatments. TCGA samples came from patients who received heterogeneous treatments-dominated by surgery. Improving the biological precision of radiotherapy is hampered by the lack of well annotated cohorts that reflect patient populations relevant for radiation oncologists. We aimed to generate transcriptomic data from needle core biopsies for a large multicentre cohort of high-risk prostate cancer patients and use the data to validate published gene signatures. Methods and materials: A total of 478 NCCN classified high-risk patients treated from 2008-2016 were identified: 244 patients received intensity modulated radiotherapy (IMRT) to the prostate only (BEDalpha/beta 1.5-3Gy of 120-180 Gy) and 234 patients received IMRT to the prostate and a high dose rate (HDR) brachytherapy boost (BEDalpha/beta 1.5-3Gy 159-265 Gy). Androgen deprivation was given to all patients for 3-36 months. Biochemical failure was defined as prostate-specific antigen (PSA) rise of >=2 ng/ml above nadir post-radiotherapy. The primary clinical end-point was 7-year biochemical relapse-free survival (bRFS). Gene expression data were generated from diagnostic needle core biopsies using Affymetrix Clariom S arrays. Two (28-gene and 32 gene) published hypoxia gene signatures and a tumour radiosensitivity index (RSI) were tested for prognostic significance [1-3]. Result(s): The median follow-up for the entire cohort was 6.3 years. Both the 28 gene (p = 0.021) and 32-gene (p = 0.033) hypoxia signatures were prognostic for 7-year bRFS. Non-prostate hypoxia signatures were not prognostic. The bRFS for radioresistant (RSI-R) vs radiosensitive (RSI-S) was prognostic in the IMRT EBRT only cohort (p = 0.01) and not in the HDR boost cohort (p = 0.8). Conclusion(s): We generated the largest high-risk prostate radiotherapy cohort with full gene expression data and showed its value in validating published gene signatures. The RSI signature should be explored further to select patients with high-risk prostate cancer who should benefit from dose escalation with a HDR brachytherapy boost. This resource will be a valuable asset for future research generating and validating signatures for personalising radiotherapy in men with prostate cancer.

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Onyx embolisation of a small bowel arteriovenous malformation prior to resection (2021)

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Type of publication:Conference abstract

Author(s):*Jones G.A.R.; *Hinwood D.; *McCloud J.; McCafferty I.

Citation:Colorectal Disease; Sep 2021; vol. 23 ; p. 126

Abstract:Small bowel arteriovenous malformation (AVM) is uncommon with an incidence of approximately 1:100,000. Nevertheless cases causing severe anaemia may necessitate surgery posing the dilemma for the surgeon at operation of exactly which portion of small bowel to resect. We present a case of a rare mid small bowel AVM definitively managed with highly selective mesenteric angiography and embolisation with Onyx immediately prior to surgical resection. Onyx is an injectable embolic fluid for which the main application is in the treatment of brain AVMs. To the authors' knowledge this is the first reported case of its use in small bowel AVM. Being black in colour Onyx demonstrates the location and extent of the abnormal bowel segment allowing preservation of normal small bowel. Secondly it reduces the blood flow in the abnormal segment reducing bleeding. A 24 year old man was referred with severe recurrent iron deficiency anaemia since childhood having required multiple blood transfusions and iron infusions. His diagnosis of mid small bowel AVM was made by capsule endoscopy showing small bowel varices and confirmed with CT angiography. On the day of the procedure at angiography the SMA was catheterised and selective injections confirmed the mid small bowel AVM. Micro catheters were then used to selectively enter jejunal branches and embolisation was performed with Onyx and micro-coils. The patient was transferred to theatre for laparotomy. Small bowel resection was performed transfixing all pedicles and stapled anastamosis. Four months post-operatively the patient has had no further problems with anaemia.

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Soft tissue extensor mechanism tendon ruptures of the knee (2021)

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Type of publication:Journal article

Author(s):Rhind J.-H.; *Lancaster P.; *Ahmed U.; *Carmont M.

Citation:British Journal of Hospital Medicine; Sep 2021; vol. 82 (no. 9); p. 1-9

Abstract:Ruptures of the extensor mechanism of the knee are serious injuries requiring prompt diagnosis and treatment. They can be divided into soft tissue and bony causes. Soft tissue tendon injuries can be either partial or complete. Rupture of the quadriceps tendon is an uncommon injury and is more frequent in patients over the age of 40 years. Patella tendon ruptures are even rarer and are more frequent in patients under the age of 40 years. Causes can be direct or indirect. Complete ruptures of the quadriceps tendon or patella tendon benefit from early surgical management, while partial ruptures may be managed non-operatively. This article gives an overview of the presentation, assessment and management of soft tissue extensor mechanism tendon ruptures for core surgical, acute care common stem and emergency medicine trainees.

Blood Cultures in Patients with Acute Covid-19 Pneumonitis: Contamination or Bacterial Co-Infection? (2021)

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Type of publication:Conference abstract

Author(s):*Nikhita Moudgil, *Afrah Riaz, *Annabel Makan *Emma-Jane Crawford, *Koottalai Srinivasan, *Nawaid Ahmad, *Harmesh Moudgil

Citation:Chest Infections, October 2021, Vol 160, Issue 4, Supplement, A546

Abstract:PURPOSE: INTRODUCTION: Research shows that 90% of blood cultures show no growth and a third of the remainder who test positive are identified as false positives [Garcia RA et al. Am J Infect Control 2015]. Although blood culture contamination rates of <1% are achievable, historical rates at <3% are industry accepted standards[Wayne PA. Clinical and laboratory Standards Institute (CLSI) document M47-A; 2007];contaminants from skin flora are the most common, but 20% are from microbes deep in the dermis layer which may be drawn into blood specimens. Evidence for early use of antibiotics managing patients with COVID19 pneumonitis is lacking but there are anecdotal concerns that more blood cultures than usual have identified organisms usually considered contaminants in sampling. Objectives were to quantify our local findings and relate these to outcome at discharge and during follow up.METHODS: Computer based retrospective review of 228 patients, mean age 71.8 (SD 8.7, range 29-87) years admitted at this hospital between March-May 2020 during the UK COVID-19 (SARS-Cov-2 RNA) peak and surge. Blood cultures reported here correspond to initial presentation with COVID-19 following a sepsis protocol. Comparative analysis by chi square (X2).RESULTS: 137/228 (60%) of patients had blood cultures at admission. 21/137 (15.3%) identified organisms from either one (n¼13) or both (n¼8) aerobic and anaerobic blood culture bottles. 12/21 (57.1%) (8 died) were identified as coagulase negative staphylococci (CoNS), traditionally considered contaminants at sampling; others included coagulase positive staph aureus (2), Klebsiella (2), E coli (2), and one each for Diptheroids, Proteus Miribalis and Aerococcus Viridans. The remaining 116 reported no growth from initial samples but 3 had positive results later in the admission (2 with CoNS, 1 with E Coli). 7/21 (33.3%) of those with any growth had died during the admission and this was proportionately similar to the 38/116 (32.8%) with no growth on blood cultures [X2 0.0027, p=.9588, not significant]. At 6 month follow up however, 15/21 (71.4%) of those who had positive findings on original cultures had died compared with 48/116 (41.4%) that had shown no growth [X2 6.4639, p=.0110, statistically significant].CONCLUSIONS: Although death rates during admission did not differ, comparing those with and without positive findings on initial blood cultures, a large percentage with positive initial findings then died during follow up. Despite several organisms traditionally considered contaminants, the higher (15.3%) reporting and potential false positive rates requires further study; this should address sampling errors but also revisit bacterial co-infection in COVID-19.CLINICAL IMPLICATIONS: Improving sampling for blood cultures, but research is also needed to make sure this is not a signal for underlying bacterial co-infection

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Improving understanding, care and management of tracheostomy and laryngectomy patients amongst Foundation Year (FY) doctors -A Quality Improvement Project (QIP) at a district general hospital (2021)

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Type of publication:
Poster presentation

Author(s):
*Samsul Islam, *Elaine France, *Nawaid Ahmad

Citation:
International Tracheostomy Symposium, September 2021

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