2023

A case of disseminated herpes zoster in an immunocompetent child (2023)

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Type of publication:
Conference abstract

Author(s):
*Jacob M.A.; *Kelly S.

Citation:
British Journal of Dermatology. Conference: 103rd Annual Meeting of the British Association of Dermatologists. Liverpool United Kingdom. 188(Supplement 4) (pp iv156-iv157), 2023. Date of Publication: June 2023

Abstract:
Herpes zoster (HZ) caused by the reactivation of varicella-zoster virus (VZV) affects mainly the adult population. The incidence is low in children (0.45 cases per 1000 individuals annually), especially in the immunocompetent. It is said to be disseminated when there are >20 lesions outside the primary and adjacent affected dermatome. We present this case to highlight a rare complication of cutaneous dissemination in a previously healthy child with HZ, following in utero exposure to varicella at 28 weeks' gestation. A 15-year-old boy presented with painful blisters in the T2 dermatome of 1 week's duration, which later spread to trunk, extremities and face. This was associated with fever and neuralgia. There was no previous history of varicella and no recent contact history. He had no significant past medical history and was not on any medications. Antenatal history revealed that his mother had varicella at 28 weeks' gestation and was treated with aciclovir. He was febrile on admission (39degreeC). There were coalesced vesiculopustules and crusted lesions with marked perilesional erythema in the T2 dermatome. In addition, disseminated vesicular lesions were seen on the trunk, extremities and face. Remaining systemic examination was unremarkable. C-reactive protein was elevated. Complete blood count and renal function tests were normal. Liver function tests, namely alanine transaminase and 7gamma;-glutamyl transferase were elevated. Blood culture showed no growth. Varicella-zoster IgG was positive. Viral swab (polymerase chain reaction) from the skin lesions was positive for varicella-zoster DNA. Infectious serology for HIV, hepatitis B and hepatitis C was negative. Antinuclear antibody and antineutrophil cytoplasmic antibodies were negative. A clinical diagnosis of HZ with cutaneous dissemination was made, and he was treated with intravenous aciclovir. Intravenous antibiotics were added for suspected secondary bacterial infection. Disseminated zoster is less common in children and mainly occurs in patients with underlying immunodeficiency like HIV, immunosuppressive drug use or malignancy. In immunocompetent children, this can happen when primary infection (varicella) has occurred in utero or the first year of life due to the low response in specific varicella-zoster virus immunity. Complications like cutaneous dissemination due to viraemia are rare in healthy children, but can affect 2-10% of immunocompromised patients. It occurs 3-4 days after the onset of dermatomal lesions. It is important to look for other complications, especially in the immunocompromised, as viraemia can affect the brain, kidneys, lung and liver. Sequelae like postherpetic neuralgia is rare, but it is important to follow-up these children to look for its development.

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Supracondylar elbow fracture management (Supra Man) a national trainee collaborative evaluation of practice (2023)

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Type of publication:
Journal article

Author(s):
Barrie A.; Kent B.; Jones R.; Hutton C.; Jones M.; Berry A.; Marusza C.; Reynolds P.; A'Court J.; Lum J.; Flannery O.; Knapper T.; Dela Cruz N.; Flaherty D.; Raza M.; Godavitarne C.; Ho S.; Brunt A.; Hardie J.; Taha A.; Kazzaz S.; Sri A.; Logishetty K.; Shah G.; Woods S.; Barwell J.; Marhoon Z.; Qaiyum T.; Punwar S.; Liew I.; Rooney A.; Watts D.; Kabwama S.; Townson A.; Baskaran D.; Vernon O.; Bryson D.; Stringfellow T.; Buddhdev P.; Gacaferi H.; Bretherton C.; Jordan S.; Thiruchandran G.; Mustafa Q.; Morcos Z.; Peters K.; Wilson C.; Dupley L.; Thomas A.; *Kabariti R.; Khaleeq T.; Davoudi K.; Cox I.; Cuthbert R.; Berber O.; Javed O.; Hafez A.; Garg V.; Kumar S.; O'Calloghan J.; Stanier P.; Bhalerao B.; Lokanathan S.; Sinnerton R.; Davies P.; John A.; Sreenivasan S.; Ferns J.; Bawa A.; Mattar A.; Gulihar A.; Yates J.; Al-Faqih M.; Kennedy J.; Baxter I.; Gilmore C.; Crone A.; McAlinden G.; Al-Sukaini A.; Syed S.; Tiwari I.R.; Black P.; Kang H.W.; Napier R.; Ferguson D.; Lim R.; Dott C.;

Citation:
Bone and Joint Journal. 105 B(1) (pp 82-87), 2023. Date of Publication: January 2023.

Abstract:
Aims: Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. this national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. Methods: this study was led by the south West Orthopaedic research division (sWOrd) and performed by the supra Man Collaborative. displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (redCap). Results: A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.8%) required revision surgery within 30 days for displacement. Conclusion: the treatment of supracondylar elbow fractures in children varies across the UK. patient cases where a paediatric orthopaedic consultant was involved had an increased tendency for lateral only K-wire fixation and for wire removal in clinic. Low rates of displacement requiring revision surgery were identified in all fixation configurations.

The purple line and its association with cervical dilatation in labour: A systematic review and meta-analysis (2023)

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Type of publication:
Systematic Review

Author(s):
*Papoutsis, Dimitrios; Antonakou, Angeliki; *Gornall, Adam; Tzavara, Chara

Citation:
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 289:91-99, 2023 Aug 25.

Abstract:
BACKGROUND: There is a growing body of evidence that the presence and length of the purple line could represent a non-invasive method of estimating and determining labour progress. OBJECTIVES: The primary outcome was to provide a systematic review and meta-analysis on the association between the purple line length and cervical dilatation in active labour. The secondary outcome was to determine the association between the purple line length and the fetal head descent, and to calculate the pooled mean length of the purple line at a cervical dilatation of 3-4 cm and at a cervical dilatation of 9-10 cm. SEARCH STRATEGY: We searched the Medline, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov and Cochrane Pregnancy and Childbirth's Trials Register databases from inception till March 25, 2023. SELECTION CRITERIA: We included observational studies of pregnant women in active first stage of labour who had their labour progress assessed with the use of regular vaginal examinations and who had the occurrence recorded and length of the purple line measured at the same time. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated study eligibility. We used the random effects and fixed effects model for meta-analysis. MAIN RESULTS: There were six eligible studies included in the systematic review that reported on 982 women in total with the purple line appearing in 760 (77.3%) of cases. We found a moderate positive pooled correlation between the purple line length with cervical dilatation (r = +0.64; 95%CI: 0.41-0.87) and fetal head descent (r = +0.50; 95%CI: 0.32-0.68). For women either in spontaneous or induced labour, the pooled mean length of the purple line was more than 9.4 cm when the cervical dilatation was 9-10 cm, whereas it was more than 7.3 cm when the cervical dilatation was 3-4 cm. CONCLUSIONS: The purple line is a non-invasive method that may potentially be used as an adjunct in labour progress assessment.

Psychological distress in lung cancer: patient selfassessment versus lung cancer nurse specialist (LCNS) judgement (2023)

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Type of publication:
Conference abstract

Author(s):
Walker S.; Lamonby V.; Orwin R.; *McAdam J.; Bate G.; Vick J.; Elrick N.; Shepherd P.; Flint A.; Dalrymple P.

Citation:
Lung Cancer. Conference: 21st Annual British Thoracic Oncology Group Conference 2023. Belfast United Kingdom. 178(Supplement 1) (pp S76), 2023. Date of Publication: April 2023.

Abstract:
Aims: Distress Thermometer (DT) tool compares LCNS' clinical judgment of patients' psychological distress to patients' self-reported assessment. Method(s): Few studies examine nurses' abilities assessing distress in patients, only one focusing lung cancer. They suggest Nurse Specialists within cancer settings struggle identifying distress using clinical judgement. The Distress Thermometer, a self-reported validated tool, can be used to screen for distress in cancer patients, but cannot replace comprehensive assessment. LCNUK members were surveyed May 2022. 44% used validated assessment tools and 75% confirmed these influenced management. LCNS each assessed 12 patients using The Distress Thermometer, face to face or telephone, occurring following first patient contact. The LCNS used DT tool assessing their perception of patient's distress level. Patients were asked to assess themselves using the same tool. Result(s): 45% assessments scored were identical 36.7% LCNS scored higher than patient 18.3% LCNS scored lower than patient 68.3% LCNS assessments within one DT point of patient Average difference of score between patient and LCNS was 0.4. 93.8% telephone assessments within 1 DT point 54.5% F2F assessments within 1 DT point Conclusion(s): LCNS's have excellent clinical judgement assessing patient distress, comparable to patient's self-assessment in most cases.

Updating the Wessex classification scheme for UK health libraries : a case study in improving inclusion and diversity in a specialist classification scheme (2023)

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Type of publication:Conference abstract

Author(s):*Curtis, Jason; Summers, Lotty

Citation:CILIP Metadata and Discovery Group Conference 2023. IET Birmingham: Austin Court, 6-8 September.

Abstract:The Wessex Classification Scheme was created by healthcare librarians in the South West of England, and was loosely based on the US National Library of Medicine classification. The scheme is widely used in healthcare libraries across the UK, both inside and outside the NHS. Although the scheme has gone through several revisions, there has been no major update since 2015, so the Wessex Classification Scheme Oversight Group was formed in September 2022 with the support of NHS England. The group aims to bring knowledge and skills from UK health library networks to improve the scheme, and also offers a chance for participants to develop skills in working with classification and subject indexing, and the opportunity to network widely. By forming a working group, it ensures the longevity of the scheme and shares the maintenance work more widely. Initially, members were asked which parts of the scheme they felt needed updating the most and sub-groups were formed for LGBTQ+ issues and gender identity (the Pride sub-group), Ethnicity and Race, and Learning Disability and Neurodiversity (the LDN sub-group) as well as a smaller team working on ‘quick and simple’ updates. The Pride sub-group undertook a review of the terminology and classification of items relating to the LGBTQ+ community, gender identity and gender affirming care and found that there were terms within the Wessex Classification Scheme that were no longer used or could be considered offensive, derogatory, or prejudicial. As a result of the review some terms were proposed to be removed completely (e.g. ‘hermaphroditism’) and other terms to be updated (e.g. ‘gender affirming surgery’ rather than ‘transsexual surgery’) using the Homosaurus as a guide in some cases. As part of the process, it was found that certain psychiatric topics were located within the same section as topics relating to sexual orientation and gender diversity. The sub-group believed this perpetuated a stereotype by linking these topics (e.g. paedophilia and incest) and so these were suggested to move from HQ to WM in the classification system. The Pride sub-group is committed to ensuring that the terms relating to the LGBTQ+ community are relevant and inclusive. Work by the Ethnicity and Race sub-group revealed terms within the Wessex subject index that were either outdated, problematic or more appropriate to a North American context than to a UK one. In addition to terms used to describe ethnic groups, related topics such as immigration, traditional medicine, homelessness and health inequalities were also considered. Appropriate sources of information were identified, and terms discussed, before making recommendations to the oversight group. The Learning Disabilities and Neurodiversity (LDN) sub-group is also looking at the language used in the subject index, and considering some broader changes to the classification schedules to bring together topics that are currently shelved in disparate areas of the classification. Some members of the LDN sub-group have lived experience of neurodiversity and are able to bring their experience to the work of the sub-group.

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Rheumatoid nodule presenting as a Morton's neuroma in the foot: An important differential diagnosis to consider (2023)

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Type of publication:
Journal article

Author(s):
*Patel R; Nand R; Sunderamoorthy D

Citation:
Radiology Case Reports. 18(7):2416-2419, 2023 Jul.

Abstract:
A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination revealed a palpable swelling over the right foot in the third intermetatarsal space. Following failed conservative management, the patient underwent excision of the neuroma. Histology revealed of necrotizing granulomas with peripheral palisading and no evidence of features specific to a neuroma. This has rarely been described previously and supports the concept of rheumatoid synovitis and nodules producing symptoms mimicking Morton's neuroma/metatarsalgia

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The effect of green tea supplementation on the anthropometric outcomes in overweight and obese women: a time and dose-response meta-analysis of randomized controlled trials (2023)

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Type of publication:
Systematic Review

Author(s):
Zhang Y; Tang N; Xia W; *Sanjid Seraj S; Pereira M; Velu P; Zhou H; Yang H; Du G

Citation:
Critical Reviews in Food Science & Nutrition. 1-10, 2023 Jun 10

Abstract:
Inconsistencies are evident within the literature regarding the role of Green Tea (GT) supplementation on women living with obesity. To address this, we conducted to determine the impact of GT supplementation on the weight, body mass index (BMI), and waist circumference (WC) in overweight and obese women using time and dose-response meta-analysis of randomized controlled trials (RCTs). This meta-analysis searched electronic Scopus, Web of Science, Embase, and PubMed/Medline databases from inception to December 1st, 2022. Data were reported as weighted mean difference (WMD) with 95% confidence interval (CI). A total of 2061 references were identified, and 15 articles with 16 RCT arms on body weight, 17 RCT arms on BMI, and 7 RCT arms on WC were included in the meta-analysis. GT supplementation significantly decreases body weight (WMD: -1.23 kg, 95% CI: -2.13 to -0.33, p = 0.007), BMI (WMD: -0.47 kg/m2, 95% CI: -0.87 to -0.07, p = 0.020) and WC (WMD: -3.46 cm, 95% CI: -6.75 to -0.16, p = 0.040). In subgroup analyses, GT consumption demonstrated lowered body weight with dosaes >=1000 mg/day (WMD: -1.38 kg), in the RCTs, which lasted >=8 wk (WMD: -1.24 kg). The non-linear dose-response assessment detected a negative correlation between the changes in body weight and BMI in green tea consumption of more than 1000 (mg/day). The GT supplementation reduced the weight, BMI, and WC in overweight and obese women. In clinical practice, healthcare professionals can recommend using GT with dosages >= 1000mg/day and duration >= 8 wk in obese women.

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Regression of a spinal schwannoma after Pomalidomide (2023)

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Type of publication:
Journal article

Author(s):
Kunnel Jomon, Mathew; Pepper, Joshua; *O'Connor, Nigel; Price, Rupert

Citation:
British Journal of Neurosurgery. 37(4):954-955, 2023 Aug

Abstract:
A 77-year old female with a history of neurofibromatosis type 2 (NF2) was diagnosed with a spinal schwannoma that was managed conservatively over a decade. During this time, follow up imaging revealed this lesion had been growing and the patient had become symptomatic from it necessitating surgical decompression. However, the patient had been diagnosed with multiple myeloma and underwent treatment with Pomalidomide chemotherapy which delayed surgery for the spinal schwannoma. Further imaging of the spine revealed significant regression in the size of the spinal schwannoma. This phenomenon has not peviously been reported and this report aims to explore the implications of Pomalidomide in patients with NF2 related spinal schwannomas.

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Clinical outcome of open ankle fractures in patients above 70 years of age (2023)

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Type of publication:
Journal article

Author(s):
*Wajiha Zahra, *Mina Seifo, Paul Cool, *David Ford, *Tosan Okoro

Citation:
World Journal of Orthopaedics. July 2023, Vol 14(7), p. 554-561

Abstract:
BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal. AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes. METHODS Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed. RESULTS A total of 37 patients were identified (median age: 84 years, range: 70-98); n = 30 females median age: 84 years, range: 70-97); n = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs (n = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs (n = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer P = 0.008, stroke P = 0.001, length of stay > 33 d P = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, P = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age P < 0.001, number of operations P < 0.001, diabetes P = 0.041). CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.

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Correlation of Pathological Findings with MRI Imaging in Traumatic Spinal Cord Injury in the Hyperacute Timeframe in a Nonhuman Primate Model (2023)

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Type of publication:
Conference abstract

Author(s):
*Fayez O.; Simmons H.; Johnson K.; Schalk D.; Brunner K.; Basu P.; Capuano S.; Nesathurai S.

Citation:
Journal of Neuropathology and Experimental Neurology. Conference: 99th Annual Meeting of the American Association of Neuropathologists, AANP 2023. Monterey, CA United States. 82(6) (pp 502), 2023. Date of Publication: June 2023.

Abstract:
Background: Traumatic Spinal Cord Injury (TSCI) remains a significant cause of morbidity and mortality in humans. Magnetic Resonance Imaging (MRI) has been a spectacular modality in management, however, data correlating MRI findings with pathological insults in the hyperacute time-frame (i.e., within one hour of injury) is limited. This is due to the time-period between injury and transport to hospital is typically one-hour or more. Only after assessment and stabilization can an MRI be completed. In this context, nonhuman primate models are essential to provide insights into this critical scientific hypothesis. Method(s): The subject was a Rhesus macaque. Baseline MRI imaging of the spine was obtained. A small laminotomy was performed at L5 level and an epidural balloon catheter was advanced to the level of the lower thoracic spine which was inflated rapidly and remained for one-hour to produce lesions consistent with TSCI. MRI imaging, with and without contrast, was obtained over the next hour. Subsequently, the subject was humanely euthanized and a post-mortem examination was conducted. Tissue sections were collected from the epicenter, caudal and cephalad sites of the lesion. Result(s): The abnormalities were most prominent with Disco- Lava sequence MRI Technique. Sagittal images of the thoracic spine displayed increased abnormalities including increased signal intensity. The findings were consistent with edema and/or hemorrhage. Histology of coronal sections at the level of injury revealed focally extensive disruption of grey matter and central canal with marked grey matter hemorrhage, acute necrosis, and mild multifocal white matter hemorrhage. Eosinophilic material and erythrocytes were found in adjacent sections, up to 2 cm caudal to the lesion. Conclusion(s): MRI abnormalities were present within one hour after injury in acute experimental spinal cord injury. The histopathological findings are consistent with the radiological abnormalities.

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