Author: Jason Curtis

Psychological impact of hair loss in women: A qualitative systematic review (2025)

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Conference abstract

Author(s):

*Mehra S.

Citation:

British Journal of Dermatology. Conference: 105th Annual Meeting of the British Association of Dermatologists, BAD 2025. Glasgow United Kingdom. 193(Supplement 1) (pp i85), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Hair loss in women is associated with profound psychological distress, affecting mental health, self-esteem and social functioning. This systematic review consolidates findings from qualitative studies to explore the psychological burden of hair loss and evaluate the efficacy of supportive interventions. The aim is to inform best practices for holistic, patient-centred management in dermatology clinics, aligning with National Institute for Health and Care Excellence guidelines and international protocols. This review adhered to the PRISMA guidelines, with a comprehensive search of the PubMed, MEDLINE, PsycINFO and Embase databases for qualitative studies published between 2010 and 2023. Keywords included 'psychological impact', 'hair loss', 'women', 'qualitative studies' and 'supportive interventions'. Inclusion criteria encompassed studies on the emotional and psychological burden of hair loss in women, with or without supportive interventions. Mixed-methods studies were included if qualitative data could be extracted. Singlecase studies and those without a psychological focus were excluded. Data were thematically synthesized to identify psychological impacts and assess the effectiveness of interventions such as counselling, peer support and cosmetic solutions. Twenty-six studies involving 1450 participants met the inclusion criteria. The key findings are reported here. (i) Emotional distress: hair loss caused significant emotional distress, with 78% of women reporting feelings of shame, anxiety or depression. Younger women and those with more extensive hair loss experienced greater psychological burdens. (ii) Impact on self-image: self-esteem was negatively affected in 85% of participants, with themes of loss of femininity and perceived diminished attractiveness. (iii) Social withdrawal: over 60% of women avoided social interactions due to embarrassment, compounding isolation and low selfworth. (iv) Supportive interventions: psychosocial therapies such as cognitive behavioural therapy (CBT) and peer support groups reduced anxiety and improved coping in 68%, while cosmetic solutions such as wigs, scalp micropigmentation and hairpieces enhanced confidence and social reintegration for 72%. Emerging themes underscored the importance of empathic clinician-patient communication, with patients emphasizing the need for guidance and emotional support alongside clinical care. Hair loss in women exerts a profound psychological impact on mental health, self-esteem and social functioning. Supportive interventions, including CBT, peer support and cosmetic solutions, effectively alleviate distress and enhance quality of life. A multidisciplinary approach integrating psychological support into routine care pathways is essential. Recommendations for practice are (i) to implement psychological assessments to identify at-risk patients; (ii) to develop integrated care models combining dermatological and psychological support; (iii) to create age-specific, culturally sensitive interventions and (iv) to educate patients on supportive therapies, fostering proactive engagement. This review highlights the critical need for dermatologists to address both the physical and psychological dimensions of hair loss, offering practical insights for patient-centred care. By incorporating psychological screening, empathetic communication and evidence-based supportive interventions, dermatology clinics can significantly improve patient outcomes.

DOI: 10.1093/bjd/ljaf085.164

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Nail changes as indicators of systemic disease: A systematic review of correlations and diagnostic outcomes (2025)

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Conference abstract

Author(s):

*Mehra S.

Citation:

British Journal of Dermatology. Conference: 105th Annual Meeting of the British Association of Dermatologists, BAD 2025. Glasgow United Kingdom. 193(Supplement 1) (pp i119), 2025. Date of Publication: 01 Jul 2025.

Abstract:

This systematic review evaluates the correlation between nail changes and systemic diseases, assessing their diagnostic utility, sensitivity and specificity. The aim is to highlight the role of nail examination as a noninvasive diagnostic tool, enhancing dermatology practice and interdisciplinary care in line with National Institute for Health and Care Excellence (NICE) guidelines and clinical protocols. This practice is particularly relevant in resource-limited settings, where access to advanced diagnostics may be restricted. A systematic review was conducted following the PRISMA guidelines. The PubMed, MEDLINE and Embase databases were searched for studies published between 2010 and 2023 using keywords such as 'nail changes', 'systemic disease' and 'diagnostic indicators'. Studies were included that analysed correlations between nail abnormalities (e.g. clubbing, Beau's lines, splinter haemorrhages, leuconychia, onycholysis) and systemic diseases like cardiovascular, pulmonary, autoimmune or metabolic conditions. Case reports and studies without statistical analysis were excluded. Data extraction focused on nail abnormalities, associated systemic diseases, and diagnostic metrics such as sensitivity and specificity. Thirty-two studies involving 7250 patients were included. Key findings demonstrated significant correlations between nail changes and systemic diseases. (i) Clubbing was associated with pulmonary and cardiovascular conditions, such as bronchiectasis and congenital heart defects, with a specificity of 92%. (ii) Beau's lines were linked to systemic stressors like severe infections, chemotherapy and malnutrition, with a sensitivity of 81%. (iii) Splinter haemorrhages were observed in vasculitis, infective endocarditis and connective tissue disorders, with a sensitivity of 78%. (iv) Leukonychia was linked to hypoalbuminaemia and liver cirrhosis, with a specificity of 85%. (v) Onycholysis was indicative of thyroid dysfunction, particularly hyperthyroidism, with a diagnostic accuracy of 80%. In 30% of cases, nail changes preceded other clinical manifestations, offering opportunities for early diagnosis and intervention. While nail findings alone lacked specificity in some cases, combining them with clinical history and investigations enhanced utility. These findings are impactful in resource-limited settings, where noninvasive tools can guide early management without expensive testing. This review underscores the value of nail examination as a noninvasive tool for identifying systemic diseases, often serving as an early indicator of pathology. Nail changes such as clubbing, Beau's lines and leuconychia provide clinically significant insights, particularly when integrated with broader assessments. Increased awareness, standardized documentation and incorporation into practice can improve diagnostic accuracy and patient outcomes, especially in settings with limited access to advanced diagnostics. Nail examination is an underutilized diagnostic tool. It bridges dermatology and systemic medicine, prompting timely referrals and collaborative management. In resource-limited settings, it offers an accessible alternative, reducing reliance on costly tests. Standardized protocols should be integrated into NICE guidelines globally.

DOI: 10.1093/bjd/ljaf085.237

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Efficacy and safety of hair gloss treatments: A systematic review of licensed products in the UK (2025)

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Type of publication:

Conference abstract

Author(s):

*Mehra S.

Citation:

British Journal of Dermatology. Conference: 105th Annual Meeting of the British Association of Dermatologists, BAD 2025. Glasgow United Kingdom. 193(Supplement 1) (pp i117-i118), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Hair gloss treatments have gained popularity for enhancing shine, hydration and overall hair health. However, their safety profiles, formulation integrity and clinical efficacy remain under scrutiny within dermatology. This systematic review evaluates the efficacy, safety and formulation of licensed hair gloss products in the UK, examining compliance with Medicines and Healthcare products Regulatory Agency (MHRA) and National Institute for Health and Care Excellence guidelines. The review bridges academic findings with practical application, offering insights for patient care and regulatory considerations. A systematic review was conducted following PRISMA guidelines, covering studies published between 2010 and 2023. Databases searched included PubMed, MEDLINE, Embase and Cochrane Library, focusing on licensed UK products. Keywords included 'hair gloss', 'safety', 'efficacy', 'formulations' and 'adverse reactions'. Products analysed were Olaplex No. 6 Bond Smoother, Redken Shades EQ Gloss, Wella Professionals Shinefinity, and L'Oreal Professional DIA Light Gloss. Data extracted included efficacy metrics (e.g. shine, hydration and smoothness), safety outcomes (e.g. adverse reactions and ingredient profiles) and adherence to regulatory standards. Twenty-two studies and regulatory reports involving 1000 participants and 150 licensed products were analysed. Key findings include the following. (i) Efficacy. Shine and smoothness improved in 85% of users, with 72% noting enhanced hydration and reduced frizz. Benefits lasted 4-6 weeks. Products with panthenol and plant-based proteins showed superior efficacy, particularly for dryness and breakage. (ii) Safety profiles. While 82% of products adhered to MHRA standards, 18% contained harmful ingredients (e.g. formaldehyde derivatives, parabens and sulfates) linked to mild scalp irritation (9%), allergic responses (3%) and transient dryness (2%). Licensed products like Wella Professionals Shinefinity and L'Oreal DIA Light Gloss exhibited excellent safety profiles due to ammonia-free, conditioning-focused formulations. (iii) Formulation integrity. 'Ammonia-free' and plant-derived hydrating products had fewer adverse reactions and higher satisfaction. Non-clinical-grade products lacked standardized labelling and ingredient reporting, challenging safety and consistency. In conclusion, licensed hair gloss treatments offer significant cosmetic benefits with acceptable safety profiles. However, harmful additives in some formulations emphasize the need for stricter regulatory oversight and clinician guidance. Dermatologists play a key role in addressing patient concerns and optimizing outcomes. Recommendations for practice are as follows. (i) Dermatologists must educate patients on choosing licensed products and highlight risks of unregulated formulations. (ii) Stricter labelling standards and transparency are essential. (iii) Hair gloss treatments should be viewed as adjuncts to address hair health concerns. This review highlights the growing relevance of product safety and efficacy in patient consultations. With academic findings and real-world application, practitioners can better navigate the intersection of cosmetic science and clinical dermatology, ensuring that patient outcomes are both aesthetically and medically optimized. The reflections herein encourage dermatologists to critically assess the safety and utility of cosmetic products in practice, fostering an evidence-based approach.

DOI: 10.1093/bjd/ljaf085.233

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Cure vs. toxicity: quantifying preferences for non-surgical management of rectal cancer using a prospective discrete choice experiment study (2025)

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Conference abstract

Author(s):

Webb E.J.; Twiddy M.; Noutch S.; Adapala R.; Bach S.P.; Brown S.; Burnett C.; Burrage A.; Gilbert A.; Hawkins M.; Howard D.; Hudson E.; Jefford M.; Kochhar R.; Saunders M.; Seligmann J.; Smith A.; Teo M.; West N.; Sebag-Montefiore D.; *Gollins S.; Appelt A.L.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1253-S1255), 2025. Date of Publication: 01 May 2025.

Abstract:

Purpose/Objective: Dose-escalation may increase the chance of successful non-surgical rectal cancer management, but requires an understanding of acceptable trade-offs between chance of cure and toxicity risks. This study is the first to measure patient preferences for non-surgical management (NOM) of rectal cancer using a discrete choice experiment (DCE). Material/Methods: A prospective, multicentre study conducted in seven UK radiotherapy centres. Patients consented to participation prior to initiation of radiotherapy-based NOM for rectal cancer (any stage), and completed the survey pre-treatment and 6 months post-treatment. The DCE was developed with qualitative patient input and had a Bayesian D-efficient design. Patients made repeated choices between hypothetical NOM treatments, described using six attributes: treatment length; chance of being cancer-free two years post-treatment; side effect risks during and two years posttreatment; support available. Participants indicated preferences for non-surgical vs. surgical treatment on a Likert scale. Baseline responses were analysed using mixed logit, quantifying trade-offs between attributes, using preference for chance of cure as the unit of measurement. Post-estimation, individual preferences conditional on choices were estimated. Changes in mean preferences pre/post-treatment were analysed using multinomial logit, with the delta method used to test for pre/post-treatment differences. Differences in preferences for surgical/nonsurgical management were assessed using Mann-Whitney U tests. Result(s): There were 96 participants recruited, and 51 completed follow-up. Participants had a mean baseline age of 68.4 and were 38.9% female. There were no significant differences between characteristics of people who did/did not complete follow-up. Figure 1 shows distributions of patients' baseline preferences. Patients on average required a 0.34 percentage point (pp) higher chance of cure to accept a 1pp higher chance of short-term side effects, compared to 0.78pp for a 1pp higher chance of long-term side effects, and 3.3pp higher chance of cure to accept support from usual GP rather than a dedicated nurse. The mean chance of cure patients would trade for shorter treatment lengths was not significantly different from 0 (p=.900). Preferences for treatment attributes did not change significantly pre/post-treatment (p-values between.374 and.759, Figure 2a). There was a significant shift in preferences towards non-surgical vs. surgical management post-treatment (p=.017, Figure 2b). Conclusion(s): Participants would accept extra toxicity in exchange for better chances of cure, suggesting most would accept treatment intensification, including dose-escalation. Participants were more concerned about long-term than shortterm side effects, highlighting the need for long-term follow-up of toxicity, and for clinical decision-making to take account of individual patients' preferences.

DOI: 10.1016/S0167-8140%2825%2901971-1

ARISTOTLE: Mature results of a phase 3 trial evaluating the addition of irinotecan to capecitabine chemoradiation in locally advanced rectal cancer (2025)

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Conference abstract

Author(s):

Sebag-Montefiore D.; Samuel L.; *Gollins S.; Glynne-Jones R.; Harte R.; West N.; Quirke P.; Myint A.S.; Bach S.; Falk S.; Parsons P.; Dhadda A.; Misra V.; Brown G.; Harrison M.; White L.; Duggan M.; Begum R.; Chang E.; Musleh R.; Lopes A.; Adams R.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2025. Vienna Austria. 206(Supplement 1) (pp S1192-S1194), 2025. Date of Publication: 01 May 2025

Abstract:

Purpose/Objective: To determine if the addition of irinotecan to capecitabine chemoradiation (CRT) improves disease-free survival in MRI-defined locally advanced rectal cancer (LARC). Material/Methods: ARISTOTLE (ISRCTN:09351447) is a phase III, multi-centre, open-label trial that randomly assigned (1:1) patients with MRI-defined LARC threatening or involving resection margins without metastases to pre-operative radiotherapy:45Gy/25 fractions combined with either capecitabine 900mg/m2 (CRT) or 650 mg/m2 bd weekdays with Irinotecan iv once-weekly 60mg/m2 (IrCRT) weeks 1-4. The primary endpoint is disease-free survival (DFS). Result(s): 75 UK sites randomised 564 eligible patients from 10/2011 to 07/2018; 284 to CRT and 280 to IrCRT. 66% male; median age 61 years (range:24-83). Radiological staging in both arms was similar:mrT3(77%), mrT4(16%); mrCRM involved(49%);resection margin threatened <=1mm(38%). Median follow-up is 62.1 months.Compared with CRT, IrCRT patients were less likely to receive 45Gy RT: 208(75%) vs 251(89%), p < 0.001; or receive >=90% capecitabine dose:187(68%) in IrCRT vs 253(89%) CRT, p < 0.001. 205(74%) IrCRT patients received >=90% irinotecan dose. >=Gd 3 non-haematological adverse events included fatigue 17(6%) vs 8(3%) p=0.06; diarrhoea:14% vs 4% p<0.001; abdominal pain 5% vs <1% p=0.001 for IrCRT and CRT respectively. >=Gd 3 haematological adverse events included leucopaenia: 9% vs 2%, p<0.001; neutropaenia: 10% vs 1%,p<0.001; and febrile neutropaenia: 1% vs <1% for IrCRT and CRT respectively. 5 patients had a grade 5 adverse event (3 lrCRT,2 CRT). The median time from the end of RT to surgery was 10.6 weeks. 238(85%) and 243(86%) patients underwent surgery in the IrCRT and CRT arms. The R0 resection rate was 90% vs 89% p=0.75 for IrCRT and CRT respectively. The pCR rate was 20% for IrCRT vs 18% for CRT p = 0.52. The rate of any post-surgical complications was similar in both arms:94(39%) for IrCRT and 91(37%) for CRT p=0.65). There is no evidence of a difference in loco-regional failure free (HR 0.94 [0.46-1.90]p=0.86, distant metastasis free (HR 0.89 [0.63-1.25] p=0.51), disease free HR 0.87 [0.64-1.18] p=0.37) or overall survival (HR 0.91[0.63-1.30],p=0.59) when IrCRT is compared with CRT. Conclusion(s): For patients with MRI-defined high risk LARC, low rates of CRM involvement and 36 month loco-regional failure were observed.The addition of irinotecan to CRT was associated with decreased radiotherapy and chemotherapy compliance and a higher rate of adverse events.There is no evidence of a difference in the pCR rate,36 month locoregional recurrence free or disease-free survival.

DOI: 10.1016/S0167-8140%2825%2900901-6

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Simultaneous integrated boost and organ at risk constraints in the APHRODITE trial (2024)

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Conference abstract

Author(s):

Iddenden J.; Howard D.; Hudson E.; Teo M.; Diez P.; Miles E.; Turtle L.; Patel R.; Appelt A.; *Gollins S.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom. 194(Supplement 1) (pp S5977-S5980), 2024. Date of Publication: 01 May 2024.

Abstract:

Purpose/Objective: APHRODITE (ISRCTN16158514), funded by Yorkshire Cancer Research, is a phase II randomised controlled trial comparing radical (chemo)radiotherapy (CRT) alone versus dose-escalated CRT with a simultaneous integrated boost (SIB). Patients with early stage rectal cancer, who are considered by their multidisciplinary team as unsuitable for radical total mesorectum excision or have a strong preference for organ preservation, will all receive 50.4Gy in 28 fractions to a small mesorectal-only planning target volume (PTV). Those in the experimental dose-escalation arm also receive up to 62Gy SIB to the primary tumour volume (PTVp). The trial is currently in active recruitment with a target sample size of 104 patients. Few studies exist detailing dose-volume constraints applied in this setting and none which examine the frequency to which they are achieved1. Anonymised trial plans were retrospectively reviewed to determine if the optimal organ at risk (OAR) dose-volume constraints as set out in the trial protocol are achievable. The conformity of the target volumes coverage was also assessed. Material/Methods: All centres completed the pre-trial radiotherapy quality assurance programme prior to recruiting. Radiotherapy planning data was requested for all patients. To date, 8 centres have recruited patients, with plan data for 46 out of 73 trial patients available at the time of analysis. Radiotherapy was planned according to their randomisation following APHRODITE dose-volume constraints. All plans were retrospectively reviewed on Velocity version 4.1 (Varian Medical Systems, Inc.) and dose-volume constraints extracted from DVH data. Conformity indices, as defined by RTOG (95% isodose volume/volume of PTV), were calculated for all PTVs. The standard deviation was calculated for optimal OAR dose-volume constraints and target volume conformity. Mann-Whitney U tests (two-tailed) were performed to test differences between the standard and dose-escalated arms. Result(s): Dose-volume constraints for the APHRODITE trial were developed from a retrospective mesorectum only planning study for a cohort of early-stage rectal cancer patients2. All constraints were considered optimal, rather than mandatory, due to the paucity of data on normal tissue dose limits in the setting of rectal cancer organ preservation. In all cases, the V95% >= 99% for both PTV and PTVp (dose-escalated arm only) were achieved. Table 1 demonstrates that centres were able to meet the optimal OAR dose-volume constraints in both trial arms in the majority of cases. Randomisation to receive a 62Gy boost did not have a statistically significant impact on achieving optimal OAR dosevolume constraints when compared to the standard arm dose. Evaluation of conformity indices in Table 2 suggested that there was a negligible difference in the conformity of PTV coverage between standard and dose-escalated patients. Mean conformity index for the mesorectal PTV was 1.15 for standard arm patients and 1.16 for patients in the escalated arm (p=0.67). For comparison, mean conformity index for the boost PTVp in the escalated arm was 1.18. The analysis of the target volume conformity test showed that 95% dose conformity is widely achievable across both trial arms in this multi-centre study. Table 2: Conformity indices of target volume and standard deviation Target Volume Mean Conformity Index Standard Deviation Standard (PTV) 1.15 0.06 Escalated (PTV) 1.16 0.05 Escalated (PTVp) 1.18 0.11 Conclusion(s): Delivering a SIB dose of up to 62.0Gy to the primary tumour volume does not have a statistically significant impact on the achievability of optimal OAR dose-volume constraints set out in the APHRODITE trial. Retrospective analysis of available plan data has shown that highly conformal SIB plans can be produced in a multi-centre setting, with resulting dose distributions being comparable to those in the standard arm.

DOI: 10.1016/S0167-8140%2824%2902083-8

Optimisation of the DLG in Mobius3D independent verification software for Ethos and TrueBeam linacs (2025)

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Conference abstract

Author(s):

*Patel A.; Albaladejo M.M.; Puchades V.P.; Amores D.R.; Arteaga J.S.; Gonzalez A.O.; Berna A.S.

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom. 194(Supplement 1) (pp S4770-S4773), 2024. Date of Publication: 01 May 2024.

Abstract:

Purpose/Objective: The purpose of this study is to demonstrate the experience in commissioning and optimising Varian's Mobius3D secondary dosimetry software for IMRT/VMAT patient specific QA using Varian TrueBeam HD-MLC and Ethos linacs, performed in the radiotherapy department at Complejo Hospitalario Universitario de Cartagena (CHUC). Material/Methods: Mobius3D provides an independent plan check against the TPS using a separate beam model and dose algorithm. This can be quantified with a 3D gamma pass rate (3%, 3mm threshold at CHUC), as well as point dose differences of seven positions within a Mobius Verification Phantom (MVP), which can be practically verified using a Semiflex 3D ionisation chamber (PTW 31021). For every plan at CHUC, this is initially done in the phantom's central position. Mobius3D was commissioned following Varian's guide for Ethos (energy 6FFF) and TrueBeam (energies 6X and 6FFF) linacs, which included a reference point dose calculation, and verification of the PDD curves, output factors, wedge factors, off-axis ratios, and the CT electron density table. The system was then evaluated against simple conformal plans, followed by more complex clinical VMAT/SBRT/SRS plans. As per the Mobius3D commissioning guidance provided by Varian, if plans are systematically returned with target volumes too hot or too cold with respect to the TPS then it is recommended that the model's dosimetric leaf gap (DLG) correction value is adjusted, which may be different for VMAT and IMRT techniques. For optimisation, Varian recommends using a small ionization chamber within an MVP insert to measure the delivered point dose from 5-10 clinical plans and comparing against the values returned by Mobius3D. This was performed on 8 IMRT plans over a range of DLG correction values. However, as the 3D gamma pass rate metric is generally more often used for comparing dose distributions, it may be more beneficial to optimise against this rather than the point dose difference. This was therefore also performed following the point dose optimisation. Result(s): The results following commissioning from plans on the Ethos linac were promising; for the default DLG values the target volume doses agreed to a sufficient degree, the 3D gamma pass rate (3%, 3mm) had a median of 99.5%, and the point dose difference had a median of -0.1%, as shown in Figure 1 (left and centre) for approximately 200 plans. This was also similar for VMAT plans on the TrueBeam linac. However, the Mobius3D results for IMRT treatments on the TrueBeam model gave target dose distributions which were consistently lower than those provided by the Eclipse TPS (AcurosXB v16). Additionally, the 3D gamma pass rates (3%, 3mm) were below the tolerance of 95%, with a median of 83.1% (n = 21), also shown in Figure 1 (right side). This therefore required optimisation of the DLG values. In this last scenario, the average point-dose difference between the plans was found for each DLG value. A trendline was plotted using linear regression, as depicted in Figure 2, and the DLG corresponding to a 0% point-dose difference was found to be 1.48 +/- 0.05mm. Similarly, the 3D gamma (3%, 3mm) pass rates were also found for each DLG value. Polynomial regression was performed to fit a cubic function to this data, also depicted in Figure 2, which gave a maximum corresponding to a DLG of 1.25 +/- 0.4mm. Considering the results from both methods, the DLG correction on the Mobius3D system for this TrueBeam and both energies was set as the average 1.4mm for IMRT, and 0mm for both VMAT and Ethos. This first value aligns closely with the value used for TrueBeam plans on the Eclipse TPS. From analysing plans following this optimisation, it was observed that the gamma3D (3%, 3mm) pass rates significantly improved, with a new higher median of 96.5% (n = 28, p < 0.001), as shown in Figure 1 (right). Conclusion(s): There is the need to optimize the DLG value for IMRT treatment plans on TrueBeam HD-MLC. Following this adjustment, the Mobius3D software gave satisfactory agreements to the TPS dose distribution for TrueBeam IMRT plans, with a substantial increase in 3D gamma (3%, 3mm) median pass rates. Ethos plans gave strong agreements without the need for optimisation, as did TrueBeam VMAT plans for the software default DLG values. It can therefore be concluded that the Mobius3D software offers a rigorous independent dose check against the TPS and is suitable for clinical use on Ethos and TrueBeam platforms, provided that a proper verification and optimization process has been previously performed.

DOI: 10.1016/S0167-8140%2824%2901289-1

Mitral Valve-in-Ring Approach for High-Risk Pannus-Related Mitral Stenosis (2025)

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Type of publication:

Journal article

Author(s):

*Yera, Hassan O; Azam, Ziyad; *Azam, Najeeb M.

Citation:

Cureus. 17(10):e94204, 2025 Oct.

Abstract:

A male patient under follow-up for degenerative mitral regurgitation, treated with a Physio annuloplasty ring two decades earlier, developed progressive shortness of breath and fluid overload, corresponding to New York Heart Association (NYHA) class III/IV. A transoesophageal echocardiogram revealed significant mitral stenosis, with a mean gradient of 11.8 mmHg due to pannus formation around the annuloplasty ring. Surgical repair posed a mortality risk of 25%-35% because of the combined risks of redo surgery, reduced left ventricular systolic function and chronic kidney disease. A transcatheter mitral valve-in-ring (TMViR) procedure was the only feasible option. A 29 mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA) was successfully implanted within the mitral ring. Four months following the procedure, the patient reported significant symptom relief and an improved quality of life (QOL), with a shift to NYHA class I/II. Follow-up echocardiography demonstrated a stable valve position, a mean gradient of 4 mmHg and mild mitral regurgitation. This case highlights TMViR as a viable option for high-risk patients with pannus-related mitral stenosis.

DOI: 10.7759/cureus.94204

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Missed on X-ray, Found on CT: A Retrospective Study on the Diagnostic Yield and Clinical Consequences of Occult Posterior Malleolus Fractures in Tibial Shaft Fractures (2025)

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Type of publication:

Journal article

Author(s):

Kanesan, Hariprasath; Choudhary, Zain; Singal, Sachin; *Kanesan, Mahesh; Hang-Kin Nam, Ronald; Radhamony, Niranj Ganeshan; Hamadto, Mohamed.

Citation:

Cureus. 17(10):e94260, 2025 Oct.

Abstract:

Background Posterior malleolus fractures (PMFs) are common in distal tibial shaft fractures yet are frequently occult on plain radiographs. Accurate preoperative characterization on CT may improve surgical planning and functional recovery. Methods We conducted a retrospective cohort study of consecutive adults (>=18 years) with mid- or distal tibial shaft fractures treated at a major trauma center (January 2022-December 2024). Demographics, imaging, fracture characteristics, management, and outcomes were abstracted. PMF detection was compared across radiography, CT, and intraoperative findings. Predictors of a posterior malleolus (PM) fragment being missed on radiography were evaluated with multivariable logistic regression. Among operatively treated cases, the effect of fixation strategy on postoperative full weight-bearing (FWB) was analyzed with a logistic model including fixation, PM status, and their interaction; pairwise, covariate-adjusted contrasts (emmeans with Tukey correction) compared strategies. An exploratory random forest provided permutation-importance rankings. Findings PMFs were present in 147/387 fractures (38.0%), more often in women (60.5%), closed injuries (76.9%), and distal fractures (98.0%). Radiography identified 116/147 PMFs (78.9%), and CT 120/147 (81.6%); 29/147 (19.7%) fragments were missed on radiographs but detected on CT or intraoperatively. Missed fragments were most frequent in undisplaced and intermediate-sized (33-50%) fragments; CT identified all posteromedial and >50% fragments. In adjusted analyses, fracture morphology was the principal correlate of radiographic omission: oblique patterns were less likely to be missed (adjusted odds ratio 0.18, 95% CI 0.04-0.60), whereas other demographic and injury variables were not significant. Among operatively managed fractures, intramedullary nailing was associated with the highest likelihood of achieving FWB and was statistically superior to plate and external fixation in pairwise, covariate-adjusted comparisons; the relative ranking of fixation methods did not differ by PM involvement. Neither PMF location (posteromedial, posterolateral, or undisplaced) nor fragment size independently predicted FWB, infection, or mal-/non-union. Conclusions Approximately two in five distal tibial shaft fractures harbour a PM fragment, and nearly one in five PMFs are occult on initial radiographs, particularly when undisplaced or of intermediate size. CT modestly increases detection and ensures complete characterisation of posteromedial and large fragments, supporting a low threshold for pre-operative CT in distal tibial fractures.

DOI: 10.7759/cureus.94260

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A Diagnostic Challenge: Sclerosed Hepatic Haemangioma Mimicking Malignancy (2025)

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Type of publication:

Journal article

Author(s):

*Lakhani, Umar A.

Citation:

Cureus. 17(10):e94449, 2025 Oct.

Abstract:

A 75-year-old lady presented to Accident and Emergency (A&E) with acute worsening shortness of breath and new palpitations. On assessment, she was found to have fast atrial fibrillation, signs of heart failure, and bilateral peripheral oedema. Investigations revealed pulmonary embolism and an incidental hepatic lesion on CT imaging, suspicious for malignancy. Multidisciplinary discussion led to liver biopsy, which confirmed a benign sclerosed haemangioma. The patient was managed conservatively for cardiac and thromboembolic complications. This case highlights the difficulty in differentiating sclerosed haemangiomas from malignant liver lesions on imaging alone and underscores the importance of biopsy and multidisciplinary decision-making in elderly patients with comorbidities. Learning points include diagnostic vigilance, safe management of anticoagulation, and avoidance of unnecessary surgery.

DOI: 10.7759/cureus.94449

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