Author: Jason Curtis

Biomarkers in Prostate Cancer: A Review (2024)

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Type of publication:
Journal article

Author(s):
Ahmadieh, Nizar; Zeidan, Toufic; Chaaya, Celine; *Cain, David; Aoude, Marc; Abouchahla, Anita; Kourie, Hampig Raphael; Nemer, Elie.

Citation:
The Gulf Journal of Oncology. 1(44):81-93, 2024 Jan.

Abstract:
BACKGROUND: Prostate cancer (PC) is the second most common cancer in men worldwide. It's the second leading cause cancer men in death. Prognostic tests based on molecular and biomarker analysis of tumor tissue may improve risk stratification of prostate cancer 2. MATERIALS AND METHODS: After a search on Pubmed for PC biomarkers, 72 papers responded to the objectives and will be included in the review. RESULTS: A plethora of biomarkers are predictive for the prognosis of PC and its response to certain therapies, while others, once thought to be indicative of prognosis in PC, were not. CONCLUSIONS: This study can help in the development of diagnostic and prognostic tests of PC and contribute to the ongoing research into already existing tests.

Mastering the Art of Dermatosurgery: Aesthetic Alchemy in Medical Excellence (2023)

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Type of publication:
Journal article

Author(s):
*Ekomwereren, Osatohanmwen; Shehryar, Abdullah; Abdullah Yahya, Noor; Rehman, Abdur; Affaf, Maryam; Chilla, Srikar P; Kumar, Uday; Faran, Nuzhat; I K H Almadhoun, Mohammed Khaleel; Quinn, Maria; Ekhator, Chukwuyem

Citation:
Cureus. 15(11):e49659, 2023 Nov.

Abstract:
Dermatosurgery, a specialized branch within dermatology, has traversed an extraordinary journey through time, shaped by ancient practices, technological leaps, and shifting societal perceptions. This review explores the evolution of dermatosurgery, highlighting its profound transformation from addressing solely medical concerns to seamlessly integrating aesthetics. From its roots in ancient civilizations, where cultural traditions laid the foundation for modern techniques, to the twentieth-century technological renaissance, marked by innovative tools and enhanced understanding of skin anatomy, dermatosurgery has emerged as a dynamic field. Societal notions of beauty and health have significantly influenced dermatosurgery, blurring the lines between medical necessity and elective aesthetic procedures. The delicate balance between satisfying aesthetic desires and upholding medical ethics is a central challenge that
dermatosurgeons face today. Open dialogue between practitioners and patients as well as psychological support plays a pivotal role in navigating this terrain. The training and ethics associated with dermatosurgery have evolved to meet the increasing demand for specialized procedures. Maintaining a focus on patient safety and satisfaction remains paramount as commercial pressures and disparities in access to care loom. Upholding best practices and standards in the field is essential for ensuring consistent, high-quality care for all patients. Looking ahead, dermatosurgery stands on the brink of a transformative era, marked by non-invasive techniques, artificial intelligence (AI) integration, and personalized medicine. The field's ability to harmonize medical science with aesthetic artistry is evident in various case studies, showcasing the intricate balance dermatosurgeons strike between addressing medical concerns and fulfilling aesthetic desires. As dermatosurgery continues to evolve, it promises to provide patients with even more precise, tailored treatments that enhance both their physical well-being and aesthetic satisfaction.

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Vesical Haemangioma in Klippel-Trenaunay-Weber Syndrome: A Clinical Case (2023)

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Type of publication:
Journal article

Author(s):
Mohamed, Ahmed; *Chin, Yew Fung; Farah, Mohamed; Mahmalji, Wasim

Citation:
Cureus. 15(12):e49952, 2023 Dec.

Abstract:
Klippel-Trenaunay-Weber (KTW) syndrome, a rare vascular disorder, often presents with cutaneous capillary malformations and soft tissue hypertrophy. However, urinary tract involvement in the form of vesical haemangiomas is a seldom-encountered clinical condition. We present a case of a 37-year-old male with KTW syndrome who exhibited recurrent gross haematuria, prompting clinical evaluation. Initial diagnostic assessments revealed erythematous changes in the bladder, consistent with haemangiomas. Despite an initial biopsy and diathermy, the patient's symptoms recurred, leading to a subsequent management strategy involving laser fulguration. This case underscores the significance of recognizing cutaneous haemangiomas as potential indicators of urinary tract involvement in KTW syndrome and highlights the challenges in managing vesical haemangiomas, where a multidisciplinary approach is essential for optimal care.

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Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial (2024)

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Type of publication:
Randomised controlled trial

Author(s):
Zahed, Ghazal; Fatahi, Somaye; Tabatabaee, Leila; Imanzadeh, Negar; *Seraj, Shaikh Sanjid; Wolters, Benjamin Hernandez; Hosseini, Amirhossein

Citation:
BMC Pediatrics. 24(1):7, 2024 Jan 03.

Abstract:
OBJECTIVES: Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS: In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS: 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 +/- 2.4 years and 8.0 +/- 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION: Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.

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Direct to test: the trend to chest CT scanning requests through primary care. (2023)

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Type of publication:
Conference abstract

Author(s):
Nahar R.; *Bosher O.; *Makan A.; Crawford E.; Srinivasan K.; Moudgil H.;

Citation:
Thorax. Conference: British Thoracic Society Winter Meeting 2023. London United Kingdom. 78(Supplement 4) (pp A258), 2023. Date of Publication: November 2023.

Abstract:
Background/Objectives Although the concept of 'direct to test' managing patients from primary care is not new, emphasis has been on improving cancer outcomes through earlier radiological detection; evidence on how General Practitioners (GPs) currently request chest CT (computer tomography) scans dealing with a broader range of diagnoses amid the backlog of referrals into secondary care in the post COVID-19 era, is anecdotal. This work (1) documents the uptake and nature of chest CT scans requested, (2) reports on appropriateness and standard of referrals, and (3) outlines subsequent findings. Methods 12 month computer data collected retrospectively on all patients undergoing chest CT scans at this secondary care hospital; GP referrals were identified through practice codes. Results 279/1230 (23%) of chest CT scans undertaken were requested through primary care; mean age of patients was 67.6 (SD 12.2, range 20-91) years with 48% males. Uptake/ trend over the preceding 12 months are shown in figure 1, GP requests remaining low. All were HRCT (High Resolution CT) rather than staging CT used to stage lung cancer or CTPA (CT Pulmonary Angiograms) investigating pulmonary thrombo-embolic disease (PTE). 263 (94%) of requests were to establish a new finding and 16 (6%) as follow up assessing earlier detected pulmonary nodules; 178 (64%) of referrals were based on symptoms with a provisional diagnosis only proposed in 140 (50%). Referral standards adequately outlining clinical context was only found in 142 (51%) but referral pathway considered appropriate in 268 (96%) with the remainder probably best referred directly to cancer pathways. Findings included bronchiectasis (23%), emphysema (15%), interstitial (including occupational) lung disease (15%) and lung cancer (2%) but with inconclusive or no new radiological finding in 117 (42%). Conclusions Approximately 23% of chest CT scans are currently being requested through primary care; although the type of CT and most referrals are appropriate, with most lung cancer and PTEs on alternate referral pathways, there remains concern where pulmonary nodules are being followed outside of a more dedicated protocol and clinic. Benefits to the patient, how GPs manage the high number of inconclusive results, and patterns of referrals to secondary care require further assessment.

Assessing continued benefits of 4C scores for mortality among patients with COVID-19 pneumonitis admitted to a teaching district general hospital (2023)

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Type of publication:
Conference abstract

Author(s):
Cox D.; Koshy K.; *Moudgil N.; *Makan A.; *Crawford E.; *Moudgil H.; *Srinivasan K.;

Citation:
Thorax. Conference: British Thoracic Society Winter Meeting 2023. London United Kingdom. 78(Supplement 4) (pp A201), 2023. Date of Publication: November 2023.

Abstract:
Background and Objectives The 4C (Coronavirus Clinical Characterisation Consortium) score incorporating patient comorbidities with measures of acute physiology and inflammation is an internationally validated prognostic tool for in-hospital mortality introduced early during the COVID-19 pandemic. With the subsequent strong uptake of SARS-CoV-2- RNA vaccines, more targeted therapies, changing virulence of the coronavirus (now predominantly omicron), and fewer reported deaths, the goal/objectives of this work were to determine continuing relevance of 4C scores by (1) reporting their distribution categorised with risk profile and (2) further analysing mortality in the immediate in-hospital setting and at 12 months. Methods Retrospective computer-based data including SARSCoV- 2-RNA vaccination status/boosters collected for patients with confirmed infection and COVID-19 pneumonitis admitted during 2 months to July 2022; subsequent analysis for mortality was by regression analysis accepting statistically significant findings for standardised beta coefficients at p<.05 adjusting for demographics, vaccination status and targeted COVID-19 directed (Remdesivir/Tocilizumab) therapeutic variables as well as oxygen (O2) and use of medical devices. Results 62 patients (47% males), with mean (SD, range) age 75.8 (15.4, 32-101) years were identified; 19 (30.6%), with mean survival 70 (67, 6-237) days (median 40 days), had died (9 in the initial admission and 10 during follow up). 55 (88.7%) had been vaccinated at least once. Distribution of 4C scores with mortality in-hospital and during follow up are shown in table 1; 8/9 (88.9%) in-hospital and 17/19 (89.5%) overall deaths were from patients with high or very high 4C scores. Independent variables statistically significant on regression analysis for in-hospital mortality included positively with 4C score (p= .018) and high O2/medical ventilatory devices (p= .000), and negatively with age (p= .048), dexamethasone (p= .046), and targeted COVID treatments (p= .036) but not gender, status/number of vaccines, or low dose O2 use. None of the variables were significant at 12 months. Conclusions Analysis of this real-life data has shown continued role for 4C scores outside of their original validation; despite no statistical significance among independent variables at 12 months, the continued mortality (30.6% in the cohort) likely reflects on the significant burden of co-morbidity.

Ankle sprains: a review of mechanism, pathoanatomy and management (2023)

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Type of publication:
Journal article

Author(s):
*Zahra W.; *Meacher H.; *Heaver C.

Citation:
Orthopaedics and Trauma. 38(1) (pp 25-34), 2024. Date of Publication: February 2024.

Abstract:
Ankle sprains are one of the most common musculoskeletal injuries. A sprain is defined as the stretching or tearing of ligaments; in the ankle these are the lateral ligamentous complex, deltoid ligament and distal tibiofibular syndesmosis ligaments. The mechanism of injury dictates which ligaments get injured, with the most common being inversion injuries causing anterior talofibular ligamentous sprain. Initial management of an ankle sprain consists of protection, rest, ice, compression and elevation. After the first 72 hours, the treatment depends on the severity of the sprain, with physiotherapy forming the mainstay of treatment in the majority of cases. In addition to strengthening exercises proprioceptive re-training helps with rehabilitation. The goal of treatment is to prevent chronic instability from occurring. Aside from syndesmotic injuries, surgical treatment is rarely required in the acute setting. Delayed ligamentous reconstruction may be required if chronic instability occurs, and is described as being an anatomic or non-anatomical reconstruction. This article reviews the anatomy, pathophysiology, clinical assessment and management of patients with ankle sprains.

Evidence-based frozen elephant trunk practice: a narrative review (2023)

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Type of publication:
Journal article

Author(s):
Kayali F.; Chikhal R.; Agbobu T.; Jubouri M.; *Patel R.; Chen E.P.; Mohammed I.; Bashir M.

Citation:
Cardiovascular Diagnosis and Therapy. 13(6) (pp 1104-1117), 2023. Date of Publication: 2023.

Abstract:
Background and Objective: The frozen elephant trunk (FET) allows a single-stage repair of complex arch pathologies due to its stented and non-stented hybrid prosthesis (HP) features. FET inherently has its own related complications including distal stent graft-induced new entry (dSINE), failure of aortic remodelling, endoleak, reintervention, and kinking of the stent. The aim of this narrative review is to discuss the latest evidence regarding the postoperative clinical outcomes of the FET procedure. Another aim is to provide an overview of results achieved using different FET devices on the global arch prostheses market. <Method(s): A comprehensive literature search was conducted using multiple electronic databases to identify and extract the relevant data and information. Key Content and Findings: This review found that the literature reported a 5-12% mortality rate post- FET, with varying figures depending on the prosthesis type. Between 0-18.2% of patients developed dSINE, while 0.1-28% developed endoleak. Reintervention occurred in 0-28% of patients and the incidence of kinking has been quoted between 0-8% in the literature. Reporting aortic remodelling rates was challenging due to the lack of standardisation and various measurements reported; however, all studies included in this review reported relative increase in true lumen diameter, reduction in the false lumen diameter, and/or false lumen thrombosis. Conclusion(s): In conclusion, FET can achieve a favourable postoperative profile in terms of survival, complications and aortic remodelling, and remains the gold-standard treatment for thoracic aortic pathologies implicating the arch and descending thoracic aorta.

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Five historical innovations that have shaped modern cardiothoracic surgery (2023)

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Type of publication:
Journal article

Author(s):
Mainwaring E.; *Patel R.; Desai C.; Acharya R.; Raveshia D.; *Shah S.; *Panesar H.; Patel N.; Singh R.

Citation:
Journal of Perioperative Practice. (pp 17504589231212967), 2023. Date of Publication: 27 Dec 2023. [epub ahead of print]

Abstract:
Throughout history, many innovations have contributed to the development of modern cardiothoracic 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 cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.

Transregional Study Highlighting the Increasing Burden of Urology Cancer Multidisciplinary Team Meetings Around the UK (2023)

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Type of publication:
Journal article

Author(s):
Kasmani, Zain; Mohamed, Wail; Siddiqui, Zain; Boksh, Saddek; Ganapathi, Shaswath; Saidani, Zakaria; Wijayasuriya, Don S; Donati-Bourne, Jack.

Citation:
Cureus. 15(11):e48501, 2023 Nov.

Abstract:
Introduction: The urology multidisciplinary team meeting (MDT) is the key weekly meeting that allows the opportunity to review results and discuss management plans for all urological cancers within a department. As populations age and cancer detection and management improve, the demand for the MDT will increase. We conducted a collaborative transregional study within the UK to evaluate the current workload on the urology MDT. Methods: The study was divided into two parts: a multicenter retrospective audit and a snapshot survey. Three UK hospitals in Birmingham, Liverpool, and Cardiff were recruited into the multicenter study. Each hospital provided full MDT lists for all weekly meetings between August 2017 and 2022. Retrospective data gathered included the number of patients discussed per week, the average age of patients per week, the time allocated to their weekly MDT, and the total number of consultants in the department. The second part of the study involved the distribution of an online questionnaire to urologists across the UK to obtain a snapshot picture with the above parameters. Results Snapshot data from 34 different UK hospitals showed MDT length ranged from 1-6 hours, patients discussed ranged from 10-90 per week, and the maximum average discussion time was 3.8 minutes per case. Furthermore, 76% (N = 28/37) of respondents said unnecessary cases were discussed. Varied suggestions were provided on how the MDT could be improved. Multicenter five-year data showed a rise in mean total numbers of patients discussed per week in all centers: a 34.8% increase in Birmingham (from 34.5 patients to 46.5 patients), a 23.5% increase in Liverpool (27.2 patients to 33.6 patients), and a 38.8% increase in Cardiff (22.7 patients to 31.5 patients). Hours per meeting were Birmingham (2), Liverpool (3), and Cardiff (4), which meant the average minutes per patient discussion were Birmingham (2.6), Liverpool (5.4), and Cardiff (7.6). Conclusion There is a rapidly rising trend across UK regions for the number of patients being discussed in the urology MDT meeting. The MDT structure and function across the country are highly variable. There is consensus that the MDT discusses cases that are unnecessary, and this has been recognized for many years. Widespread implementation of the latest MDT management guidelines is urgently required to ensure MDT meetings are able to function effectively and efficiently into the future.

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