Author: Jason Curtis

Criteria for Return to Running After Surgical Repair of Acute Achilles Tendon Rupture: A Modified Delphi Consensus Study (2026)

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Type of publication:

Journal article

Author(s):

Gaspar, Maxime; Maffulli, Nicola; Memain, Geoffrey; *Carmont, Michael R; Hardy, Alexandre; Arnaud, Choplin.

Citation:

Sports Medicine. 2026 Jul 26.

Abstract:

BACKGROUND: The annual incidence of Achilles tendon ruptures has increased by almost 3%. Despite the large amount of data available on post-injury treatment, there is a lack of evidence-based criteria to guide return to running after surgery.

OBJECTIVE: The aim of this study was to reach a consensus among experts on the criteria for resuming running following surgery for Achilles tendon rupture.

METHODS: Thirty-five international Achilles tendon experts were invited to participate in this modified Delphi study. The study was conducted in three rounds, with a threshold of 75% agreement (or disagreement) required for an item to achieve consensus. Sixteen clinical criteria were submitted to the expert panel. A five-point Likert scale was used. The study was conducted between January and June 2025.

RESULTS: Eight criteria achieved consensus after three rounds: seven criteria reached consensus for inclusion, and one criterion reached consensus for exclusion (calf circumference symmetry). The seven criteria were (1) the absence of pain in daily life; (2) the absence of pain during and after rehabilitation sessions; (3) walking without limping; (4) the ability to walk on tiptoes; (5) the ability to perform ten single-leg heel rises; (6) good single-leg balance; and (7) the patient feeling psychologically ready to resume running.

CONCLUSION: An expert consensus on the criteria to return to running after surgery for Achilles tendon rupture has been developed. These criteria, agreed by experts, may inform clinical decision making regarding return to running, but they require prospective validation before they can be used as decision rules. Further studies are needed to refine these criteria and evaluate their impact on functional outcomes during the return-to-running phase.

DOI: 10.1007/s40279-026-02506-4

Developing a comprehensive haemodynamic ultrasound assessment for critical care: Rationale and methodology from the FUSIC programme (2026)

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Type of publication:

Journal article

Author(s):

*Miller, Ashley; Peck, Marcus; Conway, Hannah; Parulekar, Prashant; Rubino, Antonio; Stephens, Jennie; Wilkinson, Jonathan; Kirk-Bayley, Justin; Waraich, Manni; Griksaitis, Michael.

Citation:

The Journal of the Intensive Care Society. 17511437261470613, 2026 Jul 31.

Abstract:

Haemodynamic ultrasound is central to bedside assessment of circulatory failure in critical care. The Focused UltraSound in Intensive Care HaemoDynamics (FUSIC HD) programme was originally designed to provide a structured national framework for physiologically focused ultrasound assessment, distinct from comprehensive diagnostic echocardiography. Since publication of the original framework, experience from training cohorts, logbook review, and centralised summative assessment has shown that a broader range of haemodynamic parameters can be acquired and interpreted in routine practice. This article outlines the rationale, development process, and methodological principles underpinning the recent revision of the FUSIC HD dataset. The updated framework incorporates additional assessment of left ventricular performance, right ventricular function, and pulmonary vascular loading, together with a refined approach to estimating left atrial pressure while maintaining emphasis on physiological coherence, bedside feasibility, and avoidance of unnecessary diagnostic complexity. The aim is not to expand diagnostic echocardiography capability, but to support more integrated haemodynamic interpretation in critically ill patients within an established training and governance structure.

DOI: 10.1177/17511437261470613

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The 2026 Surviving Sepsis Campaign Guidelines: The dissenting opinion (2026)

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Type of publication:

Journal article

Author(s):

Spiegel, Rory; Haycock, Korbin; *Miller, Ashley; Weingart, Scott; Farkas, Joshua; Ajmo, Ian; Rola, Philippe.

Citation:

American Journal of Emergency Medicine. 110:411-415, 2026 Sep 15.

Abstract:

The Surviving Sepsis Campaign (SSC) Guidelines once represented what was considered the pinnacle of care for patients with sepsis and septic shock. Unfortunately, over the past decade, successive iterations of the guidelines have drifted from what is now considered optimal care for critically ill patients with sepsis and septic shock. Moreover, the guidelines have shifted from recommendations intended to guide and support physicians based on the best available evidence, to mandated "bundles" which exert substantial influence over what is considered "standard of care" in sepsis management. This. Document is intended to serve as a refutation of sorts. A rebuttal to the most controversial and influential recommendations in the Surviving Sepsis Campaign Guidelines, while also offering guidance on how clinicians might move beyond the protocolized, metric-based care that has become the current standard promoted by the SSC and similar organizations.

DOI: 10.1016/j.ajem.2026.09.025

Ileostomy creation for rectal cancer in England: An observational study of variation, and correlates using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.

Citation:

Colorectal Disease. 28(9):e70622, 2026 Sep.

Abstract:

AIMS: The decision to create an ileostomy following anterior resection is a clinical one based on the judgement of the surgical team. However, there are few data to support decision-making. This study aimed to explore variation in, and factors associated with, ileostomy creation rates following surgery for rectal cancer in England.

METHODS: This exploratory, retrospective analysis used observational data from England's Hospital Episode Statistics (HES) dataset. All patients aged >=17 years undergoing an elective anterior resection with ileostomy creation from 1 April 2016 to 31 March 2024 were included. The primary outcome of interest was ileostomy creation at the time of index surgery.

RESULTS: In total, 17,540 anterior resections for rectal cancer were included, and 5,954 patients (33.9%) had a diverting ileostomy. Rates of ileostomy creation declined over time, from 38.6% in 2016/17 to 29.7% in 2023/24, while the number of anterior resections remained relatively stable, other than during the COVID-19 pandemic. There was substantial variation in ileostomy creation rates across hospital trusts from 5.8% to 62.5%. Greater odds of ileostomy creation were associated with younger age, male sex, mild/moderate frailty, living in a less deprived area, Asian ethnicity, higher surgeon and trust volume and earlier time periods.

CONCLUSIONS: Rates of ileostomy creation are falling, but there is huge variation in creation rates across providers and patient groups. Standardised guides on when to create an ileostomy may help reduce the extent of this variation.

DOI: 10.1111/codi.70622

Optimising Performance Through Sleep: An Evidence-Based Review (2026)

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Type of publication:

Journal article

Author(s):

*Bastock, Daniel; Amarnani, Raj.

Citation:

Cureus. 18(7):e111990, 2026 Jul.

Abstract:

Sleep is increasingly being recognised as an important factor influencing athletic performance, recovery and overall health. This narrative review aims to discuss the factors that can affect sleep in athletes and how sleep can affect performance. Traditionally, athlete well-being has focused on training and nutrition; however, new evidence and initiatives now highlight sleep as an important element of performance. This review examines current evidence on sleep duration, sleep quality and sleep disturbances in athletic populations, with a particular focus on the effects related to competition. Athletes often report shorter sleep durations than non-athletes, despite experiencing less sleep fragmentation and quicker sleep onset. One study found that on nights before a competition day, athletes went to bed earlier (22:56 hr +/- 49.2 min), woke up later (8:12 hr +/- 58.6 min) and slept for longer (7:57 hr +/- 60.9 min). A significant number of athletes face poor sleep quality, difficulty falling asleep, and excessive daytime sleepiness. Sleep disruptions are also common around competitions, with post-competition nights showing reductions in total sleep time and sleep quality compared to pre-competition nights. Factors contributing to this include late competition times, heightened physiological and psychological arousal, increased caffeine intake, travel demands and use of technology. Overall, these findings demonstrate that inadequate and disturbed sleep is widespread among athletes, especially during competition periods, which may impact recovery, cognitive function and emotional stability.

DOI: 10.1002/wjs.70558

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Thirty-Day Mortality and Morbidity Outcomes in Abdominal Wall Necrotizing Soft Tissue Infections: The STANMORE Study (2026)

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Type of publication:

Journal article

Author(s):

Balasubaramaniam, Vignesh; Mun Wong, Geoffrey Yuet; Martinino, Alessandro; Sarodaya, Varun; Abulazayem, Mohamed; Wazir, Ishaan; Scarano Pereira, Juan Pablo; Marques, Claudia Neves; Said, Amira; Wadhawan, Himanshu; Graham, Yitka; *Jain, Rajesh Kumar; *Riera, Manel; Mahdi, Ahmed Salah; Ammar, Ahmed Siddique; Mohamed, Aboelazaiem; Alfarwan, Ahmad; Sanli, Ahmet Necati; Aymar, Akilimali; Alkaseek, Akram; Khamees, Almu'atasim; Ouyahia, Amel; Kosti, Angeliki; Dawle, Anjali; Maqbool, Baila; Abdelhadi, Bassem; Parmar, Chetan; Colak, Elif; Erginoz, Ergin; Verras, Georgios-Ioannis; Abd El Hady, Haithm G; Hamdan, Hasan K H; Bakeer, Hibad Bileid; Alhadad, Hoda Salem; Elzayat, Ibrahim; Gerogiannis, Ioannis; Demma, Jonathan Abraham; Al-Shami, Khayry; Shalabi, Laila; Frountzas, Maximos; Manoj, Matthew Antony; Tokocin, Merve; Campanelli, Michela; Omar, Mohammad A; Farag Karamelghani, Mohammed Akasha; Rais, Mounira; Abu Jayyab, Mustafa Ahmad; Allahverdiyeva, Nigar; Gentileschi, Paolo; Abizade, Rashad; Huseynov, Sahib; Das, Aashna; Uludag, Server Sezgin; Cyclewala, Shabnam S; Meric, Serhat; Omarov, Taryel; Bakewell, Zoe Rachael; Singhal, Rishi; Mahawar, Kamal.

Citation:

World Journal of Surgery. 2026 Sep 10.

Abstract:

BACKGROUND: Necrotizing soft tissue infection is a rapidly progressive soft tissue infection with a high mortality rate. Limited contemporary data exist on abdominal wall necrotizing soft tissue infections. This study aimed to assess 30-day mortality and morbidity and identify associated clinical factors.

METHODS: This was a prospective, multinational, multicenter audit of adult patients (>= 18 years) with abdominal wall necrotizing soft tissue infection presenting between January 1 and June 30, 2022. Data on demographics, comorbidities, clinical features, treatment, and outcomes were collected. Univariate and multivariate regression analysis were performed to identify independent risk factors for morbidity and mortality.

RESULTS: A total of 331 patients were included from 63 centers in 27 countries. Thirty-day morbidity and mortality occurred in 200 patients (60.4%), with 47 deaths (14.2%). A LRINEC score >= 6 was observed in 134 out of 263 (51.0%) of cases. Common presenting signs were skin changes in 287 out of 327 cases (87.8%), pain out of proportion to clinical findings in 236 out of 311 cases (75.9%), and gas in soft tissue on imaging 210 out of 329 cases (63.8%). The median time to first antibiotics was 2 hours (Range 0-240 hours). The median time to surgery was 6 hours (Range 1-384 hours). In the mortality group, 29 out of 47 (61.7%) had diabetes, 33 out of 47 (70.2%) had hypertension, and 25 out of 47 (53.2%) had obesity. Bowel resection (38.3%, 18 out of 47), stoma formation (44.7%, 21 out of 47) and ICU admission (89.4%, 42 out of 47) were more common in the mortality group (p < 0.05, OR 7.47). On multivariable analysis, polymicrobial infection (OR 1.73 CI 1.01-2.95) and bowel resection (OR 3.10 CI 1.22-7.88) were independently associated with morbidity, while increasing age (OR 1.04 CI 1.01-1.07), elevated creatinine (OR1 CI 1.00-1.01), bowel resection (OR 7.47 CI 2.99-18.62), and longer time to antibiotics (OR 1.02, CI 1.00-1.04) were independently associated with mortality (p < 0.05).

CONCLUSION: Abdominal wall necrotizing soft tissue infection is associated with high early morbidity and mortality. Delays in recognition and treatment remain critical contributors. Risk stratification may assist early identification and management.

DOI: 10.1002/wjs.70558

Advances in medical and surgical management of Acanthamoeba keratitis: a comprehensive review (2026)

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Type of publication:

Journal article

Author(s):

Azzopardi, Matthew; Chong, Yu Jeat; Smith, Ella P; Barahim, Eman Khalid; *Jenyon, Thomas; Elsheikha, Hany M; Carnt, Nicole; Lakshminarayanan, Rajamani; Mehta, Jodhbir S; Rauz, Saaeha; Ting, Darren S J.

Citation:

Clinical Microbiology Reviews. 39(3):e0027725, 2026 Sep 10.

Abstract:

SUMMARY Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection with rising global incidence, largely driven by increased contact lens use. Management remains challenging due to limited therapeutic options, variable clinical responses, and a lack of standardized treatment guidelines. Diagnosis is frequently delayed because of the non-specific clinical presentation, and early use of topical corticosteroids can exacerbate disease severity and worsen outcomes. The formation of highly drug-resistant cysts in chronic infection further complicates treatment. Currently, prolonged combination therapy with topical biguanides and aromatic diamidines remains the mainstay of treatment. However, recent evidence supports the use of topical biguanide monotherapy (in higher concentrations) in AK with comparable outcomes to combination treatment. Adjunctive therapies, including azoles, miltefosine, and corticosteroids, may be beneficial in refractory disease. Surgical interventions, such as therapeutic keratoplasty, are often required in advanced or non-responsive cases. The choice of therapy is frequently empirical, guided by clinician experience and drug availability. Emerging therapeutic approaches, including antimicrobial peptides, synthetic polymers, bioactive natural compounds, and ultraviolet C therapy, show promise as more effective or better-tolerated alternatives. This review provides an up-to-date overview of current medical and surgical treatments, explores novel interventions in the pipeline, and highlights the need for evidence-based, individualized management strategies in AK.

DOI: 10.1128/cmr.00277-25

Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey (2026)

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Type of publication:

Journal article

Author(s):

*Alawattegama, Lakna Harindi; Al-Saadi, Nina; Bosanquet, David; Chetter, Ian; Fabre, Ismay; Garnham, Andrew; Gwilym, Brenig; Hitchman, Louise; Long, Judith; Magill, Laura; Worrallo, Katie; Pinkney, Thomas; Popplewell, Matthew; Wall, Michael.

Citation:

International Wound Journal. 23(4):e70846, 2026 Apr.

Abstract:

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

DOI: 10.1111/iwj.70846

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Continuous Infusion and Sequential Nephron Blockade Versus Bolus Furosemide in Acute Heart Failure: A Systematic Review (2026)

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Type of publication:

Systematic review

Author(s):

Ahmed Mohamed, Leena Awad Alkareem; *Abozaid, Khalid; Mohammed Ahmed Hassan, Hala Fakhri; Ali, Yasir; Hussein Abdalla, Nibras Elfatih; Ibrahim, Mohamed Samir Yasin; Ahmed Mohammed, Weam Mohammed; Babikir Omer, Ahmed Mohammed; Awad, Alaa.

Citation:

Cureus. 18(6):e111063, 2026 Jun.

Abstract:

Acute heart failure (AHF) is a leading cause of hospitalization worldwide, with congestion as its central pathophysiologic feature. Loop diuretics, particularly furosemide, remain the cornerstone of decongestive therapy, yet the optimal administration strategy, continuous infusion versus bolus dosing, remains debated. Furthermore, sequential nephron blockade through the addition of distal tubule-acting diuretics or sodium-glucose cotransporter-2 (SGLT2) inhibitors has emerged as a strategy to overcome diuretic resistance. This systematic review had two primary objectives: first, to compare continuous infusion versus bolus dosing of furosemide; second, to evaluate the efficacy and safety of adjunctive sequential nephron blockade (SGLT2 inhibitors, thiazides, and acetazolamide) added to loop diuretics within the context of the ongoing debate over optimal decongestion in AHF. A systematic literature search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov for studies published between 2021 and 2025. Eligible studies included randomized controlled trials (RCTs) and prospective observational studies evaluating either continuous furosemide infusion versus bolus furosemide or adjunctive sequential nephron blockade (added to loop diuretics) versus placebo, usual care, or, in one case, an active diuretic comparator. The Cochrane Risk of Bias 2 (RoB 2) tool was used for RCTs, and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used for the nonrandomized study. A narrative synthesis was performed because of substantial clinical and methodological heterogeneity. Ten studies (nine RCTs and one prospective observational study) comprising 2,972 patients were included. Continuous furosemide infusion consistently improved surrogate measures of decongestion (urine output and weight loss) compared with bolus dosing. However, these benefits did not reliably translate into improved symptoms or shorter hospital stays, and one large study reported increased renal injury and adverse events, highlighting a potential efficacy-safety trade-off. Sequential nephron blockade with SGLT2 inhibitors enhanced diuresis with favorable renal and electrolyte safety profiles and a nonsignificant trend toward lower mortality (the studies were not powered for mortality). Thiazide-based strategies achieved potent diuresis but significantly increased the risks of acute kidney injury and electrolyte disturbances without a mortality benefit. Acetazolamide improved decongestion safely but did not reduce mortality or readmissions. No single decongestive strategy is universally superior. However, direct comparisons across strategies are limited by substantial heterogeneity in study design, patient populations (e.g., renal function and congestion severity), and outcome definitions. Continuous furosemide infusion offers enhanced diuresis but inconsistent clinical benefits and potential renal harm. Based largely on surrogate outcomes from heterogeneous studies not designed to detect differences in mortality or readmissions, definitive clinical recommendations remain limited. SGLT2 inhibitors represent a promising but not yet proven adjunct in AHF, pending larger, adequately powered trials. Thiazide-based sequential blockade should be reserved for refractory cases with close monitoring. Treatment should be individualized based on baseline renal function, congestion severity, and electrolyte status.

DOI: 10.7759/cureus.111063

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Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) (2026)

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Type of publication:

Systematic review

Author(s):

Ahad, Amal; Kumar, Sandeep; Kolomar, Hugh; Williams, Jada; Abdallah, Abrar I; Sadeghzadegan, Amirali; *Yateem, Dana; Kharel, Punam; Chowdhury, Dristy; Alnajar, Fahad; Ali, Muqaddas.

Citation:

Cureus. 18(6):e111804, 2026 Jun.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with increasing global prevalence, particularly in newly industrialized countries. Fecal microbiota transplantation (FMT) has worked as an effective therapeutic strategy aimed at restoring immune homeostasis and gut microbial balance. However, a lack of standardized protocols and comprehensive safety data necessitates further evaluation. This meta-analysis aims to comprehensively analyze the efficacy of FMT in inducing clinical remission in UC, incorporating the latest randomized controlled trials (RCTs). A systematic review and meta-analysis of RCTs investigating FMT in UC were conducted. The primary outcomes were clinical and endoscopic remission, while adverse events (AEs) were assessed as secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was analyzed using the I2 statistic and Cochran's Q test. Overall, FMT demonstrated a significant benefit in inducing clinical remission compared with placebo (RR 1.55; 95% CI 1.22-1.96; p = 0.0003). For endoscopic remission, FMT showed a significant overall effect (RR 1.68; 95% CI 1.15-2.46; p = 0.007). The incidence of AEs was comparable between the FMT and control groups (RR 0.88; 95% CI 0.77-1.00; p = 0.06). This meta-analysis gives strong confirmation for the efficacy of FMT in inducing both clinical and endoscopic remission in UC patients, with a favorable safety profile. Multi-donor FMT and oral capsule administration appear to be particularly promising. Future research should focus on standardizing protocols, elucidating mechanisms of action, and conducting larger, long-term trials to optimize FMT for UC.

DOI: 10.7759/cureus.111804

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