Staff Publication

Bronchiolitis Obliterans in an Adult Male After Admission With Panton-Valentine Leucocidin Staphylococcal Pneumonia (2025)

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Type of publication:

Journal article

Author(s):

*Nadeem, Sabha; *Sargent, Georgina; *Wood, Gordon; *Ahmad, Nawaid.

Citation:

Cureus. 17(9):e91611, 2025 Sep.

Abstract:

A middle-aged man with no smoking or respiratory history presented with shortness of breath and facial swelling due to influenza. His condition deteriorated rapidly, and he required intensive care admission and intubation. He was found to have Panton-Valentine leucocidin (PVL) Staphylococcal pneumonia, with bilateral pneumothorax and subcutaneous emphysema. He responded well to antibiotics and chest drainage and was subsequently discharged. His follow-up radiology initially showed almost complete resolution. However, over the course of five years, he had multiple GP attendances and hospital admissions for recurrent infections with continued breathlessness on exertion. A follow-up CT suggested features of bronchiolitis obliterans (BO), which has not been previously recognised as associated with PVL Staphylococcal infections. Specialist teams have suggested active observation with consideration of transplantation in the event of deterioration. This case demonstrates that BO can be seen with previously unrecognised infectious aetiology and should be considered in any patient with appropriate symptomatology following a severe respiratory infection.

DOI: 10.7759/cureus.91611

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CT coronary angiography in the lipid clinic: a pilot study and lipidologist survey (2025)

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Type of publication:

Journal article

Author(s):

Graby, John; Sellek, James; Khavandi, Ali; Thompson, Dylan; Loughborough, Will W; Hudson, Benjamin J; Avades, Tony; Mbagaya, Wycliffe; Luva, Ahai; *Capps, Nigel; Shirodaria, Cheerag; Bayly, Graham; Antoniades, Charalambos; Downie, Paul F; Rodrigues, Jonathan C L.

Citation:

The International Journal of Cardiovascular Imaging. 2025 Oct 09. [epub ahead of print]

Abstract:

Guidelines recommend considering coronary calcium score (CCS) in asymptomatic patients to aid risk stratification. However, calcification occurs late in atherosclerosis. Coronary CT angiography (CCTA) can detect non-calcific plaque and inflammation before calcification develops, but impact on clinical management is not well documented. We compare coronary artery disease (CAD) detection and grading between CCS and CCTA, impact on management, and explore CCTA-derived inflammation biomarker (pericoronary fat attenuation index [FAI]) in the lipid clinic. Exploratory analysis of a prospectively maintained database of lipid clinic patients with CCS and CCTA (2018-2020). CCS grade was compared with CCTA stenosis, presence of high-risk plaque (HRP) and FAI-score analysis. UK Consultant Lipidologists completed an anonymised survey, documenting lipid target and management after sequential unblinding of CCS and CCTA data. In 45 asymptomatic patients (49% female, mean age 55 +/- 9), CCTA re-classified CAD presence in 22% (p = 0.002) and severity in 62% (p = 0.005) vs. CCS. HRP was observed in 20% (9/45), including 56% with CCS <= 100. Median LDL target with clinical vignette was 101 mg/dL (IQR 77-120), reducing to 89 mg/dL (77-120) after CCS, and 77 mg/dL (70-116) after CCTA unblinding. CCS altered LDL target in 12%, and CCTA a further 19% (chi2 57.0, p < 0.005). High FAI-score was demonstrated in 20%, including 22% of those with CCS <= 100 and 75% of those with <= mild CAD on CCTA. CCTA increased CAD prevalence and re-classified severity versus CCS, altering hypothetical management. High FAI-scores were observed across CCS and CCTA severity grades, including patients with no overt CAD.

DOI: 10.1007/s10554-025-03526-3

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Postoperative Outcomes of the Desarda Technique Versus Lichtenstein Mesh Repair for Inguinal Hernias: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Journal article

Author(s):

*Saeed, Jahanzaib; Jamal, Zohaib; Siddiqui, Asher; Muawaz, Muhammad; Saeed, Talha; *Jain, Rajesh K.

Citation:

Cureus. 17(9):e91388, 2025 Sep.

Abstract:

Inguinal hernias represent a prevalent surgical condition worldwide and constitute a significant proportion of elective general surgical procedures. While the Lichtenstein mesh repair has become the standard technique due to its tension-free approach, it is associated with several mesh-related complications, including chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. To overcome these limitations, the Desarda technique was developed as a tissue-based, mesh-free alternative that reinforces the posterior wall of the inguinal canal using a strip of the external oblique aponeurosis. This systematic review compares postoperative complications between the Lichtenstein mesh repair and Desarda techniques to inform best practices in inguinal hernia repair. This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across PubMed, Cochrane Library, Excerpta Medica database (EMBASE), Emcare, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Ovid, without language or date restrictions. Randomized controlled trials (RCTs) comparing Desarda and Lichtenstein mesh repair for primary inguinal hernia in adults were included. Data on postoperative complications were independently extracted by two reviewers. Risk of bias was assessed using the Risk of Bias 2 (ROB 2) tool (The Cochrane Collaboration, London, United Kingdom). Statistical analysis was performed using RevMan 5.4 (The Cochrane Collaboration, 2020), with risk ratios (RR) and 95% confidence intervals (CI) calculated for binary outcomes. Heterogeneity was assessed using the chi-square and I2 statistics. A total of 23 RCTs were included, comprising 2,425 patients, 1,201 of whom underwent the Desarda repair and 1,233 who underwent Lichtenstein mesh repair. The Desarda technique was associated with significantly lower rates of scrotal edema (RR = 0.52, 95% CI: 0.34-0.78, p = 0.002), seroma formation (RR = 0.68, 95% CI: 0.47-0.99, p = 0.04), foreign body sensation (RR = 0.61, 95% CI: 0.42-0.88, p = 0.009), and chronic postoperative pain (RR = 0.26, 95% CI: 0.15-0.45, p < 0.00001). While the Desarda group also showed lower rates of recurrence, wound infection, wound hematoma, and loss of sensation, these differences were not statistically significant and should be interpreted with caution. The findings suggest that the Desarda technique may be preferable to the Lichtenstein mesh repair for primary inguinal hernia, as it is associated with significantly lower rates of chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. Although other complications, such as loss of sensation, recurrence, wound infection, and hematoma, were also less frequent with the Desarda technique, these differences were not statistically significant. Overall, the outcomes were largely comparable.

DOI: 10.7759/cureus.91388

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Emergency management of anaphylaxis and the impact of the new UK ALS guidelines (2025)

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Type of publication:

Journal article

Author(s):

*Elshehawy, Mahmoud; Kadambi, Madhavi; Hughes, Deborah; Clarke, Daniel; Cooper, Angela; Inani, Mohit; Goktas, Polat; Goddard, Sarah; Diwakar, Lavanya.

Citation:

Clinical Medicine. 100519, 2025 Sep 30. [epub ahead of print]

Abstract:

BACKGROUND: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its Advanced Life Support (ALS) guidelines for anaphylaxis in 2021, emphasizing early and repeated adrenaline administration, IV fluid use, and reduced reliance on antihistamines and steroids.

METHODS: A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH) before (2018) and after (2022/23) the ALS guideline implementation.
Adherence to NICE anaphylaxis guidance was also assessed.

RESULTS: Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centers. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations.

CONCLUSION: Anaphylaxis management in these centers has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor.

DOI: 10.1016/j.clinme.2025.100519

Pertussis Infection in Children QIP: Raising Awareness Amongst Clinicians (2025)

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Type of publication:

Conference abstract

Author(s):

*Khallaf L.; *Muniu S.; *Sakremath R.; *Lee S.

Citation:

Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A301-A302), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Why did you do this work? Pertussis is a highly infectious preventable disease caused by Bordetella pertussis. Young infants under 3 months of age remain at the highest risk of severe disease with 9 reported infant deaths this year in the United Kingdom.1 We aim to raise awareness about pertussis infection among clinicians in our Paediatric Department through education. What did you do? Educational sessions were delivered from February to March 2024. Data was collected using pre- and post-session questionnaires to assess clinician's knowledge. The questionnaire included symptoms, signs, management and complications of pertussis infection. A teaching presentation was given in the first cycle. In the second cycle, an informative poster was displayed throughout our department. Data was collected and analysed using Microsoft Excel. The effectiveness of the education tool delivered was evaluated. What did you find? There were 11 participants in the first cycle and 9 in the second cycle. All participants in cycle 1 understood pertussis infection and its complications and recognised the importance of exclusion from nursery/school. In cycle 2, all demonstrated knowledge of pertussis symptoms and knew it was a notifiable disease. In the first cycle, many participants, 63% (7 out of 11 participants), were unaware of the process for requesting a pertussis test in our department, which improved slightly to 55% (5 out of 9 participants) in the second cycle. Additionally, the rate of incorrect responses decreased between cycles for several topics: the incubation period of pertussis (54.5% in cycle 1 versus 33% in cycle 2), the appropriate timing for requesting the test (18% versus 11%), and knowledge of first-line antibiotics (36% versus 22%). The rate of incorrect responses increased between cycle 1 and cycle 2, rising from 27% to 33% for the need of prophylaxis treatment and 27% to 44% for the exclusion of asymptomatic contacts. Despite interventions, knowledge of the latter showed no improvement between the two cycles. Following cycle 1, significant improvements were noted, with 100% correct responses for how to request a pertussis test, appropriate timing for ordering the tests, and the incubation period. Both cycles demonstrated improvement as all participants knew the first-line antibiotic treatment for pertussis. What does it mean? Although our sample size was small, our project showed that the overall knowledge of our clinicians improved in the 2 cycles. Ongoing education is needed to improve awareness of pertussis infection, especially during the winter months.

DOI: 10.1136/archdischild-2025-rcpch.413

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Viral Haemorrhagic Fevers: Preparation for the Next Pandemic? (2025)

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Type of publication:

Conference abstract

Author(s):

*Moumneh R.; McMonnies K.; Johnston V.; Eisen S.

Citation:

Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A123-A124), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Why did you do this work? Multiple viral haemorrhagic fevers (VHFs) are classified as high consequence infections due to high mortality and potential for human-to-human transmission. 1 To aid early identification and prevent outbreaks, our hospital has designed an electronic screening tool to be used at triage in our emergency department (ED) to identify patients presenting with fever within 21days of travel to a VHF endemic country. This study aimed to evaluate if this electronic triage tool was being used appropriately in our Paediatric ED to support early identification and appropriate management of children at risk of VHF. What did you do? A random sample of 50 children (<18 years) presenting to our central London acute hospital with current or recent history of fever (>37.5oC) between March – May 2024 had their electronic health care records reviewed (EPIC ©) to evaluate if the electronic triage tool was being used. A data extract of where the triage tool had been used in EPIC between January – March 2024 was used to identify children at risk of VHF; case notes were then reviewed for evidence of appropriate isolation and escalation. All data were anonymised and analysed using Microsoft ExcelTM. What did you find? The triage tool was used correctly in 32/ 50 febrile children (64%). The triage tool was not used in 6 cases (12%) and used incorrectly (not fully completed or incorrect information included) in 12 cases (24%). 47 children were identified in the triage tool as at risk of VHF (fever within 21days of travel to VHF endemic country). There was no evidence of consideration of VHF, isolation or escalation in any of these cases. What does this mean? Early identification of cases is key to preventing healthcare associated outbreaks, protecting both staff and patients. The current implementation of the VHF triage tool in our Paediatric ED has not been shown to assist with this early identification. The VHF triage tool was frequently not used or incorrectly completed. Even when used, identification of VHF risk did not result in appropriate isolation or escalation of children at risk of VHF. One explanation for this might be the increased number of presentations of 'fever in the returning traveller' in the paediatric population therefore the triage tool is seen as unnecessary additional workload, or the significance of high consequence infections is not considered. Following this study, we developed a paediatric specific quick reference guide for conducting VHF risk assessments and to guide early management of children 'at risk' of VHF. Multidisciplinary departmental teaching has resulted in a positive impact on staff confidence in use of the tool and in responding to identification of VHF risk (evaluation in full write-up). We plan to re-audit the use of the triage tool and subsequent management once established.

DOI: 10.1136/archdischild-2025-rcpch.166

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A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients? (2025)

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Type of publication:

Systematic Review

Author(s):

Shahid, Muhammad Salman; Ahmed, Nouman; Kamal, Zeeshan; Nathaniel, Laibah; Singla, Bhavna; Singla, Shivam; Kumawat, Sunita; Batool, Munaza; *Ekomwereren, Osatohanmwen; Anika, Nabila N; Sahil, Muhammad.

Citation:

Cureus. 17(8):e90888, 2025 Aug.

Abstract:

Proton pump inhibitors (PPIs) are widely prescribed in older adults, often beyond recommended durations, raising concerns about nutrient depletion. This systematic review examined the impact of long-term PPI use (>=6 months) on micronutrient status in older adults receiving polypharmacy. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) identified five eligible studies, including 693 participants. Results showed a 12-18% reduction in serum vitamin B12 over 12 months of PPI use. Calcium and parathyroid hormone levels declined significantly in a 12-month cohort, while bone turnover markers increased despite stable bone mineral density. Findings for magnesium were inconsistent, with results ranging from no change after 12 months to pharmacokinetic alterations without systemic depletion. Overall, the evidence consistently supports an association between prolonged PPI therapy and reductions in vitamin B12 and calcium, with conflicting results for magnesium. These deficiencies may contribute to cognitive decline, bone fragility, and increased fall risk in older adults. Routine nutritional monitoring, targeted supplementation, and deprescribing where appropriate should be considered to mitigate these risks, while further large-scale trials are needed in frail geriatric populations.

DOI: 10.7759/cureus.90888

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Anaesthetic management of colorectal surgery in a patient with chronic pericardial effusion (2025)

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Type of publication:

Journal article

Author(s):

*Ahmad, E; *Liu, H S; *Miller, A.

Citation:

Anaesthesia Reports. 13(2):e70031, 2025 Jul-Dec.

Abstract:

Chronic pericardial effusions are a peri-operative challenge as anaesthesia and surgery can precipitate haemodynamic compromise. Guidance for managing patients requiring time-sensitive non-cardiac surgery in this setting is limited. We report the case of a 43-year-old woman with a moderate chronic, asymptomatic pericardial effusion scheduled for robotic anterior resection of rectal cancer. The principal challenge was balancing the need for time-sensitive oncological surgery against the risk of haemodynamic compromise in the context of suboptimal pre-operative cardiology assessment. Surgery proceeded after multidisciplinary discussion, with pre-emptive vasopressor support and intra-operative transoesophageal echocardiography monitoring to guide management. The peri-operative course was stable, and the patient was discharged on postoperative day 4. Two months later, she required pericardial window formation for a persistent effusion which had become symptomatic. This case illustrates that non-cardiac surgery in chronic, asymptomatic pericardial effusion can be performed safely when guided by physiological reasoning, real-time echocardiography and multidisciplinary planning.

DOI: 10.1002/anr3.70031

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Patient-Reported Importance of Functional Benefit in Geographic Atrophy (2025)

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Type of publication:

Journal article

Author(s):

Dinah, Christiana; Enoch, Jamie; Ghulakhszian, Arevik; Sekhon, Mandeep; Salvatore, Serena; DeSalvo, Gabriella; Kumar, Praveen; Banerjee, Sanjiv; *Nayak, Devaki; Amoaku, Winfried; Shiew, Marianne; Osoba, Olayinka; Crabb, David P; Taylor, Deanna J.

Citation:

JAMA Ophthalmology. 2025 Sep 25. [epub ahead of print]

Abstract:

Importance: Intravitreal complement inhibitors injections (IVCIs) slowed progression of geographic atrophy (GA) lesions in several registration phase 3 trials although without benefit for prespecified secondary functional vision outcomes. Patient acceptability of these therapies needs further exploration.

Objective: To quantify the acceptability of IVCI therapy to United Kingdom patients with GA, assuming vision outcome benefits are expected.

Design, Setting, and Participants: This cross-sectional study took place at 9 geographically dispersed UK National Health Service centers from April 2023 to April 2024 among 153 participants with treatment-naive GA in at least 1 eye.

Exposures: GA in at least 1 eye.

Main Outcomes and Measures: Main outcomes were (1) acceptability of IVCI therapy based on completion of validated acceptability questionnaire. Participants were provided with a treatment information leaflet coproduced by a patients with lived experience of GA to inform them about the risks and benefits of IVCI for GA, assuming there were vision outcome benefits to this treatment and (2) response to the EuroQol 5-dimension with a vision bolt-on questionnaire to assess general health and vision-related quality of life. Spearman rank correlations and chi2 tests were used to explore associations between acceptability levels and specific ocular and sociodemographic characteristics.

Results: A total of 153 participants were recruited (93 [60%] women; mean [SD] age, 82 [7]), 57 (38%) of whom had bilateral foveal involvement. Median (IQR) visual acuity with habitual correction in the better-seeing eye and in eyes where neither eye was better or worse was logMAR, 0.30 (0.14-0.54; approximate Snellen equivalent, 20/40) and 0.47 (0.14-0.84; approximate Snellen equivalent, 20/63), respectively. Among the 153 participants, 81 (53%; 95% CI, 45-61) reported IVCIs were very much or extremely acceptable under the theoretical scenarios provided. The proportion finding IVCIs acceptable rose to 82% (95% CI, 76-88) when including those who rated prospective treatment as moderately acceptable. Belief in the perceived effectiveness of the treatment (rho, 0.52; 95% CI, 0.40-0.63; P < .001) and confidence in their ability to attend the eye clinic regularly (rho, 0.51; 95% CI, 0.38-0.62; P < .001) correlated with overall acceptability.

Conclusions and Relevance: IVCI therapy for GA may be acceptable to most UK patients with GA under the assumption that there are vision outcome benefits to this treatment. While current treatments do not result in vision outcome benefits, perceived effectiveness by patients was associated with acceptability, emphasizing the desire to quantify vision functional benefit concomitant with anatomical slowing of progression.

DOI: 10.1001/jamaophthalmol.2025.3264

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A Literature Review Assessing Whether the Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Increases the Risk of Cardiovascular Events (2025)

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Type of publication:

Journal article

Author(s):

*Ahsan, Ammar; Sahu, Muhammad Arham.

Citation:

Cureus. 17(9):e92361, 2025 Sep.

Abstract:

Non-steroidal anti-inflammatory drugs (NSAIDs) are very useful due to their multiple properties, including analgesic, antipyretic, and anti-inflammatory effects. As a result, NSAIDs have become one of the most widely administered drugs in the world. The proposed function of this drug was to act like a steroid without its harmful and common side effects. However, like any other medication, NSAIDs come with their own set of side effects, notably their gastrointestinal and cardiovascular effects. With these known side effects and its ease of availability, it is concerning, and therefore further research was required to determine if there is a significant risk of cardiovascular events associated with NSAIDs. Guideline searches were performed using the following databases: National Institute for Health and Care Excellence (NICE), TRIP, SIGN, and AHRQ, which produced 22 results; however, after screening, only one guideline was included in this review. A literature search for systematic reviews was conducted using the following databases: MEDLINE, Cochrane, and PubMed, which yielded 711 results. However, after full screening, only three systematic reviews were included. The National Institute for Health and Care Excellence (NICE) guidelines are a source of evidence-based recommendations made for healthcare professionals in the diagnosis and management of their patients. The NICE guideline focusing on NSAIDs provides advice regarding the prescription of NSAIDs, including contraindications, dosage, and mechanism of action. Three systematic reviews assessed NSAIDs and their cardiovascular effects. All three systematic reviews found an association between NSAIDs and their cardiovascular effects with varying degrees of strength. In conclusion, this review demonstrates evidence of the cardiovascular side effects related to the use of NSAIDs and raises questions about an increase in events, such as stroke, myocardial infarction, and hypertension. Evaluating the systematic reviews, it was essential to determine whether there was a statistically significant risk of cardiovascular events. All three papers suggested a linked increase in cardiovascular events; however, further research is required in order to understand which specific NSAIDs cause this. As a result, guideline alterations may need to be followed.

DOI: 10.7759/cureus.92361

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