Staff Publication

"Hot seat and cold feet": navigating pressurised emergency eye care and exploring the role of OCT / OCTA in acute-onset retinal conditions mimicking optic neuropathy (2025)

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Type of publication:

Conference abstract

Author(s):

*Nayak D.; *Kirtley F.; *Williams K.; *Husain S.;

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2025. Liverpool United Kingdom. 39 (pp 224-225), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction: Sudden loss of vision, especially when accompanied by loss of colour vision, a relative afferent pupillary defect (RAPD), and visual acuity dropping below 6/60, is an alarming symptom that often leads clinicians to suspect optic neuropathy, particularly conditions like Anterior Ischemic Optic Neuropathy (AION) or Posterior Ischemic Optic Neuropathy (PION). However, retinal conditions such as Paracentral Acute Middle Maculopathy (PAMM) and Acute Macular Neuroretinopathy (AMN), especially Type 2 AMN, can present with similar symptoms, causing diagnostic confusion. This poster explores classic findings on Optical Coherence Tomography (OCT) and OCT Angiography (OCTA) along with visual fields that can aid in distinguishing between optic neuropathy and retinal diseases, guiding appropriate management and treatment. Method(s): The study included 10 patients with a mean age of 62 years, ranging from 47 to 75 years, with an equal gender distribution (5 males and 5 females). The average initial visual acuity was 5/60, ranging from 1/60 to 6/60. All patients presented with sudden vision loss, and 9 (90%) had a relative afferent pupillary defect (RAPD). Seven patients (70%) reported loss of colour vision, and many had a history of hypertension, hyperlipidaemia, or were on statins. The initial differential diagnosis included PION in 3 patients, AION in 4 patients, and demyelination in 3 patients. Some patients were treated with high-dose steroids (60 mg/day) for suspected(GCA) or as stroke cases due to vascular risk factors. OCT and OCTA findings revealed characteristic differences between the conditions. Result(s): The final diagnoses confirmed that 4 patients had PAMM, identified by hyperreflective lesions in the inner retinal layers on OCT, particularly in the parafoveal region. 3 patients were diagnosed with AMN, based on outer retinal hyperreflective lesions and macular ischemia identified on OCTA. The remaining 3 patients were diagnosed with optic neuropathy, 2 with PION and 1 with AION, based on OCT and OCTA findings, which did not show the characteristic retinal findings of PAMM or AMN. Regarding treatment, 5 patients were started on high-dose steroids (60 mg/day) for suspected GCA, but there was no significant improvement in the PAMM and AMN patients, where retinal ischaemia, rather than optic nerve ischemia, was the underlying issue. All patients were on statins, with 8 (80%) on increased doses due to hyperlipidaemia, and 7 (70%) were on antihypertensive therapy. Patients diagnosed with PAMM and AMN were managed conservatively with observation and treatment for underlying conditions, such as controlling hypertension and hyperlipidaemia, and did not require systemic steroids or biologics. Follow-up at 6 months showed that 6 out of 7 patients with PAMM and AMN had stable or slightly improved vision, with one patient showing slight worsening but remaining stable overall. Conclusion(s): OCT and OCTA imaging provide critical diagnostic information, revealing characteristic findings of retinal ischemia in PAMM and AMN. High-dose steroids, initially prescribed for suspected giant cell arteritis (GCA) or ischemic optic neuropathies, were ineffective for PAMM and AMN, as these conditions are driven by retinal ischemia rather than optic nerve ischemia. This underscores the importance of accurate diagnosis to avoid unnecessary treatments and potential harm, as steroids can worsen PAMM by increasing blood pressure. Patients with PAMM and AMN, when managed conservatively with observation and treatment for underlying conditions, demonstrated stable or improved visual outcomes. This contrasts with optic neuropathy patients who showed minimal improvement with steroids, highlighting the significance of early differentiation for optimal management. Additionally, this study emphasizes the cost-effectiveness of OCT and OCTA. These imaging techniques provide a less expensive, non-invasive alternative to MRI and CT scans, offering quicker and more accurate diagnoses. By reducing the need for more costly imaging and unnecessary treatments, OCT and OCTA contribute to both improved clinical outcomes and reduced healthcare costs. Therefore, their use in diagnosing acute onset retinal conditions mimicking optic neuropathy can significantly enhance patient care while ensuring cost savings for healthcare systems.

DOI: 10.1038/s41433-025-03831-0

Acute stroke goes viral: cases of young and old stroke secondary to primary varicella zoster infection (2024)

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Type of publication:

Conference abstract

Author(s):

European Stroke Journal. Conference: 10th European Stroke Organisation Conference Abstracts. Basel Switzerland. 9(1 Supplement) (pp 499), 2024. Date of Publication: 01 May 2024.

Citation:

*Kondalkar K.; *Craik S.; *Osineye B.; *Srinivasan M.

Abstract:

Background and aims: Varicella zoster is a documented risk factor for development of ischemic stroke for up to 1 year following infection. Multiple cases of stroke following zoster reactivation have been reported previously. Here we outline two admissions to our ward in 2023 in which a stroke developed following primary zoster infection. Method(s): An 18 year old woman was admitted with right hand numbness, speech disturbance and headache. A CT angiogram revealed occlusion of the left middle cerebral artery. She was treated with dual antiplatelets. A lumbar puncture was performed and cerebrospinal fluid was positive for Varicella zoster. On further history the patient revealed she had chicken pox 3 months prior. She was treated with intravenous aciclovir and discharged with her neurological symptoms largely resolved. Result(s): A 75 year old male with a background of Non-Hodgkin lymphoma was admitted with acute confusion and right sided weakness and high fever. Examination also revealed a rash to the torso and head. CT revealed an area of low attenuation in the right basal ganglia, MRI revealed multiple bilateral infarctions. Lumbar puncture was performed due to suspected encephalitis and PCR was positive for Varicella zoster. The patient was treated with intravenous aciclovir however suffered a drop in consiousness. A repeat CT revealed catastrophic intracerebral bleed extending into the ventricles. The patient received palliative care and died one day later. Conclusion(s): Varicella zoster infection is an important risk factor for stroke in both younger and older adults and should be considered in unusual presentations.

DOI: 10.1177/23969873241245672

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External validation of the novel prognostic Meet-URO score in Metastatic Renal Cell Carcinoma on First Line Immune-combination therapy (2024)

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Type of publication:

Conference abstract

Author(s):

Ghose A.; Signori A.; Brown N.; Haywood S.; Tapia J.; Vijay A.; Cheung M.; Mahajan I.; Fiala O.; Abrol R.; Chauhan V.; Soe Y.S.Y.; Zargham A.; Ashley S.; Smith M.; Hardy O.; Johnston E.; Sarwer A.; Tun K.K.; Challapalli A.; Shrestha R.; Urun Y.; *Meegan J.; Rescigno P.; Parkes J.; Smalley B.; Anpalakhan S.; Buono F.; Poprach A.; Teoh J.Y.C.; Murianni V.; Catalano F.; Bimbatti D.; Buti S.; Fornarini G.; Banna G.; Rebuzzi S.E.

Citation:

Therapeutic Advances in Urology. Conference: Second International Urology Cancer Summit. Portsmouth United Kingdom. 16 (pp 13-14), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Objective: First-line immune-combination therapy based on immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) are the new mainstay in metastatic renal cell cancer (mRCC). In this setting, there is a dearth of standard prognostic/predictive parameters to guide treatment choice. The novel prognostic Meet-URO score (IMDC score + bone metastases and neutrophil-to-lymphocyte ratio – NLR) showed a higher prognostic accuracy than IMDC in 306 patients on first-line nivolumab + ipilimumab in the Italian Expanded Access Program (PMID: 36493602). Hence, the necessity to externally validate and expand to other first-line immune-combination settings. Method(s): Twenty-seven European centres were included. Baseline patient and tumour characteristics were collected, including the IMDC score along with the presence of pre-treatment bone metastases, neutrophils, and lymphocytes for calculating the Meet-URO score. The prognostic performance of Meet-URO and IMDC scores were compared and defined by the Harrell's c-index. Result(s): 1174 mRCC patient data was retrospectively collected. The median age was 64. 72.8% were male, 54.2% received nephrectomy, 62% were metastatic at diagnosis and 86.7% had clear-cell histology. 35% had bone metastases and 51.6% had NLR >= 3.2. 672 (57.2%) patients received ICI-ICI (nivolumab + ipilimumab) whereas 502 (42.8%) an ICI-TKI combination, mainly avelumab + axitinib (27.1%) and pembrolizumab + lenvatinib (14.3%). Overall, median overall survival (mOS) was 36.2 months (95% CI 31.1 – 38.5) with a median follow up of 15.5 months. The c-index of Meet-URO resulted higher than IMDC score (0.68 vs 0.65). In particular, the mOS resulted more distinctive within the Meet-URO prognostic groups: 45.8 months for group 1 (12.9% of patients), 55.0 for group 2 (25.7%), 38.1 for group 3 (23.5%), 20.9 months for group 4 (29.6%) and 10.4 for group 5 (8.2%). On the other hand, mOS was 45.8 months for IMDC favorable-risk (19.5% of patients), 38.2 for intermediate-risk (53.7%) and 16.2 for poor-risk (26.8%). Conclusion(s): In this large-scale real-world external validation analysis on mRCC patients receiving first-line immune-combinations, Meet-URO confirmed higher prognostic accuracy compared to IMDC. A further validation is planned in the ongoing Italian prospective Meet-URO 33 (REGAL) study (PMID: 38914928).

DOI: 10.1177/17562872241277067

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Evaluation of the Impact of an Emergency Focused Ophthalmology Teaching Course on the Confidence of Emergency Doctors (2024)

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Type of publication:

Conference abstract

Author(s):

*Mahon E.J.E.; *Ahnood D.

Citation:

Eye (Basingstoke). Conference: The Royal College of Ophthalmologists Annual Congress 2024. Belfast United Kingdom. 38 (pp 142), 2024. Date of Publication: 01 Nov 2024.

Abstract:

Introduction: It has been established that doctors in Accident and Emergency (A&E) departments have minimal confidence in managing ophthalmic presentations (Murray, P., et al. Eye 2016; https://doi.org/10.1038/eye.2016.99). The lack of confidence to accurately assess and manage patients presenting to A&E will likely have an impact on the quality of patient management and the quality of referrals made to eye casualties. We hypothesize that a teaching course covering core emergency ophthalmic examination and management skills will improve attendees' confidence in these areas. Method(s): Doctors currently or potentially working in A&E were invited to attend a teaching session where they would rotate between three stations which included slit lamp examination, simulation of foreign body removal and managing chemical eye injury. Teaching was delivered in small groups, with experienced staff leading the sessions. Pre-and post-course questionnaires included a 1-5 Likert scale self-assessment confidence rating on the three areas of teaching and overall confidence. Result(s): The course was attended by 13 doctors, with 46% of attendees being junior emergency specialty trainees or trainee equivalents, 38% were foundation doctors and 15% were A&E staff grade doctors equivalent to registrar. 92% of those who attended reported less than one hour of slit lamp examination time. Overall, the attendees' overall confidence went from 1.9 to 4.2 on the Likert scale. Conclusion(s): Our findings demonstrate a lack of confidence from the A&E doctors in assessing patients presenting with ophthalmic issues, with an overall confidence score of

DOI: 10.1038/s41433-024-03254-3

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intra-Peritoneal Gallstone Leading to Chronic Sinus Formation Following Laparoscopic Cholecystectomy and Common Bile Duct Exploration - Rare Case Report (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.; *Parampalli U.; *Pattar J.;

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii23-xvii24), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: Dropped gallstones can be a common occurrence during laparoscopic cholecystectomy. However, only 3% patients develop abscess secondary to intra-peritoneal spilled gallstone. We report the case of a 41-year-old woman who suffered with persistent intra-abdominal collections and sinus tract discharge following laparoscopic cholecystectomy. Case Presentation: Our patient originally underwent elective laparoscopic cholecystectomy and common bile duct (CBD) exploration for CBD stones. Two weeks later, she underwent incision and drainage procedure for port site abscess. Three years later, she re-presents with right upper quadrant pain, discharge through the umbilical wound and raised inflammatory markers. Computed Tomography (CT) scan revealed a collection postero-lateral to the right lobe of the liver, which was then drained through interventional radiology. Despite drainage, patient re-attends with recurrence of pain, a repeat CT scan confirmed a persistent peri-hepatic collection likely secondary to retained intra-peritoneal gallstone. Patient underwent diagnostic laparoscopy, in which, the collection was tracked by flushing radiological drain and then the stone was retrieved. Patient recovered well. Discussion(s): Diagnosis of an intra-peritoneal gallstone following cholecystectomy and CBD exploration can be hampered by unusual clinical presentations, radiologically occult nature of stones and the vast area they can settle into. Whilst rare, retained intra-peritoneal gallstones have the potential to cause economic burden to the health service, in addition to, the physical and psychological impact on the patient. Our case demonstrates that it is imperative to be meticulous in clearance of bile and stone spillage all cases of cholecystectomy with CBD exploration.

DOI: 10.1093/bjs/znaf270.088

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Interventions to preserve beta cell function in patients with newly diagnosed type 1 diabetes: An updated descriptive analysis of time trends in randomised controlled trials (RCTs) identified in a systematic review (2025)

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Type of publication:

Conference abstract

Author(s):

Beese S.E.; Gerard C.; Narendran P.; Price M.J.; Quinn L.; Gada R.; *Horgan T.J.; Andrews R.C.; Moore D.J.; Tomlinson C.; Sharma P.; Harris I.M.; Adriano A.; Maggs F.; Burrows M.;

Citation:

Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Aims: In newly diagnosed type 1 diabetes, residual beta cell function (indicated by c-peptide) is associated with improved glucose control and reduced long-term complications. We assessed time trends in RCTs of categories of interventions for beta cell preservation in newly diagnosed type 1 diabetes. Method(s): RCTs of any intervention for newly diagnosed type 1 diabetes measuring c-peptide were identified in Cochrane CENTRAL, MEDLINE, Embase and trials registries (to July 2024). Trends in trial characteristics were assessed, focusing on types of intervention. Result(s): The 171 completed published trials were distributed across non-antigen-specific (NAS) immunomodulatory therapies (n = 60, 33%), vitamins (n = 23, 13%), antigen-specific immunotherapies (n = 20, 11%), interventions to maintain glucose control (n = 38, 21%) and 'other' interventions (n = 39, 22%). A further 102 ongoing/ unpublished trials were included. Over 40 years, RCT frequency has increased, with 54 trials published between 2011 and 2020 and 39 since 2021. Twenty-four ongoing trials of 'other' interventions and 19 NAS trials have been initiated since 2021. Average sample size per trial has increased from 63 (SD 66) prior to 2014 to 83 (SD 110) in the last 10 years. Taking the NAS group as an example, time from completion of data collection to publication has increased. Trials with significant primary endpoint results are published 6 months quicker than non-significant findings (mean 17.6 vs 23 months). The number of NAS trials with significant results has risen from 40% (13/33) to 61% (16/26). Conclusion(s): RCTs of therapies to preserve beta cells are increasing in frequency with greater focus on NAS interventions and therapies not easily fitting standard categories. Significant findings may be published sooner.

DOI: 10.1111/dme.15498

Pulmonary Embolism and Myocardial Infarction With Non-obstructive Coronary Arteries in Immune Thrombocytopenia: Unmasking Underlying Antiphospholipid Syndrome (2026)

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Type of publication:

Journal article

Author(s):

*Shahzeb, Muhammad; Naeem, Faiqa Jabeen; *Naz, Kiran; *Irfan, Muhammad; *Ahmad, Nawaid; Rafiq, Nawal; Ul Haq, Ijaz.

Citation:

Cureus. 18(1):e100731, 2026 Jan.

Abstract:

This case report presents the clinical scenario of a 35-year-old male patient who experienced chest pain due to a combination of pulmonary embolism (PE) and myocardial infarction with non-obstructive coronary arteries (MINOCA), concurrently while undergoing treatment with avatrombopag for immune thrombocytopenia (ITP). His investigations included a CT pulmonary angiogram that confirmed a PE, a coronary angiography which was normal, a cardiac MRI which showed evidence of subendocardial infarct, and a CT coronary angiogram, which was normal. His unique presentation with these findings prompted further investigations, which revealed an undiagnosed antiphospholipid syndrome (APS) alongside a patent foramen ovale (PFO). Hence, the paradoxical thrombotic incidents were precipitated by this unique diagnosis. After establishing the diagnosis, our patient was commenced on warfarin, and his treatment protocol for ITP was changed to a different drug. He remains under haematology follow-up.

DOI: 10.7759/cureus.100731

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292