Staff Publication

Hyponatraemia Induced by Terlipressin in Patients Diagnosed with Decompensated Liver Cirrhosis and Acute Variceal Bleeding (2025)

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Type of publication:

Journal article

Author(s):

*Elshehawy, Mahmoud; *Panicker, Richel Merin; Abdelgawad, Alaa Amr; Ball, Patrick Anthony; Morrissey, Hana.

Citation:

Medicines. 12(2), 2025 Mar 28.

Abstract:

Background: Hyponatraemia is a rare but potentially life-threatening complication of terlipressin therapy. Case history: In the current case, a 39-year-old female with decompensated liver cirrhosis (Child-Pugh C) and acute variceal bleeding experienced a precipitous decline in serum sodium-from 136 mmol/L to 115 mmol/L-within 48 h of initiating terlipressin therapy. This was accompanied by marked fluid retention, reduced urine output, and symptoms of confusion and agitation. Laboratory tests confirmed dilutional hyponatraemia, characterized by urinary sodium <20 mmol/L and urine osmolality <100 mOsm/kg, indicating excessive free water reabsorption. Outcomes: The prompt discontinuation of terlipressin, fluid restriction and the cautious administration of hypertonic sodium chloride solution (2.7% NaCl) achieved a gradual normalization of sodium levels and resolution of symptoms. Fluid balance monitoring revealed a marked diuretic response following terlipressin cessation. This case aligns with existing reports, emphasizing the dual vasopressin receptor activity of terlipressin and its capacity to induce hyponatraemia, particularly in cirrhotic patients with preserved renal function and higher baseline sodium levels. Conclusions: This case and a literature review underscored the critical need for early fluid balance monitoring to detect retention. This case highlights the importance of individualized risk assessment, multidisciplinary management, and vigilant sodium correction to avoid complications. Practical recommendations are outlined to aid clinicians in the recognition and management of terlipressin-induced hyponatraemia.

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A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin (2025)

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Type of publication:

Journal article

Author(s):

Brar, Gurjasan; Dhaliwal, Anoop; Brar, Anupjot S; Sreedevi, Manasa; *Ahmadi, Yasmin; Irfan, *Muhammad; Golbari, Rebecca; Zumarraga, Daniela; *Yateem, Dana; Lysak, Yuliya; Abarca-Pineda, Yozahandy A.

Citation:

Cureus. 17(3):e81109, 2025 Mar.

Abstract:

Ultraviolet (UV) radiation significantly contributes to photoaging, with its effects varying among different Fitzpatrick skin types. Light skin (Types I-III) has a natural sun protection factor (SPF) of only 3.3, making it particularly vulnerable to DNA damage, collagen degradation, and skin cancer. Darker skin (Types IV-VI) has a natural SPF of 13.4, providing greater photoprotection while elevating the risk of post-inflammatory hyperpigmentation and delaying skin cancer diagnosis. UVA penetrates deep into the dermis, promoting collagen degradation, whereas UVB causes DNA mutations, increasing the risk of cancer. Eumelanin in darker skin mitigates oxidative stress, while pheomelanin in lighter skin functions as a pro-oxidant, increasing vulnerability to photoaging. Although incidence rates are lower, melanoma is identified at more advanced stages in those with darker skin, resulting in poorer outcomes. Protective measures, such as broad-spectrum sunscreens, antioxidants, and hydration, are crucial for all skin types but necessitate customized strategies. Individuals with lighter skin benefit from SPF 50+ and DNA-repairing compounds, whereas those with darker complexion necessitate SPF 30-50 and pigmentation-focused skincare. Comprehending the biological mechanisms and variations in UV damage facilitates the creation of customized photoprotection solutions, enhancing skin health and mitigating long-term UV-related issues for all skin types.

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Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair (2025)

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Type of publication:

Journal article

Author(s):

Lopes, Ronny; Freiha, Kinan; *Carmont, Michael R; Valentin, Eugenie; Alvino, Kylian; Mousa, Mohamed; Rauline, Gauthier; Fourchet, Francois; Picot, Brice; Hardy, Alexandre.

Citation:

American Journal of Sports Medicine. 2025 Apr 22.[epub ahead of print]

Abstract:

BACKGROUND: The Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.

PURPOSE/HYPOTHESIS: The main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: This was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.

RESULTS: A total of 50 patients (24 women and 26 men), with a mean age of 38.3 +/- 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 +/- 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.

CONCLUSION: The Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient's psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.

Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England (2025)

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Type of publication:

Journal article

Author(s):

Dawes, Mindy; Packman, Zoe; McDonald, Ruth A; *Cheetham, Mark J; Gallagher-Ball, Nannette M T; Warwick, Eleanor; Oyston, Maria; McCone, Emma; Snowden, Chris; Swart, Michael; Briggs, Tim W R; Gray, William K.

Citation:

British Journal of Anaesthesia. 2025 Apr 22.

Abstract:

BACKGROUND: Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS: This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >=17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS: Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS: We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

Exploring the prevalence and risk factors of adolescent mental health issues in the COVID and post-COVID era in the U.K.: a systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

Nwabueze K.K.; Akubue N.; Onakoya A.; Okolieze S.C.; Otaniyen-Igbinoba I.J.; Chukwunonye C.; *Okengwu C.G.; Ige T.; Alao O.J.; Adindu K.N.;

Citation:

EXCLI Journal. 24 (pp 508-523), 2025. Date of Publication: 03 Jan 2025.

Abstract:

Adolescence is a developmental phase largely characterized by rapid biological and non-biological transfor-mations, with a heightened susceptibility to social and environmental influences. Hence, adolescents are particularly vulnerable to external stressors, underscoring the need to safeguard their well-being and prioritize mental health interventions. The coronavirus disease (COVID-19) pandemic caused a global crisis with profound societal disruptions, and led to lasting impact on global public health, disproportionately affecting vulnerable populations, including adolescents. In view of the unique developmental challenges faced by adolescents, it is imperative to assess the growing burden of mental health issues exacerbated by the pandemic. This review synthesizes existing evidence on the emerging mental health challenges faced by adolescents in the United Kingdom (UK) as exacerbated by the COVID-19 pandemic. A systematic literature search was conducted using PubMed, ScienceDirect, MEDLINE, and SpringerNature databases, resulting in the selection of ten high-quality studies. A thematic analysis of the collected data revealed that depression and anxiety were the most frequently reported mental health conditions among adolescents. These conditions were particularly prevalent among adolescents who were from low-income households, those with pre-existing mental health disorders, adolescents experiencing household con-flicts, females, and those who provided self-reported data. Several key risk factors were identified, including family and peer relationships, academic pressures such as examinations and grades, financial constraints within house-holds, and the corruptive influence of social media. The findings underscore the urgency of targeted mental health interventions tailored to the specific needs of adolescents in the U.K. By addressing the identified risk factors, mental health professionals, policymakers, and educators can develop more effective strategies to mitigate the psychological impact of the pandemic on this vulnerable population. This study contributes to the evolving body of literature and emphasizes the need for evidence-based policies to foster overall well-being and resilience in adolescents navigating post-pandemic challenges.

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Rising incidence of necrotising fasciitis: a gynaecological perspective (2025)

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Type of publication:

Journal article

Author(s):

*Kaur, Harpreet; *Adekunle, Adeoye; *Ritchie, Joanne; *Rachaneni, Suneetha.

Citation:

BMJ Case Reports. 18(4), 2025 Apr 08.

Abstract:

Necrotising fasciitis is an uncommon and rapidly progressive surgical emergency. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues are key to improving survival. With our review of three cases, we aim to raise awareness of this condition among gynaecologists, who have limited familiarity with it. Two of our patients presented to emergency with vulval necrotising fasciitis while the third developed it as a complication of postoperative wound infection. All patients underwent extensive surgical debridement and required a multidisciplinary approach from gynaecologists, surgeons, the intensive care team and the tissue viability team.

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39MO Genomic framework of lung carcinoid: Analysis of the AACR GENIE database (2025)

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Type of publication:

Conference abstract

Author(s):

Immanuel A.; *Arunachalam J.; Advani K.

Citation:

ESMO Open. Conference: The ESMO Sarcoma and Rare Cancers Congress 2025. Lugano Switzerland. 10(Supplement 3) (no pagination), 2025. Article Number: 104350. Date of Publication: 01 Mar 2025.

Abstract:

Background: Carcinoid tumors, rare neuroendocrine tumors, occur in the lungs in approximately 25% of cases. The 5-year survival rate for lung carcinoid in the US is 98% for localized disease and 86% for regional disease, with a drop to 55% for metastatic cases. Patients with metastasis are often treated with temozolomide-based chemotherapy, mTOR inhibitors (everolimus), platinum-based chemotherapy, or peptide receptor radionuclide therapy. We aim to investigate potential unexplored genetic targets. We intend to explore if there is a role for immunotherapy for treatment for lung carcinoid as it is generally better tolerated and less toxic compared to chemotherapy. Method(s): Using the cBioPortal platform, we accessed the AACR GENIE version 15.0 database. Demographic data were gathered from patients with lung carcinoid. We outlined the frequency of mutated genes, copy number alterations, and structural variations in the population. Result(s): We analyzed 242 patients and 253 samples. 73.1% of the patients were females and 26.9% were males. 74.7% of samples were collected from a lung primary, while 16.2% of samples were from metastatic sites. The median age at sequencing was 62 years. The highest frequency of mutations was seen in LRP1B gene (18.4%), followed by the MN1 gene (15.8%) and the ARID1A gene (11.8%). The most structural variants were found in the MEN1 gene at 0.9% (n =2, total number of profiled samples = 226). The most common copy number alteration was PDCD1 (n=5, number of profiled samples=134) at 3.7% and CCND1 on 11q13.3 (n=4, number of profiled samples=201) at 2%. Conclusion(s): Prior studies have shown that one of the most frequently mutated pathways in pulmonary carcinoids involves MEN1 gene. We found that genomic alterations in LRP1B, ARID1A, PDCD1 and CCND1 are also frequently observed. It is well known that anti-PD1 therapy is efficient in PD1 expressing cancers. LRP1B mutation in lung cancers has been shown to affect the immune microenvironment and enhance the efficacy of immune checkpoint inhibitors. While ARID1A mutations correlate with longer median overall survival when treated with immunotherapy. The limited number of ongoing clinical trials on targeted therapies underscores the clear need to explore the genomic targets for precision therapies in lung carcinoids.

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BHSeP26 Abdominal wall reconstruction outcomes of the first 50 cases in a district general hospital (2025)

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Type of publication:

Conference abstract

Author(s):

*Gungadin P.; *Bhandari M.; *Cheetham M.; *Chakravartty S.; *Mccloud J.; *Parampalli U.

Citation:

British Journal of Surgery. Conference: 13th British Hernia Society Conference. Oxford United Kingdom. 112(Supplement 3) (pp iii6), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Background: The purpose of this study was to evaluate the short-term clinical outcomes of patients undergoing reconstruction of abdominal wall following repair of complex hernias at a recently established unit. Method(s): This retrospective study included all patients who underwent abdominal wall reconstruction for complex incisional hernias between January 2022 and March 2024. Clinical data encompassing patient demographics, operative parameters, post-operative complications, length of hospital stay and 30-day mortality was analysed. Result(s): 50 patients were included with a male to female ratio of 1:1. The median age of the participants was 62 (26-82). 25% of participants had a BMI of 35. The majority of hernias were approached with a vertical elliptical incision; Fleur de Lys incision was used in 1 case and abdominoplasty incision in 3 cases. The following reconstruction techniques were used: 27 patients underwent Rives Stoppa repair and 16 patients underwent Transversus Abdominis Muscle Release. 30% patients had Botulinum toxin injection pre-operatively. The types of mesh used included: Ultrapro 80 %, Phasix 16 % and Parietex 4 %. Complications included: Surgical site occurrence 6%, cardiorespiratory complications 10%, vascular complications 2% and bowel obstruction 4%. ICU admission included 3 out of 50 patients. Length of hospital stay in 90% patients was 5 days. 60% patients had a 6-monthly follow up where 1 recurrence was noted. Conclusion(s): The early outcomes in our patients demonstrates the feasibility to achieve acceptable outcomes in a district general hospital, by following a multidisciplinary approach and optimising modifiable risk factors preoperatively.

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