2023

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

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Type of publication:
Journal article

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

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

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

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

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Type of publication:
Journal article

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

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

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

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

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Type of publication:
Conference abstract

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

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

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

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

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Type of publication:
Conference abstract

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

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

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

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

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Type of publication:
Journal article

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

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

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

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

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Type of publication:
Journal article

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

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

Abstract:
Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice.

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

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Type of publication:
Journal article

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

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

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

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Radiological and Imaging Evidence in the Diagnosis and Management of Microbial Infections: An Update (2023)

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Type of publication:
Journal article

Author(s):
Vaishnav, Aditya; *Gurukiran, Gurukiran; Ighodaro, Osazuwa; Kandi, Venkataramana

Citation:
Cureus. 15(11):e48756, 2023 Nov.

Abstract:
Microbial infections are extremely prevalent throughout the world. Bacteria, fungi, parasites, and viruses generally cause them. Most microbial infections spread from humans to humans and from animals to humans. A vast majority of microbial infections are self-limiting. However, some microbial infections result in severe morbidity and mortality. The diagnosis of microbial infections generally depends on the direct demonstration of microbes in human clinical specimens through microscopy followed by culture. Some microbes are uncultivable, and among those that are cultivable, some take a very long time to grow in the laboratory. This causes delays in the diagnosis that may result in poor patient outcomes. Serological and molecular methods like enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively, have been extensively used to diagnose infectious diseases. However, these require costly infrastructure and adequate personnel training. In this context, alternative, more efficient, and rapid detection methods for the diagnosis of microbial infections are warranted. In this review, we comprehensively discuss the role played by radiological investigations in the diagnosis and management of infectious diseases.

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Orbital Onset: The Intricate Journey From Ear Abscess to Cavernous Sinus Thrombosis in a Diabetic Male (2023)

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Type of publication:Journal article

Author(s):*Ekomwereren, Osatohanmwen; Sunkara, Vyshnavidevi; Grezenko, Han; Hamid, Yusra H; Faran, Nuzhat; Abubakar, Muhammad.

Citation:Cureus. 15(11):e48922, 2023 Nov.

Abstract:Cavernous sinus thrombosis (CST) is a rare, yet severe condition often linked to infections in the nasal and facial areas. We present a case of a 43-year-old male farmer with diabetes who initially showed ear abscess symptoms that progressed to vision loss and CST-like symptoms. Self-treatment and an unidentified medication regimen may have worsened his condition. Advanced diagnostic evaluations, particularly magnetic resonance imaging with magnetic resonance venography, confirmed CST, likely originating from the ear infection spreading to the eyes, causing bilateral orbital cellulitis. Treatment with antibiotics, anticoagulants, and supportive therapy stabilized the patient's condition. This case emphasizes the importance of early detection and intervention in CST, especially in atypical presentations, and the need for comprehensive diagnostic and therapeutic approaches.

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A Literature Review of Perioperative Outcomes of Robotic Radical Nephrectomy (RRN) Versus Laparoscopic Radical Nephrectomy (LRN) for Renal Cell Carcinoma (RCC) (2023)

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Type of publication:Journal article

Author(s):Alzamzami, Muhannad; Geirbely, Alsamoal; *Ahmed, Mohamed B; Osman, Rabab; Gandhi, Rahi; Mohammed, Mahmoud; Elhadi, Mohammed; Kodera, Ahmed

Citation:Cureus. 15(11):e49077, 2023 Nov.

Abstract:Renal cell carcinoma (RCC) is an adenocarcinoma of the renal cortex. Radical nephrectomy remains the standard of care for managing massive renal tumours. Robotic-assisted radical nephrectomy is an increasing alternative technique to laparoscopic radical nephrectomy (LRN). The da Vinci Surgical System allows for improved dexterity, increased visualisation, tremor filtration and an ergonomic setting to enhance surgeon comfort. The aim was to compare the perioperative outcomes pertaining to operative time, intraoperative complications, blood loss and length of hospital stay between the robotic and LRN for RCC. Studies that compared the perioperative findings between robotic radical nephrectomy (RNN) and LRN for RCC were included. The literature review was carried out according to the Cochrane collaboration standards where applicable. Highly sensitive search strategies like MeSH terms and controlled vocabularies were used to identify relevant studies that compare the RNN outcomes to the LRN. Following the literature search, a total of 73 articles were collected, 60 articles were excluded at the stage of reviewing the titles, eight articles were excluded after reading the abstracts, and five articles were included in this paper. Five studies were included in this analysis, with a total sample size of 1770 patients, 735 were in the robotic arm, and 1035 were in the laparoscopic arm. Generally, there were no differences between both arms in terms of demographic data and age of patients. Closer analysis of the perioperative outcomes did not reveal significant differences between the two groups related to the estimated blood loss, length of hospital stay or post-operative complications. The laparoscopic techniques have less operative time than the robotic ones. RRN is an expanding approach for patients with RCC with some potential technical benefits over laparoscopic ones. RRN is similar to LRN in the perioperative outcomes, with few potential drawbacks of RRN, including higher costs. However, a prospective comparison of RRN with LRN in many cases at multiple centres with long-term oncological results best illustrates the status of RRN versus LRN.

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