2025

Hypertonic saline in chronic lung disease: A local experience to suggest usefulness? (2025)

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Type of publication:

Conference abstract

Author(s):

*Johnson J.; *Ahmad N.;

Citation:

Thorax. Conference: British Thoracic Society Winter Meeting 2025. Westminster . 80(Supplement 2) (pp A151-A152), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background 7% Hypertonic saline (HTS) is increasingly being used as a mucolytic therapy in patients with chronic respiratory conditions, particularly those with mucus retention and impaired airway clearance. Despite its widespread use, data on the effectiveness of HTS and its potential impact on healthcare utilisation remain sparse. Understanding its role in symptom relief and hospital admission rates is critical in optimising treatment. Aim The primary outcome was to observe an improvement in symptoms. The secondary outcome looked at reduction in hospital admissions comparing 12 months before HTS initiation with 12 months post-initiation. Method This was a retrospective cohort study from March 2023 to February 2025. We identified patients initiated on HTS, through a logbook maintained by specialist respiratory nurses. Improvement in symptoms meant improved cough, ease of mucus expectoration and change in mucus colour, which was reported in clinic letters. We also collected data of their highest Blood eosinophil count (BEC) during this period. We used MS Excel and Vassar stats (vassarstats.net) for calculations. Results A total of 36 patients were initiated on HTS, of which 42% (n=15) had Bronchiectasis, 8% (n=3) had COPD, 22% had Asthma (n=8), 11% had Asthma-COPD overlap (4) and 17% were labelled as others (n=6). Mean Age was 65 years (SD 10) with 56% females. 67% had BEC >0.3 x109/L. 72% (n=26) reported symptomatic improvement of which notably 42% (n=11) had Bronchiectasis, 27% had Asthma (n=7) and 15% (n= 4) had Asthma-COPD. 25% (n=9) noted no benefit and 1 patient's data was not found. Subjects showing symptom improvement had a higher mean BEC (0.45×109/L v .27×109/L, p=0.01) when compared with those who did not show any improvement. Our secondary outcome measure showed no effect on hospital admissions following initiation of HTS. However, 4 of 6 patients who were hospitalised over the next 12 months reported a symptomatic improvement. Conclusion Majority of patients with Bronchiectasis, Asthma and Asthma-COPD overlap derive symptomatic benefit from HTS treatment. Improvement in patients with BEC>0.3 was statistically significant, suggesting higher degree of mucus impaction in this group. HTS probably does not affect hospital admissions; but requires further validation.

DOI: 10.1136/thorax-2025-BTSabstracts.219

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Mortality from tibial shaft fractures in the elderly (MTFE)-a multicentre study of management outcomes (2025)

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Type of publication:

Journal article

Author(s):

Azhar M.S.; Selim A.; Daoub A.; Farhan-Alanie M.M.; Shah R.

Citation:

Injury. 56(12) (no pagination), 2025. Article Number: 112806. Date of Publication: 01 Dec 2025.

Abstract:

Introduction The mortality rate for tibial shaft fractures in the elderly is comparable to that of hip fractures, yet there is considerable variation in their management. Operative treatment allows for earlier weight-bearing and reduces potential complications of prolonged immobilization; however, it carries risks for this comorbid cohort. The main objective of this study was to assess the difference in 1-year mortality between operative and non-operative management. Methods A multicentre study was conducted across six trusts in England, including eight acute hospitals: three major trauma centres and five district general hospitals (DGHs). Data were collected retrospectively, covering a 5-year period from January 2017 to December 2021. The study included all patients aged 65 and over with diaphyseal tibial fractures (AO42). Patients with non-acute (>3 weeks), periprosthetic, pathological, or multiple lower limb fractures were excluded. Results A total of 171 patients were identified, comprising 38 % males and 62 % females. Of these, 59.6 % were managed operatively, while 40.4 % were managed non-operatively. The median length of stay was similar between groups (8 days non-operative vs. 8.5 days operative, p = 0.87). Non-union (21.7 % vs. 6.3 %, p < 0.001) and malunion rates (27.7 % vs. 4.6 %, p = 0.001) were significantly higher in the non-operative group. One-year mortality was also higher in the non-operative group (38.3 % vs. 12.1 %, p < 0.001). Univariate and multivariate analyses showed an odds ratio of 4.5 and 4.7 for one-year mortality with non-operative treatment, with p -values of <0.001 and 0.005, respectively. Conclusion This study demonstrated that non-operatively treated tibial shaft fractures in the elderly are associated with significantly higher rates of non-union, malunion, and 1-year mortality. Therefore, we recommend an expedited multi-disciplinary approach to managing these patients, including surgical treatment and unrestricted weight bearing where possible, to optimize outcomes. Level of Evidence Level III.

DOI: 10.1016/j.injury.2025.112806

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The spiked helmet sign in severe sepsis: an unusual electrocardiographic finding in a critically ill patient (2025)

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Type of publication:

Journal article

Author(s):

Manea, Hashim; Alhatemi, Ahmed Qasim Mohammed; Al-Ghuraibawi, Mohammedbaqer Ali; *Alhumairi, Ghaith Asaad; Al-Shammari, Ali Saad; Al-Ibraheem, Abdullah Muataz Taha; Ahmad, Ibrar; Abdulammer, Hussein Safaa.

Citation:

Oxford Medical Case Reports. 2025(11):omaf232, 2025 Nov.

Abstract:

Background: The 'spiked helmet' sign is a rare electrocardiographic (ECG) phenomenon characterized by transient ST-segment elevations mimicking an acute coronary syndrome, typically seen in critically ill patients. While often associated with severe physiological stress, its presence in sepsis is particularly uncommon.

Case Presentation: A 68-year-old male with a history of hypertension and diabetes mellitus presented to the emergency department with fever, altered mental status, and hypotension. Initial workup revealed severe sepsis secondary to pneumonia. His ECG showed pronounced ST-segment elevations in leads II, III, and aVF, with a distinctive 'spiked helmet' pattern. Troponin levels were mildly elevated, raising concerns for concurrent myocardial ischemia. However, the patient denied chest pain, and further cardiac evaluation, including echocardiography, showed no evidence of ischemia or infarction. Intensive care management included broad-spectrum antibiotics, intravenous fluids, and vasopressors. Despite the severity of his illness, the patient's condition gradually improved, and repeat ECGs showed resolution of the ST-segment elevations. The 'spiked helmet' sign was attributed to severe sepsis-induced autonomic dysfunction rather than primary cardiac pathology.

Conclusion: This case highlights the importance of recognizing the 'spiked helmet' sign as a marker of severe stress in critically ill patients, which may mimic myocardial ischemia on ECG. Prompt differentiation between this sign and true ischemia is crucial to avoid unnecessary interventions and focus on managing the underlying critical illness.

DOI: 10.1093/omcr/omaf232

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Bridging Communication Gaps to Enhance Patient Safety: A Quality Improvement (QI) Project on the Role of Abbreviations, Their Risks, and Pathways to Change (2025)

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Type of publication:

Journal article

Author(s):

*Talha, Saarah; *Smith, Ben; *Khan, Ayesha; Gaddoura, Zaina.

Citation:

Cureus. 17(10):e95843, 2025 Oct.

Abstract:

Introduction Effective communication within the multidisciplinary team (MDT) is critical to safe patient care. Whilst electronic health records have improved legibility, the widespread use of non-standardised abbreviations continues to cause misinterpretation, risking delays, errors, and compromised patient safety. Abbreviations are often used for efficiency, yet their meanings vary between specialties, creating barriers for rotating staff, cross-disciplinary colleagues, and patients reviewing discharge summaries. Quality improvement project We conducted a closed-loop quality improvement (QI) project structured around the SQUIRE 2.0 guidelines for QI initiatives. The project took place in a UK district general hospital to assess and improve understanding of commonly used ear, nose, and throat (ENT) specialty abbreviations. Eighty-two common abbreviations were identified and used in a written expansion test. In cycle one (n = 45), mean accuracy was 24.3%, with no participant exceeding 77%. Following targeted interventions (educational seminars and a printed reference guide displayed in shared spaces), a second assessment cycle was conducted with a new cohort. Post-teaching scores improved by a relative 40% to a mean of 35% (range 24%-52%). Mann-Whitney U testing confirmed statistical significance (p < 0.05). Implications and discussion Findings revealed a substantial baseline knowledge gap, highlighting a safety risk. Low-cost, high-visibility measures, such as reference posters and induction-based teaching, improved comprehension and could be readily adopted in other departments. However, residual gaps suggest the need for upstream interventions, including integration of documentation clarity training into medical education and continued departmental reinforcement. Conclusion Clinicians' baseline abbreviation comprehension was poor, but targeted education significantly improved understanding. Whilst no participant achieved complete proficiency, results show that simple, resource-light strategies can enhance communication clarity and support safer care. Broader adoption, alongside curricular change, offers a sustainable path to reducing abbreviation-related risks.

DOI: 10.7759/cureus.95843

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Hologenomic analysis of rectal mucus sampling for detection of adenomatous polyps and colorectal cancer (2025)

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Type of publication:

Journal article

Author(s):

Tock, Andrew J; Patel, Kamrun S; Morales-Walker, Emma; Zhang, Linglan; Orthodoxou, Chris; MacRitchie, Alasdair D; Njoroge, Stephen; Olaniru, Oladapo E; Mozolowski, Guy; Mendes, Ines; Baker, Dave J; Siew, Malvin; Humphrey, Hannah N; Walker-Davies, Eleanor T; McDermott, Frank; Spencer, Sue; Bird, Susan; Savva, Katerina-Vanessa; Cunningham, Christopher; Rottenburg, Hannah; Sisodia, Heena; Battersby, Nick J; *Jones, Gareth A R; *Lacy-Colson, Jon; Baggaley, Alice E; Peters, Christopher J; Dodd, Andrew; Kang, Kiran; Hamon, Chris; Crespillo-Casado, Ana; Law, Erica; Sands, Megan; Lywood, Hugo; Page, Andrew J; Daniels, Ian; Wise, Daniel.

Citation:

Nature communications . 16(1):10876, 2025 Dec 04.

Abstract:

Colorectal cancer (CRC) is the fourth most common cancer and the third leading cause of cancer-related mortality worldwide, with incidence rising among younger populations. The significant clinical and economic burden highlights the need for minimally invasive technologies capable of detecting pre-malignant and early-stage disease. Although liquid biopsy approaches have advanced, they have not achieved sufficient performance for clinical adoption when compared with colonoscopy, the current diagnostic gold standard. CRC is a mucosal pathology, yet current diagnostic methods have not leveraged mucosal biology. Here we demonstrate the clinical utility of rectal mucus specimens, collected using a minimally invasive device in an outpatient setting, without bowel preparation. Through a hologenomic approach integrating host and microbial genomics, we identify genetic and epigenetic aberrations and perturbations in microbial communities that drive the detection of adenomatous polyps and CRC in rectal mucus. Hologenomic integration enables superior stratification of CRC by disease site and stage compared with single-omics methods. In summary, we demonstrate the clinical utility of rectal mucus sampling combined with hologenomic analysis as a translatable prospective tool for diagnostic application.

DOI: 10.1038/s41467-025-66006-1

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Mastering Arterial Blood Gases in Emergency Medicine: A practical Guide (2025)

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Type of publication:

Book

Author(s):

*Nwaneri, Chukwuemeka

Abstract:

Navigate Critical Decisions with Confidence
In the high-stakes environment of the emergency department, rapid, accurate diagnosis is paramount. The Arterial Blood Gas (ABG) is an indispensable diagnostic tool, yet its complex interpretation often leaves clinicians feeling overwhelmed.
"Mastering Arterial Blood Gases in Emergency Medicine: A Practical Guide" is your definitive resource for transforming intimidating numbers into clear, actionable insights at the bedside.
Authored by an experienced emergency clinician, this book is specifically designed to equip emergency physicians, clinicians, residents, advanced practice providers, and critical care nurses with the unwavering confidence to interpret ABGs accurately and efficiently.

What You'll Discover Inside:
* The Unrivalled 6-Step Systematic Algorithm: Learn a proven, step-by-step approach to ABG interpretation that simplifies complex analysis, ensuring consistent and reliable results even under pressure.
* Practical, ED-Focused Scenarios: Bridge the gap between theory and practice with dedicated chapters on common emergency presentations, including:
* Respiratory Emergencies: COPD exacerbations, acute asthma, pneumonia, ARDS, PE, opioid overdose, and neuromuscular weakness.
* Metabolic Mayhem: Diabetic Ketoacidosis (DKA), lactic acidosis, renal failure, salicylate poisoning, toxic alcohol ingestions, severe diarrhea, and electrolyte imbalances from vomiting or diuretics.
* Other Critical Conditions: Cardiac arrest, severe trauma (hemorrhagic shock), carbon monoxide and cyanide poisoning, and early sepsis.
* Demystifying Complex Concepts: Gain clarity on the Anion Gap, Delta-Delta Gap, and the nuances of mixed acid-base disorders, transforming potential pitfalls into diagnostic triumphs.
* Oxygenation & Ventilation Mastery: Understand the critical relationship between PaO2, SaO2, and the A-a gradient to precisely assess and manage your patient's oxygenation status.
* Beyond the Numbers: Learn to integrate ABG results seamlessly with the full clinical picture, treating the patient, not just the ABG. Explore the limitations of ABGs and the strategic use of Venous Blood Gases (VBGs).
* The Future of Diagnostics: Peer into the exciting advancements in Point-of-Care (POC) testing, non-invasive monitoring, and the transformative potential of AI in ABG interpretation.
Whether you're a seasoned practitioner seeking to refine your skills or a new clinician building foundational knowledge, this practical guide cuts through the complexity, empowering you to make faster, more informed decisions that directly impact patient outcomes.
Master the ABG. Master the Emergency.

ISBN: 979-8293926329

Clinical and Functional Outcomes Following Intra-articular Platelet-Rich Plasma Injection for Knee Osteoarthritis: A Prospective Cohort Study (2025)

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Type of publication:

Journal article

Author(s):

*Murugesan, Thivagar; Mohankumar, Mahesh; Guna Surya, Pedapati Ssk Vijaya.

Citation:

Cureus. 17(10):e95297, 2025 Oct.

Abstract:

Background and objective Knee osteoarthritis (OA), a common degenerative joint disease, often leads to chronic pain and disability, particularly in middle-aged individuals. With growing interest in regenerative therapies, platelet-rich plasma (PRP) has emerged as a potential biological treatment due to its anti-inflammatory and reparative properties. This study aimed to evaluate the clinical and functional outcomes following intra-articular PRP injections in patients with early-stage knee OA. Methodology A prospective clinical trial was conducted at a tertiary care center involving 113 patients diagnosed with Kellgren-Lawrence grade 1 or 2 knee osteoarthritis. Each participant received a single intra-articular PRP injection and was followed for 24 weeks. Pain and functional outcomes were assessed using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-CRD at baseline, and at six, 12, and 24 weeks post-injection. Results At every follow-up, both VAS and WOMAC scores demonstrated significant reductions (p < 0.001). Patients with grade 1 OA showed greater improvement compared to those with grade 2 at all time points. While VAS scores decreased from 5.87 to 2.85, the
average WOMAC score fell from 32.81 at baseline to 24.89 after 24 weeks. Better results were strongly connected with younger age and lower radiographic grade. Conclusions Our results align with existing research supporting the effectiveness of PRP in managing early osteoarthritis. The treatment showed consistent symptom relief, particularly in younger patients and those with lower radiographic grades. Over a six-month period, intra-articular PRP injections offered significant pain reduction and functional improvement in early-stage knee OA, establishing it as a safe and effective therapy.

DOI: 10.7759/cureus.95297

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A Multicomponent Intervention to Improve Maternal Infection Outcomes (2025)

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Type of publication:

Journal article

Author(s):

Lissauer, David; Gadama, Luis; Waitt, Catriona; Whyte, Sonia; Burnside, Girvan; Anilkumar, Aiswarya; Makuluni, Regina; Okwaro, Peace; Yang, Liu; Waitt, Peter; Musopole, Owen; Bilesi, Rosemary; Maseko, Bertha; Lwasa, Joel; Mugahi, Richard; Olaro, Charles; Lamorde, Mohammed; Makuta, Mirriam; Kachiwaya, Chimwemwe; Mkandawire, Tionge; Malunga, Adrian; Chitsulo, Nyadani; Abitimo, Prisca; Ayabo, Tabitha; Weeks, Andrew; Martin, James; Hemming, Karla; Gallos, Ioannis; Monk, Edward J M; Riches, Jennifer; Chapuma, Chikondi; Nanyondo S, Judith; Lorencatto, Fabiana; Monahan, Mark; Allegranzi, Benedetta; Dunlop, Catherine; Atkins, Lou; Rosala-Hallas, Anna; Roberts, Tracy; Gamble, Carrol; Malata, Address; Desmond, Nicola; Kommwa, Edward; Merriel, Abi; *Parry-Smith, William; Smith, Rebecca; Ndumu, Ivy; Williams, Eleanor; Faque, Bob; Banda, Gertrude; Nyondo-Mipando, Alinane L; Twimukye, Adelline; Chater, Tim; Diplas, Aristotelis; Brizuela, Vanessa; Souza, Joao Paulo; Rylance, Jamie; Cheshire, James; Hawker, Lydia; Coomarasamy, Arri; Bonet, Mercedes.

Citation:

New England Journal of Medicine.  2025 Nov 19.

Abstract:

BACKGROUND: Maternal infection and sepsis are major causes of maternal death and severe illness worldwide, particularly in low- and middle-income countries. Inconsistent implementation of evidence-based recommendations for infection prevention and management and delays in detection and treatment of maternal sepsis contribute to the number of preventable deaths.

METHODS: We conducted a cluster-randomized trial to assess a multicomponent intervention, the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program. This program was designed to support health care providers in achieving three goals: adherence to World Health Organization (WHO) hand-hygiene standards; adoption of evidence-based practices for maternal infection prevention and management; and early detection of sepsis and use of the FAST-M (fluids, antibiotics, source control, transfer if required, and monitoring) treatment bundle. Usual care was provided in the control group, along with dissemination of guidelines. The primary outcome was a composite of infection-related maternal death, infection-related near-miss event (events in which women survived a life-threatening complication), or severe infection-related illness (deep surgical-site, deep perineal, or body-cavity infection) among women who were pregnant or had recently been pregnant.

RESULTS: We randomly assigned 59 health facilities (where 431,394 women gave birth during the trial) in Malawi and Uganda to the intervention group (30 clusters) or the usual-care group (29 clusters). A primary-outcome event occurred in 1.4% of the patients in the intervention group and in 1.9% of those in the usual-care group (risk ratio, 0.68; 95% confidence interval, 0.55 to 0.83; P<0.001). This effect was generally consistent between countries and among facilities of difference sizes and was sustained over time.

CONCLUSIONS: Implementation of the APT-Sepsis program led to a significantly lower risk of a composite of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care. (Funded by the Joint Global Health Trials scheme and others; APT-Sepsis ISRCTN number, ISRCTN42347014.).

DOI: 10.1056/nejmoa2512698

Systemic Arterial Air Embolism Following Computed Tomography (CT)-Guided Percutaneous Lung Biopsy: Case Series and review of underlying risk factors, treatment and preventive strategies (2025)

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Type of publication:

Journal article

Author(s):

*Adamu, Maimuna; *Skillicorn, Chris; *Stone, Timothy; Moudgil, Harmesh; *Abayaratne, Chulangani.

Citation:

Clinical Medicine. 100530, 2025 Nov 17.

Abstract:

BACKGROUND: Systemic arterial air embolism is an uncommon but potentially fatal complication of CT-guided transthoracic lung biopsy. Although rare, it carries significant morbidity due to cerebral and coronary ischemia.

CASE PRESENTATION: We report two cases of systemic arterial air embolism occurring during CT-guided percutaneous lung biopsies. Both patients developed acute neurological deficits immediately following the procedure, attributed to cerebral air embolism. Imaging confirmed the presence of intracranial air in subarachnoid spaces. Neurological symptoms improved with supportive management, including oxygen administration and positioning. Histopathology in both cases revealed pulmonary adenocarcinoma.

CONCLUSION: These cases highlight the importance of prompt recognition and appropriate management of systemic air embolism. Risk mitigation strategies include careful patient positioning, minimization of intrapulmonary pressure gradients, and maintenance of needle occlusion. Although rare, this complication must be anticipated by interventionalists and managed promptly to avoid permanent neurological damage.

DOI:

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Quality improvement programme for 2 week wait Gynaecology suspected cancer referrals (2025)

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Type of publication:

Service improvement case study

Author(s):

*Claire Carr

Citation:

SaTH Improvement Hub, November 2025

SMART Aim:

To improve the triage system for patients on the faster diagnosis pathway for suspected gynaecological cancers by 1st October 2025 as evidenced by more people being seen within the 28 days target.

Link to PDF poster