2025

Improving oxygen prescription compliance on acute medical wards at the Royal Shrewsbury Hospital (2025)

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Type of publication:

Service improvement case study

Author(s):

*Jeyapradeeban Arunachalam, *Evelyn Shennaike, *Omolola Awe, *Muhammad Ali

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To increase the proportion of acute medical inpatients receiving oxygen who have a valid oxygen prescription (signed, dated, with an identifiable prescriber and target saturation range) from 10.8% to at least 20% within 4 weeks on the acute medical wards at RSH.

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Improvement to Stoma Care (2025)

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Type of publication:

Service improvement case study

Author(s):

*Paula Hilditch, *Rebekah Tudor

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To improve the quality of stoma care given to patients on surgical wards as measured by pre and post teaching questionnaire and audit of stoma care practice by December 2025.

Link to PDF poster

Creatine Use and Thromboembolism Risk in Athletes: A Case Report (2025)

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Type of publication:

Journal article

Author(s):

*Abdalla, Osama S; *Mudassir, Haseeb; *Green, Hazel; *Katarki, Praveenkumar.

Citation:

Cureus. 17(12):e99242, 2025 Dec.

Abstract:

Creatine monohydrate (Cr) is a widely used supplement in the sports and fitness industry, with its popularity continuing to rise. It is well known for its ability to maintain high-energy phosphate levels during intense physical activity, thereby enhancing performance. Documented benefits of creatine supplementation include enhanced muscular development, neuroprotective effects in certain neurodegenerative conditions, and potential cardiovascular advantages. Nonetheless, a growing body of reports has raised concerns regarding possible adverse vascular effects, particularly an increased risk of thrombosis. This case underscores the potential thrombotic risks associated with creatine use and highlights the need to re-evaluate its safety profile. In addition, we provide an updated review of the literature regarding this potentially serious adverse effect.

DOI: 10.7759/cureus.99242

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Chronic Infective Endocarditis Linked to Staphylococcus epidermidis Infection of a Pacemaker Lead: A Case Report (2025)

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Type of publication:

Journal article

Author(s):

*Abdalla, Osama S; *Idris, Ghada; *Ekanayake, Darshani; *Khallaf, Laila; *Adjepon, Charlotte.

Citation:

Cureus. 17(12):e99028, 2025 Dec.

Abstract:

The diagnosis and management of pacemaker-related infective endocarditis present significant challenges, with limited available data. Accurately attributing a systemic infection to pacemaker endocarditis can be difficult, particularly in identifying vegetations and obtaining positive blood cultures from patients who have undergone non-specific antibiotic therapy. Moreover, such infections may manifest long after pacemaker implantation. Herein, we present a male patient in his 70s, with a history of pacemaker placement, who was admitted with a three-month history of fever and chills, having already completed two courses of empirical antibiotics prior to admission. Upon hospital admission, he was treated for an infection of unknown origin with intravenous antibiotics. Initial laboratory evaluations indicated leucocytosis and elevated C-reactive protein levels; however, blood cultures and infectious serologies returned normal results. A CT scan of the abdomen and pelvis was deemed unremarkable, and transthoracic echocardiography (TTE) also yielded normal findings. The empirical antibiotic regimen was discontinued, leading to three sets of blood cultures being subsequently positive for coagulase-negative Staphylococcus epidermidis. A transoesophageal echocardiography (TOE) was performed, revealing vegetation on the pacemaker lead. The patient received a triple antibiotic therapy and underwent device removal; subsequent blood cultures were negative following a four-week antibiotic course. A new pacemaker was implanted, and the patient has since remained asymptomatic. This case illustrates that coagulase-negative Staphylococcus epidermidis can infect pacemaker leads even long after installation, potentially leading to an indolent course of infective endocarditis that is difficult to diagnose and manage. Consequently, clinicians should maintain a high index of suspicion for pacemaker infective endocarditis in patients presenting with prolonged fever.

DOI: 10.7759/cureus.99028

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Autonomic Nervous System Dysregulation in Metabolic Syndrome: An Association With Hypertension and Cardiovascular Risk (2025)

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Type of publication:

Systematic Review

Author(s):

Soomra, Hoor; Mukhtar, Asad; *Asif, Fatima; Khalid, Ayesha; Noureen, Sadia; Qamar, Zeeshan; Haider, Usman.

Citation:

Cureus. 17(12):e98932, 2025 Dec.

Abstract:

Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities, including abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure, that increases the risk of type 2 diabetes and cardiovascular disease (CVD). Autonomic imbalance, characterized by increased sympathetic activity and reduced parasympathetic tone, is proposed to play an important role in the development of hypertension and adverse cardiovascular outcomes in individuals with MetS. This systematic review evaluates the association between autonomic nervous system (ANS) dysregulation and MetS. A systematic search was conducted in PubMed, Embase, Scopus, and Cochrane Library for studies published from January 2015 to September 2025. Eligible studies included human research that examined measures of autonomic function such as heart rate variability (HRV), baroreflex sensitivity, muscle sympathetic nerve activity, and plasma catecholamine levels at rest in individuals with MetS. Observational and interventional studies were included. Data were extracted and synthesized narratively. A total of 16 studies met the inclusion criteria. Most included studies reported reduced HRV, impaired baroreflex sensitivity, increased resting sympathetic nerve activity, and elevated plasma catecholamines in participants with MetS, suggesting a consistent association between ANS dysregulation and blood pressure elevation. However, causality could not be established due to the predominantly observational study designs. Current evidence indicates a significant association between autonomic dysfunction and MetS, particularly in relation to hypertension and increased cardiovascular risk. ANS biomarkers may support refined cardiometabolic risk stratification, although further prospective and mechanistic studies are needed to clarify causal pathways.

DOI: 10.7759/cureus.98932

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Checkpoint Inhibitors and Beyond: A Systematic Review of Immunotherapy in Cutaneous Malignancies (2025)

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Type of publication:

Systematic Review

Author(s):

Rashid, Yasir; Devi S, Kartika; Gonzalez-Espinosa, Tomas Faustino; Jain, Juhi; Dalain, Mujahed; Baig, Rayyan; D'Amico, Giuseppe Antonio; Mowo-Wale, Adetola G; Khomchenko, Mariia; Baby, Nima; *Yateem, Dana; Duhamel, Axel; Ali, Ramsha.

Citation:

Cureus. 17(12):e98959, 2025 Dec.

Abstract:

Skin cancers represent a major health concern, and there is a need for more effective treatment approaches, among which immune checkpoint inhibitors have become a particularly important recent development. This study aimed to explore the efficacy and tolerability of immune checkpoint inhibitors, intratumoral immunotherapies, targeted agents, and their combinations in advanced cutaneous malignancies. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-conform review of PubMed (2012-2024) identified 26 studies, including randomized trials, observational cohorts, network meta-analyses, and systematic reviews, evaluating checkpoint inhibitors, anti-PD-1/PD-L1and anti-CTLA-4. Outcomes included progression-free survival (PFS), objective response rate (ORR), overall survival (OS), biomarkers, and treatment-related adverse events. This meta-analysis of 26 studies (2012-2024) evaluated treatments for cutaneous malignancies, including melanoma, basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and Merkel cell carcinoma (MCC), covering systemic immunotherapies (PD-1, CTLA-4), combination checkpoint inhibitors, and novel approaches like IL-12 electroporation. Melanoma: PD-1 therapies showed durable benefits; ipilimumab retreatment yielded 42% two-year survival. MCC: Avelumab achieved a median OS of 12.9 months. cSCC: Nivolumab PFS 8.2 months; cemiplimab 12-month PFS >53%. Targeted therapy: BRAF/MEK inhibitors reached OS ~33 months. Emerging strategies: TIL-based and neoadjuvant immunotherapy showed high pathological and durable responses. Overall, combination therapies consistently outperformed monotherapies in survival and response. Adverse events were common, especially with combination therapy, with severe immune-related toxicities reported in 30-59% of cases, while monotherapies were generally safer. Overall, immunotherapy offers substantial, often long-lasting benefits, though careful patient selection and monitoring are essential to balance efficacy and toxicity. Combination immunotherapies and targeted regimens are more effective for advanced melanoma, although they have increased toxicity.

DOI: 10.7759/cureus.98959

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Big tooth, Big problems? (2025)

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Type of publication:

Conference abstract

Author(s):

*Shargill I.

Citation:

Journal of the World Federation of Orthodontists. Conference: 10th International Orthodontic Congress. Rio de Janeiro Brazil. 14(6) (pp 479), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background Patients that present with a macrodont can require complicated treatment. Case summary: A 14 year old patient presented with Class II division 1 incisors on class I skeletal pattern with normal FMPA complicated by a macrodont lower incisor and impacted lower second premolar teeth. Management of macrodontic teeth can be very difficult to manage as they can be unsightly and dealing with space can be difficult to manage whether this is restorative or space closure. Conclusion(s): This case report illustrates that in the patients presenting with macrodontic teeth they can be treated with orthodontics without the complications of long-term restorative implications.

DOI: 10.1016/j.ejwf.2025.07.243