2025

Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Carmont, Michael R; *Saha, Arunansu; *Rhind, John-Henry; Nilsson, Niklas; Karlsson, Jon; Nilsson-Helander, Katarina.

Citation:

Video Journal of Sports Medicine. 1(5):26350254211021859, 2021 Sep-Oct.

Abstract:

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.

Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.

Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.

Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

Link to full-text [open acces - no password required]

Mercury exposure, pink disease and Young's syndrome: a forgotten public health disaster (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Brown, Megan; Hendley, Victoria; *Ahmad, Nawaid.

Citation:

BMJ Case Reports. 18(4), 2025 Apr 26.

Abstract:

Pink disease was once a widespread phenomenon, known to physicians throughout the Western world. Its prevalence declined massively once the source, mercury, was identified in several products. In modern medicine, pink disease rarely forms a differential and is known only to few physicians, despite the long-term effects of this illness. This report details a case of a man who suffered from pink disease as a child following his mother applying teething powder containing inorganic mercury to his gums for 12 weeks, from the age of 6 months. He received no treatment at the time. Throughout his lifetime, however, the man (in his 70s) has been diagnosed as infertile, and with bronchiectasis, despite a lack of convincing history to suggest an aetiology. The cause of these pathologies remains elusive, either organically occurring or components of Young's syndrome.

Link to full-text [NHS OpenAthens account required]

Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Rai, Tanvi; Hinton, Lisa E; Mackay, Rosa; Black, Mairead; Sanders, Julia; Slade, Pauline; *Elsmore, Amy; Dhadda, Amrit; *Parry-Smith, William; Collis, Rachel; Petrou, Stavros; Stanworth, Simon; Pallman, Philip; Townson, Julia; Fye, Haddy; Geden, Ayse Gur; Collins, Peter; Bell, Sarah.

Citation:

PLoS ONE [Electronic Resource]. 20(4):e0320754, 2025.

Abstract:

BACKGROUND: Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.

METHODS: We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and usingNormalisation Process Theory.

RESULTS: The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.

CONCLUSIONS: Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial.

Link to full-text [open access - no password required]

Is It Cost-Effective to Induce Labour Early to Prevent Shoulder Dystocia? Evidence From the Big Baby Trial (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Naghdi, Seyran; Petrou, Stavros; Underwood, Martin; *Deshpande, Sanjeev; Quenby, Siobhan; Ewington, Lauren; Gardosi, Jason; Mistry, Hema.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology. 2025 May 01. [epub ahead of print]

Abstract:

BACKGROUND: The cost-effectiveness of early induction of labour for suspected large-for-gestational-age foetuses to prevent shoulder dystocia is unknown.

METHODS: A within-trial economic evaluation of induction at 38 + 0 to 38 + 4 weeks' gestation for suspected large-for-gestational-age foetuses. Resource use and costs were measured to 6 months postpartum. We estimated incremental cost per case of shoulder dystocia prevented and incremental cost per maternal quality-adjusted life year (QALY) gained. We collected data for planned caesarean sections in a cohort study.

FINDINGS: Mean combined woman and infant costs in the induction arm were 89 (95% confidence interval (CI): -79, 257) higher than the standard care arm, driven by increased neonatal costs. The incremental cost of preventing one case of shoulder dystocia was 11 879 and the incremental cost per maternal QALY gained was 39 518. The probability of early induction being cost-effective was 0.65 at a cost-effectiveness threshold of 20 000 per case of shoulder dystocia prevented, but 0.36 at a cost-effectiveness threshold of 20 000 per maternal QALY gained. The cohort study found the mean cost was 310 (95% CI: 74, 545) higher in the induction arm than in the planned caesarean group.

INTERPRETATION: Early induction of labour increased neonatal care costs. It is not a cost-effective approach when effects are restricted to maternal QALYs. Planned caesarean section might be cost-saving when compared to early induction, although we did not assess longer-term effects such as an increased risk of repeat caesarean sections. Assessments of long-term effects on the mother and infant should be
incorporated into future studies.

TRIAL REGISTRATION: ISRCTN18229892.

Link to full-text [open access - no password required]

Improving compliance to follow-up alerts in chest X-rays with consolidation through clinician education (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Adeniran-Babatunde S.F.; *Gbede O.; *Oguntoye O.; *Alkhouly M.

Citation:

Clinical Radiology. Conference: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 83(Supplement 1) (no pagination), 2025. Article Number: 106889. Date of Publication: 01 May 2025.

Abstract:

Category: Chest Background to the audit: Timely follow-up of abnormal chest X-rays (CXRs) showing consolidation as recommended by the radiologist can aid prompt diagnosis and treatment of other serious conditions with subsequent good outcomes. Research has shown that significant morbidity can occur from delay and lack of follow-up in patients with consolidation or other abnormalities on initial CXR, which is why the British Thoracic Society (BTS) recommends follow-up CXRs at around six weeks after completing treatment for all patients with consolidation on CXR to ensure resolution. This formed the premise for our audit looking into how to improve compliance to this protocol in our trust and thereby improve patient safety. Standard: BTS recommendation. Indicator: We assessed source of referral. We assessed if repeat CXR has been performed as suggested by the radiologist. We assessed the time frame suggested for the repeat CXR. We compared the actual time frame of the repeat imaging with the time frame suggested. Target: 100% compliance to follow-up alert. 100% compliance to recommended time frame. Methodology: In the first round, retrospective review of random 100 CXRs done in the trust with follow-up alert. Data collected include patient's referral source, date of the initial image, recommended time frame for repeat image and date of the follow-up CXR. The data were analysed and presented in percentages. The exact similar process was repeated for the second round three months after the intervention. Results of first audit round: 43% of the patients were referred from emergency department (ED), 39% from GP and 18% from the wards. 79% of the patients had repeat CXRs, 14% did not and 7% had died. Of those that had repeat CXRs, 46% had it done at the recommended time, 43% were done at a later date and 11% were done earlier. First action plan: Audit was presented at clinical meetings to educate clinicians on the need to request follow-up CXRs to ensure patient safety. Results of second audit round: 54% were from ED, 31% from GP and 15% from the wards. 95% had repeat CXRs while the remaining 5% had died. 78% had repeat CXRs within the recommended time, 14% were done later and 8% were done earlier. Second action plan: Presentation and teaching at clinical meetings to further reinforce and improve on follow-up compliance.

Image-guided brachytherapy for locally advanced cervical cancer: audit of practice at UHNM 2023 and re-audit 2024 (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Perera J.; Bhana R.; *Choudhury Y.; Devleena D.; Seedhouse I.; Tsui S.M.

Citation:

Clinical Oncology. Conference: SUPP: RCR Audit & QI ePoster Competitions 2024. InterContinental Hotel, Dubai Festival City United Arab Emirates. 40(Supplement 1) (no pagination), 2025. Article Number: 103820. Date of Publication: 01 May 2025.

Abstract:

Category: Gynaecology Background to the audit: Standard treatment for locally advanced cervix cancer consists of chemoradiotherapy followed by brachytherapy. Trial data show shortening overall treatment time and escalation of doses to the high-risk clinical target volume (HR-CTV) to be associated with better local control. Image-guided brachytherapy (IGBT) enables greater dose conformity and local control.<sup>1-6</sup>UHNM commenced a magnetic resonance-based IGBT service for cervical cancer in 2016. Standard: BGCS/ESGO/ESTRO/ESP/ASTRO guidelines on management of cervical cancer.<sup>7-9</sup>1. Overall treatment time should not exceed 49-56 days. 2. Total equivalent dose in 2 Gy fractions (EQD2) to 90% of the HR-CTV (D90) to be >=85 Gy. Indicator: Percentage of patients meeting each standard. Target: 100% having overall treatment less than 56 days. 90% achieving the dose to HR-CTV targets keeping organs at risk(OAR) within tolerence. Methodology: Retrospective analysis of data on IGBT for radical cervical cancer treatments from 1 January 2021 to end of March 2023 done and reviewed at May 2023 UHNM brachytherapy meeting. Initial time span selected to minimise impact of COVID. Action plan implemented and patient data for April 2023 to April 2024 re-audited. Results of first audit round: 43 UHNM and Shrewsbury patients treated. Overall treatment time data available only for 20 UHNM patients. 1 (5%) had exceeded 56 days and 7 (35%) had taken 50-56 days to complete. 37/43 (86.1%) had received a D90 HR-CTV of >85 Gy. A linear relationship between external beam radiation therapy (EBRT) completion to brachytherapy start with total treatment duration identified. First action plan: Pathway changes made to commence chemoradiotherapy on Monday/Tuesday and to schedule the whole course of chemoradiotherapy and brachytherapy at the time of referral. Ring and tandem commissioned as a priority to allow more applicator options. Results of second audit round: All 26 (100%) UHNM and Shrewsbury patients had completed treatments within 56 days. 73.1% within 49 days. 1 outside patient's chemoradiotherapy data incomplete. HR-CTV D90 >85 Gy in 85.2%. 8 patients treated with ring and tandem with 60% more needle use compared with ovoids. No patient exceeded mandatory OAR tolerences. Second action plan: Proactively scheduling brachytherapy, liaising with the regional network monthly to optimise timing and resources usage. To continue with dosimetric data collection to optimise needle placement and to review impact of needles on OAR doses and clinical outcomes in the next audit.

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

Posted on by

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.

Link to full-text [open access - no password required]

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

Posted on by

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.

Link to full-text [open access - no password required]

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

Posted on by

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.