2025

Survival outcomes in basaloid squamous cell carcinoma of the anorectal region: A Surveillance, Epidemiology, and End Results (SEER) database analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Arunachalam J.

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S87), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Basaloid squamous cell carcinoma (BSCC) of the anorectal region is a rare and aggressive variant of squamous cell carcinoma, arising primarily in the transitional zone of the anal canal and lower rectum. Historically referred to as cloacogenic carcinoma, BSCC is characterized by distinctive histological features. Chemoradiation remains the standard of care. Given its rarity, data on survival outcomes and demographic disparities are limited. We aimed to assess clinical characteristics and survival outcomes using a large U.S. population-based dataset. Method(s): We conducted a retrospective analysis using the SEER database (2000-2021) to identify patients with BSCC, defined by ICD codes 8083/3 and 8124/3, located in C21.0, C20.9, C21.1, C21.2, and C21.8. Variables extracted included age, sex, race, tumor stage, and treatments. Kaplan-Meier survival analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). Group comparisons were evaluated using the log-rank test. Result(s): A total of 3,446 patients were identified. At diagnosis, 54% were under 65 years, 75% were female, and 80% were White. Metastatic disease was present in 11%. Median OS (mOS) was 120 months. The 1-, 3-, and 5-year CSS rates were 91.1%, 78.9%, and 73.3%, respectively; 10- and 20-year CSS rates were 67.4% and 61.5%. Male patients had poorer survival (mOS 66 months) compared to females (mOS 143 months; p < 0.0001; HR 1.595, 95% CI 1.420-1.791). Patients aged >=65 had a mOS of 72 months versus 219 months for those <65 (p < 0.0001; HR 2.124, 95% CI 1.926-2.342). Median OS by stage was 25 months (metastatic), 124 months (regional), and 175 months (localized) (p < 0.0001). Patients undergoing surgery had a mOS of 154 months, and those receiving radiation therapy had a mOS of 134 months. Lack of chemotherapy was associated with worse survival (mOS 50 months; HR 1.780, 95% CI 1.570-2.020; p < 0.0001). Race was not significantly associated with survival differences. Conclusion(s): Favorable outcomes were associated with younger age, female sex, early stage, and chemotherapy. Future studies should refine treatment strategies and explore targeted therapies in BSCC to guide precision medicine. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.230

Prognostic impact of microsatellite instability and survival disparities in rectal cancer: A SEER-based retrospective analysis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Nabeta G.; Naagendran M.S.; Hegde U.;

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S97), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Microsatellite instability (MSI), a molecular marker of defective DNA mismatch repair (MMR), is observed in ~7% of rectal cancers. MSI-high (MSI-H) tumors, arising from sporadic or germline MMR deficiency, are highly responsive to immune checkpoint inhibitors. We aimed to evaluate the prognostic significance of MSI in rectal cancer in the era of immunotherapy and to explore demographic disparities in survival using real-world data from the U.S. Method(s): We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) cancer database for patients diagnosed with rectal cancer between 2018 and 2021. We assessed cancer-specific survival (CSS) across MSI subtypes-MSI-H, MSI-low (MSI-L), and microsatellite stable (MSS)-and evaluated survival differences by age, gender, race, and stage. Analyses were performed using R. Kaplan-Meier curves visualized survival outcomes, and group comparisons were done using the log-rank test. <br/>Result(s): Among 17,487 patients, 3.6% were MSI-H (n=637), 1.9% MSI-L (n=332), and 94.5% MSS (n=16,518). Overall 1-year and 3-year CSS were 90% and 75%, respectively. In metastatic patients, median CSS (mCSS) was 25 months, increasing to 36 months in those with MSI-H tumors. By MSI status, 1- and 3-year CSS were 90.6% and 77.7% for MSI-H, 89.9% and 74.9% for MSS, and 84.8% and 68.6% for MSI-L (p=0.0087). Racial disparities were evident: 1- and 3-year CSS were 92% and 80% in White patients, 88% and 70% in Black patients, and 90% and 75% in Hispanic patients (p<0.0001). Age impacted survival significantly: 1- and 3-year CSS were 91% and 74% in patients <65 years vs. 86% and 61% in those >=65 (p<0.0001). Females had better long-term survival than males, with 3-year CSS under 80% for both, but significantly higher in females (p<0.0001). Conclusion(s): MSI-H status is associated with improved survival, reinforcing its role as a favorable prognostic biomarker in rectal cancer and highlighting the importance of routine MSI testing to guide treatment decisions. Worse outcomes among older adults, males, and Black patients reflect persistent disparities in rectal cancer care. These findings underscore the urgent need to identify and address the drivers of these differences to ensure equitable outcomes. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.261

Refractory Dyspnoea in Palliative Care: Implementing High Flow Oxygen Therapy AIRVO2 Into Palliative Care and End of Life Care in the Community (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Raton M.; *Rowe N.; *Wood G.;

Citation:

American Journal of Respiratory and Critical Care Medicine. Conference: American Thoracic Society International Conference, ATS 2025. San Francisco, CA United States. 211 (no pagination), 2025. Date of Publication: 01 May 2025.

Abstract:

Palliative patients often present to secondary care settings with respiratory distress during the endstage of their disease. Conventional oxygen therapy alongside opioid therapy has widely been considered the treatment of choice for dyspnoea and symptom alleviation. With an increasing number of palliative patients and the national drive for service improvement, the Respiratory Team have identified an additional method to enhance current practice. Based on previous positive experience gained since 2013 from utilising High Flow Oxygen Therapy (HFOT) during the acute stages of respiratory disease, it was decided to extend this therapy to patients with chronic disease and palliative needs. The physiological and clinical benefits of HFOT include reduction in dyspnoea and decreased work of breathing, augmentation of respiratory drive, improved quality of life, and comfort level in this patient population. During work on the COVID cohort ward (March 2020- Dec 2021) AIRVO2 was used routinely as a first-line treatment in over 300 patients and continued in over 70 patients in the palliation/ End of Life (EoL) pathway. Since then, AIRVO2 in combination with lowdose opioids has been used in Palliative/ EoL care routinely. In 2022 the first discharge from the hospital was facilitated to continue optimised treatment. Benefits from HFOT in EoL/ Palliative usage should be focused on comfort and symptom control with optimised FiO2 requirements. We looked at three patients who were discharged from hospital on HFOT: two patients to the hospice and one home. With the combined HTOT and conventional palliative management, we observed a significantly decreased requirement of opioid use, leading to a reduction in side effects such as drowsiness or palliative sedation. This enabled patients to experience interaction with family and friends at the end of their life. On each occasion, good feedback has been received from the family, hospice, and patients. Extending HTOT usage to the community enhances best interest care for individuals and avoids abrupt termination of therapy initiated in the hospital. This prevents palliative patients with symptomatic breathlessness from having to compromise on either place of death or symptomatic breathlessness. HFOT usage out of the hospital decreases the number of readmissions with the focus on extended care in the community. Discharging patients to the community requires a clear advanced care plan and close cooperation within Multidisciplinary Team. Correct patients' selection for discharge on HFOT needs to be considered due to the limited FiO2 concentration delivery in the community.

DOI: 10.1164/ajrccm.2025.211.Abstracts.A4177

Real-World Outcomes of Transition From CGM-Augmented Non-Closed Loop (NCL) Omnipod Dash To Omnipod 5 Hybrid Closed Loop (HCL) Continuous Subcutaneous Insulin Infusion (CSII) in Adult Type 1 Diabetes(T1D) (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Cane C.; *Cooksey M.; *Wilkes V.; *Brown H.; *Jones A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e179), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: HCL CSII has recently been commissioned nationally by NHS England for type1 diabetes (T1D). We looked into the impact of transitioning from CGMaugmented non-closed loop (NCL) CSII to HCL CSII with the same insulin delivery system. Method(s): We analysed a database of T1D on CSII managed in a single district general hospital under one Consultant Diabetologist team. Patients were on Omnipod DASH with Freestyle Libre2/DexcomG6 CGM and transitioned to Omnipod 5 with Dexcom G6 with built in SmartAdjustTM technology. Data was analysed with paired sample T-test (SPSS) at baseline and 6months. Result(s): 53 patients were included, with 31females (59%) and 22males (41%). Baseline mean age was 47years (20-80), diabetes duration 24years (5-62), BMI 27.6kg/m2 (20-41), HbA1c 55-mmol/mol (30-80). At 6 months, mean weight increased by 1.2-kg (p=0.04), BMI increased by 0.2kg/m2 (p=0.617), HbA1c reduced by 3.4mmol/mol (p=0.002), Time in range: TIR (glucose 3.9-10mmol/L) improved from 63% to 71% (p <0.005). GOLD score remained unchanged at 2.0. Serum creatinine increased from 77 to 80umol/L (p=0.007), eGFR reduced from 92 to 80ml/ min (p<0.001), mean urine microalbumin, total cholesterol, grading of retinal screening remained unchanged. Diabetes Treatment Satisfaction Questionnaire, hypoglycaemia fear survey scores were unchanged and mean INSPIRE (Insulin delivery Systems: Perceptions, Ideas, Reflections and Expectations) score was 77 (40-100). Conclusion(s): This analysis demonstrates statistically significant improvement in glycaemic parameters (HbA1c and TIR) at 6 months with minimal but statistically significant weight loss. There were no significant changes in retinal screening but surprisingly some reduction in renal function was observed. Quality of life questionnaires remained unchanged but INSPIRE questionnaire for automated insulin delivery (AID) showed promising results.

DOI: 10.1089/dia.2024.78502.abstracts

Ambulatory Glucose Profile (AGP) Improvements Occur Early During Transition From Sensor Augmented Omnipod Dash to Hybrid Closed Loop Omnipod 5 in Adults With Type 1 Diabetes(T1D) (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Cane C.; *Cooksey M.; *Brown H.; *Wilkes V.; *Jones A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e174-e175), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: Significant glycaemic benefits with hybrid closed loop(HCL) continuous subcutaneous insulin infusion (CSII) over sensor augmented non-closed loop CSII must be balanced against the risks of worsening retinopathy and treatment induced neuropathy in diabetes (TIND). Method(s): We analysed a database of T1D on CSII managed in a single district general hospital. Patients on Omnipod DASH with Freestyle Libre2/DexcomG6 CGM transitioned to Omnipod 5(OP5) with Dexcom G6 with built in SmartAdjustTM technology. All patients had a target glucose of 6.1mmol/L on OP5. AGP data were analysed with paired sample T-test (SPSS) at baseline, 3months and 6months. Result(s): 53 patients (31females and 22males) with mean age 47years (20-80), diabetes duration 24years (5-62), BMI 27.6kg/m2 (20-41), HbA1c 55mmol/mol(30-80) were included. Conclusion(s): There was statistically significant and rapid improvement in GMI, level 1 & level 2 TAR, TIR and level 1 TBR between 0 and 3 months, sustained at 6 months but no significant change between 3 and 6 months. The early and rapid improvement in glycaemic control post HCL highlights the need for close monitoring of worsening retinopathy in the first year.

DOI: 10.1089/dia.2024.78502.abstracts

Treatment-Induced Neuropathy in Diabetes Post Use of Hybrid Closed Loop Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Beard N.; *Jones A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e264-e265), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: Treatment-induced neuropathy in diabetes(TIND) is a transient, painful peripheral neuropathy occasionally with autonomic component, occurring with rapid glycaemic improvement. Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) in type 1 diabetes(T1D) can improve glucose levels rapidly. Method(s): Retrospective review of two cases. Case 1: 27- year-old male, T1D for 16years, disengagement, maculopathy switched from basal-bolus insulin to HCL-CSII(Omnipod5- DexcomG6). Case 2: 44-year-old female, T1D for 42years, disengagement laser treated retinopathy, neuropathy, toe amputation switched from basal-bolus insulin to HCL-CSII(Omnipod5- DexcomG6). Result(s): Case 1: Pre-HCL HbA1c107mmol/mol. 3months post HCL HbA1c 69mmol/mol. He reported neuropathic pain in lower limbs, commenced amitriptyline for 3months with resolution. He also developed proliferative retinopathy. Case 2: Pre- HCL HbA1c96mmol/mol improved to 54mmol/mol in 6months. She developed severe neuralgic pain in both feet, improved with Pregabalin for 3months. There was no deterioration in retinopathy. Conclusion(s): TIND is more common in T1D, pathophysiology may be endoneurial ischaemia and microvascular changes due to relative hypoglycaemic state. Diagnostic criteria include (i)decrease in HbA1c by 2%(22mmol/mol) over 3months (ii)neuropathic pain and/or autonomic symptoms within 8weeks after decrease in HbA1c (iii)acute onset of neuropathic pain and/ or autonomic dysfunction for more than 2weeks requiring medical attention. It is self-limiting, lasting from weeks to months. Symptomatic treatment include antiepileptics(pregabalin) and tricyclic antidepressants are effective. There are no reported cases of TIND with HCL-CSII in literature. Our two cases highlight TIND, like worsening retinopathy, is a potential complication of rapid improvement in glycaemic control with HCL-CSII in patients with pre-existing hyperglycaemia and patients' needs counselling about the potential short-term risks.

DOI: 10.1089/dia.2024.78502.abstracts

Is There a Correlation Between Hybrid Closed Loop(HCL) Continuous Subcutaneous Insulin Infusion(CSII) Glycaemic Improvement in Type 1 Diabetes(T1D) and Worsening Sensorineural Hearing Loss? - A Case Report (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Wilkes V.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e265), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: T1D is associated with various comorbidities including sensorineural hearing loss (SNHL). HCL CSII treatment in T1D improves glucose levels rapidly. This may cause short-term worsening of retinopathy and neuropathy (treatment-induced neuropathy in diabetes). We present a case of T1D on HCL CSII with worsening hearing loss. Method(s): A 46-year-old gentleman with T1D for 30 years with pre- proliferative retinopathy had mild right sided tinnitus and sensorineural hearing loss (on pure tone audiometry) diagnosed 8 years ago. MRI internal auditory meatus was normal. He was commenced on HCL CSII (Omnipod 5 with Dexcom G6). Result(s): Pre-HCL HbA1c was 75mmol/mol. Glucose management indicator (GMI) after 4weeks rapidly dropped to 53mmol/mol which further reduced to 48mmol/mol in 6months. He reported worsening of right sided tinnitus and hearing loss with development of new left sided tinnitus. He also developed maculopathy. Conclusion(s): Approximately 9.2/1000 people with T1D develop debilitating SNHL every year. In people aged 40-60- years with T1D, hearing threshold in high frequencies(4,000- 8,000Hz) was significantly higher (25-30dB) when compared to age-matched controls (5-10dB). The mechanisms are damage to outer and inner hair cells, loss of spiral ganglion neurons through apoptosis, thickening of basement membrane, and pathologies involving stria vascularis and spiral ligament of the cochlear lateral wall. Whilst causality cannot be inferred from this case, the temporal sequence of rapidly improved glycaemic control with worsening tinnitus and hearing loss raises a possibility of its association. This requires further study preferably with pure tone audiometry, in a randomised clinical trial setting.

DOI: 10.1089/dia.2024.78502.abstracts

Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Ingram A.; Boldovjakova D.; Wilson H.; Noble J.; Prentice J.E.B.; Brasnic L.; Papala P.; Waite R.; Hatem S.M.K.; Hamad H.H.M.A.; Lilani M.J.; Hardwick S.; Pritchard W.; Cairns D.; Lamuren E.; Thomas J.; Eve M.; Gabiana P.; Matias S.; Harris S.; Christmas E.; Brockbank J.; Mackinnon L.; Chrysikopoulou M.; Vo O.K.; George R.J.; Alsaarti R.; Mohrsen S.; Macleod C.; Grossi I.; Feetham J.; Almousa O.; Lyle A.; Victoria A.; Fox C.; Mitchell C.; Kara C.; Catley C.; Shea D.; Cranmer K.; Sach L.; Willsher L.; Vitaglione M.; Forsey M.; Fox N.; Arnold R.; Reid S.; Cotterell S.; Smolen S.; Lester Y.; Dean A.; Fitchett J.; Hoyle R.; Duberley S.; Goddard W.; Lunney C.; Ogbeide C.; Mcsorland D.; Gibson M.; Riley M.R.; Bradley P.; Thomas Z.; Giles E.; Patel H.; Pathirana J.; Chappel P.; Balasingam S.; Webb S.; Elshobaky E.; Challen K.; Ibrahim M.; Connor S.; Aprjanto A.; Ghosh A.; Amer E.; Sinclair J.; Smith T.; Freitas T.D.; Smith J.; Peachey J.; Clymer J.; Squire R.; Lee A.R.; Szekeres C.; Jessup-Dunton E.; Irvine G.; Brookman I.; Grant I.; Abbas K.; Wanigabadu L.; Futcher M.; Awadalkarim M.; Parker M.; Thammaiah Y.; Blows G.R.; Evans L.; Rebolledo M.; Macfarlane R.; Felix R.B.; Baker E.; Clarke J.; Dinglasan M.; Aldridge P.; Marshall S.; Helyar S.; Kunnath T.; Baldwin G.; Lowdell J.; Vallotton N.; Dasilva R.; Sharaf T.; Awe A.; Kerr-Winter B.; Anomelechi E.; Emond F.; Sennitt H.; Khan I.; Aderounmu I.; Bath J.; Woods J.; Dudden K.; Rupchandani K.; Mccafferty L.; Aaron L.; Al-Mousa M.; Okere N.; Scott O.; Edwards R.; Copson S.; Burke S.A.; Nawaz S.; Muhammad Y.; Noor A.; Tizon A.; Passalacqua C.; Qureshi E.F.; Malik F.I.; Jaafaru H.I.; Raees H.; Khaliq M.A.; Layawen N.; Shah R.; Torres S.L.G.; Guglani S.; Ramraj S.; Sharma S.; Hassan T.M.; Betos V.; Drexel A.; Sakutombo D.; Mendes F.; Furreed H.; Morris M.G.; James M.; Fong T.; Hartin D.; Lloyd G.; Sundarraj S.T.; Rivers V.; Kelly C.; Sutherland H.; Boast M.; Kisakye E.; Britton H.; Sebastian J.; Puscas M.R.; George S.; Olawale-Fasua W.; Wood D.; Kaur J.; King S.; Heeley C.; Davy G.; Wilson G.; Bennett K.; Allsop L.; Gill M.; Thorpe N.; Turner S.; Whitworth V.; Prendergast A.D.; Jones A.; Sheppard C.; Jones K.A.; Mcgregor K.; Sekar P.; Aeman S.; O'donnell S.P.; Griffin S.; Sheikh A.; Chintamani A.; Shrestha B.; Bisht D.; Saliu E.J.; Fadhlillah F.; Mahmoud M.Y.; Wasil M.; Ragupathy R.; Moghal Z.S.; John A.; Lockett C.; Tomkinson J.; Rose K.; Aziz M.; Keenan N.; Sandhu B.; Bentley C.; Phiri E.; Adams L.; Page M.; Seaman R.; Asnani S.; Taylor C.; Butt M.; Doherty W.J.; Da'costa A.; Adedeji A.D.; Ibeh C.O.; Oduware E.O.; Dolan H.; Ofori L.; Brassington L.; Olusoga O.; Nkala P.; Gurung S.; Williams S.; Ndlovu T.; Akhuemokhan Z.B.; Gulati D.; Akande M.; Oshiotse S.; Chilcott G.; Battishill W.; Wood J.M.; Hendry R.; Pottelbergh T.M.V.; T-Michael H.; Rothwell J.; Connolly K.; Cooper L.; Quli A.; Corr H.; Orourke L.; Pettet A.; Kariyadil B.; Pile J.; Gallamoza K.; Foo M.; O'connell P.; Kirkup A.; Hall J.; Hudson L.; Waddell G.; Mckie H.; Beck J.; Harrison M.; Ternent M.; Crispin P.; Aladesanmi A.; Ahmed A.; Thomson D.; Moth G.; Haslam J.; Killeen J.; Philbin J.; Howard-Sandy L.; Warran S.; Munt S.; Humphrey C.; Langridge E.; Otoole K.; Pule P.; Miln R.; Death Y.; Davies A.; Dunn E.; Brittain E.; Kohler G.; Stacey J.; Bloch M.; Murphy M.; Griffiths O.; Awbery H.; Oyindamola O.; Aor S.S.; Gribbin A.; Edwards C.; Vorwerk C.; Jackman D.; Brown G.; Daly Z.; Naiyeju A.A.; Arrayeh A.; Giubileo A.; Sarvesh B.; Jafferji D.; Thornton H.; Mckenzie I.; Okwori I.; Rudnicka J.; Nasr M.; Hassan M.; Aliu M.; Osunsanya O.; Abdulsalam S.; Mbaekwe S.; Shedwell S.; Wickramanayake U.; Abdullahi Y.; Mcclelland B.; Willshire K.; Knight A.; Beranova E.; Tutt G.; Ramos H.; Mcarthur C.; Khoo E.; Hughes E.; Austin K.; Doran K.; Gordon M.W.G.; Oshaughnessy O.; Worgan R.; Matthews A.; Baddeley A.; Morris A.; Ndungu A.; Peters C.; Walker L.; Tilbury N.; Lubbock S.; Mapatuna C.; Kehlenbeck E.; Curtis K.; Tonkins M.; King P.; Walker R.; Gabriel Z.; Titu H.; Coyle J.; Waddington N.; Chotai C.; Ward C.; Elliott L.; Henshall A.; Pogorodnaja A.; Knowles C.; Mascia G.; Rai S.G.; Bartley S.; Ko S.T.S.; Perera Y.; Conroy E.; Nicholson J.; Taylor J.; Flanagan R.; Wilce A.; Lindsay C.; Bascombe C.; Osey C.; Tiller H.; Rogers L.; Agius N.; Barratt N.; Pitts S.; Mohammed A.; Eihebholo A.; Olaifa A.; Bowyer C.; Sutcliffe E.; Bishop O.J.; Jenkins O.; Kyriakides O.; Thomas S.; Ali S.; Mason S.; Ripsher W.; Cousins E.; Dhande K.S.; Wright L.; Bolus A.; Sykes D.; Faronbi G.O.; Slade L.; Page R.; Maiti M.; Hekal M.; Khadka S.; Border T.; Wilson W.; Lowe A.; Evans C.; Moceivei C.; Mcavoy D.; Hay F.; Homyer K.; Dunne M.; Goldmann N.; Mitchell R.; Geoghegan A.; Entwistle J.; *Marsh A.; *Stephens A.; *O'connell G.; *Gibson H.; *Stickley J.; *Witt J.; *Beekes M.; *Sowailam M.; *Ali N.A.; Stan A.; Boalch A.; Demetriou C.; Flitney C.; Munday C.; Khoory C.; Carter D.; Gould E.; Evans G.; Elghonemy H.; Latham J.; Zamari K.; Ramos L.; Howie L.; Gunning S.; Haskins W.; Ayodeji Y.S.; Potts A.; Kay D.; Perez J.; Holden J.; Pendlebury J.; Cawley K.; Shahedy N.; Doonan R.; Blevings R.; Anthony A.; Trim F.; Hadebe B.; Pherson A.M.; Mphansi E.; Tysoe S.; Masunda B.; Galliford J.; Pestell S.; Patel S.; Pickard A.; Hoare B.; Cox C.; Hart D.; Amarnani D.; Fay E.; Khedarun F.M.; Collins F.; Sysum K.; Fung M.; Corbin N.; Patel N.; Moss P.; Marques R.; Johnson R.; Parmar S.; Sarker S.; Lawrence G.; Romero M.R.; Felix R.M.B.; Raju T.; Clarson S.; Clarke B.D.; Philp E.; Wren G.; Gallacher S.; Sharir A.; Andrews B.; Faint C.; Caines C.; Everett C.; Newman D.; Cruz G.D.L.; Hughes G.; Carey H.; Reavley H.; Ayre J.; Quan J.; Caines L.; Wedge-Bull M.; Alzaatreh M.; Chong N.; Anthony N.; Chandler S.; Walford S.; Sharir T.; White T.; Heslop-Harrison W.; Dunphy A.; Trenwith B.; Coelho B.; Hunter L.; Moran R.; Pemberton A.; Suggitt B.; Pimlott B.; Bates C.; Tibke C.; Pegler D.; Daniel D.; Lamond D.; Pureti G.; Baxter H.; Melville J.; Zai K.F.T.; Mullane K.; Phyu M.P.; Gabriels N.; Mills R.; Bennett S.; Blenkinsop S.; Vikramadhithyan S.; Barnes S.; Hopkins S.; Doherty-Walls T.; Coughlan T.; Kinder J.; Clark M.; Islam M.N.; Gray R.; Ford A.; Florey L.; O'neill M.; Aspa P.; Mercer P.; Ackerley A.; Ironside J.; Haynes L.; Garcia B.; Elkhodair S.; Enegela A.; Leech C.; Hassanali F.; Rashid H.; Lalji J.; Akpoghene M.; Enegela O.A.; Hafeez-Bore O.; Oluwaseun O.; Pelasur R.; Ayres R.; Tariq R.; Mchenry R.D.; Bains B.; Jones B.; Tarant E.; Mundy M.; Pearse R.; Sibtain S.; Day A.; Campbell B.; Stagg C.; Jones D.; Atwal I.; Tompkins K.; Parsons P.; Dancer R.; Balaican A.M.; Ellis C.; Ede C.H.; Joseph J.; Hardaker O.; Ridwan R.; Khan S.; Zhao X.; Wood L.; Tampsett R.; Rao S.; Castillo W.P.H.; Ticehurst F.; Rocha J.G.D.; Chivers K.; Vecchione N.; Kader N.; Wilson S.; Adhikari S.; Ramsundar S.; Felix F.; Johnston R.; Jin Y.; Ingall E.; Rand J.; Solly R.; Naeem S.; Stirrup S.; Priestley V.; Pun A.; Olosho O.Z.; Board S.;

Citation:

Emergency Medicine Journal. (no pagination), 2025. Article Number: 214616. Date of Publication: 2025. [epub ahead of print]

Abstract:

Background: Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice. Method(s): A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS. Result(s): 8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care. Conclusion(s): Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies.

DOI: 10.1136/emermed-2024-214616

Link to full-text [NHS OpenAthens account required]

Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis (2025)

Posted on by

Type of publication:

Systematic Review

Author(s):

*Elsmore, Amy; Alayande, Gbenga; Mainwaring, Elizabeth; Jafarpour, Mahfam; Rimmer, Michael P; Cockburn, Neil; *Curtis, Jason; *Ilaalagan, Ragave; Al-Wattar, Bassel; Bell, Sarah; *Karunakaran, Bala; *Parry-Smith, William; Wu, Pensee.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology.  2025 Jul 09.

Abstract:

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of mortality and morbidity globally. While individual studies have revealed disparities in outcomes, a comprehensive summary of PPH risk across diverse groups is lacking.

OBJECTIVES: To quantify the association between ethnicity, deprivation and risk of PPH in high-income countries (HICs).

SEARCH STRATEGY: A systematic search of MEDLINE, CINAHL, EMBASE and Google Scholar from inception to 20 August 2024.

SELECTION CRITERIA: Observational and experimental studies from HICs that reported the outcome of PPH in at least two ethnic or socioeconomic groups.

DATA COLLECTION AND ANALYSIS: Two reviewers performed independent data extraction. A random-effects model was used to estimate the risk. A subgroup analysis was performed by geographical region and time period.

MAIN RESULTS: A total of 79 studies with 169 579 388 women were included, spanning 15 HICs. Ethnic minority women experienced a higher risk of PPH compared to the majority White or European group. This was seen across Black (OR 1.16, 95% CI 1.09, 1.23), Asian (OR 1.33, 95% CI 1.27, 1.39), Hispanic (OR 1.20, 95% CI 1.12, 1.29) and women from the minority ethnic group within a given study (OR 1.13, 95% CI 1.03,1.24). Due to data limitations, eight studies on PPH and socioeconomic status were summarised
narratively, indicating a higher PPH risk for those experiencing deprivation.

CONCLUSIONS: Women from an ethnic minority background or exposed to socioeconomic deprivation had an increased risk of PPH in HICs. Standardisation of data collection for ethnicity and socioeconomic status is recommended to accurately quantify and address these disparities.

DOI: 10.1111/1471-0528.18278

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

Metformin for patients with metastatic prostate cancer starting androgen deprivation therapy: a randomised phase 3 trial of the STAMPEDE platform protocol (2025)

Posted on by

Type of publication:

Randomised controlled trial

Author(s):

Gillessen, Silke; Murphy, Laura; James, Nicholas D; Sachdeva, Ashwin; El-Taji, Omar; Abdel-Aty, Hoda; Adler, Amanda I; Amos, Claire; Attard, Gerhardt; Varughese, Mohini; Gale, Joanna; Brown, Simon; *Srihari, Narayanan; Birtle, Alison J; Brown, Mick; Chan, Kitty; Chowdhury, Simon; Cross, William; Dearnaley, David P; Din, Omar; Dutey-Magni, Peter; Gilbert, Duncan C; Gilson, Clare; Gray, Struan; Grist, Emily; Hofmann, Uschi; Hudson, Andrew M; Jain, Yatin; Jeyasangar, Ganesan; Jones, Robert; Kayani, Mahaz; Langley, Ruth E; Malik, Zafar; Mason, Malcolm D; Matheson, David; McAlpine, Connor; Macnair, Archie; Millman, Robin; Murphy, Claire; Padden-Modi, Minal; Parikh, Omi; Parker, Chris; Rush, Hannah; Russell, Martin; Srinivasan, Rajaguru; Sundar, Santhanam; Tanguay, Jacob S; Turco, Fabio; Williams, Patrick; Sydes, Matthew R; Parmar, Mahesh K B; Brown, Louise C; Clarke, Noel W.

Citation:

Lancet Oncology. 2025 Jul 07.

Abstract:

BACKGROUND: Metformin is a widely used anti-diabetic drug. Several studies have suggested that metformin has anticancer activity in some malignancies, including prostate cancer. Metformin might also mitigate the adverse metabolic effects of androgen-deprivation therapy (ADT). We hypothesised that metformin might improve survival in patients with metastatic hormone-sensitive prostate cancer and reduce metabolic complications associated with ADT.

METHODS: The STAMPEDE multi-arm, multi-stage, randomised phase 3 trial recruited patients with high-risk locally advanced or metastatic adenocarcinoma of the prostate staged by conventional imaging with isotope bone and CT scanning. This publication reports findings for the most recent STAMPEDE research question, testing the addition of metformin to standard of care for non-diabetic (glycated haemoglobin [HbA1c] <48 mmol/mol [equivalent to <6.5%]) patients with metastatic disease with adequate renal function (glomerular filtration rate >=45 ml/min/1.73 m2) and WHO performance status 0-2. This trial recruited from 112 hospitals in the UK and Switzerland to the STAMPEDE protocol. Patients were randomly allocated (1:1) to standard of care or standard of care plus metformin 850 mg twice daily. Random assignment was by telephone using minimisation with a random element of 20% (developed and maintained by the MRC Clinical Trials Unit at UCL), stratified for randomising hospital, age (<70 years vs >=70 years), WHO performance status (0 vs 1 or 2), type of ADT, regular long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs; yes vs no), pelvic nodal status (positive vs negative), planned radiotherapy (yes vs no), and planned docetaxel or androgen receptor pathway inhibitor (ARPI) use (docetaxel vs abiraterone, enzalutamide, or apalutamide vs none). Standard of care comprised ADT with or without radiotherapy and with or without docetaxel or ARPI. The primary outcome measure was overall survival, defined as the time to death from any cause, assessed in the intention-to-treat population. Safety was assessed in patients who started treatment. The trial is registered with ClinicalTrials.gov, NCT00268476 and ISRCTN, ISRCTN78818544.

FINDINGS: Between Sep 5, 2016, and Mar 31, 2023, 1874 patients with metastatic disease were randomly allocated to standard of care (n=938) or standard of care plus metformin (n=936). The median patient age was 69 years (IQR 63-73) and the median PSA was 84 ng/mL (24-352). 1758 (94%) of 1874 patients were newly diagnosed with metastatic disease and 116 (6%) were diagnosed with metachronous relapsing disease. 1543 (82%) of 1874 patients received ADT plus docetaxel and 52 (3%) received abiraterone, enzalutamide, or apalutamide. The median time to most recent case report form follow-up was 60 months (IQR 49-72). 473 deaths were reported in the standard of care group; median survival was 61.8 months (IQR 29.7 to not reached). There were 453 deaths in the metformin group; median survival was 67.4 months (32.5 to not reached; HR 0.91, 95% CI 0.80-1.03; p=0.15). Grade 3 or worse adverse events were reported in 487 (52%) of 938 patients in the standard of care group and 523 (57%) of 921 patients in the standard of care plus metformin group. 61 (7%) patients in the standard of care group and 84 (9%) patients in the standard of care plus metformin group reported at least one grade 3 or worse gastrointestinal adverse event; all other body systems showed no difference in grade 3 adverse events. There were six drug-related deaths in the standard of care group and one in the standard of care plus metformin group.

INTERPRETATION: We did not find significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients with metastatic hormone-sensitive prostate cancer. The side-effect profile of metformin was as expected and consisted mainly of diarrhoea. Adverse metabolic side-effects of ADT were significantly reduced in the metformin group compared with the standard of care group.

FUNDING: Cancer Research UK, Prostate Cancer UK, and UK Research and Innovation Medical Research Council.

DOI: 10.1016/S1470-2045(25)00231-1

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