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Understanding recovery after acute kidney injury.
No full textAcute kidney injury (AKI) is not an isolated event, however, is often the start of a long-term risk trajectory for patients. While in many cases kidney function improves, dysfunction is common and carries a heightened risk of chronic kidney disease (CKD), as well as cardiovascular morbidity and mortality. Central to improving outcomes is a clear, practical understanding of what constitutes true ‘recovery’ from AKI. Yet, current definitions are inconsistent, ranging from simplistic biochemical thresholds to more nuanced, qualitative judgments. To better understand how AKI recovery is defined in practice within the UK, the UK Kidney Association (UKKA) Special Interest Group and the Association of Nephrology Nurses UK (ANN UK) AKI Community of Practice surveyed nurses working in specialist AKI roles. The survey was sent to all AKI nurses from the ANN UK AKI CoP group via email. This group were chosen as a convenience sample of specialist practitioners who were caring for people with AKI and aimed to gain an insight into how nurses working in AKI care viewed and used AKI recovery. The survey received responses from 18 AKI nurses across 16 NHS Trusts within the UK. The survey explored how these clinicians define baseline renal function, assess recovery and approach follow-up, while also reviewing awareness and use of terms such as acute kidney disease
'For the love of God, just refer me' : a co-produced qualitative study of the experiences of people with Tourette Syndrome and tic disorders accessing healthcare services in the UK
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Published by BMJ Group.OBJECTIVES: Chronic tic disorders (CTDs)-such as Tourette Syndrome (TS)-are neurodevelopmental disorders affecting at least 1% of the population, causing repetitive involuntary movements and vocalisations known as tics. This study aimed to explore the lived experiences of accessing healthcare for people with CTD or TS and their families in the United Kingdom (UK), as part of a larger programme of work to inform change to healthcare services for this population. DESIGN: Informed and designed with extensive patient and public involvement, the design utilised qualitative research using focus groups. Reflexive thematic analysis was used to analyse the data. SETTING: Participants were recruited via online support groups, social media and research registers. PARTICIPANTS: Seven focus groups were held separately with young people with tics (n=2), adults with tics (n=10) and parents/guardians of children with tics (n=11), led by a lived experience expert (coauthor PS) and facilitated by researchers. Discussion focused on three areas: the impact of living with tics, experience accessing healthcare for tics and management of tics. RESULTS: Five themes were developed highlighting challenges across the healthcare pathway, including gaining a diagnosis, and receiving treatment, resulting in the use of self-support methods to reduce tic expression or the impact of tics. Themes also illustrated perceptions that healthcare provider's knowledge impacted initial interactions with the healthcare system, and how healthcare systems were not felt to be prioritising CTDs. CONCLUSIONS: The findings highlight a lack of prioritisation for tic disorders compounded by a healthcare structure which does not support a complex condition that requires a multidisciplinary approach. This research calls for improvements to UK healthcare services for CTD.https://bmjopen.bmj.com/content/15/9/e09830
Metformin for Central Centrifugal Cicatricial Alopecia: Emerging Antifibrotic Evidence and Mechanistic Insights.
No full textMononeuritis Multiplex as a diagnostic challenge in Eosinophilic Granulomatosis with Polyangiitis: implications of early versus delayed recognition
No full textA 63-year-old female patient presented to the acute medical unit with what appeared to be a case of progressive mobility decline, a common and often nonspecific presentation in acute medicine. She described upper and lower limb weakness and numbness affecting her ability to walk. Originally, her upper limb numbness was treated as ulnar nerve compression in the community. She also had multiple episodes of shortness of breath throughout the year, which were initially managed in the community as suspected asthma exacerbations; however, her symptoms were non-specific. Routine investigations revealed severe eosinophilia (13.37 × 10⁹/L), anaemia, and leucocytosis. Neurophysiology confirmed mononeuritis multiplex, and further autoimmune testing revealed positive anti-neutrophil cytoplasmic antibodies (P-ANCA) and elevated myeloperoxidase (MPO) antibodies. This was ultimately diagnosed as eosinophilic granulomatosis with polyangiitis (EGPA), a rare presentation that challenged initial diagnostic assumptions. This case is an example of how not all presentations of EGPA are straightforward and how it might be missed in an acute medical setting. Through this case report, we wanted to emphasise the subtle and often vague nature of mononeuritis multiplex in EGPA. We would also like to highlight the implications of a delayed diagnosis on patients with EGPA and how this affects the long-term health of patients. Lastly, we would like to discuss newer treatments with anti-interleukin-5 (IL-5) target drugs, which are used to reduce relapse rates in the disease.https://www.cureus.com/articles/416846-mononeuritis-multiplex-as-a-diagnostic-challenge-in-eosinophilic-granulomatosis-with-polyangiitis-implications-of-early-versus-delayed-recognition#!
How do individuals with bipolar disorder experience ecological momentary assessment and mood monitoring? A systematic review and qualitative meta-synthesis
No full textAims: Advancements in smartphone technology and wearable devices allow for novel ways to monitor behaviour, mood, and mental state, as well as to develop new interventions. Understanding the perspectives and preferences of individuals with bipolar disorder (BD) is essential for the success of these mood monitoring interventions and for Ecological Momentary Assessment (EMA) as a data collection method. This systematic review and meta-synthesis aimed to explore the user experience of mood monitoring and EMA, including the barriers and facilitators for both individuals with BD and clinicians, as well as the intended purposes of these tools. Method(s): A systematic review and meta-synthesis of qualitative studies were conducted (PROSPERO: CRD42023396473), focusing on the experiences of participants, users, and clinicians with mood monitoring and EMA in BD. Eight electronic databases were searched, and mixed-methods studies were included. A metasynthesis approach was used to analyse the data, employing first-, second-, and third-order constructs, guided by Noblit & Hare's meta-ethnography framework. Studies were assessed for the risk of bias in qualitative research. Results were checked for coherence by individuals with lived experience and psychiatrists. Result(s): The search identified 23,515 papers. A total of 20 studies using 12 different EMA protocols were identified and included in the meta-synthesis, from which nine overarching themes emerged: adverse effects, barriers to mood monitoring, facilitators of mood monitoring, the purpose of mood monitoring, negative experiences of data sharing, positive experiences of data sharing, clinician-related barriers and concerns, clinician-related facilitators and suggestions, and desired features. Conclusion(s): This review highlights key factors that can enhance user experience, engagement, retention, usability, and acceptance of EMA and mood monitoring protocols for individuals with BD. A central finding is that users strongly value control over their data, with an emphasis on customisability and personalisation. Many users were sceptical about involving formal mental health services and preferred to use the tool as an aid for self-managing their condition in highly personal and iterative ways. We also report key adverse effects experienced by individuals with BD when engaging in mood monitoring, which may need to be addressed by incorporating additional therapeutic elements into the intervention-for example, subjective worsening of mood and the monitoring process serving as an unhelpful reminder of their mental illness.https://www.cambridge.org/core/journals/bjpsych-open/article/how-do-individuals-with-bipolar-disorder-experience-ecological-momentary-assessment-and-mood-monitoring-a-systematic-review-and-qualitative-metasynthesis/D9671405BE1057A4F0EF4579B8D447B
Pulse transit time respiratory swing as a diagnostic test for obstructive sleep apnoea in children-An observational study.
Get PDFBackground Pulse transit time (PTT) has been identified as a potentially useful tool for diagnosing obstructive sleep apnoea (OSA) due to its high sensitivity in detecting cortical arousals. However, its use in clinical practise has been disappointing as it appears to lack the ability to distinguish between individuals with or without OSA. The majority of studies evaluating PTT for sleep-disordered breathing (SDB) have assessed the pulse transit time arousal index (PTT-AI), and there are limited published data on PTT respiratory swing (PTTrs). We previously conducted an observational study of PTT in 368 children with SDB. Our findings indicated that depending on the cut-off used, PTTrs identified OSA with low-to-moderate sensitivity and moderate-to-high specificity, using limited multi-channel sleep studies (MCSS) as the comparator. Methods We conducted this cross-sectional observational study in another cohort of 1,031 children with SDB who attended a secondary care centre consecutively for MCSS between July 2022 and November 2024. Polysomnography (PSG) is not available in UK secondary care centres, and our use of MCSS in this setting is novel. We analysed the data of 629 children using multinomial regression and machine learning. Results We found a stepwise increase in PTTrs with increasing severity of SDB. Children with mild OSA had a mean PTTrs of 20.7 ms. Machine learning analysis indicated that the oxygen desaturation index (ODI3) and PTTrs were the most important predictors of SDB amongst the 15 variables studied. Conclusion Our findings suggest that PTTrs could complement oximetry to improve the detection of OSA in children. A validation study comparing PTTrs with PSG is needed.https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1632919/ful
Factors that affect eyelid show and their importance in upper eyelid blepharoplasty: a systematic review
No full textAn understanding of the complexity of the surgical anatomy of the upper eyelid and the surrounding structures is mandatory when trying to minimize complications and achieve excellent cosmetic results during eyelid surgery. Postoperative upper eyelid asymmetry is one of the most common causes of patients’ dissatisfaction, and several parameters should be taken into consideration when performing cosmetic blepharoplasties and ptosis surgery. Tarsal platform show and brow fat span are two of the most important variables pertaining to the perception of beauty and youthfulness that every oculoplastic and facial plastic surgeon should address when performing such surgery. The aim of this review paper is to provide a detailed anatomy of the upper eyelid and the surrounding structures, to highlight all the relevant factors that contribute to the perception of beauty and the changes that occur to the aging face and to address the preoperative factors that need to be carefully examined before performing upper eyelid surgery.https://www.tandfonline.com/doi/full/10.1080/01676830.2024.239811
Clinical outcomes of robotic versus laparoscopic colorectal surgery during the early learning curve: a systematic review and meta-analysis
No full textSurgery is a cornerstone for colorectal cancer treatment. Though laparoscopy surgery is a well-established technique for colorectal patients and has shown reduced hospital stay and postoperative morbidities, it has inherent limitations due to straight instruments and limited views in areas such as the pelvis. Nevertheless, recently, the robotic approach has aimed to overcome the limitations of laparoscopic techniques and offers EndoWrist technology with 3D, high definition, and stable views for precise dissection. This review aims to compare the clinical outcomes of laparoscopic and robotic surgery for colorectal cancer during the initial adoption phase of robotic techniques. A comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, resulting in the inclusion of six randomized controlled trials (RCTs) and 17 observational studies. Eligibility criteria focused on adult patients undergoing elective resection for colorectal neoplasia. A total of 23 articles were analyzed for various outcomes. Robotic surgery demonstrated a shorter postoperative hospital stay compared to laparoscopic surgery (MD = −0.132; p = 0.031) and significantly lower conversion to open surgery (OR = 1.480; 95% CI: 0.364-0.635; p = 0.000). No significant difference was observed in 30-day mortality, early postoperative complications, readmission, and reoperation rates between the two groups. Emerging evidence suggests that, during the early adoption phase, robotic surgery for colorectal cancer is associated with reduced conversion rates to open surgery and shorter postoperative hospital stays compared to laparoscopic surgery. However, comprehensive evaluation through future studies is required to elucidate long-term outcomes, cost-effectiveness, and patient-reported measures related to robotic colorectal surgery.https://www.cureus.com/articles/368432-clinical-outcomes-of-robotic-versus-laparoscopic-colorectal-surgery-during-the-early-learning-curve-a-systematic-review-and-meta-analysis#!
How to approach and manage ocular emergencies
No full textOcular emergencies require immediate recognition and intervention to prevent vision loss and other serious complications. A thorough history, clinical examination, and appropriate management can have a significant impact on patient outcomes. This article explores various ophthalmic emergencies, including traumatic and non-traumatic conditions, with emphasis on their clinical presentations, diagnostic approaches, and evidence-based management.https://www.magonlinelibrary.com/doi/abs/10.12968/jprp.2025.002
Real world multi-centre UK review of Nivolumab Monotherapy in metastatic endometrial cancer with mismatch repair deficiency during COVID-19
No full textIntroduction Immunotherapy checkpoint inhibition has shown improvement in efficacy and survival in patients with mismatch repair deficient (MMRd) advanced endometrial cancer (mEC) compared to chemotherapy. This is combined with chemotherapy in the first-line setting or as monotherapy in later lines of therapy. Objective To assess the efficacy, survival and toxicity of nivolumab monotherapy in metastatic endometrial cancer (mEC) in both first and later lines of therapy as used in the NICE COVID-19 systemic anti-cancer (SACT) guidelines. Methods A multi-centre retrospective review of mEC patients with associated MMRd who received nivolumab as per NICE COVID NG161 at 10 NHS cancer centres. Patient demographics, molecular classification and previous treatments were recorded in addition to treatment responses, duration of response, overall survival, progression-free survival and toxicities. Kaplan-Meier curves analyse the survival data. Results 52 patients were identified. Median age was 67 (37–81) years. 87.5% of patients had endometrioid histology and 75% were oestrogen receptor (ER) positive. 10.4% patients were p53 mutated. 33.3% of mEC patients were stage IV at diagnosis. 30 (62.5%) patients received nivolumab as first-line mEC therapy. 33 (68.8%) patients received nivolumab 4-weekly. Treatment response was clinician-observed in 34 (70.8%) patients, with 7 (14.5%) more having stable disease. 52%, 45% and 36% of patients were progression-free at 12, 18 and 24months, respectively. 75%, 55% and 47% of patients were alive at 12, 18 and 24 months. There was no significant difference between survival or response whether nivolumab was given in the first line or subsequent lines. 29 (60.4%) patients have discontinued treatment with 23 (44.2%) being due to progressive disease or death. 18 (37.5%) patients developed G1-2 toxicity, and 3 (6.25%) patients discontinued due to G3 toxicity. Conclusions This retrospective cohort shows that nivolumab monotherapy has good real-world disease control of mEC patients with MMR deficiency. Toxicity rates were low, and checkpoint monotherapy may be a viable option for selected first-line MMRd mEC patients.https://www.clinicaloncologyonline.net/article/S0936-6555(25)00154-2/fulltex