Smith CR, Pontonnier R, Patel T
… +2 more, Mamidanna R, Chatzikonstantinou M
Ulster Med J
· 2025 Sep · PMID 41019019
BACKGROUND: Obesity is a major public health challenge, yet formal education on bariatric and metabolic surgery (BMS) remains limited in undergraduate and early postgraduate medical training. Foundation Year 1 (FY1) doct...BACKGROUND: Obesity is a major public health challenge, yet formal education on bariatric and metabolic surgery (BMS) remains limited in undergraduate and early postgraduate medical training. Foundation Year 1 (FY1) doctors are often responsible for managing post-operative bariatric patients, but their confidence and preparedness in this area are unclear. This study aimed to assess FY1 doctors' confidence, knowledge, and perceptions of BMS, identifying educational gaps to guide future training. METHODS: A cross-sectional survey was distributed to FY1 doctors across seven hospitals in South-East London (August- December 2024). The questionnaire assessed demographics, confidence in managing BMS patients, prior training knowledge, and perceptions of obesity and BMS. RESULTS: Seventy-seven FY1 doctors participated. The majority (77.9%, n=60) had no formal BMS training, and fewer than half (42.9%, n=33) had clinical exposure to BMS patients. Only 20.8% (n=16) felt comfortable managing these patients, with confidence levels higher among those with prior clinical exposure but without statistical significance (p = 0.0682). Misconceptions were present, with 41.6% (n=32) believing obesity is self-inflicted and 7.8% (n=6) viewing BMS as cosmetic. A majority (84.4%, n=65) supported integrating BMS education into medical training. CONCLUSION: FY1 doctors demonstrated low confidence in managing bariatric patients, possibly due to limited training and exposure. Findings highlight the need for structured BMS education, focusing on peri-operative care rather than procedural details, to better equip future doctors in managing obesity and post-bariatric surgery patients.
OBJECTIVE: To investigate timing and surgical approaches of multidisciplinary management of sinogenic subdural and extradural empyema in the paediatric population. METHODS: We performed a retrospective analysis of all ca...OBJECTIVE: To investigate timing and surgical approaches of multidisciplinary management of sinogenic subdural and extradural empyema in the paediatric population. METHODS: We performed a retrospective analysis of all cases of sinogenic subdural and extradural empyema at our tertiary referral centre over a 10-year study period from 1 May 2012 to 1 May 2022. Data on demographics, presenting features, surgical management, length of stay, radiological investigations, microbiology results and long-term morbidity was recorded in a spreadsheet for analysis. RESULTS: We identified 11 children (mean age 11.3 years ± 2.3). In this sample, 7 were male (63.6%) and 4 female (36.4%). There were 7 cases of subdural empyema (63.6%), 2 cases of extradural empyema (18.2%) and 2 cases with both subdural and extradural empyema (18.2%). There were significant underlying co-morbidities in 2 cases (18%). The frontal sinus was suspected source in 10 cases (91%). Endoscopic sinus surgery was performed in 10 cases (91%); with 9 of these cases (90%) as/with the initial operation or within 24 hours of initial operation. Craniotomy was required in 9 cases total (81%), with 5 cases (56%) as/with the initial operation or within 24 hours of initial operation. After initial craniotomy 4 cases (44%) required further neurosurgical evacuation of abscess. Additionally, 2 cases managed with initial burrhole later required craniotomy. All 3 cases of small volume subdural empyema without neurological deficit were initially managed with endoscopic sinus surgery only and all cases subsequently required craniotomy. All cases with subdural empyema required craniotomy (n=9) whereas all cases with isolated extradural empyema avoided craniotomy (n=2). There was a longer length of stay in those that presented with neurology or low GCS than those that did not (27 days ± 10 compared to 86 days ± 41, p= 0.009). Long term morbidity and repeated neurosurgical intervention were more common in those cases with subdural empyema than those without subdural empyema, (55% vs 0% and 67% vs 0% respectively) although only 2 patients did not have subdural empyema (no statistical analysis available given small numbers). A Streptococcus milleri group microbe was isolated in 82% of cases. CONCLUSIONS: Endoscopic sinus surgery does not seem effective at preventing the need for craniotomy in cases of subdural empyema. It does have a role in aiding microbiological diagnosis. ESS may have a role in the treatment of extradural empyema and avoiding craniotomy. Subdural empyema has a higher morbidity and return to theatre rate than extradural empyema. Those that present with a neurological deficit or decreased GCS have a longer length of stay. Larger studies are required to assess the timing and extent of surgical interventions for subdural and extradural empyema.
Blevings PJ, Moore JE, McCaughan J
… +3 more, Reid A, Rendall JC, Millar BC
Ulster Med J
· 2025 Sep · PMID 41019016
BACKGROUND: Cystic fibrosis (CF), which is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene is the most common life-limiting autosomal recessive genetic disease in Northern Irela...BACKGROUND: Cystic fibrosis (CF), which is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene is the most common life-limiting autosomal recessive genetic disease in Northern Ireland. Currently, Northern Ireland has approximately 520 people with CF (PwCF) (312 adults, 208 children) and a defective gene carrier rate of 1 in 22 persons, with approximately 86,507 carriers within the general population. Advances in DNA sequencing technology has allowed for better genetic characterisation of CFTR mutations. The aim of this project was to (i) examine current CFTR mutation frequency and type in paediatric and adult CF populations in Northern Ireland, (ii) examine CFTR mutational trends in relation to CF patients' age groups, (iii) compare Northern Ireland CFTR most common allele frequencies with those documented globally and (iv) establish a reference/baseline of CFTR mutation information prior to the effect of CFTR modulator therapy. METHODS: Anonymised data comprising of birth year, sex, and known alleles of adult and paediatric individuals (n=520) from the Northern Ireland CF population was examined. Alleles were recorded according to legacy, protein and cDNA name and organised by mutation class and type, in accordance with CFTR2 database nomenclature. Individual known alleles frequencies from the complete Northern Ireland CF population (n=1005) were calculated and compared with the CFTR2 database, globally with CFTR data obtained from CF national registries. RESULTS: Within the Northern Ireland CF population, there were 61 different CFTR mutational variants identified in a population of 1005 alleles. In descending occurrence, the most common was F508del with 626 alleles (62.3%), followed by R117H (8.9%), G551D (5.0%), G542X (3.3%), R560T (2.8%) and P67L (2.2%). The remaining alleles were present at a frequency of <2.0%. The six most frequently detected CFTR mutations accounted for 84.4% of all alleles. Over approximately two and a half decades (1996-2021), 23 CFTR mutations remain shared. Six alleles, which were described in the 1996 CFTR analysis, were absent from the 2021 data, whilst there were additional descriptions of 39 allelic mutations, which occurred in the 2021 analysis, but which were not described in the 1996 analysis. CONCLUSION: Characterisation of CFTR mutation alleles from people with cystic fibrosis provides essential information to help predict disease severity and effect of targeted CFTR modulator therapy. These 2021 data provide a valuable genetic update from the 1996 data and a reference point on the status of the Northern Ireland CFTR mutation types and frequencies. CFTR modulator therapy has the potential to indirectly alter the current and distribution of CFTR mutation types amongst children of PwCF, due to improved clinical status and fecundity. Revisiting this in a decade from now will allow an estimation of the indirect influence of CFTR modulator therapy on CFTR mutation evolution.
On 29 November 2024, the House of Commons voted in favour of legalising assisted suicide. The aim of the Bill is to "allow adults who are terminally ill, subject to safeguards and protections, to request and be provided...On 29 November 2024, the House of Commons voted in favour of legalising assisted suicide. The aim of the Bill is to "allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life." At the time of writing, the Bill is under consideration at the Committee stage. This paper considers the implications of the bill and the appropriateness of using the "slippery slope" argument in its critique. It may be seen that when considering the practice of assisted suicide in jurisdictions where it has been legalised, the empirical form of the argument is shown to be valid. However, the logical form of the argument is less relevant as, once the principle is conceded, there are no further significant barriers and the slope is, in fact, a cliff edge. History shows that the proposed safeguards are unlikely to be robust or sufficient to withstand challenge.
Lloyd-Jones G, Shambrook J, Watson A
… +2 more, Freeman A, Wilkinson TMA
Ulster Med J
· 2025 Apr · PMID 40313996
INTRODUCTION: Early in the COVID-19 pandemic, CT was demonstrated as a sensitive tool for diagnosing COVID-19. We undertook a detailed study of CT scans in COVID-19 patients to characterise disease distribution within lu...INTRODUCTION: Early in the COVID-19 pandemic, CT was demonstrated as a sensitive tool for diagnosing COVID-19. We undertook a detailed study of CT scans in COVID-19 patients to characterise disease distribution within lung parenchyma, respiratory airways, and pulmonary vasculature, aiming to delineate underlying disease processes. METHODS: We characterised acute phase chest CT of 40 participants with COVID-19 from the REACT study, 31 with CT pulmonary angiography (CTPA), 4 with intravenous contrast enhanced CT and 5 with non-intravenous contrast enhanced CT. Participants had neither been vaccinated nor received systemic steroids. We further correlated the distribution of lung parenchymal damage on CT with contemporaneous chest radiographs. RESULTS: Parenchymal lung damage was found in all subjects. However, airways inflammation was present in only 23% (9) and limited to small areas. Notably, vascular abnormalities were dominant and characterised by dilated peripheral pulmonary vessels supplying areas of lung damage in a gravity-dependent distribution bilaterally in 95% (38), basally in 90% (36), peripherally in 92.5% (37), and posteriorly in 90% (36). Macrothrombosis was demonstrated in 23% (7) of CTPAs. Wedge-shaped peripheral lung damage, resembling areas of pulmonary vascular congestion, were distinct in 53% (21) with or without visible macrothrombosis. Pleural effusions were seen in 28% (11). Notably, lung opacification distribution in 98% of the plain radiographs matched distribution on CT (39). CONCLUSION: Our study frames COVID-19 as a pulmonary vasculopathy rather than a more conventional pneumonia which may be important not only for guiding mechanistic study design but also for the development of novel targeted therapeutics.
Dash A, O'Hagan A, Holte K
… +2 more, Friel JJ, Venkatraman L
Ulster Med J
· 2025 Apr · PMID 40313994
VEXAS syndrome is a rare and recently identified autoinflammatory disorder recently, characterized by the involvement of multiple organ systems, with manifestations in dermatology, hematology, and rheumatology. The syndr...VEXAS syndrome is a rare and recently identified autoinflammatory disorder recently, characterized by the involvement of multiple organ systems, with manifestations in dermatology, hematology, and rheumatology. The syndrome results from a somatic mutation in the UBA1 gene, leading to defective ubiquitin-mediated protein degradation, which triggers a cascade of inflammatory responses. We report the case of a 76-year-old male who presented with a recurrent rash initially suggestive of Sweet's syndrome. Following a comprehensive diagnostic workup, including genetic testing, the patient was diagnosed with VEXAS syndrome due to the identification of a pathogenic variant in the UBA1 gene. This case highlights the diagnostic challenges clinicians face when confronting rare syndromes with nonspecific clinical features. The absence of formal diagnostic criteria and its overlap with more common inflammatory and haematologic diseases complicates prompt diagnosis and management. Timely recognition, genetic confirmation, and early intervention are critical for preventing disease progression and improving outcomes in VEXAS patient.
Spontaneous rupture of a uterine artery is a rare occurrence and more often associated with postpartum haemorrhage. It is even more unusual outside pregnancy. In this report, we will describe a case of spontaneous uterin...Spontaneous rupture of a uterine artery is a rare occurrence and more often associated with postpartum haemorrhage. It is even more unusual outside pregnancy. In this report, we will describe a case of spontaneous uterine artery rupture in a 40-year-old non-pregnant female with adenomyosis who presented with severe vaginal bleeding. We will also review the aetiology of rupture of uterine artery based on the current literature.