Countess of Chester Hospital NHS Foundation Trust

Medial unicompartmental knee replacement (UKR) is a joint-preserving alternative to total knee arthroplasty for patients with isolated medial compartment osteoarthritis. Historically, anterior cruciate ligament (ACL) deficiency has been considered a contraindication to UKR due to concerns over implant failure and instability. However, synchronous ACL reconstruction with UKR has emerged as a potential solution, aiming to restore joint stability while preserving native biomechanics. This review evaluates whether outcomes differ between synchronous ACL reconstruction with UKR and conventional UKR in ACL-intact knees.A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Sixteen studies were included, comprising 1842 knees, 312 in the intervention group, and 1530 in the comparator group. Eligible studies reported outcomes such as Oxford Knee Score (OKS), Knee Society Score (KSS), implant survival, revision rates, and complications. Meta-analysis was performed using a random-effects model to account for heterogeneity.Both groups demonstrated substantial improvements in patient-reported outcome measures (PROMs), with OKS, Knee injury and Osteoarthritis Outcome Score (KOOS), and KSS scores indicating high postoperative satisfaction. Implant survivorship ranged from 87.5% to 100% in the intervention group and 92-95% in the comparator group. A statistically significant mean OKS difference of 1.6 points favoured the intervention group (p=0.0251), though this fell below the minimal clinically important difference threshold, suggesting functional equivalence.Synchronous ACL reconstruction with UKR offers comparable outcomes to conventional UKR in ACL-intact knees. This approach may be particularly beneficial for younger, active patients with ACL deficiency. Further prospective studies are needed to validate long-term efficacy and refine patient selection.

BackgroundPatients with diabetes mellitus are more likely to develop complications in healing after abdominal surgery. The study aims to compare and evaluate the process of wound healing in diabetic and nondiabetic patients following abdominal surgery.MethodsA group of 100 patients underwent elective abdominal surgeries (50 diabetic and 50 nondiabetic). A prospective observational study was performed on these patients. On days 3, 7, and 14, standardized wound healing scores were used to assess the process of wound healing after surgery. The CDC’s criteria were used to grade surgical site infections (SSIs) in this study. The factors observed for each sample were wound edema, erythema, discharge, the SSI grade, and the time it took to heal.ResultsAmong the 100 patients who received abdominal surgery, the incidence of SSI was greater in diabetic patients, i.e., 15 (30%) versus five (10%) in nondiabetics. The healing time of >14 days was experienced in 20 (40%) diabetics compared to six (12%) nondiabetics, and dehiscence of wounds was found in six (12%) and two (2%), respectively (p < 0.05). The healing duration of diabetics was also longer (18.1 ± 4.6 vs. 12.5 ± 2.9 days). Grading of infection demonstrated greater Grade I: 10 (20%) vs. 4 (8%), Grade II: 4 (8%) vs. 1 (2%), and Grade III: 1 (2%) vs. 0 (0%). High BMI and diabetes were also major predictors of poor healing.ConclusionsDiabetic people had worse postoperative wound healing after abdominal surgery. Glycemic control and perioperative strategies may help improve surgical outcomes.

Abstract Background Complex wound infections can be challenging to treat and often necessitate IV antimicrobial therapy, typically delivered in inpatient settings or via outpatient parenteral antimicrobial therapy (OPAT) services. With growing pressures across healthcare systems, strategies facilitating early discharge through effective and simple oral treatment regimens are preferred. Delafloxacin, a fluoroquinolone licensed for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and community-acquired pneumonia (CAP) in adults, offers a convenient oral dosing regimen and has broad-spectrum coverage, good tissue and biofilm penetration, and enhanced efficacy in acidic environments characteristic of infected wounds. Together, these properties make delafloxacin a promising option for the treatment of complex wound infections. We describe a case of off-label use of delafloxacin to resolve a complex polymicrobial wound infection yielding Pasteurella multocida and anaerobes, which resulted from a cat bite, and had been unresponsive to prior therapy. Case description A 55-year-old female was admitted to the hospital with a soft tissue infection of the lower right leg, as a result of a recent cat bite. The patient's wound required surgical debridement. Samples taken on admission and in theatre isolated P. multocida plus anaerobes. She was discharged home on oral co-amoxiclav. Following ongoing purulent discharge and inflammation, she was re-admitted. Her therapy was converted to IV ceftriaxone and metronidazole. She was slow to improve and was referred for debridement. Samples continued to isolate the same organisms. She was discharged home on oral doxycycline and metronidazole. Due to the lack of clinical response before finishing the further course of treatment, off-label use of delafloxacin was discussed, owing to its favourable pharmacological properties, including activity against the repeatedly isolated pathogens. The patient was converted to oral delafloxacin 450mg twice daily. Within 3 days, symptoms had improved, with reduced inflammation; after 7 days, further improvement was noted, blood parameters returned to normal levels, although there was still some purulent discharge. However, cultures showed no growth. Following a further week of delafloxacin, the patient continued to improve, with no pus evident. At the next review, inflammation had fully resolved, the patient was weight-bearing, and well enough to resume normal activities. Conclusions In this case, oral delafloxacin led to the rapid clinical resolution of a complex wound infection yielding P. multocida and anaerobes, resulting from a cat bite, and showed a poor prior response to licensed agents, despite sensitivity testing indicating susceptibility. The successful outcome of delafloxacin treatment could have been contributed to by its pharmacological properties and ease of administration, facilitating patient compliance. Furthermore, delafloxacin’s potential to facilitate early hospital discharge on a simple oral regimen could help to ease the pressures experienced by hospitals and OPAT services, whilst supporting antimicrobial stewardship objectives. Nevertheless, further evaluation is needed to help define its possible role in managing complex wound infections beyond its current license; it is essential that use is guided by appropriate governance frameworks. Transparency declarations Medical writing support was funded by Menarini group, manufacturer of delafloxacin.

Faecal incontinence (FI) is common, yet clinical guidelines rely on low-quality evidence or expert opinion. A high proportion of research is focused on areas that may not be considered a priority by patients or clinicians. This project aimed to identify the top 10 research priorities for FI in adults in equal collaboration with patients, carers and healthcare professionals in a James Lind Alliance priority setting partnership (PSP). This PSP followed established methodology supported by a multidisciplinary steering group including those with lived experience of FI. Evidence uncertainties were gathered through a survey with free-text responses, summarised in indicative summary questions and prioritised in a second survey. An independently facilitated priority setting workshop used a nominal group technique to reach consensus on the order of research priorities, with a focus on the top 10. At all stages the views of healthcare professionals and individuals with a lived experience of FI were considered equally. After the initial survey, 512 respondents submitted 991 evidence uncertainties. These produced 54 indicative summary questions. In the second survey, 373 respondents generated a shortlist of 26 questions. Finally, the top 10 research priorities were determined by consensus at a face-to-face workshop and include unanswered questions concerning prevention, investigation, education, self-management and treatment of FI. This PSP has identified a comprehensive list of top research priorities, including items of importance to both healthcare professionals and individuals with a lived experience of FI. Researchers and funders should use these priorities to inform future work.

BackgroundSupracondylar humeral fractures are common injuries in children and can be associated with high morbidity and lead to lifelong disability. The method of treatment affects the risk of complications and potentially the functional outcome. Closed reduction and percutaneous pinning CRPP has become the most widely used treatment method in high-income countries. In the current literature, both CRPP and lateral straight arm traction have been shown to give good results and reasonable levels of complications. The two methods have never been tested against each other in a randomised trial. Furthermore, these methods have not been analysed prospectively in the low and middle income context.MethodsThe study will be a prospective randomised trial comparing lateral straight arm traction LSAT against CRPP. Recruitment will be at 8 large referral hospitals in Ethiopia. Based on non-inferiority power calculation, we plan to recruit 220 patients.The principal outcome measure will be the PROMIS parent proxy upper extremity short form 8a score version 3.0 at 12 months.The secondary outcome measures will be the Flynn’s criteria; complications; PROMIS parent proxy upper extremity short form 8a score version 3.0 at 6 months; PROMIS parent proxy global health 7 + 2 score version 3.0 administered at 6 and 12 months; and economic analysis of hospital costs for the two treatment modalities.DiscussionSupracondylar humeral fractures are common and serious injuries which occur frequently in LMICs where often half the population are under 18 years of age. Such countries have limited capacity for fracture care. Finding solutions which may avoid referral and operative intervention is paramount in developing access to timely and affordable care for all people. If LSAT is non-inferior to CRPP, then children can be treated locally in a cost-effective manner with avoidance of disability.Trial registrationISRCTN Ref 62164933. Registered on 25 July 2024.

Vaccines have revolutionised the field of medicine, eradicating and controlling many diseases. Recent pandemic vaccine successes have highlighted the accelerated pace of vaccine development and deployment. Leveraging this momentum, attention has shifted to cancer vaccines and personalised cancer vaccines, aimed at targeting individual tumour-specific abnormalities. The UK, now regarded for its vaccine capabilities, is an ideal nation for pioneering cancer vaccine trials. This article convened experts to share insights and approaches to navigate the challenges of cancer vaccine development with personalised or precision cancer vaccines, as well as fixed vaccines. Emphasising partnership and proactive strategies, this article outlines the ambition to harness national and local system capabilities in the UK; to work in collaboration with potential pharmaceutic partners; and to seize the opportunity to deliver the pace for rapid advances in cancer vaccine technology.