Pilgrim Hospital

Endometriotic cyst infection is rare and typically associated with invasive pelvic procedures or pelvic inflammatory disease. We present a case of a 34-year-old nulligravida female with no recent surgical or gynaecological interventions, who developed acute abdominal pain due to a ruptured endometriotic cyst infected with Salmonella enterica serovar Typhi. This case underscores the potential for hematogenous spread of infection and the importance of considering infected endometriomas in the differential diagnosis of acute abdomen.

Testosterone replacement therapy (TRT) is commonly used to treat men with hypogonadism in order to replace the physiological levels of testosterone, although the cardiovascular safety and metabolic advantages of this treatment are still controversial. This article is a systematic review of the existing literature on the cardiovascular impact of TRT on lipid levels, inflammatory parameters, as well as endothelial activity in hypogonadal men. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar of peer-reviewed studies that were published between 2005 and 2025. The Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool was used to evaluate methodological quality, and the data were synthesized narratively due to substantial heterogeneity across study designs, including differences in TRT formulations, dosing regimens, treatment duration, and the clinical characteristics of hypogonadal populations. Quality ratings were considered when interpreting the evidence, with higher-quality studies providing stronger support for the cardiovascular effects of TRT. In this review, 25 studies were included as they met the inclusion criteria. The included studies comprised randomized controlled trials and observational research designs (systematic reviews, meta-analyses, and cohort studies). Overall, TRT was associated with reductions in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), while high-density lipoprotein cholesterol (HDL-C) showed modest increases or remained stable across studies. Anti-inflammatory effects of testosterone therapy were demonstrated by the decrease in pro-inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)) and the enhancement of endothelial-dependent vasodilation.In hypogonadal men, TRT shows some improvements in endothelial function and reduced systemic inflammation, with benefits most evident under physiological dosing, while its lipid effects may be generally neutral to mildly favorable (decrease in TC/LDL, HDL often somewhat decreased depending on formulation). Long-term cardiovascular safety appears generally reassuring with respect to major adverse cardiac events in appropriately selected patients, though some adverse events may warrant monitoring. High-quality, longer-duration trials remain needed to strengthen these conclusions.

<h3>Background</h3> Delirium is prevalent in hospice inpatient units (IPUs) (Watt, Momoli, Ansari, et al. Palliat Med. 2019;33(8):865-877), causing distress for patients and families and resulting in high care burden for staff (Rainsford, Rosenberg, Bullen. J Palliat Med. 2014;17(9):1045-8). However, delirium is often poorly recognised and managed (Hosie, Davidson, Agar, et al. Palliat Med. 2013;27(6):486-98). In 2021 a Delirium Toolkit was developed to support the detection and management of delirium among patients in three hospice IPUs. The Toolkit consisted of a ‘step-by-step’ checklist, a patient information leaflet; non-pharmacological checklist; 4AT tool and a ‘getting to know you’ form. The Toolkit was appraised through a retrospective service evaluation looking at its implementation into practice. <h3>Aim</h3> To establish if the implementation of a Delirium Toolkit has improved the recognition and management of delirium in hospice IPUs. <h3>Method</h3> A staff survey was developed using ‘normalisation process theory’ (Finch, Girling, May, et al. BMC Med Res Methodol. 2018 Nov 15;18(1):135) to test how embedded the Toolkit was in practice (n=54). Patient record data (n=399) was analysed before and after implementation to measure the impact on the incidence of delirium. In-depth interviews were conducted with four hospice staff exploring the practical application and deeper understanding of the Toolkit. <h3>Results</h3> The presence of delirium decreased following the introduction of the Toolkit (87% before; 74% after). Staff were positive about the contribution of all elements of the Toolkit and saw it as beneficial. Embedding the Toolkit was not consistent across the organisation. Some staff felt very familiar and confident in its use but not others, which varied by profession and relevance to practice. Staff were less confident in identifying hypo-delirium than they were hyper-delirium. Further training was suggested and has started to help overcome these barriers. <h3>Conclusion</h3> Support was high for the Toolkit and offers a complete package of tools and a sequential process to support the detection and management of delirium in hospice inpatients. Implementation of a similar approach is recommended in other hospice settings, with appropriate training and leadership.

<h3>Background</h3> The safe use of syringe pumps for palliative medication administration is essential in end-of-life care. However, many nursing homes in the UK face significant challenges in ensuring staff are adequately trained and competent in managing these devices (Anstey, Powell, Coles, et al. BMJ Support Palliat Care. 2016;6(3):353-61). A significant barrier is the infrequency with which syringe pumps are used in nursing homes, leading to a lack of hands-on experience among staff. Nursing homes may have limited number of residents who require syringe pumps at any given time, which makes it difficult to maintain practical proficiency in their use (Seymour, Kumar, Froggatt. Palliat Med. 2011;25(2):125-38). Additionally, there is often a high turnover rate of staff in nursing homes, meaning that new staff members may not receive adequate or ongoing training, or they may not stay long enough to develop and retain competency with this critical skill. Training tends to be theoretical with limited practical assessment or opportunities for skill refreshment. Without structured assessments, staff may lose confidence or competence over time. This skill gap poses risks to patient safety and the quality of care. <h3>Aims</h3> This project aims to address the shortage of staff competent in syringe pump management within local nursing homes. The initiative provides both initial training and practical competency assessments to improve the quality of palliative care delivered to residents (Seymour, Kumar, Froggatt. Palliat Med. 2011;25(2):125-38). <h3>Methods</h3> We deliver initial training on syringe pump theory to nursing home staff, or confirm completion of similar training within the past three months. After signing a Memorandum of Understanding, nursing homes send staff to the hospice to complete a practical competency assessment under supervision. <h3>Results</h3> Despite being in the early stages, we have had excellent engagement from nursing homes locally. We aim to collect both qualitative and quantitative data demonstrating how this project bridges the skill gap, strengthens collaboration between hospices and nursing homes, and enhances patient care and symptom management.

Pulmonary embolism (PE) is a potentially fatal condition, typically associated with known risk factors such as immobility or thrombophilia. This case describes a 55-year-old woman with cardiomegaly who developed PE one week after sustaining minor chest trauma, despite an initially normal D-dimer and CT scan. She later re-presented with worsening respiratory symptoms, and a CT pulmonary angiogram confirmed PE. She was successfully treated with anticoagulation. This case highlights the need for ongoing clinical vigilance for PE, even in low-risk patients with initially unremarkable findings, particularly when symptoms evolve. It demonstrates that even minor chest trauma can precipitate a thromboembolic event and emphasizes that a normal initial assessment should not exclude the possibility of PE if clinical status deteriorates. Furthermore, it underlines the importance of timely reassessment with repeat imaging in the presence of evolving symptoms and highlights that early recognition and prompt initiation of anticoagulation are essential for improving patient outcomes.

This study aimed to investigate the surgical management of cerebral arteriovenous malformations (AVMs) by analyzing clinical outcomes and complications in 600 patients (100%) who underwent surgery. The mean age of the cohort was 36.7 years (SD = 12.3), with a majority being female (n = 315, 52.5%). Patients were classified by AVM size: small (35.5%, n = 213), medium (31.5%, n = 189), and large (33%, n = 198). Surgical approaches included microsurgery (31.3%, n = 188), endovascular embolization (33.5%, n = 201), and radiosurgery (35.2%, n = 211). Surgical outcomes revealed that 33.8% (n = 203) achieved complete resection, 32.7% (n = 196) had partial resection, and 33.5% (n = 201) underwent no resection. Post-surgical complications were experienced by 51.5% (n = 309) of patients, with the most common being postoperative hemorrhage (15.2%, n = 91), infection (14.8%, n = 89), and seizures (9.8%, n = 59). Logistic regression identified AVM size (OR = 2.3, p = 0.01), hypertension (OR = 1.8, p = 0.03), and seizure history (OR = 1.7, p = 0.04) as significant predictors of complications. Kaplan-Meier analysis revealed that patients with complete resection had the highest one-year recovery rate (78%), compared to partial (48%) and no resection (38%). Hospital stay was significantly longer for large AVMs (mean = 18.5 days) versus small AVMs (mean = 12.3 days; p = 0.001). These findings underscore the importance of AVM size and patient comorbidities in predicting surgical outcomes and complications, highlighting the need for tailored treatment approaches.

BackgroundMetabolic syndrome (MetS) constitutes a multifaceted clinical condition characterised by a constellation of metabolic risk factors including central obesity, atherogenic dyslipidemia, elevated blood pressure, and impaired glucose metabolism, which synergistically elevate the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Rapid shifts in lifestyle have notably elevated the incidence of MetS in India, particularly in urban regions. Yet, sparse comparative data is available regarding the urban-rural differences in MetS prevalence within Tamil Nadu. Thus, this research sought to assess the prevalence of MetS and to identify associated risk factors among adults residing in urban and rural locales of Tamil Nadu.MethodsEmploying a multistage random sampling approach, this community-centric cross-sectional study encompassed 1,000 adults, evenly divided between urban (n=500) and rural (n=500) settings. Data were gathered through structured face-to-face interviews, anthropometric assessments, and biochemical analyses. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines were utilised to define MetS. Analytical methods included descriptive statistics, chi-square tests, independent samples t-tests, and multivariate logistic regression modelling to pinpoint the critical determinants of MetS.ResultsThe cumulative prevalence of MetS was 31.6% (95% confidence interval (CI): 28.7%-34.6%; 316 participants), with a higher prevalence in urban areas at 34.8% (95% CI: 31.9%-37.8%; 174 participants) compared to 28.4% in rural areas (95% CI: 25.6%-31.3%; 142 participants). The study identified significant predictors of MetS, such as age 40 years or above (adjusted odds ratio (AOR): 2.2, p<0.01), female sex (AOR: 2.8, p<0.01), tobacco smoking (AOR: 2.7, p<0.01), sedentary lifestyle (AOR: 2.7, p=0.02), minimal fruit intake (AOR: 4.4, p=0.01), habitual consumption of fried foods (AOR: 5.3, p=0.01), existing diabetes mellitus (AOR: 3.2, p=0.02), and obesity (AOR: 2.3, p=0.03).ConclusionUrban populations exhibited a higher MetS prevalence, likely attributed to modifiable dietary patterns and lifestyle choices. Regular screening initiatives, lifestyle adjustments, and targeted nutritional interventions emerge as vital preventive and therapeutic measures. Public health strategies should emphasise early detection and encourage behavioural modifications, specifically targeting at-risk populations.