Royal Victoria Infirmary

When performing Mohs micrographic and dermatologic surgery for high-risk cutaneous malignancies, particularly aggressive scalp tumors, there may be positive or indeterminate deep margins overlying clinically uninvolved bony cortex (outer table). To ensure complete tumor extirpation in these situations, the authors performed superficial bone decortication and report their case series. Over six consecutive months, superficial bone decortication was performed using a microdrill with rosehead bur after 10 Mohs micrographic surgery cases and one incomplete skin cancer excision. Cases included eight squamous cell carcinomas, two pleomorphic dermal sarcomas, and one basal cell carcinoma. The mean preoperative largest tumor diameter was 37.2 mm, and the mean postoperative largest defect diameter was 49.4 mm. Patients completed mixed-methods questionnaire with a Likert scale, dichotomous, and open-questions. The median pain value was 0 (mean 0.4) during the decortication surgery. All patients receiving Mohs surgery preferred superficial bone decortication under local anesthetic on the day of Mohs rather than referral for another day under general anesthetic.Analysis of open questions determined the procedure was similar to dental drilling -noisy with a vibratory sensation but caused little discomfort. Superficial bone decortication is a well-tolerated and safe procedure in an outpatient setting and can be readily performed after Mohs micrographic surgery in clinically uninvolved bone.

Abstract Introduction Magnesium is essential for regulating cardiovascular, neuromuscular and respiratory functions. Hypomagnesemia in older adults is often overlooked and insufficiently managed. Inadequate monitoring and correction of hypomagnesemia may leave old and frail patients more vulnerable to acute cognitive decline which in some cases can be preventable. This study assessed the current management of hypomagnesaemia in older adults admitted to the geriatric wards of an NHS Trust and its association with acute cognitive decline. Methods A retrospective review of old and frail patients admitted to geriatric wards across two hospital sites over a month was conducted. Patients aged 65 years or above and those aged between 55 to 64 with clinical frailty were included. Electronic records were used to compare acute cognitive outcomes in patients with hypomagnesaemia and those with normal magnesium levels. Multivariate analysis was performed to assess predictors of acute cognitive impairment. Results Of the 667 hospitalised older adult patients included in our study, 149 (22.3%) had hypomagnesaemia, while 518 (77.7%) had normal levels. Among the 149 patients with low magnesium, 18 (12.2%) had moderate to severe deficiency (</= 0.5 mmol/L); of these, 27.8% received intravenous supplementation, 38.9% received oral supplementation and 33.3% received no treatment. The remaining 131 patients had mild hypomagnesaemia (<0.7 mmol/L), 45 (34.4%) received some form of supplementation, while 86 (65.5%) had none. Only 60 (40.3%) of all hypomagnesaemic patients had follow up magnesium levels checked. In the multivariable logistic regression model, adjusting for age, sex and potential clinical confounders, patients with hypomagnesaemia had 2.35 times greater odds of developing acute cognitive deterioration (OR (Odds ratio) = 2.354; 95% CI (Confidence interval): 1.543–3.604; p < 0.001). These findings suggest an independent association between hypomagnesaemia and cognitive decline, underscoring the need for improved recognition and management in clinical practice. Conclusion Hypomagnesaemia may be a significant contributor to acute cognitive impairment in old and frail patients.

Abstract A major consequence of the COVID-19 pandemic has been the emergence of post-COVID syndrome (PCS), and more specifically, post-COVID fatigue (pCF), with an estimated prevalence of ∼2%. We previously showed that, compared to healthy controls, people with pCF exhibit changes in muscle physiology, cortical circuitry, and autonomic function. Here we present results from a cohort of people with pCF (N=145), between 12 weeks and 45 months post-infection. We report self-perception of fatigue; objective measures of cortical circuits via transcranial magnetic stimulation and reaction time tasks; peripheral muscle fatigue; and autonomic function such as heart rate variability. Those with pCF persisting >200 days had significantly more fatigue and showed increased cortical excitability, slower reaction times and increased peripheral muscle fatigue compared to those with < 200 days of pCF . In pCF, if there is no spontaneous recovery, fatigue worsens, and patients continue to accumulate significant neurophysiologic abnormalities.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1365:"<h3></h3> In 2021, Nakajima and colleagues published guidelines for the diagnosis and management of Normal Pressure Hydrocephalus (NPH). Locally, we set clinical standards based on these guidelines and reviewed cases of possible NPH (pNPH) seen in the Royal Victoria Infirmary between 2017-2019. 87 patients were identified of which 80% (70/87) patients met the diagnostic criteria for ‘possible NPH’. 77% (54/70) had CSF tap/drainage of which 37% (4/54) had clear documentation of objective measure of change. Of all 87 patients, 60% (52/87) had a shunt inserted and 71% (37/52) shunted patients had an improvement. The NPH Multi-disciplinary team (NPH-MDT) was set up aiming to improve the management of pNPH patients. We reviewed patients discussed in NPH-MDT in 2022. 89 patients with pNPH were identified from the database of which 84% (75/89) fulfilled diagnostic criteria for ‘possible NPH’. 27% (20/75) had CSF tap of which 100% (20/20) had clear documentation of an objective measure of change and 70% (14/20) improved. 93% (13/14) had a shunt and of those shunted 92% (12/13) had an improvement. These results show that following discussion in NPH-MDT, there was improved adherence to clinical standards for the investigation and management of NPH and improved outcomes of patients following shunts. stephanie.ong1{at}nhs.net ";}

Microbiome research focusing on late and moderate preterm infants (LMPT; 32 to 36 weeks gestation) is limited, despite rising LMPT births, large healthcare burdens, and increased risks of multiple morbidities, potentially microbially related. In this longitudinal cohort study, 16S rRNA gene sequencing was used to analyze 371 stool and 402 saliva samples from 160 LMPT infants, collected at five time points between birth and 12 months corrected age (CA), to describe spatial and temporal variability in gut and oral microbiomes. Paired stool and saliva samples (n = 337) were analyzed for potential microbial relationships. Early LMPT samples (up to 60 days of life; DOL) were also compared with data from seven extremely preterm infants (EP; <28 weeks gestation; stool n = 14, saliva n = 14). LMPT stool and saliva were composed of distinct microbial communities at each time point, and both sample types showed increasing alpha diversity over time. Stool was initially dominated by Escherichia/Shigella, Klebsiella, and Streptococcus, with Bifidobacterium becoming dominant from term equivalent age (TEA). Contrarily, saliva was dominated by Streptococcus throughout the first year, with early contributions from Staphylococcus and later Veillonella. LMPT infants had higher stool and lower saliva diversity compared with EP infants. Both sample types from EP infants were taxonomically distinct from LMPTs, with Escherichia/Shigella dominating both EP sample types throughout the first 60 DOL. The results highlight the unique trajectories of LMPT microbiomes and emphasize the role of gestational maturity in shaping microbial communities.IMPORTANCEThe oral and gut microbiome develops from birth and plays important roles in health. This has been well studied in extremely preterm infants (EP; born <32 weeks gestation) and term infants (born >38 weeks gestation), but there is a paucity of research describing oral and gut microbiome development in late and moderate preterm infants (LMPT; 32 to 36 weeks gestation). Our study analyzed microbiome development in 160 LMPT infants from birth to 12 months corrected age. The results showed distinct microbial communities in stool and saliva, with increasing alpha diversity and niche specification over time. LMPT infants' gut microbiome became dominated by Bifidobacterium by month 3, while the oral community was consistently dominated by Streptococcus. These results highlight that LMPT infants have gut and oral microbiome development that is more like term infants than EP infants, which has important implications for the care of LMPT infants.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Appendix S1: all70086-sup-0001-AppendixS1.docx. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.