Russells Hall Hospital

Overactive bladder (OAB) symptoms are prevalent in patients with bladder outlet obstruction (BOO). Although the pathogenesis of OAB in men with BOO is still under investigation, OAB symptoms might persist following an outflow surgery. It is, thus, crucial to prognosticate preoperatively the outcome of a deobstructive operation. This review aims to systematically investigate the preoperative factors that could prognosticate the persistence of OAB symptoms following deobstruction surgery in males. This is a systematic review of the current literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Randomised controlled trials and observational studies of both prospective and retrospective design were considered eligible for the analysis. The Quality in Prognosis Studies tool was used for assessing the risk of bias. Thirty studies, involving 8043 patients who had persistent storage symptoms following surgical BOO relief, were included. Across adjusted analyses, older age and a higher baseline storage symptom burden were the most frequently associated factors, though findings were inconsistent. Urodynamic measures such as detrusor overactivity, bladder capacity, and detrusor contractility showed heterogeneous results, with some positive and some protective signals. Other factors (eg, prostate volume, prostate-specific antigen, maximum flow rate, postvoid residual, and comorbidities) were uniformly null. Overall certainty of evidence was very low, reflecting inconsistency, imprecision, and reliance on single-study signals. Current evidence is of limited quality; no preoperative factor demonstrated robust prognostic value. Older age and a greater storage symptom burden may be associated with persistence in some adjusted models, whilst urodynamic prognostic factors remain uncertain.

Combination chemotherapy provides significant survival advantage in patients with advanced gastro-oesophageal adenocarcinoma compared with best supportive care. Peri-operative chemotherapy is standard of care for patients with operable disease. We hypothesised that biomarkers of genomic instability and inflammation may have clinical utility in these patients. We initiated open-label, non-randomised biomarker studies in patients with advanced disease due to receive Epirubicin, Cisplatin and Capecitabine (ECX)/Epirubicin, Cisplatin and Fluorouracil (ECF) or Epirubicin, Oxaliplatin and Capecitabine (EOX)/Epirubicin, Oxaliplatin and Fluorouracil (EOF) regimens (advanced study, n = 375), and in patients planned to receive perioperative chemotherapy with the same regimen (peri-operative study, n = 306). Relative telomere length (RTL) in peripheral blood mononuclear cells (PBMCs) and plasma levels of 10 inflammatory cytokines were analysed to determine association with progression-free and overall survival, and response. Blood samples were collected prior to treatment and on each treatment cycle. Both studies comprised biomarker discovery and validation cohorts. Here we report analysis of the discovery cohorts. In advanced disease, high pre-treatment levels of IL8 and IL10 associated with poor Progression Free Survival (PFS) and Overall Survival (OS) in univariate analysis, and IL6 with poor OS. In multivariate analysis, IL6 and IL8 remained associated with OS, and IL8 with PFS. In the perioperative study, cytokine levels were significantly lower and no relationships were observed. There was no association between RTL and any endpoint in either study. Pre-treatment RTL was not prognostic, although IL6/IL8 were negative prognostic factors in advanced disease. Levels of these were lower in patients with localised disease, suggesting an association with disease progression. Further analysis of systemic inflammatory status in gastro-oesophageal adenocarcinoma may be promising for development of future predictive biomarker signatures.

To discuss the relationships between mental health problems (MHP) and lower urinary tract symptoms (LUTS). To propose an assessment plan for identifying MHP in patients presenting with LUTS. This review is the outcome of a global multi-disciplinary think tank at the International Consultation on Incontinence (ICI-RS 2025) meeting held in June 2025 in Bristol, United Kingdom that examined the broad issue of mental health and LUTS. The relationship of MHP and LUTS in adults and children, and the possible underlying mechanisms, is presented. Robust evidence was noted for an association between MHP and LUTS, including storage symptoms, voiding symptoms, and bladder pain. However, the underlying mechanisms that underpin this relationship remain unclear. Clinical markers that might indicate MHP and screening tools for assessment by clinicians involved with LUTS care, are discussed. Recommendations are made with regard to key areas for future research. There is a consensus on the existence of a relationship between mental health problems and lower urinary tract symptoms. A better understanding of the nature of this relationship, the mechanisms that underlie it, and the best methods to assess it, is crucial to improving clinical care.

Background: Despite advances in pharmacologic management, achieving sustained remission in rheumatoid arthritis (RA) remains challenging, particularly among patients who exhibit suboptimal responses to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) such as methotrexate (MTX). The emergence of targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), including Janus kinase (JAK) inhibitors, has expanded therapeutic options by directly modulating intracellular signaling pathways central to inflammation and immune activation. Among these, tofacitinib has demonstrated efficacy in clinical trials, yet its real-world performance, safety profile, and predictors of treatment response are less clearly defined. Real-world data, reflecting diverse patient populations and routine clinical practice, are essential for complementing randomized controlled trials (RCTs) and for guiding evidence-based, individualized treatment strategies in RA management.Methods: This retrospective real-world study included 450 RA patients treated with tofacitinib following MTX failure. Demographics, clinical characteristics, laboratory results, treatment history, and comorbidities were assessed. Outcomes included changes in disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ), pain, and stiffness at six months, along with adverse event monitoring. Exploratory data analysis and machine learning models (logistic regression, random forest, XGBoost, LightGBM, and support vector machine {SVM}) were applied to predict treatment response.Results: The mean age was 51.2±12.4 years, with 236 females (52.4%). At six months, DAS28 decreased significantly (5.4±1.1-3.2±1.0; p<0.001), with 286 patients (63.6%) achieving low disease activity and 142 patients (31.6%) reaching remission. HAQ improved from 1.5±0.6 to 0.9±0.5 (p<0.001). Adverse events occurred in 132 patients (29.3%), mostly mild infections. Machine learning models identified CRP, disease duration, and baseline DAS28 as key predictors; however, the predictive performance for treatment response was generally limited, with most models showing area under the curve (AUC) values below 0.65.Conclusion: Tofacitinib demonstrated significant clinical benefit in RA patients with inadequate MTX response, with acceptable safety. While machine learning highlighted key predictors, future work with larger datasets is needed to optimize predictive accuracy and personalize therapy.

Background: Helicobacter pylori (H. pylori) infection is a leading cause of peptic ulcer disease (PUD), with eradication complicated by increasing antibiotic resistance.Objective: To prospectively evaluate and compare the efficacy of various first-line H. pylori eradication regimens in treatment-naïve patients diagnosed with PUD.Methodology: A prospective observational study was conducted from October 2023 to September 2024 at the Department of Gastroenterology, Azad Jammu and Kashmir Medical College and Abbas Institute of Medical Sciences, Muzaffarabad. A total of 252 endoscopically confirmed, treatment-naïve PUD patients were enrolled and assigned to one of the three regimens using a rotational system. Eradication success was evaluated at 6 weeks post-treatment via urea breath or stool antigen test. Antibiotic resistance was assessed using culture and sensitivity testing from gastric biopsies. Logistic regression was used to identify predictors of eradication success.Results: Among 252 patients, 84 (33.33%) received standard triple therapy, 83 (32.94%) received bismuth-based quadruple therapy, and 85 (33.73%) received concomitant therapy. Overall, H. pylori eradication was achieved in 208 patients (82.54%), including 61 (72.62%) in the triple therapy group, 71 (85.54%) in the quadruple group, and 76 (89.41%) in the concomitant group (p=0.01). Resistance to metronidazole (n=131; 52.78%), clarithromycin (n=92; 36.51%), and amoxicillin (n=17; 6.75%) was associated with significantly reduced eradication rates, particularly in dual- and triple-resistant strains. Multivariate analysis confirmed that concomitant therapy (aOR: 2.72, p=0.007) and bismuth-based quadruple therapy (aOR: 2.11, p=0.033) were significantly more effective than standard triple therapy.Conclusion: Concomitant and bismuth-based quadruple therapies are superior to standard triple therapy in H. pylori eradication, particularly in areas with high antibiotic resistance.

Diabetic ketoacidosis (DKA) remains a life-threatening complication of diabetes mellitus, with emerging concerns about its association with sodium-glucose cotransporter-2 inhibitors (SGLT2i). While SGLT2i offer significant cardiovascular and renal benefits, their potential to increase DKA risk - particularly euglycemic diabetic ketoacidosis (eDKA) - warrants systematic evaluation.This review aims to compare the incidence, clinical features, and outcomes of DKA in SGLT2i users versus non-users. A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, CINAHL, IEEE Xplore, and Web of Science. Eligible studies included comparative analyses of DKA in SGLT2i users and non-users, with retrospective and prospective designs. Data were extracted on incidence, laboratory features, precipitating factors, and clinical outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Thirteen studies were included, encompassing diverse populations and regions. SGLT2i users exhibited a higher incidence of DKA, with a notable proportion presenting as eDKA. Key distinguishing features included lower blood glucose levels, higher sodium concentrations, and prolonged hospital stays. Surgery and infections were common triggers, while mortality rates remained comparable between groups. Methodological quality was generally high, though heterogeneity precluded meta-analysis. SGLT2i use is associated with an increased risk of DKA, particularly euglycemic variants, necessitating heightened clinical vigilance. Temporary discontinuation during high-risk periods and early diagnostic suspicion are recommended. Standardized criteria for eDKA and further prospective studies are needed to optimize patient safety.

<bold>Background</bold> Severe asthma (SA) care is mostly delivered through specialised centres (SAC), but capacity and accessibility is often limited. Expanding capacity by employing spoke centres coordinated by a SAC (hub-and-spoke model) may increase capacity whilst maintaining quality of care. The objective of this study was to evaluate the effectiveness of delivering biologic treatment via a hub-and spoke model by comparing treatment accessibility and outcomes between the hub and spokes. <bold>Methods</bold> outcomes data on socio-demographics, clinical characteristics, treatment outcomes, and carbon assessments were retrieved from the service registry. Biologic treatment outcomes were compared between hub and spokes using standard statistics. <bold>Results</bold> Analysis included 74 hub and 226 spoke patients. Median age was 52 years [41.0-62.0], 64.7% were female and median baseline exacerbation number was 6.0 [4.0-8.0]. Biologics used were mepoizumab (34.6%), benralizumab (50%), omalizumab (15.4%). After 12 months of biologic treatment 80.3% (hub: 85.1%, spokes: 78.5%) of patients had positive response (≥50% reduction in exacerbations and/or mOCS dose) with similar reduction in median exacerbations [hub 5.0 (4,7) vs spokes 5.0 (4,7), p=0.39]. There was also similar improvement in ACQ-6 and asthma biomarkers. Patients travel (miles) to spoke centres was shorter than to the hub (5.8 [3.2-12.8] v 9.0 [5.0-33.7]; p<0.001), amouting to 34.5% reduction in travel carbon footprint. <bold>Conclusions</bold> delivering SA care via hub-spoke models can provide increased capacity and maintain care quality across centres. Patients treated at spokes had shorter travel journeys and reduced carbon footprint than those travelled to the hub.

Background: Rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic medications (DMARDs) remains a therapeutic challenge, necessitating the use of biologic agents such as tocilizumab.Objective: To prospectively evaluate the efficacy of tocilizumab in reducing disease activity, measured by DAS28 (ESR), and to assess its safety in terms of adverse events over a six-month follow-up in a real-world South Asian cohort.Methodology: This prospective observational study was conducted at the Department of Rheumatology, Abbas Institute of Medical Sciences, Muzaffarabad, over a two-year period (June 2022-May 2024). A total of 192 patients meeting the 2010 ACR/EULAR RA criteria, with inadequate response to at least two csDMARDs, including methotrexate and a baseline DAS28 (ESR) ≥5.1, were enrolled. Tocilizumab (4-8 mg/kg) was administered intravenously every four weeks for six months. DAS28 scores were recorded at baseline, 12 weeks, and 24 weeks. Safety was assessed through serial laboratory monitoring and systematic documentation of adverse events.Results: Of the 192 patients (77.08% female; mean age 44 ± 10.6 years), the mean DAS28 score decreased from 5.91 ± 0.42 at baseline to 3.76 ± 0.59 at 12 weeks and 2.43 ± 0.71 at 24 weeks (p < 0.001). Remission (DAS28 ≤ 2.6) was achieved in 112 patients (58.33%), while 58 (30.21%) showed partial response and 22 (11.46%) had no response. Adverse events were reported in 52 patients (27.08%), most commonly infections, lipid abnormalities, and gastritis.Conclusion: Tocilizumab is a highly effective and generally well-tolerated treatment option for RA patients unresponsive to csDMARDs, though longer follow-up and controlled comparisons are needed to confirm long-term safety and causality.

Abstract Background GIRFT data shows only 12.4% of patients in Leicester, Leicestershire, and Rutland (LLR) achieve the target 2-day length of stay (LOS) and place the region in the highest quartile for average LOS. An initial audit in 2023 found just 4.4% of patients met the target LOS. Since then, theatre and imaging capacities have increased. Aims This study aimed to evaluate overall LOS and time intervals between admission, imaging, operation, and discharge. Secondary aims included assessing digital consent adoption following its departmental implementation in 2022. Methods Data from 91 adult patients undergoing laparoscopic appendicectomy between 04/01/2023 and 04/03/2023 were analysed. Paediatric cases were excluded. Times for admission, imaging, operation, and discharge were retrieved from ICE, ORMIS, and Concentric Health. Data were analyzed using Excel, with weekday and weekend admissions compared via independent samples median tests. Results Mean times were: presentation to imaging (8.91 hours), imaging to operation (26.82 hours), operation to discharge (53.94 hours), and total LOS (3.74 days). LOS improved to 3.7 days (from 4.3), with 14.3% meeting the 2-day target. Imaging-to-operation time decreased significantly (29.15 vs. 26.82 hours, p=0.003). Weekend admissions had significantly shorter imaging-to-operation times (36.23 vs. 21.91 hours, p&amp;lt;0.01). Digital consent adoption increased to 98% from 78% last year. Conclusions LOS and time intervals have improved with enhanced imaging and weekend capacity, alongside increased digital consent uptake. However, LLR remains in the highest GIRFT quartile, necessitating further optimisation.

Abstract Aim Emergency laparoscopic cholecystectomy (ELC) practice in the United Kingdom still faces cultural barriers despite mounting evidence for its benefits. The RCS of England Cholecystectomy Quality Improvement Collaborative (Chole-QulC) supported our centre develop an ELC pathway. This study compares outcomes of elective versus ELC, and explores the impact of the ELC pathway on services Methods A prospective observational study examining emergency and elective laparoscopic cholecystectomy between December 2021 and December 2023.One-to-one propensity score matching, correlation statistics and multivariate logistical regression models were used to analyse outcomes. Results The study followed 314/585 (53.4%) emergency and 271/585 (46.3%) elective cholecystectomy patients. Matched data examined 237 patients per group. The ELC pathway achieved 81.4% first-presentation procedures, with 69.2% day-case and 84.4% next-day discharge rate. The ELC cohort experienced a nine-minutes longer operation, higher subtotal cholecystectomy (8.9% vs. 3.0%, p&amp;lt;0.001) and postoperative ERCP rates (16.9% vs. 4.6%, p&amp;lt;0.001). Subtotal cholecystectomy and postoperative ERCP were significantly associated with prolonged waiting time to surgery &amp;gt;1 year (OR 2.24, p=0.028 and OR 3.83, p=0.030 respectively). The introduction of an ELC pathway significantly reduces elective waiting time form a median of nine to three months over a two-year period (R=-0.219, R²=0.059, p&amp;lt;0.001) Conclusion An ELC pathway is safe, with additional positive implications for patient outcomes and service costs, by reducing waiting time and preoperative admissions. ELC offers a high first-presentation procedure and day-case rate.