Finerenone: Do We Really Need an Additional Therapy in Type 2 Diabetes Mellitus and Kidney Disease?

Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) face considerable cardiorenal morbidity and mortality despite existing therapies. Recent clinical trials demonstrate the efficacy of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in reducing adverse renal and cardiovascular outcomes. This editorial briefly reviews the evidence and its implications for clinical practice, advocating the use of finerenone in these high-risk patients in combination with currently established treatment agents.

Trends in Mortality Due to Cardiovascular Diseases Among Patients With Parkinson's Disease in the United States: A Retrospective Analysis.

Background: Parkinson disease (PD) and cardiovascular diseases (CVD) present significant health burdens, particularly among older adults. Patients with PD have an elevated risk of CVD-related mortality. Analyzing mortality trends in this population may help guide focused interventions.

Meta-analysis of longitudinal comparison of transcatheter versus surgical aortic valve replacement in patients at low to intermediate surgical risk.

Background: Surgical aortic valve replacement (SAVR) is the commonly used approach for aortic valve replacement (AVR) in patients with aortic stenosis at low or intermediate surgical risk. However, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to SAVR for AVR. This meta-analysis aims to assess the comparative efficacy and safety of TAVR versus SAVR in low-to-intermediate surgical risk patients by analyzing temporal trends in the outcomes of TAVR and SAVR at various follow-up intervals, providing a more detailed understanding.

A Rare Case of a Primary Non-parasitic Splenic Cyst Removed via Laparoscopic Intervention.

Splenic cysts are differentiated into primary and secondary cysts based on epithelial lining. Primary non-parasitic epithelial splenic cysts are extremely rare. We report a case of a 24-year-old male with left hypochondrial swelling with no history of abdominal trauma.

No Right Way: Removal of a Pencil Foreign Body From a Male Urethra.

Foreign body insertion into the urethra is uncommonly encountered in urology practice. Such insertion can result in a myriad of problems including bleeding, infectious sequelae, urinary retention, urethral injury or rupture, and resultant urethral stricture formation. This article describes a case in which an elderly male inserted a pencil into his urethra, which subsequently became lodged and required removal under regional anesthesia in the operating theater.

Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review.

Objective: To examine maternal and neonatal outcomes following Resuscitative Hysterotomy for out of hospital cardiac arrest (OHCA) and to compare with timing from cardiac arrest to delivery.

Methods: The review was registered with PROSPERO (CRD42023445064). Studies included pregnant women with out of hospital cardiac arrest and resuscitative hysterotomy performed (in any setting) during cardiac arrest.

Bullying, Harassment, and Undermining Behaviour in Cardiothoracic Surgery in the United Kingdom and Ireland.

Background: Bullying, harassment, and undermining behaviour has a profound detrimental effect on the multi-professional team, patient safety, and clinical outcomes. Bullying creates a poor working and training environment , increasing stress, damaging confidence, and impairing wellbeing. We sought to characterize the prevalence and nature of bullying, harassment and undermining within cardiothoracic surgery in the United Kingdom and Republic of Ireland.

Outcomes of Conservatively Managed Patients With Abdominal Aortic Aneurysm: A Single-Centre Experience.

Introduction: The results of patients at one hospital who were judged eligible for conservative care of abdominal aortic aneurysms (AAA) are examined in this research. Optimizing patient care and management tactics requires an understanding of the mortality trends and causes of death within this group.

Methodology: Sunderland Royal Hospital carried out a single-center retrospective analysis between May 2018 and January 2024.

Histopathological Examination of 404 Sleeve Gastrectomy Specimens at a Large UK Center and Systematic Review of the Published Literature.

Background: Laparoscopic sleeve gastrectomy (LSG) specimens are histologically analyzed to identify incidental pathologies. However, no guidelines recommend routine histology. This study evaluates the clinical utility of LSG sample analysis and if incidental diagnoses have a significant clinical impact.

Efficacy and Safety of Optilume Drug-Coated Balloon for Urethral Stricture Treatment: A Systematic Review and Meta-Analysis.

The Optilume drug-coated balloon (DCB) (North Plymouth, USA) is a novel treatment option for urethral stricture disease that combines mechanical dilation with localized delivery of paclitaxel, an antiproliferative drug aimed at reducing recurrence rates by inhibiting scar tissue formation. This systematic review and meta-analysis, conducted using studies published in the last 10 years up to November 2024, assessed the efficacy and safety of Optilume DCB across seven studies involving 457 patients. Key outcomes included significant reductions in symptom scores, as measured by the International Prostate Symptom Score (IPSS), and improvements in urinary flow rates (QMax).

Nationwide Cross-Sectional Analysis of Mortality Trends in Patients with Sarcoidosis and Non-Ischemic Cardiovascular Disease-The Impact of Gender, Ethnicity, Geographical Location, and COVID-19 Pandemic.

The epidemiological data regarding mortality rates of adults with sarcoidosis and non-ischemic cardiovascular disease (CVD) are limited. A retrospective observational analysis was conducted to identify trends and disparities related to sarcoidosis and non-ischemic cardiovascular disease mortality among the adult US population from 1999 to 2022. We used the Centers for Disease Control and Prevention (CDC) WONDER database to extract death certificate data for the adult US population (≥25 years).

Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial.

Importance: For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain.

Objective: To determine whether decisions based on assessment of CRP or PCT safely results in a reduction in the duration of antibiotic therapy.

Design, Setting, And Participants: A multicenter, intervention-concealed randomized clinical trial, involving 2760 adults (≥18 years), in 41 UK National Health Service (NHS) intensive care units, requiring critical care within 24 hours of initiating intravenous antibiotics for suspected sepsis and likely to continue antibiotics for at least 72 hours.

Efficacy and Safety of Artificial Urinary Sphincters in Female Patients With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Stress urinary incontinence (SUI) significantly affects the quality of life in women, causing social, psychological, and physical distress. While artificial urinary sphincter (AUS) implantation is a well-established treatment for male incontinence, it is less commonly used in female patients and is typically considered for cases where other treatments have failed. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of AUS implantation in treating SUI in female patients, focusing on continence rates, revision rates, explant rates, and perioperative complications.

Visualizing the Real Time Reduction of Pulled Elbow Using Point of Care Ultrasound (POCUS).

POCUS is a useful tool for correctly identifying pulled elbow. We believe that clinicians working in Pediatric Emergency Departments should be encouraged to embrace using it in cases which are less straightforward - either due to an atypical history or based on examination findings. This will serve to not only increase safety and improve the patient journey, but also to improve the clinician's confidence in their practice.

Evaluating the Efficacy and Cost-Effectiveness of Plasmapheresis and Intravenous Immunoglobulin in Acute Guillain-Barre Syndrome Management in Emergency Departments.

Background: Guillain-Barre Syndrome (GBS) is a severe autoimmune neuropathy that has to be treated quickly and efficiently in emergency situations, when both cost and effectiveness are vital.

Objective: To compare the clinical outcomes and cost-effectiveness of plasmapheresis and intravenous immunoglobulin (IVIG) in managing acute GBS in emergency departments.

Methodology: A prospective observational study conducted from January to December 2023 evaluated the treatment of adults with acute GBS using IVIG or plasmapheresis.

Temporal trends and disparities in atherosclerosis-associated cerebrovascular disease mortality in the United States, 1999-2020.

Background: Cerebrovascular disease (CEVD) accounts for the second leading cause of death worldwide. Despite recent advancements in treatment strategies, the prevalence and cost associated with CEVD are rising. Atherosclerosis significantly contributes to CEVD risk by restricting cerebral blood flow, leading to ischemic stroke.

Prone positioning is associated with increased insulin requirements in mechanically ventilated patients with COVID-19.

Stress hyperglycaemia is common in critical illness. We have previously observed that increasing severity of respiratory failure in patients with severe COVID-19 is associated with increased insulin demand. Given previously reported direct effects of hypoxia on insulin action, we reasoned that rapid improvements in oxygenation following prone positioning may improve insulin sensitivity and increase risk of hypoglycaemia.

A Comprehensive Analysis of Clinical Presentations, Laboratory Findings, and Etiologies of Pancytopenia: A Tertiary Care Experience.

Background Pancytopenia, while a common manifestation of a multitude of diseases, remains a relatively lesser-researched topic, especially in developing countries. Its management depends largely on identifying the etiology, which can range from simple infections to more sinister causes like leukemia. This study aims to investigate the clinical presentations, hematological findings, and etiologies of pancytopenia in a developing country.

Carbon dioxide monitoring during neonatal stabilisation at delivery (COSTA-Neo)-Multi centre observational study.

Background: The data is evolving on exhaled carbon dioxide (ECO) levels for preterm infants requiring stabilisation.

Objectives: To establish the trends of ECO levels during the first 10 minutes of stabilisation in preterm infants at birth.

Methods: We conducted a multi-centre, prospective observational study.

Scientific evidence for the updated guidelines on indications for metabolic and bariatric surgery (IFSO/ASMBS).

The 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for metabolic and bariatric surgery (MBS), replacing the previous guidelines established by the National Institutes of Health (NIH) over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams (MDTs), as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria.

National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry: a cohort study.

Aim: There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss.

Methods: Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010-2019) were identified.

Structured training pathway for robotic colorectal surgery: Short-term outcomes from five UK centres.

Aim: The aim of this study was to assess the short-term outcomes of robotic colorectal surgery implemented through a structured, standardized training pathway in five colorectal centres in the United Kingdom.

Method: A multicentre retrospective observational study was conducted, involving 523 consecutive patients who underwent robotic colorectal resection between 2015 and 2019. All participating centres followed the European Academy of Robotic Colorectal Surgery training pathway.

People, places, systems and society:A qualitative exploration of socio-cultural factors in head and neck cancer survivorship.

Purpose: People living with head and neck cancer (HNC) often endure permanent and life changing adverse effects of treatment and reduced health-related quality of life. Study of post-traumatic growth (PTG), is gaining traction to understand why some people living with cancer have better psychosocial outcomes than others. Current theoretical models on PTG point to the importance of 'socio-cultural influences' but do not provide insight into how such socio-cultural factors influence survivorship outcomes.