Ayrshire Central Hospital, also known as Irvine Central Hospital, is an NHS hospital in Irvine, North Ayrshire, Scotland. It is managed by NHS Ayrshire and Arran.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly utilized for hemorrhage control in trauma; however, zone-specific outcomes in abdominal trauma remain inadequately characterized. We retrospectively analyzed 404 patients with abdominal trauma who underwent REBOA between 2019 and 2022. Patients were stratified by aortic occlusion zone (zones 1, 2, or 3), and their demographic characteristics, injury patterns, resuscitation requirements, and clinical outcomes were compared. The cohort was predominantly male (83.8
Early diagnosis and treatment of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs) are essential because they directly impact patient quality of life. This report describes the case of an 85-year-old woman with type 2 diabetes on insulin therapy, whose glycemic fluctuations became highly unstable following irAE development. During treatment for refractory hepatocellular carcinoma with tremelimumab and durvalumab, she developed hyperglycemia and was hospitalized. Endogenous insulin secretion remained intact, and hyperglycemia improved after admission. Continuous glucose monitoring (CGM) revealed nocturnal and early-morning hypoglycemia from the fourth day of admission. Insulin requirements were tapered off; however, persistent anorexia and dyspnea led to the diagnosis of hypopituitarism through endocrine testing. For patients with diabetes who experience abnormal blood glucose fluctuations after ICI therapy, clinicians should monitor changes in endogenous insulin secretion and consider the possibility of hypoadrenocorticism. CGM may be valuable for detecting these endocrine abnormalities.
Port-wine stain (PWS) is a congenital vascular malformation commonly treated with pulsed dye laser (PDL) therapy. PDL exploits selective photothermolysis, in which hemoglobin in red blood cells (RBCs) absorbs laser energy, generating localized heat that induces endothelial damage. However, in microvessels, axial RBC migration creates a hemoglobin-depleted cell-free layer along the vessel walls, reducing laser efficacy. Hemoglobin vesicles (HbVs)—nano-sized artificial RBCs—distribute uniformly within these layers, offering the potential to enhance hemoglobin distribution and laser absorption. To investigate the impact of HbV administration on PDL therapy, a three-dimensional numerical model of human skin tissue containing vascular networks was developed. Monte Carlo simulations were used to evaluate laser absorption, and thermal conduction analysis was performed to compute temperature distributions and estimate thermal damage via the Arrhenius model. Two conditions were considered: Case 1 (without HbV administration) and Case 2 (with HbV administration). In Case 2, HbV administration increased optical absorption in vessel walls and enhanced thermal damage, particularly in subpapillary vessels. The threshold energy fluence required to induce irreversible thermal damage was reduced, and heat flux at the upper vessel walls was elevated. These findings indicate that HbV administration enhances the homogeneity and efficacy of PDL-induced vascular damage, potentially allowing effective treatment at lower energy fluences while minimizing off-target tissue injury. The study provides a theoretical basis for optimizing PDL parameters in PWS therapy and underscores the potential of patient-specific treatment protocols using artificial blood substitutes.
INTRODUCTION:Exercise may slow Multiple Sclerosis (MS) progression and is considered safe for all people with MS. A review of exercise for those with severe MS was published in 2017, with guidelines for physical activity and exercise updated in 2020. The evidence base has subsequently increased, warranting further review. OBJECTIVE:To investigate the effectiveness of exercise interventions on physiological fitness, physical and cognitive function, common symptoms, and disease impact in people with severe MS. METHODS:A search was conducted across five electronic databases. Randomised control trials applying an exercise intervention to participants diagnosed with MS, EDSS 6.5-8.0, with outcome measures of physiological fitness, physical function, cognitive function, spasticity, fatigue, or disease impact were included. RESULTS:In total 29 studies published in 31 articles were included, with 1181 participants. Only six studies included participants exclusively with an EDSS ≥6.5. Studies predominantly reported outcome measures of physiological fitness (n = 16), physical function (n = 25), and MS symptoms and disease impact (n = 25), with the majority finding an improvement in at least one outcome measure. Comparatively few studies reported outcome measures of upper limb function (n = 4) and cognitive performance (n = 3). CONCLUSIONS:Exercise appears to improve physiological fitness, physical function, and disease impact, but not disability status. These improvements largely occurred in studies which included participants at an EDSS <6.5. Improvements were limited in studies which exclusively recruited participants at an EDSS ≥6.5. Further research is required to establish the specific effects for those severely affected by MS, especially those who are non-ambulatory.
Background Dermatological disorders often require histopathological examination of skin biopsies to ensure accurate diagnosis and effective management. Aim of the work To describe the spectrum of clinical and histopathological diagnoses for skin manifestations presenting in rheumatic diseases(RDs) patients referred for skin biopsy, and to assess the diagnostic accuracy of both. Patients and methods This retrospective study was conducted at Aseer Central Hospital and included clinical and histopathological diagnoses from 415 skin biopsies extracted from medical records. Results The mean age of cases was 40.1 +/- 17.8 years;230 females and 185 males (F:M 1.24:1), 40(9.6 %) were juvenile. Among 415 skin biopsies, the most common clinical skin diagnosis was psoriasis(12.3 %) followed by discoid lupus erythematosus(DLE)(11.6 %), vasculitis(11.3 %) and morphea(4.3 %). Histopathologically, leucocytoclastic vasculitis was found in 17.3 %, psoriasis in 10.1 %, DLE in 8.7 %, and vasculitis and morphea in 5.1 % each. The most common site for skin biopsy was the lower limbs(41 %) followed by head/neck(24.3 %) and upper limbs(16.63 %). 37.8 % of cases had a matched clinical with histopathological diagnosis. Clinical diagnoses were similar according to gender. For pathological diagnosis, granuloma annulare was found only in females, while keratosis and erythema only in males. In juvenile cases, psoriasis was found in 27.5 % of males vs 8.3 % of females(p = 0.001) and lupus profundus in 7.5 % of males vs 1.3 % of females(p = 0.03), and so were significantly more frequent. A double diagnosis was significantly lower histopathologically(2.4 %) compared to clinical diagnosis (8.2 %)(p < 0.0001). Conclusion A clinicopathological gap exists in skin manifestations and biopsy findings in RD patients. Raising the awareness of rheumatologists to this issue is warranted for cutaneous manifestations and histopathological findings.
