Author: Jason Curtis

A Case of Ventricular Standstill in Hypertrophic Cardiomyopathy: The Role of AV Block and Beta-Blockers (2025)

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Type of publication:

Conference abstract

Author(s):

*Owolabi O.H.; *Yera H.O.; *Choy C.H.; *Htet K.; *Kundu S.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A30-A33), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction Atrioventricular (AV) nodal disease is a rare but serious complication of hypertrophic cardiomyopathy (HCM), often leading to conduction abnormalities. While atrial fibrillation is common, high-degree AV block (AVB) is rare. We present a case of hypertrophic obstructive cardiomyopathy (HOCM) complicated by ventricular standstill, emphasizing the need for early recognition and management. Case Presentation A 46-year-old man with a family history of HCM (mother with ICD) presented with exertional dyspnea, palpitations, and presyncope for six months. No family history of sudden cardiac death. Examination revealed HR 76 bpm, BP 115/75 mmHg, and an ejection systolic murmur. ECG showed ventricular hypertrophy, dagger-shaped Q waves, Twave inversions, first-degree AVB (280 ms), and ventricular ectopics (figures 1 and 2). Troponin and NT-proBNP were elevated. Echocardiography confirmed HOCM with severe septal hypertrophy, a maximal LVOT gradient of 43 mmHg, and systolic anterior motion of the mitral valve. Indexed left atrial volume was 48 mL/m2 (figures 3 and 4). CT coronary angiogram was normal. He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement (figure 5). He was started on bisoprolol 2.5 mg OD and within 48 hours developed intermittent high-degree AVB (2:1, 3:1). Bisoprolol was discontinued due to worsening conduction abnormalities, but he later developed symptomatic complete heart block, necessitating emergency ICD placement. Discussion HCM is the most common genetic heart disease, inherited in an autosomal dominant manner in 50% of cases. MYBPC3 mutations are frequently linked to high-degree AV block.1 While atrial fibrillation is common in HCM, highdegree AV block remains rare. First-degree AVB in HCM is increasingly recognized as a marker of disease progression and arrhythmic risk.1 Mechanisms include left atrial enlargement (predisposing to atrial fibrillation and thromboembolism) and myocardial fibrosis, promoting electrical instability.1 Our patient had a 3.1% five-year sudden cardiac death risk and developed high-degree AV block and ventricular standstill. This progression was likely exacerbated by bisoprolol, which slowed AV conduction in the setting of pre-existing firstdegree AV block. Beta-blockers, though essential in HCM management, should be used cautiously in patients with conduction abnormalities. This case underscores the need for personalized HCM management. First-degree AVB may identify high-risk individu- als requiring closer monitoring, medication adjustments, and early device therapy. Conclusion High-degree AV block and ventricular standstill are rare but significant complications of HCM. First-degree AVB may serve as an early risk marker linked to left atrial enlargement, fibrosis, and arrhythmias. Clinicians should monitor conduction abnormalities closely, especially when prescribing AV-slowing medications. Genetic evaluation, surveillance, and individualized treatment strategies are crucial for optimizing outcomes in HCM patients.

DOI: 10.1136/heartjnl-2025-BCS.33

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Lipid Management Post Myocardial Infarction: A Call for Improved Monitoring and Therapy Intensification (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Kukoyi B.; Joshi M.; Tran P.; Lo T.; Ajiboye J.; Oyedeji O.

Citation:

Heart. Conference: British Cardiovascular Society Annual Conference, BCS 2025. Manchester United Kingdom. 111(Supplement 3) (pp A210-A211), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Background Lipid management is a cornerstone of secondary prevention in acute coronary syndrome (ACS). Despite established national guidelines, real-world practice often reveal gaps in lipid monitoring and intensification of lipid-lowering therapy. This study investigated these challenges in a large tertiary centre, proposing a streamlined pathway to address these gaps. Methods A retrospective analysis was conducted in 225 ACS patients (92 STEMI and 133 NSTEMI) from July-August 2023. We assessed lipid monitoring on admission and 2-3 months post-discharge, prescription rates of high-intensity statins and use of alternative lipid-lowering therapies. Multivariate logistic regression evaluated the relationship between highintensity statin initiation and lipid monitoring rates on admission and follow-up, adjusted for comorbidities. Results Initial guideline adherence was strong, with 83.1% having lipids checked on admission and 83.6% prescribed high-intensity statins (table 1). After adjusting for ACS type and comorbidities, patients started on high-intensity statin were nearly twice as likely to have lipids checked on admission (90.4% vs. 45.9%, p<0.001). Notably, patients not receiving high-intensity statins were more likely to have a prior history of ACS (43.2% vs 26.1%, p=0.035). Despite the perceived higher severity of STEMI, there was no significant difference in post-discharge lipid-checking rates between STEMI and NSTEMI patients (51.1% vs 53.4%, p=0.735). In terms of follow-up, only 52.4% of patients had lipids rechecked post-discharge, leaving almost half without adequate monitoring. Neither high-intensity statins nor ezetimibe initiation increased the likelihood of follow-up lipids. Among 118 patients with follow-up lipid assessment, 69.5% achieved target levels. However, of the 36 patients (30.5%) not meeting targets, only 3 (8.3%) had therapy intensified limited to the use of ezetimibe, highlighting a critical gap in care. Conclusion This study highlights the dichotomy between strong initial guideline adherence and significant lapses in follow-up care and therapy intensification. Whilst this single- centre study limits generalisability, several interesting observations emerged. The association between high-intensity statin prescription and admission lipid check highlights the importance of fostering a culture of guideline adherence, where attention to one aspect of care positively influences others. Patients with prior ACS were less likely to receive high-intensity statins, potentially due to perceived stability on existing regimen, leading to missed opportunities for therapy intensification. More strikingly, nearly half of the cohort lacked adequate lipid monitoring on follow-up with restricted use of lipid-lowering therapies. This highlights the need for a structured approach involving cardiac rehabilitation and primary care team via the proposed pathway (Figure 1) to ensure better lipid management in this high-risk cohort.

DOI: 10.1136/heartjnl-2025-BCS.206

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Evaluation of practice patellofemoral instability collaborative (EPPIC) (2025)

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Type of publication:

Journal article

Author(s):

Kosy J.; Thomas W.; Higgin R.; Thomas J.; Odeh A.; Archer J.; Bache C.E.; Gaffey A.; Buddhdev P.; Bosman H.; Tun Ngu A.W.; Stringfellow T.; Lebe M.; Parikh S.; Sanalla A.; Khan W.; Tennyson M.; Hislop S.; Lenihan J.; Ahmed Almustafa M.A.; Baskaran D.; To K.; Hughes W.; Butt M.M.; Venkatesh R.; Dawood L.; Archer D.; Jamjoom A.; Reddy G.; Anand S.; Rajput V.; Akrawi H.; Loeffler M.; AL-Sukaini A.; Ramasamy A.; Syed S.; Khan M.; Thonse R.; Paramasivan A.; Morton R.; Mahmood A.; Luo W.; Umer H.M.; Haslam P.; Hancock G.; Servant C.; Gill J.; Karssiens T.; Wood R.; Bowditch M.; Deo H.; Barwell J.; Hourston G.; Wyatt D.; Chen A.; Williams J.; Sivaprakasam M.; Young J.; Khwaja M.; Sleiman S.; Bowman N.; Napier R.J.; Finlayson G.; Jones K.; Blyth M.J.; Hopper G.P.; Wheelwright B.; Dalgleish S.; Davies P.S.E.; Sinnerton R.J.H.; Banziger C.; Abell A.; McNamara I.; Hasan R.; Liew I.; Archunan M.; Watts D.; Subhash S.; Negus O.; Muller S.; Irvine S.; Bottomley N.; Woods A.; Bretherton C.; Myatt R.; Paul C.; Gacaferi H.; Smith J.; Newman J.; Cohen A.; Cruickshank J.; Kahn R.; Matheron G.; Patel J.; Crane E.; *Roach R.; *Kabariti R.; *Khaleeq T.; Rushbrook J.; Morcos Z.; Thiruchandran G.; Barrett-Lee J.; Bailey L.; Subramanian S.; Britton J.; Tindall A.; Cheema K.; Oluku J.; Saleh A.; Chahal J.; Fernandes A.; Papadopoulus D.; Dellis S.; El-Raheb K.; Akintade A.; Saraglis G.; Mitchell S.; Leow J.M.; Mandalia V.; Skinner E.; Middleton S.; Schranz P.; Gillespie G.; Howard J.; White T.; Makaram N.; Simpson C.; Johnstone P.; Akhtar K.; Karam E.; Ferguson D.; Cuthbert R.; Wickramarachchi L.; Liang K.; Bhutta A.; Havenhand T.; Hoggett L.; Rogers G.; Waugh C.; Cowie J.; Ashraf T.; Sweed T.; Mussa M.; Dong H.; Ashraf Y.; Stoddard J.; Jayasuriya R.; George H.; Craik J.; Rose L.; Wei R.; Clark D.; Donovan R.; Shiels S.; Tilston T.; Johnson D.; Baigent T.; Iqbal K.; Mughal E.; Dewan V.; Chauhan G.; Habeebullah A.; Bleibleh S.; Kaur J.; Thanikachalam P.; Metcalfe A.; Weiyun W.N.; Krishnan H.; Eldridge J.; Beaumont O.; Sheath P.C.; Stoneham A.; Morley W.; Gibson C.; Fraig H.; Bowen D.; Hossain F.; Sur H.; Sherbaz S.; Osman K.; Khadabadi N.; Saleemi A.; Arif M.; Moores T.; Nicolai P.; Sibbel J.; Nabulyato W.; Pathan A.; Mcgarvey C.; Ahmed M.; Logishetty K.; Al-Hourani K.; Baileyi M.; Hingi C.

Citation:

Knee. 57 (pp 325-334), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: The management of patellofemoral instability in the United Kingdom remains poorly standardised. Through the British Association for Surgery of the Knee trainee collaborative, we aimed to identify which procedures (and in which combination) were being used to surgically manage this common condition across the UK. Method(s): A retrospective national audit was conducted via a trainee collaborative analysing local trust data between 1st January 2014 and 31st December 2019. Data from institutions registered for the EPPIC audit was compiled and analysed for degree of compliance against more recently published national guidelines. Result(s): Fifty (n = 50) sites submitted data, totalling 3189 skeletally mature patients. The median age was 26.7 (SD 0.5) years and 63.3 % were female. An isolated lateral release was performed in 8 %, an isolated medial patellofemoral ligament reconstruction (MPFLR) was performed in 37 % of patients and proximal realignment surgery was conducted in 8 % of patients. Trochleoplasty was required in 11 % of patients, with combined MPFLR and tibial tubercle osteotomy (TTO) being undertaken in 22 % of patients. Combined MPFLR, TTO and trochleoplasty was undertaken in 3 % of patients. Conclusion(s): This audit highlights the national variation in surgical treatment of a common orthopaedic presentation. Despite the lack of evidence, an isolated lateral release is still being performed. There remains a lack of standardisation within the UK in the management of recurrent patellar instability, highlighting the need for national consensus of appropriate surgical interventions.

DOI: 10.1016/j.knee.2025.06.015

Bronchiolitis Obliterans in an Adult Male After Admission With Panton-Valentine Leucocidin Staphylococcal Pneumonia (2025)

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Type of publication:

Journal article

Author(s):

*Nadeem, Sabha; *Sargent, Georgina; *Wood, Gordon; *Ahmad, Nawaid.

Citation:

Cureus. 17(9):e91611, 2025 Sep.

Abstract:

A middle-aged man with no smoking or respiratory history presented with shortness of breath and facial swelling due to influenza. His condition deteriorated rapidly, and he required intensive care admission and intubation. He was found to have Panton-Valentine leucocidin (PVL) Staphylococcal pneumonia, with bilateral pneumothorax and subcutaneous emphysema. He responded well to antibiotics and chest drainage and was subsequently discharged. His follow-up radiology initially showed almost complete resolution. However, over the course of five years, he had multiple GP attendances and hospital admissions for recurrent infections with continued breathlessness on exertion. A follow-up CT suggested features of bronchiolitis obliterans (BO), which has not been previously recognised as associated with PVL Staphylococcal infections. Specialist teams have suggested active observation with consideration of transplantation in the event of deterioration. This case demonstrates that BO can be seen with previously unrecognised infectious aetiology and should be considered in any patient with appropriate symptomatology following a severe respiratory infection.

DOI: 10.7759/cureus.91611

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CT coronary angiography in the lipid clinic: a pilot study and lipidologist survey (2025)

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Type of publication:

Journal article

Author(s):

Graby, John; Sellek, James; Khavandi, Ali; Thompson, Dylan; Loughborough, Will W; Hudson, Benjamin J; Avades, Tony; Mbagaya, Wycliffe; Luva, Ahai; *Capps, Nigel; Shirodaria, Cheerag; Bayly, Graham; Antoniades, Charalambos; Downie, Paul F; Rodrigues, Jonathan C L.

Citation:

The International Journal of Cardiovascular Imaging. 2025 Oct 09. [epub ahead of print]

Abstract:

Guidelines recommend considering coronary calcium score (CCS) in asymptomatic patients to aid risk stratification. However, calcification occurs late in atherosclerosis. Coronary CT angiography (CCTA) can detect non-calcific plaque and inflammation before calcification develops, but impact on clinical management is not well documented. We compare coronary artery disease (CAD) detection and grading between CCS and CCTA, impact on management, and explore CCTA-derived inflammation biomarker (pericoronary fat attenuation index [FAI]) in the lipid clinic. Exploratory analysis of a prospectively maintained database of lipid clinic patients with CCS and CCTA (2018-2020). CCS grade was compared with CCTA stenosis, presence of high-risk plaque (HRP) and FAI-score analysis. UK Consultant Lipidologists completed an anonymised survey, documenting lipid target and management after sequential unblinding of CCS and CCTA data. In 45 asymptomatic patients (49% female, mean age 55 +/- 9), CCTA re-classified CAD presence in 22% (p = 0.002) and severity in 62% (p = 0.005) vs. CCS. HRP was observed in 20% (9/45), including 56% with CCS <= 100. Median LDL target with clinical vignette was 101 mg/dL (IQR 77-120), reducing to 89 mg/dL (77-120) after CCS, and 77 mg/dL (70-116) after CCTA unblinding. CCS altered LDL target in 12%, and CCTA a further 19% (chi2 57.0, p < 0.005). High FAI-score was demonstrated in 20%, including 22% of those with CCS <= 100 and 75% of those with <= mild CAD on CCTA. CCTA increased CAD prevalence and re-classified severity versus CCS, altering hypothetical management. High FAI-scores were observed across CCS and CCTA severity grades, including patients with no overt CAD.

DOI: 10.1007/s10554-025-03526-3

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Postoperative Outcomes of the Desarda Technique Versus Lichtenstein Mesh Repair for Inguinal Hernias: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Journal article

Author(s):

*Saeed, Jahanzaib; Jamal, Zohaib; Siddiqui, Asher; Muawaz, Muhammad; Saeed, Talha; *Jain, Rajesh K.

Citation:

Cureus. 17(9):e91388, 2025 Sep.

Abstract:

Inguinal hernias represent a prevalent surgical condition worldwide and constitute a significant proportion of elective general surgical procedures. While the Lichtenstein mesh repair has become the standard technique due to its tension-free approach, it is associated with several mesh-related complications, including chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. To overcome these limitations, the Desarda technique was developed as a tissue-based, mesh-free alternative that reinforces the posterior wall of the inguinal canal using a strip of the external oblique aponeurosis. This systematic review compares postoperative complications between the Lichtenstein mesh repair and Desarda techniques to inform best practices in inguinal hernia repair. This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across PubMed, Cochrane Library, Excerpta Medica database (EMBASE), Emcare, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Ovid, without language or date restrictions. Randomized controlled trials (RCTs) comparing Desarda and Lichtenstein mesh repair for primary inguinal hernia in adults were included. Data on postoperative complications were independently extracted by two reviewers. Risk of bias was assessed using the Risk of Bias 2 (ROB 2) tool (The Cochrane Collaboration, London, United Kingdom). Statistical analysis was performed using RevMan 5.4 (The Cochrane Collaboration, 2020), with risk ratios (RR) and 95% confidence intervals (CI) calculated for binary outcomes. Heterogeneity was assessed using the chi-square and I2 statistics. A total of 23 RCTs were included, comprising 2,425 patients, 1,201 of whom underwent the Desarda repair and 1,233 who underwent Lichtenstein mesh repair. The Desarda technique was associated with significantly lower rates of scrotal edema (RR = 0.52, 95% CI: 0.34-0.78, p = 0.002), seroma formation (RR = 0.68, 95% CI: 0.47-0.99, p = 0.04), foreign body sensation (RR = 0.61, 95% CI: 0.42-0.88, p = 0.009), and chronic postoperative pain (RR = 0.26, 95% CI: 0.15-0.45, p < 0.00001). While the Desarda group also showed lower rates of recurrence, wound infection, wound hematoma, and loss of sensation, these differences were not statistically significant and should be interpreted with caution. The findings suggest that the Desarda technique may be preferable to the Lichtenstein mesh repair for primary inguinal hernia, as it is associated with significantly lower rates of chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. Although other complications, such as loss of sensation, recurrence, wound infection, and hematoma, were also less frequent with the Desarda technique, these differences were not statistically significant. Overall, the outcomes were largely comparable.

DOI: 10.7759/cureus.91388

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Emergency management of anaphylaxis and the impact of the new UK ALS guidelines (2025)

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Type of publication:

Journal article

Author(s):

*Elshehawy, Mahmoud; Kadambi, Madhavi; Hughes, Deborah; Clarke, Daniel; Cooper, Angela; Inani, Mohit; Goktas, Polat; Goddard, Sarah; Diwakar, Lavanya.

Citation:

Clinical Medicine. 100519, 2025 Sep 30. [epub ahead of print]

Abstract:

BACKGROUND: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its Advanced Life Support (ALS) guidelines for anaphylaxis in 2021, emphasizing early and repeated adrenaline administration, IV fluid use, and reduced reliance on antihistamines and steroids.

METHODS: A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH) before (2018) and after (2022/23) the ALS guideline implementation.
Adherence to NICE anaphylaxis guidance was also assessed.

RESULTS: Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centers. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations.

CONCLUSION: Anaphylaxis management in these centers has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor.

DOI: 10.1016/j.clinme.2025.100519

Pertussis Infection in Children QIP: Raising Awareness Amongst Clinicians (2025)

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Type of publication:

Conference abstract

Author(s):

*Khallaf L.; *Muniu S.; *Sakremath R.; *Lee S.

Citation:

Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A301-A302), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Why did you do this work? Pertussis is a highly infectious preventable disease caused by Bordetella pertussis. Young infants under 3 months of age remain at the highest risk of severe disease with 9 reported infant deaths this year in the United Kingdom.1 We aim to raise awareness about pertussis infection among clinicians in our Paediatric Department through education. What did you do? Educational sessions were delivered from February to March 2024. Data was collected using pre- and post-session questionnaires to assess clinician's knowledge. The questionnaire included symptoms, signs, management and complications of pertussis infection. A teaching presentation was given in the first cycle. In the second cycle, an informative poster was displayed throughout our department. Data was collected and analysed using Microsoft Excel. The effectiveness of the education tool delivered was evaluated. What did you find? There were 11 participants in the first cycle and 9 in the second cycle. All participants in cycle 1 understood pertussis infection and its complications and recognised the importance of exclusion from nursery/school. In cycle 2, all demonstrated knowledge of pertussis symptoms and knew it was a notifiable disease. In the first cycle, many participants, 63% (7 out of 11 participants), were unaware of the process for requesting a pertussis test in our department, which improved slightly to 55% (5 out of 9 participants) in the second cycle. Additionally, the rate of incorrect responses decreased between cycles for several topics: the incubation period of pertussis (54.5% in cycle 1 versus 33% in cycle 2), the appropriate timing for requesting the test (18% versus 11%), and knowledge of first-line antibiotics (36% versus 22%). The rate of incorrect responses increased between cycle 1 and cycle 2, rising from 27% to 33% for the need of prophylaxis treatment and 27% to 44% for the exclusion of asymptomatic contacts. Despite interventions, knowledge of the latter showed no improvement between the two cycles. Following cycle 1, significant improvements were noted, with 100% correct responses for how to request a pertussis test, appropriate timing for ordering the tests, and the incubation period. Both cycles demonstrated improvement as all participants knew the first-line antibiotic treatment for pertussis. What does it mean? Although our sample size was small, our project showed that the overall knowledge of our clinicians improved in the 2 cycles. Ongoing education is needed to improve awareness of pertussis infection, especially during the winter months.

DOI: 10.1136/archdischild-2025-rcpch.413

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Viral Haemorrhagic Fevers: Preparation for the Next Pandemic? (2025)

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Type of publication:

Conference abstract

Author(s):

*Moumneh R.; McMonnies K.; Johnston V.; Eisen S.

Citation:

Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A123-A124), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Why did you do this work? Multiple viral haemorrhagic fevers (VHFs) are classified as high consequence infections due to high mortality and potential for human-to-human transmission. 1 To aid early identification and prevent outbreaks, our hospital has designed an electronic screening tool to be used at triage in our emergency department (ED) to identify patients presenting with fever within 21days of travel to a VHF endemic country. This study aimed to evaluate if this electronic triage tool was being used appropriately in our Paediatric ED to support early identification and appropriate management of children at risk of VHF. What did you do? A random sample of 50 children (<18 years) presenting to our central London acute hospital with current or recent history of fever (>37.5oC) between March – May 2024 had their electronic health care records reviewed (EPIC ©) to evaluate if the electronic triage tool was being used. A data extract of where the triage tool had been used in EPIC between January – March 2024 was used to identify children at risk of VHF; case notes were then reviewed for evidence of appropriate isolation and escalation. All data were anonymised and analysed using Microsoft ExcelTM. What did you find? The triage tool was used correctly in 32/ 50 febrile children (64%). The triage tool was not used in 6 cases (12%) and used incorrectly (not fully completed or incorrect information included) in 12 cases (24%). 47 children were identified in the triage tool as at risk of VHF (fever within 21days of travel to VHF endemic country). There was no evidence of consideration of VHF, isolation or escalation in any of these cases. What does this mean? Early identification of cases is key to preventing healthcare associated outbreaks, protecting both staff and patients. The current implementation of the VHF triage tool in our Paediatric ED has not been shown to assist with this early identification. The VHF triage tool was frequently not used or incorrectly completed. Even when used, identification of VHF risk did not result in appropriate isolation or escalation of children at risk of VHF. One explanation for this might be the increased number of presentations of 'fever in the returning traveller' in the paediatric population therefore the triage tool is seen as unnecessary additional workload, or the significance of high consequence infections is not considered. Following this study, we developed a paediatric specific quick reference guide for conducting VHF risk assessments and to guide early management of children 'at risk' of VHF. Multidisciplinary departmental teaching has resulted in a positive impact on staff confidence in use of the tool and in responding to identification of VHF risk (evaluation in full write-up). We plan to re-audit the use of the triage tool and subsequent management once established.

DOI: 10.1136/archdischild-2025-rcpch.166

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A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients? (2025)

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Type of publication:

Systematic Review

Author(s):

Shahid, Muhammad Salman; Ahmed, Nouman; Kamal, Zeeshan; Nathaniel, Laibah; Singla, Bhavna; Singla, Shivam; Kumawat, Sunita; Batool, Munaza; *Ekomwereren, Osatohanmwen; Anika, Nabila N; Sahil, Muhammad.

Citation:

Cureus. 17(8):e90888, 2025 Aug.

Abstract:

Proton pump inhibitors (PPIs) are widely prescribed in older adults, often beyond recommended durations, raising concerns about nutrient depletion. This systematic review examined the impact of long-term PPI use (>=6 months) on micronutrient status in older adults receiving polypharmacy. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) identified five eligible studies, including 693 participants. Results showed a 12-18% reduction in serum vitamin B12 over 12 months of PPI use. Calcium and parathyroid hormone levels declined significantly in a 12-month cohort, while bone turnover markers increased despite stable bone mineral density. Findings for magnesium were inconsistent, with results ranging from no change after 12 months to pharmacokinetic alterations without systemic depletion. Overall, the evidence consistently supports an association between prolonged PPI therapy and reductions in vitamin B12 and calcium, with conflicting results for magnesium. These deficiencies may contribute to cognitive decline, bone fragility, and increased fall risk in older adults. Routine nutritional monitoring, targeted supplementation, and deprescribing where appropriate should be considered to mitigate these risks, while further large-scale trials are needed in frail geriatric populations.

DOI: 10.7759/cureus.90888

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