Open access

Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; *Saha, Arunansu; *Rhind, John-Henry; Nilsson, Niklas; Karlsson, Jon; Nilsson-Helander, Katarina.

Citation:

Video Journal of Sports Medicine. 1(5):26350254211021859, 2021 Sep-Oct.

Abstract:

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.

Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.

Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.

Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

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Managing obstetric bleeding in Wales: A qualitative evaluation of the OBS Cymru care bundle using Normalisation Process Theory (2025)

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Type of publication:

Journal article

Author(s):

Rai, Tanvi; Hinton, Lisa E; Mackay, Rosa; Black, Mairead; Sanders, Julia; Slade, Pauline; *Elsmore, Amy; Dhadda, Amrit; *Parry-Smith, William; Collis, Rachel; Petrou, Stavros; Stanworth, Simon; Pallman, Philip; Townson, Julia; Fye, Haddy; Geden, Ayse Gur; Collins, Peter; Bell, Sarah.

Citation:

PLoS ONE [Electronic Resource]. 20(4):e0320754, 2025.

Abstract:

BACKGROUND: Post-partum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The Obstetric Bleeding Strategy (OBS) care bundle for PPH management was adopted into Welsh national guidelines in 2019 (as OBS Cymru), and is currently being implemented across 36 sites in the rest of the UK through the OBS UK stepped-wedge cluster randomised controlled trial. We conducted a qualitative evaluation of the OBS care bundle five years after its adoption to inform plans for optimising its implementation across the UK.

METHODS: We conducted ethnographic observations, informal conversations and qualitative interviews with multidisciplinary teams (MDT) in four maternity units in Wales. Data were analysed thematically and usingNormalisation Process Theory.

RESULTS: The OBS Cymru protocol was used daily and MDT members believe it improves the quality and safety of PPH management. The paper proforma supporting OBS Cymru was the 'boundary object' that kept the care bundle in view while clarifying individualised roles across the MDT during a PPH and prompting improved and continuous communication as bleeding progressed. The standardisation of processes through the care bundle was seen as enabling all staff with an overall knowledge of PPH care, while situating the prominence of their particular roles within a greater whole. Enacting the bundle in practice varied slightly across different settings, according to staffing structures (e.g., in delivery rooms versus theatre births) and caseload, and some residual tensions remained regarding expectations from different staff members and levels of support provided regarding OBS Cymru.

CONCLUSIONS: Despite some small-scale variations, OBS care bundle has become normalised as standard PPH care in Wales. Insights from this evaluation, such as the centrality of the proforma in holding the bundle together, and need for greater clarity in staff role expectations, have informed implementation plans for the OBS UK trial.

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Is It Cost-Effective to Induce Labour Early to Prevent Shoulder Dystocia? Evidence From the Big Baby Trial (2025)

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Type of publication:

Journal article

Author(s):

Naghdi, Seyran; Petrou, Stavros; Underwood, Martin; *Deshpande, Sanjeev; Quenby, Siobhan; Ewington, Lauren; Gardosi, Jason; Mistry, Hema.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology. 2025 May 01. [epub ahead of print]

Abstract:

BACKGROUND: The cost-effectiveness of early induction of labour for suspected large-for-gestational-age foetuses to prevent shoulder dystocia is unknown.

METHODS: A within-trial economic evaluation of induction at 38 + 0 to 38 + 4 weeks' gestation for suspected large-for-gestational-age foetuses. Resource use and costs were measured to 6 months postpartum. We estimated incremental cost per case of shoulder dystocia prevented and incremental cost per maternal quality-adjusted life year (QALY) gained. We collected data for planned caesarean sections in a cohort study.

FINDINGS: Mean combined woman and infant costs in the induction arm were 89 (95% confidence interval (CI): -79, 257) higher than the standard care arm, driven by increased neonatal costs. The incremental cost of preventing one case of shoulder dystocia was 11 879 and the incremental cost per maternal QALY gained was 39 518. The probability of early induction being cost-effective was 0.65 at a cost-effectiveness threshold of 20 000 per case of shoulder dystocia prevented, but 0.36 at a cost-effectiveness threshold of 20 000 per maternal QALY gained. The cohort study found the mean cost was 310 (95% CI: 74, 545) higher in the induction arm than in the planned caesarean group.

INTERPRETATION: Early induction of labour increased neonatal care costs. It is not a cost-effective approach when effects are restricted to maternal QALYs. Planned caesarean section might be cost-saving when compared to early induction, although we did not assess longer-term effects such as an increased risk of repeat caesarean sections. Assessments of long-term effects on the mother and infant should be
incorporated into future studies.

TRIAL REGISTRATION: ISRCTN18229892.

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Hyponatraemia Induced by Terlipressin in Patients Diagnosed with Decompensated Liver Cirrhosis and Acute Variceal Bleeding (2025)

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Type of publication:

Journal article

Author(s):

*Elshehawy, Mahmoud; *Panicker, Richel Merin; Abdelgawad, Alaa Amr; Ball, Patrick Anthony; Morrissey, Hana.

Citation:

Medicines. 12(2), 2025 Mar 28.

Abstract:

Background: Hyponatraemia is a rare but potentially life-threatening complication of terlipressin therapy. Case history: In the current case, a 39-year-old female with decompensated liver cirrhosis (Child-Pugh C) and acute variceal bleeding experienced a precipitous decline in serum sodium-from 136 mmol/L to 115 mmol/L-within 48 h of initiating terlipressin therapy. This was accompanied by marked fluid retention, reduced urine output, and symptoms of confusion and agitation. Laboratory tests confirmed dilutional hyponatraemia, characterized by urinary sodium <20 mmol/L and urine osmolality <100 mOsm/kg, indicating excessive free water reabsorption. Outcomes: The prompt discontinuation of terlipressin, fluid restriction and the cautious administration of hypertonic sodium chloride solution (2.7% NaCl) achieved a gradual normalization of sodium levels and resolution of symptoms. Fluid balance monitoring revealed a marked diuretic response following terlipressin cessation. This case aligns with existing reports, emphasizing the dual vasopressin receptor activity of terlipressin and its capacity to induce hyponatraemia, particularly in cirrhotic patients with preserved renal function and higher baseline sodium levels. Conclusions: This case and a literature review underscored the critical need for early fluid balance monitoring to detect retention. This case highlights the importance of individualized risk assessment, multidisciplinary management, and vigilant sodium correction to avoid complications. Practical recommendations are outlined to aid clinicians in the recognition and management of terlipressin-induced hyponatraemia.

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A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin (2025)

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Type of publication:

Journal article

Author(s):

Brar, Gurjasan; Dhaliwal, Anoop; Brar, Anupjot S; Sreedevi, Manasa; *Ahmadi, Yasmin; Irfan, *Muhammad; Golbari, Rebecca; Zumarraga, Daniela; *Yateem, Dana; Lysak, Yuliya; Abarca-Pineda, Yozahandy A.

Citation:

Cureus. 17(3):e81109, 2025 Mar.

Abstract:

Ultraviolet (UV) radiation significantly contributes to photoaging, with its effects varying among different Fitzpatrick skin types. Light skin (Types I-III) has a natural sun protection factor (SPF) of only 3.3, making it particularly vulnerable to DNA damage, collagen degradation, and skin cancer. Darker skin (Types IV-VI) has a natural SPF of 13.4, providing greater photoprotection while elevating the risk of post-inflammatory hyperpigmentation and delaying skin cancer diagnosis. UVA penetrates deep into the dermis, promoting collagen degradation, whereas UVB causes DNA mutations, increasing the risk of cancer. Eumelanin in darker skin mitigates oxidative stress, while pheomelanin in lighter skin functions as a pro-oxidant, increasing vulnerability to photoaging. Although incidence rates are lower, melanoma is identified at more advanced stages in those with darker skin, resulting in poorer outcomes. Protective measures, such as broad-spectrum sunscreens, antioxidants, and hydration, are crucial for all skin types but necessitate customized strategies. Individuals with lighter skin benefit from SPF 50+ and DNA-repairing compounds, whereas those with darker complexion necessitate SPF 30-50 and pigmentation-focused skincare. Comprehending the biological mechanisms and variations in UV damage facilitates the creation of customized photoprotection solutions, enhancing skin health and mitigating long-term UV-related issues for all skin types.

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Exploring the prevalence and risk factors of adolescent mental health issues in the COVID and post-COVID era in the U.K.: a systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

Nwabueze K.K.; Akubue N.; Onakoya A.; Okolieze S.C.; Otaniyen-Igbinoba I.J.; Chukwunonye C.; *Okengwu C.G.; Ige T.; Alao O.J.; Adindu K.N.;

Citation:

EXCLI Journal. 24 (pp 508-523), 2025. Date of Publication: 03 Jan 2025.

Abstract:

Adolescence is a developmental phase largely characterized by rapid biological and non-biological transfor-mations, with a heightened susceptibility to social and environmental influences. Hence, adolescents are particularly vulnerable to external stressors, underscoring the need to safeguard their well-being and prioritize mental health interventions. The coronavirus disease (COVID-19) pandemic caused a global crisis with profound societal disruptions, and led to lasting impact on global public health, disproportionately affecting vulnerable populations, including adolescents. In view of the unique developmental challenges faced by adolescents, it is imperative to assess the growing burden of mental health issues exacerbated by the pandemic. This review synthesizes existing evidence on the emerging mental health challenges faced by adolescents in the United Kingdom (UK) as exacerbated by the COVID-19 pandemic. A systematic literature search was conducted using PubMed, ScienceDirect, MEDLINE, and SpringerNature databases, resulting in the selection of ten high-quality studies. A thematic analysis of the collected data revealed that depression and anxiety were the most frequently reported mental health conditions among adolescents. These conditions were particularly prevalent among adolescents who were from low-income households, those with pre-existing mental health disorders, adolescents experiencing household con-flicts, females, and those who provided self-reported data. Several key risk factors were identified, including family and peer relationships, academic pressures such as examinations and grades, financial constraints within house-holds, and the corruptive influence of social media. The findings underscore the urgency of targeted mental health interventions tailored to the specific needs of adolescents in the U.K. By addressing the identified risk factors, mental health professionals, policymakers, and educators can develop more effective strategies to mitigate the psychological impact of the pandemic on this vulnerable population. This study contributes to the evolving body of literature and emphasizes the need for evidence-based policies to foster overall well-being and resilience in adolescents navigating post-pandemic challenges.

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DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study (2025)

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Type of publication:

Journal article

Author(s):

Issa, Mohamed Talaat; *Sultana, Emiko; Hamid, Mohammed; Mohamedahmed, Ali Yasen; Albendary, Mohamed; Zaman, Shafquat; Bhandari, Santosh; *Ball, William; Narayanasamy, Sangara; Thomas, Pradeep; Husain, Najam; Peravali, Rajeev; Sarma, Diwakar.

Citation:

International Journal of Colorectal Disease. 40(1):68, 2025 Mar 15.

Abstract:

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.

METHODS: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient
demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.

RESULTS: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated
with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.

CONCLUSION: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant
lesions.

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Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

*Patel, Ravi; Khan, Muhammad Murtaza; Gibson, William; Banerjee, Robin; Pardiwala, Asif.

Citation:

Chinese Journal of Traumatology.  2025 Feb 19. [epub ahead of print]

Abstract:

PURPOSE: Surgical management of the lateral end of clavicle fractures hasbeen a challenge for orthopedic surgeons considering the high rate ofnon-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.

METHODS: A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.

RESULTS: A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score.

CONCLUSION: Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.

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Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks (2025)

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Type of publication:

Journal article

Author(s):

Brothwell, Shona Lc; Fitzsimons, Patricia E; Gerrard, Adam; Schwahn, Bernd C; Stockdale, Christopher; Bowron, Ann; Anderson, Mark; Hart, Claire E; Hannah, Romanie; Ritchie, Francesca; *Deshpande, Sanjeev A; Sreekantam, Srividya; Watts, Gemma; Yap, Sufin; Mundy, Helen; Veiraiah, Aravindan; Collins, Abigail; Cozens, Alison; Morris, Andrew A; Crushell, Ellen.

Citation:

Archives of Disease in Childhood. 2025 Mar 11. [epub ahead of print]

Abstract:

INTRODUCTION: Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.

OBJECTIVE: To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).

METHODS: A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.

RESULTS: Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.

CONCLUSION: Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children,
especially those under 8 years of age, should avoid slush ice drinks containing glycerol.

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Alopecia Areata: Understanding the Pathophysiology and Advancements in Treatment Modalities (2025)

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Type of publication:

Journal article

Author(s):

Abarca, Yozahandy A; Scott-Emuakpor, Renee; Tirth, Jhanavi; Moroz, Oksana; Thomas, George Pandarakalam; *Yateem, Dana; Golbari, Rebecca; Aphia, Ninigail; Lysak, Yuliya; Narasimhan, Niketa; Siddiqui, Humza F.

Citation:

Cureus. 17(1):e78298, 2025 Jan.

Abstract:

Alopecia areata (AA) is an autoimmune condition that presents with non-scarring hair loss affecting multiple patients worldwide during their lifetime. It ranges from well-defined patchy to diffuse total hair loss, impacting all hair-bearing areas of the body. AA most commonly predominantly manifests on the scalp. The pathophysiology of AA is complex and multi-faceted. The findings of our review article were consistent with the recent literature, delineating autoimmunity, genetic susceptibility, and environmental aspects to be the contributing factors. One of the main causes of AA is believed to be the disruption in the immune privilege of the hair follicles. Multiple genetic loci involved in hair follicle maturation and immune process have been linked to the development of AA as evidenced by several studies. It has been postulated that psychological stressors, smoking, alcohol consumption, sleep disturbances, gut microbiota, and drugs play a role in the pathogenesis of AA by exacerbating the immune response against the hair follicles. AA is a clinically diagnosed disorder. Topical, intra-lesional, and oral corticosteroids, topical and oral minoxidil, cyclosporine, and other immune therapy drugs are widely accepted first-line treatment options, although incomplete remission and relapses are common. Recently JAK-2 inhibitors and mesenchymal stem cell exosomes have shown promising results, potentially treating severe and refractory hair loss. AA has a bidirectional relationship with psychological symptoms as it can lead to social anxiety and depression, which in turn can aggravate hair loss. Hence, it is crucial to implement a holistic approach to managing AA including topical and systemic therapies, psychological counseling, and lifestyle modifications. It is imperative to fully declinate the pathophysiological mechanisms of the disease and formulate therapies in future research to help clinicians and dermatologists devise definitive guidelines to treat the condition for long-term remission.

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