Staff Publication

Factors predicting conversion from colon capsule endoscopy to conventional optical endoscopy-findings from the CESCAIL study (2025)

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Type of publication:

Journal article

Author(s):

Lei, Ian Io; Parisi, Ioanna; Bhandare, Anirudh; Perez, Francisco Porras; Lee, Thomas; Shehkar, Chander; McStay, Mary; Anderson, Simon; Watson, Angus; Conlin, Abby; Badreldin, Rawya; Malik, Kamran; Jacob, John; Dixon, Andrew; *Butterworth, Jeffrey; Parsons, Nicholas; Koulaouzidis, Anastasios; Arasaradnam, Ramesh P.

Citation:

BMC Gastroenterology. 25(1):363, 2025 May 13.

Abstract:

BACKGROUND: Colon capsule endoscopy (CCE) has become an alternative to traditional colonoscopy for low-risk patients. However, CCE's low completion rate and inability to take biopsies or remove polyps often result in a CCE-to-conventional colonoscopy conversion (CCC).

OBJECTIVE(S): The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC.

METHODS: This prospective study analysed data from patients who underwent CCE as part of the CESCAIL study from Nov 2021 till June 2024. Predictive factors were examined for their association with CCC, including patient demographics, comorbidities, medications, and laboratory results from symptomatic and surveillance groups. Statistical methods such as LASSO, linear, and logistic regression were applied.

RESULTS: Six hundred and three participants were analysed. Elevated f-Hb levels (OR = 1.48, 95% CI:1.18-1.86, p = 0.0002) and smoking (OR = 1.44, 95% CI: 1.01-2.11, p = 0.047) were significantly associated with CCC. The area under the curve (AUC) of elevated f-Hb for predicting CCC was 0.62 after adjusting for confounders. Diabetes was linked to poor bowel preparation (OR = 0.40, 95%CI:0.18-0.87, p = 0.022). Alcohol (p = 0.004), smoking (p = 0.003), psychological conditions (p = 0.001), and haemoglobin levels (p = 0.046) were significantly associated with the number of polyps, whilst antidepressants (p = 0.003) and beta-blockers (p = 0.001) were linked to the size of polyps.

CONCLUSION: Non-smokers with lower f-Hb levels are less likely to need conventional colonoscopy (CCC). Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness.

DOI: 10.1186/s12876-025-03828-9

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Robotic Versus Laparoscopic Approaches to Distal Pancreatectomy: Quality Assessment of the Current Evidence (2025)

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Type of publication:

Journal article

Author(s):

*Khan, Attam Ullah; Khan, Adan; Danial, Arbab.

Citation:

JCPSP, Journal of the College of Physicians & Surgeons – Pakistan. 35(5):628-635, 2025 May.

Abstract:

Pancreatic surgery, associated with technical difficulties and high complication rates, remains a challenge for surgeons. The laparoscopic approach has been shown to have benefits over the open approach; however laparoscopic distal pancreatectomy (LDP) still has its challenges. Robotic distal pancreatectomy (RDP) offers a technical edge over the laparoscopic approach in terms of superior imaging and ergonomics. Whether the technical advantages translate into improved outcomes is to be established. The aim of this study was to produce an overview of systematic reviews, summarising the evidence to date comparing RDP and LDP in terms of intraoperative, postoperative, and oncological outcomes and assessing the quality of the included reviews. Three electronic databases, PubMed, Embase, and Scopus, were searched to identify systematic reviews with meta-analyses comparing RDP with LDP. The AMSTAR-2 format was used to assess the quality of the studies. Fourteen systematic reviews were identified for inclusion. RDP had a significantly higher rate of spleen preservation, significantly shorter hospital stay, and a significantly lower rate of conversion to open surgery, whilst having higher total costs compared to LDP. The overall quality of the reviews was variable. The evidence suggests that RDP has potential advantages over LDP in terms of higher spleen preservation rate, shorter hospital stays, and lower conversion rate to open surgery, whilst maintaining comparability with most other outcomes. Based on the variable quality evidence, RDP is a safe alternative to LDP.

DOI: 10.29271/jcpsp.2025.05.628

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Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gardosi, Jason; Ewington, Lauren Jade; Booth, Katie; Bick, Debra; Bouliotis, George; Butler, Emily; *Deshpande, Sanjeev; Ellson, Hanna; Fisher, Joanne; *Gornall, Adam; Lall, Ranjit; Mistry, Hema; Naghdi, Seyran; Petrou, Stavros; Slowther, Anne-Marie; Wood, Sara; Underwood, Martin; Quenby, Siobhan.

Citation:

Lancet. 2025 May 01.

Abstract:

BACKGROUND: The benefits and harms of early induction of labour to reduce shoulder dystocia in fetuses suspected to be large for gestational age (LGA) are uncertain. We aimed to investigate whether early induction of labour is associated with a reduced risk of shoulder dystocia compared with standard care.

METHODS: In this open-label, randomised controlled phase 3 trial, women aged >=18 years with a suspected LGA fetus (estimated fetal weight >90th customised percentile) as identified by ultrasound scan between 35 weeks and 0 days (35+0 weeks) of gestation and 38+0 weeks' gestation, recruited from 106 hospitals across England, Scotland, and Wales in the UK, were randomly assigned (1:1) by web app to standard care or induction of labour between 38+0 weeks' gestation and 38+0 weeks' gestation using minimisation, balancing site, estimated fetal weight percentile (<=95th EFW percentile or >95th EFW percentile), and maternal age (<=35 years or >35 years). Key exclusion criteria included drug-treated diabetes, gestational diabetes, and elective caesarean section or induction already planned or indicated for any reason. Our primary outcome was incidence of shoulder dystocia, assessed by a masked independent expert adjudication panel who reviewed participants' delivery notes. Induction of labour was anticipated to result in birth 10.5 days earlier with a 300 g lower birthweight on average than standard care. We did an intention-to-treat (ITT) analysis in all participants for whom we had primary outcome data, and a per-protocol analysis in participants in the induction group who went into labour or were induced at 38+0 to 38+0 weeks' gestation versus participants in the standard care group who had not started labour, been induced, or had an elective caesarean section before 38+0 weeks' gestation. This study was registered with ISRCTN (18229892) and is no longer recruiting.

FINDINGS: Between June 8, 2018, and Oct 25, 2022, 2893 women were randomly assigned to induction of labour (n=1447) or standard care (n=1446); the trial was terminated before the target of 4000 participants was reached on advice of the data monitoring committee following the lower-than-expected incidence of shoulder dystocia in the standard caregroup. Two participants in the induction group and seven in the standard care group had missing data for the primary outcome and were excluded from the ITT analysis. In the ITT analysis, 33 (2.3%) of 1445 babies in the induction group versus 44 (3.1%) of 1439 in the standard care group had shoulder dystocia (risk ratio [RR] 0.75 [95% CI 0.51-1.09]; p=0.14) with a mean difference of -6.0 days' (95% CI -6.3 to -5.6) gestation and -163.6 g (-190.0 to -137.1) birthweight between trial groups. 355 (24.6%) of 1446 mothers in the standard care group were induced, delivered, or went into labour at or before 38+0 weeks' gestation. In the per-protocol analysis, 27 (2.3%) of 1180 babies in the induction group versus 40 (3.7%) of 1074 in the standard care group had shoulder dystocia (RR 0.62 [0.41-0.92]; p=0.019), and there was a mean difference of -8.1 days' (-8.4 to -7.9) gestation and -213.3 g (-242.0 to -184.6) birthweight between trial groups. One neonatal death occurred from perinatal asphyxia after shoulder dystocia in the standard care group, and one neonatal death occurred following sepsis and congenital pneumonia in the induction group. 88 (6.1%) of 1447 mothers in the induction group had an adverse event versus 108 (7.5%) of 1446 in the standard care group (RR 0.81 [0.62 to 1.06]; p=0.13). Similar numbers of serious adverse events were reported in both groups.

INTERPRETATION: No significant difference in incidence of shoulder dystocia was found between trial groups in the ITT analysis, probably due to the high proportion of earlier-than-expected deliveries in the standard care group reducing the intended between-group differences in gestational age and birthweight. However, in the per-protocol analysis, compared with all deliveries after 38+0 weeks' gestation, induction of labour between 38+0 weeks' gestation and 38+0 weeks' gestation did show a significant reduction in shoulder dystocia. This study provides pregnant women with suspected LGA fetuses and their clinicians important information about choices and decision making for timing and mode of birth.

DOI: 10.1016/ S0140-6736(25)00162-X

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Nigeria introduces the world's first Men5 CV meningitis vaccine (2025)

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Type of publication:

Journal article

Author(s):

Aderinto N.; Olatunji G.; Kokori E.; Ogieuhi I.J.; Alao A.E.; Ajimotokan O.I.; Victoria O.O.; *Akinruli O.A.; Olawoyin M.T.

Citation:

Discover public health. 22(1) (no pagination), 2025. Article Number: 194. Date of Publication: 01 Dec 2025

Abstract:

Meningitis is a serious and potentially life-threatening condition due to inflammation of the brain and spinal cord's meninges. It has various etiologies, among which bacterial meningitis appears to be the most prevalent. Nigeria, the largest country in Africa has now become the first country to roll out a new vaccine called the Men5CV, being able to offer protective against five meningococcal bacterial strains (A, C, W, Y, and X), it offers hope to low-income and developing countries across the world. Clinical trials showed consistent efficacy with minimum adverse effects, and as such it has been approved by the World Health Organization (WHO). 1686 suspected cases were recorded within the last four years in Nigeria, with about 124 confirmed deaths. Despite the success with the MenA conjugate vaccine, other strains still persist. Through a 13-year collaborative effort, there has been significant protection. The rollout of the MEN4CV marks a critical step towards the goal of the WHO in completely eradicating meningitis by 2030. Although challenges like religious reasons and limited vaccine supply exist, we believe with effective training for healthcare practitioners and effective distribution of vaccines to remote areas, these obstacles can be overcome.

DOI: 10.1186/s12982-025-00592-9

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Is this Acute Manifestation of Adrenal Crisis? (2025)

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Type of publication:

Journal article

Author(s):

*Nwaneri C.

Citation:

Acta Medica International. 12(1) (pp 66-71), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Adrenal crisis is a life threatening complication of both primary and secondary adrenocortical insufficiency. The diagnosis of adrenal crisis requires a high index of suspicion, such as circulatory collapse, refractory hypotension, and metabolic acidosis. The clinical features are because of both mineralocorticoid and glucocorticoid deficiencies. The primary and initial treatment is intravenous cortisol therapy, and saline (sometimes glucose). Case presentation was used in this 43 year old woman who presented with dizziness, anorexia, vomiting, generalized weakness, and lethargy. She had a history of recent tuberculosis infection and was commenced on antituberculosis therapy, rifampicin. Her biochemical profile was suggestive of impending adrenal crisis. Her chest X ray and computed tomography were grossly normal. The patient recovered completely and was discharged home with the resolution of her deranged metabolic and electrolyte derangements. Appropriate specialist care is vital in patients with adrenal crisis, coupled with initial aggressive fluid resuscitation and acid base balance and good intensive care.

DOI: 10.4103/amit.amit_89_24

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Cognitive impairment (chemobrain) in early breast cancer patients treated with anthracycline/taxane chemotherapy (2025)

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Type of publication:

Conference abstract

Author(s):

Kenny L.; Vicidomini R.; Wardeh S.A.; Riddle P.; *Pettit L.; Gayani P.; Staples E.; McLeavy L.; Kanwar J.; Edison P.

Citation:

ESMO Open. Conference: Abstract Book of the ESMO Breast Cancer Congress 2025. Munich Germany. 10(Supplement 4) (no pagination), 2025. Article Number: 104998. Date of Publication: 01 May 2025.

Abstract:

Background: Chemotherapy-induced cognitive impairment (CICI) occurs in ~33% of post-chemotherapy breast cancer patients, and is associated with transient or enduring cognitive deficits. However, the aetiology and underlying pathophysiology is yet to be determined. Method(s): 270 early breast cancer patients who received anthracycline (AC/EC) and/or taxane chemotherapy within the previous 12 months were enrolled from UK sites. Clinical and neurocognitive tests were performed on an Artificial Intelligence platform. 18 patients with low cognitive scores, along with 19 controls, underwent further in-person neurocognitive assessments and brain MRI(3T) in Imperial College London. MRI images were analysed using Region of Interest (ROI) and Voxel-Based Morphometric (VBM) analysis. Result(s): The mean age of the patients was 55.6 years (controls=66.7) and average time between initiation of chemotherapy and MRI was 14.1 months. 13/18 received AC/EC-taxanes, 2 received TC, and 3 received taxanes. At the time of MRI, most patients had completed cytotoxic therapy, and 89% were undergoing endocrine therapy. ROI and VBM analyses of CICI patients consistently demonstrated significantly lower grey matter volumes (mm3) and surface areas (mm2) in the following regions: cingulate cortex, medial and orbitofrontal regions of the frontal lobe, precuneus and parietal areas, temporal pole, and lingual cortex. This was associated with poorer semantic, verbal fluency and lower MMSE scores in CICI patients. Conclusion(s): This preliminary data reveals significant cerebral morphological changes and cognitive impairment following anthracycline-taxane chemotherapy. This highlights an urgent need to investigate CICI in a larger cohort of patients to evaluate whether chemotherapy could induce neurodegenerative process so that long-term preventative strategies could be developed.

DOI: 10.1016/j.esmoop.2025.104998

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Time perception in shoulder dystocia management; a secondary analysis of the prospective cohort simulation SAFE study (2025)

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Type of publication:

Journal article

Author(s):

*Papoutsis D.; Klazoglou P.; Valasoulis G.; Tzavara C.;

Citation:

European Journal of Obstetrics and Gynecology and Reproductive Biology. 311 (no pagination), 2025. Article Number: 114016. Date of Publication: 01 Jul 2025.

Abstract:

Objective: The aim of this study was to explore and quantify the potential improvement and retention of time perception in a simulated childbirth complicated by shoulder dystocia with use of high-fidelity simulation. Method(s): This was a secondary analysis of the previously conducted prospective cohort SAFE study. Registered midwives and final year Midwifery students were invited to attend a one-day workshop in 6-monthly intervals at the University of Western Macedonia in Greece between October 2021-November 2022. There was a 30-minute initial assessment, a 30-minute theoretical and hands-on training, and a 30-minute post-training assessment on shoulder dystocia management. We identified the actual-time and the self-reported perceived-time of delivery at the start and end of each workshop and measured the difference between them to determine if there was any improvement and retention of time perception through consecutive workshops. Result(s): The baseline workshop recruited 101 participants with mean age of 26.7 +/- 9.8 years (range:20-59), of which 53 participated at the 6 month and 33 at the 12 month workshop. There was a significant improvement in time perception by approximately 34.8 % at the end of the baseline workshop, which was retained after 6 and 12 months. 80.2 % of participants experienced a 'time-distortion effect' towards the same direction and felt that the simulated delivery lasted longer than the actual time recorded by the birthing simulator. Those who were more competent at the start of the baseline workshop demonstrated a better time perception. Conclusion(s): The skill of time perception in shoulder dystocia can be improved and retained through simulation training.

DOI: 10.1016/j.ejogrb.2025.114016

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Is Hybrid Closed Loop Continuous Subcutaneous Insulin Infusion Beneficial in Adults with Type 1 Diabetes(T1D) on Continuous Glucose Monitoring: A Reallife District General Hospital Perspective (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A275-A276), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D.We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single District General Hospital (DGH) service on CSII from 2011 onwards. %Time in range (TIR), %hypoglycaemia (%hypo) and HbA1c were analysed with independent samples T-Test (SPSS software). Result(s): 302 patients were included: mean age was 44 years (range 19-81), female:male 57:43, diabetes duration 25years (range 2-61), and mean pre-CSII HbA1c 63mmol/mol. 218 were on HCL, 21 partial closed loop(PCL) and 63 were NCL. All patients were either on real-time(rt)CGM or intermittently scanned( is)CGM. HCL users were on Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor and NCL patients mostly on Omnipod DASH with rtCGM or isCGM. For HCL vs NCL systems, mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) were significantly improved on HCL. There was a trend to reduced %hypo (1.64% vs 2.64%,p = 0.08) but not statistically significant. Conclusion(s): This analysis demonstrates significantly better glycaemic control, in both HbA1c and TIR parameters, in HCL CSII users compared to NCL CSII in T1D. Hypoglycaemia was reduced but did not achieve statistical significance, possibly due to overall low rate of hypoglycaemia in the entire cohort. We speculate patients would have been responding to CGM alarm warnings to abort actual hypoglycaemic events.

Is Continuous Glucose Monitoring (CGM) the Critical Technological Intervention in Adults with Type 1 Diabetes(T1D) on Continuous Subcutaneous Insulin Infusion (CSII) Therapy? (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A230), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: We assessed impact of CGM in existing CSII patients with T1D switching to hybrid closed loop (HCL), partial closed loop (PCL) or remaining on non-closed loop (NCL) CSII. Method(s): Outcomes of patients with T1D on CSII in an adult service from 2011 were reviewed. Analysis of %Time in range (%TIR), %hypoglycaemia (%hypo) and HbA1c was done with SPSS. Result(s): 302 patients were included. 183 were on Tandem T-Slim(T-Slim), 58 Omnipod Dash(DASH), 39 Medtronic780G(780G), 11 Medtronic670G(670G), and 7 Medtronic640G(640G). 218 were on HCL, 21 PCL and 63 NCL. All were on either real-time (rt)CGM (DexcomG6, GuardianG3 or GuardianG4) or intermittently scanned (is)CGM (Freestyle Libre2). T-Slim, DASH, 780G, 670G, 640G showed mean HbA1c of 53.8, 55.6, 53.0, 62, 52.8mmol/mol; %TIR of 70, 64, 72, 61, 56%; and %hypo of 1.7, 1.8, 2.0, 1.4, 4.0% respectively. Post-hoc analysis only showed statistically significant benefits with HbA1c for T-Slim over 670G, and 780G over 670G; %TIR for 780G over 640G and %hypo for T-Slim over 640G. Mean HbA1c and %TIR were significantly better on HCL vs NCL and PCL, but not %hypo. PCL did not show benefit over NCL in HbA1c, %TIR or %hypo. Conclusion(s): We propose CGM confers the most important interventional benefit in patients already on CSII. HCL provided additional benefits in improving glycaemia, both TIR and HbA1c, but not hypo in patients on CGM. PCL does not provide additional benefits over NCL in patients on CGM. QOL indices, however, may show additional benefits both in HCL and PCL.

Does Age Influence Clinical and Patient Satisfaction Outcomes in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII) And Continuous Glucose Monitoring (CGM)? (2024)

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Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A124), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There is a possibility of subconscious bias towards using complex technology in young adults. Patient perceptions towards treatment may be influenced by age. We explored outcomes and patient experiences in various age groups with Type 1 Diabetes(T1D). Method(s): Database of patients within a single adult pump service was analysed for HbA1c, %time in range(%TIR), %hypoglycaemia(%hypo). Additionally, for Hybrid closed-loop patients Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections, and expectations (INSPIRE)scores were analysed in different age groups. Result(s): 302 patients were included: mean age 44 years (range 19-81), 57% females, mean diabetes duration 25years (range 2- 61), and mean pre-CSII HbA1c 63mmol/mol. 218 users had hybrid closed-loop(HCL), 21 partial closed-loop and 63 non-closed-loop CSII. All were on CGM. Only 2 patients were aged above 75years and excluded from statistical analysis. Compared to the entire cohort, 19-25-year-olds had worse mean HbA1c(53.8vs58.8%), TIR(68.7vs59%) and %hypo(1.79vs2.33%), of which only %hypo was not statistically significant. Clinical outcomes were similar in all other groups. Positive Correlation(r) with age was noted with TIR(r = 0.263,p <0.001), DTSQ(r = 0.143, p = 0.03), and negative correlation with %hypo(r = -0.127, p = 0.028), HypoFS(r = -0.309, p <0.001), T1DDS(r = -0.244,p <0.001), and INSPIRE(r = – 0.146,p = 0.038). HypoFS were worse in younger individuals with progressive improvement with increasing age. Conclusion(s): Young adults (19-25 years) had worse clinical outcomes compared to other adults on CSII. Diabetes distress, fear of hypoglycaemia was higher in younger individuals. Use of complex technology including HCL was equally embraced across all age groups, though younger patients may have greater acceptance.