Staff Publication

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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Anaesthetic management of colorectal surgery in a patient with chronic pericardial effusion (2025)

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Type of publication:

Journal article

Author(s):

*Ahmad, E; *Liu, H S; *Miller, A.

Citation:

Anaesthesia Reports. 13(2):e70031, 2025 Jul-Dec.

Abstract:

Chronic pericardial effusions are a peri-operative challenge as anaesthesia and surgery can precipitate haemodynamic compromise. Guidance for managing patients requiring time-sensitive non-cardiac surgery in this setting is limited. We report the case of a 43-year-old woman with a moderate chronic, asymptomatic pericardial effusion scheduled for robotic anterior resection of rectal cancer. The principal challenge was balancing the need for time-sensitive oncological surgery against the risk of haemodynamic compromise in the context of suboptimal pre-operative cardiology assessment. Surgery proceeded after multidisciplinary discussion, with pre-emptive vasopressor support and intra-operative transoesophageal echocardiography monitoring to guide management. The peri-operative course was stable, and the patient was discharged on postoperative day 4. Two months later, she required pericardial window formation for a persistent effusion which had become symptomatic. This case illustrates that non-cardiac surgery in chronic, asymptomatic pericardial effusion can be performed safely when guided by physiological reasoning, real-time echocardiography and multidisciplinary planning.

DOI: 10.1002/anr3.70031

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Patient-Reported Importance of Functional Benefit in Geographic Atrophy (2025)

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Type of publication:

Journal article

Author(s):

Dinah, Christiana; Enoch, Jamie; Ghulakhszian, Arevik; Sekhon, Mandeep; Salvatore, Serena; DeSalvo, Gabriella; Kumar, Praveen; Banerjee, Sanjiv; *Nayak, Devaki; Amoaku, Winfried; Shiew, Marianne; Osoba, Olayinka; Crabb, David P; Taylor, Deanna J.

Citation:

JAMA Ophthalmology. 2025 Sep 25. [epub ahead of print]

Abstract:

Importance: Intravitreal complement inhibitors injections (IVCIs) slowed progression of geographic atrophy (GA) lesions in several registration phase 3 trials although without benefit for prespecified secondary functional vision outcomes. Patient acceptability of these therapies needs further exploration.

Objective: To quantify the acceptability of IVCI therapy to United Kingdom patients with GA, assuming vision outcome benefits are expected.

Design, Setting, and Participants: This cross-sectional study took place at 9 geographically dispersed UK National Health Service centers from April 2023 to April 2024 among 153 participants with treatment-naive GA in at least 1 eye.

Exposures: GA in at least 1 eye.

Main Outcomes and Measures: Main outcomes were (1) acceptability of IVCI therapy based on completion of validated acceptability questionnaire. Participants were provided with a treatment information leaflet coproduced by a patients with lived experience of GA to inform them about the risks and benefits of IVCI for GA, assuming there were vision outcome benefits to this treatment and (2) response to the EuroQol 5-dimension with a vision bolt-on questionnaire to assess general health and vision-related quality of life. Spearman rank correlations and chi2 tests were used to explore associations between acceptability levels and specific ocular and sociodemographic characteristics.

Results: A total of 153 participants were recruited (93 [60%] women; mean [SD] age, 82 [7]), 57 (38%) of whom had bilateral foveal involvement. Median (IQR) visual acuity with habitual correction in the better-seeing eye and in eyes where neither eye was better or worse was logMAR, 0.30 (0.14-0.54; approximate Snellen equivalent, 20/40) and 0.47 (0.14-0.84; approximate Snellen equivalent, 20/63), respectively. Among the 153 participants, 81 (53%; 95% CI, 45-61) reported IVCIs were very much or extremely acceptable under the theoretical scenarios provided. The proportion finding IVCIs acceptable rose to 82% (95% CI, 76-88) when including those who rated prospective treatment as moderately acceptable. Belief in the perceived effectiveness of the treatment (rho, 0.52; 95% CI, 0.40-0.63; P < .001) and confidence in their ability to attend the eye clinic regularly (rho, 0.51; 95% CI, 0.38-0.62; P < .001) correlated with overall acceptability.

Conclusions and Relevance: IVCI therapy for GA may be acceptable to most UK patients with GA under the assumption that there are vision outcome benefits to this treatment. While current treatments do not result in vision outcome benefits, perceived effectiveness by patients was associated with acceptability, emphasizing the desire to quantify vision functional benefit concomitant with anatomical slowing of progression.

DOI: 10.1001/jamaophthalmol.2025.3264

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A Literature Review Assessing Whether the Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Increases the Risk of Cardiovascular Events (2025)

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Type of publication:

Journal article

Author(s):

*Ahsan, Ammar; Sahu, Muhammad Arham.

Citation:

Cureus. 17(9):e92361, 2025 Sep.

Abstract:

Non-steroidal anti-inflammatory drugs (NSAIDs) are very useful due to their multiple properties, including analgesic, antipyretic, and anti-inflammatory effects. As a result, NSAIDs have become one of the most widely administered drugs in the world. The proposed function of this drug was to act like a steroid without its harmful and common side effects. However, like any other medication, NSAIDs come with their own set of side effects, notably their gastrointestinal and cardiovascular effects. With these known side effects and its ease of availability, it is concerning, and therefore further research was required to determine if there is a significant risk of cardiovascular events associated with NSAIDs. Guideline searches were performed using the following databases: National Institute for Health and Care Excellence (NICE), TRIP, SIGN, and AHRQ, which produced 22 results; however, after screening, only one guideline was included in this review. A literature search for systematic reviews was conducted using the following databases: MEDLINE, Cochrane, and PubMed, which yielded 711 results. However, after full screening, only three systematic reviews were included. The National Institute for Health and Care Excellence (NICE) guidelines are a source of evidence-based recommendations made for healthcare professionals in the diagnosis and management of their patients. The NICE guideline focusing on NSAIDs provides advice regarding the prescription of NSAIDs, including contraindications, dosage, and mechanism of action. Three systematic reviews assessed NSAIDs and their cardiovascular effects. All three systematic reviews found an association between NSAIDs and their cardiovascular effects with varying degrees of strength. In conclusion, this review demonstrates evidence of the cardiovascular side effects related to the use of NSAIDs and raises questions about an increase in events, such as stroke, myocardial infarction, and hypertension. Evaluating the systematic reviews, it was essential to determine whether there was a statistically significant risk of cardiovascular events. All three papers suggested a linked increase in cardiovascular events; however, further research is required in order to understand which specific NSAIDs cause this. As a result, guideline alterations may need to be followed.

DOI: 10.7759/cureus.92361

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Epidemiology of metatarsal fractures in Shropshire 2020-2023 (2025)

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Type of publication:

Journal article

Author(s):

*Garton, Mark; *Rowlands, Jenni; *Roach, Richard.

Citation:

Archives of Osteoporosis. 20(1):126, 2025 Sep 18

Abstract:

The epidemiology of metatarsal fractures remains poorly understood. We identified retrospectively all adults with >= 1 radiologically confirmed metatarsal fracture, over 3 years. Young men and women had similar fracture rates, but overall risks were significantly higher for women (RR 1.99, 95% CI 1.76-2.26), driven by age-related falls in male fracture incidence.

PURPOSE: Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period.

METHODS: Radiology reports were searched for all patients aged >= 18 years between 2020 and 2023, using the terms 'metatarsal' AND 'fracture', to identify patients with >= 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data.

RESULTS: A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals.
Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18-29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76-2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34-6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32-2.12).

CONCLUSION: Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.

DOI: 10.1007/s11657-025-01603-7

Ultrasound shear wave elastography - a reliable protocol for the assessment of the stiffness of the supraspinatus tendon (2025)

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Type of publication:

Journal article

Author(s):

*Black, Martin; *Lumsden, Gordon; *Dodenhoff, Ron

Citation:

Shoulder And Elbow. 17585732251376351, 2025 Sep 15. [epub ahead of print]

Abstract:

Background: The continued evolution of shear wave elastography (SWE) in the measurement of supraspinatus tendon stiffness can assist in both rehabilitation and surgical monitoring with the potential to improve patient outcomes. It can provide non-invasive, quantitative data of elastic properties of tendons which are altered in the presence of pathological change. This study evaluates the inter- and intra-rater reliability of a standardised SWE assessment protocol of the supraspinatus
tendon.

Methods: Shear wave velocity (SWV, m/s) values of 52 healthy, asymptomatic supraspinatus tendons were recorded using SWE. Two raters scanned each tendon on two separate occasions, seven days apart, using a strict protocol.

Results: Intraclass correlation coefficient (ICC) for inter-rater reliability was 0.78. Intra-rater reliability was 0.81 for rater one and 0.89 for rater two, respectively. Minimal detectable change (MDC95) ranged between 1.28 and 1.82 m/s for intra- and inter-rater reliability. Mean SWV values (m/s) for rater one were 9.08 +/- 1.44 and 9.29 +/- 1.48; and for rater two 8.72 +/- 1.35 and 8.87 +/- 1.43, for trial one and two.

Conclusion: The results demonstrate reliable SWV measurements between and within raters in the supraspinatus tendon, providing normative values and a protocol which may be utilised clinically. Level of evidence: Level III Diagnostic Study.

DOI: 10.1177/17585732251376351

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Early Versus Delayed Diuretic Administration and Urine-Guided Strategies in Acute Decompensated Heart Failure: A Systematic Review of Clinical Outcomes (2025)

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Type of publication:

Systematic review

Author(s):

Muzammil, Rabeet; Mohammad, Ahmad; Hammad, Muhammad; Ahmed, Adeel; Hussain, Aadil; Rashid, Wardah; Yousaf, Rabia; Singla, Shivam; Singla, Bhavna; *Ekomwereren, Osatohanmwen; Asante Baadu, Francis; Irshad, Ahmad.

Citation:

Cureus. 17(8):e89408, 2025 Aug.

Abstract:

This systematic review explores the impact of diuretic timing and strategy on outcomes in patients with acute decompensated heart failure (ADHF). A total of seven studies were included, comprising randomized controlled trials (RCTs), pre-specified sub-analyses, and observational data. Early administration of intravenous loop diuretics, particularly within the first 60 to 90 minutes of hospital arrival, was generally associated with improved short-term outcomes, including reduced in-hospital and 30-day mortality. Furthermore, guided diuretic strategies using urine sodium or urinary biomarkers showed promise in enhancing decongestion efficiency and predicting therapeutic response, although long-term benefits remain uncertain. Despite some heterogeneity in study design, timing definitions, and outcome measures, this review underscores the clinical significance of prompt and tailored diuretic therapy. These findings highlight the need for timely intervention and more personalized management strategies in ADHF, while also identifying gaps for future large-scale trials.

DOI: 10.7759/cureus.89408

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Atypical Presentation of Varicella-Zoster Virus Encephalitis in an Elderly Immunocompetent Adult: Early Diagnosis and Positive Outcome Following Treatment (2025)

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Type of publication:

Journal article

Author(s):

*Adewoye, Oluwaseun G; Halim, Mohamed A; *Srinivasan, Meena; *Owolabi, Olasunkanmi H.

Citation:

Cureus. 17(7):e88535, 2025 Jul.

Abstract:

Varicella encephalitis following herpes zoster ophthalmicus (HZO) is a rare but serious complication that can occur due to the reactivation of the varicella-zoster virus (VZV). HZO involves the ophthalmic division of the trigeminal nerve, typically presenting with a dermatomal rash, and can lead to various ocular complications. In some cases, this reactivation can extend to the central nervous system, resulting in encephalitis, which can lead to significant morbidity and mortality, particularly in immunocompromised or elderly individuals. This report describes a case of VZV encephalitis complicating HZO in an elderly immunocompetent male who presented with altered mental status following an initial presentation of HZO in the absence of a dermatomal rash, with a tentative diagnosis of an acute ischemic stroke. Early diagnostic confirmation was achieved through cerebrospinal fluid analysis and polymerase chain reaction, which identified VZV central nervous system infection. The patient was administered intravenous acyclovir, leading to complete neurological recovery. This case underscores the necessity of including VZV encephalitis in the differential diagnosis of acute encephalopathy, even when typical dermatological signs are absent. Furthermore, it emphasizes the critical role of prompt antiviral therapy in ensuring favorable clinical outcomes. Additionally, this case illustrates that VZV encephalitis can mimic stroke-like symptoms, highlighting the potential for misdiagnosis and the importance of considering infectious etiologies in such presentations.

DOI: 10.7759/cureus.88535

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Practical Considerations in the Management of Frail Older People with Diabetes (2025)

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Type of publication:

Journal article

Author(s):

*Abdelhafiz, Dima; Abdelhafiz, Ahmed.

Citation:

Diseases. 13(8), 2025 Aug 06.

Abstract:

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients' views, wishes and preferences are in the heart of these plans.

DOI: 10.3390/diseases13080249

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