2025

Standardising Acute Coronary Syndrome Management: The Impact of Electronic Order Sets on Prescribing Compliance in a Tertiary Cardiology Centre. (2025)

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Type of publication:

Conference abstract

Author(s):

*Bhambra G.; Fan L.

Citation:

Heart. Conference: BACPR Annual Conference 2025. Glasgow United Kingdom. 111(Supplement 5) (pp A9), 2025. Date of Publication: 01 Nov 2025.

Abstract:

Background Acute Coronary Syndrome (ACS) management relies on timely and accurate prescribing of evidence-based pharmacological therapies as per NICE NG185 guidelines. However, inconsistencies in prescribing practices, especially between cardiology-trained and non-cardiology clinicians, can lead to delays in optimal treatment, inconsistencies in care, and suboptimal discharge planning. Aim To evaluate whether implementing a standardised electronic prescribing order set improves compliance with NICE NG185 recommendations in ACS patients admitted to a tertiary cardiology centre. Method A retrospective review was conducted using EPMA (Electronic Prescribing and Medicines Administration) preintervention (June-October 2022, n=221) and post intervention (February-March 2023, n=76). Patients admitted with STEMI or NSTEMI were assessed within 1-3 days of admission for prescribing compliance with five core ACS medications: aspirin, beta-blockers, statins, proton pump inhibitors (Table present) (PPIs) and ACE inhibitors (ACEi). Following governance approval, a standardised electronic NICE-aligned order set was implemented on the EPMA system. Prescribing compliance pre and post intervention were compared and analysed for significance. Results Pre-intervention (NSTEMI=104, STEMI=117) revealed universal aspirin prescribing (100%), but notable omissions in other therapies: beta-blockers (70.6%), PPIs (72.9%), ACEi (71.5%) and statins (91.4%) [table 1]. Post-intervention (NSTEMI=28, STEMI=48) showed significant prescribing improvements: beta-blockers: +20.2% (p=0.0007), PPIs: +15.3% (p=0.0102), and ACEi: +10.1% (p=0.1143). Statin prescribing showed smaller changes (+3.3%) [table 1]. Conclusion Introducing standardised electronic order sets significantly improved prescribing compliance for ACS medications, particularly beta-blockers and PPIs. This intervention promoted adherence to NICE NG185 guidelines, reduced prescribing variability, streamlined medication reconciliation and improved discharge readiness. Embedding digital decision-support tools into EPMA can enhance early initiation of secondary prevention and facilitate a smoother transition to cardiovascular rehabilitation to optimise ACS care. Future directions will focus on sustainability and scalability across additional clinical settings and specialties to standardise ACS care.

DOI: 10.1136/heartjnl-2025-BACPR.15

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Multidisciplinary team stakeholder event driving development of a novel Haemolytic Disease of the Fetus and Newborn (HDFN) national database for improving clinical outcomes of pregnancy affected by alloimmunisation (2024)

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Type of publication:

Conference abstract

Author(s):

Wilkes N.; Jeffs B.; Morton S.; Rogers L.; *Shields J.; Graham S.; Young B.; Asquith B.; O'Shea M.; McBride C.; Wilkes C.; Hazell M.

Citation:

Transfusion Medicine. Conference: 41st Annual Scientific Meeting of the British Blood Transfusion Society. Glasgow United Kingdom. 34(Supplement) (pp 37-38), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: HDFN is caused by incompatibility between maternal and fetal red cells, stimulating maternal antibody formation and attacking antigen positive fetal red cells, causing haemolysis (Poole and Daniels, 2007). Severity ranges from mild symptoms of jaundice & anaemia to fatal haemolysis (RCOG, 2014). Scientific advances including anti-D prophylaxis and fetal genotyping have improved clinical care and reduced the occurrence of HDFN (BSH, 2016). Guidelines recommend regularly monitoring maternal blood samples during pregnancy to determine antibody formation and titration, identifying any potential risk to the fetus, thus informing clinical decisions and intervention (BSH, 2016). Reviewing guidelines through evidence base analysis is best for patients, ensuring appropriate management plans. NHSBT historically collected data on outcomes of pregnancies with clinically significant alloantibodies. This project aims to launch a novel data collection platform populating a national pregnancy outcomes database ensuring best practice, prevention and treatment in HDFN. Stakeholder engagement and collaboration is essential, here we present the insights gained and the next steps. Method(s): Stakeholders were surveyed prior to the event to inform current practice and guide the face-to-face event agenda. Continuous improvement tools (including Kano analysis) were employed to facilitate guided evaluation and re-design of the current questionnaire & novel digital platform needs. Stakeholders were split into groups with various professional backgrounds allowing different perspectives to be sought. Following the event attendees had access to the collaborative whiteboard tool, Miro, to further understand challenges and requirements. Results and Discussion: Stakeholder output was key to redesigning a user-friendly questionnaire and drive development of a novel digital platform to promote national uptake. Multidisciplinary team collaboration of clinical, laboratory and operational colleagues across organisations gained helpful intel enabling patient focussed outcomes. This approach enabled open discussions capturing ideas to frame service development. Utilisation of the Kano model was an insightful way of understanding user requirements. Conclusion(s): The expanding dataset will be used to inform future guidelines by questioning which pregnancies are at higher risk of HDFN. Increased information aids in providing optimal care to mothers and their babies. Usage of large datasets to benefit patient outcomes are key strategic priorities within Transfusion 2024 (Stanworth et al, 2023).

DOI: 10.1111/tme.13084

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Tumour immune microenvironment prognostic factors in locally advanced rectal cancer, a systematic review (2025)

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Type of publication:

Journal article

Author(s):

Ball, Alasdair; *Lefroy, Rebecca; Price, Malcolm; McArthur, David; Beggs, Andrew.

Citation:

Frontiers in Oncology. 15:1688696, 2025.

Abstract:

Introduction: Understanding factors influencing individual survival outcomes following surgical resection of locally advanced (LARC) rectal cancer remains challenging. Novel biomarkers could show emerging promise in this setting. This study aimed to systematically review the literature on immune prognostic factors in LARC.

Methods: The review protocol was preregistered on the PROSPERO database (CRD42023460541). Included studies were required to report overall survival and at least one immune prognostic factor for at least ten patients with LARC. Final searches of MEDLINE, EMBASE and Central were concluded on 8th September 2023. The risk of bias was assessed using the QUIPS tool.

Results: 22 retrospective cohort studies involving 2,622 LARC patients were included in the review. We did not find any published data on immune prognostic factors in locally recurrent rectal cancer. Due to inconsistency of immune prognostic factor definitions and measurement methods, meta-analysis would not be meaningful. Instead, the results are presented descriptively. Risk of bias was concentrated in the participation, attrition, and confounding domains. Greater cytotoxic cell infiltration was associated with improved overall survival. There was inconsistent evidence of an association of PD-L1 expression and survival. M2 macrophage infiltration and homozygous germline FPR1 loss-of-function were associated with worse survival.

Discussion: These findings support a role for both innate and acquired immune systems in mediating outcomes following surgery for LARC and suggest that further work into immunomodulation may show promise in improving LARC treatment.

DOI: 10.3389/fonc.2025.1688696

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Artificial Intelligence in Colonoscopy: A Systematic Review of Adenoma Versus Polyp Detection Rates (2025)

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Type of publication:

Systematic Review

Author(s):

Rabba, Waseem; *Asif, Fatima; Younis, Muhammad Y; Nasrullah, Haris; Fatima, Laraib; Arif, Muhammad A.

Citation:

Cureus. 17(12):e98528, 2025 Dec.

Abstract:

Colonoscopy is the gold standard in the prevention of colorectal cancer, but the miss rates of adenoma are high, which restricts its efficacy. To improve lesion recognition, artificial intelligence (AI), especially computer-aided detection (CADe) systems, has been introduced. The aim of this systematic review was to compare AI-assisted colonoscopy in terms of its ability to improve adenoma detection rate (ADR) and polyp detection rate (PDR). An extensive search was performed on PubMed, Embase, and Cochrane Library from 2015 to 2025. There were 17 randomized controlled trials (RCTs) comparing the use of AI-assisted colonoscopy with normal colonoscopy. The methodological quality measure of the included RCTs was Cochrane Risk of Bias 2.0 (RoB 2.0), which subdivided the studies based on low risk, some concerns, or high risk of bias based on whether they were biased in this or that domain. The robVis tool was used to produce the visual summaries. AI-aided colonoscopy effectively enhanced both adenoma detection rate (ADR) and polyp detection rate (PDR) in all of the included studies over conventional colonoscopy. In adenoma detection, accuracy was more than 85%, and in polyp detection, more than 90%. The advantage was also found especially in the detection of small and flat adenomas, which are very often missed in routine practice. The use of AI in colonoscopy is strongly associated with an increase in the detection rate of adenoma and polyps, minimizing the risk of underdiagnosis. The results highlight the clinical promise of AI in the form of a decision-support tool across gastroenterologists and suggest that AI can be applied to enhance the outcomes of preventive and screening colorectal cancer. Future research should be cost-efficient and practical, and combined with some clinical activities.

DOI: 10.7759/cureus.98528

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Functional and Radiological Outcomes Following Volar Locking Plate Fixation for Distal Radius Fractures: A Prospective Analytical Study (2025)

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Type of publication:

Journal article

Author(s):

Mohankumar, Mahesh; *Murugesan, Thivagar; Balamurugan, P; Venkadesh, A; Vishal, M; Muralikrishnan, R.

Citation:

Journal of Orthopaedic Case Reports. 15(12):421-429, 2025 Dec.

Abstract:

Introduction: Most frequent injuries of the Upper limb are a distal radius fracture (DRF). If they aren't handled well, they might cause problems for a long time. There are several techniques to treat this issue, but volar locking plate fixation has become increasingly prevalent since it may restore anatomical alignment, provide stable fixation, and allow for early movement. This study aimed to evaluate the functional and radiological results of distal end radius fractures treated with volar locking plate
fixation.

Materials and Methods: In this prospective analytical investigation, 60 patients with DRFs, ranging in age from 18 to 80 years, were enrolled. Patients were treated with open reduction and internal fixation using volar locking devices. Functional results are evaluated using the Gartland and Werley Demerit Point System and goniometry. Radial length, radial inclination, palmar tilt, and articular step-off were employed to quantify radiological outcomes. Follow-up evaluations were conducted at 2, 4, and 6 weeks, in addition to 6 months. We used the Statistical Package for the Social Sciences version 20 to analyze the data and discovered that P < 0.05 was significant.

Results: Patients exhibited substantial improvement in wrist function across all planes of motion, with plantar flexion rising from 31.6degree at 2 weeks to 67.8degree at 6 months, and dorsiflexion from 31.7degree to 66.4degree. Supination and pronation also became a lot better, becoming close to normal levels after 6 months. The radiographic restoration was good, with a mean radial length of 8.8 mm, an inclination of 17.6degree, and a palmar tilt of 8.9degree. There were very few complications (6.7% arthritis, 6.7% malunion).

Discussion: Our results support previous research showing volar plating offers robust fixation, restores anatomical alignment, and facilitates early mobility. Correlation study revealed that palmar tilt and articular congruity substantially impacted functional recovery, emphasizing the need of meticulous surgical reduction.

Conclusion: Volar locking plate fixation is an effective treatment for DRFs, characterized by low complication rates and excellent functional and radiological outcomes.

DOI: 10.13107/jocr.2025.v15.i12.6578

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RESECT: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gallagher K.; MacLennan S.; Bhatt N.; Clement K.; Zimmermann E.; Khadhouri S.; Kulkarni M.; Gaba MPhil F.; Anbarasan T.; Asif A.; Light A.; Ng A.; Chan V.W.-S.; Nathan A.; Cooper D.; Aucott L.; Sakthivel D.; Akand M.; Piazza P.; Marcq G.; O'Brien T.; Nielsen M.; Giudice F.D.; Simpson K.; Orecchia L.; Teixeira B.; Geisenhoff A.; Hill G.; Fukuokaya W.; Hidalgo B.G.; El-Hajj A.; Elgamal M.; Fanshawe J.; Wang B.; Lee T.; Manecksha R.; Rivas J.G.; Arda E.; Elhadi M.; Rossi S.; Teoh J.Y.-C.; Kasivisvanathan V.; Hussein I.; Longshaw A.; Kostakopoulos N.; Khadhouri S.A.S.; Kruczynska A.E.; Dimitropoulos K.K.D.; McPhee A.; Gilanliogullari K.P.; Natalie S.; Rutigliani L.; Shallcross O.R.; Dokubo I.I.; Lamb B.W.; Jimie J.H.; Hussein B.; O'Neill C.; Nelson A.R.; MacLeod A.; Arumainayagam N.; Maqboul F.; Agrawal S.; Burns H.; Bekarma H.J.; Mohammad S.; Misurati M.O.; Raslan M.Y.; Anwar A.; Gkikas C.; Alexander C.; Warren H.; Byrnes K.; Edison M.; Croghan S.; Oo E.; Beder D.; Thurtle D.R.; Janebdar H.; Reeves F.; Chua C.U.; Mcalindon J.; Hasan H.; Ng P.Y.; Mayor N.; Attar H.A.; Delacave H.S.T.; Atiyah A.; Atiyah Z.; Jelski J.E.R.; Peacock J.; Davenport K.; Shipstone D.; Malla R.A.; Krishna K.K.I.; Nizov A.; Somov P.; Ahmed Z.; McCann C.; Glackin A.J.; Asaad W.; Bain A.J.; Bordenave M.G.; Ray E.R.; Ghonaimy A.S.; Madaan S.; Fontaine C.L.L.; Daggamseh A.M.K.; Pascoe J.J.; Horn C.; Fuge O.; Laoye A.; Deytrikh A.; Thomas A.G.; Ravishankar K.; Clark M.C.; Panayi Z.; Shillito S.H.; Srirangam S.J.; Bradley C.; Lee X.W.J.W.J.; Mcilhenny C.; Leask J.; sarkar S.; chetwood A.S.A.; Paramore L.; Ali A.S.A.; Odey J.; Sheweita M.S.S.; Ekwueme K.C.; Yogeswaran C.; Mohamed Y.; Trimboli M.; Shafii M.; Duffy S.A.; Morton S.; Bandeira de Mello K.L.; Harris A.; Bruce A.; Fanshawe J.R.; Tan N.J.; Mensah E.; Walters U.; Lami M.; Omar M.A.; Kadhim H.; Gami M.N.; Hawizy A.A.M.H.; Devadoss B.J.; Breish M.; Pina I.; Cresswell J.; Simoes A.; Papadopolous G.G.; Thomas M.M.T.; Ahmed I.I.A.; Sekhon N.C.; Alleemudder A.; Okwuchi D.D.; Willmott S.V.; Majumdar P.; Coyle M.; Simson N.; Egbe A.; Nair A.; Nair M.A.N.; Kailavasan M.; Douglas-Moore J.L.; Elajnaf M.R.; Jackson B.L.; Hamami H.; Hemmant J.; Siraj M.; Craciun M.E.; Lyttle M.; Shendy M.S.; Abdalla A.; Mukherjee R.; Mihuna A.; Kantartzi A.; Atkins C.R.M.; Uddin J.; Motiwala F.; Fanshawe J.B.; Mxxxensah E.; Chan K.H.Y.; Vasdev N.N.V.; Hassan M.M.; Pushkaran A.K.; Salik M.; Barrass B.J.R.; Jones A.; Shakir J.; Waterhouse R.H.; Tan S.; Shah S.; Simpson R.G.; Mohee A.R.; Smith P.M.; Middela S.G.; Gunendran T.; Bhat T.; Mehmood S.M.; Masood S.; Karna S.; Ibiok I.A.; Ollandini G.; Yarwood A.; Hill G.T.; Kanda Swamy G.V.; Healy R.; Faek Halaseh S.A.; Lee S.-M.; Hughes C.M.; Ali O.H.; Boaz R.J.; Gabriel M.M.; Finch W.; Hammad O.O.; Heba S.T.; Yun J.W.; Pandian S.K.; Oliver R.L.; Almpanis S.S.A.; Boxall N.E.; Adamu-Biu F.I.; Pushpa-Rajah J.A.; Miakhil I.; Mera Z.; Sultana A.; Potter J.J.; Coombs L.; Laghari S.; Khan I.A.; Warner R.M.; Olaitan O.; Akman J.; Green W.J.F.; Dooldeniya M.D.; Turo R.K.; Kabia A.A.; Onowa V.E.; Anand C.V.; Tanasescu G.G.T.; Sells L.A.; Acyatan M.G.; Smith T.G.; Lokman U.U.L.; Ramachandra M.; Hodgson D.J.; *Sid Ahmed M.A.M.B.; *Moghe D.; *Ong K.K.; *Tasleem A.M.; Blick C.; Toia B.B.T.; Maduwe Gedara S.R.K.R.K.; Mohsin H.; Bleakley C.; McGrath M.J.; Ng M.G.; Parsons B.; Lindsay J.S.; Volanis D.; Wijayasuriya D.S.C.R.; Wilkinson J.; White A.; Cox A.; Calmuc A.; Fung C.; Taktak S.; Lazarowicz H.P.; Starmer B.; Chippagiri A.S.; Gallegos C.; Kerr E.; Penny N.M.; Green E.A.; Jones C.M.; Colvin H.V.; David R.; Davies M.; Qamar B.Q.; Humayun-Zakaria N.K.; Hussain A.; Dhanasekaran A.K.; Mangera A.F.; Pereca J.L.P.; Akinjise-Ferdinand O.; Rosario D.J.; *Dhother J.; *Mohamed G.; *Jenny Bo Y.N.; *Chin Chin Y.F.Y.F.; *Varma R.K.; *Elves A.; Elmansouri A.J.N.V.; Edris F.F.E.; Voss J.; Parfitt C.M.; Buckland G.R.E.; Antoniou V.; Sinha M.M.; Douglas J.; Campbell J.M.; Bondad J.; Khuoge S.; Gipson C.; Dawam D.; Lecoyte A.; Waley L.G.; Hawthorne R.; Ridgway A.; Warren K.S.; Maniarasu S.; Mistry R.; Stroman L.; Hassan M.; Ayres B.; Pinkney R.T.M.; El-Taji O.; McCabe J.; Oliyide A.E.; Chibuzo I.N.C.; Vaggers S.N.; Dyer J.E.; MacKenzie K.R.; Miller A.; Tait C.D.; Thorman H.E.; Ippoliti S.; Ilie P.C.; Babawale O.D.; Mitchell V.; O'Rourke S.; Ross A.; O'Halloran R.; Hayes J.; Gray S.B.; Day E.K.; Shirwac H.; jaibaji R.; Tang S.C.; Kennedy C.; Szabados B.; Baldini C.; Nowers J.; Sarmah P.P.B.; Williams K.G.; Tan L.J.; Boden A.K.; Simpkins S.J.; Clement K.D.; Khan R.S.S.; Ravindraanandan M.; Lango A.; Kitchen M.; Gommersall L.M.; Thomas M.; Al-Mitwalli A.; Featherstone J.M.; Catto J.; Chari N.; Nikolinakos P.; Ellis D.S.J.; Papadopoulos D.I.; Charitopoulos K.; Carey M.M.; Gordon E.M.; Lau D.H.W.H.; El-Koubani O.; Ayers J.R.S.; Hina S.; Gartner T.; James J.E.G.; Simpson K.R.S.; Mariappan P.; Ibrahim M.E.; Dallash M.H.; Jallad S.; Bencatova Z.; Karanjia R.N.; Whiting D.; Frymann R.J.; Farag S.S.F.; Whitburn J.A.S.; Miah S.; Khattab H.; Kondylis F.; Amin Alsayed Alkhawalka M.A.

Citation:

European Urology. (no pagination), 2025. Date of Publication: 2025.

Abstract:

Background and objective We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates. Methods This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome. Key findings and limitations A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]). Conclusions and clinical implications Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.

DOI: 10.1016/j.eururo.2025.09.4174

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The Profound Impact of the COVID-19 Pandemic on the Epidemiology of Quadriceps and Patellar Tendon Ruptures: Insights From a Single Trust in the United Kingdom (2025)

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Type of publication:

Journal article

Author(s):

*Murugesan, Thivagar; *Abdullmalek, Hidayatul Rasyidah Syida; *Kondi, Suresh; *Rehman, Hamood Ur; *Carmont, Mike; *Heaver, Catriona; *Okoro, Tosan.

Citation:

Cureus. 17(11):e98022, 2025 Nov.

Abstract:

Introduction Quadriceps and patellar tendon ruptures are uncommon but disabling injuries that require surgical repair. Changes in physical activity patterns during and after the COVID-19 pandemic may have influenced their occurrence. This study compares the incidence, demographics, and seasonal distribution of these injuries before and after the pandemic within a single UK NHS trust. Methods A retrospective review was performed of all patients undergoing primary repair of quadriceps or patellar tendon ruptures at the Shrewsbury and Telford NHS Trust from January 2014 to December 2024. The pre-COVID period (2014-2019) was compared with the post-COVID period (2021-2024), with 2020 excluded due to major service disruption and atypical clinical pathways during the first pandemic year. Annual incidence rates were calculated as cases per 100,000 population, using year-specific catchment population estimates from the Office for National Statistics (ONS). Demographic variables, injury characteristics, and seasonal patterns were extracted from electronic records. Between-period comparisons used the Mann-Whitney U test. No adjustment for age, BMI, or comorbidities was performed. Results A total of 203 patients were identified, including 95 pre-COVID and 108 post-COVID. The median age was 63 years (range 15-90), with a male-to-female ratio of 7.8:1. Injuries occurred most frequently in autumn (28%). The median annual incidence increased from 4.6 per 100,000 pre-COVID to 8.3 per 100,000 post-COVID (incidence rate ratio 1.8, p = 0.0073). The median number of cases per year rose from 16 to 27 between periods. Conclusion The incidence of surgically treated quadriceps and patellar tendon ruptures increased in the post-COVID period. Although the study does not adjust for potential confounders, the findings suggest an association between the post-pandemic era and higher injury rates. Further research with multivariable analysis is needed to clarify contributing factors.

DOI: 10.7759/cureus.98022

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Shoulder Injury Related to Vaccine Administration (SIRVA) After COVID-19 Vaccination: A Retrospective Study (2025)

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Type of publication:

Journal article

Author(s):

*Manoharan, Gopikanthan; *Murugesan, Thivagar; Winton, Jo; Smith, Matthew; Brownson, Peter.

Citation:

Cureus. 17(11):e98023, 2025 Nov.

Abstract:

BACKGROUND: The global administration of billions of COVID-19 vaccine doses has raised concerns about potential adverse effects, contributing to vaccine hesitancy. While transient mild discomfort is common after intramuscular vaccination, persistent and severe post-vaccination shoulder pain has led to recognition of Shoulder Injury Related to Vaccine Administration (SIRVA). SIRVA is characterised by shoulder pain and restricted range of motion typically occurring within 48 hours of inoculation, thought to result from inadvertent vaccine delivery into the subdeltoid bursa. In addition to its clinical definition, SIRVA is also viewed as a medicolegal construct, particularly in the context of vaccine injury compensation frameworks. This study aimed to describe our experience with patients presenting with SIRVA-like symptoms following COVID-19 vaccination, compare these findings with published literature, and assess clinical outcomes.

METHODS: A retrospective study was conducted at a major trauma centre. All patients presenting to the orthopaedics department with atypical shoulder symptoms following COVID-19 vaccination between January and December 2021, with at least six months of follow-up, were reviewed. Only patients meeting the Health Resources and Services Administration (HRSA) Vaccine Injury Table diagnostic criteria for SIRVA were included. Data on demographics, vaccine type, clinical findings, investigations, treatment, and outcomes were collected.

RESULTS: Of the 31 patients presenting with post-vaccination shoulder symptoms, 16 (52%) met the HRSA criteria for SIRVA. The mean age was 54 years, and 63% were female. All patients presented with shoulder pain and reduced range of motion. The mean follow-up duration was 12 months. Most patients (94%) were treated non-operatively with analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs), and physiotherapy. At one-year follow-up, 44% achieved complete or near-complete recovery, while 31% (n =5) reported no improvement and required specialist referral.

CONCLUSION: SIRVA is a rare complication following COVID-19 vaccination and is best considered a medicolegal term rather than a definitive diagnosis. Strict adherence to diagnostic criteria is essential, as overdiagnosis may occur among patients with coincidental post-vaccination shoulder pain. While most cases resolve with conservative management, a subset may experience persistent symptoms. Evidence suggests that SIRVA is more likely related to improper injection technique rather than the vaccine itself.

DOI: 10.7759/cureus.98023

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A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Meta-Analysis of Outcomes (2025)

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Type of publication:

Systematic Review

Author(s):

*Ibrahim, Abdelrahman; Khamdan, Khadija; Sadiq, Salman; *Lyeeq, Ahmed; Narayanswamy, Nikhil; Saeed, Abu.

Citation:

Cureus. 17(11):e98180, 2025 Nov.

Abstract:

Prosthetic joint infection (PJI) is a devastating complication of total hip and knee arthroplasty. Whilst two-stage revision has long been considered the gold standard treatment, the 1.5-stage revision has emerged as a viable alternative. However, the optimal surgical strategy remains a subject of debate. The aim of this meta-analysis was to evaluate the comparative outcomes of 1.5-stage versus two-stage revision for PJI. A
systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting comparative outcomes of 1.5-stage versus two-stage revision were included, and their risk of bias was assessed. Reinfection, failure of infection eradication, aseptic loosening, overall complications, readmission, and periprosthetic fracture were the evaluated outcome parameters. All comparative studies reporting on patients who underwent either a 1.5-stage or a two-stage revision were included in the final analysis. The 1.5-stage revision was associated with a significantly lower rate of reinfection (odds ratio (OR): 0.62; 95% confidence interval (CI) 0.40-0.96, p = 0.03) but a significantly higher rate of aseptic loosening (OR: 6.12; 95% CI 1.09-34.22, p = 0.04) when compared with the two-stage revision. No significant difference was found in the rates of infection eradication (OR: 1.35; 95% CI 0.80-2.27, p =
0.26), overall complications, readmission, dislocations, or periprosthetic fracture between the two groups. A subgroup analysis for knee PJI was consistent with the main analysis for reinfection. The meta-analysis of the best available evidence indicates that a 1.5-stage revision for PJI is associated with a lower rate of reinfection but a higher risk of aseptic loosening. High-quality randomized controlled trials are needed to
definitively establish the optimal surgical strategy for managing PJI.

DOI: 10.7759/cureus.98180

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Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials. (2025)

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Type of publication:

Systematic Review

Author(s):

Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; *Khalid, Saad Muhammad; Hasan, Ali; Majeed, Salman; Shahzad, Muhammad Aamir; Shahzad, Maryam; Ahmed, Mushood; Ahmed, Raheel; Gardezi, Syed Anjum.

Citation:

International Journal of Colorectal Disease. 2025 Dec 30.

Abstract:

BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

DOI: 10.1007/s00384-025-05014-5

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