2026

Pulmonary Embolism and Myocardial Infarction With Non-obstructive Coronary Arteries in Immune Thrombocytopenia: Unmasking Underlying Antiphospholipid Syndrome (2026)

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Type of publication:

Journal article

Author(s):

*Shahzeb, Muhammad; Naeem, Faiqa Jabeen; *Naz, Kiran; *Irfan, Muhammad; *Ahmad, Nawaid; Rafiq, Nawal; Ul Haq, Ijaz.

Citation:

Cureus. 18(1):e100731, 2026 Jan.

Abstract:

This case report presents the clinical scenario of a 35-year-old male patient who experienced chest pain due to a combination of pulmonary embolism (PE) and myocardial infarction with non-obstructive coronary arteries (MINOCA), concurrently while undergoing treatment with avatrombopag for immune thrombocytopenia (ITP). His investigations included a CT pulmonary angiogram that confirmed a PE, a coronary angiography which was normal, a cardiac MRI which showed evidence of subendocardial infarct, and a CT coronary angiogram, which was normal. His unique presentation with these findings prompted further investigations, which revealed an undiagnosed antiphospholipid syndrome (APS) alongside a patent foramen ovale (PFO). Hence, the paradoxical thrombotic incidents were precipitated by this unique diagnosis. After establishing the diagnosis, our patient was commenced on warfarin, and his treatment protocol for ITP was changed to a different drug. He remains under haematology follow-up.

DOI: 10.7759/cureus.100731

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Feb 06.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

Investigating the course of atopic eczema up to 1 year following completion of Narrowband UVB (NBUVB) phototherapy (2026)

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Type of publication:

Journal article

Author(s):

Bajaj, Sonali; Desai, Prachi; Singh, Akanksha; *Jain, Dimple; Wahie, Shyamal.

Citation:

Clinical & Experimental Dermatology. 2026 Feb 10. [epub ahead of print]

Abstract:

BACKGROUND: Narrowband UVB (NBUVB) is a second-line treatment for chronic moderate-to-severe atopic eczema unresponsive to adequate topical therapy, and is known to induce good short-term improvement of eczema severity. However, it is unclear how adult patients fare with their eczema severity long after completion of a course of NBUVB.

OBJECTIVES: We aimed to investigate the severity of atopic eczema in adults, 1 year following completion of NBUVB, using validated clinical activity measures.

METHODS: We undertook a multi-centre prospective observational study of adults with moderate-to-severe atopic eczema who were prescribed NBUVB as part of their standard clinical care. Assessments were made at baseline prior to starting NBUVB, at the end of NBUVB and at 4, 8 and 12 months after completion of NBUVB.

RESULTS: Eighty participants with moderate-to-severe atopic eczema (mean SCORAD 39.2, POEM 18.5, IGA 3.2) underwent NBUVB therapy. Significant reductions were observed post-treatment: SCORAD decreased to 17.8, POEM to 8.2, and IGA to 1.7 (p<0.001 achieved for all time points). These therapeutic effects were sustained at 4, 8, and 12 months post-treatment (n=27 at 12 months). Loss of follow-up was attributed to non-attendance exacerbated by the COVID-19 pandemic and patient relocation. Mild adverse events (n=5), including erythema and eczema flares, were reported, with no serious events.

CONCLUSIONS: These findings indicate that NBUVB may provide a long-lasting effect for patients who complete a course, helping to diminish their eczema severity to a more manageable level.

DOI: 10.1093/ced/llag066

Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292

Remote home cardiotocography: A systematic review and meta-analysis (2026)

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Type of publication:

Systematic Review

Author(s):

Le Vance, Jack; *Adeoye, Adekunle; Man, Rebecca; Eltaweel, Nashwa; Gurney, Leo; Morris, R Katie; Hodgetts Morton, Victoria.

Citation:

PLOS Digital Health. 5(1):e0001184, 2026 Jan.

Abstract:

Cardiotocography (CTG) is a common investigative modality in obstetrics to evaluate the fetal condition. Advancements in digital technology has enabled the innovation of CTG monitoring for usage in the home setting. This review aims to comprehensively examine the current evidence on the effectiveness and applicability of home antenatal CTG monitoring. MEDLINE, EMBASE, Cochrane, Web of Science, and PubMed databases were searched from inception to June 2025. Primary studies examining home antenatal CTG were included. For randomised controlled trials (RCTs), the joint primary outcomes were perinatal mortality and emergency caesarean section. For observational studies, the feasibility, diagnostic accuracy, qualitative and economic burden of home CTG were evaluated. RCTs were eligible for meta-analysis using risk ratio or mean difference, with 95% confidence intervals. Included observational studies were narratively described due to significant methodological heterogeneity. 39 studies (28 observational, seven RCTs and four qualitative studies), comprising of 7240 participants were included. Home antenatal CTG monitoring was non-inferior to conventional care across all meta-analysed maternal, perinatal and healthcare usage outcomes. GRADE assessments were low/very low quality of evidence. Home CTG monitoring was feasible in several settings and remote interpretation was graded as moderate to excellent. Transmission failures were frequently low but commonly occurred due to infrastructure and/or equipment errors. Remote CTG monitoring demonstrated comparative capabilities to conventional CTG with respect to coincidence and beat-to-beat variability. Overall acceptability ratings were high for patient and providers. Often implementation costs were high but accrued back by non-fixed savings when compared against routine care. High-quality studies were underrepresented, particularly when assessing service-led and safety outcomes. Home antenatal CTG monitoring demonstrates noninferiority to conventional care across several outcomes, representing a promising avenue for antenatal management However, current evidence is of low quality and additional high-quality evidence with sufficient methodological detail and standardised outcome assessment is required prior to making definitive recommendations.

DOI: 10.1371/journal. pdig.0001184

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Is robotic surgery ready for emergency cholecystectomy? A systematic review and meta-analysis of robotic versus laparoscopic approach in acute cholecystitis (2026)

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Type of publication:

Systematic Review

Author(s):

Jamal, Zohaib; Talal, Muhammad Anza; Saeed, Jahanzaib; Siddiqui, Asher; Haider, Muhammad Ijlal; Zafar, Khizra; Zaidi, Hammad.

Citation:

Journal of Robotic Surgery. 20(1):166, 2026 Jan 12.

Abstract:

INTRODUCTION: Acute cholecystitis is typically managed with laparoscopic cholecystectomy, though inflammation and distorted anatomy can increase operative difficulty. Robotic cholecystectomy may offer technical advantages through improved visualisation and instrument dexterity, yet current evidence is limited, heterogeneous, and entirely observational, with no randomized trials comparing the two approaches in the emergency setting. This systematic review and meta-analysis synthesises existing comparative data to determine whether robotic assistance confers meaningful operative or postoperative benefits over standard laparoscopy in acute cholecystitis.

MATERIALS AND METHODS: A PRISMA-compliant systematic review and meta-analysis was performed. Comprehensive searches of major databases (2015-2025) identified comparative studies of robotic versus laparoscopic cholecystectomy for acute/emergency cholecystitis in adults. Eligible studies reported at least one perioperative or postoperative outcome; elective, paediatric, single-incision, and non-comparative designs were excluded. Outcomes included operative time, conversion, intra-operative complications, bile duct injury, length of stay, readmission, reoperation, and mortality. Risk of bias was assessed using ROBINS-I. Meta-analyses were conducted in RevMan using random-effects models, with heterogeneity assessed by I2 and standard continuity corrections applied for zero-event studies.

RESULTS: Seven observational studies comprising 143,717 patients met the inclusion criteria. Operative time and length of stay could not be meta-analysed due to inconsistent reporting and were therefore summarised narratively, with both outcomes appearing broadly comparable between robotic and laparoscopic groups. Meta-analysis demonstrated a significantly lower risk of conversion to open surgery with robotic cholecystectomy (RR 0.61, 95% CI 0.50-0.75; I2 = 44%). No significant differences were observed between robotic and laparoscopic approaches for intra-operative complications (RR 0.72, 95% CI 0.38-1.36; I2 = 40%), bile duct injury (RR 0.97, 95% CI 0.77-1.21; I2 = 0%), overall postoperative complications (RR 1.10, 95% CI 0.80-1.52; I2 = 95%), 30-day readmission (RR 0.88, 95% CI 0.50-1.54; I2 = 18%), reintervention or return to theatre (RR 0.33, 95% CI 0.04-2.48; I2 = 78%), or 30-day mortality (OR 1.28, 95% CI 0.86-1.90; I2 = 0%). Event rates for bile duct injury, major complications, reintervention, and mortality were uniformly low across all cohorts, limiting the precision of pooled estimates. Risk-of-bias assessment using ROBINS-I indicated a moderate to serious overall risk of bias in six of the seven studies, primarily due to residual confounding, non-random treatment allocation, and incomplete reporting of disease severity and operative complexity.

CONCLUSION: Robotic cholecystectomy is a safe and feasible alternative to laparoscopy for acute cholecystitis, demonstrating a consistent reduction in conversion to open surgery and comparable intra-operative and postoperative safety outcomes. However, as current evidence is limited to heterogeneous observational studies with incomplete clinical detail, robust prospective research-with detailed severity grading, surgeon-experience assessment, workflow evaluation, and cost-effectiveness analysis-is needed to more clearly define its role in emergency biliary surgery.

DOI: 10.1007/s11701-026-03145-7

Vascular Eagle's syndrome: difficult diagnosis in patient with recurrent transient ischaemic attack. (2026)

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Type of publication:

Journal article

Author(s):

Lyons, T; *Saunders, T; Littleton, E; Monksfield, P; Tiwari, A.

Citation:

Annals of the Royal College of Surgeons of England. 2026 Jan 12.

Abstract:

Eagle's syndrome describes the elongation of the styloid process. The condition has been recognised for over 90 years and causes a wide range of symptoms depending on the level of compression. Compression of the internal carotid artery by the styloid process is referred to in the literature as 'stylocarotid syndrome' or 'vascular Eagle's syndrome' (VES), presenting most commonly as arterial dissection and cerebrovascular events. We present the case of a 53-year-old patient who presented with multiple cerebrovascular events over a six-month period. Computed tomography angiography (CTA) suggested VES; however, magnetic resonance imaging (MRI) of the neck revealed no arterial wall abnormalities, including dissection. Despite the escalation of medical therapy, the patient continued to experience multiple transient ischaemic attacks. Following multidisciplinary team discussion and exclusion of other sources of emboli, a transcervical styloidectomy was performed freeing compression of the carotid artery, resulting in the complete resolution of symptoms. VES should be considered in patients with recurrent or unexplained cerebrovascular or cervical neurogenic symptoms even in the absence of arterial injury. We recommend early styloidectomy when there is a strong clinical suspicion of VES to achieve definitive symptom resolution.

DOI: 10.1308/rcsann.2025.0113

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