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Item Methotrexate associates with ischemic cardiovascular risk reduction in males but not females: a transatlantic cardiovascular consortium for people with rheumatoid arthritis observational study.(Springer International, 2025-04-18) Karpouzas, George A; Ormseth, Sarah R; Van Riel, Piet; Myasoedova, Elena; Gonzalez-Gay, Miguel A; Corrales, Alfonso; Rantapaa-Dahlqvist, Solbritt; Sfikakis, Petros; Dessein, Patrick; Hitchon, Carol A; Pascual-Ramos, Virginia; Yanez, Irazu C; Colunga-Pedraza, Iris J; Galarza-Delgado DA; Azpiri-Lopez , Jose; Semb, Anne G; Misra, Durga P; Kitas, George D; Hauge, Ellen M; Harbor-UCLA Medical Center; Radboud University Medical Centre; University of Cantabria; The Dudley Group NHS Foundation Trust et alPatients with rheumatoid arthritis (RA) experience higher cardiovascular risk. Methotrexate may decrease this risk, although it is unclear whether males and females similarly benefit. We explored the influence of sex on the effect of methotrexate use on cardiovascular risk in RA. An observational cohort of 4362 patients, 3223 (73.9%) females, without cardiovascular disease were included from an international cardiovascular consortium for RA. Outcomes were (a) major adverse cardiovascular events (MACE) including cardiovascular death, myocardial infarction, or stroke and (b) any ischemic cardiovascular events (iCVE) including MACE, angina, revascularization, transient ischemic attack, and peripheral arterial disease. The effects of sex, prevalent methotrexate use at enrollment visit and their interaction on MACE and iCVE were assessed with multivariable Cox regression models, reporting adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). There were 237 first MACE and 358 first iCVE. The sex by methotrexate interaction was significant for MACE (p = 0.005) and iCVE (p = 0.006), suggesting the effect of methotrexate use on cardiovascular risk differed among males and females. In males, methotrexate use associated with lower risk of MACE (HR 0.32, [95% CI 0.12-0.83]) and iCVE (HR 0.43 [95% CI 0.21-0.85]). In females, methotrexate use was not associated with MACE (p = 0.267) or iCVE (p = 0.407). In sensitivity analyses, models with inverse probability of treatment weighting and models additionally adjusting for inflammation yielded similar results. Methotrexate use associated with cardiovascular benefit in males but not females with RA and the effect was independent of inflammation.Item Increased clinical capacity within an NHS Musculoskeletal service following implementation of 'Getting it Right: Addressing Shoulder Pain'. a service evaluation.(Elsevier B.V., 2025-04-01) Wallace, L; Shaw, N; Hart, D; Jones, G; Deacon, P; The Dudley Group NHS Foundation TrustTo determine the impact on clinical capacity resulting from the implementation of the GRASP (Getting it Right: Addressing Shoulder Pain) trial methodology for managing shoulder rotator cuff disorders (RCDs) within a Community Musculoskeletal (MSK) Service. This entailed utilising a single, one hour appointment for the assessment and management of patients with RCDs (GRASP Pathway). The GRASP trial investigated progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2�2 factorial, randomised controlled trial.Item The obese population's views on the symptoms and risks of chronic venous insufficiency - 2 (OBVIOUS-2) cross-sectional survey.(Sage Publications Inc., 2025-04-01) Popplewell, Matthew A; Mahesh, Sindoora; Nandra, Sandip; Juszczak, Maciej; Ashby, Helen; Wall, Michael L; The Dudley Group NHS Foundation Trust; University of Birmingham; Newcastle University et alIndividuals with high body mass index (BMI) are more likely to have symptomatic LLVD than age matched populations with normal BMI. National priorities in venous disease set by the James Lind Alliance focus on improving access to healthcare and patient education. The aims of this study are to determine patient knowledge and potential burden of LLVD in a population of patients attending a UK, regional weight management service. A postal questionnaire containing 12 questions relating to LLVD and obesity was distributed to the active list of patients under the weight management medical service at Dudley Group of Hospitals between May 2022-23. Respondents were provided with a stamped, addressed envelope to return the questionnaire. Ethical approval was granted by the Hampshire Research & Ethics Committee. Some 367 questionnaires were distributed to patients currently enrolled in specialist weight management services. 103 complete responses were received (28%), Most patients were between 50 and 70 years of age. 25% of patients already had a formal diagnosis of LLVD, with a further 84 (82%) reported signs or symptoms which may be related to LLVD. Almost half (49/103, 48%) had concerns over their skin quality with a similar proportion (25/103, 51%) having sought medical help. The majority (71/103, 69%) were unaware of the association between obesity and LLVD. Twelve participants had education regarding simple adjuncts designed to improve symptoms and/or prevent ulceration (emollients, dressings, stockings, or leg elevation). Four participants had previously undergone treatment for varicose veins. In a population of patients accessing weight management services, we have demonstrated that a quarter of patients have already received a diagnosis of LLVD, however there is for a greater undiagnosed burden of LLVD in part due to lack of patient and possibly clinician awareness.Item Meta-analysis on the role of sodium-glucose cotransporter 2 inhibitor on atrial fibrillation recurrence after catheter ablation in patients with diabetes.(Elsevier B.V., 2025-04-01) Muhammad, Shoaib; Yousaf, Amman; Ahmad, Soban; Ahsan, Muhammad; Ghaffar, Fariha; Qazi, Aleena; Changezi, HameemNo abstractItem Implementation of a national AI technology program on cardiovascular outcomes and the health system(Nature Portfolio, 2025-04-04) Fairbairn, Timothy A; Mullen, Liam; Nicol, Edward; Lip, Gregory Y H; Schmitt, Matthias; Shaw, Matthew; Tidbury, Laurence; Kemp, Ian; Crooks, Jennifer; Burnside, Girvan; Sharma, Sumeet; Chauhan, Anoop; Liew, Chee; Waidyanatha, Sawan; Iyenger, Sri; Beale, Andrew; Sunderji, Imran; Greenwood, John P; Motwani, Manish; Reid, Anna; Beattie, Anna; Carter, Justin; Haworth, Peter; Bellenger, Nicholas; Hudson, Benjamin; Rodrigues, Jonathan; Watson, Oliver; Venugopal, Vinod; Bull, Russell; O'Kane, Peter; Deshpande, Aparna; McCann, Gerald P; Duckett, Simon; Mansoubi, Hatef; Parish, Victoria; Sehmi, Joban; Rogers, Campbell; Mullen, Sarah; Weir-McCalL, Jonathan; Liverpool Heart and Chest Hospital; University of Liverpool; Royal Brompton and Harefield Hospital; The Dudley Group NHS Foundation Trust.Coronary artery disease (CAD) is a major cause of ill health and death worldwide. Coronary computed tomographic angiography (CCTA) is the first-line investigation to detect CAD in symptomatic patients. This diagnostic approach risks greater second-line heart tests and treatments at a cost to the patient and health system. The National Health Service funded use of an artificial intelligence (AI) diagnostic tool, computed tomography (CT)-derived fractional flow reserve (FFR-CT), in patients with chest pain to improve physician decision-making and reduce downstream tests. This observational cohort study assessed the impact of FFR-CT on cardiovascular outcomes by including all patients investigated with CCTA during the national AI implementation program at 27 hospitals (CCTA n = 90,553 and FFR-CT n = 7,863). FFR-CT was safe, with no difference in all-cause (n = 1,134 (3.2%) versus 1,612 (2.9%), adjusted-hazard ratio (aHR) 1.00 (0.93-1.08), P = 0.97) or cardiovascular mortality (n = 465 (1.3%) versus 617 (1.1%), aHR 0.96 (0.85-1.08), P = 0.48), while reducing invasive coronary angiograms (n = 5,720 (16%) versus 8,183 (14.9%), aHR 0.93 (0.90-0.97), P < 0.001) and noninvasive cardiac tests (189/1,000 patients versus 167/1,000), P < 0.001). Implementation of an AI-diagnostic tool as part of a health intervention program was safe and beneficial to the patient pathway and health system with fewer cardiac tests at 2 years.Item Drug-Coated Balloon Treatment for Urethral Strictures: Is This the Future? A Review of the Current Literature(MDPI, 2025-04-26) Kapriniotis, Konstantinos; Loufopoulos, Ioannis; Apostolopoulou, Apostolopoulou; Anderson, Paul C B; Papaefstathiou, Efstathios; Whipps Cross Hospital; Ipswich hospital; Aristotle University of Thessaloniki; The Dudley Group NHS Foundation Trust et alUrethral strictures significantly impact patients' quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing fibrosis and stricture recurrence. Paclitaxel's antiproliferative and antifibrotic properties inhibit excessive collagen deposition, improving long-term outcomes. DCB treatment is now included in guidelines for managing recurrent bulbar strictures less than 3 cm in length. Recent studies, including the ROBUST trials, have demonstrated the efficacy of Optilume in improving the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). DCB has also shown a significant reduction in reintervention rates compared with endoscopic treatments in long-term studies, confirming its safety profile. However, the durability of DCB in complex or longer strictures remains uncertain, and its role as a salvage therapy post-urethroplasty requires further investigation. DCB represents a promising, cost-effective advancement in managing recurrent bulbar urethral strictures, particularly for patients unsuitable for urethroplasty. Future research should focus on refining patient selection criteria and exploring indications for other anatomical sites.Item Characteristics and outcomes of hospitalized patients with Isolated and systemic cardiac sarcoidosis: Analysis of the Nationwide readmissions database 2016-2021(Elsevier, 2025-04-01) Ahmed, Raheel; Paray, Behary Nitish; Sawatari, Hiroyuki; Wafa, Syed Emir Irfan; Ramphul, Kamleshun; Ahmed, Mushood; Jain, Hritvik; Deshpande, Saurabh; Khanji, Mohammed; Wells, Athol Umfrey; Collins, Peter; Mohammed, Selma; Abou-Ezzeddine, Omar; Kouranos, Vasilis; Sharma, Rakesh; Chahal, Anwar; Royal Brompton Hospital; Imperial Cooege London; Royal Devon University Healthcare NHS Foundation Trust; The Dudley Group NHS Foundation Trust et alTo identify any differences in the characteristics and outcomes of patients with Isolated cardiac sarcoidosis (iCS) vs systemic cardiac sarcoidosis (sCS). Patients and methods: All inpatient encounters in the Nationwide Readmission Database from 2016 to 2021 were analyzed for the rates, predictors, costs and mortality during index and unplanned 90-days readmissions for iCS and sCS patients. Patients with ischemic heart disease were excluded. Results: 1,667 patients were identified (57.8 % male), of which, 1,013 (60.8 %) had iCS and 654 (39.2 %) had sCS. The median (IQR) age of iCS patients was slightly older [57.0 (49.0-66.0) vs 56.0 (48.0-64.0), p = 0.04]. On index admission, iCS patients had higher prevalence of ventricular tachycardia (36.9 % vs 28.8 %, p = 0.001) and catheter ablation (5.6 % vs 2.8 %, p = 0.006). The predictors for all-cause readmissions were Charlson Comorbidity Index (CCI) (HR 1.19, 95 % CI 1.01-1.40, p = 0.04), age (HR 0.98 (0.97-1.00), p = 0.01) and the use of anticoagulant therapy (HR 1.92, 95 % CI 1.35-2.72, p < 0.001). Patients with sCS were more likely to be readmitted with heart failure compared to iCS patients (SHR 3.78, 95 % CI 1.11-12.94, p = 0.03). During subsequent readmission, iCS and sCS patients had comparable rates of in-hospital mortality, median length of stay and healthcare-associated costs. No independent predictors of in-hospital mortality at readmission were ascertained. Conclusions: Isolated CS patients, when compared to systemic CS, had a greater prevalence of ventricular tachycardia and catheter ablation. They were less likely to be re-hospitalized with heart failure within 90-days. Age, higher CCI, and use of anticoagulant therapy were predictors for all-cause readmissions.Item Effect of drain omission after mastectomy on cosmesis, patient satisfaction and interval to adjuvant therapy(Royal Collage of Surgeons Endland, 2025-04-08) Hector, LR; To, N; Leusink, AE; Elfadl, D; Voynov, V; Roche, N; Rusby, JE; Cambridge University Hospital NHS Foundation Trust; The Royal Marsden NHS Foundation Trust; University of Birmingham; The Dudley Group NHS Foundation TrustIntroduction:�Omission of closed suction drains in women undergoing simple mastectomy has become the standard in the United Kingdom (UK) with studies demonstrating no difference in symptomatic seroma rates or complications. A theoretical concern is that a large-volume seroma distorts the skin envelope, potentially resulting in inferior long-term postoperative aesthetic appearance and patient satisfaction. Furthermore, the seroma may lead to a delay in adjuvant treatment, in particular, chest wall radiotherapy. There is currently no objective scoring system to evaluate the postoperative appearance after simple mastectomy. Methods:�Patients who had undergone a drainless unilateral simple mastectomy at the Royal Marsden Hospital attending for annual surveillance contralateral mammography between October 2016 and July 2017 were invited to complete a BREAST-Q questionnaire and attend medical photography for panel assessment of aesthetic outcome. Patient satisfaction in this cohort was compared with results from the UK National Mastectomy and Breast Reconstruction Audit (NMBRA) 2011, which was conducted at a time when surgical drains were routinely placed. Results:�The proportion of patients satisfied with their appearance was similar to that of NMBRA 2011. BREAST-Q results were in line with the published literature. A panel assessment scoring system for simple mastectomies was developed. There was no difference in delays to adjuvant treatment between the study and NMBRA cohort. Conclusions:�Omission of drains in women undergoing simple mastectomy did not result in inferior aesthetic outcomes or lower patient satisfaction, nor did it result in delay to adjuvant treatment. BREAST-Q results were in line with the literature. A panel assessment scoring system for simple mastectomy was developed.Item Effects of treatment with janus kinase inhibitors on coronary microvascular perfusion in patients with rheumatoid arthritis: an observational prospective cohort study(Springer, 2025-04-19) Anyfanti, Panagiota; Angeloudi, Eleni; Pagkopoulou, Eleni; Boutel, Maria; Moysidou, Georgia-Savina; Deuteraiou, Kleopatra; Bekiari, Eleni; Doumas, Michael; Kitas, George D; Dimitroulas, Theodoros; Aristtle University of Thessaloniki; National and Kapodistrain University of Athens Medical School; The Dudley Group NHS Foundation TrustDespite their increasing use and their proven efficacy in the treatment of rheumatoid arthritis (RA), Janus kinase (JAK) inhibitors have been questioned by credible cardiovascular safety concerns. To date, mechanistic links of cardiovascular complications to JAK inhibitors remain largely unexplored. We aimed to investigate the effect of JAK inhibition on coronary microvascular blood flow in a previously published cohort of treated patients with RA. We prospectively enrolled RA patients initiating treatment with JAK inhibitors. Study procedures were performed at baseline and repeated 3 months after treatment. Patients underwent applanation tonometry in the radial artery to assess subendocardial viability ratio (SEVR) otherwise known as Buckberg index, a noninvasive marker of myocardial perfusion. Thirteen patients with RA were enrolled, of whom 11 completed the study. All patients presented with at least one cardiovascular risk factor (e.g., age ? 65 years, history of current or past smoking, obesity, hypertension). No change in other than antirheumatic treatment was performed during the study, and no significant changes were observed in baseline characteristics other than triglyceride levels. Compared to baseline, three months treatment with JAK inhibitors did not significantly alter SEVR values [126 (102-144) % vs. 134 (106-251) %, p = 0.083]. Three months treatment with JAK inhibitors did not seem to significantly affect myocardial perfusion in a small RA cohort with cardiovascular risk factors, who would be presumably more vulnerable to adverse treatment-related cardiovascular effects. Larger studies with longer follow-up are needed to document the effects of JAK inhibitors on the myocardium.Item A 3-week pause versus continued Bruton tyrosine kinase inhibitor use during COVID-19 vaccination in individuals with chronic lymphocytic leukaemia (IMPROVE trial): a randomised, open-label, superiority trial(Elsevier, 2025-04-02) Cook, Jonathan A; Patten, Piers E M; Peckham, Nicholas; Moss, Paul; Phillips, Neil; Abhishek, Abhishek; Roberts, Thomas; Hodges, Marie; Talbot, Georgina; Barber, Vicki; Francis, Anne; Shields, Adrian M; Duley, Lelia; Hoogeboom, Robbert; Willett, Brian J; Scott, Sam; Parry-Jones, Nilima; Eyre, Toby A; Plested, Gareth; Vandici, Gratian; Wandroo, Farooq Ahmad; Hutchinson, Claire; Paneesha, Shankara; Murray, Duncan J; Martinez-Calle, Nicolas; Jenkins, Stephen; Heartin, Earnest; Parry, Helen M; University of Oxford; Kings College London; University of Birmingham; The Dudlet Group NHS Foundation Trust et alBackground:�Chronic lymphocytic leukaemia is the commonest leukaemia and is associated with profound immunosuppression. Bruton tyrosine kinase inhibitors (BTKi) have revolutionised chronic lymphocytic leukaemia management; however, therapy impairs vaccine-induced immunity. We evaluated whether a 3-week pause of BTKi treatment improved spike protein receptor binding domain (RBD) immunity to SARS-CoV-2 booster vaccination while maintaining disease control. Methods:�We performed an open-label, two-arm, parallel-group, randomised trial in secondary-care haematology clinics in 11 UK hospitals. Participants aged 18 years or older, diagnosed with chronic lymphocytic leukaemia, and currently taking BTKi therapy (frontline or relapsed setting) for at least 12 months were eligible. Participants were randomly allocated (1:1, by a centralised computer randomisation program, stratified by BTKi therapy line) to pause BTKi for 3 weeks, starting 6 days before their SARS-CoV-2 vaccination booster date, or to continue therapy as usual. Neither participants nor clinical staff were blinded but laboratory staff were. Intramuscular injection of either original BA.1 or original BA.4/5 bivalent mRNA vaccine (50 ?g mRNA-1273 or 30 ?g BNT162b2), or 5 ?g protein-based Vidprevtyn Beta (Sanofi Pasteur, Lyon, France) were received according to the national vaccination programme schedule. The primary outcome measure was anti-spike-RBD-specific antibody titre 3 weeks after vaccination and analysis performed by intention to treat (as randomly allocated, irrespective of compliance) following trial completion. This trial is registered with ISRCTN, 14197181, and has been completed. Findings:�Between Oct 10, 2022, and June 8, 2023, 99 individuals (71 [72%] male and 28 [28%] female, with 89 [90%] of White ethnicity) were randomly allocated to groups pausing (n=50 [51%]) or continuing (n=49 [49%]) their BTKi therapy, and followed up for 12 weeks. At 3 weeks after vaccination, the geometric mean anti-spike-RBD-specific antibody titre was 218�8 U/mL (SD 122�9) in the continue group and 153�4 U/mL (103�2) in the pause group, with geometric mean ratio 1�104 (95% CI 0�565-2�158, p=0�77) using a mixed-effects model. The only serious adverse event during the 12-week follow-up was the death of one participant in the pause group due to COVID-19 infection 2 months after randomisation. Interpretation:�Although the study was slightly underpowered, the results suggest that pausing BTKi around the time of vaccination is not beneficial for immunity and should not be recommended in clinical practice.Item The obese population's views on the symptoms and risks of chronic venous insufficiency - 2 (OBVIOUS-2) cross-sectional survey(Sage Publications, 2025-04-01) Popplewell, Matthew A; Mahesh, Sindoora; Nandra, Sandip; Juszczak, Macie; Ashby, Helen; Wall, Michael L; The Dudley Group NHS Foundation Trust; University of Birmingham; Newcastle University et alIntroductionIndividuals with high body mass index (BMI) are more likely to have symptomatic LLVD than age matched populations with normal BMI. National priorities in venous disease set by the James Lind Alliance focus on improving access to healthcare and patient education. The aims of this study are to determine patient knowledge and potential burden of LLVD in a population of patients attending a UK, regional weight management service.MethodsA postal questionnaire containing 12 questions relating to LLVD and obesity was distributed to the active list of patients under the weight management medical service at Dudley Group of Hospitals between May 2022-23. Respondents were provided with a stamped, addressed envelope to return the questionnaire. Ethical approval was granted by the Hampshire Research & Ethics Committee.ResultsSome 367 questionnaires were distributed to patients currently enrolled in specialist weight management services. 103 complete responses were received (28%), Most patients were between 50 and 70 years of age. 25% of patients already had a formal diagnosis of LLVD, with a further 84 (82%) reported signs or symptoms which may be related to LLVD. Almost half (49/103, 48%) had concerns over their skin quality with a similar proportion (25/103, 51%) having sought medical help. The majority (71/103, 69%) were unaware of the association between obesity and LLVD. Twelve participants had education regarding simple adjuncts designed to improve symptoms and/or prevent ulceration (emollients, dressings, stockings, or leg elevation). Four participants had previously undergone treatment for varicose veins.ConclusionIn a population of patients accessing weight management services, we have demonstrated that a quarter of patients have already received a diagnosis of LLVD, however there is for a greater undiagnosed burden of LLVD in part due to lack of patient and possibly clinician awareness.Item Ream and run technique offers equivalent clinical outcomes as anatomical total shoulder arthroplasty but with a high rate of complications: A systematic review and meta-analysis(Elsevier, 2025-04-01) Mostafa, Omar E S; Jordan, Robert W; Thangarajah, Tanujan; MacLean, Simon; Woodmass, Jarret; D'Alessandro, Peter; Malik, Shahbaz S; The Dudley Group NHS Foundation Trust; University hospital Birmingham NHS Foundation Trust; University College London Hospital NHS Foundation Trust et alThis review aims to explore if the Ream and Run (RnR) technique is associated with better outcomes and lower complications than the traditional Anatomical Total Shoulder Replacement (aTSA) for osteoarthritis. Methods:�A systematic search of the literature was conducted using Medline, Embase and Cochrane in accordance with the PRISMA guidelines on March 2, 2024. Only comparative studies of adult patients with glenohumeral osteoarthritis (OA) comparing RnR and aTSA were included. Basic demographics, patient-reported outcome measures (PROMs) and complications were extracted and analysed. Quality assessment was performed using the Newcastle-Ottawa Score (NOS) tool and meta-analysis of outcomes reported by two or more studies was performed using Cochrane RevMan Web. Results:�A total of 1548 patients were pooled from eight studies [RnR 738 vs aTSA 810]. Mean age in the RnR group ranged from 52.8 to 60.3 years with 93.6 % being male, compared with age range of 53-67.5 years in the aTSA group with 56 % being male. Five patients in the RnR group were Walch grade C or D, compared with three patients in the aTSA. No difference was observed between the two groups in post-operative SST score [P < 0.04], post-operative ASES score [P = 0.57] or degree of post-operative forward flexion [P < 0.41]. There was a statistically significant improvement in post-operative degree of external rotation, favouring RnR [MD -8.35, 95 % CI -14.69 to -2.01, P < 0.01] but without a significant clinical importance. The overall rate of complications in the RnR group was 15.4 % and 5.3 % in the aTSA group. The commonest reported complication in RnR group was chronic pain and stiffness (3.9 %) and soft tissue failure in the aTSA group (2.7 %). Overall rate of return-to-theatre was 7 % in RnR and 2.7 % in aTSA group. Conclusion:�Both aTSA and RnR offer improvement in shoulder PROMS. However, the overall re-operation rate and complications appeared high in RnR group. The choice of technique should be tailored to the patient's pre-operative baseline, activity level and desired goals.Item Characteristics and outcomes of hospitalized patients with Isolated and systemic cardiac sarcoidosis: Analysis of the Nationwide readmissions database 2016-2021(Elsevier, 2025-04-01) Ahmed, Raheel; Behary Paray, Nitish; Sawatari, Hiroyuki; Wafa, Syed Emir Irfan; Ramphul, Kamleshun; Ahmed, Mushood; Jain, Hritvik; Deshpande, Saurabh; Khanji, Mohammed; Wells, Athol U; Collins, Peter; Mohammed, Selma; Abou-Ezzeddine, Omar; Kouranos, Vasilis; Sharma, Rakesh; Chahal, Anwar.; Royal Brompton Hospital; Imperial Cooege London; Royal Devon University Healthcare NHS Foundation Trust; The Dudley Group NHS Foundation Trust et alTo identify any differences in the characteristics and outcomes of patients with Isolated cardiac sarcoidosis (iCS) vs systemic cardiac sarcoidosis (sCS). All inpatient encounters in the Nationwide Readmission Database from 2016 to 2021 were analyzed for the rates, predictors, costs and mortality during index and unplanned 90-days readmissions for iCS and sCS patients. Patients with ischemic heart disease were excluded. 1,667 patients were identified (57.8 % male), of which, 1,013 (60.8 %) had iCS and 654 (39.2 %) had sCS. The median (IQR) age of iCS patients was slightly older [57.0 (49.0-66.0) vs 56.0 (48.0-64.0), p = 0.04]. On index admission, iCS patients had higher prevalence of ventricular tachycardia (36.9 % vs 28.8 %, p = 0.001) and catheter ablation (5.6 % vs 2.8 %, p = 0.006). The predictors for all-cause readmissions were Charlson Comorbidity Index (CCI) (HR 1.19, 95 % CI 1.01-1.40, p = 0.04), age (HR 0.98 (0.97-1.00), p = 0.01) and the use of anticoagulant therapy (HR 1.92, 95 % CI 1.35-2.72, p < 0.001). Patients with sCS were more likely to be readmitted with heart failure compared to iCS patients (SHR 3.78, 95 % CI 1.11-12.94, p = 0.03). During subsequent readmission, iCS and sCS patients had comparable rates of in-hospital mortality, median length of stay and healthcare-associated costs. No independent predictors of in-hospital mortality at readmission were ascertained. Isolated CS patients, when compared to systemic CS, had a greater prevalence of ventricular tachycardia and catheter ablation. They were less likely to be re-hospitalized with heart failure within 90-days. Age, higher CCI, and use of anticoagulant therapy were predictors for all-cause readmissions.Item Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review(Springer, 2025-04-03) Goel, Harsh; Roma, Nicholas; Morgan, Michael; Arora, Riya; Sreejith, Nayanika; Goyal, Deepak; Nadar, Sunil; St. Luke's University Hospital; Northwest Anglia Foundation NHS Trust; The Duldey Group NHS Foundation Trust et alTrimetazidine is a metabolic modulator that acts as a competitive inhibitor of the terminal enzyme in the ?-oxidation pathway to shift energy substrate from free fatty acids to the more oxygen-efficient glucose metabolism. The resulting conservation of cellular adenosine triphosphate generation in the face of ischemia/hypoxia mediates the anti-ischemic efficacy of trimetazidine. Clinically, trimetazidine has been approved as an add-on treatment in patients with symptomatic angina that is poorly controlled with first-line agents or who cannot tolerate the first-line therapy. In addition, trimetazidine has demonstrated antioxidant, cytoprotective, and anti-apoptotic activity with applications beyond angina. The aim of this review was to summarize the mechanism of action and anti-anginal efficacy of trimetazidine and to discuss the putative role of these pleiotropic effects and the evidence behind its application in cardiovascular diseases in general.Item Age-stratified analysis of delayed fixation outcomes of femoral neck fracture among adults: A retrospective study at a tertiary care trauma center(Sage Journals, 2025-04-30) Shahzad, Muhammad G; Dawood, Muhammad H; Hussain, Kazim; Gul, Shakeel; Sultan, Syed A; Zarar, Musab; Shaheed Mohtarma Benazir Bhutto Insitute of Trauma; Creek General Hospital; The Dudley Group NHS Foundation TrustThis study investigated the delayed fixation outcomes of femoral neck fractures stratified by age and surgical delay in adult patients at a tertiary care trauma center. A retrospective study was conducted involving patients with femoral neck fractures admitted to the orthopedic ward of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma between January 2019 and March 2023. Participants aged 18-60 years who underwent delayed surgery (>48 h) were included. Data on patient demographics, fracture and surgical characteristics, and outcomes were analyzed. This study utilized chi-square or Fisher's exact tests to compare outcomes between patients stratified by surgical delays as well as age. Among 108 participants, 63.9% were aged 18-30 years and 36.1% were aged 31-60 years. Avascular necrosis was predominantly observed in older patients who underwent surgery within 7 days (P = 0.001), whereas other complications such as nonunion and infection were more prevalent in patients aged 18-30 years whose surgery was delayed by >7 days (P = 0.303). Patients who underwent surgery within 7 days had shorter length of hospital stay and faster return to work in both age groups (P < 0.05), whereas those aged 18-30 years experienced the opposite when surgery was delayed beyond 7 days. Surgical fixation within 7 days leads to better recovery and fewer complications in adults with femoral neck fractures, whereas delayed surgery provides acceptable outcomes. Age-specific protocols are key to optimizing results.Item Are Allied Health Professionals (AHPs) research ready? A regional evaluation in England: the Research ABC project (AHPs Building Research Capacity Across the Black Country)(BMC Medical Education, 2025-04-08) Aries, Ali; Burgess, Roanna; Wallace, Louise; Hadley-Barrows, Tina; Palmer, Amy; Leslie, Rosalind; The Royal Wolverhampton NHS Trust; Keele University; Sandwell and West Birmingham NHS Trust; The Dudlet Group NHS Foundation Trust et alBackground:�Research active organisations achieve better healthcare outcomes. The Research ABC Project (Allied Health Professions (AHPs) Building Research Capacity Across the Black Country), funded from 1/8/23-31/3/24 by a Clinical Research Network West Midlands Improvement and Innovation grant, was commissioned to facilitate the Black Country Integrated Care System to address the four domains of Health Education England's AHPs' Research and Innovation Strategy for England (capacity, capability, context and culture). This evaluation aimed to understand research-readiness, initiate research skills development through bespoke training, increase research capacity of the local AHP Community and inform the Integrated Care Board of future requirements.Item Influence of body mass index on cardiovascular risk in rheumatoid arthritis varies across anti-citrullinated protein antibody status and biologic use(BMJ Journals, 2025-04-05) Karpouzas, George Athanasios; Gonzalez-Gay, Miguel A; Corrales, Alfonso; Myasoedova, Elena; Rantap��-Dahlqvist, Solbritt; Sfikakis, Petros P; Dessein, Patrick; Hitchon, Carol; Pascual-Ramos, Virginia; Contreras-Y��ez, Irazu; Colunga-Pedraza, Iris J; Galarza-Delgado, Dionicio A; Azpiri-Lopez, Jose Ramon; Semb, Anne Grete; van Riel, Piet Leonardus Cornelis Maria; Misra, Durga Prasanna; Patrick, Durez; Bridal, Logstrup Brian; Hauge, Eellen-Margrethe; Kitas, George; Ormseth, Sarah R; The Lundquist Institute; Harbor-UCLA Medical Centre; University of Cantabria, The Dudley Group NHS Foundation Trust et alThe impact of body mass index (BMI) on cardiovascular risk in rheumatoid arthritis (RA) is unclear. RA characteristics may influence the association between BMI and risk. Disease activity, which predicts cardiovascular risk, is associated with obesity only among anticitrullinated antibody (ACPA)-positive patients. Biologics alter body composition and mitigate cardiovascular risk in RA. We explored the association of BMI with cardiovascular risk and whether this varied across ACPA status and biologic use. We evaluated 3982 patients from an international observational cohort. Outcomes included (a) first major adverse cardiovascular event (MACE) encompassing myocardial infarction, stroke or cardiovascular death; and (b) all events comprising MACE, angina, revascularisation, transient ischaemic attack, peripheral arterial disease and heart failure. Multivariable Cox models stratified by centre risk evaluated the impact of BMI, ACPA, biologics and their two- and three-way interactions on outcomes. Results: We recorded 192 MACE and 319 total events. No main effects of BMI, ACPA or biologics were observed. A three-way interaction between them on MACE (p-interaction<0.001) and all events (p-interaction=0.028) was noted. Among ACPA negative patients, BMI was inversely associated with MACE (HR 0.38 (95% CI 0.25 to 0.57)) and all events (HR 0.67 (0.49 to 0.92)) in biologic users but not non-users (p-for-interaction <0.001 and 0.012). Among ACPA-positive patients, BMI was associated with MACE (HR 1.04 [1.01-1.07]) and all events (HR 1.03 (1.00 to 1.06)) independently of biologic use. BMI is inversely associated with cardiovascular risk only among ACPA-negative biologic users. In contrast, BMI is associated with cardiovascular risk in ACPA-positive patients independently of biologic use.Publication Outcomes of deep brain stimulation surgery in the management of dystonia in glutaric aciduria type 1(Springer Nature Link, 2025-03-02) Lumsden, Daniel E; Tsagkaris, Stavros; Cleary, Jon; Champion, Michael; Mundy, Helen; Mostofi, Abteen; Hasegawa, Harutomo; McClelland, Verity M; Bhattacharjee, Shakya; Silverdale, Monty; Gimeno, Hortensia; Ashkan, Keyoumars; Selway, Richard; Kaminska, Margaret; Hammers, Alexander; Lin, Jean-Pierre; Evelina London Children's Hospital Guy's and St Thomas NHS Foundation Trust; King's College London; The Dudley Group NHS Foundation TrustGlutaric aciduria type 1 (GA1) is a rare autosomal recessive organic acidaemia caused by deficiency of the glutaryl-CoA dehydrogenase enzyme. We describe the outcomes following deep brain stimulation (DBS) for the management of dystonia of children and adults with glutaric aciduria type 1 (GA1). Cases with GA1 were identified from the institutional databases of two tertiary movement disorder services. Data were extracted from clinical records using a standardised proforma, including baseline clinical characteristics, imaging and neurophysiological findings, complications post-surgery, and outcomes as measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BMFDRS) motor scores and the Canadian Occupation Performance Measure (COPM). A total of 15 children were identified aged 3-17.5 with a median age of 11.5 years at neurosurgery, and one adult undergoing DBS aged 31 years. Baseline BMFDRS motor score ranged from 58.5-114, median 105. GMFCS-equivalence level was 5 (i.e. non-ambulant) for 10/16 cases. Surgery was tolerated in all cases without evidence of metabolic decompensation. BFMDRS motor score 1-year post-surgery ranged from 57.5-108.5 (median 97.25) and at last follow-up 57.5-112 (median 104) (no statistically significant change compared to baseline at either time point, P > 0.05). COPM data were available for 11/13 children and young people (CAYP). Clinically significant improvement was reported in 7/11 at 1 year and 8/11 at last follow-up. Four CAYP transitioned to adult services. Death occurred in three cases during follow-up, in no case related to DBS. DBS may be considered as a management option for children with GA1 who have appropriately selected goals for intervention.Publication Intracorporeal versus extracorporeal anastomosis in laparoscopic total gastrectomy: a systematic review and meta-analysis(Wolters Kluwer, 2025-02-26) Zaman, Shafquat; Hussain, Mohammad I; Kausar, Maria; Mostafa, Omar ES; Mohamedahmed, Ali Y; Hajibandeh, Shahab; Hajibandeh, Shahin; Camprodon, Ricardo; Sellahewa, Chaminda; University Hospitals of Derby and Burton NHS Foundation Trust; University of Birmingham; The Dudley Group NHS Foundation Trust et alBackground: To evaluate outcomes of intracorporeal (IOJ) versus extracorporeal (EOJ) oesophagojejunostomy following laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer. Methods: A comprehensive search of various electronic databases was conducted. Comparative studies of IOJ versus EOJ following LTG in patients with gastric malignancy were included. Primary outcomes were anastomotic leak, anastomotic bleeding, and anastomotic stricture formation. Secondary outcomes included operative time, length of hospital stay (LOS), volume of intra-operative haemorrhage, number of harvested lymph nodes, time to flatus, time to soft diet, intra-abdominal infection, pulmonary infection, surgical site infection (SSI), duodenal stump leak, pancreatic fistula occurrence, postoperative ileus, re-operation, and mortality. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale was used to assess risk of bias. Results: Seventeen non-randomised studies enrolling 2,960 patients divided between an IOJ (n = 1430) and EOJ (n = 1530) group were included. IOJ was associated with significantly lower risk of anastomotic stricture (P = 0.01), volume of intra-operative bleeding (P = < 0.001), and SSI (P = 0.04) compared to EOJ. No difference was found in anastomotic leak (P = 0.93); anastomotic bleeding (P = 0.35); operative time (P = 0.63); LOS (P = 0.30); lymph node yield (P = 0.17); time to first flatus (P = 0.77); time to resumption of soft diet (P = 0.32); intra-abdominal infection (P = 0.22); pulmonary infection (P = 0.45); duodenal stump leak (P = 0.46); pancreatic fistula occurrence (P = 0.16); and paralytic ileus (P = 0.59), re-operation (P = 0.50), and mortality (P = 0.23) between the two groups. Conclusions: LTG for gastric malignancy with IOJ may be associated with lower risk of anastomotic stricture and SSI compared to the extracorporeal approach. However, future adequately powered randomized studies are needed to compare the two techniques.Publication Spotlight on hypertension in the African Continent(Nature Publishing Group, 2025-02-05) Khan, Zakirullah; Nadar, Sunil K.; The Dudley Group NHS Foundation TrustNo abstract available.