Open access

Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) (2026)

Posted on by

Type of publication:

Systematic review

Author(s):

Ahad, Amal; Kumar, Sandeep; Kolomar, Hugh; Williams, Jada; Abdallah, Abrar I; Sadeghzadegan, Amirali; *Yateem, Dana; Kharel, Punam; Chowdhury, Dristy; Alnajar, Fahad; Ali, Muqaddas.

Citation:

Cureus. 18(6):e111804, 2026 Jun.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with increasing global prevalence, particularly in newly industrialized countries. Fecal microbiota transplantation (FMT) has worked as an effective therapeutic strategy aimed at restoring immune homeostasis and gut microbial balance. However, a lack of standardized protocols and comprehensive safety data necessitates further evaluation. This meta-analysis aims to comprehensively analyze the efficacy of FMT in inducing clinical remission in UC, incorporating the latest randomized controlled trials (RCTs). A systematic review and meta-analysis of RCTs investigating FMT in UC were conducted. The primary outcomes were clinical and endoscopic remission, while adverse events (AEs) were assessed as secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was analyzed using the I2 statistic and Cochran's Q test. Overall, FMT demonstrated a significant benefit in inducing clinical remission compared with placebo (RR 1.55; 95% CI 1.22-1.96; p = 0.0003). For endoscopic remission, FMT showed a significant overall effect (RR 1.68; 95% CI 1.15-2.46; p = 0.007). The incidence of AEs was comparable between the FMT and control groups (RR 0.88; 95% CI 0.77-1.00; p = 0.06). This meta-analysis gives strong confirmation for the efficacy of FMT in inducing both clinical and endoscopic remission in UC patients, with a favorable safety profile. Multi-donor FMT and oral capsule administration appear to be particularly promising. Future research should focus on standardizing protocols, elucidating mechanisms of action, and conducting larger, long-term trials to optimize FMT for UC.

DOI: 10.7759/cureus.111804

Link to full-text [open access - no password required]

Coexistence of Elevated Mean Platelet Volume and Bleeding Symptoms in Chronic Kidney Disease: A Discordant Hemostatic Profile (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Adeyeye, Ayomide; Abdul Sattar, Tehzeeb; Mani Tripathi, Kaushalendra; Ali, Sahil; Samuel, Paul Sunday; Uzzaman, Gkm Rashik; *Oso, Ayodeji; Abughazal, Mahmoud Am; Shreen, Sibgha

Citation:

Cureus. 18(6):e111383, 2026 Jun.

Abstract:

BACKGROUND: Hemostasis in chronic kidney disease (CKD) is currently becoming a complicated and disturbed process, not a simple bleeding disorder. Recent evidence suggests that the combination of elevated mean platelet volume (MPV) and bleeding, particularly during the initial phases of the disease, is a discordant hemostatic profile.

OBJECTIVE: To examine the association between mean platelet volume (MPV) and bleeding symptoms among patients with chronic kidney disease (CKD) and to evaluate the utility of platelet indices in characterizing a discordant hemostatic profile.

METHODS: This analytical cross-sectional study recruited 527 patients with CKD from tertiary care centers. Bleeding was measured on a questionnaire that included typical bleeding symptoms and a bleeding score. Platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet count, were provided in the medical records. Data were evaluated using nonparametric tests, logistic regression, and receiver operating characteristic (ROC) curves.

RESULTS: Bleeding symptoms were observed in 298 patients (56.5%). Bleeding participants had increased MPV, which increased with increasing CKD stages. Multivariate analysis showed MPV was significantly associated with bleeding symptoms (OR = 2.88, p < 0.001). ROC curves indicated moderate discriminative ability (area under the curve (AUC) = 0.730), but poor performance of PDW and non-predictive value of platelet count.

CONCLUSION: CKD is associated with a discordant hemostatic profile of elevated MPV alongside bleeding symptoms. MPV may serve as a potential marker associated with bleeding symptoms in patients with CKD.

DOI: 10.7759/cureus.111383

Link to full-text [open access - no password required]

Trochanteric Buttress Plate Augmentation of the Proximal Femoral Nail for Unstable Intertrochanteric Fractures: A Randomized Controlled Trial (2026)

Posted on by

Type of publication:

Randomised controlled trial

Author(s):

*Abdelaty Shalaby, Mohamed H; *Khafagy, Doaa G; Hosny, Mohamed M; Eltantawy, Ahmed E; Omran, Ali M.

Citation:

Cureus. 18(2):e104235, 2026 Feb.

Abstract:

BACKGROUND: Unstable intertrochanteric (IT) fractures pose a significant challenge in orthopedic surgery.

OBJECTIVE: To investigate the effectiveness of combining a trochanteric buttress plate (TBP) with a proximal femoral nail (PFN) for managing unstable IT fractures.

METHODS: This randomized controlled open-label study was performed on 90 patients with recent unstable IT fractures (Evans types 1c, 1d, 1e, or 2). Patients were randomly divided into two groups: Group A was treated with standard PFN fixation. Group B was treated with PFN integrated with TBP augmentation. Assessments were conducted at two weeks and monthly for six months. Functional outcomes were assessed using the modified Harris Hip Score (mHHS).

RESULTS: Operative time and blood loss were significantly higher in Group B (PFN+TBP) than in Group A (standard PFN) (P = 0.005 and 0.006, respectively). Postoperative mHHS was significantly higher in Group B at all follow-up intervals from two weeks to six months (P < 0.05).

CONCLUSIONS: The integration of the TBP with PFN for unstable IT fractures significantly improves functional outcomes without increasing major complications, despite a modest increase in operative time and blood loss.

DOI: 10.7759/cureus.104235

Link to full-text [open access - no password required]

Point-of-care echocardiography training pathways: a global perspective and the need for standardisation (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Abbawy, Marcus, Holden, Finlay, Fisher, Tom, Nasa, Prashant, Manjunathasawamy, Akshay Hiryur, Renukappa, Suresh, Suresh, Subashini, Kumar, Nanda, Ingram, Tom, Hothi, Sandeep, Cotton, James M, *Maharaj, Aruna, Chacko, Cyril, Veenith, Tonny

Citation:

Open Heart. 13(1), 2026 May 26.

Abstract:

Point-of-care ultrasound echocardiography has become an indispensable tool for rapid clinical assessment in emergency medicine. This review article examines the heterogeneity in training pathways globally, outlining the advantages and presenting the challenges to standardisation, documentation practices and quality assurance. By reviewing current curricula, training methods and international models, we aim to identify the positive elements and propose a framework for an ideal national training programme, including the potential role of an examination and higher education institutions.

DOI: 10.1136/openhrt-2026-004057

Link to full-text [open access - no password required]

Artificial Intelligence and Digital Therapy for Adolescent Mental Health in the UK; Opportunities, Barriers, and Ethical Consideration (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Adindu K.N.; Akubue N.; Jude N.O.; Onakoya A.; Chukwunonye C.; Odion O.; *Okengwu C.G.; Uchechukwu N.; Osita-Obasi P.Z.; Ezike A.; Bello I.; Olenloa E.; Eruteya O.O.; Oyewole S.A.

Citation:

SSRN. (no pagination), 2025. Date of Publication: 20 May 2025.

Abstract:

Background: Adolescence constitutes a critical developmental stage marked by the onset of mental health difficulties, yet timely access to effective mental health care remains a significant challenge for many adolescents in the United Kingdom (UK). Artificial intelligence (AI)-enabled digital therapies present innovative opportunities to address these gaps. Objective(s): This systematic review critically assesses current evidence on AI-driven digital interventions for adolescent mental health within the UK, highlighting their potential opportunities, barriers to implementation, and pertinent ethical considerations. Method(s): Employing a mixed-methods design, a systematic literature review adhering to PRISMA guidelines was combined with thematic analysis of semi-structured interviews. Comprehensive database searches (MEDLINE, PsycINFO, Web of Science; 2013-2023) targeted studies involving UK adolescents (ages 11-19) using AI-based mental health technologies. Included studies underwent rigorous quality appraisal (Cochrane RoB 2.0, ROBINS-I, CASP). Additional insights were gathered through stakeholder interviews (clinicians, AI developers, adolescent users). Result(s): Twenty-seven studies met inclusion criteria, investigating interventions such as AI chatbots, predictive analytics, mobile apps, and virtual environments targeting anxiety and depression. Key opportunities identified include enhanced accessibility for underserved populations, personalization through adaptive algorithms, proactive early-risk detection, scalability, cost-efficiency, and improved engagement via interactive interfaces. Significant implementation barriers encompassed technical infrastructure limitations, data security concerns, insufficient longitudinal efficacy data, socioeconomic disparities, and clinician scepticism. Ethical challenges emphasized informed consent, algorithm transparency, potential biases, unclear accountability, and clinician deskilling risks. Conclusion(s): AI-driven digital interventions offer substantial promise for augmenting adolescent mental health services in the UK. However, realizing their full potential necessitates addressing infrastructural, ethical, and evidentiary challenges through robust governance frameworks and continued rigorous research.

DOI: 10.2139/ssrn.5253224

Link to full-text [open access - no password required]

Carbapenem-resistant Enterobacterales across the UK: A nationwide study of carbapenemase testing and novel antimicrobial activity (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Baltas I.; Drury K.; Harrison T.; Moore N.; Lester R.; Chattaway M.A.; England B.; Cattrall J.W.S.; Donaldson C.J.; Jamal Khan D.P.; Carroll A.; Ball D.; Wareham D.W.; Pahalage R.; Banavathi K.; Drazho B.; Shorrocks R.E.; Hlaing W.; Adhikaree N.; Ryan F.; Thompson J.V.; Connolly G.; Shibu P.; Ale E.; Mirfenderesky M.; Jain S.; Fowler S.; Beard K.; Hughes G.; Bonnici G.; Mohammed T.; Brown K.; Drazich-Taylor S.; Martinez A.S.; Lipworth S.; Crawford-Jones D.; Elnour M.; Moore J.; Democratis J.; McCormick J.; Hussain A.; Islam J.; Jenkins D.; Stoesser N.; Hopkins K.; Demirjian A.; Hatcher J.; Soares A.L.; Kirby A.; Grandjean L.; Riley U.; Stephens J.; Joseph A.; Winzor G.; Jackson K.E.; Kandil H.; Barker B.; Planche T.; Jawad S.; Merrick B.; Snell L.B.; Subbaraj K.P.; Munthali P.G.; Clayton J.J.; Varghese R.; Jones C.R.; Hardman N.L.; Komosa M.M.; Heppell B.M.; Halstead F.D.; Qaiser S.; Mavrogiorgou E.; Nye C.; Bamber S.; Locke T.E.; Whatmore J.; Mohamed F.; Adobah E.; Knox K.; Campbell O.; Carson A.A.; North P.; Albur M.; Tickell-Painter M.; Mooney H.; Coward A.; Shah A.; Choudhury R.Y.; Sughayer H.M.; Graham C.; Mutch C.P.; Dewar S.; Hesing S.C.; Khan S.; Garcia-Mingo A.; Garcia D.M.; Penciu F.; Kosaraju K.; Davey E.; Vazquez A.M.; Qazzafi Z.; *Anand M.; Navalan H.; Roberts S.; Mermerelis D.; Read A.; Rangaiah J.; Austin-Hutchison R.; Price J.R.; Peters J.; Stevens M.; Knapper F.; Merchant N.; Davies F.; Vanstone G.L.; Allen D.; Prior-ong M.; Tuharska Z.; Soper I.; Tsui R.; Watts A.; Kakkar N.; Patel M.; Townsley H.; Saajan P.; Claxton A.P.; Burns P.J.; Jeppesen C.A.; Lee M.; Tudor A.; Macnaughton E.; McKeating C.; Dhillon R.; Okoliegbe I.; Sakka N.E.; Scott K.S.; Wang D.B.; Wilson B.; Laing-Herridge K.; Diver-Hall E.

Citation:

International Journal of Antimicrobial Agents. 67(10) (no pagination), 2026. Article Number: 107898. Date of Publication: 01 Oct 2026. [epub ahead of print]

Abstract:

Background Carbapenem-resistant Enterobacterales (CRE) are increasing in the UK, but the drivers of this rise and effective treatment options remain uncertain. Methods Ninety-seven acute National Health Service Trusts, including 192 UK hospitals, submitted data on 8840 consecutive, non-duplicate CRE (October 2023 to September 2024) and local laboratory methods. Results Predominant CRE species were Klebsiella pneumoniae (30.6%, 2709/8840), Escherichia coli (29.3%, 2592/8840), Enterobacter cloacae complex (22.2%, 1966/8840). Overall, 21.8% (1927/8840) of CRE were collected in outpatient settings. Overall, 85.5% (7279/8513) of CRE underwent carbapenemase detection testing, with significant variation depending on species, specimen type, and baseline antibiogram. Carbapenemases detected were OXA-48-like (22.3%, 1967/8840), NDM (18.6%, 1645/8840), KPC (9.2%, 817/8840), IMP (2.0%, 178/8840), VIM (0.7%, 62/8840), multi-carbapenemase producers (4.0%, 351/8840). Overall, 51.2% (4526/8840) of CRE were tested against >=1 novel agent. In-house antimicrobial susceptibility testing availability was common for ceftazidime-avibactam (90.7%, 88/97) and cefiderocol (73.2%, 71/97), while less common for meropenem-vaborbactam (41.2%, 40/97), imipenem-relebactam (21.6%, 21/97), aztreonam-avibactam (11.3%, 11/97). OXA-48-like- (97.6%, 1138/1166) and KPC producers (96.2%, 429/446) remained susceptible to ceftazidime-avibactam; KPC producers to meropenem-vaborbactam (99.4%, 160/161) and imipenem-relebactam (98.4%, 62/63). Cefiderocol resistance was 32.4% overall and higher among NDM- (58.4%) and multi-carbapenemase producers (50.3%). Ceftazidime-avibactam plus aztreonam synergy was performed for 17.2% (286/1658) of aztreonam-resistant metallo-beta-lactamase-producers; synergy was observed in 78.7% (225/286) of cases. Colistin resistance was 10.6% (153/1445) among non-intrinsically resistant species. Conclusions Whilst most UK CRE are tested for carbapenemases, coverage gaps persist. The community burden of CRE is increasing. Cefiderocol resistance is concerningly high, particularly among metallo-beta-lactamase-producers.

DOI: 10.1016/j.ijantimicag.2026.107898

Link to full-text [open access - no password required]

Understanding the Nuanced Concept of Hemodynamic Incoherence and Its Underlying Physiology (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Rola P.; *Miller A.; Haycock K.; Spiegel R.; Rikhraj K.; Kattan E.; Hernandez G.

Citation:

Journal of Clinical Medicine. 15(15) (no pagination), 2026. Article Number: 5811. Date of Publication: 01 Aug 2026. [epub ahead of print]

Abstract:

Hemodynamic incoherence is commonly defined as a dissociation between normalization of macrocirculatory variables and persistent impairment of tissue perfusion. However, this phenomenon is not physiologically homogeneous. We propose a conceptual distinction between two forms of macro-microcirculatory incoherence. Type 1 incoherence represents primary microcirculatory dysfunction, in which intrinsic alterations in microvascular regulation and flow distribution lead to heterogeneous capillary perfusion despite apparently adequate upstream hemodynamics, as observed in sepsis. In contrast, Type 2 incoherence reflects secondary impairment of microcirculatory flow resulting from hemodynamic constraints elsewhere in the circulation, including excessive vasoconstriction, limited cardiac forward flow, or venous congestion. In this setting, impaired perfusion arises from ineffective transmission of flow across the system rather than primary microvascular failure. The four-interface model of the circulation provides a unifying physiological framework to interpret these mechanisms as failures of energy transfer across sequential hemodynamic domains. Recognizing these distinct forms of incoherence may improve not only physiologic interpretation of shock and help avoid conflating fundamentally different mechanisms under a single conceptual entity, but also be key in individualizing therapeutic interventions to the proper phenotypes of tissue malperfusion

DOI: 10.3390/jcm15155811

Link to full-text [open access - no password required]

Variation in antenatal anaemia guidelines across the NHS in the United Kingdom: A cross-sectional study (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Haynes S.; Balboula I.; Collins P.; *Parry-Smith W.; Fye H.; *Elsmore A.; Collis R.; De Lloyd L.; Churchill D.; Bell S.F.; Stanworth S.J.

Citation:

British Journal of Haematology. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Antenatal anaemia affects up to 30% of pregnant women in the United Kingdom and is a recognised clinical priority. National management guidance is published by the British Society of Haematology (BSH), but the extent to which local National Health Service (NHS) guidelines align with it is unknown. We conducted a cross-sectional document analysis of antenatal anaemia guidelines from 49 NHS sites across the United Kingdom, obtained through two national research programmes. Two reviewers independently extracted data on screening, diagnosis, treatment and monitoring, using the 2020 BSH guideline as the national reference standard. The included guidelines represented approximately 33% of annual UK births. Screening and diagnostic haemoglobin thresholds were broadly consistent with BSH guidance, whereas substantial variation was concentrated in treatment and monitoring: oral iron indications, dosing and duration; haemoglobin thresholds and clinical criteria for intravenous iron; and the timing, biomarkers and response definitions used after treatment. Ferritin thresholds, reassessment intervals and response criteria were frequently absent or divergent. Variation was greatest in domains where the underlying evidence base is least resolved. These findings characterise the nature and extent of guideline-level variation across NHS maternity care and identify priority areas for future research and national guideline development.

DOI: 10.1111/bjh.70780

Link to full-text [open access - no password required]

Temporal Trends and Demographic and Geographic Disparities in Stroke Mortality Among US Adults Aged 25-64 Years (1999-2020): A CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Analysis (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Farahmandian, Ronit; Kananyan, Mariam; Alonso, Jorge E; Saro-Naenwi, Naomi; Ajibade, Tolulope; Kaurani, Purvi; Gudapati, Vamsi Krishna; Gomez-Sauceda, E Lucano; Clarke, Cleve; Arra, Srihitha; Imam, Bashir; *Gupta, Anchal R; Makkieh, Yahya.

Citation:

Cureus. 18(8):e113934, 2026 Aug.

Abstract:

BACKGROUND: Stroke remains a major contributor to mortality in the United States. Understanding long-term temporal changes and demographic and geographic disparities in stroke mortality is essential for identifying high-risk populations and guiding targeted prevention strategies.

METHODS: This retrospective observational study analyzed stroke mortality among US adults aged 25-64 years from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths with stroke recorded as the underlying cause were identified using International Classification of
Diseases, 10th Revision (ICD-10) codes I60-I64 and were analyzed collectively as overall stroke mortality. Age-adjusted mortality rates per 100,000 population were assessed overall and stratified by sex, race, US Census region, and urbanization level. Joinpoint regression was used to identify temporal changes and estimate the annual percent change (APC) for each temporal segment and the average annual percent change (AAPC) across the complete study period.

RESULTS: A total of 382,253 stroke deaths were identified. The overall age-adjusted mortality rate (AAMR) decreased significantly from 1999 to 2012 (APC, -2.41%; 95% CI, -2.77 to -2.21), remained statistically unchanged from 2012 to 2018, and increased significantly from 2018 to 2020 (APC, 4.36%; 95% CI, 1.51 to 6.06). The full-period AAPC was -1.23% (95% CI, -1.42 to -1.11). Men had higher AAMRs than women and experienced a significant increase during 2018-2020. Black or African American adults had the highest race-specific AAMR, the South had the highest regional AAMR, and noncore counties had the highest urbanization-specific AAMR. Full-period AAPCs were significantly negative across all examined subgroups; however, significant later-period increases occurred among men, American Indian or Alaska Native adults, White adults, residents of the
West, large fringe metropolitan counties, and noncore counties.

CONCLUSION: Premature stroke mortality declined substantially over the complete study period, but progress was uneven across demographic and geographic groups. Persistently elevated mortality and recent reversals in selected populations highlight the need for targeted prevention and continued surveillance.

DOI: 10.7759/cureus.113934

Link to full-text [open access - no password required]

Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

Posted on by

Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

Link to full-text [open access - no password required]