2025

Cardiovascular disease morbidity is associated with social deprivation in  subjects with familial hypercholesterolaemia (FH): A retrospective cohort  study of individuals with FH in UK primary care and the UK Simon Broome  register, linked with national hospital records (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Iyen, B; Qureshi, N; Kai, J; *Capps, N; Durrington, P N; Cegla, J; Soran, H; Schofield, J; Neil, H A W; Humphries, S E.

Citation:

Atherosclerosis. 403:119142, 2025 Feb 18.

Abstract:

BACKGROUND: Social deprivation is associated with higher cardiovascular disease (CVD) morbidity and mortality. We examined whether this is also observed in people with Familial Hypercholesterolaemia (FH).

METHODS: Subjects with FH and linked secondary care records in Hospital Episode Statistics (HES) were identified from UK Clinical Practice Research Datalink (CPRD) and the Simon Broome (SB) adult FH register. Cox proportional hazards regression estimated hazard ratios (HR) for composite CVD outcomes (first HES outcome of coronary heart disease, myocardial infarction, angina, stroke, transient ischaemic attack, peripheral vascular disease, heart failure, coronary revascularisation interventions (PCI and CABG)) in Index of Multiple Deprivation (IMD) quintiles.

RESULTS: We identified 4309 patients with FH in CPRD (1988-2020) and 2956 in the SB register. Both cohorts had considerably fewer subjects in the most deprived compared to the least deprived quintile (60 % lower in CPRD and 52 % lower in SB). In CPRD, the most deprived individuals had higher unadjusted HRs for composite CVD (HR 1.71 [CI 1.22-2.40]), coronary heart disease (HR 1.63 [1.11-2.40]) and mortality (HR 1.58 [1.02-2.47]) compared to the least deprived but these became insignificant after adjusting for age, sex, smoking and alcohol consumption. In the SB register, hazard ratios for composite CVD increased with increasing deprivation quintiles and remained significant after adjustment for age, sex, smoking and
alcohol consumption (adjusted HR in quintile 5 vs quintile 1 = 1.83 [1.54-2.17]).

CONCLUSIONS: Strikingly fewer individuals with FH are identified from lower socioeconomic groups, though the most deprived FH patients have the highest risk of CVD and mortality. In CPRD, this risk was largely explained by smoking and alcohol consumption, but not in the SB register. More effective strategies to detect FH and optimise risk factor management, are needed in lower socioeconomic groups.

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

Embracing qualitative approaches in gastroenterology research: a call to action (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Little S.; Tawn J.; Khalil G.; Hardasani R.; Radford S.; Das D.; Peerally M.F.;

Citation:

Frontline Gastroenterology. (no pagination), 2025. Article Number: flgastro-2024-102952. Date of Publication: 2025 [epub ahead of print]

Abstract:

Link to full-text [NHS OpenAthens account required]

A multi-centred retrospective cohort study comparing JAK inhibitor therapies in moderate to severe ulcerative colitis (2025)

Posted on by

Type of publication:

Conference abstract

Author(s):

Kumar A.; Baxter J.; Rimmer P.; Noble B.; Makki M.; Chikhlia A.; Cheesbrough J.; Disney B.; *Muir J.; Karova M.; *Butterworth J.; Bower J.; Sagar N.; Al-Talib I.; Nahal J.; Hatta A.; Ali N.; Sagar V.; Varyani F.; Smith S.; Bourne S.; Hsu Y.K.; Eltahir A.; De silva S.; Harvey P.;

Citation:

Journal of Crohn's and Colitis. Conference: 20th Congress of ECCO. Berlin Germany. 19(Supplement 1) (pp i2143), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Background: Tofacitinib, filgotinib and upadacitinib are JAK inhibitors (JAKi) that are licensed for treatment in moderate to severe ulcerative colitis (UC). Whilst these drugs have demonstrated efficacy against placebo, there is no head-to-head data. This study aims to compare the clinical efficacy between these drugs.

Method(s): This is a multi-centred, retrospective cohort study with data collected from January 2018 to June 2024. Patients with UC were recruited on their first JAKi, irrespective of previous advanced therapies. Clinical remission (faecal calprotectin (FCP) <250, Mayo 1, UCEIS 1, pMayo 2, SCCAI 2) and response (50% reduction in FCP from baseline, reduction in partial Mayo or UCEIS by 3 or more, or sustained <3) was measured at 3- and 6-months. If a patient stopped taking JAKi, they were considered to have failed both response and remission. Data was non-parametric and outcome measures were compared using Chi-squared tests.

Result(s): There was a total of 266 patients included in the final analysis. 70 (26%) were on upadacitinib, 47 (18%) on filgotinib and 149 (56%) on tofacitinib (Table 1). At least 87% (129/149) on tofacitinib had exposure to a previous biologic compared to 80% (56/70) for upadacitinib and 66% (31/47) for filgotinib. At 3-months, clinical response in upadacitinib, filgotinib and tofacitinib was demonstrated in 83%, 74% and 75% patients, respectively and clinical remission was seen in 69%, 64% and 52%, respectively. At 6-months, clinical response was demonstrated in 79%, 65% and 63%, respectively and remission was seen in 75%, 61% and 51%, respectively. Upadacitinib demonstrated significantly higher 3-months remission rate (p=0.019) and 6-months response (p=0.010) and remission rates (p= 0.001) compared to tofacitinib. In the bio-exposed cohorts, upadacitinib demonstrated greater 6-months remission rates (71%) compared to 64% on filgotinib (p=NS) and 52% tofacitinib (p= 0.022). In bio-naive cohorts (n=50), upadacitinib demonstrated greater 6-months remission rates (93%) compared to 56% on filgotinib (p=0.024) and 50% tofacitinib (p= 0.009). Combining the JAKi, 90% of patients were not on steroids at 3-months and 94% were not on steroids at 6-months. A total of 26 patients had a colectomy at the time of their JAKi, 17 on tofacitinib, 5 on filgotinib and 4 on upadacitinib.

Conclusion(s): This study demonstrates that upadacitinib is more likely to achieve 3- and 6-month remission compared to tofacitinib. In a small subgroup of bio-naive patients Upadacitinib was more likely to achieve 6-month remission compared to filgotinib and tofacitinib. JAKi were associated with minimal adverse events and importantly, the efficacy of JAKi does not appear diminished by prior biologic use.

Link to full-text [no password required]

Doctor when can I drive? A systematic review and meta-analysis of brake reaction time in patients returning to driving after hip arthroscopy for femoroacetabular impingement (FAI) (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Patel, Ravi; Sokhal, Balamrit Singh; Fenton, Carl; Omonbude, Daniel; Banerjee, Robin; Nandra, Rajpal.

Citation:

Hip International, 2025 Feb 24.[epub ahead of print]

Abstract:

BACKGROUND: A common question from patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is when they may return to driving.

PURPOSE: We aimed to perform a formal systematic review and meta-analysis to address this issue.

METHODS: A systematic review and meta-analysis followed PRISMA guidelines. Databases searched included OVID, EMBASE, and COCHRANE through July 2024 for articles with keywords and MeSH terms like "Hip arthroscopy," "Femoroacetabular Impingement," "total brake response time," and "reaction time" related to driving. Titles and full articles were reviewed for quality and relevance. Statistical analysis was done using Review Manager Version 5.4.A total of 39 articles were reviewed, with 5 meeting inclusion criteria. All selected articles used brake reaction time (BRT) as an outcome measure. A meta-analysis compared pre- and postoperative BRT values. Data were analysed for the right and left hips combined, followed by a subgroup analysis by laterality. BRT values were divided into preoperative and 2, 4, 6, and 8 weeks postoperative periods.

RESULTS: The studies assessed 160 patients, with 142 undergoing hip arthroscopy for FAI. The mean age was 32.75 +/- 9.4 years, with a male-to-female ratio of 73:69. The right hip was affected in 68% of
patients. Preoperative BRT ranged from 566 to 1960 milliseconds, while postoperative BRT ranged from 567 to 1860 milliseconds between week 2 and week 12.

CONCLUSIONS: BRTs returned to baseline or control values and continued to improve 4 weeks post-surgery for FAI. It is safe to recommend a return to driving at 4 weeks after hip arthroscopy for FAI.

Severe hypocalcemia and hypophosphatemia following Denosumab administration in a multi-comorbidity patient (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Sagdeo, Anuja; *Elshehawy, Mahmoud; Rakieh, Chadi; Ball, Patrick; Morrissey, Hana.

Citation:

Medicine & Pharmacy Reports. 98(1):144-148, 2025 Jan.

Abstract:

The case is presented of an elderly patient (DCP) with extensive medical history, including osteoporosis, who developed hypocalcaemia and hypophosphataemia whilst treated with denosumab, while prescribed concomitant calcium and vitamin D therapies. The management of this complex case involved a multidisciplinary team (MDT) approach, incorporating the patient's wishes. It included discontinuation of denosumab and intravenous (IV) and oral mineral supplementation that yielded gradual amelioration of calcium and phosphate levels. This case demonstrates the importance of vigilant monitoring and appropriate management in patients receiving denosumab, particularly those with multiple comorbidities. It carries important considerations for using denosumab for osteoporosis treatment in patients with complex medical backgrounds. Ethical clearance waiver was granted by the Trust Research Ethics Committee on 18/01/2024.

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

Leadership and service improvement (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Hamer, Chelsea

Citation:

OTnews, March 2025, p. 48-50

Abstract:

Last year, Chelsea Hamer completed a leadership placement which saw her focus on upskilling staff and introducing splinting within an inpatient occupational therapy service for neurological patients. Here she shares the outcomes.

Ethnic and Socioeconomic Variation in Pre-Conception Long-Term Conditions: A Cross-Sectional Electronic Health Record Study of 3.4 Million Pregnancies in CPRD Aurum (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Cockburn N.; Singh M.; Wambua S.; Gonzalez-Izquierda A.; Lee S.I.; Phillips K.; *Elsmore A.; *Ilaalagan R.; Holland R.; Hanley S.J.; Laws E.; Hodgetts-Morton V.; Gibbon M.; Judd N.A.; Seymour R.G.; Taylor B.; Chandan J.S.; *Parry-Smith W.; Nirantharakumar K.

Citation:

SSRN. (no pagination), 2025. Date of Publication: 23 Jan 2025 [preprint]

Abstract:

Background: Inequalities in pregnancy outcomes between different ethnic groups and backgrounds of deprivation have been observed in the UK and elsewhere for several decades. Pre-existing long-term health conditions increase risks of adverse outcomes and require focussed action to diagnose, prevent, and manage these conditions. We aimed to estimate differences in the prevalence of pre-conception long-term conditions between different groups to assess health needs.

Methods: This was a cross-sectional study conducted in primary care using Clinical Practice Research Datalink (CPRD) Aurum data. Diagnostic information was extracted from CPRD Aurum at the beginning of all eligible pregnancies for 79 conditions between 2000 and 2021. Age-standardised was estimated and risk ratios calculated between the overall population, and ethnic groups and Index of Multiple Deprivation quintiles. Statistical process control was used to detect conditions with elevated prevalence within groups.

Findings: In 2021, at the start of a pregnancy, women from ethnic minority groups were less likely to have been diagnosed with any one of the 79 conditions than the general population. Women from mixed ethnic groups were 4% more likely to be diagnosed, and from white ethnic groups 2% more likely to be diagnosed. Women from black groups were 5% less likely to be diagnosed, from Asian groups 26%, other ethnic groups 32%, and women missing ethnic group information 13%. Women living in the most deprived quintile of areas were 8% more likely to have been diagnosed than the overall population, and from least deprived areas 8% less likely to have been diagnosed.

Interpretation: Pre-existing long-term conditions are a major driver of maternal morbidity and mortality, but the healthcare needs and policy priorities differ substantially between ethnic and socially disadvantaged groups. Universal health policies that narrow inequalities and targeted action are both needed to meet health needs equitably.

Link to full-text [no password required]

Assessing SPECT/CT for the identification of cartilage lesions in the knee joint: A systematic review (2025)

Posted on by

Type of publication:

Systematic review

Author(s):

Rix L.; *Tushingham S.; Wright K.; Snow M.;

Citation:

Osteoarthritis and Cartilage Open. 7(1) (no pagination), 2025. Article Number: 100577. Date of Publication: 01 Mar 2025.

Abstract:

Background: Single-photon emission computerised tomography with conventional computer tomography (SPECT/CT) is an emerging technology which may hold clinical value for the identification of cartilage lesions in the knee joint. The intensity and distribution of SPECT/CT uptake tracer may identify physiological and structural information in the absence of structural change on other imaging modalities.

Objective(s): To systematically assess the utility of SPECT/CT in the detection of chondral lesions within the knee joint, in patients presenting with knee pain, with or without structural change.

Result(s): PubMed, Science Direct, Web of Knowledge, and NHS databases were searched for English language articles focusing on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Animal studies, cadaver studies, comparator radiological technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded. From the search, 11,982 manuscripts were identified, and screened for relevance. Seven studies were identified and scored low on QUADAS-2 bias review. SPECT/CT correlated with lesions found on other imaging modalities and during intraoperative assessment. Furthermore, in some cases, SPECT/CT out-performed other modalities in the detection of cartilage lesions.

Conclusion(s): Evidence suggests SPECT/CT may be a useful tool for the detection and localisation of cartilage lesions, particularly in discrepant cases when there is an absence of lesions on other imaging modalities, or a lack of correlation with patients' symptoms. Further studies are required to confirm the conclusions of this review.

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

Base of Thumb Fractures: A Review of Anatomy, Classification, and Management (2025)

Posted on by

ype of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Devasia, Thomas; *Khan, Muhammad Murtaza; *Abdullah, Faliq; *Singh, Rohit; Simons, Adrian William.

Citation:

Cureus. 17(1):e76729, 2025 Jan.

Abstract:

Fractures of the thumb metacarpal base are uncommon but significant due to their critical role in hand functionality and hand grip strength. These fractures exhibit diverse patterns, including extra-articular, Bennett, Rolando, and highly comminuted fractures, each with unique implications for management and outcomes. Each type presents unique challenges in achieving anatomical reduction, stability, and favorable long-term outcomes. This review explores the anatomy of the trapeziometacarpal joint, classification systems, clinical presentation, imaging techniques, and management strategies for these fractures. Stable extra-articular fractures often respond well to closed reduction and casting, while displaced intra-articular fractures generally require surgical intervention. Bennett fractures are typically treated using closed reduction and percutaneous pinning or open reduction and internal fixation. Rolando and comminuted fractures pose greater challenges due to their inherent instability and often necessitate advanced techniques such as locking plates, external fixation, or arthroscopic-assisted procedures. Achieving anatomical reduction is paramount to prevent complications such as joint incongruity, instability, and post-traumatic arthritis. Optimal treatment approaches depend on fracture patterns, stability, and patient-specific factors, with surgical techniques tailored to preserve thumb function and minimize long-term morbidity.

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

Fish Tank-Associated Mycobacterium Marinum Infection in an Immunocompromised Host (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Khan, Attam; *Jain, Dimple.

Citation:

BMJ Case Reports. 18(2), 2025 Feb 05.

Abstract:

Mycobacterium marinum infection can be challenging to diagnose and treat, especially in immunocompromised patients on tumour necrosis factor alpha inhibitors. A patient with collagenous colitis on infliximab presented with ulcerated plaques accompanied by nodules in a sporotrichoid fashion. Initial treatments failed until a biopsy confirmed M. marinum Multiple antibiotic regimens, including rifampicin and ciprofloxacin, were required due to resistance. The case underscores the importance of patient education on avoiding aquatic environments, considering atypical mycobacterial infections in differentials for immunocompromised patients with sporotrichoid lesions, and prioritising urgent diagnostic biopsies. Treatment can be lengthy, often requiring up to 12 months, emphasising the need for ongoing patient counselling and multidisciplinary management. Current guidelines recommend a combination of ethambutol and macrolides, though further research is necessary to optimise treatment protocols.

Link to full-text [NHS OpenAthens account required]