• Effect of deviated nasal septum on eustachian tube dysfunction: a systematic review and meta-analysis

  Awan, Muhammad Ozair; Spinos, Dimitrios; Hussain, Muzamil; Muzaffar, Jameel; Khanna, Aman; Qayyum, Asad; Accorona, Remo; Iftikhar, Haissan (2025)

  Objective: A range of chronic ear complaints may be attributed to Eustachian tube dysfunction. Eustachian tube dysfunction secondary to a deviated nasal septum has been described in several clinical studies, with symptomatic improvement demonstrated following septoplasty. However, uncertainty exists as to the size of the effect and consistency between studies. Methods: Electronic searches were carried out of Pubmed, Embase and the Cochrane Library for adult patients with complaints of nasal obstruction and/or impairment and/or complaints of ear fullness undergoing nasal surgery. Results: Seven studies met the inclusion criteria. Studies evaluated the effect of nasal surgery on Eustachian tube dysfunction using a variety of outcomes, including Eustachian tube function tests, the Eustachian Tube Dysfunction Questionnaire-7, tympanometry and Nasal Obstruction Symptom Evaluation scores. The results demonstrated the positive impact of nasal surgery on various outcomes related to Eustachian tube dysfunction. Conclusion: Nasal surgery has been demonstrated to have promising results as a therapeutic option for patients with Eustachian tube dysfunction and a deviated nasal septum, offering significant symptom relief and improved quality of life. Through the integration of the treatment of nasal symptoms in the management of Eustachian tube dysfunction, clinicians can adopt a comprehensive approach to addressing the underlying pathologies contributing to Eustachian tube dysfunction.
• Draf III in the acute phase of pott's puffy tumor: a scoping review

  Kakar, Sahil; Ali, Haris; Khan, Husnaa Fathima Ali Azamathullah; Amjad, Rameez; Sharma, Akshara; Tariq, Muhammad Daoud; Shahid, Muhammad Sohaib; Ahmed, Shahzada Khuram; Iftikhar, Haissan (2025)

  Background Pott's puffy tumor (PPT) is a rare but serious sequela of frontal sinusitis characterized by osteomyelitis of the frontal bone with subperiosteal abscess formation. Surgical management has traditionally been delayed until resolution of the acute infection. This scoping review evaluates the safety and outcomes of performing “Hot” Draf III (modified Lothrop) surgery during the acute phase of PPT. Methods A review was conducted in accordance with PRISMA guidelines. Literature searches were performed across PubMed, Embase, Scopus, and ClinicalTrials.gov without date restriction. Eligible studies included patients undergoing Draf III surgery acutely (within 28 days of presentation) for PPT. Data were extracted on demographics, surgical approach, complications, and reintervention rates. Pooled analysis was performed using a random-effects model with Freeman–Tukey transformation to stabilize variance. Results Five studies met the inclusion criteria, encompassing nine patients (seven males, two females; mean age 50.3 years). All underwent acute Draf III surgery, primarily via endoscopic approaches (88.9%). Meta-analysis demonstrated a pooled complication rate of 0% (95% CI: 0%–40%) and a reintervention rate of 3% (95% CI: 0%–71%), with no significant heterogeneity (I² = 0%). Conclusion “Hot” Draf III surgery appears to be a safe and effective management option for PPT during the acute phase, offering low complication and reintervention rates. While these findings support early surgical intervention, larger, prospective studies are required to validate long-term outcomes and define patient selection criteria. Summary Early surgical intervention is feasible: All included patients underwent Draf III surgery acutely (within 28 days), demonstrating the practicality of early intervention for Pott's puffy tumor. Excellent safety profile: Meta-analysis revealed a pooled complication rate of 0%, suggesting that acute Draf III surgery carries minimal perioperative risk. Low reintervention rate: The pooled reintervention rate of 3% supports the durability and efficacy of early Draf III in managing acute frontal sinusitis with osteomyelitis. Favorable outcomes with endoscopic approach: Most surgeries were performed endoscopically (88.9%), reflecting the advantages of minimally invasive techniques in reducing morbidity and recovery time. Need for further evidence: Although findings are consistent across available studies, larger prospective cohorts are required to confirm the long-term safety and efficacy of “Hot” Draf III procedures.
• The contribution of advanced practitioners to equitable and person-centred continence care

  Alsararatee, Hasan H (2025-12-04)

  Continence problems remain widespread across community and secondary care, yet provision in the UK continues to be shaped by inequities, fragmented commissioning, stigma and variation in workforce capability. This article examines the contribution of advanced practitioners (APs) to continence care through the four pillars of practice and considers how their clinical expertise, leadership influence, educational role and engagement with research can strengthen assessment, co-ordination and person-centred support. Evidence from national reports and existing studies demonstrates the need for improved pathways, enhanced staff capability and dignity-focused practice, particularly for populations affected by frailty, cognitive impairment, or cultural and communication barriers. By integrating comprehensive assessment, sensitive communication, culturally responsive engagement and informed use of innovation, APs can advance equitable continence provision and improve the lived experience of individuals with bladder and bowel needs. The article concludes that AP-led practice is essential for progressing continence care within a system that requires greater consistency, stronger evaluation and sustained attention to wellbeing and quality of life.
• Narrative review on post-stroke outcomes through recognition of frailty, sarcopenia, and palliative care needs

  Kotlega, Dariusz; Kobus-Kotlega, Katarzyna; Szczuko, Malgorzata (2025)

  Stroke survivors frequently experience long-term disability, post-stroke fatigue, frailty, sarcopenia, falls, and psychosocial distress, which together drive poorer functional recovery, rehospitalization, institutionalization, and caregiver burden. This narrative review synthesizes contemporary evidence on the prevalence, mechanisms, and clinical impact of post-stroke fatigue, frailty, sarcopenia, and falls and examines their links with palliative care needs, healthcare costs, and emerging telehealth models. A PubMed and Google Scholar search up to October 2025 identified studies on stroke and fatigue, frailty, sarcopenia, falls, palliative care, and telehealth, with an emphasis on clinical studies, trials, systematic reviews, and guidelines in adults. Frailty and sarcopenia are highly prevalent after stroke and predict mortality, poor functional outcome, reduced rehabilitation response, and higher care needs. Post-stroke fatigue is common, multifactorial, and associated with worse quality of life and reduced return-to-work rates. Falls are frequent and arise from the combined effects of focal neurological deficits and systemic frailty/sarcopenia. Despite substantial symptom burden, palliative care is often introduced late and inconsistently. We summarize brief, validated screening tools, such as the Clinical Frailty Scale, SARC-F plus grip strength, Malnutrition Universal Screening Tool, Fatigue Severity Scale/Neurological Fatigue Index for Stroke, Short Physical Performance Battery, and fall-risk instruments. We propose pragmatic timepoints and referral thresholds for their use in stroke services. Multicomponent interventions that integrate exercise, nutritional optimization, psychosocial support, and structured fall prevention can reduce frailty, sarcopenia, and falls and improve function and mood. Telemedicine and telerehabilitation may enhance access and continuity but risk widening digital inequities. Earlier, structured palliative approaches aligned with patient goals are needed across the frailty-sarcopenia-stroke continuum. Implementing integrated screening-intervention pathways and hybrid telehealth models could improve long-term outcomes for stroke survivors and their caregivers while supporting more efficient use of healthcare resources.
• Unmasking pulmonary vein thrombosis: a rare mimic of pulmonary embolism

  Alsararatee, Hasan H; Ahmed, Kawser; Elachola, Mohammed (2025)

  A female in her 50s was referred by her general practitioner (GP) with a 6-day history of left calf pain and swelling. She had a history of recurrent deep vein thrombosis (DVT) and a strong family history of thrombosis involving her mother and sibling. On examination, there was mild tenderness in the left calf with <3 cm asymmetry. Blood tests were normal apart from an elevated D-dimer. Doppler ultrasound ruled out DVT. However, an ECG performed at the GP clinic confirmed paroxysmal atrial fibrillation, and the patient also reported palpitations and shortness of breath at that time. Her Wells score for pulmonary embolism was 7.5, warranting urgent CT pulmonary angiography (CTPA) and initiation of therapeutic enoxaparin. CTPA demonstrated acute pulmonary vein thrombosis rather than pulmonary embolism. A multidisciplinary team discussion was held, and apixaban was commenced following haematology consultation. Follow-up CTPA confirmed complete resolution of the thrombus.
• Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials

  Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; Khalid, Saad Muhammad; Hasan, Ali; et al. (2026-01)

  Background and objective Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC. Methods A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model. Results Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade. Conclusion IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.
• Free fatty acids correlate with the interleukin-1 beta and interleukin-1 receptor antagonist in the early subacute phase of stroke

  Kotlega, Dariusz; Drozd, Arleta; Zembron-Lacny, Agnieszka; Morawin, Barbara; Ryterska, Karina; Szczuko, Malgorzata (2025-11)

  Inflammation contributes to the pathogenesis of ischaemic stroke both as a long-term causal factor and through the inflammatory cascade in acute stroke. Interleukin-1 beta (IL-1β) is a potent pro-inflammatory molecule, while interleukin-1 receptor antagonist (IL-1Ra) acts as its antagonist. Free fatty acids (FFAs) play a role in atherosclerosis formation and serve as substrates for inflammatory molecules. This study aimed to determine the potential interplay between FFAs, IL-1β, and IL-1Ra in stroke patients. A prospective analysis was conducted on 73 ischaemic stroke patients. All participants had their FFA, IL-1β, and IL-1Ra levels assessed. Significant correlations between IL-1β and certain FFAs were detected: C15:0 pentadecanoic acid (rho = 0.488), C15:1 cis-10 pentadecanoic acid (rho = 0.473), C17:1 cis-10 heptadecanoic acid (rho = 0.411), C18:0 stearic acid (rho = 0.302), C24:0 lignoceric acid (rho = −0.280), C24:1 nervonic acid (rho = −0.276), C18:2n6t linoleic acid (rho = −0.272), C17:0 heptadecanoic acid (rho = 0.241), and C13:0 tridecanoic acid (rho = 0.238). After multivariate analysis C15:0 pentadecanoic acid remained statistically significant. The strongest correlation was found between IL-1Ra and fatty acids: C15:1 cis-10-pentadecanoid acid (rho = −0.357), C18:2n6t linoleic acid (rho 0.341) and C24:1 nervonic acid (rho 0.302), but after multivariate analysis significantly correlated remained: C22:1n9 13 erucic acid (rho = 0.299), C18:3n6 gamma-linoleic acid (rho = 0.277), with close to significant correlation with C22:4n6 docosatetraenoate (rho = −0.241, p = 0.055). Certain FFAs may play a role in enhancing both pro- and anti-inflammatory responses in the early subacute phase of stroke, where inflammatory and resolving processes are ongoing. Fatty acids such as C15:0 pentadecanoic acid, C15:1 cis-10 pentadecanoic acid and C22:4n6 docosatetraenoate might be involved in pro-inflammatory responses, while C22:1n9 13 erucic acid and C18:3n6 gamma-linoleic acid in the anti-inflammatory pathways with the overlay of IL-1β and IL-1Ra.
• Febrile convulsion and cervical lymphadenopathy as initial presentation of incomplete node-first Kawasaki disease.

  Anjum, Muhammad; Rafiq, Anjum (2025)

  Node-first Kawasaki disease (NFKD) is an atypical variant of Kawasaki disease (KD), presenting with fever and cervical lymphadenopathy before other classical features appear. This presentation often mimics bacterial cervical lymphadenitis (BCL), leading to misdiagnosis and treatment delays. We report a toddler initially treated for presumed BCL after presenting with a febrile convulsion and isolated lymphadenopathy. Failure to respond to antibiotics and the later appearance of rash, conjunctivitis and a small coronary artery aneurysm on echocardiography led to the diagnosis of incomplete NFKD. This case underscores the importance of early consideration of incomplete or atypical KD criteria in children with persistent fever and lymphadenopathy unresponsive to antibiotics. Delaying diagnosis until full clinical criteria develop may increase the risk of coronary complications. Early use of cardiac biomarkers, echocardiography and awareness of incomplete KD criteria can help distinguish KD from BCL, enabling timely diagnosis and treatment to improve outcomes.
• Evaluating advanced clinical practitioners' engagement with the four pillars of advanced practice in the UK: a scoping review

  Alsararatee, Hasan H (2025-12-25)

  Aims/Background Despite national frameworks outlining the four pillars of advanced practice (clinical practice, leadership and management, education, and research), engagement of Advanced Clinical Practitioners (ACPs) in the UK remains inconsistent, and significant challenges persist. This scoping review aimed to explore ACPs’ engagement with each pillar and to identify both successful and challenging factors. Methods A scoping review was conducted following Arksey and O’Malley’s framework in 2005 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken across five databases (CINAHL, MEDLINE, Scopus, PsycInfo, and Cochrane Library) and grey literature sources. The search covered studies published from 2017 to 2025, in line with the introduction of the Multi-professional Framework. A three-stage screening process was used to identify eligible studies, and data were extracted using a standardised form. Thematic analysis was employed to synthesise the findings. Results Thirty-three studies met the inclusion criteria. The review identified strong ACP engagement in clinical practice, including contributions to direct patient care, improved patient satisfaction, and reduced waiting times. However, engagement with the leadership, education, and research pillars was inconsistent and often limited by excessive workload, lack of protected time, and ambiguity in role definitions. Structural variation across National Health Service (NHS) trusts further contributed to disparities in advanced clinical practice role development and utilisation. Conclusion Advanced clinical practice roles are firmly embedded in clinical care but remain underutilised in leadership, research, and education. Addressing these disparities requires clearer career pathways, organisational investment, and structured policy support to enable ACPs to contribute fully across all four pillars of practice.
• Course review: Yorkshire clinical courses - essential plastic surgery skills for junior doctors course

  Rajananthanan, Asveny (2026-01)

  Circumspectus Medicinae Course Review: Yorkshire Clinical Courses - Essential Plastic Surgery Skills for Junior Doctors Course Rajananthanan, Asveny MBChB Author Information Annals of Plastic Surgery 96(1):p 7-9, January 2026. | DOI: 10.1097/SAP.0000000000004543 Buy Abstract Plain Language Summary Contemporary medical curricula exhibits substantial gaps in plastic surgery education, with 70 percent of medical students completing their training without formal exposure to the specialty. The Essential Plastic Surgery Skills (EPS) course addresses these educational deficits through simulation-based learning for junior trainees. The 2-day program, conducted at Waterton Park Hotel, Wakefield, attracted a global audience from medical students to general practitioners. Faculty comprised 17 experienced educators providing 1:3 teacher to student ratios with continuous feedback and personalised instruction. Day 1 covered fundamental skills including skin closure, lesion excision, and tendon repair using biological specimens. Day 2 advanced to burns management, skin grafting, flap reconstruction and microsurgical techniques utilising porcine and poultry models. Course evaluation demonstrated adequate simulation equipment with sufficient time allocation for comprehensive skill development. The EPS course bridges the gap between undergraduate and postgraduate surgical training through simulation, addressing practical skill deficits while providing skill acquisition opportunities in a controlled learning environment. The program represents structured experience for those trainees interested in seeking broad plastic surgery exposure or transferable surgical skills.
• The role of community nurses in rash examination, assessment and management

  Alsararatee, Hasan H (2026-01-02)

  Community nurses play a significant role in the identification, assessment and treatment of rashes and associated skin conditions. It is important for them to be familiar with the location, pattern, appearance and feel of different types of rashes for timely diagnoses and escalation, if required. This article explores the processes of inspection, palpation, diagnostic tools and management strategies relevant to community nursing practice.
• Pedicled flaps versus free radial forearm flap for phalloplasty in female to male gender-confirming surgery: a systematic review

  Netshiongolwe, Thendo; Mitchell, Sebastian; Kathiravelupillai, Senthooran; Subbiah, Praveen; Zien, Ming; Khajuria, Ankur (2025)

  Background: The field of gender-affirming surgery is rapidly evolving, with plastic surgery units worldwide increasingly offering these services. Phalloplasty is a critical component of female-to-male (FTM) transition, providing significant psychological and functional benefits. Although robust comparative trials are scarce, expert consensus favors the radial forearm free flap (RFF) when feasible. This systematic review directly compares outcomes of pedicle anterolateral flap (pALT) and the RFF in FTM gender-affirming surgery. Methods: A systematic review was conducted following the PRISMA guidelines, searching PubMed/Medline, Scopus, Web of Science, ProQuest, and EBSCO for eligible studies. Two independent reviewers screened and selected studies, resolving discrepancies by consensus. Flap survival and patient satisfaction were the primary outcome measures. Secondary outcomes included standing voiding ability, penetrative sexual function, number of operative stages, surgical duration, anesthetic techniques, and donor site morbidity or acceptance. Risk of bias was assessed using ROBINS-I, and evidence quality was evaluated using GRADE. Results: A total of 19 studies comprising 769 patients (614 RFF, 155 pALT) were included. Both techniques demonstrated comparable outcomes, although the ALT required significantly less operative time (RFF vs pALT, 290 vs 516 minutes). Flap failure rates were low for both groups (1.9% RFF, 0.6% pALT; P = 0.348), and patient satisfaction was high (78% RFF vs 76.2% pALT; P = 1.0). Risk of bias assessment indicated serious selection bias due to the observational nature of studies. GRADE evaluation rated the evidence as low, reflecting the absence of randomized trials in this field. Conclusions: The RFF remains the most reliable technique for phalloplasty, with the pALT serving as a secondary option when the RFF is not feasible. However, the limited number of studies and the lack of standardized outcome reporting in gender-affirming surgery make it difficult to draw definitive conclusions or establish evidence-based recommendations. Although both flap types are considered safe for female-to-male phalloplasty, the small patient cohorts and absence of randomized data contribute to the ongoing uncertainty in determining the optimal approach.
• Gastrointestinal Dystonia in children and young people with severe nurological impairment & palliative care needs: a systematic review

  Warlow, Timothy; Yates, Jill; Taylor, Naomi; Villanueva, Gemma; Koodiyedath, Bindu; McElligott, Fiona; Holt, Susie; Anderson, Anna-Karenia (2025-10)

  Background: Increasing numbers of young people with severe neurological impairment are suffering from gastrointestinal symptoms, which may result in nutritional failure and ultimately death. Gastrointestinal dystonia is a recently described clinical diagnosis amongst patients with severe neurological impairment, and no systematic review of existing evidence currently exists. Aim: To conduct a systematic review of existing evidence for the management of gastrointestinal dystonia in children and young people with severe neurological impairment and palliative care needs. Method: A systematic review assessing pharmacological and non-pharmacological treatments was undertaken using standard Cochrane methodology. We searched Cochrane CENTRAL, MEDLINE, EMBASE, and PsycInfo. All databases were searched from inception, and no language restrictions were used. Results: 1580 references were identified. After abstract screening, 56 references were reviewed at full text, and a case report and case series were identified for inclusion. Low-quality, indirect evidence exists for the management of gastrointestinal dystonia, including symptom management, hydration and nutrition decisions, and end-of-life care. Conclusions: There is a paucity of existing evidence directly relating to gastrointestinal dystonia, but low-quality indirect evidence from studies of children with severe neurological impairment and gastrointestinal symptoms exist, which may begin to inform clinical practice.
• Atypical case of Lemierre's syndrome secondary to cellulitis of the orofacial region

  Mepani, V.N; Visavadia, B. G. (2025-03-17)

  Lemierre's syndrome is a rare condition associated with infection of the oropharynx. We present an atypical case in a young healthy female who developed the condition secondary to a skin infection of the lip and chin. She also developed sepsis and chest pain. She was commenced on broad-spectrum antibiotics early and was fortunate to avoid aggressive surgical treatment. This case highlights the need for clinicians to consider this rare condition in addition to recognising its manifestations.
• The impact of nutrition misinformation on public health and practice: a review

  Alsararatee, H. H.; Yunusa, N. M. (2025-10-23)

  The widespread use of digital platforms, particularly social media, has transformed public access to nutrition information, presenting both opportunities and problems for public health. Although these platforms can enhance health education, they also facilitate the rapid spread of misinformation, often propagated by individuals without professional credentials. Nutrition misinformation shapes public perceptions and behaviours, with detrimental effects on dietary practices and increasing the burden of non-communicable diseases. Online content lacking peer review, scientific grounding or transparency can mislead individuals and erode trust in evidence-based nutrition science. Strategies to counter these effects include strengthening digital and health literacy, implementing policy reforms and ensuring that public health bodies provide accurate, engaging online information to build public resilience against misleading dietary claims.
• Respiratory failure with pregnancy: acute exacerbation of asthma or cardiogenic pulmonary oedema

  Gupta, Megha; Sharma, Dhruva (2025)

  We present a complex case involving a 37-year-old pregnant woman at 13 weeks of gestation who developed respiratory failure. The patient had a known history of asthma, which initially created a diagnostic challenge, resulting in treatment for an acute asthma exacerbation. However, as the patient's clinical condition deteriorated, further investigations were conducted, leading to a diagnosis of severe rheumatic mitral valve stenosis. The patient underwent emergency mitral valve replacement, unfortunately resulting in a miscarriage. Nevertheless, the final maternal outcome was favourable.
• Comparing foundation doctors' confidence and dermatologists' expectations in inpatient referrals: a multi-site survey

  Khorshid, Kimia S.; Fattahi, Arash; Khorshid, Mohsen (2025)

  Background: Inpatient dermatology referrals rely on non-dermatologist doctors to recognise and communicate skin problems effectively. Limited dermatology training during medical school may leave newly qualified doctors underprepared for this responsibility. Objectives: This study aimed to evaluate foundation doctors' confidence in core dermatological skills and knowledge and to compare these with dermatologists' expectations based on observed inpatient referral quality across two UK hospital sites. Methods: A cross-sectional survey was conducted at Basildon University Hospital and Northampton General Hospital in England. Foundation year doctors (n = 87) completed questionnaires assessing confidence (on Likert scales 1-5) in describing skin lesions, identifying urgent dermatological conditions, knowing what information to include in referrals, and using common treatments. Dermatologists (n = 8) were surveyed on expected referral information, common deficiencies, and examples of inappropriate referrals. Descriptive statistics were used to compare responses. Results: Across both sites, most foundation doctors reported low confidence in describing skin lesions and identifying serious dermatoses: only 8-29% rated themselves "confident" or "extremely confident." Over 65% were not confident in using different emollients (only 2-10% felt confident). Only ~30% of foundation doctors were aware of the British Association of Dermatologists (BAD) handbook. Dermatologists consistently expected detailed clinical information in referrals but noted that many lacked these elements. Common conditions like eczema, psoriasis, scabies, and drug eruptions were cited as being referred inappropriately. Conclusions: Foundation doctors reported limited confidence in fundamental dermatological assessment and management skills, reflecting inadequate undergraduate dermatology training. Dermatologists observed corresponding deficiencies in referral quality. This mismatch may lead to suboptimal patient management and unnecessary specialist referrals. Improving dermatology education for medical students and resident doctors is recommended, alongside clearer referral guidelines and continued dermatologist feedback.
• Multidisciplinary high-fidelity simulation training for the management of laryngospasm following general and local anesthetic procedures

  Ali, Suliman; Devabalan, Yadsan; Gao, Chuanyu; Bidaye, Rohan (2025)

  Introduction: Laryngospasm is a potentially life-threatening airway emergency characterized by sudden, involuntary contraction of the laryngeal muscles, leading to partial or complete airway obstruction. Effective management of laryngospasm hinges on prompt recognition and appropriate intervention. The increase in laryngeal procedures performed under local anesthesia in outpatient settings necessitates that all involved multidisciplinary healthcare professionals be proficient in recognizing and managing laryngospasm promptly. Methods: A simulation-based training day was designed to provide a structured, multidisciplinary approach to the recognition and management of laryngospasm through both theoretical learning and hands-on practical experience during two high-fidelity simulation scenarios, using advanced manikins and a realistic clinical environment to replicate real patient responses and team dynamics (local anesthetic and general anesthetic). Each scenario was followed by a structured debriefing session where participants received immediate feedback from faculty members. Pre- and post-course feedback forms were collected to assess changes in knowledge, confidence, and perceived competence, each considered a primary outcome representing complementary aspects of learning targeted by the training. Results: Around 19 pre- and post-questionnaires were evaluated. Roles varied from resident doctors, ENT consultants, healthcare assistants, nurses, CNS, and speech and language therapists. All participants completed both simulation scenarios, and feedback was collected after the full training day. Overall, there was a statistically significant improvement (p<0.05) in participants' confidence and perceived competence in recognizing and managing laryngospasm. Conclusions: This study suggests that a multidisciplinary high-fidelity simulation workshop can enhance confidence and perceived competence in managing laryngospasm across both local and general anesthetic scenarios. Although knowledge gains were not statistically significant, the training's greatest value lies in fostering non-technical skills such as communication, leadership, and teamwork, which underpin effective airway crisis management and patient safety. Future sessions incorporating larger cohorts, objective assessments, and anesthetist participation may further strengthen the educational and clinical impact of this multidisciplinary approach.
• Use of incentive spirometry to prevent acute chest syndrome (ACS) in patients with sickle cell disease (SCD): a systematic review

  Elkanzi, Tasneem; MohamedTaha, Ghadeer; Papageorgiou, Georgia (2025)

  Sickle cell disease (SCD) is a genetic hematological disorder that causes the production of sickle-shaped red blood cells. These abnormal cells reduce the oxygen-carrying ability around the body and obstruct blood flow, potentially resulting in devastating complications such as acute chest syndrome (ACS). The objective of this systematic review is to assess whether incentive spirometry is effective in reducing the incidence of ACS in patients with SCD. This review searched databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to August 17, 2025. Randomized controlled trials (RCTs) that used incentive spirometry in patients with SCD were included in the review. Inclusion criteria for this review include patients diagnosed with SCD who have received incentive spirometry, with outcomes compared against standard prevention for ACS or other alternative interventions aimed at preventing or managing lung pathology. Studies must report on at least one of the following outcomes: incidence of ACS, pulmonary function, hospital stay duration, hospitalization rates, or adverse effects. This study found that three RCTs (29 patients, 38 patients, and 20 patients with a total of 124 hospitalizations) were included in this review. Two studies compared incentive spirometry to standard care, while only one compared incentive spirometry to positive expiratory pressure (PEP). A meta-analysis was conducted between two studies, with one trial suggesting that incentive spirometry successfully reduced the incidence of ACS and the other trial suggesting that it could not successfully reduce it. A meta-analysis of both studies found that incentive spirometry did not successfully reduce the incidence of ACS in patients with SCD (RR=0.51; 95% CI (0.21, 1.33)). The quality of this evidence was very low, due to the wide confidence interval, high risk of bias, and substantial heterogeneity. This review concluded that incentive spirometry could not successfully reduce the incidence of ACS in patients with SCD. Limitations of the studies used included small sample sizes and heterogeneity between study populations (i.e., children vs. adults). Therefore, further research is required to assess this, including larger, well-designed RCTs to be conducted focusing on core outcome sets (COS).
• Patterns of antibiotic resistance in community-acquired infections: a study from a tertiary care hospital

  Habib, Aleeza; Rauf, Muhammad; Shah, Nandan Kumar; Roohani, Muhammad Umer; Qadar Roohani, Muhammad Hamzatul; Ahmad, Arbaz (2025)

  Background: Antibiotic resistance in community-acquired infections (CAIs) has emerged as a growing global concern with serious clinical and public health implications. Rising resistance to first-line therapies is reducing treatment effectiveness, increasing healthcare costs, and contributing to higher morbidity and mortality. Objective: The objective is to evaluate the patterns of antibiotic resistance among bacterial isolates from CAIs in patients presenting to a tertiary care hospital and to assess their associated clinical outcomes to inform empirical therapy and support antimicrobial stewardship initiatives. Methodology: A descriptive observational study was conducted at the Microbiology Department of Gujranwala Medical College, Gujranwala, Pakistan, from February 11, 2024, to February 11, 2025. The study included 560 individuals with suspected CAIs who tested positive for bacterial infection. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method in accordance with Clinical and Laboratory Standards Institute guidelines. Data analysis was conducted using Statistical Package for the Social Sciences version 26 (IBM Corp., Armonk, NY). Results: Of the 560 patients, 314 (56.07%) were men and 246 (43.93%) were women; 188 patients (33.57%) were aged 18-40 years. The most common specimen was urine (n = 234, 41.79%), followed by blood (n = 112, 20.00%). The predominant pathogens were Escherichia coli (n = 216, 38.57%) and Staphylococcus aureus (n = 104, 18.57%). Among E. coli isolates, 169 (78.24%) showed resistance to ciprofloxacin and 153 (70.83%) to ceftriaxone. Methicillin-resistant S. aureus (MRSA) was identified in 67 of 104 isolates (64.42%). Multidrug-resistant (MDR) organisms were detected in 188 patients (33.57%) and were significantly associated with treatment failure (38.30%), prolonged hospital stay (53.72%), antibiotic escalation (68.62%), and inhospital mortality (11.17%). Carbapenem-resistant infections were found in 32 patients (5.71%), with a mortality rate of 28.13% (n = 9). Conclusion: This study demonstrates a high burden of MDR organisms in CAIs, with poor clinical outcomes, particularly in carbapenem-resistant and MRSA infections. These findings emphasize the urgent need for strengthened antimicrobial stewardship, continuous surveillance of resistance trends, and locally tailored empirical treatment guidelines in community healthcare settings.

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