Identifying the body mass index of children awaiting dental surgery under general anaesthetic: an audit.

Children with overweight or obesity are at risk of experiencing perioperative complications during general anaesthesia (GA). At Guy's and St Thomas' NHS Foundation Trust in London, children who require dental surgery under GA are placed on a waiting list for the Dental Day Surgery Unit (DDSU) or the Evelina London Children's Hospital (ELCH), which has inpatient beds and a paediatric intensive care unit, depending on their body mass index (BMI) and centile thresholds. The waiting list for the ELCH is longer than for the DDSU.

Early investigation of sensorineural hearing loss enables diagnosis of rare metabolic diseases, such as mucopolysaccharidosis type III.

A toddler presented to audiovestibular medicine with mild bilateral, sensorineural hearing loss identified via the Newborn Hearing Screening Programme. This report focuses on the early clinical assessment and aetiological investigation which prompted testing for metabolic disease and highlights the parents' perspective. Early investigation led to a relatively early diagnosis of mucopolysaccharidosis (MPS) type IIIA: Sanfilippo disease which enabled the family to access a novel treatment option which otherwise would not have been possible.

Folic and folinic acid load tests for dynamic assessments of compliance and metabolism in folate deficiency and hyperhomocysteinaemia patients unresponsive to high-dose folate replacement.

We describe the utility of 'folic and folinic acid load tests' in the investigation of a 26-year-old woman with persistently low serum folate and moderate hyperhomocysteinaemia unresponsive to folic acid supplements. Serum folate, plasma 5-methyltetrahydrofolate (5-MTHF), red cell 5-MTHF and plasma total homocysteine at baseline, 2-h, 4-h and 2- or 4-days (if applicable) post administration of a large dose of oral folic acid, or oral or parenteral folinic acid were measured. The tests confirmed non-compliance but also suggested an unsuspected possible defect in the folate pathway based on differential response to folic versus folinic acid supplements.

Integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders: discrete choice experiment.

Background: Given the increasing recognition of the value of greater integration of physical and mental health services for children and young people, we aimed to evaluate preferences among parents for the characteristics associated with integrated health service provision for two conditions (eating disorders, functional symptom disorders).

Methods: Two discrete choice experiments (DCEs) were conducted, using electronic surveys. Participants were adult parents of children and young people.

Organic Foreign Body in the Eye, a Diagnostic Challenge: A Case of a Wooden, Intra-orbital Foreign Body Presenting at the Emergency Department.

Intra-orbital organic foreign body injuries occur within the eye but without the involvement of the orbit itself. A 39-year-old man self-presented to the emergency department complaining of sudden onset of pain surrounding his left eye and of reduced vision. The initial examination was unremarkable except for two healing lesion marks above his left upper eyelid.

IPEM topical report: guidance on 3D printing in radiotherapy.

There has been an increase in the availability and utilization of commercially available 3D printers in radiotherapy, with applications in phantoms, brachytherapy applicators, bolus, compensators, and immobilization devices. Additive manufacturing in the form of 3D printing has the advantage of rapid production of personalized patient specific prints or customized phantoms within a short timeframe. One of the barriers to uptake has been the lack of guidance.

Myocardial ischaemia following COVID-19: a cardiovascular magnetic resonance study.

The pathophysiology of myocardial injury following COVID-19 remains uncertain. COVID-HEART was a prospective, multicentre study utilising cardiovascular magnetic resonance (CMR) to characterise COVID-related myocardial injury. In this pre-specified analysis, the objectives were to examine (1) the frequency of myocardial ischaemia following COVID-19, and (2) the association between ischaemia and myocardial injury.

Weight discrimination partially mediates the longitudinal relationship between Body Mass Index and pain.

Pain is common among individuals with high Body Mass Index (BMI). This study investigated weight discrimination as a mediator of the longitudinal relationship between BMI and the presence of moderate/severe pain among adults from the English Longitudinal Study of Ageing (ELSA) cohort. ELSA is a longitudinal study of middle-aged and older adults living in England.

Need for and update on clinical trials for uncomplicated type B aortic dissection.

The mainstay of management for uncomplicated type B aortic dissection is currently optimal medical therapy, targeting blood pressure and heart rate, along with serial imaging. There is a paucity of data that informs whether early intervention with thoracic endografting in this group of patients will promote aortic remodeling and better long-term outcomes. Investigations to date, including the Investigation of Stent Grafts in Aortic Dissection (INSTEAD), INSTEAD-XL, and Acute Dissection: Stent Graft or Best Medical Therapy (ADSORB) studies, have compared thoracic endovascular aortic repair (TEVAR) with optimal medical therapy in patients with uncomplicated type B aortic dissection but have not shown a benefit for TEVAR conclusively.

Neurodevelopmental disorders in children with cleft lip and palate: a systematic review.

Individuals with orofacial clefts (OFCs) may be at an increased risk of developing autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). This systematic review provides a summary of the most recent data regarding the prevalence of ASD and ADHD in the OFC population and compares this to the general paediatric population. Multiple databases were searched including PubMed/Medline and Embase in July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42024565219).

Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method.

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management.

Functional Outcomes in the Distal End of Radius Fracture: A Prospective Study in a Tertiary Care Center.

Objectives: The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.

Methods: A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III.

Novel Diagnostics in Food Allergy.

Food allergy is increasing in prevalence, and poses significant challenges for individuals and their families, adversely impacting their quality of life. Misdiagnosis can lead to unnecessary dietary and social limitations, and increased food allergy risk, while failure to diagnose may result in life-threatening anaphylaxis. Therefore, a precise diagnosis is of the utmost importance; however, barriers exist at every stage of the diagnostic process.

A contemporary review of the management strategies for sickle cell disease related ischaemic and stuttering priapism.

Sickle cell disease is one of the most common autosomal recessive genetic disorders with 23% and over 70% of men with this condition, experiencing episodes of ischaemic priapism and stuttering priapism, respectively, with potentially severe consequences. The effective prevention of sickle cell disease induced ischaemic priapism and stuttering priapism requires a multidisciplinary and multimodal approach. A search of the English literature was performed utilising Pubmed® and Google Scholar to identify publications on contemporary and novel treatment options, with their associated treatment outcomes if available, that are utilised to prevent stuttering priapism episodes and hence a fulminant ischaemic priapism.

Covered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry.

Background: Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair.

The limited clinical utility of a routine creatine kinase (CK) on admission to a psychiatric inpatient unit.

Background: Creatine kinase (CK) is an intracellular enzyme expressed most commonly in tissues such as skeletal muscle. CK can be used as an investigation to support the diagnosis of conditions such as neuroleptic malignant syndrome (NMS), a rare idiosyncratic drug reaction - classically to antipsychotic medications - which can be fatal. Routine screening of CK in psychiatric inpatients is a known practice, but its value is uncertain.

Uncertainty-aware automatic TNM staging classification for [F] Fluorodeoxyglucose PET-CT reports for lung cancer utilising transformer-based language models and multi-task learning.

Background: [F] Fluorodeoxyglucose (FDG) PET-CT is a clinical imaging modality widely used in diagnosing and staging lung cancer. The clinical findings of PET-CT studies are contained within free text reports, which can currently only be categorised by experts manually reading them. Pre-trained transformer-based language models (PLMs) have shown success in extracting complex linguistic features from text.

Hydroxychloroquine in combination with platinum doublet chemotherapy as first-line treatment for extensive-stage small cell lung cancer (Study 15): A randomised phase II multicentre trial.

Background: Most patients with small-cell lung cancer (SCLC) present with extensive-stage (ES) disease and have a poor prognosis despite achieving high initial response rates to platinum-based doublet chemotherapy. This study evaluated whether adding hydroxychloroquine (HCQ) to chemotherapy could improve outcomes.

Methods: This was a randomised multicentre phase II trial.

Imaging NRF2 activation in non-small cell lung cancer with positron emission tomography.

Mutations in the NRF2-KEAP1 pathway are common in non-small cell lung cancer (NSCLC) and confer broad-spectrum therapeutic resistance, leading to poor outcomes. Currently, there is no means to non-invasively identify NRF2 activation in living subjects. Here, we show that positron emission tomography imaging with the system x radiotracer, [F]FSPG, provides a sensitive and specific marker of NRF2 activation in orthotopic, patient-derived, and genetically engineered mouse models of NSCLC.

Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative.

Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures.

Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting.

Chronic Inflammation Offers Hints About Viable Therapeutic Targets for Preeclampsia and Potentially Related Offspring Sequelae.

The combination of hypertension with systemic inflammation during pregnancy is a hallmark of preeclampsia, but both processes also convey dynamic information about its antecedents and correlates (e.g., fetal growth restriction) and potentially related offspring sequelae.

Serum Folate Concentrations in Exclusively Breastfed Preterm Infants Who Received No Supplementary Oral Folic Acid After Discharge: A Prospective Cohort Study.

Adequate folate intake is required in preterm infants for rapid growth and development, but there is little evidence to back recommendations. We aimed to assess folate status in preterm infants at discharge and in early infancy, according to exposure to folate sources, particularly in those exclusively/predominantly breastfed. A prospective, multicenter, observational cohort study was conducted in the UK, involving 45 preterm infants <33 weeks' gestational age (GA) exclusively/predominantly fed human milk when approaching NICU (Neonatal Intensive Care Unit) discharge.

Rationale and strategies for improving glycaemic control in diabetic patients undergoing cardiac surgery: a narrative review.

Background And Objective: The global prevalence of diabetes mellitus has markedly risen in recent years. Consequently, there has been a rise in the number of patients with diabetes undergoing cardiac surgery. Despite the existence of national and international guidelines to improve surgical outcomes in patients with diabetes, perioperative diabetes management optimisation remains inadequate resulting in these patients experiencing increased rates of surgical morbidity and mortality.