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Global prevalence of metabolic syndrome in patients with Rheumatoid arthritis: a systematic review and meta-analysis.
No full textBACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that increases the risk of systemic complications, particularly metabolic syndrome (MetS). MetS, defined by central obesity, hypertension, hyperglycemia, and dyslipidemia, not only raises cardiovascular risk but also worsens the prognosis of RA. This meta-analysis aimed to estimate the global prevalence of MetS in RA patients and identify clinical factors contributing to its occurrence. METHODS: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science. Studies included in the analysis diagnosed RA and defined MetS using standardized guidelines. Pooled estimates were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. All statistical analyses were conducted using Stata. The study is registered with PROSPERO (CRD420251007337). RESULTS: The overall pooled prevalence of MetS among RA patients was 30.3% (95% CI: 28.5-32.2). Country-specific analyses showed the highest prevalence in Iraq (57.3%; 95% CI: 49.7-66.4), Croatia (49.6%; 95% CI: 35.8-63.3), and Singapore (47.1%; 95% CI: 42.7-51.6), and the lowest in Congo (12.0%; 95% CI: 5.5-20.5), Algeria (14.0%; 95% CI: 10.0-18.7), and South Korea (17.2%; 95% CI: 7.3-30.1). When stratified by continent, the estimates varied noticeably. In Africa, the proportion was 25.7% (95% CI: 21.6-30.0%); in Asia, the estimate rose to 30.8% (95% CI: 27.1-34.6%); Europe recorded a similar figure at 29.8% (95% CI: 26.9-32.7%); North America had an estimate of 31.1% (95% CI: 25.5-36.9%); and South America demonstrated the highest proportion at 38.8% (95% CI: 34.4-43.3%). Meta-regression analyses identified significant associations between MetS prevalence and key clinical variables, including waist circumference (WC) (β = 0.01; P = 0.01), body mass index (BMI) (β = 0.04; P < 0.01), triglycerides (TG) (β < 0.01; P = 0.04), and fasting blood glucose (FBG) (β < 0.01; P < 0.01), with high-density lipoprotein (HDL) levels showing an inverse association (β = -0.01; P < 0.01). Among various diagnostic criteria, the highest prevalence estimates were obtained with the National Cholesterol Education Program and International Diabetes Federation (NCEP/IDF) criteria (39.2%; 95% CI: 30.6-48.1), followed by the Joint Consensus (JC) criteria (37.2%; 95% CI: 28.0-46.9) and the 2004 revision of the National Cholesterol Education Program ATP III (NCEP 2004) criteria (35.4%; 95% CI: 29.0-42.0). CONCLUSION: The substantial prevalence of MetS among RA patients underscores the need for a proactive, integrated approach to cardiovascular risk management. Clinicians should consider routine screening for MetS components-such as central obesity, hypertension, dysglycemia, and dyslipidemia-particularly given the significant associations with WC, BMI, TG, and FBG levels. CLINICAL TRIAL NUMBER: Not applicable
Surgical training for simple and complex hernia repair in the UK: results of a nationwide training survey.
Get PDFIntroduction: Abdominal wall reconstruction (AWR) is increasingly recognised as a subspecialty in general surgery, owing to the growing complexity and advancement of hernia repair techniques. Concerns have been raised among UK hernia specialists about current surgical training adequately preparing trainees for both simple and complex hernia procedures. Methods: A CHERRIES-compliant survey was developed by a panel of hernia experts to evaluate UK training in hernia surgery. The 41-item questionnaire assessed perceived competence and confidence in performing eight types of hernia repair, categorised as simple (primary inguinal, umbilical, laparoscopic inguinal and Rives-Stoppa) or complex (recurrent inguinal, component separation and parastomal hernia repair), along with broader AWR-related topics (open abdomen management, participation in multidisciplinary meetings). The survey was disseminated via social media, targeted chat groups and surgical conferences. Results: The survey was conducted from 21 January to 27 September 2024. Of approximately 500 possible respondents, 116 completed the survey (47 surgical trainees (ST) 7-8s, 30 clinical fellows and 34 consultants), yielding an estimated 22.2% response rate. Curriculum requirements were met only for open inguinal and umbilical hernia repair. Although there are no formal curriculum requirements for complex repairs, trainee exposure remains limited; two-thirds had performed fewer than ten recurrent inguinal or component separation procedures. For parastomal hernias, confidence was highest with suture repair despite these being associated with poor outcomes. Overall, median confidence scores were highest for simple repairs and lowest for complex ones. Conclusions: Current UK surgical training provides inadequate exposure to complex AWR, highlighting the need for targeted curriculum improvement.https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2025.0065?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubme
A modified guidewire reinsertion technique following inadvertent wire removal during dynamic hip screw fixation surgery
No full texthttps://publishing.rcseng.ac.uk/doi/full/10.1308/rcsann.2024.004
Diagnostic tools and methods for dermatological assessment
No full textAdvanced clinical practitioners (ACPs) play an essential role in dermatological care but often encounter challenges due to limited training in dermatological assessments and investigations. This two-part series aims to address these gaps by offering a structured approach specifically for ACPs. Part one focused on conducting a thorough history-taking and physical examination to establish a solid foundation for diagnosis. Part two contributes to the existing literature by detailing essential diagnostic tools and emerging technologies that empower ACPs to enhance diagnostic accuracy and patient-centred care. These include traditional methods such as skin biopsies, histopathology, microbiological testing, immunofluorescence, dermatoscopy and relevant blood tests, as well as innovative advancements such as artificial intelligence (AI) tools and imaging techniques. In addition, the integration of quality-of-life (QoL) measures highlights the broader impact of skin diseases on patients' mental and emotional wellbeing. By combining clinical examination skills, diagnostic innovations and holistic assessments ACPs can provide more effective and empathetic dermatological care, ultimately improving outcomes and diagnostic confidence.https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2024.038
Caesarean Section Following Abdominoplasty With Mesh Repair: A Case Report.
Get PDFAbdominoplasty with mesh reinforcement is an increasingly used surgical technique for abdominal wall restoration, but there is limited literature regarding pregnancy and delivery following such procedures. We report the case of a 38-year-old woman with a history of previous caesarean section and subsequent abdominoplasty with mesh repair who underwent an elective caesarean section at 39 weeks' gestation. Intraoperatively, the mesh was encountered beneath the rectus muscles and was sharply dissected to access the peritoneal cavity. The baby was delivered via a standard lower uterine segment incision. Estimated blood loss was 1500 millilitres, and the patient had an uneventful recovery. Literature regarding caesarean delivery after abdominoplasty with mesh is scarce, with only isolated reports available. While mesh reinforcement provides structural benefits, it raises potential concerns for subsequent pregnancy and surgical access. Our case demonstrates that caesarean section after mesh-reinforced abdominoplasty is feasible with careful surgical planning. This report highlights the technical considerations of caesarean section in women with prior mesh repair and underscores the need for further long-term follow-up to assess maternal outcomes and abdominal wall integrity
Factors predicting conversion from colon capsule endoscopy to conventional optical endoscopy-findings from the CESCAIL study
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
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view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.Background Colon capsule endoscopy (CCE) has become an alternative to traditional colonoscopy for low-risk patients. However, CCE's low completion rate and inability to take biopsies or remove polyps often result in a CCE-to-conventional colonoscopy conversion (CCC). Objective(s) The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods This prospective study analysed data from patients who underwent CCE as part of the CESCAIL study from Nov 2021 till June 2024. Predictive factors were examined for their association with CCC, including patient demographics, comorbidities, medications, and laboratory results from symptomatic and surveillance groups. Statistical methods such as LASSO, linear, and logistic regression were applied. Results Six hundred and three participants were analysed. Elevated f-Hb levels (OR = 1.48, 95% CI:1.18–1.86, p = 0.0002) and smoking (OR = 1.44, 95% CI: 1.01–2.11, p = 0.047) were significantly associated with CCC. The area under the curve (AUC) of elevated f-Hb for predicting CCC was 0.62 after adjusting for confounders. Diabetes was linked to poor bowel preparation (OR = 0.40, 95%CI:0.18–0.87, p = 0.022). Alcohol (p = 0.004), smoking (p = 0.003), psychological conditions (p = 0.001), and haemoglobin levels (p = 0.046) were significantly associated with the number of polyps, whilst antidepressants (p = 0.003) and beta-blockers (p = 0.001) were linked to the size of polyps. Conclusion Non-smokers with lower f-Hb levels are less likely to need conventional colonoscopy (CCC). Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness.https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03828-
Oncologic outcomes of template versus radioguided salvage lymph node dissection for node-only recurrent prostate cancer on prostate-specific membrane antigen Positron emission tomography scan: results from a multi-institutional collaboration.
No full textIn patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer, whether radioguided surgery (RGS) might improve oncologic outcomes as compared with template sLND remains unknown. This study included 259 patients who experienced a prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy and underwent pelvic sLND at 11 tertiary referral centers between 2012 and 2022. Lymph node recurrence was documented by prostate-specific membrane antigen positron emission tomography scans. The outcomes included biochemical recurrence (BCR) and clinical recurrence (CR) after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. A Cox regression analysis was used to test the hypothesis that surgical technique for sLND (template vs RGS) might be associated with oncologic outcomes. Overall, 80 (31%) and 179 (69%) patients received template and radioguided sLND, respectively. PSA level at sLND was higher in the template than in the radioguided group (median: 1.3 vs 0.6 ng/ml; p < 0.0001), whereas the number of positive nodes on final pathology did not differ between the groups (p = 0.13). The first postoperative PSA level was higher in the template than in the radioguided group (median: 0.5 vs 0.1 ng/ml; p < 0.0001). Overall, there were 181 cases of BCR and 76 cases of CR after sLND. The median follow-up for survivors was 21 mo (interquartile range: 7, 36). The 2-yr BCR-free survival rate for patients in the template versus RGS sLND group was 18% (95% confidence interval [CI]: 9%, 29%) versus 30% (95% CI: 22%, 37%). The 2-yr CR-free survival rate for the template versus RGS sLND group was 51% (95% CI: 35%, 65%) versus 73% (95% CI: 65%, 80%). On multivariable analyses, we did not find evidence of a statistically significant difference between the groups with respect to BCR after sLND (p = 0.7), whereas men treated with RGS had a lower risk of CR after sLND than those receiving template sLND (hazard ratio: 0.51; 95% CI: 0.29, 0.92; p < 0.026). Results of the sensitivity analyses were generally consistent with our main findings. Our data suggest that, in men with node-recurrent prostate cancer treated with sLND, RGS may offer important surgical guidance for surgeons, and this may eventually translate into improved oncologic outcomes. Awaiting further evidence on long-term outcomes of RGS, our study represents the most solid comparative data on different techniques for sLND and provides relevant data for counseling patients with node-only recurrent prostate cancer.https://www.eu-focus.europeanurology.com/article/S2405-4569(25)00149-X/abstrac
Consensus on long-term follow-up and surveillance of elective primary shoulder arthroplasty using a real-time Delphi technique.
Get PDFBACKGROUND: Long-term follow-up of elective primary shoulder arthroplasty remains contentious. A real-time Delphi technique allows a single survey to obtain a consensus from experts on the optimum surveillance protocol. METHODS: A real-time Delphi consensus study was delivered using Surveylet. Delphi statements surveyed whether a type of shoulder arthroplasty requires follow-up in the initial 10 postoperative years and beyond 10 postoperative years. Further statements related to surveillance episode format were included. British Elbow and Shoulder Society members were invited to participate. Participants rated agreement with statements using a 5-point Likert scale. Study results were used to produce expert-opinion recommendations that were presented to a patient group. RESULTS: The study received 37 responses of which 31 were complete. 78% of respondents were orthopaedic surgeons and 19% were physiotherapists. Mean survey visits per participant was 3.8 (total 140). The patient group included 13 patients. Consensus agreement was reached on surveillance requirement for numerous shoulder arthroplasty types and aspects of surveillance format, including requirement for radiological assessment and completion of a patient-reported outcome measure. All patients expressed agreement with the resulting expert-opinion recommendations. DISCUSSION: A real-time Delphi among expert clinicians identified areas of consensus in long-term surveillance of elective primary shoulder arthroplasty
Venous Thromboembolism (VTE) risk assessment in acute inpatient mental health wards in Sherwood Oaks and Millbrook Unit (now Blossomwood Unit), Nottinghamshire Healthcare NHS Foundation Trust
No full textAims: To assess compliance with the trust policy and NICE guidelines on VTE risk assessment for new admissions into the acute psychiatric wards in Millbrook and Sherwood Oaks mental hospitals, Nottinghamshire NHS Foundation Trust. Method(s): A retrospective audit looked at case notes of patients aged 20-80 years, admitted within a 2 weeks period across 8 wards in April 2023. This was re-audited in April 2024 after all recommendations were actioned. Infornation was collated and manually analysed. Data collected included but not exclusive to date of admission, date VTE risk assessment was done and the level of VTE risk identified. These were compared with the standard criteria which were the trust policy 02.21 - 'Patients who are admitted should have VTE risk assessment within 24 hours of admission' and the NICE guidelines NG(82) 2019 - 'Assess all acute psychiatric patients to identify their risk of VTE and bleeding as soon as possible after admission to hospital or by the time of the first consultant review'. Result(s): The first cycle found that only 69.3% of the patients admitted were assessed on admission (with 50% assessed within 24 hours of admission) whereas 30.7% were not assessed throughout the duration of their admission. The second audit cycle showed remarkable improvements. 80.5% were assessed for VTE risk (63.9% within 24 hours of admission) whereas 19.5% were not assessed. The level of risk was categorized into low, moderate and high risk using Well's scoring system. 69% of patients who were assessed in the first cycle, had low risk but risk of 31% of the cohort of patients audited were unknown because they were not assessed. In the second cycle,80.5% had low risk whereas 19.5% of the patients fell under the unknown category due to not having been assessed. Conclusion(s): The importance of VTE risk assessment in acute inpatient wards can never be overemphasized. Studies show that psychiatric inpatients are likely to be at an increased risk of VTE due to - use of psychotropic agents, reduced mobility, dehydration as a result of self-neglect or suicidal attempts, prolonged restraints, sedation, co-morbid physical health problems etc. There are still lapses in our patient management that need to be considered in order to provide an outstanding patient care and safety.https://www.cambridge.org/core/journals/bjpsych-open/article/venous-thromboembolism-vte-risk-assessment-in-acute-inpatient-mental-health-wards-in-sherwood-oaks-and-millbrook-unit-now-blossomwood-unit-nottinghamshire-healthcare-nhs-foundation-trust/CB41617A3AAF4A31D40FA57D455DC06
Is open pyeloplasty still a practical option for pediatric patients in resource-limited settings compared to laparoscopic and robotic approaches?
No full textOBJECTIVE: To explore the feasibility of open pyeloplasty (OP) for treating pediatric pelviureteric junction obstruction in resource-limited settings in the era of robot assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP). METHODS: A total of 168 patients (56 each) were randomized to receive RALP, LP, or OP, respectively. RESULTS: The operative time for the RALP was significantly higher (P < 0.001) compared to LP and open OP. The length of stay (LOS) for RALP and LP was substantially lower (P < 0.001) compared to the OP, with average stays of 2.8 ± 1.5 days, 3.1 ± 1.2 days, and 6.4 ± 8.1 days, respectively. In the RALP group, 54 (96.4%) had a non-obstructed drainage pattern post-operatively compared to 52 (92.8%) in the LP group, and 53 (94.6%) patients in the OP group (P = 0.363). Only 2 (3.6%) patients in the RALP group and 4 (7.1%) patients in the LP group, and 3 (5.3%) patients in OP group, exhibited obstructed drainage on dynamic nuclear scan. Grade II complications (urine leakage) occurred in 2 patients in the RALP cohort, and in 3 patients in the LP cohort. The leakage typically resolved within 10 days and did not require further intervention. Higher-grade complications (Clavien Grade 3 and 4a), such as hydronephrosis, were identified in both the RALP and OP groups (one case each). CONCLUSION: Due to comparable success rates and minimal complications, OP is a viable alternative to minimally invasive RALP and LP in treating pediatric patients with PUJO, particularly where cost and equipment availability are limiting factors