Chelsea and Westminster Hospital

A comprehensive review of maternal, obstetric and neonatal outcomes in pregnancies in females with cystic fibrosis (fwCF) following the introduction of Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy in a novel, dedicated CF-Maternal Health service. Retrospective data review from a CF-Maternal Health service between September 2020 and February 2025. A large adult-CF service in London, UK. Pregnant fwCF attending the Royal Brompton Hospital CF Service. Review of CF-Maternal Health service data. Maternal, obstetric and neonatal outcomes. Fifty-three fwCF completed 67 pregnancies, with 69 infants born. There were no stillbirths, neonatal or maternal deaths. ETI-therapy was reported in 81% of pregnancies. In fwCF without CF-Diabetes, 57% developed gestational diabetes. Hospital admission to treat an infective pulmonary exacerbation was required in 31% of pregnancies. Forty-five percent of pregnancies delivered vaginally; 78% of babies were born at term. A major congenital abnormality was diagnosed in 4% of infants. Baseline lung-function correlated positively with birth-weight and gestation at birth. FwCF have improved maternal, obstetric and neonatal outcomes since the introduction of ETI-therapy, within a dedicated CF-Maternal Health service.

As a pluricultural country, Mexico must promote breastfeeding through intercultural approaches. Although existing research remains limited, the exclusion and precarious living conditions experienced by many Indigenous communities render such efforts both challenging and essential for reducing inequalities in breastfeeding support. Moreover, while low breastfeeding rates at both global and local levels have been extensively documented through quantitative studies, the lived experiences of Indigenous mothers remain highly variable and underexplored. To date, qualitative research centered on Indigenous breastfeeding mothers' perspectives is scarce. This paper presents a case study of breastfeeding practices within a Tzeltal Indigenous community, examining the embodied, co-participatory, and situated dimensions of maternal care. Using qualitative methods and Interpretative Phenomenological Analysis within the 'Operational Research Group and Participatory Inquiry´ framework. A total of 19 Tzeltal-speaking mothers who were breastfeeding their children participated in the study, conducted on November 12, 2024, in the Tzeltal community of San Juan Cancuc, Chiapas. Data were collected through group sessions documented with field notes and audio recordings. The material was analyzed using conventional content analysis with emergent coding, grounding interpretations in participants' lived, embodied, affective, communal, and contextual breastfeeding experiences, allowing categories to be inductively generated from participants' narratives. The findings highlight that breastfeeding practices within a Tzeltal Indigenous community are not merely an individual act but a deeply relational, embodied and communitarian experience shaped by sociocultural, cosmogonic and spatial-contextual factors. This qualitative study, grounded in an intercultural perspective and centered on Indigenous mothers' breastfeeding experiences, advocates for a more nuanced, interculturally oriented approach to breastfeeding promotion, protection, and support -one that recognizes the affective, embodied, and collective dimensions of maternal care. By attending to local beliefs, cosmogonies, and shared practices surrounding traditional breastfeeding, the study offers crucial insights that contribute to advancing reproductive justice for women, infants, and their communities, while underscoring the importance of intercultural strategies in the design and implementation of breastfeeding policies in a pluricultural country such as Mexico.

Securing the appendiceal stump is a critical step in laparoscopic appendicectomy, the gold-standard treatment for managing acute appendicitis. Endoloops are widely used in appendiceal stump ligation owing to their simplicity and cost-effectiveness, but practice varies between surgeons in the use of one or two loops. This study aimed to compare outcomes between single and double endoloop closure and to explore surgeon perspectives. A mixed methods approach was used to compare the use of one or two endoloops. A retrospective cohort analysis included patients undergoing laparoscopic appendicectomy in a UK district general hospital between August 2023 and January 2025, comparing post-operative complications and operating time between single and double endoloop ligation. Overall complications were defined as any complications within the 30-day post-operative period while clinically relevant complications referred to intra-abdominal abscess, stump leak, or stump appendicitis. A focus group of operating surgeons was analysed thematically to explore decision-making factors. Among 191 patients included, 50 (26%) received a single endoloop and 141 (74%) received two. No statistically significant difference in clinically relevant 30-day complications was observed (12% vs. 9.9%; p = 0.07) with overlapping confidence intervals for all complication outcomes. Operative time was shorter in the single-endoloop group (84 ± 41.5 vs. 108.5 ± 31.9 min; p = 0.004). Thematic analysis identified three key influences on endoloop choice: perceived security through tradition, assessment of appendiceal base integrity, and training considerations. No statistically significant difference in clinically relevant post-operative complications was observed between single and double endoloop closure, although the study may be underpowered to detect rare events. Single endoloop closure was associated with a shorter operative time, which may be partly confounded by disease severity. Surgical decision-making remains influenced by training culture and tradition rather than evidence-based practice, and full standardisation is challenging given variability in case complexity and surgeon expertise.

There is evidence that living with obesity can affect an individual's pay and employment, but there is little evidence on the impact of weight-management interventions in improving labour market outcomes of individuals. We evaluate the impact of bariatric surgery on monthly earnings and employee status among working-age adults, and examine variations across sociodemographic characteristics. This population-based, retrospective longitudinal cohort study for England included 40,662 individuals who had a bariatric surgery procedure and obesity diagnosis between 1 April 2014 and 31 December 2022, with no bariatric surgery history in the previous 5 years, and were 25 to 64 years old at the date of surgery. 49,921 individuals sampled from the general population who had not had bariatric surgery were also included, matched by age and sex. The main outcome measures were monthly employee pay-for all months and only months where the individual was in paid employment-expressed in 2023 prices and paid employee status. Among people living with obesity who had bariatric surgery, there was a sustained increase in monthly employee pay from 6 months after surgery with a mean increase of £84 per month (95% confidence interval [Cl]: 63-106) 5 years after surgery compared with the 6 months before surgery. There was a sustained increase in the probability of being a paid employee from 4 months after bariatric surgery, with a mean increase of 4.3 percentage points (95% Cl: 3.7-4.9) 5 years after surgery. Bariatric surgery is associated with an increased probability of being employed, resulting in increased earnings. This suggests that living with obesity negatively impacts labour market outcomes and that obesity management interventions are likely to generate economic benefits both to individuals and on a macroeconomic level by increasing the likelihood of employment of people living with obesity.

Primary 48-week analyses of the WISARD trial showed maintenance of virological suppression in most participants with K103N mutation when switched from standard regimens to dolutegravir plus rilpivirine (DTG/RPV). In this proof-of-concept pilot study we evaluate 96-week efficacy and safety of DTG/RPV. Open-label, parallel, two-arm, randomised trial across 32 sites in seven European countries. Treatment-experienced HIV-1 participants with HIV RNA <50 copies/mL and documented prior K103N mutation, switched to DTG/RPV either immediately (DTG/RPV-I) or deferred after week 48 (DTG/RPV-D [control]; randomised 2:1). Endpoints were confirmed virological failure (CVF), virological suppression, safety, and changes in patient-reported outcomes from baseline to weeks 48/96. Of 140 randomised participants (95 DTG/RPV-I, 45 control), 4 had CVF by week 48 (3 DTG/RPV-I, 1 control) and 4 further patients had CVFs by week 96 (2 in each arm). Of the total 8 CVFs through week 96, HIV-1 RNA was ≥400 copies/mL in 4; only one sample amplified with no emergent DTG- or RPV-associated resistance mutations. The other three samples did not amplify due to insufficient sample. The week 96 proportion of subjects with virological suppression was 84.2% for DTG/RPV-I and 73.3% for DTG/RPV-D groups (difference +10.9%, 95% confidence interval -4 to +25.8; p=0.168). Serious adverse events were infrequent in both groups, and none were considered related to study medication. HRQoL, participant satisfaction, and sleep quality were stable over time and similar in both groups. Week 96 data confirm that switching to DTG/RPV maintains virological suppression and is safe in most participants with a history of K103N.

No abstract available.