Hull Royal Infirmary

Hypertension remains a leading contributor to cardiovascular morbidity and premature mortality worldwide, with increasing prevalence observed among younger populations. Although avoidable lifestyle factors account for a substantial proportion of hypertension risk, prevention efforts depend heavily on adequate awareness and understanding of these factors. This study examines the level of knowledge of avoidable risk factors of hypertension among university students in England and evaluates the relationship between these factors and hypertension status. A cross-sectional quantitative design was employed using a structured questionnaire administered to students at a large English university. Descriptive statistics, chi-square analysis, and multinomial logistic regression were used to analyse the data. Findings indicate a high level of knowledge of avoidable risk factors, including alcohol consumption, obesity, high salt intake, and junk food consumption. Despite this, significant associations were observed between several avoidable risk factors and hypertension status, particularly alcohol use, body mass index, salt intake, and frequent consumption of junk food. The results highlight a clear disjunction between knowledge and health behaviour, suggesting that awareness alone is insufficient to reduce hypertension risk among university students. The study underscores the need for prevention strategies that extend beyond information provision to address behavioural, social, and environmental drivers of risk.

Background: Gastric and gastro-oesophageal junction cancers encompass a heterogeneous group of malignancies with distinct histological and biological characteristics. Histological classification remains central to diagnosis, prognostication, and therapeutic decision-making, particularly in settings where molecular profiling is not routinely available. Objective: This study examined the histological spectrum and classification patterns of gastric and gastro-oesophageal junction cancers diagnosed over a ten-year period in Anambra State, South-East Nigeria. Methods: A retrospective review was conducted of gastric and gastro-oesophageal junction cancer cases diagnosed between January 2011 and December 2020 across four major histopathology laboratories in Anambra State. Archived haematoxylin and eosin–stained slides and paraffin blocks were reviewed. Tumours were classified according to the 2019 World Health Organization classification of gastric tumours, with carcinomas further categorised using the Lauren classification system. Descriptive statistics and chi-square testing were applied, with statistical significance set at p < 0.05. Results: Ninety-three cases met inclusion criteria. Carcinomas constituted the majority of tumours, followed by mesenchymal tumours, lymphomas, and neuroendocrine tumours. Tubular adenocarcinoma was the most frequent carcinoma subtype, while intestinal-type carcinoma predominated under the Lauren classification. Most graded carcinomas were well differentiated. No statistically significant associations were identified between histological subtype and patient age or sex. Conclusion: Gastric and gastro-oesophageal junction cancers in this setting are dominated by epithelial malignancies, particularly tubular and intestinal-type adenocarcinomas. The observed histological profile aligns with patterns reported across Nigeria and other low- and middle-income settings, underscoring the continuing relevance of morphology-based classification in regional cancer practice.

A 38-year-old woman with relapsing-remitting multiple sclerosis (RRMS) treated with alemtuzumab developed severe Graves’ thyrotoxicosis presenting with palpitations, chest tightness, dizziness, and marked tachycardia with a heart rate of 160 per minute. Despite escalating antithyroid medications and beta-blockers, her condition progressed to thyroid storm that was resistant to medical therapy. Urgent total thyroidectomy was performed after preoperative euthyroidism was achieved with Lugol’s iodine. Histopathology confirmed Graves’ disease and revealed an incidental papillary thyroid carcinoma. This case is unique because it illustrates a rare instance of alemtuzumab-induced autoimmune thyroid disease progressing to treatment-refractory thyroid storm, further complicated by an incidental papillary thyroid carcinoma, an extremely uncommon coexistence. It highlights the need for heightened vigilance in monitoring alemtuzumab-treated patients for severe thyroid dysfunction and the importance of timely surgical intervention when medical therapy fails. Overall, it emphasizes that alemtuzumab-related thyrotoxicosis can evolve into a life-threatening treatment-resistant thyroid storm, and concurrent thyroid malignancy may be found incidentally, underscoring the value of multidisciplinary management and early surgical consideration.

<bold>Introduction:</bold> Remission is now an aspiration for asthma patients on biologics, although there is no agreed definition. Predicting the likelihood of remission at an early stage on treatment would improve precision therapy. <bold>Aims:</bold> To identify the characteristics at 4 and 16 weeks on treatment associated with remission at 1 year in a real-world asthma cohort on benralizumab. <bold>Methods:</bold> BenRex is a multicentre study of exacerbations on benralizumab for severe eosinophilic asthma. We defined remission at 1 year as meeting all of: no OCS for asthma (for maintenance/exacerbation); ACQ <1.5 and FEV1 ≥ 80% predicted and/or ≥ 10% higher than baseline FEV1% predicted. Forest plots of associations between early changes at 4 and 16 weeks and remission at 1 year were derived from logistic regression models. <bold>Results:</bold> 36 of 136 subjects (26.5%) met remission criteria. Subjects achieving remission were older (p=0.04). Male and female participants achieved remission at similar rates (p=0.84). Fig 1 shows predictors of remission using changes from baseline at 4 and 16 weeks. FEV1 and SGRQ improvement are strongly associated with subsequent remission. <bold>Conclusion:</bold> An improvement in FEV1 of ≥100 ml and SGRQ change of double the MCID at 4 and 16 weeks on benralizumab are strongly associated with clinical remission at one year. <fig><object-id>erj;66/suppl_69/PA4619/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder and Skin changes) syndrome is a rare paraneoplastic syndrome caused by a clone of aberrant plasma cells, mostly prevalent in middle-aged men. This is very rare, especially in women of reproductive age group. We are presenting a rare case of POEMS syndrome in pregnancy, who suffered from a full-blown picture of the multisystem involvement of hypothyroidism, hyperprolactinaemia, Empty Sella syndrome leading to panhypopituitarism and benign intracranial hypertension, peripheral neuropathy with trigeminal neuralgia and adrenal insufficiency. She was treated with autologous stem cell transplantation with adjuvant chemotherapy. This case report is a detailed description of the journey from in vitro fertilisation to delivery, the numerous challenges faced and how this was managed with the help of a multidisciplinary involvement to provide optimum perinatal outcome for the patient. Lack of any proper guideline about management of this rare syndrome in pregnancy made this more challenging.

Introduction: Blunt abdomen trauma is common in surgical emergencies. Faster detection of intra-abdominal damage in BAT patients using a FAST scan and CT scan can lead to early treatment, reducing complications associated with late detection. This study aims to evaluate the diagnostic accuracy of FAST scans compared to CT scans in detecting intra-abdominal injuries. Methodology: The study, conducted at Lahore General Hospital's Emergency Department from July 3, 2024, to January 2, 2025, enrolled 366 subjects meeting inclusion criteria. Patients had initial FAST exams and subsequent CT scans. FAST scans, performed by supervised residents using SAOTE MYLAB SEVEN, focused on detecting free intra-abdominal fluid in three pouches. Positive FAST results indicated fluid presence, leading to CT confirmation. Regardless of USG readings, all patients underwent FAST to compare outcomes and assess injuries for recording alongside patient details in a study proforma. Data was analyzed using SPSS V-20 for diagnostic measures. Results: In this study, 336 patients were enrolled meeting the criteria. 66.7% were males and 33.3% were females. Ages ranged from 14 to 50 years, with a mean of 32.3±12.6 years. The study found FAST scan sensitivity at 94.5%, specificity at 80.6%, PPV at 95.5%, NPV at 86.9%, and accuracy at 91.9% for identifying intra-abdominal injury positively. Conclusion: The FAST scan shows diagnostic accuracy similar to CT scans, based on local and international data, making it useful for triaging blunt abdominal trauma patients.

The aim of our study was to assess the mid-term efficacy and safety of the FREDX flow diverting stent (FDS) in the treatment of intracranial aneurysms. The FREDX FDS is relatively new with limited data on its longer-term effectiveness and safety profile. Patients with intracranial aneurysms treated with the FREDX FDS at two UK centres, between March 2021 and July 2022 with at least 18months follow-up, were retrospectively reviewed. Clinical, procedural and imaging data was analyzed. Twenty-two patients with 24aneurysms treated with the FREDX device, and had completed at least 18months of follow-up, were included in this study. The rate of complete aneurysm occlusion (Raymond-Roy ClassI) was 83.3% at amean follow-up duration of 21.5 months. One case of major adverse event (4.3%) related to apost-procedural stroke which is also the only case of permanent neurological deficit (4.3%) in our cohort. Three cases of minor adverse events (13.0%) and 2cases of asymptomatic adverse events (8.7%) were also recorded. Use of the FREDX FDS to treat intracranial aneurysms has acceptable safety profile and efficacy in the mid-term.

PurposeTo describe diagnostic approaches and management strategies for patients with primary hyperparathyroidism (PHPT) and recent fracture in England.MethodsWe developed a survey based on a patient at high fracture risk and a new diagnosis of probable PHPT. The survey was circulated among 50 secondary care professionals identified by the Society for Endocrinology Calcium and Bone special interest group. Descriptive statistics, combinatorial, and thematic analyses were employed.ResultsIn the patient with hyperparathyroidism and a recent fracture, 54% of respondents favoured a 24-hour urinary calcium: creatinine clearance ratio, with 85% opting to do so after correcting vitamin D levels. Thirty-two percent (16/50) preferred the spot urinary calcium:creatinine clearance ratio, as a random test (56%, n = 9/16). Ninety-six percent of the respondents agreed they would include a fracture risk assessment in their management plan. Eighty-five percent of the respondents selected dual-energy X-ray absorptiometry scans of the lumbar spine, total hip, and femoral neck as the most popular choice. Before initiating antiosteoporotic medications (AOMs), 94% of the respondents preferred correcting vitamin D levels with diverse regimens. IV zoledronate acid was the preferred AOM, and 58% (n = 29/50) supported cinacalcet usage if the patient was ineligible for parathyroid surgery, while 26% (n = 13/50) opposed cinacalcet use entirely. No significant correlation was found between status as an endocrinology consultant or working in a tertiary care hospital and these management preferences.Main ConclusionThis study of National Health Service medical staff identified highly-varied clinical practices in managing PHPT in the setting of high fracture risk, highlighting the need for pragmatic guidelines and wider education.

Healthcare delivery is made more convenient and effective via telemedicine, which enables physicians to conduct virtual consultations and evaluations with pediatric patients. The purpose of this systematic review was to evaluate the efficacy of telemedicine as compared to physical appointments in the pediatric population. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for the available literature using pre-specified inclusion and exclusion criteria. These databases provided 968 relevant research articles, which Endnote software screened for duplicates. Fourteen studies were considered relevant for full-text evaluation. After complete text evaluation, only 11 of these articles were found to be relevant. The Newcastle-Ottawa Scale (NOS) was used for the risk of bias assessment of all included studies. Eleven articles in all satisfied the requirements for inclusion and were added to the review. Every study was classified as either a cluster randomized trial (27%) or a randomized controlled trial (RCT) (73%). There were between 22 and 400 participants in each trial. Medical conditions evaluated included obesity (27%), mental health disorders (9%), asthma (18%), otitis media (9%), skin disorders (9%), type 1 diabetes (9%), attention deficit hyperactivity disorder (ADHD) (9%), and pancreatic insufficiency associated with cystic fibrosis (1/11). Telemedicine strategies employed included telemedicine-based screening visits (9%), smartphone-based therapies (27%), phone counseling (18%), and videoconferencing visits between patients and doctors (45%). The outcomes of the telemedicine procedures in every included study were on par with or superior to those of the control groups. Medication adherence, appointment completion rates, life satisfaction, symptom management, and disease progression were all outcomes associated with these findings. Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, healthcare professionals, and caregivers may benefit from using both telemedicine services and traditional in-person healthcare services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.