James Paget University Hospital

Head trauma is a major cause of chemosensory deficit, with olfactory loss occurring in approximately 22% of cases. Following head injury, olfactory and gustatory loss are often unassessed; patients are often unaware of the problem, thus presenting late to specialist clinics. To determine the role of screening olfactory and gustatory testing in patients following head trauma. This prospective cohort study, conducted at three secondary hospitals, included patients with head injury aged ≥ 18 years, with capacity to consent within 30 days of injury. Patients with previous head injury requiring admission or with pre-existing olfactory/gustatory loss were excluded. Participants underwent screening chemosensory assessment using Burghart Sniffin' Sticks and Taste Strips. If significant loss was identified, patients were referred to Smell & Taste clinic to be seen within 3 months of injury for extended testing. A total of 121 participants took part in the study (65 male, 56 female); 71% experienced olfactory dysfunction and 62% gustatory dysfunction post head injury. There was no statistically significant association between gender and olfactory/gustatory dysfunction (p > 0.05). Older participants experienced a higher prevalence of olfactory and gustatory dysfunction. Seven participants progressed to a follow-up consultation in the Smell & Taste Clinic, all of whom had persistent olfactory dysfunction. Our study highlights that a significant proportion of mild head injuries result in olfactory/gustatory dysfunction, thus reinforcing the use of psychophysical testing in this patient cohort. Improvements should be made to ensure they receive suitable follow-up in a Smell & Taste clinic.

Background:Orthoplastic surgery integrates orthopedic and plastic surgical expertise and principles in the context of complex lower limb pathologies involving bone and soft tissue. Rapid advancements in the field have revolutionized the multidisciplinary approach to such conditions and have allowed for advancements in techniques used and outcomes achieved. We performed the first bibliometric analysis focused on the 100 most-cited articles related to lower limb orthoplastic surgery (LLOS) to analyze emerging trends and provide guidance for future research in the field.Methods:The 100 most-cited articles related to LLOS were identified on Web of Science across all databases and all years. Study details, including total citation count, study outcomes, primary orthoplastic pathology, and the modality used, were extracted, and the level of evidence was also assessed.Results:The 100 most-cited articles in LLOS were referenced by a total of 12,225 articles. Citation counts per article ranged significantly from 62 to 691 (mean: 103 ± 88.9). The majority of studies were retrospective cohorts (n = 59, mean citations: 139.8 ± 110.5). Only 1 study achieved level I status, highlighting a significant gap in methodological quality research within the field. Most studies focused on clinical outcomes (n = 88), whereas trauma and open fractures were the most common pathologies (n = 94), and flap coverage was the most common orthoplastic modality (n = 79) discussed.Conclusions:Overall, the majority of the most influential articles in LLOS are of lower level evidence. Future research should prioritize improving methodological rigor and applying orthoplastic principles beyond trauma care.

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical approach for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) seeking bowel continuity. While laparoscopy improves recovery, robotic-assisted surgery may offer advantages in pelvic procedures. However, its comparative efficacy remains unclear. This systematic review followed PRISMA guidelines to compare short-term outcomes of robotic-assisted IPAA with laparoscopic and open techniques. Literature was searched across PubMed, Embase, Web of Science, and the Cochrane Library for studies from January 2000 to June 2025. Included studies compared adult patients (≥ 18years) undergoing IPAA for malignancy, UC or FAP. Primary outcomes were operative time, blood loss, hospital stay, and complications; secondary outcomes included conversion to open surgery, readmission, and reoperation. Meta-analysis was performed using pooled odds ratios, mean difference and 95% confidence intervals. Ten studies including 3,166 patients met inclusion criteria. Robotic IPAA was associated with a shorter length of stay (WMD - 1.1days, 95% CI - 1.8 to - 0.3) and a non-significant trend toward fewer conversions to open surgery (OR 0.33, 95% CI 0.10-1.13). However, robotic procedures had longer operative times. Estimated blood loss did not differ significantly, and no significant differences were found in postoperative complications, anastomotic leaks, readmissions, or reoperations. Robotic-assisted IPAA is a safe and viable alternative to laparoscopic and open surgery, offering benefits in shorter hospital stay and conversion rates. Although operative times are longer, morbidity is comparable. Further prospective studies are needed to confirm these findings and evaluate long-term functional outcomes.

Abstract Background/Aims Central retinal artery occlusion (CRAO) is one of the ocular manifestations of giant cell arteritis (GCA), presenting in up to 14% of GCA patients with eye symptoms. Typically, this presentation is unilateral; however, bilateral CRAO is exceptionally rare in GCA. Diagnosis poses challenges, particularly in the subset of GCA patients, termed as occult GCA, who primarily manifest with eye symptoms and may exhibit normal inflammatory markers. A high suspicion of GCA is crucial in cases of bilateral CRAO to avert permanent visual loss (PVL). We present a case of bilateral CRAO with normal inflammatory markers, later confirmed GCA. Methods Case report Results A 74-year-old lady presented to the eye casualty with visual loss in both eyes upon waking up. Ophthalmological examination revealed bilateral macular ischemia due to bilateral CRAO (Fig). She was referred to medical team for further work-up. She had similar symptoms a couple of weeks prior when vision resolved itself within 24 hours. She also described mild jaw pain on chewing for the last 5 days. Her CRP was 5 (n ≤ 5) and ESR was 21 (n ≤ 30). She was started on prednisolone 60 mg daily with suspicion of GCA. However, further investigations were carried out to find underlying cause. Echocardiogram, ANA, ANCA, and CT head and body were normal. Ultrasound for temporal arteries showed equivocal wall thickening; however, temporal artery biopsy confirmed the diagnosis of GCA. Unfortunately, she could not regain her vision after starting steroids. Conclusion This case highlights the occult presentation of GCA, secondary to the unique features of bilateral CRAO with normal inflammatory markers. Mansfield-Smith et al. (2023) presented 10 years of data from Norwich, showing that 12.5% of GCA patients with visual loss did not exhibit any cranial or systemic features. Only a few cases of bilateral CRAO secondary to GCA have been reported in the literature. Hayreh et al. (1998), in a prospective study, described that patients with occult GCA tend to have significantly lower inflammatory markers compared to those with systemic features. Clinicians, particularly rheumatologists, should remain aware of this rare GCA presentation to facilitate prompt diagnosis and treatment, potentially preventing PVL. Disclosure M. Ghaffar: None. S. Thapa: None. H. Abdullah: None. U. Arain: None. D. Makkuni: None.

Social isolation and loneliness seriously impact the physical and mental quality of health and longevity. Social isolation and loneliness are important yet neglected social determinants for people of all ages. Cardiovascular diseases (CVD) are among the leading causes of death globally, and loneliness has been linked to worsening outcomes of CVD. This review aims to evaluate the impact of loneliness/social/self-isolation among adults living with any cardiovascular disease. A systematic search was done from inception to 23rd January 2025 on PubMed and Google Scholar, and 4,198 articles were synthesized; these articles were screened for duplication, and the duplicate articles were removed. A total of 3,606 articles underwent title and abstract screening, and 3,505 articles were removed following the predefined eligibility criteria. One hundred and one articles underwent full-text screening, and only 13 articles were included for qualitative analysis. We includedadults aged 18 and above living alone/socially isolated with any cardiovascular disease. This systematic review analyzed 13 studies across eight countries, encompassing 63,978 participants, of whom 12,110 were identified as living alone or socially isolated, 7,264 male and 3,745 female participants; one study included only male participants, while two studies didn't mention the number of male and female participants. The findings provide compelling evidence that loneliness is associated with adverse cardiovascular disease (CVD) outcomes, including increased mortality, recurrent cardiovascular events, and higher hospitalization rates. Addressingloneliness and social isolation should be a priority in cardiovascular disease prevention and management. Integrating social interventions could significantly improve the prognosis of individuals living with CVD, ultimately reducing morbidity and mortality rates in this vulnerable population.

To investigate the management of recurrent head and neck squamous cell carcinoma (rHNSCC) and describe survival outcomes. Post hoc subgroup analysis of a retrospective national observational cohort was conducted. All patients with rHNSCC who received a definitive treatment decision between September 1, 2021 and November 30, 2021 were included. Survival analysis was stratified according to subsite, primary versus recurrent disease, and surgical versus nonsurgical treatment. Data from 202 rHNSCC patients were derived from a cohort of 1488 patients submitted by 50 UK centers. Median age was 66 years (IQR 58-74), and 142 (70.3%) were male. The most common recurrence subsites were oropharynx (20.5%), oral cavity (19.5%), larynx (16.4%), and hypopharynx (14.9%). Ninety-three (48.4%) were managed curatively. Surgery was the most common treatment for laryngeal (59.4%), oral cavity (60.5%), hypopharyngeal (44.8%), and oropharyngeal (37.5%) cancers. Two-year overall (OS), disease-free (DFS), disease-specific (DSS), and local recurrence free survival (LRFS) were 41.1%, 39.1%, 42.2%, and 39.3%, respectively. rHNSCC treated with surgery had improved OS (p = 0.0005), DFS (p = 0.012), DSS (p = 0.0003), and LRFS (p = 0.007), over nonsurgical treatments. Compared to primary cancers, rHNSCC presents with more advanced T stage (p < 0.001) and distant metastasis (p < 0.001), receives less curative treatment (p < 0.001), and has worse survival outcomes (all p < 0.001). On multivariate analysis, salvage surgery, radiotherapy, and p16 status were independent prognostic factors of all survival outcomes. Recurrent HNSCC is associated with highrates of incurable disease and worse survival than primary cancers. Surgery remains the most common curative treatment in rHNSCC, however future studies are necessary to improve patient selection and optimize outcomes following salvage treatment.

Abstract PURPOSE: To examine baseline OCT characteristics of patients initiated on aflibercept 2mg that achieved good and suboptimal VA after the first injection and post-loading. METHODS: Patients with nAMD initiated on aflibercept therapy were recruited from December 2019 to August 2021. Demographic and OCT (Spectralis, Heidelberg Engineering) features associated with good VA (VA&gt;=68 ETDRS letter score, Snellen &gt;= 6/12) and poor VA (VA &lt; 54 letter score, Snellen &lt; 6/18) or lost &gt;= 5 ETDRS letters after first injection (V2) and after the loading phase (V4) were analysed using logistic regression via generalised estimating equations. RESULTS: A total of 1,999 eyes of 1,862 patients were analysed. The mean age was 79.3 (SD 7.8) years, 1,126 (60.5%) were female, predominantly white ethnic background (1,772 [95.2%]) and the mean presenting VA was 58.0 (SD 14.5) ETDRS letter score. After V4, 930 (46.6%) of 1,994 eyes achieved VA&gt;=68 ETDRS letter score and 457 (22.9%) achieved VA&lt;54 ETDRS letter score. The OCT parameters found to be associated with reduced odds of VA &gt;=68 ETDRS letter score and increased odds of VA &lt; 54 ETDRS letter score included foveal-involving IRF, PCV (vs. Type 1), RAP (vs. Type 1), Type 2 eyes (vs. Type 1), foveal-involving CNV (vs. non-foveal CNV), any component of CNV complex, increased CST, foveal-involving SRHM, foveal-involving atrophy, foveal-involving fibrosis, foveal-involving EZ loss, foveal-involving ELM loss, ungradable EZ loss, ungradable ELM loss and foveal-involving EZ/ELM loss. CONCLUSION: This study could help inform patients about their post-loading VA based on OCT characteristics at presentation.

Abstract Background Emergency laparotomy (EL) comprises a high-risk group of surgical procedures, associated with a significantly increased risk of death in the following 5 years. EL are performed on a heterogeneous population, of which at least 50% are ≥ 70 years old. Accurate preoperative risk prediction is vital for planning care, patient shared decision, and improving outcomes. To date, no prediction tool can reliably estimate long-term outcomes, including mortality, following an EL. Methods This is a multicenter, retrospective, observational, cohort study that investigated the correlation between actual mortality at 1, 3, and 5 years and predicted 30-day mortality (30-dm) using NELA and ACS-NSQIP risk prediction tools, following EL, in adults aged ≥18, over 2 years, in two UK centers. The sample size was calculated at 385 cases. GraphPad-Prism 10.1.1. was used for statistical analysis. Results 626 cases were analyzed. The male/female ratio was 0.85, age 70 years (55;78); BMI 24.94kg/m² (22;29); preoperative lactate 1.7 mmol/L (1.2;2.6), clinical frailty score 3 (2;4); and Charlson Comorbidity Index 4(2;5) (all data is expressed as median+IQR). The 1, 3, and 5-year survival were 76%, 67%, and 61%, respectively. A perfect positive correlation between NELA and ACS-NSQIP 30-dm and the 1-year actual mortality was found (R²=1). At 3 years only NELA correlated positively to actual mortality (R²=0.23, p&amp;lt;0.05). The 5-year mortality correlated positively with both predictors - NELA: R²=0.61, p&amp;lt;0.001; ACS-NSQIP: R²=0.31, p&amp;lt; 0.05. Conclusion Both NELA and ACS-NSQIP risk calculators can predict mortality at 1,3 and 5 years after an emergency laparotomy, with NELA expressing a stronger correlation.