Newham University Hospital

AimsMultiple guidelines provide recommendations for assessing future risk of cardiovascular events in asymptomatic individuals without known coronary artery disease (CAD). We systematically reviewed current national and international guidelines that include imaging strategies for detecting subclinical CAD.Methods and resultsMEDLINE and EMBASE were searched for relevant guidelines published between January 2010 and December 2025. Major international guideline repositories and medical society websites were also screened. Two reviewers independently screened records assessed methodological rigour using the AGREE II instrument and extracted recommendations. Of four identified guidelines, three met predefined rigour thresholds and were included in the final analysis. Guidelines discouraged coronary artery calcium (CAC) use as a population-wide screening tool or in high-risk individuals. All three guidelines recommended limited use of scoring as a risk modifier in asymptomatic individuals when cardiovascular risk remains uncertain or near treatment thresholds and highlighted its role in shared decision-making. Differences were observed in the target populations for CAC assessment, recommendation strength, and re-screening intervals. Although CAC scoring was the principal imaging modality evaluated, CT coronary angiography was discussed in one guideline but not recommended due to insufficient evidence of clinical benefit.ConclusionCardiovascular imaging for the detection of asymptomatic coronary artery disease is not recommended in the guidelines for population screening or in high-risk patients. CAC use is recommended in specific cases such as where patients are near treatment thresholds for primary prevention. Ongoing randomized studies may provide further outcomes and cost effectiveness driven insights.

Nail and periungual involvement in secondary syphilis is a rare and overlooked manifestation of Treponema pallidum infection because pain, paronychia, and onycholysis often mimic bacterial or fungal nail disease and lead to misdiagnosis. Secondary syphilis usually presents with a non-itchy, generalised rash affecting the palms and soles, yet this clue is missed when nail changes dominate. This study describes the clinical, microbiologic, and histopathologic features of extensive syphilitic nail and periungual disease through a newly documented case involving complete twenty-digit involvement and evaluates diagnostic and therapeutic patterns across published cases from 2020 to 2024. A mixed observational design combined detailed clinical data from the index patient with a structured review of six eligible reports that documented confirmed secondary syphilis, nail or periungual involvement, diagnostic methods, and treatment outcomes. Variables analysed included digits affected, systemic features, diagnostic modalities, treatment regimen, and recovery time. Descriptive statistical methods were used to summarise shared patterns. Seven total cases, including the index patient, were reviewed: 86% presented with systemic features, all demonstrated positive treponemal serology, and 71% had histopathologic confirmation. Clinical outcomes were uniformly favourable, with full resolution occurring within six to twelve weeks following antitreponemal therapy. The index case received doxycycline 100 mg twice daily for twenty-eight days and achieved complete recovery with full nail regrowth by week eight. These findings show consistent diagnostic and treatment patterns and establish syphilitic nail and periungual disease as a reproducible manifestation of secondary syphilis. Early treponemal testing in chronic or multifocal periungual inflammation may improve diagnostic accuracy and reduce unnecessary antimicrobial exposure.

Social deprivation and cardiovascular disease occur in overlapping cohorts of patients. Ameliorating the burden of social deprivation may improve both adherence to treatment for cardiovascular disorders and outcomes, but this hypothesis has yet to be proven. The aim of this work is to develop a screening pathway to identify and then provide targeted intervention for patients with concurrent social deprivation and cardiovascular disease at a specialist care public hospital in London, United Kingdom. The primary outcome of this work is to create a social prescribing pathway. A 3- phase approach was taken. The first phase assessed the level of deprivation in a cohort of patients using a digital screening tool. The second phase assessed the feasibility of introducing a digital screening tool with limited support, while also assessing the validity of the tool itself. The third phase built on learning from phase I and II to co-produce a pathway to accurately screen patients and address common needs, and evaluate the effectiveness and impact of social intervention in this group. In phase I, we screened 360 patients on a digital pathway using a screening tool. The questionnaire was circulated to 360 patients of whom 168 (46%) responded. We found that 61/168 (36%) “always”, “often” or “sometimes” had difficulty making ends meet. We used this phase to evaluate the baseline level of deprivation in a population of cardiovascular patients in our area. In phase II, screening was deployed in the setting of a cardiology clinic where adoption of the digital tool was not supported with face-to-face onboarding, the level of digital exclusion became more relevant. Evaluation of the process revealed only 69/150 (46%) patients were able to register for the digital service, but fewer 38/150 (25%) responded to the screening questionnaire. Amongst that group, 16/38 (42%) flagged for a self-reported level of deprivation, the majority of which related to financial instability. No attempt was made to improve uptake of the digital tool in the first and second phases, as the goal of the early work was to determine its effectiveness as a non-supported tool. The final phase of this work, where a patient focus group was provided with this data and asked for feedback, provided a process evaluation of the methods used in the first few phases. We present learning from phased introduction of a screening questionnaire for deprivation in a specialist care hospital. Digital tools exclude some patients so future pathways must employ a multimodality approach to improve engagement. Patients with lived experience reinforced the value of identifying these issues and encouraged sensitivity to barriers to access. Management of expectations is important when providing a new service.

Purpose To evaluate the association of right ventricular (RV) strain metrics derived from feature-tracking cardiac MRI with incident heart failure (HF). Materials and Methods This retrospective analysis included data of 45 700 participants (23 764 female) from the UK Biobank Imaging Study between August 2006 and July 2010. Cardiac MRI scans were performed using standardized UK Biobank protocols and equipment. Image analysis was performed with feature-tracking module of a certified postprocessing software (cvi42 prototype version 5.13.7). Biologically implausible and statistical outliers were excluded. The association of each RV global strain marker (global longitudinal strain [GLS], global circumferential strain [GCS], and global radial strain [GRS]) with incident HF was assessed using univariable and multivariable Cox regression models adjusted for established clinical features and RV imaging markers with known prognostic values. Results The mean age ± SD of the 45 700 study participants (23 764 female) was 65 years ± 7.7, and median follow-up was 3 years. Lower absolute RV GLS, RV GCS, and RV GRS were associated with increased HF risk (hazard ratio [HR]: 1.34, 1.37, and 0.71, respectively; P < .001 for all). According to multivariable analyses adjusted for conventional RV imaging markers and clinical covariates, only RV GLS independently predicted HF (HR: 1.16; 95% CI: 1.02, 1.33; P = .04). Conclusion In the general population, RV GLS, RV GCS, and RV GRS are independently predictive of HF after accounting for clinical features. RV GLS demonstrated independent predictive value against conventionally used RV imaging markers and clinical features. Keywords: Cardiac MRI, Right Ventricle, Myocardial Strain, Heart Failure, Survival Analysis Supplemental material is available for this article. © RSNA, 2025.

Current guideline criteria for surgical intervention in chronic aortic regurgitation (AR) rely on fixed thresholds of left ventricular size and ejection fraction, but these metrics may overlook early myocardial injury and under-appreciate patient heterogeneity, particularly in women and older adults. Cardiovascular magnetic resonance (CMR) offers robust quantification of regurgitant volume, three-dimensional ventricular volumes, and both focal (late gadolinium enhancement) and diffuse (T1-mapping–derived extracellular volume) fibrosis. Observational studies have linked CMR-detected fibrosis to worse clinical outcomes and less favourable reverse remodelling after valve intervention, suggesting that fibrosis may mark the transition from compensated overload to irreversible myocardial damage. In this narrative review, we appraise the limitations of current guidelines, compare echocardiographic and CMR approaches to AR assessment, and summarize the evidence supporting myocardial fibrosis as a potential imaging biomarker for risk stratification. We discuss how integrating CMR-derived fibrosis metrics with volumetric and functional data could personalize timing of aortic valve intervention. While prospective studies are needed to validate fibrosis-guided decision-making, this evolving paradigm holds promise for earlier identification of patients at risk for irreversible myocardial injury, with the ultimate goal of preserving ventricular function and improving long-term outcomes.

The COVID-19 pandemic has significantly impacted global health systems, with emerging evidence suggesting unique implications for pediatric populations with endocrine disorders. While children generally experience milder acute COVID-19 symptoms, those with pre-existing endocrine conditions may face heightened risks due to the interplay between viral infection and endocrine homeostasis. This systematic review aimed to synthesize evidence on the relationship between endocrine disorders and COVID-19 severity in children, focusing on disease outcomes, metabolic control, and management challenges during the pandemic. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library. Ten studies meeting the inclusion criteria were selected after screening 638 records. Data were extracted on study characteristics, patient demographics, endocrine disorders, COVID-19 severity outcomes, and key findings. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) tool. A narrative synthesis was performed due to heterogeneity in study designs and outcomes. The review revealed significant pandemic-related disruptions in pediatric endocrine health, including increased central precocious puberty cases and elevated BMI z-scores in children with obesity. Diabetes outcomes were mixed: type 1 diabetes patients had better mortality prognoses than type 2 diabetes patients, but diabetic ketoacidosis rates surged. Thyroid dysfunction and stable medication adherence in congenital adrenal hyperplasia were also noted. Risk of bias varied, with three studies rated low, five rated moderate, and two rated as high risk of bias. COVID-19 exacerbated endocrine disorders in children through direct viral effects and indirect lifestyle and healthcare disruptions. The findings underscore the need for adaptive care strategies, including telehealth and mental health support, to mitigate long-term impacts. Future research should prioritize prospective studies to evaluate sustained effects and interventions for at-risk populations.

Purpose of reviewOn World Encephalitis Day 19th February 2025, Encephalitis International launched the World Health Organization technical brief on encephalitis, highlighting the growing public health challenge and need for improved diagnostics. This review summarises the published literature over the last 18 months on novel methods of identifying the aetiology of neurological infections and existing research gaps.Recent findingsThere is an increased availability and sensitivity of multiplex polymerase chain reaction assays and untargeted metagenomic sequencing in clinical practice. This is contributing to increasing diagnostic yield in suspected neurological infections. Preliminary results suggest that novel serological methods such as phage immunoprecipitation sequencing (Phip-seq) may be useful where molecular approaches are negative.SummarySignificant progress in improving diagnostics has been made in the last decade. Going forward, multicentre studies and meta-analyses are needed to achieve adequate power in ascertaining the role of novel diagnostic methods in neurological infections. Studies need to investigate the impact on patient management and cost-effectiveness. The role of other omics methods in identifying host biomarkers for utilisation in diagnostic algorithms needs further work.Search strategyA database search of PubMed (MEDLINE) for English language peer-reviewed primary research articles published from 1/9/2023/9 until 28/2/2025 was conducted. Search terms used a combination of the words ‘central nervous system infection’, ‘neurological infection’, ‘cerebrospinal fluid’, ‘encephalitis’, ‘meningitis’ and ‘diagnostics’. The full search terms are reported in the Appendix.

Artificial intelligence (AI) is a set of computational methods that interprets the data given, uncovers the underlying patterns associated with the complexity of data, and provides the prediction of outcomes that have become increasingly relevant in urology. The current application of AI in urology predominately focuses on disease diagnosis and risk factor analysis in urologic oncology and male infertility. While many candidate models have been proposed in the literature, efforts to construct clinically meaningful data by incorporating patient-specific and multidisciplinary approaches should be carried out to improve the clinical applicability of AI in driving personalised treatment planning and disease prognosis. Looking forward, AI has the potential to drive targeted training in urology, from surgical techniques to patient-specific surgical procedure simulation, in combination with other technologies such as augmented reality. In order to achieve this, patient involvement should be considered in the model development stage, which also addresses issues surrounding the ethical deployment of AI in the clinical environment. It is possible to see AI playing a collaborative role with surgeons in improving clinical efficiency in the future. Level of evidence: Not Applicable

Sjogren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands resulting in xerostomia and dry eyes affecting entire body. A 40-year-old woman presented with generalized weakness and shortness of breath. She had reduced muscle power (2/5) with reduced tone, and absent reflexes in four limbs. Further investigation revealed severe hypokalemia with metabolic acidosis. She was treated with intravenous potassium chloride and diagnosed with Sjogren's syndrome based on her serology profile. After treatment, her condition improved. Hypokalemia occurs due to increased renal excretions of potassium. Distal Renal Tubular Acidosis is a major cause of potassium loss in urine. Sjogren's Syndrome is an important cause of Distal Renal Tubular Acidosis, which can present as severe hypokalemia. Although it commonly presents with symptoms like dry eyes and dry mouth, it can rarely present as Distal Renal Tubular Acidosis and hypokalemia as the primary presentation. Sjogren's syndrome should be suspected in patients with hypokalemia with features of Distal Renal Tubular Acidosis.