Whiston Hospital

Suicidal behaviors are a major public health concern, yet their burden remains poorly defined in Nigeria, a country with a predominantly young population. This study aimed to comprehensively assess the prevalence and correlates of suicidal ideation, planning, and attempt in Nigeria. We systematically searched medical literature databases for studies published up to November 2025 that reported the prevalence of suicidal behaviors in the Nigerian general population or specific subgroups, using diagnoses or validated screening tools. Random-effects meta-analysis were conducted, with heterogeneity explored using meta-regression and subgroup analysis. Overall, 53 studies comprising 132,514 individuals were included. The prevalence of suicidal ideation in the general population was 7.9% (95%CI: 4.6, 13.4), while suicidal planning and attempts were estimated at 1.9% (95%CI: 0.9, 4.0) and 1.3% (95%CI: 0.4, 4.3), respectively. Suicidal ideation was associated with sociodemographic factors, including marital status, educational attainment, and employment status, and was more common in conflict-prone regions. Compared with the general population, suicidal behaviors were more prevalent among adolescents and young people, people living with HIV, and pregnant women. Notably, the prevalence also increased over time. These findings indicate that suicidal behaviors are common in Nigeria and highlight the need for targeted intervention strategies for high-risk populations.

Background: Urinary incontinence (UI) is a common yet underdiagnosed condition in women, particularly in low- and middle-income countries (LMICs) like Pakistan. The lack of awareness, social stigma, and fragmented healthcare services contribute to limited access to appropriate diagnosis and management. Purpose of the Review: This review aims to evaluate the prevalence, risk factors, awareness, and current management strategies for UI among women in Pakistan. It also seeks to propose a comprehensive framework for the establishment of specialized continence clinics, integrating community-based screening, district-level care, and tertiary urogynecology-functional urology centers. Results: The prevalence of UI in Pakistan ranges from 11% to 45%, with postpartum women and those of higher parity be-ing most affected. Awareness of UI as a treatable medical condition is very low, with fewer than 10% seeking care. Conserva-tive treatments such as pelvic floor muscle training (PFMT) are inconsistently delivered, while pharmacologic and minimal-ly invasive treatments are rarely accessible outside tertiary centers. Advanced treatments, such as polyacrylamide hydrogel (Bulkamid®) and botulinum toxin, are unavailable to most patients. Conclusion: Establishing a tiered, cost-effective model for continence care, starting with community screening and educa-tion, followed by district-level continence clinics and tertiary care centers, can improve access to UI services in Pakistan. Pol-icy reforms, training, and international partnerships are essential to expanding and sustaining these services.

Systemic hyper-inflammation is an established cause of organ dysfunction, evidenced by the multi-organ failure observed in sepsis. Similarly, the process of death invokes a complex set of events leading to profound hyper-inflammation. It is reasonable to infer that in deceased organ donors, death-induced hyperinflammation could have significant consequences for organs being offered for transplant. This systematic review aimed to; 1) clarify what is currently known about the sources of inflammation following death, and 2) systematically review the current body of evidence reporting levels of inflammation in deceased donors and living donors and linking donor inflammation with kidney transplant outcome. The systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 8. We searched the Medline, Web of Science, Scopus and CINHAL databases from January 2000 to March 2023 for articles relating donor inflammation with kidney transplant outcomes. The National Institute of Health 'Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies' was used to assess validity of studies. Twenty-one studies were analysed, collectively totalling 3397 donors and 4596 recipients. A high degree of heterogeneity in inflammatory markers and transplant outcomes studied existed between studies, yet collective evidence showed higher inflammation, complement activation, and tissue injury in deceased donors compared with living donors, and strongly suggested associations with poorer short- and long-term transplant outcomes.

Electrochemotherapy (ECT) is a locoregional cancer treatment primarily used in the palliative management of cutaneous metastases from malignant melanoma. However, its clinical effectiveness, safety, and cost-effectiveness in this setting are poorly defined. The aim of this systematic review is to assess the clinical effectiveness, safety, quality of life (QoL) outcomes, and cost-effectiveness of ECT in the treatment of locally advanced stage III/IV melanoma with in-transit metastasis or loco-regional recurrence. A literature search of MEDLINE and Embase from 2005 to 2024 was performed using the keywords “electrochemotherapy” and “skin cancer”. After duplicate removal, 708 studies were identified, 107 English-language papers from 2020 to 2024 were screened, with 47 full texts reviewed. Ten studies met the inclusion criteria and were included for review. Data extraction and reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. ECT achieved complete response (CR) rates of 24-85.7%, overall response rates (ORRs) of 63-100%, and one-year overall survival of 60.4-92.6%. ECT was well tolerated with minimal systemic toxicity and minor adverse effects. QoL was maintained post-treatment, and cost-effectiveness analysis suggested economic viability in particular patient cohorts. ECT demonstrated improved tumour control and survival outcomes when combined with systemic immunotherapy. ECT is a safe, well-tolerated, and clinically effective treatment for stage III/IV metastatic melanoma, providing a valuable alternative for patients unsuitable for surgery or systemic chemotherapy. Further prospective RCTs are needed to establish its long-term role in melanoma care.

Balint syndrome is a rare disorder caused by bilateral parieto-occipital damage, most often occurring within the posterior watershed territory between the middle and posterior cerebral arteries. It is characterized by a triad of simultanagnosia, optic ataxia, and oculomotor apraxia, and is often misdiagnosed as delirium, dementia, or cortical blindness, particularly in elderly patients. We report a case of an 82-year-old woman who presented with confusion and visuospatial disorientation following a collapse. Her visual acuity was preserved, but she demonstrated simultanagnosia and oculomotor apraxia. Computed tomography of the brain revealed bilateral occipital watershed infarcts, consistent with Balint syndrome secondary to posterior border-zone infarction. She was managed with secondary stroke prevention and commenced on neurorehabilitation focusing on visuospatial and visuomotor retraining. This case highlights the importance of recognizing Balint syndrome as a rare manifestation of posterior circulation stroke. Awareness of its classic triad facilitates early diagnosis, appropriate neuroimaging correlation, and tailored rehabilitation to optimize patient outcomes.

Improving oral health in patients with acutely dysphagic stroke is a plausible approach to prevent pneumonia. We aimed to determine whether a phase 3, definitive trial of oral health care (OHC) treatments, supported by staff education and training, is feasible in stroke unit care. The CHOSEN (Chlorhexidine or Toothpaste, Manual or Powered Brushing to prevent Pneumonia Complicating Stroke) trial was conducted and reported in line with the Consolidated Standards of Reporting Trials 2010 statement extended to feasibility trials. We aimed to recruit 120 participants with acute stroke and dysphagia within 24 hours of admission, from 4 stroke units in the northwest of England, randomized (1:1:1:1) to 1 of 4 OHC treatments: manual toothbrush or powered toothbrush with either nonfoaming toothpaste or chlorhexidine 1% gel. Stroke unit nursing staff received standardized education and training. Feasibility was assessed using a priori criteria. Between January 2022 and end of January 2023, 626 patients were screened. A total of 101 participants (median age, 73 [interquartile range, 62-80] years; median National Institutes of Health Stroke Scale score, 10 [interquartile range, 5-18]; 44% women) were enrolled (77% of eligible patients approached). Adherence was 91%, with no substantial difference between the OHC treatments, and 88% completed follow-up. There were 19 serious adverse events but no marked differences between allocated OHC treatments. In exploratory secondary analyses, again there were no substantial differences in survival, incident pneumonia, modified Rankin Scale score, or quality of life at 3 months between the OHC treatment allocations. OHC treatments incorporating chlorhexidine and powered brushing and supported by standardized staff training appeared feasible and safe in patients with acutely dysphagic stroke. Progression criteria were met for a definitive trial of efficacy and cost effectiveness. URL: https://doi.org/10.1186/ISRCTN52421361; Unique identifier: ISRCTN52421361.

Abstract Introduction The management of complications following bariatric surgery can be challenging due to the patients’ habitus and the unique complexity of some of the complications. With the explosion of medical tourism, anecdotal evidence suggests that an increase in such complications nationwide. We wanted to evaluate our management of bariatric complications in our centre to assess our outcomes and to plan our service for the future. Method Patients referred to the bariatric on-call service from April 1, 2023, to August 1, 2024, were analysed using a prospectively populated database. Data on demographics, location of initial procedure, complications, management, and outcomes were recorded. Results 90 patients were referred to the service. Most patients had their initial operation in the United Kingdom (59%), 37% had their operation abroad, of which the commonest location was Turkey (32%). Many patients (64%) were treated conservatively with no surgical, radiological or endoscopic intervention. 32 patients needed active intervention of which the commonest procedure was laparoscopic removal of gastric band (35%), followed by endoscopic gastric balloon removal (19%) and laparoscopic/open surgery for internal hernia (19%). The 90-day mortality rate for all 32 interventions were 0. There were 2 deaths noted in patients in the operative group after discharge, but this was not related to the surgical intervention. Discussion Patients treated at the regional centre generally experience positive outcomes. However, some patients require immediate management at their presenting hospital due to the urgent nature of their complications or clinical instability. To support these cases, the centre provides 24/7 consultant-led advice and guidance.

Abstract The foundation of AWR is posterior component separation by Rives-Stoppa (RS) retro-rectus sublay mesh repair, and transversus abdominis release (TAR). Traditional teaching dictates an initial laparotomy with full adhesiolysis to enable fascial closure and an intraperitoneal approach to component separation. We describe a novel extraperitoneal AWR approach, performing posterior component separation and sublay mesh repair with the peritoneum remaining closed. This maintains an intact visceral sac for faster dissection, reduced bowel handling, and facilitates take-down of the hernial orifice. We present our 3-year follow-up series of extraperitoneal ‘closed’ AWR. Method Retrospective case-note analysis of consecutive patients (n = 231) undergoing AWR 2018-2021 by a single plastic and general surgeon consultant team, with 3-year follow-up period. Results Extraperitoneal component separation was performed in all 231 patients as either RS (n = 186, 80.5%) or TAR (n = 45, 19.5%). Radical skin excision provided surgical access in 225 patients (97.4%), mean excision weight 1297 g (85–18000 g), mean BMI 30.9 (16.9–55.4). Direct fascial closure achieved in 97% (bridged repair n = 7, 3%). Hernia recurrence 1.7% (n = 4) at 3 years. Intraperitoneal procedures (bowel resection/anastomosis) performed in 2 patients (1.5%). Postoperative ileus 0%. Mean inpatient stay 4.6 days (SD 2.5). Post-operative complications; surgical site occurrence (SSO) (n = 26, 11.3%); respiratory (n = 21, 9.1%): VTE (n = 4, 1.7%): seroma (n = 16, 6.9%). Subsequent small bowel obstruction/laparotomy (n = 1, 0.4%). Conclusion The extraperitoneal approach to AWR is a safe, effective and reproducible technique, minimising postoperative ileus and bowel injury risk, promotes shorter duration of surgery and early postoperative discharge. This provides excellent outcomes and low hernia recurrence rate.

BackgroundThe incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.MethodsWe included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.ResultsThe primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).ConclusionTyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.