Search Results (363)

An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article

Background: There is little information about the effectiveness of oral nutritional supplements (ONS) in combatting nutrient inadequacies in primary care, where most malnutrition exists. Aim: To examine the extent to which readymade ONS add or displace the nutrients consumed in the diet and their impact on combatting dietary inadequacies. Methods: 308 free-living people >50 years with medium + high risk of malnutrition (Malnutrition Universal Screening Tool) were randomised to receive readymade low volume (2.4 kcal/mL), liquid ONS plus dietary advice (ONS + DA) or dietary advice alone (DA). Intake was assessed at baseline (24 h recall) and 4-weekly for 12 weeks (3-day diet record). Total nutrient intake was benchmarked against UK and European dietary reference values (DRVs). The proportion of energy and nutrients from the ONS that added or displaced those from the diet (net addition/displacement) was calculated. Results: ONS + DA led to significantly greater total energy and nutritional intakes, with 25/29 nutrient intakes significantly higher than with DA alone. There were no significant differences in dietary energy and nutrient intakes from food between the groups. There was little or no displacement of nutrients from the diet, with over 90% of the energy and nutrients consumed in the ONS additive to the diet. ONS + DA more than halved the number of people with nutrient intakes that failed to meet DRVs and the number of nutrients per person that did not meet DRVs compared to DA alone. Conclusions: Supplementation with readymade, low volume (2.4 kcal/mL) liquid ONS overcomes most nutrient intake inadequacies in malnourished older people in primary care without significantly reducing intake from the diet. This makes ONS an effective way to improve nutritional intakes above dietary advice alone to improve the outcomes for the management of older people at risk of malnutrition. Full article

Background/Objectives: Computed tomography (CT) of the head is vital in diagnosing neurological conditions but poses concerns regarding radiation exposure. Traditional diagnostic reference levels (DRLs) are based on anatomical regions, potentially overlooking variations in radiation requirements driven by clinical indication. This study aimed to establish clinical indication-specific DRLs (DRLCIs) for adult head CT to support precision benchmarking and optimise patient safety. Methods: A retrospective observational study was conducted using data from 378 adult patients undergoing non-contrast CT head scans between September 2022 and February 2024. Data on patient demographics, protocols, and radiation dose metrics (Computed Tomography Dose Index Volume and Dose–Length Product) were extracted using DoseWatch™ software. Protocol parameters were standardised across clinical indications such as trauma, stroke, headache, seizure, and infection. Descriptive statistics and correlation analyses were performed. Descriptive statistics, including means, standard deviations, and percentile distributions, were calculated. Correlation analyses were conducted using Pearson’s correlation coefficient to examine relationships between dose metrics and patient variables such as age and body mass index. Results: Mean CTDIvol values ranged from 50.58 mGy (trauma) to 52.90 mGy (infection), while DLP values ranged from 1052.52 to 1219.98 mGy·cm. Percentile distributions were narrow, indicating effective protocol standardisation. The strongest correlation was observed between CTDIvol and DLP (r = 0.89), while age and body mass index showed negligible influence on dose metrics. Comparative analysis showed alignment with international benchmarks from the UK, Qatar, Bahrain, and Nigeria. Conclusions: This study establishes DRLCIs for adult head CT, demonstrating consistent radiation dose delivery across indications with minimal variability. Clinical indication-based benchmarking enhances dose optimisation and aligns with global radiological protection frameworks. Full article

The evidence regarding allopurinol’s effects on renal function among people with hyperuricemia and gout has been conflicting, though clinicians are often cautious about using allopurinol in chronic kidney disease (CKD). We sought to examine the relation between allopurinol use in those with gout and CKD and the risk of worsening renal function. We conducted a time-stratified propensity score (PS)-matched cohort study on the IQVIA Medical Research Data representative of the UK general population. Among participants 18–89 years old with gout and CKD 3–4 not on urate-lowering therapy within one year prior, we identified new users of allopurinol and matched them 1:1 with a non-user. We analyzed the relation between incident allopurinol use and the changes in the eGFR at one year of follow-up using linear regression adjusted for the potential confounders included in the PS model. We PS-matched 10,716 allopurinol initiators to 10,716 non-users, among whom 42% were female, the mean age was 74 years and 7% had CKD4. The progression to dialysis or kidney transplant was similar in both groups. The mean eGFR prior to the study entry was 48.4 mL/min among allopurinol initiators and 49.5 mL/min among non-users, while the last eGFR within one year was 49.4 and 49.7 mL/min, respectively. The allopurinol initiators had an adjusted mean increase in the eGFR of 0.81 mL/min (95% CI 0.57–1.05) greater than that of non-users. Among those with gout and CKD 3–4, allopurinol did not worsen renal function and may have slightly improved it, suggesting that allopurinol is not detrimental to patients with gout who have CKD. Full article

Background/Objectives: To evaluate the efficacy and safety of using the preservative-free topical proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) to control postoperative pain after epithelium-off corneal crosslinking (CXL) for keratoconus. Methods: This is an observational study of patients with mild to severe keratoconus who have undergone epithelium-off CXL. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 min (Vibex Rapid; Avedro, Inc.), followed by continuous UV-A light (Avedro KXL system; Avedro, Inc.) for 30 min at an intensity of 3 mW/cm² and an energy of 5.4 J/cm². All patients were prescribed postoperative proxymetacaine hydrochloride PRN with an allowed frequency of up to eight times per 24 h for the first 3 days to control postoperative pain. Patients were reviewed at 1–2 weeks postoperatively for a comprehensive examination, including assessment of delayed corneal healing, removal of the bandage contact lens, and recording of subjective symptoms. Results: There were 223 eyes of 180 patients with a mean age of 24.9 ± 8.6 years (range: 13–38 years). Male patients were 72%. At their planned first postoperative visit, we found no corneal healing abnormalities, such as persistent epithelial defects, epithelial irregularities, or early postoperative stromal haze, in any patient. All patients subjectively reported that proxymetacaine drops helped them to control postoperative pain, particularly in the first 48 h. Conclusions: None of the patients reported pain after 3 days of using proxymetacaine drops up to eight times a day for the first 3 days. It appears to be a safe and effective solution to control postoperative pain without any complications. Full article

This study explores the optimization of solar energy harvesting in Truro City in the UK using PVSyst simulations integrated with real-time meteorological data. Focusing on panel orientation, tilt angle, shading, and albedo, the research aimed to enhance both energy efficiency and economic viability of photovoltaic (PV) systems in green buildings. A 100 kWp rooftop solar installation served as the case study. Energy outputs derived from spreadsheet-based models and PVSyst simulations were compared to validate results. Optimal tilt angles were identified between 35° and 39°, and the azimuth angle of 0° yielded the highest energy gain without requiring solar tracking. Fixed configurations with a 5 m pitch showed only a 10% shading loss, requiring 1680 m² of space and generating an average of 646.83 kWh/m² monthly. Compared to recent works, our integration of real-time climate data improved simulation accuracy by 6–9%, refining operational planning and decision-making processes. This included better timing of high-load activities and enhanced prediction for grid feedback. The study demonstrates that data-driven optimization significantly improves performance reliability and system design, offering practical insights for solar infrastructure in similar temperate climates. These results provide a benchmark for urban energy planners seeking to balance performance and spatial constraints in PV deployment. Full article

Japanese encephalitis virus (JEV) is a mosquito-borne orthoflavivirus and a major cause of human encephalitis throughout Asia, although it is currently not reported in Europe. To assess the potential impact of climate change, such as increased temperatures, and the potential for native Cx. pipiens to transmit JEV genotype I in the United Kingdom (UK), we have investigated vector competence at two different temperatures. Culex pipiens f. pipiens were provided a bloodmeal containing JEV genotype I at 7.8 × 10⁸ PFU/mL. Mosquitoes were maintained for 14 days at 21 °C or 25 °C, and rates of infection, dissemination, and transmission potential were assessed. There was no evidence for virus infection, dissemination, or potential for transmission at 21 °C. However, at 25 °C, virus infection was detected in 5 of 36 mosquitoes (13.9%). Of these, JEV disseminated to legs and wings in three specimens (3/5) and viral RNA was detected in saliva from one specimen (1/3). These data indicate that at elevated temperatures of 25 °C, UK Cx. pipiens f. pipiens could transmit JEV genotype 1. Full article

Background: In addition to the well-known vitamin D metabolites 25(OH)D and 1,25(OH)₂D, the catabolite 24,25(OH)₂D may also reflect vitamin D status and influence biological and skeletal processes. However, the effects of UVR-induced synthesis on 24,25(OH)₂D levels and the 25-VMR (24,25(OH)₂D3:25(OH)D3 ratio) remain unclear. Objectives: We aimed to assess how a single standardised UVR dose influences the production of 25(OH)D3, 24,25(OH)₂D3, 1,25(OH)₂D3 and 25-VMR, with a comparison between younger and older adults being conducted to explore potential age-related differences in vitamin D metabolism. Methods: A total of 11 young (18–40 years; 7M, 4F) and 10 older (65–89 years; 6M, 4F) skin type I-III volunteers received a single sub-erythemal dose of solar simulated UVR (SSR) (95% UVA: 320–400 nm, 5% UVB: 290–320 nm, 1.3 standard erythemal dose) during winter time in the UK (vitamin D trough season), exposing approximately 35% of the body surface area. The Blood was assayed for 25(OH)D3, 24,25(OH)₂D3 and 1,25(OH)₂D3 using LC-MS/MS at baseline, 24 h and 7 days following UVR exposure. Results: There was a significant increase in 25(OH)D3 from baseline (44 ± 22 nmoL/L) to 24 h post-UVR (48 ± 22 nmoL/L) in the combined age group (p = 0.044), but no significant differences were found in 24,25(OH)₂D3 in the combined group, or between young and older volunteers for both metabolites. 1,25(OH)₂D3 concentrations were higher in young groups (163 ± 60 pmoL/L) than in older (105 ± 38 pmoL/L) groups at 7 days post-UVR (p = 0.044). The 25-VMR decreased from baseline (9 ± 3) to 24 h post-UVR (7.5 ± 2.1) in the combined group (p = 0.003). Conclusions: Our data suggest that a single sub-erythemal UVR challenge does not influence 24,25(OH)₂D3 concentration in younger and older adults at 24 h and 7 days post-UVR and that the significant difference seen in the 25-VMR between baseline and 24 h post-UVR is due to the increase in 25(OH)D3 concentration post-UVR. This is in line with vitamin D oral supplementation studies, and indicates that low doses of UVR trigger the metabolic pathway, without affecting the catabolic pathway. Full article

Background/Objectives: Long-acting insulin glargine (iGlar) has been available as a biosimilar since 2014 in the UK. We reviewed previous prescribing to evaluate if the anticipated cost savings with biosimilars were realized with iGlar. Methods: This study investigated prescribing patterns of long-acting iGlar (100 units/mL) in cartridges and pre-filled pens from 2020 to 2024 across primary care organizations in England, Northern Ireland, Scotland, and Wales. Results: iGlar prescribing declined in all of the four nations. From 2020 to 2024, the total prescribed quantity of biosimilars persistently increased in all countries, reaching 24% in England, 5% in Northern Ireland, 24% in Scotland, and 11% in Wales, all in 2024. Consequently, the proportion of Lantus prescriptions (as quantity) decreased but continued to exceed that of all available iGlar products combined in all countries in all years analyzed. By 2024, Lantus was also priced lower than the most common biosimilar, Abasaglar, across all nations. Conclusions: The introduction of biosimilars does not automatically result in altered prescribing practices, though we show that the most commonly prescribed iGlar was also the least expensive product at the end of the analysis period. At launch and for several years after, biosimilars failed to gain strong utilization, despite cost advantages, highlighting the need for active switching policies and prescriber engagement. Full article

Background/Objectives: The STRIVE study was a multicentre, open-label, real-world clinical trial evaluating the effectiveness of a targeted prescribing pathway for liraglutide 3.0 mg as an adjunct to standard care versus standard care alone in people with obesity attending Specialist Weight Management Services (SWMS) in the UK and Ireland. This post hoc analysis focuses on the standard care arm to explore differences in outcomes between sites, particularly the potential impact of offering meal replacements as part of usual care. Methods: Participants included individuals with a BMI ≥ 35 kg/m² and at least one obesity-related complication who received standard care at five SWMS sites. All sites provided specialist nutrition and exercise counselling; however, only the Dublin site (n = 40) included meal replacements as part of routine care. Baseline characteristics and weight change data were compared between the Dublin and UK cohorts (n = 92) at 52 and 104 weeks. Statistical comparisons were made using appropriate parametric and non-parametric tests. Results: At baseline, the Dublin cohort was significantly older (p < 0.01), had a higher prevalence of hypertension (p < 0.05), and a lower reported incidence of depression/anxiety (p < 0.05) than the UK cohort. At week 52, the Dublin group achieved greater mean weight loss (−6.1%, SD ± 5.7%) compared to the UK cohort (−1.3%, SD ± 6.7%, n = 27, p < 0.01). By week 104, Dublin participants maintained a mean weight loss of −4.4% (SD ± 5.7%) while UK participants had a mean weight gain of 0.37% (SD ± 7.6%) (p < 0.05). Conclusions: The integration of meal replacements as part of usual care may have contributed to the greater and sustained weight loss observed in the Dublin cohort compared to other SWMS in the UK. Full article

Background/Objectives: Total knee arthroplasty (TKA) is considered as important final line of treatment for several conditions such as knee osteoarthritis. Interestingly, culture, demographics, and health care systems may differ between countries, leading to different outcomes. Understanding this variation can help in enhancing patient care and rehabilitation therapy. This study aimed to compare primary TKA patients from the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK) pre- and post-surgery, representing two different populations and cultural backgrounds. Methods: A retrospective cohort sample was collected from the UK and one prospective cohort sample was collected in the KSA. Demographic characteristics and the Oxford knee score (OKS) were compared preoperatively and 6 and 12 months postoperatively. Results: A total of 259 patients were included in the study. Significant differences were observed in demographic characteristics. Patients in the UK cohort were five years older and 7 kg/m² lower in body mass index (BMI) than those in the KSA cohort. The proportion of male patients was higher in the UK cohort (37%) compared to the KSA cohort (17%). Preoperatively, the OKS was significantly (p = 0.001) worse in the Saudi cohort (15 ± 4) compared to the UK cohort (19 ± 6). After 6 months postoperatively, both groups improved; however, there was a significant difference, with a higher value for the KSA cohort compared to the UK cohort. By 12 months post-TKA, the difference in OKS between the populations no longer existed. Conclusions: Although there are notable differences in demographics and preoperative OKS, the functional outcomes at 12 months post-TKA were comparable between the two populations. These findings suggest that while cultural and demographic factors may influence early postoperative recovery, 12-month outcomes tend to converge across different populations. Full article

Physical activity allows people to obtain multidimensional benefits. Regular practice and following the recommendations can provide the benefits mentioned above. However, it has been evidenced that the variability in the environmental temperature is a determining factor to adhere to the regular practice of physical activity. From this point of view, it has become evident that researchers have joined criteria to explore the effects of climate change or global warming on physical activity or physical education. This study is the first bibliometric analysis of the scientific literature related to physical activity, physical education, global warming, and climate change. The objective of the present bibliometric review was to examine annual publication trends, identifying the categories, journals, and countries with the highest number of publications on this topic. In addition, the secondary objective was to identify the most productive and prominent authors, highlight the most cited articles, and determine the keywords most used by the authors. We analyzed 261 papers published in journals indexed in the Web of Science, examining the trend followed by annual publications, identifying prolific and prominent co-authors, leading countries and journals, most cited papers, and most used author keywords. The annual publications followed an exponential growth trend (R² = 90%), which means that there is great interest in the scientific community for this object of study. The Journal of Physical Activity & Health was the journal with the most published papers. M.S. Tremblay and E.Y. Lee were the most prominent co-authors, and as reference authors on the subject, M. Nieuwenhuijsen and H. Khreis were the most prominent authors. The three countries with the highest productivity are the USA, the UK, and Canada. Although a total of 29 keywords were identified, only 25 of them were commonly recurrent, with the most used being climate change and physical activity. Full article

This study investigates the relative benefits of solar thermal (ST) and photovoltaic (PV) systems integrated with air-source heat pumps for domestic hot water production in newly built residential buildings. Using calibrated DesignBuilder simulations of “The Future Home” located in Energy House 2.0, an environmental chamber, the study analyzes energy performance and carbon emissions for eight scenarios: (1) baseline heat pump only, (2) heat pump with 4 m² PV panels, (3) heat pump with 4 m² ST panels, (4) heat pump with 2 m² PV + 2 m² ST panels, and (5–8) variants with increased hot water demand. While ST systems directly heat water through thermal energy transfer, PV systems contribute to water heating indirectly by providing electricity to power the heat pump. The results show that the ST system provides 964.6 kWh of thermal energy annually, increasing to 1528 kWh with enhanced hot water demand, while a similarly sized PV system generates 532.5 kWh of electricity. The research reveals that Standard Assessment Procedure methodology’s fixed hot water demand assumptions could significantly underpredict solar thermal benefits, potentially discouraging UK house builders from adopting this technology. Full article

A pilot-scale (4000 L) continuous flow electromethanogenic reactor (EMR), also known as a microbial electrochemical cell coupled with an anaerobic digester (MEC-AD), treating brewery wastewater was designed and installed at Hepworth’s Brewery, UK. This investigation presents a 4-fold increase in size compared to the next largest pilot-scale MEC-AD system presented in the literature, providing findings to inform the operation of a 52,000 L MEC-AD system (currently under construction). Housed in a 20 ft shipping container, the pilot system features four 1000 L reaction vessels arranged in series, each with a working volume of 900 L. Each reaction vessel contained 8 electrode modules. The system was tested over varying organic loading rates (OLRs), achieved through systematic reductions in hydraulic retention time (HRT). HRTs between 24 and 1.8 days were investigated to align with commercial viability targets. OLRs were observed from 0.4 to 7.5 kgCOD/m³/d. A maximum stable OLR of 6.75 kgCOD/m³/d at a HRT of 2.3 days was observed while maintaining COD removal of 65 and 88% over the first two vessels. This pilot demonstrated commercially viable performance of an EMR at a brewery, resulting in the purchase of the technology at commercial scale (52,000 L) to form part of a wastewater treatment system. Full article