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  • Cardiovascular disease in the context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A comprehensive narrative review

    Mustafa, Attia; Kite, Chris; Lagojda, Lukasz; Dallaway, Alexander; Chantha, Kamaljit Kaur; Than, Nwe Ni; Kassi, Eva; Kyrou, Ioannis; Randeva, Harpal S.; University Hospitals Coventry and Warwickshire NHS Trust; University of Warwick; Omar Al Mukhtar University; University of Wolverhampton; University of Chester; University of Sheffield; National and Kapodistrian University of Athens (MDPI, 2025-11-21)
    Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic hepatic disease with a rising global prevalence (25–38% of the general population). As a new term, MASLD was introduced in 2023 to replace the previous nomenclature of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD). This new term/definition introduced changes in the diagnostic criteria and underscores the direct link between cardio-metabolic risk and this prevalent liver disease. In this context, the present review examines the clinical and pathophysiological links between MASLD and cardiovascular disease (CVD), providing a robust evidence synthesis of primarily systematic review data on the association between MASLD and coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF). This association appears to be not only synergistic, but also independent of other known CVD risk factors, highlighting MASLD as a key cardio-metabolic risk factor that merits prompt diagnosis and treatment. The development of MASLD-related cardiovascular morbidity increases with the severity of the underlying hepatic pathology, particularly with progression to steatohepatitis and fibrosis. Notably, growing evidence highlights the links between MASLD and CVD through cardiac structural, electrical, and functional alterations that can progress to CAD, AF, and new-onset HF. Recognizing these links in clinical practice underscores the importance of early detection and multi-disciplinary management of MASLD to prevent disease progression and CVD complications.
  • Organ wide toxicological assessment of common edible herbs and their mixtures as used in home remedies

    Wodi, Chigeru; Ezaka, Ebere; Ukwah, Boniface N; Eze, Ukpai A; Ebonyi State University; De Montfort University (The Korean Society of Environmental Health and Toxicology, 2023-06)
    The use of home remedies for medicinal purposes, most of which are edible plants has continued to be a practice in many homes. However, there has been an increasing report of chronic use with lethal effect. Among the commonly used herbal/ medicinal plants were ginger, garlic and lemon. These were seen to be prevalent across continents with brewing and crude extraction being the most means of consumption. This study investigated the organ wide toxicity of this extract following chronic consumption of crude extract. Twenty-five albino Wister rats, five in each group were used for this experiment. Each animal received 0.5ml/kg body weight of either ginger extract, garlic extract, lemon juice, or a mixture of equal volumes of all three extract (v/v) respectively twice daily for seven (7) days. Statistics were represented as ±SE; P≤0.05 was considered significant. Previous studies have shown that moderate consumption of these medicinal plants were beneficial and have shown no deleterious effect. This study observed no change in the weight of the experimental animals. The weight of the animals continued to increase except for the group that received lemon and the mixture, but these were not significant. It was observed that chronic consumption induced organ wide toxicity to include the liver, kidney, intestinal epithelium, stomach, and pancreas. These were shown to alter tissue architecture and the cell morphology. Packed cell volume was reduced in the lemon and the group that received a combination of all extracts (p=o.03). Blood differentials showed changes in levels. An elevated basophil level was observed in ginger and garlic (p<0.0001; p=0.0006). Monocyte levels increased progressively across each group when compared to the control with the most elevated level seen in the group that received the mixture (p<0.0001). Lymphocyte count was reduced across all the groups that received the extract except for animals that received ginger. This study suggests the application of caution among users of these medicinal plants and continues to draw attention to the need for harmonization and standardization of safe use doses.
  • Awareness and Knowledge of Antimicrobial Resistance, Antimicrobial Stewardship and Barriers to Implementing Antimicrobial Susceptibility Testing among Medical Laboratory Scientists in Nigeria: A Cross-Sectional Study

    Huang, Sheng; Eze, Ukpai A; Coventry University; De Montfort University (later University of Chester) (MDPI, 2023-04-26)
    Background: Antimicrobial resistance (AMR) is now considered one of the greatest global health threats. This is further compounded by a lack of new antibiotics in development. Antimicrobial stewardship programmes can improve and optimize the use of antibiotics, thereby increasing the cure rates of antibiotic treatment and decreasing the problem of AMR. In addition, diagnostic and antimicrobial stewardships in the pathology laboratories are useful tools to guide clinicians on patient treatment and to stop the inappropriate use of antibiotics in empirical treatment or narrow antibiotics. Medical Laboratory Scientists are at the forefront of performing antibiotics susceptibility testing in pathology laboratories, thereby helping clinicians to select the appropriate antibiotics for patients suffering from bacterial infections. Methods: This cross-sectional study surveyed personal antimicrobial usage, the knowledge and awareness on AMR, and antimicrobial stewardship, as well as barriers to antimicrobial susceptibility testing among medical laboratory scientists in Nigeria using pre-tested and validated questionnaires administered online. The raw data were summarized and exported in Microsoft Excel and further analyzed using IBM SPSS version 26. Results: Most of the respondents were males (72%) and 25–35 years old (60%). In addition, the BMLS degree was the highest education qualification most of the respondents (70%) achieved. Of the 59.2% of the respondents involved in antibiotics susceptibility testing, the disc diffusion method was the most commonly used (67.2%), followed by PCR/Genome-based detection (5.2%). Only a small percentage of respondents used the E-test (3.4%). The high cost of testing, inadequate laboratory infrastructure, and a lack of skilled personnel are the major barriers to performing antibiotics susceptibility testing. A higher proportion of a good AMR knowledge level was observed in male respondents (75%) than females (42.9%). The knowledge level was associated with the respondent’s gender (p = 0.048), while respondents with a master’s degree were more likely to possess a good knowledge level of AMR (OR: 1.69; 95% CI: 0.33, 8.61). Conclusion: The findings of this study indicate that Nigerian medical laboratory scientists had moderate awareness of AMR and antibiotic stewardship. It is necessary to increase investments in laboratory infrastructure and manpower training, as well as set up an antimicrobial stewardship programme to ensure widespread antibiotics susceptibility testing in hospitals, thereby decreasing empirical treatment and the misuse of antibiotics.
  • Metabolic, androgenic, and physical activity profiles in women aged over 40 years with polycystic ovary syndrome: A comparative analysis using UK Biobank data

    Kite, Chris; Kyrou, Ioannis; Randeva, Harpal S.; Lahart, Ian M.; Brown, James E. P.; University of Wolverhampton; University Hospitals Coventry and Warwickshire NHS Trust; University of Chester; Coventry University; Aston University; University of Warwick; Agricultural University of Athens (SAGE Publications, 2025-11-21)
    Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women, linked to metabolic, hormonal, and psychological issues. Management typically involves lifestyle changes, including increased physical activity and reduced sedentary behaviour. Objectives: To compare the health profiles and behaviours of women with and without PCOS. Design: This study analysed data from the UK Biobank, which is a prospective cohort study. Methods: Women with PCOS in the UK Biobank were identified, while age- and body mass index (BMI)-matched controls were randomly selected. Data on factors associated with PCOS severity and self-reported lifestyle behaviours were analysed. Group differences were tested for significance, and participants were categorised by health behaviours to assess morbidity risk. Results: The study included 319 women with PCOS (mean age: 43.9 years) and 638 in each control group. Significant differences (p < 0.05) were observed in anthropometric (e.g. body weight, BMI, waist and hip circumference, and body fat), cardio-metabolic (e.g. blood pressure, triglycerides, and glycated haemoglobin), and androgenic (e.g. sex hormone-binding globulin) indices. Differences were most pronounced between PCOS and age-matched controls but remained when BMI was also considered. Women with PCOS engaged in less vigorous physical activity and had higher screen time and sedentary behaviours. Those with the lowest physical activity and highest sedentary time had the worst health profiles and highest morbidity risk, regardless of group. Conclusion: Women with PCOS exhibit poorer health despite only slight lifestyle differences. Across all participants, lower physical activity and higher sedentary behaviour were linked to increased health risks. Further research is needed to clarify causal relationships between lifestyle factors and PCOS.
  • Loss of the RNA binding protein HuR in early murine limb mesenchyme does not affect development but leads to impaired bone homeostasis in adulthood

    Fu, Shijian; Johnson, Kirsty A.; Winstanley‐Zarach, Phaedra; Ersoy, Ufuk; Adlmanninger, Elena; McDermott, Benjamin T.; Keenan, Craig; Vasilaki, Aphrodite; Kanakis, Ioannis; Milner, Peter I.; et al. (Wiley, 2025-11-20)
    In this study, we examined how a critical posttranscriptional regulator, the RNA‐binding protein HuR (gene name Elavl1), contributes to the development and maintenance of limb skeletal tissue. Using the Prx1‐Cre knockout model, we examined the effect of germline knockout (Elavl1KO) and limb mesenchyme‐specific knockout (MSC‐Elavl1KO) of HuR on limb development. We found that Elavl1KO disrupted the development of the limb skeleton and was associated with a loss of signaling from the apical ectodermal ridge (AER). In contrast, MSC‐Elavl1KO did not appear to affect skeletal development. Mature MSC‐Elavl1KO mice appeared healthy, but their limb skeleton exhibited abnormal bone structure in both males and females at 2.5 months of age. Osteoblasts isolated from MSC‐Elavl1KO mice exhibited lower expression of osteoblastic marker genes, and their ability to generate a mineralized matrix was markedly impaired. RNA‐Seq analysis of these osteoblasts demonstrated that loss of HuR substantially influenced their transcriptome, affecting genes associated with a wide range of cellular processes. Finally, using siRNA knockdown in the human MG63 cell line, we identified that loss of HuR leads to increased mRNA turnover of the osteoblastic transcription factor Runx2. Overall, the study has demonstrated a critical role for HuR‐mediated posttranscriptional control in skeletal development and homeostasis, but finds that its expression in mesenchyme‐derived cells only becomes critical in mature skeletal tissue.
  • Erratum to: An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH)

    Danivas, Vijay; Bharmal, Mufaddal; Keenan, Paul; Jones, Steven; Karat, Samuel Christaprasad; Kalyanaraman, Kumaran; Prince, Martin; Krishna, Murali; Fall, Caroline H. D.; Krishna, Murali; et al. (Springer, 2016-11-11)
    A co-author’s name was published incorrectly in the original publication of the article. The author name “Muffadal Bharmal” should be “Mufaddal Bharmal”. The original article has been updated accordingly.
  • Mapping the age of autistic spectrum condition diagnosis, affected by sex and Intellectual disability

    Burns, Heather; Taylor, Ruth; Jones, Steven; University of Chester (Emerald, 2025)
    Introduction/purpose: Autism is a complex neurodevelopmental condition thought to affect 1 in 100 children globally. More commonly diagnosed in males, and during childhood, diagnoses are increasingly being made throughout adulthood. Purpose: To establish what age autistic people receive their diagnosis, and whether the age of diagnosis was influenced by their sex and by the presence of intellectual disability. Design: A quantitative, cross-sectional, retrospective study. Data was collected from the Primary Care records of 6 GP Practices covering Ellesmere Port, a large town in Northwest England with 71,210 people registered. Mean age of diagnosis was calculated for the group then for each subgroup, to allow comparison between males and females, and those with and without a documented intellectual disability. Findings: Data from 1130 autistic participants were analysed. Age of participants was between 3 - 81 years with an age of autism diagnosis of 1 - 72 years. 85.6% of participants were diagnosed with autism by the age of 25 years, most commonly at 3 years of age (11.9%). The average age of diagnosis was 2.48 years later for females diagnosed across the lifespan. Average age of diagnosis was 5.05 years later for those with a learning disability. Practical implications: This study highlights the importance of healthcare professionals, educators and care givers recognising autistic traits in people across the lifespan, including the potential for diagnostic overshadowing. There are implications for commissioning autistic services, to ensure adequate assessment pathway capacity for adolescents and adults as well as children.
  • Educational strategies for managing moral distress in student nurses: A scoping review

    Kite, Chris; Timmins, Rebecca; University of Wolverhampton; University of Chester (Wiley, 2025-11-03)
    Aims: To explore what content, teaching and learning activities are advocated by nurse educators to mitigate moral distress and related concepts in student nurses. Review Methods: The review was conducted according to Joanna Briggs Institute guidelines. The search strategy adopted their three-step method for systematic reviews. The eligibility criteria reflected the Population, Concept, Context format. Results: Following searches, 3809 records were screened against eligibility criteria, resulting in 42 eligible papers being included; 29 research studies and 13 non-empirical papers. We identified 236 content suggestions, mapped to 70 subject codes. Also, 217 teaching and learning activities are suggested and mapped to 41 coded activities. Data is charted in tables and figures and results are discussed per related concept of moral distress. Conclusions: Educational content, and teaching and learning activities are heterogenous across the concepts influencing moral distress. There is overlap of content across different concepts. Moral sensitivity received the most publications. Development of research and educational strategies addressing other interrelated concepts would be advantageous for evidence-based curriculum development. Recommendations are made to develop evidence-based content and teaching and learning activities.
  • Antibiotic use among university students in malaria therapy and its implications for antimicrobial resistance in Nigeria: a quantitative cross-sectional study

    Ali, Victor Ekoche; Uketeh, Sunday Nguher; Hamza, Abdulbasit; Obiajulu, Ikechukwu; Okeke, Sandra Ugochi; Asika, Marvellous Oluebube; Obong, Abigail Effiong; Aminu, Husna Yetunde; Ominyi, Jude; Eze, Ukpai; et al. (SpringerDiscover, 2025-10-27)
    Background: Antimicrobial resistance (AMR) is a global health crisis, driven partly by inappropriate antibiotic use. In Nigeria, malaria remains highly prevalent and often mismanaged with antibiotics, particularly in presumed malaria-typhoid co-infections. This study examined patterns of antibiotic use in malaria treatment among university students, highlighting implications for AMR. Methods: A cross-sectional survey was conducted among undergraduates purposively selected from 12 universities across Nigeria’s six geopolitical zones. Data were collected via validated online questionnaires (February–March 2025) and analysed using descriptive statistics, chi-square tests, logistic regression, and Spearman correlation (SPSS v26). Results: Of 646 respondents, > 97% demonstrated general antibiotic knowledge, yet 27.6% misidentified chloroquine as an antibiotic. While 94.6% correctly recognised antibiotics for bacterial infections, about one-fifth believed they were effective against fungal, parasitic, or viral diseases. Despite 84.7% AMR awareness, 49.1% reported using antibiotics for malaria treatment. Misuse was highest in the Northeast (62.3%), Northwest (63.7%), and South-South (32.9%). In the Northeast, key drivers included prior experience (35.4%), pharmacist advice (29.9%), and peer influence (28.0%), while only 6.7% followed physician prescriptions. Misuse correlated with the belief that antibiotics treat all illnesses (rs = 0.329, p < 0.001). Nearly half (49.5%) accessed antibiotics without prescriptions. Conclusions: High AMR awareness contrasts with persistent misuse of antibiotics for malaria, reflecting misconceptions, regional disparities, and weak regulation. Targeted education, stricter antibiotic controls, and improved diagnostics are urgently needed to curb AMR in Nigeria.
  • Effectively supporting widening participation learners in medical education through a capability approach lens

    Vivekananda-Schmidt, Pirashanthie; Sandars, John; Husain, Lopa; Leadbetter, Peter; Marshall, Michelle; University of Sheffield; Edge Hill University (International Journal of Medical Education, 2024-09-20)
    Editorial
  • Intermittent prophylactic antibiotics for bronchiectasis

    Spencer, Sally; Donovan, Tim; Chalmers, James D.; Mathioudakis, Alexander G.; McDonnell, Melissa J.; Tsang, Anthony; Leadbetter, Peter; Edge Hill University; University of Cumbria; University of Dundee; University of Manchester; Galway University Hospital; Manchester Metropolitan University (Wiley, 2022-01-05)
    BACKGROUND: Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life. Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis. OBJECTIVES: To evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittent regimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and children with a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes. DATA COLLECTION AND ANALYSIS: We analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency; serious adverse events and secondary outcomes: antibiotic resistance; hospital admissions; health-related quality of life. MAIN RESULTS: We included eight RCTs, with interventions ranging from 16 to 48 weeks, involving 2180 adults. All evaluated one of three types of antibiotics over two to six cycles of 28 days on/off treatment: aminoglycosides, ß-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV<sub>1</sub> ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies. Antibiotic versus placebo: cycle of 14 days on/off. Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93; I<sup>2</sup> = 65%; 2 studies, 469 participants; moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35; I<sup>2</sup> = 0%; 2 studies, 624 participants; high-certainty evidence). Serious adverse events, lung function (FEV<sub>1</sub>), health-related quality of life, and adverse effects did not differ between groups. Antibiotic versus placebo: cycle of 28 days on/off. Antibiotics did not reduce overall exacerbation frequency (RR 0.92, 95% CI 0.82 to 1.02; I<sup>2</sup> = 0%; 8 studies, 1695 participants; high-certainty evidence) but there were fewer severe exacerbations (OR 0.59, 95% CI 0.37 to 0.93; I<sup>2</sup> = 54%; 3 studies, 624 participants), though this should be interpreted with caution due to low event rates. The risk of antibiotic resistance was more than twofold higher based on a pooled analysis (OR 2.20, 95% CI 1.42 to 3.42; I<sup>2</sup> = 0%; 3 studies, 685 participants; high-certainty evidence) and consistent with unpooled data from four further studies. Serious adverse events, time to first exacerbation, duration of exacerbation, respiratory-related hospital admissions, lung function, health-related quality of life and adverse effects did not differ between study groups. Antibiotic versus usual care. We did not find any studies that compared intermittent antibiotic regimens with usual care. Cycle of 14 days on/off versus cycle of 28 days on/off. Exacerbation frequency did not differ between the two treatment regimens (RR 1.02, 95% CI 0.84 to 1.24; I<sup>2</sup> = 71%; 2 studies, 625 participants; moderate-certainty evidence) However, inconsistencies in the results from the two trials in this comparison indicate that the apparent aggregated similarities may not be reliable. There was no evidence of a difference in antibiotic resistance between groups (OR 1.00, 95% CI 0.68 to 1.48; I<sup>2</sup> = 60%; 2 studies, 624 participants; moderate-certainty evidence). Serious adverse events, adverse effects, lung function and health-related quality of life did not differ between the two antibiotic regimens. AUTHORS' CONCLUSIONS: Overall, in adults who have frequent chest infections, long-term antibiotics given at 14-day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits.
  • The relationship between facilitating emotional cues and medical students’ clinical communication performance in qualifying exams

    Leadbetter, Peter; Fletcher, Ian; O'Sullivan, Helen; Edge Hill University; Lancaster University; University of Chester (University of Toronto Press, 2023-07-06)
    A cross-sectional study design explored the relationship between medical students' Objective Structured Clinical Examination (OSCE) clinical communication ratings and their responsiveness to simulated patient (SP) verbal emotional cues in their qualifying OSCE. Data were collected from two cohorts of fourth-year medical students (n = 37), and responses to patient cues that facilitated further disclosure or related discussion - known as provide space responses - from two OSCE communication stations were measured by coding video footage with the Verona Coding Definition of Emotional Sequences (VR-CoDES). The 37 medical students were representative of the larger cohort (n = 508) in terms of age. A significant positive correlation with a medium effect was found between OSCE clinical communication ratings and provide space responses. OSCE clinical communication ratings could differentiate between students who adopted patient-centred facilitative behaviours and those who did not.
  • A response to Simpson and Hope's ‘From policy to practice: Measuring success in widening participation’

    Sandars, John; Vivekananda‐Schmidt, Pirashanthie; Husain, Lopa; Leadbetter, Peter; Edge Hill University; University of Sheffield (Wiley, 2024-06-15)
    A letter to the editor
  • “The perception of visiting Holocaust sites on undergraduate students learning process”

    Bussu, Anna; Leadbetter, Peter; Richards, Michael; Edge Hill University (Springer, 2022-05-13)
    This paper presents the main findings of a qualitative research project. The aim of the research was to explore undergraduate students’ perceived knowledge acquisition and awareness of the Holocaust, after visiting Auschwitz concentration camp in Poland. The qualitative study (focus groups & semi-structured questionnaires) involved three cohorts of students and lecturers from a university in the North West of England. The participants visited the Holocaust-related sites in Poland from 2016 to 2019. Findings indicate that students’ who actively engaged in visits to Holocaust related sites developed knowledge and awareness of the Holocaust. For many participants, this knowledge and awareness was facilitated via a reflective process that enabled empathic connection between these historical events and the students. The study also highlighted practical strategies that could be implemented to enhance the experience for future cohorts of undergraduate students visiting holocaust related sites. By adding to the limited literature on Holocaust education with undergraduate students, the study highlighted the importance and directions for future research in this area to inform future pedagogic practice.
  • Has the pandemic response entrenched a pathogenic emphasis in education?

    Leigh, Jacqueline; Borwell, Juliet; Garrow, Amanda; Kenny, Amanda; Knight, Kate; Monks, Rob; Roberts, Debbie; Whaley, Victoria; Wright, Karen; Edge Hill University; Health Education England (South East); Liverpool John Moores University; University of Lincoln; University of Chester; University of Bradford; University of Central Lancashire (MA Healthcare, 2022-11-12)
    Commentary
  • Efficacy and safety of allogeneic hematopoietic stem cell transplantation in curing Sickle Cell Disease: A systematic review and meta-analysis of single-arm studies

    Folarin, Moteleola; Al-Zubaidi, Hanaan; Moore, Emma; Eze, Ukpai; Palanisamy, Navaneethan; University of Chester (Elsevier, 2025-09-13)
    Sickle cell disease (SCD) is a life-threatening hemolytic genetic disorder affecting approximately 20 to 25 million people globally. Conventional treatment, like hydroxyurea, is supportive but not a cure. Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) has gained popularity recently as it offers a potential cure for SCD. Although several independent studies exist supporting this, there is a lack of consolidated evidence for a more comprehensive analysis of clinical outcomes. In this systematic review and meta-analysis, we assessed the safety and efficacy of allo-HSCT in SCD, offering information on results for various age groups, donor types, conditioning procedures/regimens, and stem cell sources. A systematic literature search was carried out in PubMed and Scopus for articles published between January 2010 and March 2025. Articles that satisfied the inclusion requirements were subjected to quality assessment using the Newcastle-Ottawa Scale (NOS). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed throughout. Statistical analyses were performed using meta, an R package. The meta-analysis of 58 studies (n = 7931) revealed allo-HSCT to have 94%, 86%, 20%, 14%, 9%, 6% for overall survival (OS), event-free survival (EFS), acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD), graft-failure (GF), and mortality, respectively, in SCD. Subgroup analysis demonstrated that clinical outcomes varied based on the type of donors, conditioning procedures/regimens and stem cell sources. The findings of this study show that allo-HSCT is safe and efficacious in curing SCD with an OS of 94%. GF and GVHD issues could be reduced by following personalized conditioning regimens/post-transplantation prophylaxis.
  • The acceptability of the Fire and Rescue Service working with primary care to improve identification of mental health problems in older adults. A mixed-method qualitative study

    Fisher, Tamsin; Chew-Graham, Carolyn A.; Corp, Nadia; Farooq, Saeed; Kingston, Paul; Read, Ian; Southam, Jane; Spolander, Gary; Stevens, Dean; Walchester, Mark; et al. (Royal College of General Practitioners, 2023-11-29)
    Background: Mental ill-health in older adults (aged 60 years and over) is often underdiagnosed and undertreated. Older adults are less likely to access mental health services owing to perceived stigma and fear of being a burden. Non-traditional providers of health care, such as the Fire and Rescue Services (FRS), provide a possible solution to facilitate early detection of problems and help-seeking among older adults, especially in the context of pressured statutory services. Aim: To examine whether and how FRS Home Fire Safety Visits (HFSV) could be optimised to include detection and signposting for mental health problems — particularly anxiety and depression — in older adults. Design & setting: This mixed-method qualitative study took place in the West Midlands, UK in 2022. Method: This study involved focus groups (n = 24) and interviews with FRS staff (n = 4) to develop an in-depth contextual understanding of he acceptability and feasibility of expanding HFSV to include identification of anxiety and depression. Results: FRS staff were open to expanding their HFSVs to include mental health, provided they had sufficient training and support from partner agencies in primary and social care settings to accept referrals for service users presenting with symptoms of anxiety and/or depression. Conclusion: The positive reputation of FRS staff and engagement with older adults suggests that HFSV could support the detection of anxiety and depression in older adults, and appropriate signposting to other services including primary care.
  • Gestational low-protein diet impairs mitochondrial function and skeletal muscle development by inducing immune responses in male offspring

    Altinpinar, Atilla Emre; Alameddine, Moussira; Ersoy, Ufuk; Kanakis, Ioannis; Pekovic-Vaughan, Vanja; Ozanne, Susan E.; Goljanek-Whysall, Katarzyna; Vasilaki, Aphrodite; The MRC - Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool; University of Chester; Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories; University of Galway (Elsevier, 2025-10-10)
    Maternal nutrition is essential for proper fetal and postnatal organ maturation and is linked to the future risk of developing metabolic syndrome, cardiovascular disease, and muscle loss. There is still limited understanding how a low-protein intake during gestation influences skeletal muscle development, inflammation, and the related pathways. This study aimed to investigate the impact of gestational low-protein diet in mice on skeletal muscle development and inflammatory responses in male offspring. Pups born from mothers fed a low-protein diet (LPD) were lactated by normal protein diet (NPD)-fed mothers and maintained on NPD post-weaning (LNN group). Offspring born from mothers fed an NPD and maintained on an NPD during lactation and beyond were used as controls (NNN group). In 21-day-old offspring from protein-restricted mothers, RNA-Seq analysis showed upregulation of immune response–related genes, enriching adaptive immunity pathways. Additionally, LNN group exhibited elevated markers of inflammation, along with disruptions in antioxidant defence balance and macrophages infiltration in gastrocnemius muscle at 3 months of age. Energy metabolism was impaired, as indicated by changes in related proteins and enzymes involved in mitochondrial function. We conclude that gestational LPD adversely affects skeletal muscle development in male offspring.
  • Impact of vaccination on pertussis-related hospital admissions in children in Scotland from January 2013 to July 2024: a cohort study

    Hasan, Taimoor; Wilkinson, Ewan; Decraene, Valérie; Kouzeli, Ariadni; Gibbons, Cheryl; Chua, Vera; Vivancos, Roberto; Ghebrehewet, Sam; Public Health Scotland; University of Chester; UK Health Security Agency; NIHR Health Protection Research Unit in Gastrointestinal Infections; University of Warwick; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections (European Centre for Disease Control and Prevention, 2025-10-02)
    BACKGROUND: In Scotland, the number of pertussis infections recorded in children in 2024 was the highest of any year in the last decade. The protective role of vaccination against severe infection and associated hospitalisations has not been assessed. AIM: To investigate the effect of vaccination and sociodemographic factors on pertussis-related hospitalisations in Scottish children aged under 18 years. METHODS: In a retrospective cohort study, laboratory-confirmed pertussis cases from January 2013 to July 2024 were extracted from the national electronic surveillance system and linked to hospitalisation data from Scottish Morbidity Records and vaccination data from the national immunisations database. The outcome was a pertussis-associated hospitalisation. Multivariable logistic regression was used to calculate odds ratios (OR) for the association between vaccination status and hospitalisation, adjusted for age, sex, ethnicity and deprivation status. RESULTS: There were 3,982 laboratory-confirmed cases of pertussis during the study period. Children fully vaccinated for age had significantly lower odds of hospitalisations than unvaccinated children (adjusted OR (aOR): 0.31; 95% CI: 0.21–0.46). Being partially vaccinated for age did not significantly reduce hospitalisations relative to unvaccinated children (aOR: 0.80; 95% CI: 0.47–1.33). In the univariable analysis, children living in the most deprived areas had significantly more hospitalisations than those in the least deprived areas (OR: 3.90; 95% CI: 2.41–6.56). This association was not significant when adjusted for the effect of vaccination (aOR: 1.47; 95% CI: 0.84–2.66). CONCLUSIONS: Fully vaccinated children had significantly lower odds of hospitalisation, indicative of less severe disease. This emphasises the importance of fully vaccinating children according to the childhood immunisation schedule.
  • ‘We’re not daft, we’re not stupid, we can still learn’ – the impact of informal science learning on wellbeing in acquired brain injury

    Wilkie, Lowri; Fisher, Zoe; Kemp, Andrew H.; Charles, Suzanna; Fletcher, Jessica; Swansea University; Regional Neuropsychology and Community Brain Injury Service, Morriston Hospital; Swansea Bay University Health Board; University of Chester (Taylor & Francis, 2025-10-03)
    Science engagement centres offer interactive, hands-on experiences that foster curiosity and public engagement with science. This pilot study explores the integration of a UK science engagement centre, Oriel Science, into social prescribing for individuals with acquired brain injury (ABI). A ten-week structured intervention was delivered through science-based workshops. Quantitative wellbeing outcome measures were combined with qualitative reflections from participants, caregivers and academic presenters. Findings showed consistent improvements in wellbeing, with participants reporting enhanced cognitive engagement, motivation and social connection. The sessions provided a stimulating environment that helped participants reconnect with cognitive skills they felt had been lost after injury. Academic presenters also found the experience unexpectedly rewarding themselves, noting strong participant engagement and a renewed sense of purpose. This is the first study to link a science engagement centre with healthcare delivery, offering science-based social prescribing as part of ABI rehabilitation. Results highlight the potential of curiosity driven learning to support recovery, promote wellbeing and strengthen scientific literacy. The study underscores the role of universities in public engagement, particularly in an age where science communication and critical thinking are vital for societal resilience.

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