Craigavon Area Hospital (Irish: Ospidéal Cheantar Craigavon) is a teaching hospital in Portadown, Craigavon, County Armagh, Northern Ireland. It serves an estimated 241,000 people from the boroughs/districts of Craigavon, Banbridge, Armagh and Dungannon–South Tyrone. It is managed by the Southern Health and Social Care Trust and is located within the townland of Lisnisky, beside the A27 road, at the edge of Portadown.
AIMS:Congestion signals heart failure progression and drives decompensation. Reliable management strategies remain poorly developed. We evaluated 12-months of congestion-guided clinical management following implantation of an inferior vena cava (IVC) sensor. METHODS AND RESULTS:Data were combined from two prospective studies (FUTURE-HF and FUTURE-HFII) (N=65, mean age 65.7±9.5 years; 75.4% NYHA III; 90.8% HFrEF). Patients recorded daily IVC parameters. Adjudicated safety outcomes, sensor-derived IVC area measurement versus CT imaging, medication adjustments, and clinical outcomes at 12-months were analysed.No adjudicated device or procedure-related serious adverse events occurred. Excellent correlation was observed between sensor-derived and CT-derived IVC area (n=44; R2=0.97; mean relative error <5%). Patient adherence was 93% and a sustained, significant reduction in IVC area was observed (8.1%, p<0.005), correlated with clinical improvements (p<0.001), despite no significant change in body weight. Improvements were observed in NYHA functional class (Class III: 74.5% improved to 40.0%; p<0.01) and NT-proBNP (median 1697 reduced to 998 ng/L; p<0.001). HF events (HFEs) were lower post-implant (0.31/year, 1.67/year pre-implant; 84.5% relative reduction; rate ratio: 0.18; 95% CI: 0.08-0.29). Medication adjustments (n=415) included diuretic titration (57%) and increased use of guideline directed medical therapy from baseline to 12-months (28%). CONCLUSIONS:Congestion management through ambulatory IVC monitoring demonstrated excellent safety, sustained accuracy, and high levels of patient adherence at 12-months after sensor implantation. This was associated with improved HF congestion status and a lower observed rate of HFEs, supporting investigation of congestion-guided management using IVC monitoring in a pivotal randomized clinical trial.
Abstract Alopecia areata (AA) is a T-cell-mediated autoimmune disease characterized by nonscarring hair loss of variable extent. There is no standard treatment for severe AA and access to treatment varies widely. Evidence from clinical trials shows that ritlecitinib is more effective than placebo at improving hair regrowth. Ritlecitinib was approved in March 2024 for use in the UK for those aged > 12 years with severe alopecia areata [Severity of Alopecia Tool (SALT) > 50]. We aimed to (i) characterize the demographics and clinical features of patients started on ritlecitinib, (ii) determine treatment response in terms of the proportion of patients achieving SALT ≤ 20 at serial follow-up visits and (iii) review the safety profile. Patients prescribed ritlecitinib were identified from centralized pharmacy records across four hospital sites. We created a registry of demographics and clinical course. Data analysis was undertaken using Jamovi. We present the first 31 patients established on treatment with ritlecitinib. Their average age was 36 years (range 12–63 years; 15% were adolescents). The female-to-male ratio was 4 : 1. The mean disease duration was 11 years. The mean baseline Dermatology Life Quality Index and SALT were 17 and 84, respectively. Thirteen patients had previously received biologic or systemic treatment. All patients had received ≥ 52 weeks of ritlecitinib. In total, 41% of patients achieved SALT ≤ 20 at week 36, with 21% achieving a SALT score of 0. Overall, our response rate (defined as SALT < 20 at 1 year) was 51%. Treatment response was slow, with only eight patients showing any benefit by week 16. Oral adjuvant therapies (minoxidil, n = 3) were largely reserved for refractory cases. Two patients had treatment interruption owing to transient blood abnormalities or infection. There were no serious adverse events. Our real-world data show encouraging early results for both safety and efficacy. Time to treatment response is an important consideration. International AA registries will play a crucial future role, particularly regarding unanswered questions regarding predictors of response and treatment duration.
Introduction Medial patellofemoral ligament (MPFL) reconstruction is a useful technique for managing patellar instability. Various grafts choices and outcomes are reported, however, no randomised control trial directly comparing autograft to synthetic grafts exist. This paper is the result of a previously published clinical trial protocol directly comparing graft choices. Methods An ISRCTN registered, non-inferiority, prospective randomised-control trial was conducted. Full trial protocol was previously published. Patient demographics, radiological parameters and clinical outcomes were collated. A sample size was estimated based on previously published studies. A 1:1 recruitment with block randomisation was performed. Validated knee outcome scores are reported. Data was blinded for all analyses based on an intention to treat design. A p < 0.05 was considered statistically significant. Results A total of 20 patients in each arm were prospectively followed for a minimum of 2 years post surgery. Follow up retained an adequately powered study based on the protocol. Mean age of 19.1 ± 3.6 years. Tegner, Lysholm, Kujala, International Knee Documentation Committee (IKDC) and Banff Patellar Instability Index (BPII) all improved post operatively, mainly at 1 year. Recovery trajectory showed 2/3 improve at 1 year, and further improvement occurs in 1/3 of patients out to 2 years irrespective of graft choice. Outcome scores were not significantly different between graft groups at any time points. Functional strength assessment showed significantly higher strength with autologous reconstruction at 1 and 2 years post op. Conclusion No significant difference in outcomes were observed between autologous hamstring and synthetic reconstruction of the MPFL. Further large scale Randomised Control Trials (RCTs) are required comparing autograft and synthetic alternatives.
