King's College Hospital NHS Foundation Trust is an NHS trust in London, England. It is closely involved with Guy's and St Thomas' NHS Foundation Trust, with which it shares its chair, Sir Hugh Taylor, its strategy director and IT director. It is assumed that the two organisations will eventually merge.
Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein-associated disease (MOGAD) are the major types of demyelinating disorders of the central nervous system (CNS). Demyelinating disorders impact women disproportionately and frequently present during reproductive years. These conditions can cause significant neurological disability and psychosocial challenges, especially for women. Because they often present during reproductive years, clinicians frequently manage contraception, pregnancy, and the postpartum period alongside disease control. Sex-specific evidence, therefore, becomes especially important for treatment decisions. Despite this, sex-specific differences in epidemiology, immunopathology, clinical features, and therapeutic response remain inconsistently addressed in both clinical practice and research. In this review, we synthesize current evidence on the factors underlying the female predominance observed in MS, NMOSD, and MOGAD, and discuss the clinical consequences of these findings. We investigate the influence of sex hormones, X-chromosome–mediated immune regulation, and immunological changes associated with pregnancy and the postpartum period, as well as disease-specific mechanisms. We also examine how these factors affect diagnosis, prognosis, therapeutic decision-making, pregnancy management, and quality of life. Finally, we highlight important gaps in knowledge and underscore the necessity for a sex-informed approach to the diagnosis, management, and research of autoimmune demyelinating diseases.
To evaluate shifts in waist-to-height ratio (WHtR) categories among adults with obesity or overweight, with or without prediabetes, treated with tirzepatide in the SURMOUNT-1 study. This post hoc analysis included 2,538 participants from the SURMOUNT-1 Phase 3, double-blind, randomized, placebo-controlled trial. Adults with BMI ≥ 30 or ≥ 27 kg/m² and at least one obesity-related complication (ORC), excluding diabetes, were randomized to receive once-weekly tirzepatide (5, 10, or 15 mg) or placebo, alongside a reduced-calorie diet and increased physical activity. Participants were grouped by baseline WHtR (≤ 0.49, > 0.49 to ≤ 0.59, > 0.59) according to the National Institute for Health and Care Excellence (NICE) framework. Participants with prediabetes at baseline had additional follow-up data beyond week 72, and shifts in their WHtR categories at week 176 were also included. Change from baseline in WHtR was analyzed using a mixed model for repeated measures (MMRM). Shift tables were used to summarize changes from baseline to post-baseline WHtR category levels. At baseline, 89.8
There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy. We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95
OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.
Background: African-derived populations are disproportionately affected by primary open-angle glaucoma (POAG) and face increased risks of surgical failure due to anatomical and genetic factors. This report identifies challenges in glaucoma care and strategies to optimize surgical outcomes in patients from African-derived backgrounds. Methods: Six UK-based consultant ophthalmic glaucoma surgeons with extensive experience in diverse patient populations convened to discuss challenges and key approaches for optimising glaucoma filtration surgery outcomes in African-derived populations. Their opinions were supplemented by published literature to propose tailored recommendations and address some of the known challenges in this important patient group. Results: Surgical treatment of glaucoma among African-derived populations includes challenges such as Tenon's thickness, variable wound healing, and an increased risk of scarring. Preoperatively, outcomes can be improved through patient education, counselling and ocular surface optimisation, including reduction of preservative exposure. Intraoperatively, surgeons may consider the use of general anaesthesia or conscious sedation in younger patients, higher or prolonged mitomycin C exposure tailored to individual risk, and separate closure of Tenon's capsule and conjunctiva to reduce bleb failure. Proactive postoperative care should include intensified steroid regimens and 5-fluorouracil use when indicated. Conclusion: These insights support the delivery of culturally informed, evidence-based glaucoma care tailored to patients from African-derived backgrounds. By adopting a personalised and proactive approach, healthcare professionals may achieve more consistent and favourable surgical outcomes in this high-risk group.
