Nevill Hall Hospital (Welsh: Ysbyty Nevill Hall) is a district general hospital in Abergavenny, north Monmouthshire, Wales. It is managed by the Aneurin Bevan University Health Board.
Chronic hand eczema (CHE) is associated with substantial functional impairment and reduced quality of life. Delgocitinib, a pan-Janus kinase (JAK) inhibitor, has emerged as a promising topical treatment for CHE. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of topical delgocitinib 20-30 mg/g compared with vehicle in patients with CHE. PubMed, Embase, Cochrane Library, ClinicalTrials.gov, EU CTR, and WHO ICTRP were searched up to 15 February 2026. The primary outcome was treatment success at week 16, defined as clear or almost clear skin with a ≥ 2-point improvement on the Investigator's or Physician's Global Assessment (IGA/PGA). Secondary outcomes included treatment success at weeks 4 and 8, changes in Hand Eczema Symptom Diary (HESD) itch and pain scores, and safety outcomes. Relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Three publications reporting four RCTs involving 1154 patients were included, with 752 receiving delgocitinib and 402 receiving vehicle. At week 16, treatment success was significantly higher with delgocitinib (RR 3.17; 95% CI 1.78-5.65; p < 0.01), corresponding to an absolute risk difference of 16.9% and a number needed to treat (NNT) of 6 (95% CI 3-16). Similar results at weeks 4 and 8. Delgocitinib also led to significantly greater improvements in HESD itch and pain scores. No significant differences were found in overall adverse events (AEs), treatment-related AEs, or serious AEs. Discontinuation due to AEs was lower in the delgocitinib group. Delgocitinib 20-30 mg/g demonstrated greater efficacy than vehicle and a favourable safety profile, supporting its use as a topical treatment for CHE.
ABSTRACT Background Bronchopulmonary neuroendocrine tumors (bpNETs) are uncommon lung neoplasms posing significant diagnostic and therapeutic challenges. This study evaluates the impact of the transformation of the South Wales Neuroendocrine Cancer Service on diagnostic and management outcomes for bpNETs. Methods We retrospectively analyzed data from patients with typical and atypical carcinoids (TC and AC) diagnosed before and after commissioned service transformation (September 2017). Data were collected from network cancer databases and clinical portals. Demographics, diagnostic pathway times, diagnostic tests, treatment modalities, and survival outcomes were analyzed. Results Following transformation, significant reductions were observed in median times from presentation to diagnosis (p = 0.009), symptom onset to diagnosis (p = 0.006), and presentation to treatment (p = 0.020). No other significant differences were noted between pre‐ and post‐transformation groups. Incidental diagnoses increased, especially in TCs (53%). Usage of CgA, HIAA, EBUS biopsies, and Gallium PET scans increased post‐transformation. Surgical treatments were common, but there was an increase in systemic therapy post‐transformation. Conclusion Implementation of a collaborative care model and NET service transformation led to significant improvements in pathway times. This is one of the few studies describing such improvements in NETs. While survival outcomes showed promising trends, further research is needed to assess the long‐term impact on patient outcomes.
Abstract Background Ectopic posterior pituitary (EPP) is a rare congenital malformation caused by abnormal migration of neurohypophyseal tissue during embryogenesis. It is commonly associated with varying degrees of hypopituitarism. Clinical presentation may be subtle, resulting in delayed diagnosis, particularly in adolescence. Case Presentation A 17-year-old male was referred for assessment of delayed puberty and chronic fatigue. He reported a complete lack of energy, muscle aches, back pain, reduced exercise tolerance, and inability to participate in sports. Examination revealed a prepubertal appearance with absent secondary sexual characteristics, puffy hands, and height below the 50th centile. Hormonal evaluation demonstrated panhypopituitarism. IGF-1 was profoundly low at 2 nmol/L. Gonadotropins were suppressed (LH 0.1 IU/L, FSH 0.4 IU/L) with testosterone <0.2 nmol/L. Thyroid function tests showed inappropriately normal TSH of 4.4 mIU/L with low free T4 of 7.9 pmol/L, consistent with secondary hypothyroidism. Random cortisol was 47 nmol/L, and a short Synacthen test confirmed secondary adrenal insufficiency. MRI of the pituitary revealed an ectopic posterior pituitary, identified as a 4-mm T1-hyperintense focus at the median eminence, with absence of the posterior pituitary bright spot in the sella. Bone age was significantly delayed at 12.6 years compared with a chronological age of 16.8 years. The patient was commenced on hormone replacement therapy including prednisolone, levothyroxine, and intramuscular testosterone (Sustanon 250 mg every four weeks), with planned follow-up at six months. Prednisone was chosen by the patient to simplify dosing and improve adherence. Conclusions This case illustrates a rare but important cause of delayed puberty and chronic fatigue in adolescence. Recognition of ectopic posterior pituitary and associated hypopituitarism is essential, as early diagnosis and timely hormone replacement can significantly improve growth, pubertal progression, and overall quality of life.
Waiting times for severe asthma care in Wales are long, with many patients not accessing biologic medications in a timely manner. This quality improvement project used the Kotter Model, aiming to improve the efficiency and reduce waiting times of the severe asthma service at Aneurin Bevan University Health Board. Areas for improvement were identified via a mapping exercise, with the impact of targeted changes assessed using the metric of patient waiting times. Areas for improvement included referral, triage, diagnosis, multidisciplinary team meeting access and discharge/follow-up care. After 12 months, targeted changes resulted in an 8-week reduction in waiting times between multidisciplinary team approval and biologic prescribing, with the number of patients discussed per month in these meetings increasing from five to 30. This demonstrates how targeted changes and holistic pathway evaluation can lead to substantial improvements in patient waiting times and service efficiencies, while enhancing access to diagnostics and treatments for severe asthma and, potentially, other therapy areas.
Infertility is a global health issue with multiple causes, including environmental factors. Mycotoxins—secondary metabolites produced by fungi—are increasingly recognized as potential contributors to reproductive dysfunction. This review explores the impact of mycotoxins on reproductive health, examining their role in fertility impairment through mechanisms such as hormone disruption, gametogenesis impairment, and uterine toxicity. Mycotoxins are widespread in food and the environment, posing health risks that extend beyond known carcinogenic and immunotoxin effects. Exposure to mycotoxins such as ochratoxin A (OTA) and zearalenone (ZEA) has been linked to epigenetic alterations, endocrine disruption, and direct cellular damage in reproductive tissues. These findings are supported by epidemiological data, animal models, and experimental research, emphasizing regional variations in exposure due to differences in agricultural practices and food contamination. Mycotoxin exposure is associated with adverse reproductive outcomes, including reduced sperm quality, menstrual irregularities, and increased miscarriage risk. The biological mechanisms involve oxidative stress, hormone dysregulation, and direct toxicity to gametes and reproductive organs. Reducing mycotoxin exposure through dietary precautions, improved food safety regulations, and environmental controls may help protect reproductive health. Further research is needed to clarify exposure thresholds and develop targeted interventions.
