North Middlesex University Hospital, known locally as North Mid, is a district general hospital in Edmonton in the London Borough of Enfield. The hospital is managed by North Middlesex University Hospital NHS Trust.
Glaucoma is a common condition that damages the optic nerve, usually as a result of an increase in intraocular pressure (IOP). It can be divided into two types: open-angle glaucoma (OAG) and acute angle-closure glaucoma (AACG). OAG is believed to occur due to dysfunction in aqueous outflow through the trabecular meshwork (TM) of the eye as it flows from the posterior to the anterior chamber. AACG manifests when a bulging iris blocks the iridocorneal angle, commonly caused by pupillary block due to pupil dilation, leading to fluid buildup and increased IOP, potentially resulting in complete vision loss. As a result of an aging population, chronic conditions are increasing in number, necessitating the use of systemic medications to treat them. However, many of these medications may affect the eye, predisposing it to different ocular morbidities. This narrative review will examine the effects of these medications on glaucoma development, specifically focusing on the effects of corticosteroids on OAG through increased aqueous humor resistance in the TM and the effects of sulfonamides, anticholinergics, antidepressants, cholinergics, anticoagulants, and certain supplements on AACG as a result of their sympathomimetic properties and the disruption of the lens-iris structure.
Background:Imported falciparum malaria represents a significant health care burden disproportionate to its incidence. UK guidelines have traditionally recommended admission for all cases of nonsevere falciparum malaria. However, it is recognized that cases of nonsevere malaria meeting appropriate clinical criteria do not require additional supportive treatment and can be managed safely outpatient. Routine inpatient management may increase reluctance to present to hospital early and increase health care system and patient costs. Methods:We conducted a prospective multisite cohort study across 5 UK centers from 2019 to 2024, evaluating outpatient management of adults with nonsevere falciparum malaria. One hundred twenty-one patients received outpatient treatment with artemether-lumefantrine (AL) for 3 days, with structured follow-up including clinical review and/or repeat malaria testing. A micro-costed subanalysis of 2 sites compared the cost of care of outpatient treatment with a control group, defined as nonsevere malaria cases who were clinically similar but admitted overnight. Results:Clinical or parasitological cure within 2 weeks of initial blood film was achieved in 91% (99/109) of patients receiving outpatient artemether-lumefantrine therapy with appropriate follow-up. No escalations to high-dependency or intensive care and no deaths occurred during the study period. Among those requiring further intervention, 50% (5/10) did not complete the initial course. A cost analysis of outpatients vs patients admitted for nonclinical reasons demonstrated significant savings, with median costs of £1248 and £1792, respectively. Conclusions:Outpatient management of carefully selected patients with nonsevere falciparum malaria appears clinically safe and economically justified. These findings support development of standardized outpatient protocols for nonsevere falciparum malaria, potentially reducing health care costs while maintaining patient safety.
Café-au-lait macules (CALMs) constitute a major diagnostic criterion for neurofibromatosis type 1 (NF1), yet infants presenting exclusively with CALMs often do not fulfill full diagnostic criteria in early life. This retrospective cohort study aimed to quantify longitudinal changes in CALM burden during the first two years of life in children with NF1 and to assess the relevance of early lesion number for subsequent diagnostic threshold fulfillment. Sixty-three children with NF1 who initially presented with typical multiple CALMs were included. CALM counts were documented at 6, 12, and 24 months using standardized digital photography. CALM counts increased significantly over time (χ2(2) = 124.097, p < 0.001; Kendall’s W = 0.985), rising from a mean of 5.86 ± 2.63 at 6 months to 17.49 ± 7.75 at 24 months. While 38.1
Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy, and timely, risk-adapted management is critical to prevent functional and aesthetic complications. Although international evidence-based guidelines are well established, their implementation in everyday primary care practice remains inconsistent. We conducted a pragmatic, cross-sectional, web-based survey between November 2024 and February 2025 to characterize real-world management patterns of IHs among Greek primary care physicians who had completed a nationally accredited e-learning program on IH recognition and treatment. The survey comprised 10 multiple-choice items addressing treatment initiation criteria, pharmacologic strategies, monitoring and imaging practices, and treatment discontinuation. Seventy-four physicians participated, including 48 pediatricians (64.9%) and 26 general practitioners (GPs; 35.1%). Head and neck IHs larger than 2 cm prompted intervention in 40/48 pediatricians (83.3%) and 24/26 GPs (92.3%), compared with significantly lower intervention rates for similarly sized lesions on the trunk or extremities (30/48, 62.5% vs. 10/26, 38.5%; p = 0.048). Ulceration was infrequently recognized as an independent indication for systemic therapy (12/48 pediatricians, 25.0%; 4/26 GPs, 15.4%). Propranolol was widely adopted as first-line treatment; however, initiation most commonly occurred after 12 weeks of age (59/74 physicians, 79.7%), inpatient commencement was strongly favored even in low-risk cases (67/74, 90.5%), and dosing clustered around 2 mg/kg/day (71/74, 95.9%). Treatment discontinuation was typically abrupt (49/74, 66.2%), with structured tapering and post-treatment relapse surveillance infrequently reported. Despite shared theoretical training, substantial variability persists in the real-world management of IHs in Greek primary care, reflecting an implementation gap rather than a lack of knowledge. These findings highlight the need for context-sensitive national guidance emphasizing risk-adapted initiation and dosing, clearly defined imaging thresholds, safe outpatient pathways, and standardized follow-up to improve consistency and equity of care.
