Northwick Park Hospital (NWPH) is a major National Health Service hospital situated near the town of Harrow, North West London, managed by the London North West University Healthcare NHS Trust. It is located off Watford Road in the London Borough of Brent; closely bordering the London Borough of Harrow.
The 8-aminoquinoline antimalarials are used to prevent P. vivax relapses. Recent evidence suggests high total dose primaquine (7 mg/kg) provides optimal efficacy, however, many countries, including Ethiopia, use low total dose primaquine (3.5 mg/kg). To understand the risks and benefits of different primaquine dosing regimens for P. vivax malaria in Ethiopia, we undertook a systematic review and individual patient data meta-analysis. We searched for antimalarial efficacy studies in patients with uncomplicated P. vivax mono-infections conducted in Ethiopia, published between January 1, 2000, and March 8, 2024. Studies were included if they had at least 28 days of follow-up and included a treatment arm with daily primaquine, commenced within seven days of starting antimalarial treatment. Study investigators were approached to share individual patient data, which were standardised and pooled. We performed a one-stage meta-analysis to estimate the cumulative incidence of P. vivax recurrence by day 180 with different primaquine total dose regimens. The number and proportion of gastrointestinal symptoms on days 5–7 and clinically significant haemolysis within 14 days were described and stratified by daily primaquine dose. PROSPERO CRD42023491851. Of 297 identified studies, 5 were eligible for inclusion. Data from 1,378 patients from all 5 studies were obtained. The cumulative incidence of P. vivax recurrence by day 180 was 61.0
Rapid diagnosis of giant cell arteritis (GCA) is essential to prevent ischemic complications. Color Doppler ultrasound (CDUS) and high-resolution magnetic resonance imaging (MRI) are increasingly used as alternatives or adjuncts to temporal artery biopsy, but their comparative diagnostic performance remains uncertain. We performed a systematic review and bivariate random-effects meta-analysis of diagnostic accuracy studies in adults with suspected GCA. Studies reporting extractable 2×2 data against temporal artery biopsy, or accepted clinical reference standards when biopsy was unavailable, were included. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pooled sensitivity, specificity, diagnostic odds ratios (DOR), and summary receiver operating characteristic (ROC) curves were calculated, with evaluation of heterogeneity and publication bias. Thirty-nine studies, including 3,619 patients, met the inclusion criteria. Thirty-one studies assessed CDUS (2,766 patients) and 12 evaluated MRI (853 patients). For CDUS, the median sensitivity was 0.83 (range 0.17-1.00) and the median specificity was 0.88 (range 0.59-1.00), with a median DOR of 24.9 and substantial between-study variability. MRI demonstrated a median sensitivity of 0.88 (range 0.61-1.00), a median specificity of 0.92 (range 0.71-1.00), and a higher median DOR of 72.0, with more consistent estimates. Evidence of small-study or publication bias was observed for MRI (p≈0.0004) and was borderline for CDUS (p≈0.055). QUADAS-2 assessments were generally favorable, though common limitations included variable blinding, heterogeneous imaging protocols, and differences in corticosteroid timing. MRI demonstrates higher and more consistent diagnostic performance than CDUS. CDUS can achieve high accuracy in experienced centers but shows notable operator dependence. Both modalities support imaging-based diagnostic pathways for GCA, with the choice influenced by local expertise, resource availability, and corticosteroid exposure.
Osteosarcoma is a rare and aggressive malignancy with limited therapeutic advances despite extensive clinical research. Discontinuation and failure to publish trial results contribute to research waste and may delay progress in patient care. We aimed to characterize osteosarcoma clinical trials registered on ClinicalTrials.gov and evaluate factors associated with trial discontinuation and nonpublication. We performed a cross-sectional analysis of interventional osteosarcoma trials registered on ClinicalTrials.gov as of July 1, 2025. Trial characteristics, including completion status, publication status, study design, funding source, trial phase, and enrollment size, were extracted. Multivariable logistic regression was performed to identify factors associated with trial discontinuation and nonpublication. Among 210 eligible trials, 62 (29.5
INTRODUCTION:Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. METHODS:A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. RESULTS:Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100 μg or diamorphine 300 μg pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. DISCUSSION:An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.
BACKGROUND:To update previous work assessing the relative efficacy and safety of cladribine tablets compared to currently approved disease-modifying treatments (DMTs) in patients with active relapsing-remitting multiple sclerosis (RRMS), using systematic literature review (SLR) and network meta-analysis (NMA). METHODS:Systematic literature searches were conducted in MEDLINE, Embase, MEDLINE In-Process and CENTRAL databases to identify English-language publications of relevant studies of approved DMTs for RRMS. Searches were conducted from database inception to January 2017, and then further updated from January 2017 to September 2022. Conference websites and trial registries were also searched. NMA considered the effects of DMTs on annualized relapse rate (ARR), confirmed disease progression (CDP), proportion relapse-free (RF), and safety. RESULTS:Of 21,181 unique articles retrieved and screened, 66 studies met the inclusion criteria and had their data extracted, including 17 new studies since the previous review; of these, 57 studies assessing 20 DMTs contributed to the NMA. In patients with active RRMS, cladribine tablets were associated with a significant 58% reduction in ARR versus placebo; cladribine tablets were similar or significantly better than other DMT regimens. For 6-month CDP, improvements with cladribine tablets were significantly greater than those of placebo, with no comparator DMT demonstrating significantly better results. For both efficacy endpoints, cladribine tablets ranked sixth among DMTs, behind ofatumumab, ublituximab, alemtuzumab, natalizumab, and ocrelizumab. The overall adverse event risk for cladribine tablets was statistically comparable to all other oral DMTs and both interferon beta-1a regimens. CONCLUSIONS:In this updated SLR and NMA, cladribine tablets remain a comparatively effective and safe alternative to other currently approved DMTs in populations of patients with active RRMS.
