The Ulster Hospital, commonly known as the Ulster, is a teaching hospital in Dundonald (at the eastern edge of Belfast) in County Down, Northern Ireland. It is within the townland of Ballyregan, beside the A20 road. It provides acute services in the North Down, Ards and Castlereagh council areas, as well as east Belfast. It is managed by the South Eastern Health and Social Care Trust.
Depression is a common but often under-recognized and appreciated comorbidity in patients with acute heart failure (AHF), thereby contributing to poor clinical outcomes and significant healthcare burden. The Patient Health Questionnaire-9 (PHQ-9) is a widely accepted depression screening tool, whereas the shorter Patient Health Questionnaire-2(PHQ-2) offers a rapid alternative suitable in busy clinical scenario. However, evidence supporting the use of PHQ-2 in AHF patients within sub-Saharan Africa remains limited. This study evaluated the agreement and diagnostic accuracy of the PHQ-2 compared with to PHQ-9 and explored sociodemographic factors associated with positive depression screening on the PHQ-2. This cross-sectional study recruited 100 adults admitted for AHF at a tertiary hospital in Ibadan, South West of Nigeria. Participants completed the PHQ-2 and PHQ-9 tools, and probable depression was defined by PHQ-2 ≥ 3 and PHQ-9 ≥ 10. Diagnostic performance metrics were calculated using standard statistical measures. Agreement was assessed with Cohen’s kappa and predictors of positive PHQ-2 screening were identified using logistic regression. Prevalence of depression was 19
The presence of gynaecomastia can result in significant psychological distress. Surgical intervention should aim to remove glandular tissue whilst ensuring an aesthetically pleasing result. We present a case of excisional gynaecomastia correction with simultaneous enhancement of the pectoral contour with a modified dermal flap. This method utilises otherwise redundant autologous tissue without an additional donor site. We report an aesthetically pleasing result and discuss other modalities of pectoral enhancement currently described in the literature.
Neonates born with congenital vertical talus ('rocker-bottom foot') are challenging to diagnose and manage. The immediate management is generally based on assessing for Edwards syndrome (trisomy 18) or other similar severe life-limiting chromosomal disorders when there are dysmorphic features suggestive of a genetic syndrome, and no clear neurological focus such as a neural tube defect or spinal muscular atrophy disorder. Often the initial fluorescent in situ hybridisation genetic testing is reported as normal, appearing to exclude a trisomy diagnosis. We use two similar neonatal case scenarios with different diagnoses to discuss the next steps in genetic testing and the use of microarray, karyotyping and whole exome sequencing tools in managing these complex cases.
Filgotinib, a selective Janus kinase 1 (JAK1) inhibitor, is an oral small-molecule therapy that reduces cytokine-mediated inflammation by inhibiting JAK-1 dependant signalling pathways, including those involving interleukin-6 (IL-6) and type I interferons1. While clinical trials support its safety and efficacy, real-world data, particularly in the UK and Ireland, are limited. A retrospective cohort study was conducted at the Ulster Hospital, Northern Ireland, the largest centre within the South Eastern Health and Social Care Trust. Patients with active ulcerative colitis (UC) who initiated filgotinib between November 2022 to March 2025 were identified via electronic health records. Demographics, disease duration, prior therapies, and clinical/biochemical markers were collected at baseline and approximately 12 weeks post-treatment. Parameters analysed included Partial Mayo Score (PMS), C-reactive protein (CRP), faecal calprotectin (FC), and serum albumin. Paired t-tests compared changes from baseline for each parameter. Forty-six adult patients were included (24 males, 22 females; median age 35.5 years, range 19–73). The median follow-up duration was 10 months, with a range of 4 to 29 months. The median disease duration was 7 years, and the median duration of filgotinib therapy was 9 months, with a range of 1 to 29 months. 23 patients (50%) were biologic-naïve and 23 (50%) were receiving biologic therapy, including 10 (21.7%) who had previously received ≥2 biologics. Based on the Partial Mayo Score (PMS; n = 40), remission (Partial Mayo Score ≤2) was achieved in 19 biologic-naïve patients and 13 receiving biologics. PMS significantly improved from a mean of 5 at baseline to 1.7 at 12 weeks; with clinical remission increased from 7 patients (17.5%) at baseline, to 31 patients (77.5%) at week 12 post-filgotinib treatment. CRP (n = 44) and serum albumin (n = 43) showed non-significant trends (p = 0.33 and p = 0.81, respectively). Faecal calprotectin (n = 10) decreased significantly from 1260 µg/g to 218 µg/g (p = 0.026). Filgotinib was well tolerated; 34 (73.9%) reported no side effects, with mild gastrointestinal symptoms such as nausea or abdominal discomfort, in the remainder. No serious adverse events occurred during treatment. At week 12, 42 (91%) patients continued treatment and 4 patients (8.7%) discontinued. This real-world study provides the first evidence from Northern Ireland supporting the use of filgotinib in UC. Filgotinib was associated with significant improvements in Partial Mayo Score and faecal calprotectin, favourable safety, and high treatment persistence, consistent with clinical trial findings and supporting its effectiveness and safety in practice. Reference: 1. Traves PG, Murray B, Campigotto F, Galien R, Meng A, Di Paolo JA. JAK selectivity and the implications for clinical inhibition of pharmacodynamic cytokine signalling by filgotinib, upadacitinib, tofacitinib and baricitinib. Ann Rheum Dis. 2021;80(7):865-875. doi:10.1136/annrheumdis-2020-219012 Conflict of interest: Woo Ling, Kimberlee: Nil Walsh, Caolan: Nil Tham, Tony: Nil Maybin, Nicola: Nil
