Royal Glamorgan Hospital

Anal fissure is one of the most painful anal conditions. Various management options are available, including topical nitrites, calcium channel blockers, botulinum toxin injection, and lateral internal sphincterotomy. This study aimed to assess the efficacy and safety of botulinum toxin A (BT) injection for the management of symptomatic chronic anal fissures by conducting a systematic review of the literature and meta-analysis of published randomized controlled trials (RCTs).

A systematic search was conducted using the Embase and Medline search platforms. The search identified 264 papers published from January 1974 to December 2023, 35 of which were RCTs. Meta-analysis was performed on the collected data with a random effects model using Freeman-Tukey arcsine-transformed proportions. A p value less than 0.05 was considered to indicate statistical significance. The I² test was used to assess heterogeneity.

A total of 1532 patients were included. After data were pooled, 1117 patients out of 1532 (72.7%) demonstrated healing of the fissure after the first injection of BT (P < 0.001, I² = 86.6%). Subgroup analysis was performed on the basis of the follow-up period in months. Nine studies reported that a second BT injection was needed for patients who did not respond after the initial injection. Twenty-nine out of 38 patients (78.5%) responded to the second injection (p < 0.001, I² = 50.6%). Complications were observed in 88 out of 1532 patients (4.02%) (p < 0.001, I² = 60.2%).

BT injection is a safe treatment approach for chronic symptomatic anal fissures, typically associated with only minor, temporary complications. Evidence also supports the use of repeat injections for managing recurrent or persistent symptoms.

Post-intensive care syndrome (PICS) describes a cluster of ongoing symptoms experienced by a large proportion of patients previously admitted to critical care. Despite a large rise in survival following critical care, interventions to support recovery and combat PICS are lacking. It has been suggested that the use of digital tools such as virtual reality (VR) may play a useful role in the development of recovery-supporting interventions. We engaged with people with lived experience of critical care admission to coproduce a VR intervention ( V i R tual RE ality to A i D recover Y post ICU (VR READY)). Here, we present a protocol for the initial feasibility and acceptability testing of this intervention.

This is a single-arm, single-site, non-randomised feasibility trial of VR READY. Up to 25 participants recently admitted to critical care will be recruited to use the VR READY intervention for at least 5 min per day for a period of 14 days. Participants must have capacity to consent and be free from ongoing delirium in order to participate. Outcomes relating to sleep and well-being will be measured at baseline and at day 14 after intervention delivery. The primary outcome is feasibility, which will be assessed according to prespecified criteria. Participants will complete a qualitative interview to assess acceptability of the intervention, trial design and outcomes approximately 1 month after completing the intervention period. No formal statistical analysis of outcomes will be conducted, but these will be summarised descriptively. Interviews will be subjected to reflexive thematic analysis.

This study received a favourable ethical opinion by North-East York Research Ethics Committee (Ref 23/NE/0113) in June 2024. Study results will be disseminated through the peer review literature, ISRCTN registry and directly to participants, which will be facilitated by the study public and patient involvement steering group.

NCT88854487 .

Our review aimed to determine the prevalence of - and factors associated with - hearing loss, oral and olfactory disease, frozen shoulder, trigger finger, and hair loss in young adults with type 1 diabetes. These conditions were selected based on research team interests, existing literature, and group discussion.

We conducted a quantitative narrative review using a systematic process to identify cohort and cross-sectional studies involving young adults with type 1 diabetes (mean age 18-30 years). PubMed, CINAHL, and Cochrane were searched (January 2000-February 2024). Grey literature was not restricted, and quality appraisal was undertaken. Extracted data were synthesised and summarised narratively.

The initial search found 3924 records and after title, abstract and full-text review, 19 records met inclusion criteria. Hearing loss prevalence ranged from 22.6 to 48.0 %, with age, diabetes duration, and systolic blood pressure identified as prominent associated features. For oral disease, peridontitis prevalence was 4.7 %, while alveolar bone loss ranged from 24.6 to 43.9 %; age was the primary associated factor. No eligible data were identified regarding frozen shoulder, trigger finger, or hair loss.

Further research is needed to characterize the prevalence and risk factors of atypical complications in type 1 diabetes. Clinical care should be guided by a robust understanding of these under-recognised comorbidities.