Savan Shah

To summarize current evidence on Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) applications and outcomes in facial plastic surgery. PRP and PRF are autologous platelet concentrates with regenerative potential. They release growth factors that promote tissue repair, angiogenesis, extracellular matrix remodeling, graft integration, and scar remodeling, making them increasingly relevant in facial plastic surgery. A narrative review of clinical studies, meta-analyses, and systematic reviews was conducted. Key outcomes included wound healing, graft retention, postoperative edema and ecchymosis, scar improvement, and patient satisfaction. PRP improved wound healing, reduced crusting, and enhanced patient satisfaction in rhinoplasty, while PRF decreased cartilage resorption and improved graft stability. In rhytidectomy, PRP offered modest reductions in edema and ecchymosis. Both agents enhanced scar revision and fat graft outcomes, with PRF showing superior remodeling and long-term graft retention. In periorbital rejuvenation, PRP improved pigmentation and satisfaction, whereas PRF improved skin texture and wrinkles. Both were safe with minimal adverse events. PRP and PRF are effective biologic adjuncts in facial plastic surgery, supporting tissue regeneration, graft integration, and aesthetic outcomes. Efficacy is influenced by patient factors and technique. High-quality, procedure-specific trials are needed to optimize protocols.

Purpose Thyroid nodules are rare in children but have a higher malignancy rate compared to adults. Risk factors and predictors of thyroid cancer in children with thyroid nodules are not well-characterised. This systematic review aims to evaluate risk factors and predictors of malignancy in paediatric thyroid nodules. Methods PubMed, Embase and Cochrane databases were searched up to 6th April 2026. A quality assessment of the included articles was performed, along with a meta-analysis using the random-effects model. Results Sixteen studies met the inclusion criteria, comprising 2,634 patients (794 malignant and 1,840 benign cases). Papillary thyroid cancer represented the majority of cancers (84.5%). Variables that were significantly associated with thyroid cancer in the meta-analysis were as follows: previous radiation exposure, odds ratio (OR) 1.96 [95% CI 1.15, 3.34]; palpable lymphadenopathy, OR 7.73 [95% CI 3.03, 19.75]; intranodal calcifications, OR 10.33 [95% CI 3.20, 33.37]; increased vascularity, OR 3.21 [95% CI 1.95, 5.28]; and elevated thyroid stimulating hormone levels, mean difference + 0.92 mIU/L [95% CI 0.50, 1.35]. Quality assessment using the Newcastle-Ottawa Scale, with a majority of studies scoring ≥ 7 stars. Conclusion The identification of predictors of thyroid cancer in children with thyroid nodules will inform the development and evaluation of models with a view to improving preoperative diagnosis.

Introduction: Mastoid surgery is technically challenging with complex three-dimensional (3D) anatomy. With reduced access to traditional training methods and increasing new technologies available, virtual reality simulation is being evaluated in a regional training program as an adjunct to existing training structures. Methods: Twenty higher surgical trainees were instructed to complete a cortical mastoidectomy and posterior tympanotomy on a VOXEL-MAN simulator (VOXEL-MAN, Hamburg, Germany). A pre- and post-session questionnaire was completed. Results: The visual analogue score for familiarity with the temporal bone 3D anatomy, cortical mastoidectomy and posterior tympanotomy surgical landmarks increased by 1.8 cm (p<0.0001), 1.4 cm (p<0.0001) and 2.2 cm (p<0.0001), respectively. Thirty percent of trainees felt that they had received adequate otology exposure within the last two years; 20% felt they would acquire enough experience to become a consultant otologist. Conclusion: The VOXEL-MAN temporal bone simulator is effective in improving perceived anatomical and surgical knowledge and trainee confidence. Incorporating it into training programmes can help trainees compensate for the impact of the pandemic.

The operating theatre represents a key contributor to healthcare-derived emissions. Here, we outline the carbon footprint of a lumbar microdiscectomy at our regional unit in Greater Manchester, with the use of AI technology. In doing so, we aim to define the extent of the environmental impact and identify carbon hotspots for sustainable change. Our unit of analysis covered the start of the patient journey into hospital through to the final outpatient appointment. Publicly available and locally sourced data was used. An inventory analysis of two lumbar microdiscectomies was conducted. Each item was categorised reconciled against our AI-powered ‘CO2 analysis’ database. Kilograms of carbon dioxide equivalent (kg CO2e) was chosen as the primary measure of impact. An average lumbar microdiscectomy at our trust generates 477.73kg CO2e. The operation (173.89kg CO2e, 36.40%) and the inpatient stay (144.67kg CO2e, 30.28%) constituted the biggest contributors. Single-use intraoperative equipment contributed to over three-quarters of the total emissions from the operation. By defining the environmental burden of elective spinal surgery, we have identified carbon hotspots to target for sustainable change. Substituting polluting elements for carbon-friendly alternatives and challenging the single-use culture, modern healthcare systems can help pave the way to a ‘net zero’ healthcare system.

BACKGROUND The healthcare industry is a significant contributor to global emissions, with the operating theatre representing a key contributor. Inquiry into the ecological impact of surgery is a novel and important field of research. OBJECTIVE Here, we outline the carbon footprint of a lumbar microdiscectomy at our regional unit in Greater Manchester with the use of AI technology. In doing so, we aim to define the extent of the environmental impact and identify targets for sustainable change. METHODS Our functional unit of analysis was defined as the start of the patient journey into hospital through to the final outpatient appointment. We used a combination of publicly available and locally sourced data. A detailed inventory analysis of two lumbar microdiscectomies were conducted. Each item was categorised reconciled against our AI-powered ‘CO2 analysis’ database. Kilograms of carbon dioxide equivalent (kg CO2e) was chosen as the primary measure of impact. RESULTS An average lumbar microdiscectomy at our trust, as per our defined functional unit of analysis generates 477.73kg CO2e, equivalent to a return flight from Manchester to Berlin. The operation (173.89kg CO2e, 36.40%) and the inpatient stay (144.67kg CO2e, 30.28%) constituted the biggest contributors. Single-use intraoperative equipment contributed to over three-quarters of the total emissions from the operation. CONCLUSIONS By defining the environmental burden of elective spinal surgery, we have identified carbon hotspots that can be targeted for sustainable change. By substituting polluting elements for carbon-friendly alternatives and challenging the single-use culture, we can all play our part in paving the way to a ‘net zero’ healthcare system.

Background: The benefits of near-peer learning are well established in several aspects of undergraduate medical education including preparing students for Objective Structured Clinical Examinations (OSCEs). The COVID-19 pandemic has resulted in a paradigm shift to predominantly online teaching. Objective: This study aims to demonstrate the feasibility and benefits of an exclusively online near-peer OSCE teaching program in a time of significant face-to-face and senior-led teaching shortage. Methods: A teaching program was delivered to penultimate-year students by final-year students at Manchester Medical School. Program development involved compiling a list of salient topics and seeking senior faculty approval. Teachers and students were recruited on Facebook. In total, 22 sessions and 42 talks were attended by 72 students and taught by 13 teachers over a 3-month period. Data collection involved anonymous weekly questionnaires and 2 separate anonymous student and teacher postcourse questionnaires including both quantitative and qualitative components. Results: On a scale of 1-10, students rated the quality of the program highly (mean 9.30, SD 1.15) and felt the sessions were highly useful in guiding their revision (mean 8.95, SD 0.94). There was a significant increase in perceived confidence ratings after delivery of the program (P<.001). Teachers felt the program helped them better understand and retain the subject material taught (mean 9.36, SD 0.81) and develop skills to become effective clinical teachers (mean 9.27, SD 0.79). Conclusions: This is the first study demonstrating the efficacy of a near-peer OSCE teaching program delivered exclusively online. This provides an exemplary framework for how similar programs should be encouraged given their efficacy and logistical viability in supplementing the undergraduate curriculum.

BACKGROUND The benefits of near-peer learning are well established in several aspects of undergraduate medical education including preparing students for Objective Structured Clinical Examinations (OSCEs). The COVID-19 pandemic has resulted in a paradigm shift to predominantly online teaching. OBJECTIVE This study aims to demonstrate the feasibility and benefits of an exclusively online near-peer OSCE teaching program in a time of significant face-to-face and senior-led teaching shortage. METHODS A teaching program was delivered to penultimate-year students by final-year students at Manchester Medical School. Program development involved compiling a list of salient topics and seeking senior faculty approval. Teachers and students were recruited on Facebook. In total, 22 sessions and 42 talks were attended by 72 students and taught by 13 teachers over a 3-month period. Data collection involved anonymous weekly questionnaires and 2 separate anonymous student and teacher postcourse questionnaires including both quantitative and qualitative components. RESULTS On a scale of 1-10, students rated the quality of the program highly (mean 9.30, SD 1.15) and felt the sessions were highly useful in guiding their revision (mean 8.95, SD 0.94). There was a significant increase in perceived confidence ratings after delivery of the program (P<.001). Teachers felt the program helped them better understand and retain the subject material taught (mean 9.36, SD 0.81) and develop skills to become effective clinical teachers (mean 9.27, SD 0.79). CONCLUSIONS This is the first study demonstrating the efficacy of a near-peer OSCE teaching program delivered exclusively online. This provides an exemplary framework for how similar programs should be encouraged given their efficacy and logistical viability in supplementing the undergraduate curriculum.

Background: There is no consensus among clinicians regarding recommencement of antithrombotic agents following conservative management of a Chronic Subdural Hematoma (cSDH). Thus, the primary objective of this study was to determine the most commonly recommended interval and whether the data reveal a general consensus that should be adopted. Methods: A retrospective analysis of Salford Royal Foundation Trust’s Neurosurgical referral database for patients referred with a cSDH between March 2017 and March 2020 was carried out. Patients were sorted by whether they were on blood-thinning medications. Results: Over the 3-year period, there were a total of 1220 referral and 1099 patients. 502 (41.14%) of these referrals and 479 (43.59%) patients were on one more blood thinning agent. Of these patients 221 (46.13%) conservative management, there was a clear male predominance (M: F ≈ 2.5:1) in this cohort. 2 weeks was the most commonly advised time-frame (n = 76, 36.36%) to withhold. Of the 234 referrals, there were 13 (5.88%) re-referrals in total. Crucially, there was no significant difference in reaccumulation rates between patients asked to withhold their blood thinners for 2 weeks versus those asked to stop for longer than 2 weeks (P = 0.57). Conclusion: For the majority of bleeds, there is no clear benefit from asking patients to withhold their anticoagulant/antiplatelet for longer than 2 weeks. In cases, where it is deemed appropriate to stop for longer than 2 weeks, clear instructions should be provided and documented along with reasons behind the decision.