Faculty Bibliography

When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming 'ADHD is over-diagnosed' could be used to deny people with properly-diagnosed ADHD the care they deserve.

Nuclear speckles are membraneless organelles implicated in multiple RNA processing steps. In this work, we systematically characterize the sequence logic determining RNA localization to nuclear speckles. We find extensive similarities between the speckle localization code and the RNA splicing code, even for transcripts that do not undergo splicing. Specifically, speckle localization is enhanced by the presence of unspliced exon-like or intron-like sequence features. We demonstrate that interactions required for early spliceosomal complex assembly contribute to speckle localization. We also show that speckle localization of isolated endogenous exons is reduced by disease-associated single nucleotide variants. Finally, we find that speckle localization strongly correlates with splicing kinetics of splicing-competent constructs and is linked to the decision between exon inclusion and skipping. Together, these results suggest a model in which RNA speckle localization is associated with the formation of the early spliceosomal complex and enhances the efficiency of splicing reactions.

Combined oral contraceptives (COC) decrease androgen levels by inhibiting androgen production and increasing sex hormone binding globulin. COC can therefore be used in the treatment of androgen-mediated dermatologic conditions. Hormonal contraceptives may also contribute to some dermatologic diseases through interactions with estrogen and/or progesterone receptors. In part two of this continuing medical education article, we discuss evidence regarding the mechanism and efficacy of hormonal contraceptives as therapeutics for acne, hirsutism, and hair loss, and review potential dermatologic SE of hormonal contraceptives to guide dermatologists in utilizing this therapy in their practices.

OBJECTIVES/OBJECTIVE:Silicosis is one of the most common forms of pneumoconiosis worldwide. In Rwanda, there is a lack of data on the silicosis burden and occupational risk among underground miners. METHODS:We conducted a cross-sectional study among all miners from eight cassiterite (tin ore) mining sites in Kayonza district, eastern Rwanda. Questionnaire data and chest radiography were collected at Rwinkwavu District Hospital. Two radiologists reviewed all the chest radiographs using International Labour Organization (ILO) criteria, with a third radiologist reviewing films with ILO rating discrepancies. Logistic regression was performed to investigate risk factors associated with radiographic silicosis. RESULTS:In total, 1021 mine workers were included in the primary outcome (risk) analysis. The median age was 32 years (IQR 26-40), and 948 participants (93%) were male. Of all participants, 94 (9%) were diagnosed with silicosis in the primary analysis. Increased odds of silicosis were associated with working in a blasting station (adjusted OR (aOR) 3.30; 95% CI 1.68 to 6.45), excavation station (aOR 2.77; 95% CI 1.09 to 7.04), drilling station (aOR 2.51; 95% CI 1.34 to 4.70), exposure to tobacco (aOR 1.92; 95% CI 1.14 to 3.24) and increased time of working in mining (aOR 1.05 per year spent in mining; 95% CI 1.01 to 1.09). CONCLUSIONS:High-risk mining tasks, tobacco use and duration of mining employment were significantly associated with increased risk of having a silicosis diagnosis. Our results indicate that screening and preliminary occupational risk analysis in a rural mining cohort is technically feasible.

OBJECTIVES/OBJECTIVE:HIV viral load (VL) testing using polymerase chain reaction (PCR) is a mainstay of treatment monitoring, but is technically demanding, time-consuming, and costly. We investigated whether antibody measurements can detect VL rebound, leveraging a recent analytic treatment interruption (ATI) study, NCT03225118. METHODS:We tested longitudinal specimens in N=22 ATI participants (91% male, 38-61 year age range, 2.1-15.9 years VL suppression pre-ATI) using Limiting Antigen (LAg) antibody assays, measured as normalized optical density (ODn). We used Bayesian inference to fit linear mixed effects models, including time between first detectable VL and ODn rise, time between peak VL and peak ODn, and ODn rate-of-change after VL re-suppression. RESULTS:LAg ODn increased 4.36 weeks (95% CI: 3.58, 5.79) after treatment interruption and 2.78 weeks (95% CI: 1.94, 4.15) after VL became detectable. ODn peaked 1.03 weeks (95% CI: 0.25, 1.93) after VL peaked, increasing 1.70 fold (95% CI: 1.39, 2.08) compared to pre-interruption. After VL re-suppression, ODn declined by -0.015 units per week (95% CI: -0.017, -0.013) over one year of follow-up. CONCLUSIONS:LAg antibody levels rose in all participants 2-4 weeks after VL detection in treatment interruption. Longitudinal antibody measurements could support facile, rapid, low-cost HIV treatment monitoring.

Knee injuries are one of the most common complaints in sports medicine. Magnetic resonance imaging is an essential adjunct to clinical evaluation for many traumatic injuries and overuse conditions. Given the heavy use of knee magnetic resonance imaging, developing faster magnetic resonance imaging acquisition methods and deployment in clinical practice would be valuable. In this article, we illustrate a spectrum of knee abnormalities from our clinical practice, utilizing a recently developed, publicly available sub-5-minute knee magnetic resonance imaging protocol with super-resolution image reconstruction based on deep learning. We review common traumatic injuries and overuse conditions of the knee and illustrate cases with this novel fast knee magnetic resonance imaging protocol.

OBJECTIVES/OBJECTIVE:To summarize and provide clinical insights on the most impactful publications related to critical care pharmacotherapy in 2025. METHODS:A systematic search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) was conducted between January 1, 2025 and October 5, 2025. Inclusion criteria consisted of randomized controlled trials with prospective study designs evaluating a critically ill adult patient population receiving pharmacotherapeutic interventions and reporting clinical endpoints. A multi-disciplinary and geographically diverse group of critical care clinicians was assembled and an a-priori defined three-round modified Delphi process was performed, with a focus on the publications determined to be the most impactful or novel. RESULTS:The systematic search yielded a total of 1609 articles for review and 1566 were excluded, leaving 43 articles to be included in the modified Delphi process. In each round, articles were scored based on their overall contribution to the literature and novelty with articles achieving a score at or above the median progressing to the next modified Delphi round. The six included articles are summarized. Article topics include alternative sedation options in mechanically ventilated patients, thrombolytic usage in acute ischemic strokes, management of coagulopathic bleeding following cardiac surgery, and use of corticosteroids in severe community-acquired pneumonia. CONCLUSIONS:This concise review identified, summarized, and offered insights on the most relevant critical care pharmacotherapy publications in the year 2025.

Respiratory viruses-including SARS-CoV-2 (COVID-19), Respiratory Syncytial Virus (RSV), and Influenza-pose significant risks to immunocompromised patients, who experience attenuated vaccine responses and higher morbidity. To address evolving vaccine recommendations for the 2025-2026 season, the Infectious Diseases Society of America (IDSA), in collaboration with the Vaccine Integrity Project (VIP) and partner organizations, developed rapid guidelines for U.S.-licensed vaccines targeting these viruses. The guideline applies to adults and children with compromised immunity due to hematologic malignancy, solid organ or hematopoietic cell transplantation, autoimmune disease on immunosuppressants, HIV with severe immunosuppression, and similar conditions. Strong recommendations, supported by moderate-certainty evidence, endorse timely administration of age-appropriate COVID-19, RSV, and Influenza vaccines, with guidance on optimal timing relative to immunosuppressive therapy and transplantation. Co-administration of these vaccines is considered appropriate. Research gaps remain in immunogenicity, durability, and clinical effectiveness, particularly for patients receiving B-cell-depleting therapies or early post-transplant. Priority areas include defining correlates of protection, optimizing vaccine schedules, evaluating high-dose or adjuvanted formulations, and improving real-world effectiveness and safety data. Equity and access strategies are essential to ensure uptake among vulnerable populations. These guidelines aim to support evidence-based decision-making and highlight the need for harmonized, multi-virus research to inform tailored vaccination strategies for immunocompromised individuals.

Clinical evaluations of large language models (LLMs) have rapidly expanded since 2022, yet their evidence base remains opaque. The overwhelming volume of studies creates challenges for manual curation and review. However, LLMs themselves offer the scalability and capability to evaluate the ever-growing evidence base. This LLM-assisted review identified 4,609 peer-reviewed studies in clinical medicine between January 2022 and September 2025, equating to roughly 3.2 papers per day. Only 1,048 studies used real-world patient data and of these only 19 were prospective randomized trials; most addressed simulated scenarios (n = 1,857) or exam-style tasks (n = 1,704). ChatGPT and related OpenAI models constitute 65.7% of evaluated models, with Gemini/Bard a distant second constituting 13.1% of evaluated models. Patient-facing communication and education comprised 17% of tasks, followed by knowledge retrieval, and education and assessment simulation. Across 1,046 head-to-head comparisons, LLMs outperformed humans in 33% of comparisons, with a strong dependency on task realism and level of training. At least 25% of studies had sample sizes less than 30. Despite the growth of LLMs in medicine, rigorous, patient-centered evidence remains scarce, underscoring the need for larger prospective trials before clinical adoption.