Inhaled corticosteroids and pneumonia in COPD at primary care level (2018)

Type of publication:
Conference abstract

Author(s):
*Ibrahim J.; *Ali A.; *Zeb M.; *Crawford E.; *Makan A.; *Srinivasan K.; *Moudgil H.; *Ahmad N.

Citation:
Thorax 2018;73(Suppl 4):A114

Abstract:
Background Association between inhaled corticosteroids and pneumonia in COPD population is well known.1 And the risk of pneumonia is greatest with the use of high dose inhaled corticosteroids (HD-ICS).2 Hence, further work to reduce the prescription of HD-ICS should be informed by local practices. Aim We aimed to assess the incidence of pneumonia in COPD patients based at primary practices in our region according to their HD-ICS prescriptions. And thereby develop methods to safely wean off HD-ICS in this population. Methods Data was obtained on all hospital admissions for pneumonia between April-September 2017 with a secondary diagnosis code of J44 indicating COPD, from the head of information at our clinical commissioning group. We divided this data at a general practice level. We also obtained data on prescription of HD-ICS at each of the general practices till September 2017 from openprescribing.net. Statistical results were obtained from MS Excel and Vassar Stats. Results There are 14 general practices in the region. There were 123 pneumonia admissions to hospital with a secondary diagnosis of COPD. This included 50% males (n=62) with a mean age (SD) of 75 (9.7) years. There were 5 practices with >10 pneumonia admissions during this period and when compared with those with <10 pneumonia admissions, the median (IQR) COPD population was 107 patients (103-126) v 47 patients (32-69) [p<0.05] with a median (IQR) use of HDICS prescriptions 239 (170-290) v 108 (86-172) [p<0.05]. Conclusion Our data show an association between HD-ICS prescriptions and pneumonia in COPD population at a primary care level in our region. Having looked at the data including GP practices with higher prescriptions of HD-ICS, we have developed an algorithm (figure 1) to wean patients off HD-ICS while at the same time promoting awareness through local interest group meetings. (Figure Presented) .

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Real-world Effectiveness and Safety of Pazopanib in Patients With Intermediate Prognostic Risk Advanced Renal Cell (2018)

Type of publication:
Conference abstract

Author(s):
Procopio G.; Bamias A.; Schmidinger M.; Hawkins R.; Sanchez A.R.; Estevez S.V.; *Srihari N.; Kalofonos H.; Bono P.; Pisal C.B.; Hirschberg Y.; Dezzani L.; Ahmad Q.; Rodriguez C.S.; Jonasch E.

Citation:
Annals of Oncology (2018) 29 (suppl_8): p.313

Abstract:
Introduction: The objective of this study was to determine the effectiveness and safety of pazopanib in patients with intermediate-risk advanced/metastatic renal cell carcinoma in the PRINCIPAL study (NCT01649778). Patients and Methods: Patients had clear-cell advanced/metastatic renal cell carcinoma and met intermediaterisk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Assessments included progression-free survival, overall survival, objective response rate, and safety. We also evaluated effectiveness based on number of risk factors, age, and performance status (PS), as well as safety in older and younger patients.
Result(s): Three hundred forty-three and 363 intermediate-risk MSKCC and IMDC patients were included, respectively. The median progression-free survival was 13.8 months (95% confidence interval [CI], 10.7-18.1 months) and 7.4 months (95% CI, 6.2-10.3 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 13.1 months (95% CI, 10.7-18.1 months) and 8.1 months (95% CI, 6.4-10.7 months) for patients with 1 and 2 IMDC risk factors, respectively. The median overall survival was not reached and was 15.2 months (95% CI, 12.3-26.5 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 33.9 months (95% CI, 33.9 months to not estimable) and 19.4 months (95% CI, 14.3 months to not estimable) with 1 and 2 IMDC risk factors, respectively. A lower overall response rate was observed with Eastern Cooperative Oncology Group PS >= 2 (vs. PS < 2). All-grade treatment-related adverse events occurred in approximately 63% of patients, and the safety profile among older and younger patients was similar.
Conclusion(s): Outcomes with pazopanib in intermediate-risk patients suggest that patients can be further stratified by number of risk factors (1 vs. 2) and Eastern Cooperative Oncology Group PS (< 2 vs. >= 2) to more accurately predict outcomes. Patients with intermediate-risk advanced renal cell carcinoma are a heterogeneous population, having either 1 or 2 risk factors. It is unclear whether all patients in this risk category should be treated similarly. A secondary analysis of the PRINCIPAL study of pazopanib found that patients can be stratified by number of risk factors and Eastern Cooperative Oncology Group performance status to more accurately predict outcomes.

Patulous Eustachian tube obliteration using endovascular coils: A novel technique (2018)

Type of publication:
Journal article

Author(s):
*Jolly K.; *Darr A.; Chavda S.V.; Ahmed S.K.

Citation:
Journal of Laryngology and Otology; Jun 2018; vol. 132 (no. 6); p. 564-566

Abstract:
Background: Patulous Eustachian tube is a distressing condition characterised by chronic patency of the Eustachian tube and its failure to close. Patients typically present with symptoms of autophony and aural fullness. In patients requiring surgical intervention, a variety of different procedures have been demonstrated (both transtympanic and endonasal), with limited success. Evidence of the effectiveness of a number of surgical interventions is limited to small case series only.
Objective(s): This paper describes a novel treatment for patulous Eustachian tube using a 3 mm VortX Diamond endovascular coil. Case report: A transnasal endoscopic approach was adopted, with cannulation of the Eustachian tube orifice using a Relieva sinus guide suction tube from a balloon sinuplasty set. The coil was deployed 1.5 cm deep into the Eustachian tube. Post-operative imaging was used to confirm correct positioning. Regular follow up was arranged. The patient reported complete resolution of her symptoms.
Conclusion(s): The technique has so far proved highly effective and minimally invasive. It will be employed in more patients to fully establish its effectiveness in treating patulous Eustachian tube.

The safety and efficacy of laparoscopic ventral mesh rectopexy – Can excellent outcomes be achieved in a district general (2018)

Type of publication:
Conference abstract

Author(s):
*Yassin N.A.; *Orfanos G.; *Farquharson A.L.; *Lacy-Colson J.C.H.

Citation:
Surgical Endoscopy; Dec 2018; vol. 32; Supplement 2, p. S553

Abstract:
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is a popular treatment for symptoms of obstructive defecation in patients suffering with rectal prolapse and rectorectal intussusception. The procedure is technically challenging and may result in serious complications, such as mesh erosions. This study examines the clinical and functional outcomes of patients undergoing VMR in a district general hospital.
Method(s): A retrospective analysis was made of a prospectively maintained database of all laparoscopic VMR procedures. All cases performed by 2 surgeons between February 2012 and June 2016 were included. Length of stay, post-operative complications and functional outcomes were assessed.
Result(s): One hundred patients underwent a laparoscopic VMR procedure during the study period. The mean age was 59.7 years. Nineteen of the patients had external prolapse and 81 had functional bowel symptoms with internal prolapse (rectocele and/or intussusception) as demonstrated on proctography. Pre-operative investigations and pelvic floor multi-disciplinary team (MDT) discussions were performed in all cases. Forty percent of patients had previous pelvic surgery. In the external prolapse group there were 2/19 recurrences (10%). Functional improvement was reported in 96% of the patients. There was only 1 mesh complication (1%).
Conclusion(s): Laparoscopic VMR is an effective and safe procedure for the treatment of symptoms of obstructive defecation. This procedure can be safely performed in the district general hospital setting with excellent clinical and functional outcomes. Thorough preoperative investigations, MDT discussions and standardisation of the surgical technique lead to excellent outcomes.

Genetic Deletion of the Lipid Raft Protein Caveolin-1 Leads to Worsening Renal Fibrosis (2018)

Type of publication:
Journal article

Author(s):
*Chand S, Hazeldine J, Smith S, Borrows R.

Citation:
Journal of Clinical Nephrology and Renal Care 2018 Jun;4(1):037

Abstract:
Background
Renal disease is a major global public health issue. Renal interstitial fibrosis is the characteristic histopathological finding in all progressive renal disease. Caveolin-1 is the essential structural protein for lipid rafts called caveolae that are ubiquitously distributed among fibroblasts, endothelial and epithelial cells. Caveolin-1 acts as an intracellular signalling pathway chaperone in fibrotic disease. Presently, caveolin-1 expression is associated with more severe renal disease in human and previous murine studies. In non-renal fibrosis, caveolin-1 protects against fibrosis. The purpose of this study was to investigate if caveolin-1 knockout led to an increased fibrotic phenotype using the unilateral ureteric obstruction model of renal fibrosis.
Methods
Using 2 time-points of the unilateral ureteric obstruction model, wild-type and caveolin-1 knockout mouse kidneys were analysed for caveolin-1 expression and markers of fibrosis using histology, Gomori staining, real-time quantified polymerase chain reaction, Western blotting and confocal microscopy.
Results
Confocal microscopy shows caveolin-1 staining mainly in glomerulus, lining of tubules as well as the vasculature. There was increased caveolin-1 expression the longer the unilateral obstruction occurred as well as in the contralateral compensating non-obstructed kidney. Caveolin-1 knockout had less fibrosis at day 3 histologically but more at day 14 as compared to wild-type. There were significantly more F4/80 positive staining cells at day 3 and day 14 in the wild-type injured kidney as compared to the caveolin-1 knockout mouse.
Conclusion
Caveolin-1 knockout leads to a worse fibrosis upon unilateral ureteric obstruction. Caveolin-1 expression manipulation timing remains to be elucidated in reducing renal fibrosis.

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Strategies for investigating the genetics of chronic kidney disease (2018)

Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July 4(1): 004-006.

Abstract:
This short review describes the strategies employed for investigating genetic variation in chronic kidney disease as well as highlighting potential shortfalls that should be overcome in future studies.

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Caveolin-1 in renal disease (2018)

Type of publication:
Journal article

Author(s):
*Chand S.

Citation:
Scientific Journal of Genetics and Gene Therapy. 2018 July: 007-014.

Abstract:
Caveolin-1 is the essential structural formation for lipid raft formation. It has been ascribed to several
disease processes in humans due to its ubiquitous distribution. Patients with chronic kidney disease suffer
great morbidity and mortality where manipulation of caveolin-1 could lead to new potential therapeutic
targets in this patient group. This review highlights caveolin-1 structure, signalling and provides examples
of studies of caveolin-1 single nucleotide polymorphism in chronic kidney disease.

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