Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation (2021)

Type of publication:
Conference abstract

Grossi U.; *Lacy-Colson J.; Brown S.; Cross S.; Eldridge S.; Scott S.M.; Taheri S.; Knowles C.

Colorectal Disease. Conference: 16th Scientific and Annual Meeting of the European Society of Coloproctology, ESCP 2021. Virtual. 23(Supplement 2) (pp 3), 2021. Date of Publication: October 2021.

Aim: Effectiveness of laparoscopic ventral mesh rectopexy (LVMR) in patients with defecatory disorders secondary to internal rectal prolapse (IRP) is poorly evidenced. A UK-based multicentre randomized controlled trial (RCT) was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up. Method(s): A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR with those who had undergone surgery.Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to 3 arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72 weeks). Clinical efficacy of LVMR compared to controls was measured as a 1.0-point reduction in PAC-QOL and PAC-SYM scores at 24 weeks. Secondary outcome measures included 14-day diary data, GAD7, PHQ9, St Marks incontinence score, PISQ12, CC-BRQ, and BIPQ. Result(s): Of 42 eligible patients, 28 (67%) females were randomized from 6 institutions. Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the 3 arms. Compared to baseline, significant reduction in PAC-QOL and PAC-SYM scores were observed at 24 weeks post-surgery (-1.09 [95%CI -1.76, -0.41], P = 0.0019, and -0.92 [-1.52, -0.32], P = 0.0029). As opposed to PAC-QOL (-1.38 [-2.94, 0.19], P = 0.0840 at 72 weeks), improvements in PAC-SYM scores persisted to 72 weeks (-1.51 [-2.87, -0.16], P = 0.0289). Compared to baseline, no differences were found on secondary outcomes, except for significant improvements on CC-BRQ and BIPQ at 24 and 48 weeks. Conclusion(s): There was evidence of a short-term effect of LVMR for IRP up to 36 weeks. Improvements in quality of life declined over follow-up up to 72 weeks.

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Unilateral Testicular Tuberculosis: An Extra-Pulmonary Manifestation (2021)

Type of publication:Journal article

Author(s):*Al-Hashimi KA; Said UN

Citation:Cureus, 2021 Oct 19; Vol. 13 (10), pp. e18896

Abstract:The pathogenicity of Mycobacterium tuberculosis (M. tuberculosis) causes it to most commonly manifest within the respiratory system (pulmonary tuberculosis); however, 15% of cases undergo extra-pulmonary spread to various organs. Genitourinary tuberculosis (GUTB) is a rare form of tuberculosis infection which has a propensity to affect the genitourinary tract, primarily affecting the kidneys, epididymis, seminal vesicles and prostate; however, 0.5% of cases result in infection of the testicles. This may present unilaterally or bilaterally with varying atypical presentations, thus misleading physicians in diagnosis. We present a case in a 48-year-old patient admitted to the surgical assessment unit in our hospital presenting with a unilateral painful testicular lesion and scrotal changes. He was admitted nine weeks prior for unexplainable constitutional symptoms however presented again whilst awaiting follow up in an outpatient clinic. Ultrasound guidance and fine-needle aspiration & culture (FNAC) of the lesion resulted in a positive diagnosis for M. tuberculosis. He underwent anti-tuberculous chemotherapy treatment for six months as per clinical guidance with adequate clinical response.

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Reduction in cardiovascular disease morbidity of men and women with familial hypercholesterolaemia (FH) associated with availability of high intensity statins: A cohort study using data from the UK Simon Broome Register linked with secondary care records (2021)

Type of publication:Conference abstract

Author(s):Iyen B.; Qureshi N.; Roderick P.; *Capps N.; Durrington P.N.; McDowell I.F.W.; Cegla J.; Soran H.; Schofield J.; Neil H.A.W.; Kai J.; Weng S.; Humphries S.E.

Citation:Atherosclerosis Plus. Conference: HEART UK 34th Annual Medical & Scientific Virtual Conference. Virtual, Online. 43(Supplement) (pp S5), 2021. Date of Publication: September 2021.

Abstract:Background: Previous studies of the Simon Broome (SB) FH register reported that, compared to the low-intensity statin period (1992-2008), the standardised cardiovascular disease (CVD) mortality ratio in the high-intensity statin period (2009-2015) was 22% lower in men but 115% higher in women. Linkage of the register with Hospital Episodes Statistics (HES) data has now enabled prospective evaluation of CVD morbidity based on inpatient care. Method(s): Standardised Morbidity Ratios (SMbR) compared to age and sex-matched UK primary care patients were calculated [95% confidence intervals] for risk of composite CVD (first HES outcome of CHD, MI, stable or unstable angina, stroke, TIA, PVD, heart failure, PCI and CABG) in men and women under and over the age of 50 years. Result(s): 2,988 (52.5% women) SB register participants had HES records. The SMbR was higher in women than men in both age groups and during both time periods. Compared to 1997-2007, in both men and women aged <50 years the SMbR fell significantly in the 2008-2017 period (8.7[7.3-10.3] vs 17.9[15.7-20.5] and 12.8[10.4-15.7] vs 20.8[17.1-25.4] respectively. By contrast in both sexes in those >50 years in the later time period there was no significant reduction in CVD-admission incidence rates or in SMbR (Men, 6.6[5.3-8.2] vs 5.8[5.0-6.8], Women, 9.2[7.8-10.7] vs 7.5 [6.6-8.5]). Conclusion(s): While the rate of CVD morbidity due to FH has encouragingly fallen significantly over time in both sexes aged <50 years, it has not done so in those >50. This emphasises the importance of early identification and optimal lipid-lowering throughout life for subjects with FH. Funded by the NIHR HTA project 15/134/02 and BHF grants RG3008 and PG008/08.

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Appropriately timed COVID-19 PCR testing for hospital inpatients (2021)

Type of publication:Conference abstract

Author(s):*Raffeeq Z.; *Ahmad N.; *Crawford E.; *Dev D.; *Makan A.; *Srinivasan K.; *Moudgil H.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA448

Abstract:Background: Nosocomial spread of Coronavirus has been an issue for hospitals across the UK, with a recent report by Public Health England (PHE) and the London School of Hygiene and Tropical Medicine (LSHTM) stating that the effective reproduction rate of SARS-CoV-2 in hospitals has been projected to have been as high as 14 during the first wave of the pandemic [1]. In order to stifle this spread hospital Infection and Prevention Control (IPC) set out regular guidelines concerning when patients should be tested for COVID-19.
Aims and objectives: We attempted to assess how well our trust followed the IPC guidance for testing patients for COVID-19, specifically with regard to swab timing following admission to hospital.
Methods: We analysed all admissions to the hospital during the week of 1st October 2020 to the 7th October 2020. We looked at how many patients were appropriately swabbed on day 1, and day 5, as was required according to IPC guidance at the time.
Results: We found that of the 266 patients admitted in the said week, 4 patients (1.5%) had a swab greater than 24 hours after admission, and 17 (6.39%) patients did not have a PCR swab at all. 148 patients stayed in hospital 5 days or greater, with 19 patients (17.27%) receiving their second swab correctly on day 5 of admission and 91 patients (82.73%) either not having their swab on the correct day or not having a follow up swab at all.
Conclusion: While testing on entry was generally done in a timely manner, follow-up swabs are not performed according to the guidelines set out by IPC, and therefore not following evidence-based practice.

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Another aspect of COVID pandemic: where has all the Flu gone? (2021)

Type of publication:Conference abstract

Author(s):*Chapman T.; *Etel E.; *Moudgil H.; *Srinivasan K.; *Crawford E.; *Makan A.; *Ahmad N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3255

Abstract:Background: United Kingdom is officially in the Flu season since the beginning of October 2020. Flu season in the southern hemisphere particularly in Australia and New Zealand have shown dramatic reduction in cases of Influenza during the COVID pandemic.
Aims: Our objective was to look at the incidence of Flu in our rural district general hospital, which has also been affected by the COVID pandemic.
Method: We carried out a retrospective analysis of all patients in hospital during the 3rd and 4th week of January 2021, who had a Flu swab taken. Our hospital used a kit to detect the presence of Flu A, Flu B, Respiratory Syncytial Virus(RSV) A &B and SARS-CoV2 at the same time. Data analysis was done on MS Excel.
Results: 247 patients in hospital had a swab performed for all 4 viruses. 52% were males(n=129) with a Mean Age(SD)73 (14.7) years.120 tested positive for SARS-CoV2 of which 55%(n=66) were males with a mean age(SD)73 (14.6) years. Zero tested positive for Influenza A/B and RSV A/B.
Conclusion: Our small cohort of hospital patients reflected the trend of flu cases present in the Southern Hemisphere, during peak Flu season. It is possible regular hand washing and masks donning contributed to this. In addition, competitive inhibition of the Flu virus by SARS-CoV2 is likely through its binding of sialic acid receptors on the host's cell surface, commonly used by Influenza viruses to gain entry into cells [2]. More laboratory studies are needed to confirm this.

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Impact of COVID-19 on patients with chronic lung disease (2021)

Type of publication:Conference abstract

Author(s):*Etel E.; *Chapman T.; *Moudgil H.; *Srinivasan K.; *Makan A.; *Crawford E.; *Ahmad N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3265.

Abstract:Background: Patients with chronic lung disease especially Asthma and/or Chronic Obstructive Pulmonary Disease (COPD) are at an increased risk of acquiring COVID-19. Hence, these patients have been asked to shield in the United Kingdom (UK) during the pandemic.
Aims: Our objective was to look at the severity of COVID and in-hospital mortality, in patients that had COPD and/or Asthma and were admitted to our rural district general hospital with a positive PCR for SARS-CoV2.
Method: We carried out a retrospective analysis from the 3rd and 4th week of January 2021, on patients in our hospital with COVID-19 and COPD and/or Asthma. The severity of COVID was defined by their need for O2+ devices (Non-invasive ventilation in the form of BiPAP, CPAP or CPAP HOOD and High flow nasal cannula). We used MS Excel for data analysis.
Results: 247 patients were in hospital, 52% males(n=129) with a mean age(SD) 73 (14.7) years. We excluded 127 who tested negative for SARS-CoV2 and then a further 92 who had tested positive for SARS-CoV2 but did not have COPD and/or Asthma.
In total, 28 patients were included in the study. 79% males(n=22). Mean age(SD) 75 (11.5) years. 29(n=8) had severe disease and needed treatment with O2+ device. Of these, 50%(n=4) died during admission. Overall unadjusted mortality was 25%(n=7) and these patients had on an average 3 comorbidities with a mean age(SD) of 80 (14) years.
Conclusion: Retrospective analysis in our cohort of COVID-19 patients’ showed 23% have underlying COPD and/or Asthma and within this group
1) 1 in 3 patients will have severe disease needing O2+ treatment
2) 1 in 4 patients will die
3) Mean Age of 80 years and ≥ 3 comorbidities will carry a poor prognosis.

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Managing COVID-19 illness: chest radiographs support defining both prognosis and follow up (2021)

Type of publication:Conference abstract

Author(s):*Etel E.; *Chapman T.; *Moudgil H.; *Srinivasan K.; *Makan A.; *Crawford E.; *Ahmad N.;

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA459

Abstract:Introduction: Chest radiology is pivotal managing acute COVID-19 illness but potentially equally important to follow up. Objectives of this study were to (1) quantify those with COVID requiring follow up, (2) investigate how findings relate to severity, and (3) report abnormal radiology at follow up estimating continued demands.
Methods: Retrospective analysis of 217 patients, mean age 71.8 (SD 8.7, range 29-87) years, admitted March to May 2020 and subsequently tracked. Patients requiring >40% FiO2, and/or respiratory device support had severe disease and CXRs were normal or abnormal to COVID changes. Data analysed using statistical software reporting comparisons by chi square (X2).
Results: Initial CXRs for 123/213 (58%) patients were abnormal; 59/153 (39%) surviving admission attended follow up; others defaulted or were not requested with normal CXR or expected poor prognosis. 39 (66%) CXRs improved, 20 (34%) remained abnormal; of these, 9 patients had chest CT scans. Severe disease contributed to higher mortality, respectively 37/58 (64%) versus 46/159 (29%), X2 (df 1, n=217) 21.87, p=.0001. Comparing abnormal with normal CXR, 47/122 (39%) versus 11/91 (12%) had severe disease, X2 (df 1, n=213) 18.38, p=.000018. 55/123 (45%) versus 28/90 (31%) of those with initial abnormal CXR have since died, X2 (df 1, n=213) 4.04, p=.0044.
Conclusions: Mortality is associated with both the severity of illness and initial COVID related abnormal CXR; 58% have such changes at presentation and among the survivors having follow up radiology improves in two-thirds with approximately half the others then investigated by chest CT giving some indication to planning future services.

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Blood lactate level in patients with severe COVID-19: Does it have any added value? (2021)

Type of publication:Conference abstract

Author(s):*Hassan R.; *Moudgil H.; *Crawford E.J.; *Makan A.; *Srinivasan S.; *Ahmad N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3472.

Abstract:Background: Increased blood lactate (BLac) concentration is common in critically ill patients. They are measured to estimate disease severity, predict morbidity and mortality. A level >2mmol/L is an outcome predictor in Septicaemia. COVID-19 mimics features of Sepsis with reports suggesting that BLac would be of added benefit in predicting survivorship in patients with COVID-19.
Aims: We set out to validate the role of BLac levels in our cohort of RT-PCR+ severe COVID-19 patients admitted to the respiratory support unit (RSU) of a district general hospital in United Kingdom (UK)
Methods: We carried out a retrospective analysis of all patients admitted to the RSU with features of severe COVID-19 as set out by the World Health Organisation (5). Data was collected for the 2 months of November and December 2020. We used Microsoft Excel for analysis and vassar stats for statistical evaluation
Results: 60 patients were admitted to RSU in the time period. 60% males (n=36) with a Mean age (SD) 69.5 (13.6) years
Mean (SD) BLac measured in all patients was 1.5 (0.42) mmol/L. 17% (n=10) patients had BLac between 2 mmol/L to 2.5 mmol/L, of which 2 patients have died. Blac level in patients with Age>65 years (n=38) was < 2.0 mmol/L; Mean (SD) 1.49 mmol/L (0.42). Overall, 9 patients died during this period with Mean (SD) BLac of survivors 1.51 mmol/L (0.4) v non-survivors 1.47 mmol/L (0.54) (p=0.4)
Conclusion: Analysis of our small cohort of severe COVID-19 patients’ show
1) Despite having features of Sepsis, Blac is below the critical threshold of 2mmol/L for majority of the patients
2) Blac >2mmol/L did not predict increased mortality and there was no significant difference in the Mean Blac between survivors and non survivors

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Hospital re-admissions and deaths associated with COVID-19 illness: survival analysis (2021)

Type of publication:Conference abstract

Author(s):*Ali Z.; *Ahmed S.; *Makan A.; *Crawford E.; *Srinivasan K.; *Dev D.; *Ahmad N.; *Moudgil H.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, OA4194

Abstract:Introduction: With better than anticipated survival (73.5%) of patients admitted with COVID-19 (SARS-Cov-2 RNA) at this hospital concern is whether this is linked to higher re-admission rates or later deaths. Relating to initial severity, objectives were to (1) analyse survival during follow up, and (2) document pattern of re-admissions.
Methods: Retrospective analysis of 217 patients, mean age 71.8 (SD 8.7, range 29-87) years admitted with COVID-19 during the 2020 UK peak and surge. Patients requiring >40% FiO2 demand or oxygen plus devices had severe illness. CXR were abnormal if with COVID changes. Analysis using statistical software reports Kaplan Meier survival curves with log rank tests and comparisons by chi square (X2).
Results: Deaths climbed from 60/217 (27.6%) at discharge to 83/217 (38.2%) during follow up >250 days. Figure below shows survival curves based on initial severity; separation of curves highlights worse trajectory with severe disease [X2 (df 1, n=213) 29.42 p=.0000058]. Similar curves were noted in patients with abnormal (58%) initial CXRs [X2 (df 1, n=213) 5.53, p=.019]. 51/157 (32.5%) surviving initial admission were re-admitted with an early date skew of re-admissions.
Conclusions: Data confirm the trend in deaths after discharge and high re-admissions early after discharge. Survival is predicted by severity of respiratory dependency and CXR COVID changes.

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Is there an endotype to the treatable eosinophilic trait of chronic obstructive pulmonary disease (COPD) (2021)

Type of publication:Conference abstract

Author(s):*Walsh O.; *Marathe M.; *Moudgil H.; *Srinivasan K.; *Crawford E.; *Makan A.; *Ahmad, N.

Citation:European Respiratory Journal 2021; 58: Suppl. 65, PA3425.

Abstract:Introduction: There has been much interest in defining phenotypes in COPD particularly in relation to eosinophils and whether it is a treatable trait. Augusti el al (1) have suggested defining an endotype of COPD and moving away from clinical measures, when it comes to offering treatment. An endotype in eosinophilic COPD remains to be explored. Our main aim was to define an endotype for the treatable eosinophilic trait of COPD particularly focusing on the Body Mass Index (BMI), as previous reports have shown this trait may have a BMI>=25 kg/m2(2). Methods and Aims: A retrospective analysis was done reviewing the results of all COPD patients with an FEV1: FVC ratio <0.7, discussed at the local Multi-disciplinary Team meeting in 2019 and 2020. We excluded patients with Asthma and Overlap syndrome. Serum eosinophil levels over the past 3 years and BMI were obtained from the local electronic portal and MDT pro forma. We compared highest 3 year eosinophil counts (EC) in those with BMI < and >=25 kg/m2. We used MS Excel and Vassar stats for statistical calculations. <br/>Result(s): 168 patients were reviewed of which 24 patients were excluded based on the inclusion criteria, leaving 144 patients for analysis. The mean age (SD) was 57 (6.8) years. 58% (n= 84) were males. 39% (n=56) patients had BMI<25 kg/m2 (Group A) and 61% (n=88) patients had BMI>=25 kg/m2 (Group B). Mean (SD) of EC was 0.16×109/L (0.08) in Group A v Mean (SD) of EC 0.34 x109/L (0.14) in Group B [95% CI 0.14-0.21; p < 0.0001]. Our data show that patients with a BMI>=25 kg/m2 is an endotype of COPD patients who have EC>0.2 x109/L. Further research into this endotype and targeted treatments for eosinophilic COPD needs to be carried out.

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