COVID-19 disease and cardiac involvement-a local experience (2021)

Type of publication:
Conference abstract

Author(s):
*Ahmed M.R.; *Islam S.; *Challinor E.; *Ingram T.; *Khan A.

Citation:
Heart; Jun 2021; vol. 107

Abstract:
Aims The aim of this review to assess cardiac involvement in patients with severe COVID-19 patients. We review all patients with COVID 19 disease admitted in our trust requiring transthoracic echocardiograms on their clinical indications. Background Cardiac involvement in COVID-19 disease has been found to be prognostic factor and has been related with higher mortality and morbidity. In a large series with COVID-19 those with heart disease had a fatality rate around 10.5%.1 2 Methods All adult patients who were COVID-19 positive on PCR admitted between March 2020 and February 2021, who had an echocardiogram, were identified through our local database. Their demographics, co-morbid, troponin levels and Pro NT-BNP were analysed. All echocardiograms reports which were finalised by the imaging cardiologist were included in our analysis. Results There were a total of 41 patients who had echocardiograms during their stay in the hospital with COVID-19 disease. Mean age was 70 (range 45-90) years old. There were 70% male and 30% female patients. 12% were diabetic, 49% hypertensive and 40% had previous heart disease. Pulmonary embolism diagnosed in 10% of patients by CT pulmonary angiogram. 56% of patients required high flow oxygen and 21% need mechanical ventilation. Almost all patients had troponin and CRP levels on admission. Mean troponin level 215 and mean CRP levels were 197. Mean D dimer levels 1130, and mean creatinine levels were 138. 92% had evidence of lung involvement in chest X-ray. 13% patients had new evidence of a diagnosis of left ventricular dysfunction on echocardiography. Similarly, 27% had a new diagnosis of right ventricular dysfunction. Mean left ventricular diastolic dimension were 4.6 cm and systolic dimension. 2% had echo diagnosis of left ventricular thrombus echocardiographic studies. Mean PA pressure on echocardiography were 35 mmHg and mean E/A ratio was 1.2. 17% of patients were found to have pericardial effusion but none causing haemodynamic compromise. Conclusion This data suggests high incidence of right and left ventricular involvement in patients with severe COVID-19 disease. We recommend that all patients with COVID-19 disease admitted to hospital and requiring oxygen should have transthoracic echocardiograms during their admission.

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Non-contrast MRI for assessment of thoracic aorta dimension (2021)

Type of publication:
Conference abstract

Author(s):
*Gupta M.; *Ingram T.; *Clarke H.; *Pakala V.; *Lee E.; Hargreaves O.; *Otun J.

Citation:
Heart; Jun 2021; vol. 107

Abstract:
Introduction Multi-modality imaging plays a significant role in evaluating and interval monitoring of patients with aortopathies. Echocardiogram is the first screening test followed by Computerised Tomography (CT) and/ or Magnetic Resonance Imaging (MRI). Most patients require repeated scans at interval. Both CT and MRI require contrast administration and furthermore, radiation exposure in CT. Locally, we have c adopted surveillance scanning with non-contrast MR to overcome the above limitations. This is not widely practised. Aim The aim of the study is to compare inter-modality agreement between CT (gold standard) and non-contrast MRI measurements of ascending aortic dimensions. Methods 126 consecutive patients underwent non-contrast
MRI thoracic aorta our hospitals between 2017 and 2021. Thirty-eight patients (61% males, age 61+/-14 years) have had both CT and MRI. A retrospective analysis was conducted to assess the inter-modality agreement of ascending aorta measurements. Statistical analysis was done using R programme (R studio). A Bland-Altman graph was used to assess inter-modality agreement of ascending aorta measurements. Differences in measurements of the two modalities were reported as mean and 95% confidence interval. Results There is good linear correlation (Pearson’s R=0.86, p<0.05) between CT and MRI measurements. Mean difference between CT and MRI measurements was 2.39mm, 95% confidence interval 6.5mm to 8.4mm, see figure 1. Conclusion
There is good inter-modality agreement of ascending aorta measurements between CT non contrast MRI in our experience. Non contrast MRI has the advantage of requiring no radiation and no need for contrast. This is desirable particularly in young patients requiring long term surveillance.

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Suitability for low-dose rivaroxaban based on compass trial: A district general hospital perspective (2021)

Type of publication:
Conference abstract

Author(s):
*Asad M.; *Irfan Kazi S.; *Makan J.; *Gupta M.; Alaguraja P.; McCaughey D

Citation:
Heart; Jun 2021; vol. 107

Abstract:
Introduction COMPASS trial has recommended that low-dose rivaroxaban reduces major adverse cardiac and limb events among patients with stable atherosclerotic vascular disease. In the real-world practice, the recommendations from COMPASS trial can be used as a standard to recognise potentially suitable patients. The objective of our study was to establish the cohort of patients identified as COMPASS-eligible for low dose rivaroxaban. Methods A health service evaluation of Cardiology Outpatients from Shrewsbury and Telford Hospital NHS Trust (SaTH) was carried out. The specific characteristics of the selected cohort included known stable atherosclerotic vascular disease while the inclusion and exclusion criteria incorporated in the COMPASS
trial was used as a standard. The SaTH clinical databases from January 2021 were utilized to conduct a retrospective analysis to identify patients who could prospectively benefit from low-dose rivaroxaban. Results Among the 99 patients who were found to have stable atherosclerotic vascular disease, 34 patients were deemed eligible for low dose rivaroxaban. Patients in our COMPASS-eligible group included 26 patients who were >=65years of age while 8 patients were noted to be <65 years of age. Further analysis revealed that 94% of the patients had coronary artery disease as compared with only 6% found to have peripheral artery disease. In this cohort of patients, 79 % of the non-eligible patients were excluded due to underlying atrial fibrillation. Conclusion About one-third of our cohort of patients met the COMPASS criteria and could potentially benefit from low dose rivaroxaban therapy. There is certainly a strong mandate for introduction of rivaroxaban
following the COMPASS trial recommendations. Local protocols should be established to ensure that this window of opportunity to prevent major adverse cardiovascular and limb events is not missed in the clinical practice.

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Genetic mechanisms of critical illness in COVID-19 (2021)

Type of publication:
Journal article

Author(s):
Pairo-Castineira E.; Clohisey S.; Rawlik K.; Parkinson N.; Fourman M.H.; Russell C.D.; Furniss J.; Wang B.; Griffiths F.; Oosthuyzen W.; Millar J.; Shih B.; Zechner M.; Haley C.; Meikle J.; Finernan P.; Mcmaster E.; Law A.; Baillie J.K.; Paterson T.; Wackett T.; Armstrong R.; Weaver J.; Boz C.; Golightly A.; Ward M.; Mal H.; SzoorMcElhinney H.; Brown A.; Hendry R.; Stenhouse A.; Cullum L.; Law D.; Law S.; Law R.; Swets M.; Day N.; Taneski F.; Duncan E.; Kenneth Baillie J.; Lyons R.; Tenesa A.; Klaric L.; Bretherick A.D.; Richmond A.; Meynert A.; Grimes G.; Hayward C.; Ponting C.; Meynert A.M.; Wham M.; Ponting C.P.; Vitart V.; Wilson J.F.; Pasko D.; Walker S.; Kousathanas A.; Moutsianas L.; Caulfield M.; Scott R.; Bogaert D.; Gountouna E.; Porteous D.J.; Wrobel N.; Clark R.; Coutts A.; Donnelly L.; Gilchrist T.; Hafezi K.; Macgillivray L.; Maclean A.; McCafferty S.; Morrice K.; Fawkes A.; Murphy L.; Harrison D.; Rowan K.; Wu Y.; Yang Z.; Zhai R.; Zheng C.; Shen X.; Beale R.; Keating S.; Walsh T.; Docherty A.B.; Yang J.; Knight J.; Klenerman P.; Summers C.; Shankar-Hari M.; Turtle L.; Moore S.C.; Solomon T.; Turtle L.C.W.; Hardwick H.; Semple M.G.; Ho A.; Hinds C.; Horby P.; Horby P.W.; Nichol A.; Maslove D.; Ling L.; McAuley D.; Montgomery H.; Pereira A.C.; Krieger J.E.; Marques E.; Jannes C.E.; Renieri A.; Mari F.; Daga S.; Baldassarri M.; Fallerini C.; Fava F.; Valentino F.; Doddato G.; Giliberti A.; Bruttini M.; Croci S.; Meloni I.; Frullanti E.; Di Sarno L.; Tommasi A.; Palmieri M.; Tita R.; Amitrano S.; Pinto A.M.; Mencarelli M.A.; Rizzo C.L.; Dunning J.; Thwaites R.S.; Openshaw P.J.M.; Collier D.; Wood S.; Zak A.; Borra C.; Matharu M.; May P.; Alldis Z.; Mitchelmore O.; Bowles R.; Easthope A.; Bibi F.; Lancoma-Malcolm I.; Gurasashvili J.; Pheby J.; Shiel J.; Bolton M.; Patel M.; Taylor M.; Zongo O.; Ebano P.; Harding P.; Astin-Chamberlain R.; Choudhury Y.; Cox A.; Kallon D.; Burton M.; Hall R.; Blowes S.; Prime Z.; Biddle J.; Prysyazhna O.; Newman T.; Tierney C.; Kassam J.; Ostermann M.; Campos S.; Bociek A.; Lim R.; Grau N.; Jones T.O.; Whitton C.; Marotti M.; Arbane G.; Bonner S.; Hugill K.; Reid J.; Welters I.; Waugh V.; Williams K.; Shaw D.; Roman J.F.; Martinez M.L.; Johnson E.; Waite A.; Johnston B.; Hamilton D.; Mulla S.; McPhail M.; Smith J.; Barclay L.; Hope D.; McCulloch C.; McQuillan L.; Clark S.; Singleton J.; Priestley K.; Rea N.; Callaghan M.; Campbell R.; Andrew G.; Marshall L.; McKechnie S.; Hutton P.; Bashyal A.; Davidson N.; Polgarova P.; Stroud K.; Pathan N.; Elston K.; Agrawal S.; Battle C.; Newey L.; Rees T.; Harford R.; Brinkworth E.; Williams M.; Murphy C.; White I.; Croft M.; Bandla N.; Gellamucho M.; Tomlinson J.; Turner H.; Davies M.; Quinn A.; Hussain I.; Thompson C.; Parker H.; Bradley R.; Griffiths R.; Scriven J.; Nilsson A.; Bates M.; Dasgin J.; Gill J.; Puxty A.; Cathcart S.; Salutous D.; Turner L.; Duffy K.; Puxty K.; Joseph A.; Herdman-Grant R.; Simms R.; Swain A.; Naranjo A.; Crowe R.; Sollesta K.; Loveridge A.; Baptista D.; Morino E.; Davey M.; Golden D.; Jones J.; Moreno Cuesta J.; Haldeos A.; Bakthavatsalam D.; Vincent R.; Elhassan M.; Xavier K.; Ganesan A.; Purohit D.; Abdelrazik M.; Morgan J.; Akeroyd L.; Bano S.; Lawton T.; Warren D.; Bromley M.; Sellick K.; Gurr L.; Wilkinson B.; Nagarajan V.; Szedlak P.; Cupitt J.; Stoddard E.; Benham L.; Preston S.; Laha S.; Slawson N.; Bradshaw Z.; Brown J.; Caswell M.; Melling S.; Bamford P.; Faulkner M.; Cawley K.; Jeffrey H.; London E.; Sainsbury H.; Nagra I.; Nasir F.; Dunmore C.; Jones R.; Abraheem A.; Al-Moasseb M.; Girach R.; Padden G.; Egan J.; Brantwood C.; Alexander P.; Bradley-Potts J.; Allen S.; Felton T.; Manna S.; Farnell-Ward S.; Leaver S.; Queiroz J.; Maccacari E.; Dawson D.; Delgado C.C.; Saluzzio R.P.; Ezeobu O.; Ding L.; Sicat C.; Kanu R.; Durrant G.; Texeira J.; Harrison A.; Samakomva T.; Willis H.; Hopkins B.; Thrasyvoulou L.; Jackson M.; Zaki A.; Tibke C.; Bennett S.; Woodyatt W.; Kent A.; Goodwin E.; Brandwood C.; Smith L.; Rooney K.; Thomson N.; Rodden N.; Hughes E.; McGlynn D.; Clark C.; Clark P.; Abel L.; Sundaram R.; Gemmell L.; Brett M.; Hornsby J.; MacGoey P.; Price R.; Digby B.; O’Neil P.; McConnell P.; Henderson P.; Henderson S.; Sim M.; Kennedy-Hay S.; McParland C.; Rooney L.; Baxter N.; Pogson D.; Rose S.; Daly Z.; Brimfield L.; Phull M.K.; Hussain M.; Pogreban T.; Rosaroso L.; Salciute E.; Grauslyte L.; Brealey D.; Raith E.; MacCallum N.; Bercades G.; Hass I.; Smyth D.; Reyes A.; Martir G.; Clement I.D.; Webster K.; Hays C.; Gulati A.; Hodgson L.; Margarson M.; Gomez R.; Baird Y.; Thirlwall Y.; Folkes L.; Butler A.; Meadows E.; Moore S.; Raynard D.; Fox H.; Riddles L.; King K.; Kimber S.; Hobden G.; McCarthy A.; Cannons V.; Balagosa I.; Chadbourn I.; Gardner A.; Horner D.; McLaughlanv D.; Charles B.; Proudfoot N.; Marsden T.; McMorrow L.; Blackledge B.; Pendlebury J.; Harvey A.; Apetri E.; Basikolo C.; Catlow L.; Doonan R.; Knowles K.; Lee S.; Lomas D.; Lyons C.; Perez J.; Poulaka M.; Slaughter M.; Slevin K.; Thomas V.; Walker D.; Harris J.; Drummond A.; Tully R.; Dearden J.; Philbin J.; Munt S.; Rishton C.; O’Connor G.; Mulcahy M.; Dobson E.; Cuttler J.; Edward M.; Norris J.; Hanson K.; Poole A.; Rose A.; Sloan B.; Buckley S.; Brooke H.; Smithson E.; Charlesworth R.; Sandhu R.; Thirumaran M.; Wagstaff V.; Suarez J.C.; Kaliappan A.; Vertue M.; Nicholson A.; Riches J.; Solesbury A.; Kittridge L.; Forsey M.; Maloney G.; Cole J.; Davies R.; Hill H.; Thomas E.; Williams A.; Duffin D.; Player B.; Radhakrishnan J.; Gibson S.; Lyle A.; McNeela F.; Patel B.; Gummadi M.; Sloane G.; Dormand N.; Salmi S.; Farzad Z.; Cristiano D.; Liyanage K.; Thwaites V.; Varghese M.; Meredith M.; Lim W.S.; Mills G.; Willson J.; Harrington K.; Lenagh B.; Cawthron K.; Masuko S.; Raithatha A.; Bauchmuller K.; Wiles M.; Ahmad N.; Barker J.; Jackson Y.; Kibutu F.; Bird S.; Watson G.; Martin J.; Bevan E.; Brown C.W.; Trodd D.; English K.; Bell G.; Wilcox L.; Katary A.; Gopal S.; Lake V.; Harris N.; Metherell S.; Radford E.; Moore F.; Bancroft H.; Daglish J.; Sangombe M.; Carmody M.; Rhodes J.; Bellamy M.; Garg A.; Kuravi A.; Virgilio E.; Ranga P.; Butler J.; Botfield L.; Dexter C.; Fletcher J.; Shanmugasundaram P.; Hambrook G.; Burn I.; Manso K.; Thornton D.; Tebbutt J.; Penn R.; Hulme J.; Hussain S.; Maqsood Z.; Joseph S.; Colley J.; Hayes A.; Ahmed C.; Haq R.; Clamp S.; Kumar R.; Purewal M.; Baines B.; Frise M.; Jacques N.; Coles H.; Caterson J.; Rai S.G.; Brunton M.; Tilney E.; Keating L.; Walden A.; Antcliffe D.; Brett S.; Gordon A.; Templeton M.; Rojo R.; Banach D.; Arias S.S.; Fernandez Z.; Coghlan P.; Williams D.; Jardine C.; Bewley J.; Sweet K.; Grimmer L.; Johnson R.; Garland Z.; Gumbrill B.; Phillips C.; Ortiz-Ruiz de Gordoa L.; Peasgood E.; Tridente A.; Shuker K.; Greer S.; Lynch C.; Pothecary C.; Roche L.; Deacon B.; Turner K.; Singh J.; Howe G.S.; Paul P.; Gill M.; Wynter I.; Ratnam V.; Shelton S.; Naisbitt J.; Melville J.; Baruah R.; Morrison S.; McGregor A.; Parris V.; Mpelembue M.; Srikaran S.; Dennis C.; Sukha A.; Verlander M.; Holding K.; Riches K.; Downes C.; Swan C.; Rostron A.; Roy A.; Woods L.; Cornell S.; Wakinshaw F.; Creagh-Brown B.; Blackman H.; Salberg A.; Smith E.; Donlon S.; Mtuwa S.; Michalak-Glinska N.; Stone S.; Beazley C.; Pristopan V.; Nikitas N.; Lankester L.; Wells C.; Raj A.S.; Fletcher K.; Khade R.; Tsinaslanidis G.; MacMahon M.; Fowler S.; Coventry T.; Stewart R.; Wren L.; Mwaura E.; Mew L.; Scaletta D.; Williams F.; Inweregbu K.; Lancaster N.; Cunningham M.; Daniels A.; Harrison L.; Hope S.; Jones S.; Crew A.; Wray G.; Matthews J.; Crawley R.; Carter J.; Birkinshaw I.; Ingham J.; Scott Z.; Pearson H.; Howard K.; Joy R.; Roche S.; Clark M.; Purvis S.; Morrison A.; Strachan D.; Clements S.; Black K.; Parmar C.; Altabaibeh A.; Simpson K.; Mostoles L.; Gilbert K.; Ma L.; Alvaro A.; Thomas M.; Faulkner B.; Worner R.; Hayes K.; Gendall E.; Blakemore H.; Borislavova B.; Goff E.; Vuylsteke A.; Mwaura L.; Zamikula J.; Garner L.; Mitchell A.; Mepham S.; Cagova L.; Fofano A.; Holcombe H.; Praman K.; Szakmany T.; Heron A.E.; Cherian S.; Cutler S.; Roynon-Reed A.; Randell G.; Convery K.; Stammers K.; Fottrell-Gould D.; Hudig L.; Keshet-Price J.; Peters M.; O’Neill L.; Ray S.; Belfield H.; McHugh T.; Jones G.; Akinkugbe O.; Tomas A.; Abaleke E.; Beech E.; Meghari H.; Yussuf S.; Bamford A.; Hairsine B.; Dooks E.; Farquhar F.; Packham S.; Bates H.; Armstrong L.; Kaye C.; Allan A.; Medhora J.; Liew J.; Botello A.; Anderson F.; Cusack R.; Golding H.; Prager K.; Williams T.; Leggett S.; Golder K.; Male M.; Jones O.; Criste K.; Marani M.; Anumakonda V.; Amin V.; Karthik K.; Kausar R.; Anastasescu E.; Reid K.; Smith M.; Hormis A.; Walker R.; Duncan T.; Uriel A.; Ustianowski A.; T-Michael H.; Bruce M.; Connolly K.; Smith K.; Partridge R.; Griffin D.; Mupudzi M.; Muchenje N.; Martin D.; Filipe H.; Eastgate C.; Jackson C.; Gratrix A.; Foster L.; Martinson V.; Stones E.; Abernathy C.; Parkinson P.; Reed A.; Prendergast C.; Rogers P.; Woodruff M.; Shokkar R.; Kaul S.; Barron A.; Collins C.; Beavis S.; Whileman A.; Dale K.; Hawes J.; Pritchard K.; Gascoyne R.; Stevenson L.; Jha R.; Lim L.; Krishnamurthy V.; Parker R.; Turner-Bone I.; Wilding L.; Reddy A.; Whiteley S.; Wilby E.; Howcroft C.; Aspinwall A.; Charlton S.; Ogg B.; Menzies D.; Pugh R.; Allan E.; Lean R.; Davies F.; Easton J.; Qiu X.; Kumar S.; Darlington K.; Houston G.; O’Brien P.; Geary T.; Allan J.; Meikle A.; Hughes G.; Balasubramaniam M.; Latham S.; McKenna E.; Flanagan R.; Sathe S.; Davies E.; Chablani M.; Kirkby A.; Netherton K.; Archer S.; Yates B.; Ashbrook-Raby C.; Cole S.; Casey M.; Cabrelli L.; Chapman S.; Hutcheon A.; Whyte C.; Almaden-Boyle C.; Pattison N.; Cruz C.; Vochin A.; Kent H.; Thomas A.; Murdoch S.; David B.; Penacerrada M.; Lubimbi G.; Bastion V.; Wulandari R.; Lorusso R.; Valentine J.; Clarke D.; Serrano-Ruiz A.; Hierons S.; Eckbad C.; Ramos L.; Demetriou C.; Mitchard S.; White K.; White N.; Pitts S.; Branney D.; Frankham J.; Watters M.; Langton H.; Prout R.; Page V.; Varghes T.; Cowton A.; Kay A.; Potts K.; Birt M.; Kent M.; Wilkinson A.; Jude E.B.; Turner V.; Savill H.; McCormick J.; Coulding M.; Siddiqui S.; Mercer O.; Rehman H.; Potla D.; *Capps N.; *Donaldson D.; *Button H.; *Martin T.; *Hard K.; *Agasou A.; *Tonks L.; *Arden T.; *Boyle P.; *Carnahan M.; *Strickley J.; *Adams C.; *Childs D.; *Rikunenko R.; *Leigh M.; *Breekes M.; *Wilcox R.; *Bowes A.; *Tiveran H.; *Hurford F.; *Summers J.; *Carter A.; *Hussain Y.; *Ting L.; *Javaid A.; *Motherwell N.; *Moore H.; *Millward H.; *Jose S.; *Schunki N.; *Noakes A.; *Clulow C.; Sadera G.; Jacob R.; Jones C.; Blunt M.; Coton Z.; Curgenven H.; Ally S.M.; Beaumont K.; Elsaadany M.; Fernandes K.; Ali Mohamed Ali I.; Rangarajan H.; Sarathy V.; Selvanayagam S.; Vedage D.; White M.; Truman N.; Chukkambotla S.; Keith S.; Cockerill-Taylor J.; Ryan-Smith J.; Bolton R.; Springle P.; Dykes J.; Thomas J.; Khan M.; Hijazi M.T.; Massey E.; Croston G.; Reschreiter H.; Camsooksai J.; Patch S.; Jenkins S.; Humphrey C.; Wadams B.; Msiska M.; Adanini O.; Attwood B.; Parsons P.; Tatham K.; Jhanji S.; Black E.; Dela Rosa A.; Howle R.; Thomas B.; Bemand T.; Raobaikady R.; Saha R.; Staines N.; Daniel A.; Finn J.; Hutter J.; Doble P.; Shovelton C.; Pawley C.; Kannan T.; Hill M.; Combes E.; Monnery S.; Joefield T.; Popescu M.; Thankachen M.; Oblak M.; Little J.; McIvor S.; Brady A.; Whittle H.; Prady H.; Chan R.; Ahmed A.; Morris A.; Gibson C.; Gordon E.; Keenan S.; Quinn H.; Benyon S.; Marriott S.; Zitter L.; Park L.; Baines K.; Lyons M.; Holland M.; Keenan N.; Young M.; Garrioch S.; Dawson J.; Tolson M.; Scholefield B.; Bi R.; Richardson N.; Schumacher N.; Cosier T.; Millen G.; Higham A.; Turki S.; Allen L.; Crisp N.; Hazleton T.; Knight A.; Deery J.; Price C.; Turney S.; Tilbey S.; Beranova E.; Wright D.; George L.; Twiss S.; Wadd S.; Postlethwaite K.; Gondo P.; Masunda B.; Kayani A.; Hadebe B.; Whiteside J.; Clarke N.; Donnison P.; Trim F.; Leadbitter I.; Butcher D.; O’Sullivan S.; Purewal B.; Bell S.; Rivers V.; O’Leary R.; Birch J.; Collins E.; Anderson S.; Hammerton K.; Andrews E.; Burns K.; Edmond I.; Todd A.; Donnachie J.; Turner P.; Prentice L.; Symon L.; Runciman N.; Auld F.; Halkes M.; Mercer P.; Thornton L.; Debreceni G.; Wilkins J.; Crickmore V.; Subramanian G.; Marshall R.; Jennings C.; Latif M.; Bunni L.; Spivey M.; Bean S.; Burt K.; Linnett V.; Ritzema J.; Sanderson A.; McCormick W.; Bokhari M.; Kapoor R.; Loader D.; Ayers A.; Harrison W.; North J.; Belagodu Z.; Paramsothy R.; Olufuwa O.; Gherman A.; Fuller B.; Stuart C.; Kelsall O.; Davis C.; Wild L.; Wood H.; Thrush J.; Durie A.; Austin K.; Archer K.; Anderson P.; Vigurs C.; Thorpe C.; Knights E.; Boyle N.; Price A.; Kubisz-Pudelko A.; Wood D.; Lewis A.; Board S.; Pippard L.; Perry J.; Beesley K.; Rattray A.; Lee E.; Lennon L.; Douglas K.; Bell D.; Boyle R.; Glass L.; Nauman Akhtar M.; Dent K.; Potoczna D.; Pearson S.; Horsley E.; Spencer S.; Mullan D.; Skinner D.; Gaylard J.; Barber R.; Hewitt C.; Hilldrith A.; Shepardson S.; Wills M.; Jackson-Lawrence K.; Gupta A.; Timlick E.; Gorman C.; Otahal I.; Gales A.; Coetzee S.; Sell C.; Raj M.; Peiu M.; Quaid S.; Watson E.; Elliott K.; Mallinson J.; Chandler B.; Turnbull A.; Finch C.; Holl C.; Cooper J.; Evans A.; Khaliq W.; Collins A.; Gude E.T.; Love N.; van Koutrik L.; Hunt J.; Kaye D.; Fisher E.; Brayne A.; Tuckey V.; Jackson P.; Parkin J.; Tariq A.; Houlden H.; Tucci A.; Hardy J.; Moncur E.; Highgate J.; Cowley A.; Mitra A.; Stead R.; Behan T.; Burnett C.; Newton M.; Heeney E.; Pollard R.; Hatton J.; Patel A.; Kasipandian V.; Allibone S.; Genetu R.M.; O’Brien L.; Omar Z.; Perkins E.; Davies K.; Tetla D.; Shelley B.; Irvine V.; Williams S.; Williams P.; Goodsell J.; Tutton R.; Bough L.; Winter-Goodwin B.; Kitson R.; Pinnell J.; Wilson A.; Nortcliffe T.; Wood T.; Home M.; Holdroyd K.; Robinson M.; Shaw R.; Greig J.; Brady M.; Haigh A.; Matupe L.; Usher M.; Mellor S.; Dale S.; Gledhill L.; Shaw L.; Turner G.; Kelly D.; Anwar B.; Riley H.; Sturgeon H.; Ali A.; Thomis L.; Melia D.; Dance A.; Humphreys S.; Frost I.; Gopal V.; Godden J.; Holden A.; Swann S.; Smith T.; Clapham M.; Poultney U.; Harper R.; Rice P.; Reece-Anthony R.; Gurung B.; Moultrie S.; Odam M.; Mayer A.; Bellini A.; Pickard A.; Bryant J.; Roe N.; Sowter J.; Lang K.; Taylor J.; Barry P.; Hobrok M.; Tench H.; Wolf-Roberts R.; McGuinness H.; Loosley R.; Hawcutt D.; Rad L.; O’Malley L.; Saunderson P.; Seddon G.; Anderson T.; Rogers N.; Ruddy J.; Harkins M.; Beith C.; McAlpine A.; Ferguson L.; Grant P.; MacFadyen S.; McLaughlin M.; Baird T.; Rundell S.; Welsh B.; Hamill R.; Fisher F.; Gregory J.; Campbell A.; Smuts S.; Carson G.; Merson L.; Sigfrid L.; Alex B.; Bach B.; Barclay W.S.; Chand M.; Cooke G.S.; Sriskandan S.; Harrison E.M.; Norman L.; Pius R.; Drake T.M.; Fairfield C.J.; Knight S.R.; Mclean K.A.; Murphy D.; Shaw C.A.; Zambon M.; da Silva Filipe A.; Ho A.Y.W.; Palmarini M.; Robertson D.L.; Scott J.T.; Thomson E.C.; McDonald S.; Fletcher T.; Green C.A.; Hiscox J.A.; Ijaz S.; Khoo S.; Mentzer A.J.; Noursadeghi M.; Paxton W.A.; Pollakis G.; Price N.; Rambaut A.; Sancho-Shimizu V.; de Silva T.; Stuart D.; Tedder R.S.; Thompson A.A.R.; Donohue C.; Dalton J.; Girvan M.; Saviciute E.; Roberts S.; Harrison J.; Marsh L.; Connor M.; Halpin S.; Gamble C.; Leeming G.; Greenhalf W.; Shaw V.; Ganna A.; Cordioli M.; Niemi M.E.K.; Sulem P.; Sveinbjornsson G.; van Heel D.A.; Shelton J.F.; Shastri A.J.; Ye C.; Weldon C.H.; FilshteinSonmez T.; Coker D.; Symons A.; Aslibekyan S.; Auton A.; Esparza-Gordillo J.; Benetti E.; Furini S.; Montagnani F.; Emiliozzi A.; Fabbiani M.; Rossetti B.; Zanelli G.; Bargagli E.; Bergantini L.; D’Alessandro M.; Cameli P.; Bennet D.; Anedda F.; Marcantonio S.; Scolletta S.; Franchi F.; Mazzei M.A.; Guerrini S.; Conticini E.; Cantarini L.; Frediani B.; Tacconi D.; Spertilli C.; Feri M.; Donati A.; Scala R.; Guidelli L.; Spargi G.; Corridi M.; Nencioni C.; Croci L.; Caldarelli G.P.; Spagnesi M.; Piacentini P.; Bandini M.; Desanctis E.; Cappelli S.; Canaccini A.; Verzuri A.; Anemoli V.; Ognibene A.; Vaghi M.; D’Arminio Monforte A.; Merlini E.; Mondelli M.U.; Mantovani S.; Ludovisi S.; Girardis M.; Venturelli S.; Sita M.; Cossarizza A.; Antinori A.; Vergori A.; Rusconi S.; Riva A.; Siano M.; Gabrieli A.; Francisci D.; Schiaroli E.; Scotton P.G.; Andretta F.; Panese S.; Scaggiante R.; Gatti F.; Parisi S.G.; Castelli F.; Quiros-Roldan M.E.; Magro P.; Zanella I.; Della Monica M.; Piscopo C.; Capasso M.; Russo R.; Andolfo I.; Iolascon A.; Fiorentino G.; Carella M.; Castori M.; Merla G.; Aucella F.; Raggi P.; Marciano C.; Perna R.; Bassetti M.; Di Biagio A.; Sanguinetti M.; Masucci L.; Valente S.; Mandala M.; Giorli A.; Salerni L.; Zucchi P.; Parravicini P.; Menatti E.; Baratti S.; Trotta T.; Giannattasio F.; Coiro G.; Lena F.; Coviello D.A.; Mussini C.; Bosio G.; Martinelli E.; Mancarella S.; Tavecchia L.; Crotti L.; Picchiotti N.; Gori M.; Gabbi C.; Sanarico M.; Ceri S.; Pinoli P.; Raimondi F.; Biscarini F.; Stella A.

Citation:
Nature; Mar 2021; vol. 591 (no. 7848); p. 92-98

Abstract:
Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 x 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 x 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 x 10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 x 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

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A rare case of anti-NMDA receptor encephalitis associated with an ovarian teratoma (2021)

Type of publication:
Conference abstract

Author(s):
*Korrapati S.; *Sahu B.; *Parry-Smith W.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; May 2021; vol. 128 ; p. 135

Abstract:
Introduction Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an auto-immune and paraneoplastic encephalitis with an incidence of 1.5 per million population per year. About 80% are women and nearly half of them have an ovarian teratoma. It is associated with antibodies against NR1 or NR2 subunits of NMDA receptor in cerebrospinal fluid (CSF) and serum. Given the rarity of occurrence, it remains an unrecognised entity among gynaecologists. Hence, we report a case of anti-NMDAR encephalitis associated with ovarian teratoma. Case report A 34-year-old woman attended under physicians with confusion, memory loss and agitation. She had a history of bilateral ovarian teratomas removed in 2018. Patient’s vitals and neurological examination were normal. She was unable to perform motor tasks. Routine laboratory examinations and CT head were normal except for mild leucocytosis (WCC 13.3). She was empirically treated for infectious encephalitis. CSF examination showed normal glucose and protein, negative for viral PCR, gram staining but positive for NMDA receptor antibodies, prompting us to explore for an underlying tumour. CT abdomen/pelvis showed 9mm focus of fat suspicious of residual/recurrent teratoma in right adnexa. PET CT showed no metabolically active pathology. She was commenced on first line immunotherapy, IV Methylprednisolone followed by IV immunoglobulins and then plasma exchange. Following gynaecology MDT decision, she underwent laparoscopic right oophorectomy. Histopathology revealed a right ovarian teratoma. Postprocedure her neurological symptoms including confusion & memory retention improved considerably. Conclusion Anti-NMDAR encephalitis is rare but potentially debilitating condition. It is important to remove any associated ovarian teratoma promptly to improve outcome.

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A case of antepartum haemorrhage at 18 weeks gestation leading to DIC (2021)

Type of publication:
Journal article

Author(s):
*Barker V.; *Biswas N.; Brett-Miller C.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology; Jun 2021; vol. 128 ; p. 77

Abstract:
Objective A rare case of vaginal bleeding before 20 weeks’ gestation with a 1.2 L blood loss leading to
Disseminated Intravascular Coagulation. Follow up of the case at 25 weeks gestation revealed an ongoing pregnancy with resolution of clotting function. Case report A 33 year old patient who had previously had six normal vaginal deliveries attended labour ward at 18 + 6 weeks gestation with pain, a sensation of pressure and a small amount of brown PV loss. She previously had a small bleed at 15 weeks’ gestation when a subchorionic bleed was demonstrated on scan. Thirty minutes after arrival she started to bleed very heavily and within forty minutes had lost more than 1 litre of fresh blood. On examination she had a closed cervix with active ongoing bleeding. A bedside ultrasound scan revealed a viable pregnancy. Tranexamic acid 1 g was given intravenously. Clotting function on admission was markedly deranged; INR 2.4, prothrombin time 23.5, activated partial thromboplastin time 56, fibrinogen < 0.3 and D-Dimer 2157. Disseminated intravascular coagulation was diagnosed. Following discussion with the haematology consultant, she received two units of cryoprecipitate. The bleeding subsequently settled with total loss of 1.2 litres. She had further blood tests which showed normalisation of clotting function within 24 h. Departmental ultrasound scan showed no evidence of bleeding on scan but placenta was noted to extend to the cervix. Follow up at 25 weeks showed an ongoing pregnancy with no further bleeding. Discussion Disseminated Intravascular Coagulation is a rare complication of pregnancy and can be associated with a number of obstetric disorders including placental abruption and praevia, amniotic fluid embolism, intrauterine fetal demise, HELLP syndrome, preeclampsia/eclampsia, septic abortion, intrauterine infection, PPH and acute fatty liver of pregnancy. It can occur at any time in pregnancy but most commonly occurs in the 3rd trimester. DIC can be diagnosed using the International Society on Thrombosis and Haemostasis DIC Diagnostic Criteria. The classic picture is a prolonged prothrombin time and activated partial thromboplastin time, low platelets, low fibrinogen and elevated D-dimer test. Management involves addressing the obstetric cause and supportive therapy. Conclusion DIC occurs secondary to a trigger which stimulates the release of procoagulant substances resulting in activation of the clotting pathway. The hypercoagulable state in pregnancy increases the vulnerability of pregnant women. This is a rare case of rapid onset DIC in the second trimester with an ongoing pregnancy.

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Reduced vitamin D levels associated with increased COVID-19 related deaths (2021)

Type of publication:
Conference abstract

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

Citation:
American Journal of Respiratory and Critical Care Medicine; May 2021; vol. 203 (no. 9)

Abstract:
RATIONALE: Vitamin D supports immunity and inflammation by inhibiting proinflammatory cytokine release from macrophages and up-regulating the expression of anti-microbial peptides exhibiting anti-viral activity. Respiratory epithelial cells also convert inactive 25(OH)D (main circulating vitamin D) to 1,25(OH)2D3 enabling high local concentrations of this biologically active form to increase the expression of vitamin D-regulated genes. Studies continue to investigate the therapeutic effects and establish the optimal serum levels of 25(OH)D required to reduce the impact of respiratory tract infections whilst avoiding toxic hypercalcaemic high-dose ‘blind’ supplementation. Analysing patients admitted to hospital with COVID-19 (SARS-CoV-2 RNA) during the first phase of the pandemic, objectives and focus on reporting were to (1) document the population where measured vitamin D levels are readily available whilst quantifying those on supplements and (2) compare
outcome at discharge depending on most recent available vitamin D status. METHOD(S): Computer data including clinical outcomes were examined for the 516 patients (55% male) with mean age 67.4 (SD 18.3, range 0 to 100) years admitted from our semi-rural predominantly white European population to our District General Hospitals (Teaching) during the 4 months (March to June 2020) in the first phase of the COVID-19 illness in the UK. Outcomes (death during admission versus discharged alive) were analysed with SPSS comparing those with reduced versus adequate vitamin D levels. RESULT(S): Collectively (n=516), vitamin D levels (historical or updated) were available on 163 (31.5%) of patients; 17 (3.3%) undertaken during the admission. Data were skewed with median level 47 (interquartile range 24.1 to 66.9) nmol/L. 74 (14.3%) were already on vitamin D supplements and for an additional 10 (1.9%) this was initiated during the admission. Among the 163 patients, 86 (52.7%) had reduced vitamin D levels (deficient or insufficient) and these had worse outcomes with 29/86 (33.7%) having died during the admission compared with 13/74 (17.6%) of those with adequate levels: X2 (df 1, n=163) 6.02, p=.014. Table 1 categorises
distribution of values. CONCLUSION(S): Data highlight (1) less than a third of admitted COVID-19 patients have recorded vitamin D levels and of these more than half have reduced levels, (2) 14.3% are already taking vitamin D, (3) very few get
tested during the acute admission or get started on supplements, and (4) there is a statistical difference highlighting adverse outcome (death versus discharged alive) for those with reduced vitamin D levels.

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Appendicitis with concurrent COVID-19 infection in a patient during the third trimester of pregnancy (2021)

Type of publication:
Journal article

Author(s):
*Sanders-Davis L.J.; *Ritchie J.

Citation:
BMJ Case Reports; Jun 2021; vol. 14 (no. 6)

Abstract:
This article presents an unusual case of appendicitis in pregnancy complicated by the novel coronavirus (SARS-CoV-2). The novel coronavirus has affected the way medicine is practised across most parts of the world with over 160 000 000 global cases to date. Tackling management of these cases is more complex when other pathological processes are ongoing. Appendicitis is a common occurrence in pregnancy, with most obstetric centres seeing about one or two cases a year. Though maternal morbidity and mortality are relatively unimpacted by this event, fetal loss and preterm labour are common sequelae. This case involves a 35-year-old woman presenting in her third trimester with abdominal pain and who went on to be diagnosed with concurrent appendicitis and SARS-CoV-2 infection. Although spinal anaesthesia would be most appropriate as it avoids aerosol generation, general anaesthetic techniques were indicated due to thrombocytopenia in this case. She underwent a successful appendicectomy, although preterm delivery was indicated as a result of maternal and fetal concerns.

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FUSIC HD. Comprehensive haemodynamic assessment with ultrasound (2021)

Type of publication:
Journal article

Author(s):
*Miller A.; Peck M.; Clark T.; Conway H.; Olusanya S.; Fletcher N.; Aron J.; Coleman N.; Parulekar P.; Kirk-Bayley J.; Wilkinson J.N.; Wong A.; Stephens J.; Rubino A.; Attwood B.; Walden A.; Breen A.; Waraich M.; Nix C.; Hayward S.

Citation:
Journal of the Intensive Care Society; 2021 [epub ahead of print]

Abstract:
FUSIC haemodynamics (HD) – the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the
Intensive Care Society (ICS) – describes a complete haemodynamic assessment with ultrasound based on ten
key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or
inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there
features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary
artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first
system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical
interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the
training pathway and summarises the ten clinical questions. Further details are included in an online
supplementary appendix.

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Impact of COVID-19 pandemic on the 2WW breast referrals to a district general hospital (2021)

Type of publication:
Conference abstract

Author(s):
*Tokode O.; *Rastall S.; *Wilson M.

Citation:
European Journal of Surgical Oncology; May 2021; vol. 47 (no. 5)

Abstract:
Introduction: Recommendations were issued to the hospital Trusts to configure service delivery to balance cancer care with the safety of the patient and the hospital staff during the COVID-19 pandemic. The public felt the service restrictions might lead to delays in diagnosis and treatment of cancer patients. We compared the management of 2ww breast referrals in our centre between May to July 2019 and 2020. Method(s): We triaged all referrals to face-face consultation or initial telephone consultation during the pandemic. Patients with suspicious symptoms were offered face-face consultation after the telephone triage. Result(s): Overall, breast patients’ referrals fell by 28.3% during the pandemic. 10.2% reduction was noted in May (95% CI 6.73 – 13.59, p<0.001) but a non-significant increase was recorded in June and July. Waiting time reduced by 8.43 days (95% CI -8.88 to -7.98, p< 0.0001). Breast cancer suspicion increased across all age groups in 2020 (+10.4% to + 16.2%). Breast cancer diagnosis rose by 2.0% in 2020 (95% CI 0.19 – 3.92, p=0.030). No cancer was diagnosed among under 29 years. 29.1% of the 522 patients triaged to telephone consultation were discharged, and 70.9% needed face-to-face follow-up. One patient discharged after telephone consultation was later diagnosed with breast cancer. Conclusion(s): COVID-19 pandemic did not lead to a prolonged waiting time or reduced breast cancer diagnosis, but there was an overall reduction in referrals to our breast service.

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