Author: Jason Curtis

Mucus plugging and mucolytics in patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD); investigating impact on short term mortality (2024)

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Type of publication:

Conference abstract

Author(s):

*Abugassa E.; *Bosher O.; *Makan N.; *Crawford E.; *Saleem M.A.; *Srinivasan K.; *Moudgil H.

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA3010), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Although mucus plugging occluding medium to large sized airways in COPD is associated with increased long term all-cause mortality, acute exacerbations require further investigation, particularly where, despite reducing morbidity and improving quality of life, long-term use of mucolytics remains controversial. Objectives were (1) to quantify chest CT evidence of mucus plugging, (2) relate findings to mucolytics, and (3) investigate mucus plugging association with short term mortality.

Method(s): Retrospective review of 100 patients admitted with exacerbation of COPD (105 admissions).comparative analysis by chi square (x2) and logistic regression, significant p<.05.

Result(s): Mean (SD, range) age was 74.7 (10.5, 41-97) years with 54% male; mean FEV1/FVC 55% with FEV1 1.2(0.59, 0.4-3.6) litres at 49% predicted. 23 were on long term oxygen (LTOT). Mean stay was 6.3 (1-41) days. 24 died in the first 6 months. Where a historical or admission chest CT was available (n=82), 12 (15%) had mucus plugging with mucolytics prescribed to 6 (50%) compared to 32/70 (46%) without plugging (x2 0.057, NS). 9/56 (16%) with mucus plugging vs 3/26 (12%) without (x2 0.2921, NS) had emphysema and 3/13 (23%) vs 9/69 (13%) without (x2 1.016, NS) bronchiectasis. Regression investigating mortality at 6 months showed adverse outcomes for male sex, lower FEV1, and LTOT.

Conclusion(s): 15% with acute COPD admissions have current or historical evidence of mucus plugging. Mucolytics are prescribed for 45% irrespective of prior CT radiology. Mortality (24%) at 6 months is high but not shown related to mucus plugging or reduced by mucolytics.

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Cost of Tuberculosis (TB) screening and contact tracing an Eastern European immigrant population seasonally employed at an agricultural farm in the United Kingdom (2024)

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Type of publication:

Conference abstract

Author(s):

*George S.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA1475), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Economic data inform public health measures; a co-ordinated approach to TB contact tracing, guided by Public Health England (PHE), was undertaken assessing a non English speaking Eastern European immigrant population seasonally employed at an agricultural farm and we (1) report direct costs, (2) identify cultural issues and risks employing such a population Methods: After an initial pilot study of work-based contacts of an index case, contact lists incorporating workforce in every shift pattern back-dated two years to his UK entry were identified. Direct costs included T-spot testing (Oxford Immunotec) and translators (Romanian, Polish, Lithuanian, Italian) along with secondary care charges at tariff with uniform cross-charge among providers. TB drug costs (managing latent or disease) were from the British National Formulary.
Result(s): 258/331 (78%) workers took up testing. 80 (31%) were then referred for contact screening; of these, 47 had latent and 3 active disease. 16 defaulted, 5 declined, 4 were pregnant, and 5 lost moved elsewhere. Most had no registered General Practitioner and no pre-employment health check, BCG or radiology. Anecdotally, several returned to their parent countries for healthcare advice despite measures to overcome language barriers. Main direct costs (51,497-52) equated to 199-60/person screening and 1029-95/person treated for either latent or TB disease.
Conclusion(s): Language and cultural barriers are challenges to TB screening/contact tracing. Direct costs are 200 (UK pound sterling = 1.17 Euro) per patient screened and five times this amount treating latent or active disease.

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Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK (2024)

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Type of publication:

Conference abstract

Author(s):

Mannan S.; Waseem T.; Safwan N.; Ganaie M.;

Citation:

Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK.

Abstract:

Background: Pleural infection remains a significant burden on mortality and morbidity in the Western world even with the advancement of clinical management.

Objective(s): This paper aims to study the clinical course of empyema thoracic patients managed in a tertiary hospital in the UK.

Method(s): We did a retrospective observational study of the hospital's electronic records of patients who were diagnosed and managed for empyema thoracic from January 2021 to December 2022.

Result(s): The total cohort was 104 empyema thoracic patients. The mean age was 60. The affected males were almost double than females (68 vs 36). We did a retrospective RAPID score of our cohort. The RAPID score could not be calculated for 35 patients due to the unavailability of pleural fluid data. High inpatient mortality (23%) was observed in the medium- risk (RAPID score 3-4) group and high 3-month mortality (25%) was observed in the high-risk (RAPID score 5-7) group. The majority of the patients were managed conservatively. No difference was noticed in the median length of hospital stay (11d) in all the risk groups. A high rate of (37%) surgical management was observed in the low-risk (RAPID score 0-2) group.

Conclusion(s): Our cohort's data comply with the predicted mortality risk of the RAPID score. We emphasize that RAPID score calculation can be a significant tool in the management of empyema thoracic patients.

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Title: Is smoking associated with higher cardiovascular risk and increased unplanned acute medical attendance? A retrospective analysis from the Lung Cancer screening cohort (2023)

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Type of publication:

Conference abstract

Author(s):

Haider R.; Finn E.; *Zeb S.; *Bharwana F.; Fitzgerald A.; Iftikhar S.; Hussain I.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA1345), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Intro: Active smoking plays a crucial role in cardiovascular disease. We looked at the rate of attendance to primary and secondary care amongst current smokers with increased QRISK and CAT scores.

Methodology: Data were drawn retrospectively from electronic medical records from a large tertiary care hospital covering Staffordshire region over a one year period 2019-2020. Data was extracted from lung cancer screening cohort.

Result(s): The data comprised of 1232 patients (516 female, 716 male). Of these, 566 were exsmokers and 666 current smokers. Average age was 62 years. Analysis was done using ANOVA. This confirms that current heavy smokers, had an increased QRISK score >10 (p value <0.05, 95% CI 0.00 to 0.02). 1 year mortality in this group was 2.8%. Heavy smokers were not at an increased risk of attending primary care (p value 0.862) or at increased risk of unplanned secondary care admissions (p value 0.09) as compared to light smokers. Median length of hospital stay was 8 (0 – 16) bed days in heavy smokers as compared to 4 bed days (0 – 8) in ex smokers. Female ex smokers had fewer hospital attendances as compared to female current smokers, male current and ex smokers (p value <0.05, tests statistic 4.207). A high CAT score was documented as >20 denoting impact of COPD on patient's life. It was not identified as a predictor of increased attendance to primary or secondary care.

Conclusion(s): Heavy smokers have a higher economic burden on acute secondary care on account of higher number of bed days. Early smoking cessation intervention may help reduce attendance into secondary care.

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The continued burden of pleural mesothelioma; a review of 10 years experience at this hospital Trust (2023)

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Type of publication:

Conference abstract

Author(s):

*Gohir Q.; *Mcadam J.; *Crawford E.; *Bosher O.; *Saleem M.; *Srinivasan K.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA3444), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Background: Prognosis with pleural mesothelioma depends not only on histological typing but also distribution of metastatic disease (including stage 4 with distant spread) and performance status. Analysing all patients presenting at his hospital Trust over 10 years, this work (1) reports the pattern of metastatic disease and, accepting the complex multi-modality approach to treatment, (2) relates findings to survival.

Method(s): Retrospective computer based analysis conferring with oncology and radiology records. 169 patients (84% male) with mean (range) age 74.4 (44 to 93) years.

Result(s): Respectively, performance status was 0 (16%), 1 (34%), 2 (26%), 3 (18%) and 4 (1%). 70% only had thoracic disease (pleural, pericardial, mediastinal, pulmonary) and 30% extrathoracic extension (chest wall/extrapleural, diaphragmatic, peritoneal/omental/ascites), liver/spleen/adrenal, spine and bone, and other (including brain and brachial plexus). Overall, 94% were diagnosed on tissue samples; where histology was clarified, 63% with epithelioid survived longer at (mean) 15 months compared to the 37% with 12.6 months for sarcomatoid or biphasic typing. Although active treatments often involved the complexity of multimodality, 34% had best supported care (usually worse performance status).

Conclusion(s): Findings highlight the aggressive nature of pleural mesothelioma confirming at least 30% had extrathoracic metastases and marginally improved outcomes with epithelioid histology.

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Placenta accreta spectrum: imaging and diagnosis (2025)

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Type of publication:

Journal article

Author(s):

*Self A.; Cavallaro A.; Collins S.L.;

Citation:

Obstetrician and Gynaecologist. (no pagination), 2025. Date of Publication: 2025.

Abstract:

Key content: Antenatal imaging is a screening tool integral to ensuring women are cared for in the most appropriate setting. The pretest probability of PAS should be considered before any imaging is performed. PAS is an iatrogenic disease. Any process which disrupts the endometrium increases the risk. Caesarean birth is the most common cause. Specialist placental assessment in asymptomatic women should be offered between 24 and 28 weeks. Ultrasound and MRI have similar diagnostic value, and MRI should only be used as an adjunct following ultrasound assessment by a specialist in placental imaging. Learning objectives: To understand the pathophysiology of PAS. To understand the distinction between screening for and diagnosis of PAS. To increase confidence in the interpretation of sonographic features of PAS. To provide a rationale for PAS care being provided in centres of excellence. Ethical issues: If women increasingly prefer caesarean section over vaginal birth, it is likely that this trend will result in increasing numbers of complex caesarean deliveries and PAS cases. Many studies have shown decreased morbidity and mortality if PAS cases are managed by an experienced multi-disciplinary team (MDT) in a PAS centre of excellence; therefore, accurate screening and timely referral are vital to improve patient care for women with risk factors.

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Ethnic disparity in the care and management of non-ST-segment elevation myocardial infarction and its impact on short-term and long-term survival: a long-term study of a national registry (2024)

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Type of publication:

Conference abstract

Author(s):

Yera H.; Weight N.; Moledina S.M.; Mamas M.A.;

Citation:

European Heart Journal. Conference: European Society of Cardiology Congress, ESC 2024. London United Kingdom. 45(Supplement 1) (no pagination), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: Previous examination of data from the United Kingdom indicates no apparent ethnic disparity in the treatment of patients hospitalised with non-ST-segment elevation myocardial infarction (NSTEMI). However, it remains uncertain whether this lack of disparity results in similar long-term survival outcomes among ethnic minority groups, particularly those with multiple underlying risk factors for coronary artery disease, when compared to White patients.

Purpose(s): To assess the impact of quality of care on short-term and long-term survival among NSTEMI patients while examining disparities based on ethnicity.

Method(s): We analysed records of 252,964 individuals diagnosed with NSTEMI from the Myocardial Ischaemia National Audit Project database spanning 2005 to 2019, alongside Office of National Statistics data for mortality. Among them, 233,158 were identified as White patients, while 19,806 were categorised as belonging to ethnic minority groups (Asian, Black, and mixed ethnicity). Propensity score matching was used to compare average treatment effects between cohorts while survival was compared using Cox regression model.

Result(s): Ethnic minorities were younger (median age in years) (66 vs. 73, P < 0.001), predominantly male (70% vs. 63%, P < 0.001), and exhibited a higher prevalence of cardiovascular risk factors such as diabetes (52% vs. 24%, P < 0.001), hypertension (67% vs. 54%, P < 0.001), hypercholesterolemia (49% vs. 34%, P < 0.001), and chronic renal dysfunction (13% vs. 8%, P < 0.001). Ethnic minorities more frequently underwent invasive coronary angiography (80% vs. 68%, P < 0.001), percutaneous coronary intervention (53% vs. 44%, P < 0.001), and coronary artery bypass grafting (5% vs. 4%, P < 0.001). After conducting propensity score matching, both cohorts had no significant differences in in-hospital all-cause mortality [odds ratio (OR) 1.13, confidence interval (CI) 0.89 – 1.43; P = 0.268], cardiac mortality (OR 1.20, CI 0.89 – 1.54; P = 0.209), one-year mortality (OR 1.01, CI 0.89 – 1.13; P = 0.893) and major adverse cardiovascular events (OR 1.21, CI 0.95 – 1.48; P = 0.108). However, upon conducting a five-year survival analysis, ethnic minorities had better survival rates than their White counterparts (Hazard ratio (HR) 0.89, CI 0.86-0.92; P < 0.001).

Conclusion(s): Despite ethnic minorities being at a higher risk for coronary artery disease, our findings indicate that they experience better five-year survival rates than White patients. This suggests equitable access to care and potentially a more aggressive treatment approach in this relatively young patient cohort.

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Examining perioperative factors in latex-allergic reactions (2025)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Parmar, Dilen; *Bhojwani, Ajay; Singh, Rohit; Nandra, Rajpal; Banerjee, Robin.

Citation:

Journal of Perioperative Practice. 2025 Jan 16. [epub ahead of print]

Abstract:

Despite the implementation of latex-free gloves, the issue of natural rubber latex hypersensitivity persists within medical practice, posing challenges for both patients and health care professionals. A comprehensive understanding of the demographic groups susceptible to this condition is essential, along with the establishment of robust perioperative assessment and management protocols aimed at minimising complications and enhancing safety. This article endeavours to delve into the intricacies of perioperative management concerning latex hypersensitivity among patients, while also elucidating its ramifications for health care practitioners.

Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium (2024)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; *Gurukiran, Gurukiran; *Abdullah, Faliq; *Kumar, Sairam; Ford, David; Hamid, Muhammad A; Wani, Kubra Farooq.

Citation:

Cureus. 16(12):e75099, 2024 Dec.

Abstract:

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent. This quality improvement initiative aimed to assess and improve compliance with early confusion and vitamin D screening in elderly hip fracture patients, with the goal of facilitating timely interventions to reduce the risk of POD. Methods A two-cycle audit was conducted in the Trauma and Orthopaedics Department at Royal Shrewsbury Hospital. The first cycle (April-June 2023) assessed baseline compliance with confusion (Abbreviated Mental Test Score (AMTS)) and vitamin D screening within 24 hours of admission. Identified barriers informed an intervention consisting of educational sessions, visual prompts, and checklist integration. The second cycle (August-October 2023) evaluated the impact of these measures. Compliance rates, timing of
assessments, and prevalence of abnormal biochemical and cognitive screening results were analyzed using Fisher's exact test (p < 0.05). Results Baseline compliance with screening was 27 patients (27%) out of 100, with primary barriers including lack of awareness and logistical challenges. Post-intervention compliance improved significantly for 54 patients (52.4%) out of 103 (p = 0.0003). Screening timeliness also increased, with 45 patients (83.33%) out of 54 screenings completed within 24 hours in cycle 2 compared to 14 patients (51.85%) out of 27 in cycle 1 (p = 0.0039). Biochemical analysis revealed persistently high rates of vitamin D deficiency, underscoring the need for early detection. AMTS scores correlated with abnormal confusion screens but highlighted limitations in cognitive-only assessments. Conclusion This quality improvement (QI) initiative demonstrated the efficacy of targeted interventions in improving screening compliance for confusion and vitamin D deficiency in elderly hip fracture patients. The findings advocate for integrating proactive, dual-focused screening protocols into clinical workflows to address modifiable risk factors for POD. Future research should explore the long-term impact of such measures on POD incidence, recovery trajectories, and functional outcomes while emphasizing the need
for sustained adherence to screening protocols.

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Lisfranc Injury: a Comprehensive Analysis of Long Term Outcomes - the Oswestry Experience. (2024)

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Type of publication:

Journal article

Author(s):

*Patel, R; Cheruvu, M S; Daoub, A; *Singh, R A; Banerjee, R; Hill, S.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(6):369-375, 2024.

Abstract:

PURPOSE OF THE STUDY: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment.

MATERIAL AND METHODS: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple
foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria.

RESULTS: We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results.

CONCLUSIONS: In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury.