2021

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

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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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COACH: Challenging osteoarthritis and changing health (2021)

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Type of publication:Conference abstract

Author(s):*Haines-Eynon A.

Citation:Physiotherapy, 2021. Conference: Virtual Physiotherapy UK 2020 Conference. Virtual, Online. 113(Supplement 1) (pp e52-e53)

Abstract:Purpose: To develop, implement and evaluate an integrated rehabilitation programme for patients with hip and knee osteoarthritis (OA). To encourage behavioural changes by using social prescribing to facilitate longer-term management. Method(s): Patients with OA of the hip and/or knee were eligible for the class. An attempt was made to include as many patients as possible even with comorbidities. Any patients with any cardiac or respiratory conditions were still eligible provided they were able to manage any acute changes to their condition. Patients were assessed by a physiotherapist following a referral from a GP, ESP or consultant who completed an induction including 4 outcome measures; MSK-HQ, numeric rating scale (NRS), 30-s sit to stand and 4 x 10 m walk test. Patients took part in a 6-week programme consisting of 6 weekly 1 h sessions. Each session included a targeted strengthening circuit and a changing education presentation designed to help people improve their understanding of the condition. The final session which focused around longer term self management was attended by the Healthy Lifestyles Team to educate patients on available services within the local community. At the end of the final session all outcome measures were repeated and patients were given a patient satisfaction questionnaire. On completion of the class patients were given the opportunity to continue with their exercise programme in the hospital gym for a further period of time or encouraged to continue with their exercises in their local gym. They were referred back to their physiotherapist if they were still not able to manage their symptoms. Result(s): One hundred and twenty-three patients started the class, three of these were referred back to their physiotherapist as they were unable to engage in the class environment and a further 17 did not complete the course after the initial session. At least 75% of patients had repeat scores greater than or equal to their initial results on all outcome measures. The minimal clinically important improvement (MCII) value was achieved in 50.6% of patients in the MSK-HQ, 31.6% in the 4 x 10 m walk test, 36.7% in the NRS and 46.5% in the 30 s sit to stand test. Conclusion(s): The results demonstrate an important improvement to patient's pain and function following six exercise class and educational sessions. A wide inclusion criterion with patients who had multiple comorbidities meant these outcomes are more representative of the population and are more generalizable. Giving patients a starting point and a seamless approach from a hospital environment to self-management makes it more likely that patients will continue with a healthy lifestyle reducing the need for recurring visits to healthcare providers. Impact: The class had capacity for up to 12 patients allowing patients more treatment time compared to a routine 20 min follow up appointment. Also by avoiding 1:1 physiotherapy appointments the strain on acute services and its associated costs were reduced. This programme Identifies a further effective treatment option for patients with hip and knee OA. Funding acknowledgements: No funding was required for this study.

A study analysing the effect of wet wraps in patients of atopic dermatitis (2021)

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Type of publication:Journal article

Author(s):Kakroo S.N.; Beg M.A.; *Kakroo B.

Citation:Journal of Pakistan Association of Dermatologists. 31(4) (pp 588-594), 2021

Abstract:Objective We sought to evaluate the efficacy of wet wrap therapy treatment in patients with Atopic dermatitis. Methods Total 30 patients, (25 males and 5 females) were enrolled in this study with severe dermatitis [SCORAD] score >=50) were enrolled in this study. For disease severity SCORAD was used, for quality of life dermatology life quality index (DLQI) scores, visual analog scale (VAS) for pruritus and investigator's global assessment (IGA) was used. For evaluation of water content in the corneum, the capacitance was measured by Corneometer (Courage and Khazaka, Cologne, Germany), and TEWL was measured by Tewameter TM210 (Courage and Khazaka). The lipid amount of skin surface was assessed by Sebumeter (Courage and Khazaka). The patients underwent WWT (daily dose: 15 g Mometasone furoate cream+100g Vaseline ointment) twice daily for 2 h/session for 7 days. Results There was significant improvement in lesions, quality of life and itching. SCORAD was clearly decreased, epidermal water content was increased, and transepidermal water loss was decreased after wet-wrap dressing. Conclusion Wet wrap therapy (WWT) can relieve pruritus, reduce skin lesions, and improve quality of life.

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Mapping the human genetic architecture of COVID-19 (2021)

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Type of publication:Journal article

Author(s):

COVID-19 Host Genetics Initiative. Includes James Moon, Nigel Capps, Sanal Jose, Colene Adams, Anita Agasou, Amy Bowes, Pauline Boyle, Mandy Carnahan, Anne Carter, Danielle Childs, Kelly Hard, Yasmin Hussain, Michael Leigh, Rachel Rikunenko, Jo Stickley, Helen Tivenan, Rebecca Wilcox, Tracie Arden, Mandy Beekes, Heather Button, Denise Donaldson, Fran Hurford, Ayesha Javaid, James Jones, Terry Martin, Helen Millward, Nichola Motherwell, Julie Summers, Louise Ting & Louise Tonks of Shrewsbury and Telford Hospital NHS Trust

Citation:Nature. 2021, Vol. 600(7889) (pp 472-477)

Abstract:The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to SARS-CoV-2 and the severity of COVID-19<sup>1,2</sup>, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases<sup>3-7</sup>. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease.

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Acute cholecystectomy in elderly - age is not a limit (2021)

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Type of publication:
Conference abstract

Author(s):
*Gupta A.; *Rashid M.U.; *Rupasinghe N.; *Adjepong S.; *Rink J.; *Kirby G.; *Jain R.; *Riera M.; *Parampalli U.; *Pattar J.

Citation:
British Journal of Surgery. Conference: UGI Congress 2021. Belfast United Kingdom. 108 (SUPPL 9) pp. ix34

Abstract:
Background: Acute or hot cholecystectomy (AC) has been established as a safe and efficacious modality of managing acute biliary pathology. However, it has been performed with caution in the elderly (defined by the world health organisation as patients over the age of 65). The NICE guidance in this area does not preclude this practise on elderly patients. Our acute cholecystectomy service treats patients of all ages according to performance status and fitness for surgery rather than age we audited our results in this age group. Method(s): All patients over the age of 65 who underwent acute cholecystectomy in the dedicated emergency cholecystectomy lists were audited from the period starting 31st December 2019 to 31st June 2021. Patient demographics, co-morbidies and surgical factors were recorded. The primary outcomes measure was in hospital stay and readmission, secondary outcome were complications and perioperative mortality. Result(s): 41 elderly patients underwent AC during the audit period, (male 18: female 23). Majority of patients had acute cholecystitis 30(73%). The median inpatient stay following surgery was 2 days(range 2-5 days) and the median admission to surgery time was 6 days (range 5-12 days). Only 3(7%) patients had a subtotal cholecystectomy. There was only 3 complications from surgery which were all between a clavien-dindo score of 2 and 3. There were 3 readmission in the immediate post-operative period. There was one 30-day mortality which was from necrotising pancreatitis as a result of ERCP and not from the operation. Conclusion(s): Acute cholecystectomy in this age group appears to be safe and effective way to treat acute biliary pathology and compares similarly to the outcomes in the younger

Managing hypertension in type 2 diabetes – the basics (2021)

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Type of publication:Interactive case study

Author(s):*Morris, David

Citation:Diabetes and Primary Care; 2021; 23(6)

Abstract:Brought to you by Diabetes & Primary Care, this interactive case study takes you through the basic considerations of managing hypertension in type 2 diabetes. The scenario is not unusual and is one that, as a primary healthcare worker, you could easily be confronted with. By actively engaging with this case history, you should feel more confident and empowered to manage effectively such a problem in the future.

Fatty liver disease and type 2 diabetes (2021)

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Type of publication:Interactive case study

Author(s):*Morris, David

Citation:Diabetes and Primary Care; 2021; 23(5)

Abstract:This interactive case study, presented by Diabetes & Primary Care, takes you through the necessary considerations in managing fatty liver disease in an individual with type 2 diabetes. The scenario is not unusual and is one that, as a primary healthcare worker, you could easily be confronted with. By actively engaging with this case history, you should feel more confident and empowered to manage effectively such a problem in the future.

Steroid-induced hypoglycaemia (2021)

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Type of publication:Interactive case study

Author(s):*Morris, David

Citation:Diabetes and Primary Care; 2021; 23(4)

Abstract:Brought to you by Diabetes & Primary Care, the three mini-case studies presented below take you through what it is necessary to consider in identifying and managing steroid-induced hyperglycaemia. Each scenario provides a different set of circumstances that you could meet in your everyday practice. By actively engaging with them, you will feel more confident and empowered to manage effectively such problems in the future.

Hypoglycaemia and type 2 diabetes (2021)

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Type of publication:Interactive case study

Author(s):*Morris, David

Citation:Diabetes and Primary Care; 2021; 23(4)

Abstract:Brought to you by Diabetes & Primary Care, the four mini-case studies presented below will help you to consider what constitutes hypoglycaemia, what its causes and risk factors are in type 2 diabetes, how to detect and manage it in primary care, and strategies for minimising the risk. Each scenario provides a different set of circumstances that you could meet in your everyday practice. By actively engaging with them, you will feel more confident and empowered to manage effectively such problems in the future.