Improving outcomes for older people with diabetes (2021)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Jul 2021; vol. 32 (no. 7); p. 270-276

Abstract:
Older people with diabetes have unique challenges. David Morris discusses the importance of individualising care for this group of people An individualised approach aiming to maximise safety, preserve autonomy and improve quality of life is needed when helping an older person to manage their diabetes. It is important to interpret the older person's diabetes in the context of their overall health concerns, including reference to co-morbidities, cognitive function, lifestyle, social setting, and life expectancy, and practice nurses are well placed to work in partnership with people with diabetes to achieve this. Pharmacological treatment goals must be realistic, acknowledging the metabolic consequences of old age, the risks of hypoglycaemia and the dangers of
polypharmacy.

A UK Expert Consensus Approach for Managing Symptomatic Arteriovenous Fistula (AVF) Stenosis in Haemodialysis Patients (2021)

Type of publication:
Journal article

Author(s):
Jaffer, Ounali; Gibbs, Paul; Gibson, Matthew; Gilbert, James; Hanko, Jennifer; Jeevaratnam, Praveen; Jones, Robert; *Nicholas, Johann; Ramnarine, Raymond; Sivaprakasam, Rajesh; Steiner, Kate; Tippett, Richard; Wilkins, Jason

Citation:
Cardiovascular and interventional radiology; Nov 2021; vol. 44 (no. 11); p. 1736-1746

Abstract:
PURPOSE Stenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus. METHODS A modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice. RESULTS The usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultra-high-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions. CONCLUSIONS These recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.

Requirement of interventional treatment in a patient being conservatively managed for persistent pneumothorax over a prolonged period (2021)

Type of publication:
Journal article

Author(s):
*Brenac, Sophia

Citation:
BMJ case reports; Jul 2021; vol. 14 (no. 7)

Abstract:
An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.

Link to full-text [NHS OpenAthens account required]

Evidence-based use of newer agents in type 2 diabetes (2021)

Type of publication:
Journal article

Author(s):
*Morris, D.

Citation:
Journal of Prescribing Practice; Jun 2021; vol. 3 (no. 6); p. 224-234

Abstract:
The DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors are newer agents for glycaemic control in type 2 diabetes that can offer additional health benefits. All three treatments carry a low risk of hypoglycaemia. GLP-1 RAs and SGLT-2 inhibitors are associated with weight loss and DPP-4 inhibitors are weight neutral. The GLP-1 RAs and SGLT-2 inhibitors offer protection against cardiovascular events. SGLT-2 inhibitors are the agents of choice to add on to metformin for glycaemic control in chronic kidney disease and heart failure, with GLP-1 RAs an alternative to be considered if SGLT-2 inhibitors are poorly tolerated or contraindicated. DPP-4 inhibitors are very well tolerated. Gastrointestinal side-effects can be problematic with GLP-1 RAs though frequently these settle with time. Genital thrush is a common side-effect with SGLT-2 inhibitors and diabetic ketoacidosis is a rare but serious side-effect. It is important that healthcare professionals with responsibility in diabetes familiarise themselves with these treatments in order to know when and how to safely and effectively deploy them. The selection of newer agents should be based on careful assessment of individual circumstances. Overall, the standpoint has shifted from a largely glucocentric approach to one considering the impact of treatments on weight, risk of hypoglycaemia, and co-morbidities (notably atherosclerotic cardiovascular disease, heart failure and chronic kidney disease). Case histories are used in the article to illustrate the pragmatic use of these agents.

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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Myocardial bridges: A meta-analysis (2021)

Type of publication:
Systematic Review

Author(s):
*Roberts W.; Ang C.; Charles S.M.; Tubbs R.S.; Loukas M.; Holda M.K.; Walocha J.; Lachman N.

Citation:
Clinical Anatomy; Jul 2021; vol. 34 (no. 5); p. 685-709

Abstract:
Myocardial bridges are anatomical entities characterized by myocardium covering segments of coronary arteries. In some patients, the presence of a myocardial bridge is benign and is only incidentally found on autopsy. In other patients, however, myocardial bridges can lead to compression of the coronary artery during systolic contraction and delayed diastolic relaxation, resulting in myocardial ischemia. This ischemia in turn can lead to myocardial infarction, ventricular arrhythmias and sudden cardiac death. Myocardial bridges have also been linked to an increased incidence of atherosclerosis, which has been attributed to increased shear stress and the presence of vasoactive factors. Other studies however, demonstrated the protective roles of
myocardial bridges. In this study, using systematic review and a meta-analytical approach we investigate the prevalence and morphology of myocardial bridges in both clinical imaging and cadaveric dissections. We also discuss the pathophysiology, clinical significance, and management of these anatomical entities.

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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