COVID-19

Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in inflammatory bowel disease patients treated with infliximab and vedolizumab (2022)

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Type of publication:Journal article

Author(s):Lin S.; Kennedy N.A.; Saifuddin A.; Sandoval D.M.; Reynolds C.J.; Seoane R.C.; Kottoor S.H.; Pieper F.P.; Lin K.-M.; Butler D.K.; Chanchlani N.; Nice R.; Chee D.; Bewshea C.; Janjua M.; McDonald T.J.; Sebastian S.; Alexander J.L.; Constable L.; Lee J.C.; Murray C.D.; Hart A.L.; Irving P.M.; Jones G.-R.; Lees C.W.; Altmann D.M.; Boyton R.J.; Goodhand J.R.; Powell N.; Kok K.B.; Bokth F.; Cipriano B.; Francia C.; Khalid N.; Khatun H.; Kingston A.; Lee I.; Lehmann A.; Naik K.; Pabriaga E.; Plaatjies N.; Samuels K.; Saich R.; Cousins H.; Thomas R.; Brown M.; White B.; Tilley B.; Muhammed R.; Bi R.; Cotter C.; Grove J.; Hong K.; Howman R.; Clayton S.; Sultan S.; Rooney M.; Cottrill C.; Singh S.; Dawe C.; Hull R.; Silva N.; Manning J.; Finlayson L.; Roebuck A.; Dawson J.; Sonwalkar S.; Chambers N.; Robinson M.; Haigh A.; Matapure L.; Raine T.; Kapizioni C.; Strongili K.; Thompson T.; Ahmed M.; Kontos C.; Bourges C.; Barbutti I.; Gozzard M.E.; Hendy P.; Bull R.; Costa P.; Davey L.; Hannington H.; Nundlall K.; Martins C.; Avanzi L.; Carungcong J.; Barr S.; Appleby R.; Johnson E.; Phillis K.; Gascoyne R.; Crowder A.; Whileman A.; London I.; Grounds J.; Martin E.; Price J.; Cawley K.; Dhar A.; Brown E.; Cowton A.; Warner B.; Stuart C.; Lacey L.; de Silva S.; Allcock C.; Harvey P.; Jones L.; Cooke E.; Brooks J.; Baker P.; Beadle H.; Cruz C.; Potter D.; Collum J.; Masters F.; Kumar A.; Coetzee S.; Peiu M.; Icke B.; Raj M.; Gaynor E.; Chadokufa S.; Huggett B.; Meghari H.; El-Khouly S.; Kiparissi F.; Girshab W.; Claridge A.; Fowler E.; McCafferty L.; Christodoulides K.; Clifford A.; Dawson P.; Honap S.; Lim S.; Luber R.; Mahiouz K.; Meade S.; Reynolds R.; Stanton A.; Tripoli S.; Hare N.; Balachandran S.; North E.; North J.; Browne B.; Jameson E.; Siaw Y.H.; Manzano L.; Segal J.; Al-Bakir I.; Khakoo I.; Thoua N.; Davidson K.; Miah J.; Canclini L.; Hall A.; Hayes M.; Myers S.; Talbot A.; Turnbull J.; Whitehead E.; Stamp K.; Pattinson A.; Mathew V.; Sherris L.; Harvey A.; Hicks L.; Byrne T.-M.; Cabreros L.; Downing-Wood H.; Hunter S.; Prabhudev H.; Balarajah S.; Ibraheim H.; Torkizadeh M.; Lo J.W.; Liu Z.; Sutherland H.; Wilhelmsen E.; Mackintosh K.; Verma A.M.; Sebastian J.; Peerally M.F.; Raymode P.; Guerdette A.-M.; Kent A.; Choong L.M.; Pantaloni B.; Ravdas P.; Vadamalayan B.; Foley S.; Arnold B.; Heeley C.; Lovegrove W.; Sowton D.; Allsop L.; Gregory H.; Smith P.J.; Bretland G.; King S.; Lofthouse M.; Rigby L.; Subramanian S.; Tyrer D.; Martin K.; Probert C.; Kamperidis N.; Adedoyin T.; Baden M.; Chacko F.; Cicchetti M.; Saifuddin M.A.; Yesupatham P.; Gowda R.; Williams M.; Kemp K.; Akhand R.; Gray G.; John A.; John M.; Mohammed T.; Sathe D.; Jones N.; Soren J.; Sprakes M.; Burton J.; Kane P.; Lupton S.; Bartholomew J.; MacFaul G.; Scaletta D.; Siamia L.; Williams F.; Green C.; Ver Z.; Lamb C.A.; Doona M.; Hogg A.; Jeffrey L.; King A.; Speight R.A.; Doyle J.; Owen R.; Mowat C.; Rice D.; MacFarlane S.; MacLeod A.; Mohammed S.; Murray S.; Elliott A.; Morris M.A.; Coke L.; Hindle G.; Kolokouri E.; Wright C.; Lee C.; Ward N.; Dann A.; Lockett M.; Cranfield C.; Jennings L.; Srivastava A.; Ward L.; Jeynes N.; Ranga P.; Rajasekhar P.; Gallagher L.; Patterson L.; Ward J.; Basnett R.; Murphy J.; Parking L.; Lawson E.; Short S.; Devadason D.; Moran G.; Khan N.; Tarr L.; Olivia C.; Limdi J.; Goulden K.; Javed A.; McKenzie L.; Bhandari P.; Baker-Moffatt M.; Dash J.; Le Poidevin A.; Downe H.; Bombeo L.; Blackman H.; Wiles A.; Bloxham H.; Dias J.; Nadar E.; Curgenven H.; Macdonald J.; Finan S.; McMeeken F.; Mahmood M.; Shields S.; Seenan J.P.; DeSilva D.; Malkakorpi S.; Carson R.; Whiteoak S.; Edger-Earley K.; Vamplew L.; Ingram S.; Botfield S.; Hammonds F.; James C.; Ahmad T.; Aspinall G.; Hawkins S.; Marriott S.; Redstone C.; Windak H.; Adam A.-M.; Mabb H.; Murray C.; Diaba C.; Joseph F.; Pakou G.; Gleeson Y.; Berrill J.; Stroud N.; Pothecary C.; Roche L.; Turner K.; Deering L.; Israel L.; Baker E.; Cutler S.; Evans R.M.; Nash M.; Mallison G.; Roynon A.; Gordon J.; Levell E.; Zagalo S.; Fraser W.; Hoad I.; Kirkineziadis N.; Russell R.; Henderson P.; Millar M.; Fagbemi A.; Jennings F.; Mayor I.; Wilson J.; Alexakis C.; Michalak N.; Saunders J.; Burton H.; Cambridge V.; Clark T.; Ekblad C.; Hierons S.; Katebe J.; Saunsbury E.; Perry R.; Brookes M.; Davies K.; Green M.; Plumbe A.; Ormerod C.; Christensen H.; Keen A.; Ogor J.; Anthony A.; Newitt E.; Trim F.; Casey R.; Seymour K.; Fogden E.; Russell K.; Phillips A.; Abdulla M.; *Butterworth J.; *Adams C.; *Buckingham E.; *Childs D.; *Magness A.; *Stickley J.; *Motherwell N.; *Tonks L.; *Gibson H.; *Pajak S.; Thomas C.; Brinkworth E.; Connor L.; Cook A.; Rees T.; Harford R.; Wesley E.; Moss A.; Lucas J.; Lorimer C.; Oleary M.; Dixon M.; Ramadas A.; Tregonning J.; Okeke O.; Jackson W.; Koumoutsos I.; George V.; Kunhunny S.; Laverick S.; Anderson I.; Smith S.; Patel K.; Ali M.; Mhandu H.; Rana A.; Spears K.; Teixeira J.; Pollok R.; Mencias M.; Seaward A.; Sousa J.; Said N.; Soomaroo M.; Raspa V.; Tacouri A.; Reps N.; Martin R.; Selinger C.; Carbonell J.; Onovira F.; Quartey D.; L'Anson A.; Ashworth A.; Bailey J.; Dunn A.; Mahmood Z.; Campbell R.; Marsh L.; Rahman M.; Davies S.; Habibi R.; Jessup-Dunton E.; Joefield T.; Layug R.; Patel V.; Vere J.; Turner V.; Kilroy S.; Walker G.; Atkins S.; Growdon J.; McNeill C.; Cooney R.; Bennett L.; Bowlas L.; Shariff S.; Fraser A.; Punnette D.; Bishop-Hurman C.; Undrell E.; Belfield K.; Din S.; Addleton C.; Appleby M.; Brown J.; Holding K.; Hooper P.; deCaestecker J.; Watchorn O.; Hayward C.; Inniss S.; Pritchard L.; Rudge K.; Carney A.; Andreyev J.; Hayhurst C.; Lockwood C.; Osborne L.; Roper A.; Warner K.; Hindle J.; Watt C.; Szymiczek K.; Mehta S.; Bell J.; Blad W.; Whitley L.; Dhamaraj D.; Baker M.; Sivamurugan E.J.; Evans M.; Cummings F.; Harris C.; Jones A.; Krauze L.; Rahmany S.; Earl M.; Vowles J.; Torokwa A.; Petrova M.; Procter A.; Stanley J.; Silvamoniz C.; Bettey M.; Wahid A.; Morrison Z.; Thomas-Turner R.; Yendle L.; Muller J.; Mitchell M.; Kirkwood J.; Barnes A.; Chaudhary R.; Claridge M.; Ellis C.; Kemp C.; Tobi O.; Milton J.; Johnston E.; Oblak M.; Godden J.; Lees C.; Alexander D.; Covil K.; Derikx L.; Siakavellas S.; Baxter H.; Robertson S.; Smith L.; Poulose B.; Colemam A.; Balint M.; Rhys-Jones G.; Johns K.; Hughes R.; Phipps J.; Taylor A.; MacPhee C.; Brooks S.; Smith K.; Howard L.; Wood D.; Muddu A.; Barman L.; Mallinson J.; Neale T.; Ionita D.; Elliot K.; Turnball A.; Thomas I.; Andrews K.; Sutton J.; Jones C.M.; Roberts J.; Bishop J.

Citation:Nature Communications. 13(1) (no pagination), 2022. Article Number: 1379. Date of Publication: December 2022 [epub ahead of print]

Abstract:Anti tumour necrosis factor (anti-TNF) drugs increase the risk of serious respiratory infection and impair protective immunity following pneumococcal and influenza vaccination. Here we report SARS-CoV-2 vaccine-induced immune responses and breakthrough infections in patients with inflammatory bowel disease, who are treated either with the anti-TNF antibody, infliximab, or with vedolizumab targeting a gut-specific anti-integrin that does not impair systemic immunity. Geometric mean [SD] anti-S RBD antibody concentrations are lower and half-lives shorter in patients treated with infliximab than vedolizumab, following two doses of BNT162b2 (566.7 U/mL [6.2] vs 4555.3 U/mL [5.4], p <0.0001; 26.8 days [95% CI 26.2 – 27.5] vs 47.6 days [45.5 – 49.8], p <0.0001); similar results are also observed with ChAdOx1 nCoV-19 vaccination (184.7 U/mL [5.0] vs 784.0 U/mL [3.5], p <0.0001; 35.9 days [34.9 – 36.8] vs 58.0 days [55.0 – 61.3], p value < 0.0001). One fifth of patients fail to mount a T cell response in both treatment groups. Breakthrough SARS-CoV-2 infections are more frequent (5.8% (201/3441) vs 3.9% (66/1682), p = 0.0039) in patients treated with infliximab than vedolizumab, and the risk of breakthrough SARS-CoV-2 infection is predicted by peak anti-S RBD antibody concentration after two vaccine doses. Irrespective of the treatments, higher, more sustained antibody levels are observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Our results thus suggest that adapted vaccination schedules may be required to induce immunity in at-risk, anti-TNF-treated patients.

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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: An international cohort study (2021)

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Type of publication:Journal article

Author(s):Ward A.E.; Nepogodiev D.; Ahmed I.; Chaudhry D.; Dhaif F.; Bankhad-Kendall B.; Mahmood A.; Marais L.; Metcalfe A.; Parsons N.; Siaw-Acheampong K.; Dawson B.E.; Evans J.P.; Glasbey J.C.; Gujjuri R.R.; Heritage E.; Jones C.S.; Kamarajah S.K.; Keatley J.M.; Li E.; McKay S.C.; Pellino G.; Tiwari A.; Simoes J.F.F.; Trout I.M.; Venn M.L.; Wilkin R.J.W.; Ademuyiwa A.O.; Agarwal A.; Al Ameer E.; Alderson D.; Arnaud A.P.; Augestad K.M.; BankheadKendall B.; Benson R.A.; Chakrabortee S.; Blanco-Colino R.; Brar A.; Minaya Bravo A.; Breen K.A.; Lima Buarque I.; Caruana E.; Cunha M.F.; Di Saverio S.; Elhadi M.; Farik S.; Fiore M.; Fitzgerald J.E.; Gallo G.; Ghosh D.; Gomes G.M.A.; Hutchinson P.; Isik A.; Lawani I.; Lederhuber H.; Leventoglu S.; Loffler M.W.; Mazingi D.; Mohan H.; Moore R.; Moszkowicz D.; Ng-Kamstra J.S.; Metallidis S.; Moug S.; Niquen M.; Ntirenganya F.; Outani O.; Pata F.; Pinkney T.D.; Pockney P.; Radenkovic D.; Ramos-De La Medina A.; Roberts K.; Santos I.; Schache A.; Schnitzbauer A.; Shaw R.; Shu S.; Soreide K.; Spinelli A.; Sundar S.; Tabiri S.; Townend P.; Tsoulfas G.; Van Ramshorst G.; Wright N.; Mak J.K.C.; Kulkarni R.; Sharma N.; Nankivell P.; Tirotta F.; Parente A.; Breik O.; Kisiel A.; Cato L.D.; Saeed S.; Bhangu A.; Griffiths E.; Pathanki A.M.; Ford S.; Desai A.; Almond M.; Kamal M.; Chebaro A.; Lecolle K.; Truant S.; El Amrani M.; Zerbib P.; Pruvot F.R.; Mathieu D.; Surmei E.; Mattei L.; Dudek J.; Singhal T.; El-Hasani S.; Nehra D.; Walters A.; Cuschieri J.; Davidson G.H.; Ho M.; Wade R.G.; Johnstone J.; Bourke G.; Brunelli A.; Elkadi H.; Otify M.; Pompili C.; Burke J.R.; Bagouri E.; Chowdhury M.; Abual-Rub Z.; Kaufmann A.; Munot S.; Lo T.; Young A.; Kowal M.; Wall J.; PeckhamCooper A.; Winter S.C.; Belcher E.; Stavroulias D.; Di Chiara F.; Wallwork K.; Qureishi A.; Lami M.; Sravanam S.; Shah K.; Chidambaram S.; Smillie R.; Shaw A.V.; Bandyopadhyay S.; Cernei C.; Bretherton C.; Jeyaretna D.; Ganau M.; Piper R.J.; Duck E.; Brown S.; Jelley C.; Tucker S.C.; Bond-Smith G.; Griffin X.L.; Tebala G.D.; Neal N.; Vatish M.; Noton T.M.; Ghattaura H.; Maher M.; Fu H.; Risk O.B.F.; Soleymani Majd H.; Sinha S.; Aggarwal A.; Kharkar H.; Lakhoo K.; Verberne C.; Mastoridis S.; Senent-Boza A.; Sanchez-Arteaga A.; Benitez-Linero I.; Manresa-Manresa F.; Tallon-Aguilar L.; Melero-Cortes L.; FernandezMarin M.R.; Duran-Munoz-Cruzado V.M.; Ramallo-Solis I.; Beltran-Miranda P.; Pareja-Ciuro F.; Anton-Eguia B.T.; Dawson A.C.; Drane A.; Oliva Mompean F.; GomezRosado J.; Reguera-Rosal J.; Valdes-Hernandez J.; Capitan-Morales L.; Del Toro Lopez M.D.; Tang A.; Beamish A.J.; Price C.; Bosanquet D.; Magowan D.; Solari F.; Williams G.; Nassa H.; Smith L.; Elliott L.; McCabe G.; Holroyd D.; Jamieson N.B.; Mariani N.M.; Nicastro V.; Li Z.; Parkins K.; Spencer N.; Harries R.; Egan R.J.; Motter D.; Jenvey C.; Mahoney R.; Fine N.; Minto T.; Henry A.; Gill C.; Dunne N.; Sarma D.R.; Godbole C.; Carlos W.; Tewari N.; Jeevan D.; Naredla P.; Khajuria A.; Connolly H.; Robertson S.; Sweeney C.; Di Taranto G.; Shanbhag S.; Dickson K.; McEvoy K.; Skillman J.; Sait M.; Al-Omishy H.; Baig M.; Heer B.; Lunevicius R.; Sheel A.R.G.; Sundhu M.; Santini A.J.A.; Fathelbab M.S.A.T.; Hussein K.M.A.; Nunes Q.M.; Jones R.P.; Shahzad K.; Haq I.; Baig M.M.A.S.; Hughes J.L.; Kattakayam A.; Rajput K.; Misra N.; Shah S.B.; Clynch A.L.; Georgopoulou N.; Sharples H.M.; Apampa A.A.; Nzenwa I.C.; Sud A.; Podolsky D.; Coleman N.L.; Callahan M.P.; Dunstan M.; Beak P.; Gerogiannis I.; Ebrahim A.; Alwadiya A.; Goyal A.; Phillips A.; Bhalla A.; Demetriou C.; Grimley E.; Theophilidou E.; Ogden E.; Malcolm F.L.; Davies-Jones G.; Ng J.C.K.; Mirza M.; Hassan M.; Elmaleh N.; Daliya P.; Bateman A.; Chia Z.; A'Court J.; Konarski A.; Faulkner G.; Talwar R.; Patel K.; Askari A.; Jambulingam P.S.; Shaw S.; Maity A.; Hatzantonis C.; Sagar J.; Kudchadkar S.; Cirocchi N.; Chan C.H.; Eberbach H.; Bayer J.; Erdle B.; Sandkamp R.; Kaafarani H.; Breen K.; Bankhead-Kendall B.; Alser O.; Mashbari H.; Velmahos G.; Maurer L.R.; El Moheb M.; Gaitanidis A.; Naar L.; Christensen M.A.; Kapoen C.; Langeveld K.; El Hechi M.; Mokhtari A.; Main B.; MacCabe T.; Newton C.; Blencowe N.S.; Fudulu D.P.; Bhojwani D.; Baquedano M.; Caputo M.; Rapetto F.; Flannery O.; Hassan A.; Edwards J.; Ward A.; Tadross D.; Majkowski L.; Blundell C.; Forlani S.; Nair R.; Guha S.; Brown S.R.; Steele C.; Kelty C.J.; Newman T.; Lee M.; Chetty G.; Lye G.; Balasubramanian S.P.; Sureshkumar Shah N.; Sherif M.; Al-Mukhtar A.; Whitehall E.; Giblin A.; Wells F.; Sharkey A.; Adamec A.; Madan S.; Konsten J.; Van Heinsbergen M.; *Sou A.; *Simpson D.; *Hamilton E.; *Blair J.; Jimeno Fraile J.; Morales-Garcia D.; Carrillo-Rivas M.; Toledo Martinez E.; Pascual A.; Landaluce-Olavarria A.; Gonzalez De Miguel M.; Fernandez Gomez Cruzado L.; Begona E.; Lecumberri D.; Calvo Rey A.; Prada Hervella G.M.; Dos Santos Carregal L.; Rodriguez Fernandez M.I.; Freijeiro M.; El Drubi Vega S.; Van Den Eynde J.; Oosterlinck W.; Van Den Eynde R.; Sermon A.; Boeckxstaens A.; Cordonnier A.; De Coster J.; Jaekers J.; Politis C.; Miserez M.; Galipienso Eri M.; Garcia Montesino J.D.; Dellonder Frigole J.; Noriego Munoz D.; Lizzi V.; Vovola F.; Arminio A.; Cotoia A.; Sarni A.L.; Bekheit M.; Kamera B.S.; Elhusseini M.; Sharma P.; Ahmeidat A.; Gradinariu G.; Cymes W.; Hannah A.; Mignot G.; Shaikh S.; Agilinko J.; Sgro A.; Rashid M.M.; Milne K.; McIntyre J.; Akhtar M.A.; Turnbull A.; Brunt A.; Stewart K.E.; Wilson M.S.J.; Rutherford D.; McGivern K.; Massie E.; Duff S.; Moura F.; Brown B.C.; Asaad P.; Wadham B.; Aneke I.A.; Collis J.; Warburton H.; Fountain D.M.; Laurente R.; Sigamoney K.V.; Dasa M.; George K.; Naqui Z.; Galhoum M.; Lipede C.; Gabr A.; Radhakrishnan A.; Hasan M.T.; Kalenderov R.; Pathmanaban O.; Colombo F.; Chelva R.; Subba K.; Abou-Foul A.K.; Khalefa M.; Hossain F.; Moores T.; Pickering L.; Shah J.; Anthoney J.; Emmerson O.; Bevan K.; Makin-Taylor R.; Ong C.S.; Callan R.; Bloom O.; Vidya R.; Chauhan G.; Kaur J.; Burahee A.; Bleibleh S.; Pigadas N.; Snee D.; Bhasin S.; Crichton A.; Habeebullah A.; Bodla A.S.; Yassin N.; Mondragon M.; Dewan V.; Giuffrida M.C.; Marano A.; Palagi S.; Di Maria Grimaldi S.; Testa V.; Peluso C.; Borghi F.; Simonato A.; Puppo A.; D'Agruma M.; Chiarpenello R.; Pellegrino L.; Maione F.; Cianflocca D.; Pruiti Ciarello V.; Giraudo G.; Gelarda E.; Dalmasso E.; Abrate A.; Daniele A.; Ciriello V.; Rosato F.; Garnero A.; Leotta L.; Chiozza M.; Anania G.; Urbani A.; Koleva Radica M.; Carcoforo P.; Portinari M.; Sibilla M.; Archer J.E.; Odeh A.; Siddaiah N.; Baumber R.; Parry J.; Carmichael H.; Velopulos C.G.; Wright F.L.; Urban S.; McIntyre R.C.; Schroeppel T.J.; Hennessy E.A.; Dunn J.; Zier L.; Parmar C.; McCluney S.; Shah S.; Munoz Vives J.M.; Osorio A.; Gomez Diaz C.J.; Guariglia C.A.; Soto Montesinos C.; Sanchon L.; Xicola Martinez M.; Guardia N.; Collera P.; Diaz Del Gobbo R.; Sanchez Jimenez R.; Farre Font R.; Flores Clotet R.; Brathwaite C.E.M.; Liu H.; Petrone P.; Hakmi H.; Sohail A.H.; Baltazar G.; Heckburn R.; Madhvani K.; Hampton M.; Hormis A.P.; Young R.; Miu V.; Sheridan K.; MacDonald L.; Green S.; Onos L.; Dean B.; Luney C.; Myatt R.; Williams M.A.; McVeigh J.; Alqallaf A.; Ben-Sassi A.; Mellor K.; Joshi P.; Joshi Y.; Crichton R.; Sonksen J.; Aldridge K.; Layton G.R.; Karki B.; Jeong H.; Pankhania S.; Asher S.; Folorunso A.; Mistry S.; Singh B.; Winyard J.; Mangwani J.; Babu B.H.B.; Liyanage A.S.D.; Newman S.; Blake I.; Weerasinghe C.; Ballabio M.; Bisagni P.; Longhi M.; Armao T.; Madonini M.; Gagliano A.; Pizzini P.; Alga A.; Nordberg M.; Sandblom G.; Jallad S.; Lord J.; Anderson C.; El Kafsi J.; Logishetty K.; Saadya A.; Midha R.; Ip M.; Subbiah Ponniah H.; Stockdale T.; Bacarese-Hamilton T.; Foster L.; James A.; Anjarwalla N.; Marujo Henriques D.; Hettige R.; Baban C.; Tenovici A.; Salerno G.; Hardie J.; Page S.; Anazor F.; King S.D.; Luck J.; Kazzaz S.; Patel M.; Shabana A.; Alanbuki A.; Usman O.; Hkruijff S.; De Vries J.P.P.M.; Steinkamp P.J.; Jonker P.K.C.; Van Der Plas W.Y.; Bierman W.; Janssen Y.; Borgstein A.B.J.; Gisbertz S.S.; Van Berge Henegouwen M.I.; Enjuto D.; Perez Gonzalez M.; Diaz Pena P.; Gonzalez J.; Marqueta De Salas M.; Martinez Pascual P.; Rodriguez Gomez L.; Garces Garcia R.; Ramos Bonilla A.; Herrera-Merino N.; Fernandez Bernabe P.; Cagigal Ortega E.P.; Hernandez I.; Garcia De Castro Rubio E.; Cervera I.; Kashora F.; Siddique M.H.; Singh A.; Barmpagianni C.; Basgaran A.; Basha A.; Okechukwu V.; Bartsch A.; Gallagher P.; Maqsood A.; Sahnan K.; Leo C.A.; Lewis S.E.; Ubhi H.K.; Exley R.; Khan U.; Shah P.; Saxena S.; Zafar N.; Abdul-Jabar H.; Mongelli F.; Bernasconi M.; Di Giuseppe M.; Christoforidis D.; La Regina D.; Arigoni M.; Liew I.; Al-Sukaini A.; Mediratta S.; Saxena D.; Boal M.; Dean H.; Higgs S.; Stanger S.; Abdalaziz H.; Constable J.; Ishii H.; Preece R.; Dovell G.; Gopi Reddy R.; Dehal A.; Shah H.B.; Cross G.W.V.; Seyed-Safi P.; Smart Y.W.; Kuc A.; Al-Yaseen M.; Jayasankar B.; Balasubramaniam D.; Abdelsaid K.; Mundkur N.; Gallagher B.; Hine T.; Keeler B.; Soulsby R.E.; Taylor A.; Davies E.; Ryska O.; Raymond T.; Rogers S.; Tong A.; Hawkin P.; Kinnaman G.; Meagher A.; Sharma I.; Holler E.; Dunning J.; Viswanath Y.; Freystaetter K.; Dixon J.; Hadfield J.N.; Hilley A.; Egglestone A.; Smith B.; Arkani S.; Freedman J.; Youssef M.; Sreedharan L.; Baskaran D.; Shaikh I.; Seebah K.; Reid J.; Watts D.; Kouritas V.; Chrastek D.; Maryan G.; Gill D.F.; Khatun F.; Ranjit S.; Parakh J.; Sarodaya V.; Daadipour A.; Khalifa M.; Bosch K.D.; Bashkirova V.; Dvorkin L.S.; Kalidindi V.K.; Choudhry A.; Marx W.; Espino Segura-Illa M.; Sanchez Aniceto G.; Castano-Leon A.M.; Jimenez-Roldan L.; Delgado Fernandez J.; Perez Nunez A.; Lagares A.; Garcia Perez D.; Santas M.; Paredes I.; Esteban Sinovas O.; Moreno-Gomez L.; Rubio E.; Vega V.; Vivas Lopez A.; Labalde Martinez M.; Garcia Villar O.; Pelaez Torres P.M.; Garcia-Borda J.; Ferrero Herrero E.; Gomez P.; Eiriz Fernandez C.; Ojeda-Thies C.; Pardo Garcia J.M.; Wynn Jones H.; Divecha H.; Whelton C.; Board T.; Hardie C.; Powell-Smith E.; Alotaibi M.; Maashi A.; Zowgar A.; Alsakkaf M.; Izquierdo O.; Ventura D.; Castellanos J.; Lara A.; Escobar D.; Arrieta M.; Garcia De Cortazar U.; Villamor Garcia I.; Cioci A.; Ruiz G.; Allen M.; Rakoczy K.; Pavlis W.; Saberi R.; Sobti A.; Khaleel A.; Unnithan A.; Memon K.; Pala Bhaskar R.R.; Maqboul F.; Kamel F.; AlSamaraee A.; Madani R.; Kumar L.; Nisar P.; Agrawal S.; Llaquet Bayo H.; Duchateau N.; De Gheldere C.; Martin J.; Cheng D.; Yang H.; Fayad A.; Wood M.L.; Persad A.; Groot G.; Pham H.; Hakami I.; Boeker C.; Mall J.; Smith H.; Haugstvedt A.F.; Jonsson M.L.; Caja Vivancos P.; Villalabeitia Ateca I.; Prieto Calvo M.; Marin H.; Martin Playa P.; Gainza A.; Aragon Achig E.J.; Rodriguez Fraga A.; Melchor Corcostegui I.; Mallabiabarrena Ormaechea G.; Garcia Gutierrez J.J.; Barbier L.; Pesantez Peralta M.A.; Jimenez Jimenez M.; Municio Martin J.A.; Gomez Suarez J.; Garcia Opere G.; Pascua Gomez L.A.; Onate Aguirre M.; Fernandez-Colorado A.; De La Rosa-Estadella M.; Gasulla-Rodriguez A.; Serrano-Martin M.; Peig-Font A.; Junca-Marti S.; Juarez-Pomes M.; Garrido-Ondono S.; Blasco-Torres L.; Molina-Corbacho M.; Maldonado-Sotoca Y.; Gasset-Teixidor A.; Blasco-Moreu J.; Turrado-Rodriguez V.; Lacy A.M.; De Lacy F.B.; Morales X.; Carreras-Castaner A.; Torner P.; Jornet-Gibert M.; Balaguer-Castro M.; Renau-Cerrillo M.; Camacho-Carrasco P.; Vives-Barquiel M.; Campuzano-Bitterling B.; Gracia I.; Pujol-Muncunill R.; Estaire Gomez M.; Padilla-Valverde D.; Sanchez-Garcia S.; Sanchez-Pelaez D.; Jimenez Higuera E.; Picon Rodriguez R.; Fernandez Camunas A.; Martinez-Pinedo C.; Garcia Santos E.P.; Munoz-Atienza V.; Moreno Perez A.; Lopez De La Manzanara Cano C.A.; Crego-Vita D.; Huecas-Martinez M.; Domenech J.; Rosello Anon A.; Sanguesa M.J.; Bernal-Sprekelsen J.C.; Catala Bauset J.C.; Renovell Ferrer P.; Martinez Perez C.; Gil-Albarova O.; Gilabert Estelles J.; Aghababyan K.; Rivas R.; Rivas F.; Escartin J.; Blas Laina J.L.; Nogues A.; Cros B.; Talal El-Abur I.; Garcia Egea J.; Yanez C.; Kauppila J.H.; Sarjanoja E.; Tzedakis S.; Bouche P.A.; Gaujoux S.; Gossot D.; Seguin-Givelet A.; Fuks D.; Grigoroiu M.; Sanchez Salas R.; Cathelineau X.; MacEk P.; Barbe Y.; Rozet F.; Barret E.; Mombet A.; Cathala N.; Brian E.; Zadegan F.; Conso C.; Baldwin A.J.; West R.; Gammeri E.; Catton A.; Marinos Kouris S.; Pereca J.; Singh J.; Patel P.; Handa S.; Kaushal M.; Kler A.; Reghuram V.; Tezas S.; Oktseloglou V.; Mosley F.; De La Cruz Monroy M.F.I.; Bobak P.; Omar I.; Ahad S.; Langlands F.; Brown V.; Hashem M.; Williams A.; Ridgway A.; Pournaras D.; Britton E.; Lostis E.; Ambler G.K.; Chu H.; Hopkins J.; Manara J.; Chan M.; Doe M.; Moon R.D.C.; Lawday S.; Jichi T.; Singleton W.; Mannion R.; Stewart G.D.; Ramzi J.; Mohan M.; Singh A.A.; Ashcroft J.; Baker O.J.; Coughlin P.; Davies R.J.; Durst A.Z.E.D.; Abood A.; Habeeb A.; Hudson V.E.; Kolias A.; Lamb B.; Luke L.; Mitrasinovic S.; Murphy S.; Ngu A.W.T.; O'Neill J.R.; Waseem S.; Wong K.; Georgiades F.; Hutchinson P.J.; Tan X.S.; Pushpa-Rajah J.; Colquhoun A.; Masterson L.; Abu-Nayla I.; Walker C.; Balakrishnan A.; Rooney S.; Irune E.; Byrne M.H.V.; Durrani A.; Richards T.; Sethuraman Venkatesan A.; Combellack T.; Williams J.; Tahhan G.; Mohammed M.; Kornaszewska M.; Valtzoglou V.; Deglurkar I.; Rahman M.; Von Oppell U.; Mehta D.; Koutentakis M.; Syed Nong Chek S.A.H.; Hill G.; Morris C.; Shinkwin M.; Torkington J.; Cornish J.; Houston R.; Mannan S.; Ayeni F.; Tustin H.; Bordenave M.; Robson A.; Vimalachandran D.; Manu N.; Eardley N.; Krishnan E.; Serevina O.L.; Martin E.; Jones A.; Roy Mahapatra S.; Clifford R.; Matthews W.; Mohankumar K.; Khawaja I.; Palepa A.; Doulias T.; Premakumar Y.; Jauhari Y.; Koshnow Z.; Bowen D.; Uberai A.; Hirri F.; Stubbs B.M.; McDonald C.; Manickavasagam J.; Ragupathy K.; Davison S.; Dalgleish S.; McGrath N.; Kanitkar R.; Payne C.J.; Ramsay L.; Ng C.E.; Collier T.; Khan K.; Evans R.; Brennan C.; Henshall D.E.; Drake T.; Harrison E.M.; Zamvar V.; Tambyraja A.; Skipworth R.J.E.; Linder G.; McGregor R.; Brennan P.; Mayes J.; Ross L.; Smith S.; White T.; Jamjoom A.A.B.; Pasricha R.; Holme T.; Abbott S.; Razik A.; Thrumurthy S.; Steinke J.; Baker M.; Howden D.; Baxter Z.; Osagie L.; Bence M.; Fowler G.E.; Massey L.; Rajaretnam N.; John J.; Goubran A.; Campain N.; McDermott F.D.; McGrath J.S.; Ng M.; Pascoe J.; Phillips J.R.A.; Daniels I.R.; Raptis D.A.; Pollok J.M.; MacHairas N.; Davidson B.; Fusai G.; Soggiu F.; Xyda S.; Hidalgo Salinas C.; Tzerbinis H.; Pissanou T.; Gilliland J.; Chowdhury S.; Varcada M.; Hart C.; Mirnezami R.; Knowles J.; Angamuthu N.; Vijay V.; Shakir T.; Hasan R.; Tansey R.; Ross E.; Loubani M.; Wilkins A.; Cao H.; Capitelli-McMahon H.; Hitchman L.; Ikram H.; Andronic A.; Aboelkassem Ibrahim A.; Totty J.; Tayeh S.; Chase T.; Humphreys L.; Ayorinde J.; Ghanbari A.; Cuming T.; Williams K.; Chung E.; Hagger R.; Karim A.; Hainsworth A.; Flatman M.; Trompeter A.; Hing C.; Brown O.; Tsinaslanidis P.; Benjamin M.W.; Leyte A.; Tan C.; Smelt J.; Vaughan P.; Santhirakumaran G.; Hunt I.; Raza M.; Labib A.; Luo X.; Sudarsanam A.; Rolls A.; Lyons O.; Onida S.; Shalhoub J.; Sugand K.; Park C.; Sarraf K.M.; Erridge S.; Kinross J.; Denning M.; Yalamanchili S.; Abuown A.; Ibrahim M.; Martin G.; Davenport D.; Wheatstone S.; Andreani S.M.; Bath M.F.; Sahni A.; Judkins N.; Rigueros Springford L.; Sohrabi C.; Bacarese-Hamilton J.; Taylor F.G.; Patki P.; Tanabalan C.; Reynolds J.; Alexander M.E.; Smart C.J.; Stylianides N.; Abdalla M.; Newton K.; Bhatia K.; Edmondson R.; Abdeh L.; Jones D.; Zeiton M.; Ismail O.; Naseem H.; Advani R.; Fell A.; Smith A.; Halkias C.; Evans J.; Nikolaou S.; English C.; Kristinsson S.; Oni T.; Ilahi N.; Ballantyne K.; Woodward Z.; Merh R.; Robertson-Smith B.; Mahmoud A.; Ameerally P.; Finch J.G.; Gnanachandran C.; Pop I.; Rogers M.; Yousef Y.; Mohamed I.; Woods R.; Zahid H.; Mundy G.; Aujayeb A.; Townshend D.; McLarty N.; Shenfine A.; Jackson K.; Johnson C.; Dass D.; Ford D.; Khan J.; Thiruchandran G.; Toh S.K.C.; Ahmad Y.; Allana A.; Bellis C.; Babawale O.; Phan Y.C.; Lokman U.; Ismail M.; Koc T.; Witek A.; Duggleby L.; Shamoon S.; Stefan S.; Clancy H.; Singh S.; Mukherjee S.; Ferguson D.; Smith C.; Mansuri A.; Thakrar A.; Wickramarachchi L.; Cuthbert R.; Sivayoganathan S.; Chui K.; Karam E.; Dott C.; Shankar S.; Singh R.; Lane J.; Colvin H.V.; Badran A.; Cadersa A.; Williams S.; Cumpstey A.; Hamady Z.; Aftab R.; Wensley F.; Byrne J.; Morrison-Jones V.; Sekhon G.K.; Shields H.; Shakoor Z.; Yener A.; Talbot T.; Khan A.; Alzetani A.; Cresner R.; Johnson D.; Hughes I.; Hall J.; Rooney J.; Chatterji S.; Zhang Y.; Owen R.; Rudic M.; Hunt J.; Zakai D.; Thomas M.; Aladeojebi A.; Ali M.; Gaunt A.; Barmayehvar B.; Gowda M.; Mansour F.; Jarvis M.; Halliday E.; Lefroy R.; Nanjaiah P.; Ali S.; Kitchen M.; Lin D.J.; Rajgor A.D.; Scurrah R.J.; Kang C.; Watson L.J.; Harris G.; Royle T.; Cunningham Y.; James G.; Steel B.; Luk A.C.O.; Stables G.; Doorgakant A.; Thiruvasagam V.G.; Carter J.; Reid S.; Mohammed R.; Marlow W.; Ferguson H.; Wilkin R.; Konstantinou C.; Yershov D.; Vatish J.; Denning A.; Das R.; Powell S.; Magee C.; Agarwal K.; Mangos E.; Nambirajan T.; Flindall I.; Mahendran V.; Hanson A.; De Marchi J.; Hill A.; Farrell T.; Davis N.F.; Kearney D.; Nelson T.; Picciariello A.; Papagni V.; Altomare D.F.; Granieri S.; Cotsoglou C.; Cabeleira A.; Branco C.; Serralheiro P.; Alves R.; Teles T.; Lazaro A.; Canhoto C.; Simoes J.; Costa M.; Almeida A.C.; Nogueira O.; Oliveira A.; Athayde Nemesio R.; Silva M.; Lopes C.; Amaral M.J.; Valente Da Costa A.; Andrade R.; Guimaraes A.; Guerreiro P.; Ruivo A.; Camacho C.; Duque M.; Santos E.; Breda D.; Oliveira J.M.; De Oliveira Lopez A.L.; Garrido S.; Colino M.; De Barros J.; Correia S.; Rodrigues M.; Cardoso P.; Martins R.; Teixeira J.; Soares A.P.; Morais H.; Pereira R.; Revez T.; Manso M.I.; Domingues J.C.; Henriques P.; Ribeiro R.; Ribeiro V.I.; Cardoso N.; Sousa S.; Martins Dos Santos G.; Miranda P.; Garrido R.; Peralta Ferreira M.; Ascensao J.; Costeira B.; Cunha C.; Rio Rodrigues L.; Sousa Fernandes M.; Azevedo P.; Ribeiro J.; Lourenco I.; Gomes H.; Mendinhos G.; Nobre Pinto A.; Taflin H.; Abdou H.; Richmond M.; Clark J.; O'Meara L.; Hanna N.; Cooper Z.; Salim A.; Hirji S.A.; Brown A.; Chung C.; Hansen L.; Okafor B.U.; Roxo V.; Raut C.P.; Jolissaint J.S.; Mahvi D.A.; Reinke C.; Ross S.; Thompson K.; Manning D.; Perkins R.; Volpe A.; Merola S.; Ssentongo A.; Ssentongo P.; Oh J.S.; Hazelton J.; Maines J.; Gusani N.; Garner M.; Horvath S.; Martin R.C.G.; Bhutiani N.; Choron R.; Peck G.; Soliman F.; Abbas A.; Soliman A.; Kim B.; Jones C.; Dauer M.D.E.; Renza-Stingone E.; Hernandez E.; Gokcen E.; Kropf E.; Sufrin H.; Hirsch H.; Ross H.; Engel J.; Sewards J.; Diaz J.; Poggio J.; Sanserino K.; Rae L.; Philp M.; Metro M.; McNelis P.; Petrov R.; Rehman S.; Pazionis T.; Quintana M.; Jackson H.; Lumenta D.B.; Nischwitz S.P.; Richtig E.; Pau M.; Srekl-Filzmaier P.; Eibinger N.; Michelitsch B.; Fediuk M.; Papinutti A.; Seidel G.; Kahn J.; Cohnert T.U.; Kantor E.; Kahiu J.; Hossain N.; Hosny S.; Sultana A.; Taggarsi M.; Vitone L.; Lambert J.; Vaz O.P.; Sarantitis I.; Shrestha D.; Timbrell S.; Shugaba A.; Jones G.P.; Gardner A.; Tripathi S.S.; Greenhalgh M.S.; Emerson H.; Vejsbjerg K.; Pearce L.; McCormick W.; Fisher A.; Singisetti K.; Aawsaj Y.; Barry C.; Blanco J.; Vanker R.; Ghobrial M.; Jones G.; Kanthasamy S.; Fawi H.; Awadallah M.; Chen F.; Cheung J.; Tingle S.; Abbadessa F.; Sachdeva A.; Rai B.; Chan C.D.; McPherson I.; Booth K.; Mahmoud Ali F.; Pandanaboyana S.; Grainger T.; Nandhra S.; Patience A.; Rogers A.; Roy C.; Williams T.; Dawe N.; McCaffer C.; Riches J.; Bhattacharya S.; Moir J.; Kalson N.S.; Elamin Ahmed H.; Mellor C.; Saleh C.; Koshy R.M.; Hammond J.; Sanderson L.; Wahed S.; Phillips A.W.; Ghosh K.; Rogers L.J.; Labib P.L.; Miller D.; Minto G.; Hope N.; Marchbank A.; Emslie K.; Panahi P.; Ho B.; Perkins C.; Clough E.; Roy H.; Enemosah I.; Campbell R.; Natale J.; Gohil K.; Rela M.; Raza N.; Menakaya C.; Webb J.I.; Antar M.; Modi N.; Sofat R.; Noel J.; Nunn R.; Adegbola S.; Eriberto F.; Sharma V.; Tanna R.; Lodhia S.; Carvalho L.; Osorio C.; Antunes J.; Lourenco S.; Balau P.; Godinho M.; Pereira A.; Keller D.S.; Smart N.J.

Citation:BMJ Open. 11(11) (no pagination), 2021. Article Number: e050830.

Abstract:Objectives: Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting: Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions: Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.

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

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Type of publication:Conference abstract

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

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

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

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

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Type of publication:Conference abstract

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

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

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

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

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Type of publication:Conference abstract

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

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

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

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

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Type of publication:Conference abstract

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

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

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

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

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Type of publication:Conference abstract

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

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

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

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

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Type of publication:Conference abstract

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

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

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

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Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity (2022)

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Type of publication:
Journal article

Author(s):
Fallerini C.; Picchiotti N.; Baldassarri M.; Zguro K.; Daga S.; Fava F.; Benetti E.; Amitrano S.; Bruttini M.; Palmieri M.; Croci S.; Lista M.; Beligni G.; Valentino F.; Meloni I.; Tanfoni M.; Minnai F.; Colombo F.; Cabri E.; Fratelli M.; Gabbi C.; Mantovani S.; Frullanti E.; Gori M.; Crawley F.P.; Butler-Laporte G.; Richards B.; Zeberg H.; Lipcsey M.; Hultstrom M.; Ludwig K.U.; Schulte E.C.; Pairo-Castineira E.; Baillie J.K.; Schmidt A.; Frithiof R.; Mari F.; Renieri A.; Furini S.; Montagnani F.; Tumbarello M.; Rancan I.; Fabbiani M.; Rossetti B.; Bergantini L.; D'Alessandro M.; Cameli P.; Bennett D.; Anedda F.; Marcantonio S.; Scolletta S.; Franchi F.; Mazzei M.A.; Guerrini S.; Conticini E.; Cantarini L.; Frediani B.; Tacconi D.; Raffaelli C.S.; Feri M.; Donati A.; Scala R.; Guidelli L.; Spargi G.; Corridi M.; Nencioni C.; Croci L.; Caldarelli G.P.; Spagnesi M.; Romani D.; Piacentini P.; Bandini M.; Desanctis E.; Cappelli S.; Canaccini A.; Verzuri A.; Anemoli V.; Pisani M.; Ognibene A.; Pancrazzi A.; Lorubbio M.; Vaghi M.; Monforte A.D.; Miraglia F.G.; Mondelli M.U.; Girardis M.; Venturelli S.; Busani S.; Cossarizza A.; Antinori A.; Vergori A.; Emiliozzi A.; Rusconi S.; Siano M.; Gabrieli A.; Riva A.; Francisci D.; Schiaroli E.; Paciosi F.; Tommasi A.; Scotton P.G.; Andretta F.; Panese S.; Baratti S.; Scaggiante R.; Gatti F.; Parisi S.G.; Castelli F.; Quiros-Roldan E.; Antoni M.D.; Zanella I.; Monica M.D.; Piscopo C.; Capasso M.; Russo R.; Andolfo I.; Iolascon A.; Fiorentino G.; Carella M.; Castori M.; Aucella F.; Raggi P.; Perna R.; Bassetti M.; Biagio A.D.; Sanguinetti M.; Masucci L.; Guarnaccia A.; Valente S.; Vivo O.D.; Doddato G.; Tita R.; Giliberti A.; Mencarelli M.A.; Rizzo C.L.; Pinto A.M.; Perticaroli V.; Ariani F.; Carriero M.L.; Sarno L.D.; Alaverdian D.; Bargagli E.; Mandala M.; Giorli A.; Salerni L.; Zucchi P.; Parravicini P.; Menatti E.; Trotta T.; Giannattasio F.; Coiro G.; Lena F.; Lacerenza L.G.; Coviello D.A.; Mussini C.; Martinelli E.; Mancarella S.; 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Hopkins B.; Thrasyvoulou L.; Jackson M.; Zaki A.; Tibke C.; Bennett S.; Woodyatt W.; Kent A.; Goodwin E.; Brandwood C.; Clark R.; Smit 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.; 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.; Wraith 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.; 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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.; Keshetprice 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.; McParland C.; 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.; Jacqui M.; Hormis A.; Walker R.; Collier D.; Duncan T.; Uriel A.; Ustianowski A.; T-Michael H.; Bruce M.; Connolly K.; Smith K.; Partridge R.; Griffin D.; McDonald 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.; Roche L.; Chablani M.; Kirkby A.; Netherton K.; Archer S.; Yates B.; Ashbrook-Raby C.; Cole S.; Cabrelli L.; Chapman S.; Casey M.; Austin P.; Hutcheon A.; Whyte C.; Almaden-Boyle C.; Pattison N.; Cruz C.; Vochin A.; Kent H.; Murdoch S.; David B.; Penacerrada M.; Lubimbi G.; Bastion V.; Wulandari R.; Valentine J.; Clarke D.; Serrano-Ruiz A.; Hierons S.; 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.; Kay A.; Potts K.; Birt M.; Kent M.; Wilkinson A.; Jude E.; Turner V.; Savill H.; McCormick J.; Clark M.; Coulding M.; Siddiqui S.; Mercer O.; Rehman H.; Potla D.; *Capps N.; *Donaldson D.; *Jones J.; *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.; Mohamed Ally S.; Beaumont K.; Elsaadany M.; Fernandes K.; Ali Mohamed Ali I.; Rangarajan H.; Sarathy V.; Selvanayagam S.; Vedage D.; White M.; Smith 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.; 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Trim F.; Leadbitter I.; O'Sullivan S.; Purewal B.; Bell S.; Rivers V.; O'Leary R.; Collins E.; Anderson S.; Hammerton K.; Andrews E.; Burns K.; Edmond I.; Salutous D.; 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.; Bokhari M.; Kapoor R.; Loader D.; Ayers A.; Harrison W.; North J.; Belagodu Z.; Parasomthy 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.; Thomas A.; 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.; Nauman Akhtar M.; Dent K.; Potoczna D.; Pearson S.; Horsley E.; Spencer S.; Phillips C.; Mullan D.; Skinner D.; 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Saad C.; Al-Sarraj Y.; Al-Muftah W.; Badji R.; Thani A.A.; Ismail S.I.;

Citation:
Human Genetics. 2022, Vol 141(1) (pp 147-173)

Abstract:
The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management.

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Creating and employing an admission bloods based diagnostic aide for COVID-19 to assist cohort-based isolation strategies (2022)

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Type of publication:
Conference abstract

Author(s):
*Baker J.; *Day S.; *Marsh A.

Citation:
Emergency Medicine Journal. Conference: Royal College of Emergency Medicine Annual Scientific Conference, RCEM 2022. Belfast United Kingdom. 39(3) (pp 259-260), 2022. Date of Publication: March 2022.

Abstract:
Aims/Objectives/Background In the COVID-19 pandemic the Shrewsbury and Telford Hospital NHS Trust has isolated suspected cases in high and low suspicion cohort bays to reduce nosocomial infection. Before rapid PCR swabs were in routine use, we sought tools to aide identifying COVID-19 positive patients. Methods/Design We collected data from two cohorts in April and June 2020 totalling 317 patients, with positivity rates of 33% and 5% respectively. We retrospectively correlated neutrophil count, lymphocyte count, LDH and AST to positive and negative swab results. Predictive value of COVID-19 positivity was assessed via their receiver operator characteristic. Areas under the curve were as follows: Neutrophils 0.75, lymphocytes 0.64, combined neutrophil and lymphocyte count 0.82, AST 0.65 and LDH 0.7. We developed a diagnostic aide to assist in allocation of high and low suspicion based on parameters for neutrophil count, lymphocyte count and LDH, each of which was assigned red (higher probability) or green (lower probability) in a 'traffic light' system. Combined and applied retrospectively to 252 patients with suspected COVID-19, with a positivity prevalence of 5%, three green values generated a negative predictive value for COVID-19 of 100%, two greens 98% and three reds a positive predictive value for COVID-19 of 44%. Results/Conclusions This diagnostic aide was applied from August 2020 within the Trust Emergency Departments and Acute Medical Units to aide cohort decisions. A retrospective application to all 213 patients with positive swabs admitted from August to November 2020 demonstrated that 69% were highlighted as at least two 'red lights' and only 1.4% were erroneously highlighted as three 'green lights'. The aide is an example of a rapidly developed evidence based tool and, particularly if updated with data from other centres, could be widely employed in low-resource healthcare settings. (Figure Presented).