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Sikora A, Keats K, Murphy DJ, Devlin JW, Smith SE, Murray B, Buckley MS, Rowe S, Coppiano L, Kamaleswaran R. A common data model for the standardization of intensive care unit medication features. JAMIA Open 2024; 7:ooae033. [PMID: 38699649 PMCID: PMC11064096 DOI: 10.1093/jamiaopen/ooae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Common data models provide a standard means of describing data for artificial intelligence (AI) applications, but this process has never been undertaken for medications used in the intensive care unit (ICU). We sought to develop a common data model (CDM) for ICU medications to standardize the medication features needed to support future ICU AI efforts. Materials and Methods A 9-member, multi-professional team of ICU clinicians and AI experts conducted a 5-round modified Delphi process employing conference calls, web-based communication, and electronic surveys to define the most important medication features for AI efforts. Candidate ICU medication features were generated through group discussion and then independently scored by each team member based on relevance to ICU clinical decision-making and feasibility for collection and coding. A key consideration was to ensure the final ontology both distinguished unique medications and met Findable, Accessible, Interoperable, and Reusable (FAIR) guiding principles. Results Using a list of 889 ICU medications, the team initially generated 106 different medication features, and 71 were ranked as being core features for the CDM. Through this process, 106 medication features were assigned to 2 key feature domains: drug product-related (n = 43) and clinical practice-related (n = 63). Each feature included a standardized definition and suggested response values housed in the electronic data library. This CDM for ICU medications is available online. Conclusion The CDM for ICU medications represents an important first step for the research community focused on exploring how AI can improve patient outcomes and will require ongoing engagement and refinement.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA 30912, United States
| | - Kelli Keats
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA 30912, United States
| | - David J Murphy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA 30322, United States
| | - John W Devlin
- Northeastern University School of Pharmacy, Boston, MA 02115, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA 30601, United States
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC 27514, United States
| | - Mitchell S Buckley
- Department of Pharmacy, Banner University Medical Center Phoenix, Phoenix, AZ 85032, United States
| | - Sandra Rowe
- Department of Pharmacy, Oregon Health and Science University, Portland, OR 97239, United States
| | - Lindsey Coppiano
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA 30322, United States
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30322, United States
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA 30322, United States
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30322, United States
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O'Brien H, Franciosi AN, Murphy DJ, Shand JA, McCarthy C. An 85-Year-Old Woman with Unexplained Hypoxia. Ann Am Thorac Soc 2024; 21:658-662. [PMID: 38557418 DOI: 10.1513/annalsats.202306-578cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Alessandro N Franciosi
- Department of Respiratory Medicine
- School of Medicine, University College Dublin, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, and
- School of Medicine, University College Dublin, Dublin, Ireland
| | - James A Shand
- Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland; and
| | - Cormac McCarthy
- Department of Respiratory Medicine
- School of Medicine, University College Dublin, Dublin, Ireland
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Keats K, Deng S, Chen X, Zhang T, Devlin JW, Murphy DJ, Smith SE, Murray B, Kamaleswaran R, Sikora A. Unsupervised machine learning analysis to identify patterns of ICU medication use for fluid overload prediction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.21.24304663. [PMID: 38562806 PMCID: PMC10984037 DOI: 10.1101/2024.03.21.24304663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Intravenous (IV) medications are a fundamental cause of fluid overload (FO) in the intensive care unit (ICU); however, the association between IV medication use (including volume), administration timing, and FO occurrence remains unclear. METHODS This retrospective cohort study included consecutive adults admitted to an ICU ≥72 hours with available fluid balance data. FO was defined as a positive fluid balance ≥7% of admission body weight within 72 hours of ICU admission. After reviewing medication administration record (MAR) data in three-hour periods, IV medication exposure was categorized into clusters using principal component analysis (PCA) and Restricted Boltzmann Machine (RBM). Medication regimens of patients with and without FO were compared within clusters to assess for temporal clusters associated with FO using the Wilcoxon rank sum test. Exploratory analyses of the medication cluster most associated with FO for medications frequently appearing and used in the first 24 hours was conducted. RESULTS FO occurred in 127/927 (13.7%) of the patients enrolled. Patients received a median (IQR) of 31 (13-65) discrete IV medication administrations over the 72-hour period. Across all 47,803 IV medication administrations, ten unique IV medication clusters were identified with 121-130 medications in each cluster. Among the ten clusters, cluster 7 had the greatest association with FO; the mean number of cluster 7 medications received was significantly greater in patients in the FO cohort compared to patients who did not experience FO (25.6 vs.10.9. p<0.0001). 51 of the 127 medications in cluster 7 (40.2%) appeared in > 5 separate 3-hour periods during the 72-hour study window. The most common cluster 7 medications included continuous infusions, antibiotics, and sedatives/analgesics. Addition of cluster 7 medications to a prediction model with APACHE II score and receipt of diuretics improved the ability for the model to predict fluid overload (AUROC 5.65, p =0.0004). CONCLUSIONS Using ML approaches, a unique IV medication cluster was strongly associated with FO. Incorporation of this cluster improved the ability to predict development of fluid overload in ICU patients compared with traditional prediction models. This method may be further developed into real-time clinical applications to improve early detection of adverse outcomes.
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Affiliation(s)
- Kelli Keats
- Augusta University Medical Center, Department of Pharmacy, Augusta, GA
| | - Shiyuan Deng
- University of Georgia Franklin College of Arts and Sciences, Department of Statistics, Athens, GA, USA
| | - Xianyan Chen
- University of Georgia Franklin College of Arts and Sciences, Department of Statistics, Athens, GA, USA
| | - Tianyi Zhang
- University of Georgia Franklin College of Arts and Sciences, Department of Statistics, Athens, GA, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, Boston, MA
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA
| | - David J Murphy
- Emory University, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, USA
| | - Susan E Smith
- University of Georgia College of Pharmacy, Department of Clinical and Administrative Pharmacy, Athens, GA, USA
| | - Brian Murray
- University of Colorado Skaggs School of Pharmacy, Aurora, CO, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Andrea Sikora
- 1120 15th Street, HM-118 Augusta, GA 30912
- University of Georgia College of Pharmacy, Department of Clinical and Administrative Pharmacy, Augusta, GA, USA
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Weaver BW, Murphy DJ. A Combined Assessment Tool of Teamwork, Communication, and Workload in Hospital Procedural Units. Jt Comm J Qual Patient Saf 2024; 50:219-227. [PMID: 38072739 DOI: 10.1016/j.jcjq.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 03/01/2024]
Abstract
Teamwork, communication, and workload issues continue to contribute to patient safety events. The authors developed a diagnostic mixed methods toolkit combining a behavior observation tool, semistructured interview guide, and surveys to proactively identify relevant gaps. Applied across 14 units at three hospitals, this toolkit yielded 344 findings with 156 associated recommendations and took, on average, four days of observation. On a scale from 1 (not at all helpful) to 6 (substantially helpful), leaders indicated that the assessment and its recommendations were very helpful (median 5, interquartile range 5-6, 34 survey respondents, 47.9% individual-level response rate, 85.7% unit-level response rate). Integrating this tool into a broader safety strategy can help inform organizational improvement efforts.
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O'Donnell C, Crilly S, O'Mahony A, O'Riordan B, Traynor M, Gitau R, McDonald K, Ledwidge M, O'Shea D, Murphy DJ, Dodd JD, Ryan S. Continuous Positive Airway Pressure but Not GLP1-mediated Weight Loss Improves Early Cardiovascular Disease in Obstructive Sleep Apnea: A Randomized Proof-of-Concept Study. Ann Am Thorac Soc 2024; 21:464-473. [PMID: 38096106 DOI: 10.1513/annalsats.202309-821oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Rationale: Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular (CV) morbidity and mortality, but the benefit of continuous positive airway pressure (CPAP) is uncertain. However, most randomized controlled trials have focused on the role of CPAP in secondary prevention, although there is growing evidence of a potential benefit on early CV disease. Weight loss in combination with CPAP may be superior but is difficult to achieve and maintain with conventional measures alone. Objectives: The aim of this study was to gain insights into the effect of CPAP on early atherosclerotic processes and to compare it with a glucagon-like peptide (GLP)-1-mediated weight loss regimen in patients with OSA. Methods: We performed a randomized proof-of-concept study comparing CPAP, a GLP1-mediated weight-loss regimen (liraglutide [Lir]), and both in combination for 24 weeks in 30 consecutive patients with OSA (apnea-hypopnea index >15 events/h; body mass index 30-40 kg/m2; and no history of diabetes, heart failure, or unstable CV disease). In addition to extensive evaluation for CV risk factors and endothelial function at baseline and end of study, subjects underwent 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET-CT) for the measurement of aortic wall inflammation (target-to-background ratio) and coronary computed tomography angiography for semiautomated coronary plaque analysis. Results: Baseline characteristics were similar between groups. CPAP alone and in combination resulted in greater reduction in apnea-hypopnea index than Lir alone (mean difference, -45 and -43 events/h, respectively, vs. -12 events/h; P < 0.05). Both Lir and combination treatment led to significant weight loss, but only CPAP alone resulted in significant decrease in vascular inflammation (aortic wall target-to-background ratio from 2.03 ± 0.34 to 1.84 ± 0.43; P = 0.010), associated with an improvement in endothelial function and a decrease in C-reactive protein. Low-attenuation coronary artery plaque volume as a marker of unstable plaque also decreased with CPAP (from 571 ± 490 to 334 ± 185 mm3) and with combination therapy (from 401 ± 145 to 278 ± 126 mm3) but not with Lir. Conclusions: These data suggest that CPAP therapy, but not GLP1-mediated weight loss, improves vascular inflammation and reduces unstable plaque volume in patients with OSA. Further large randomized controlled studies are warranted to assess the benefit of CPAP therapy in modifying early CV disease. Clinical trial registered with www.clinicaltrials.gov (NCT04186494).
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Affiliation(s)
- Cliona O'Donnell
- Pulmonary and Sleep Disorders Unit
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Rachael Gitau
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Kenneth McDonald
- Department of Cardiology, and
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Mark Ledwidge
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Donal O'Shea
- Department of Endocrinology, St. Vincent's University Hospital, Dublin, Ireland; and
- School of Medicine, University College Dublin, Dublin, Ireland
| | - David J Murphy
- Department of Radiology
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Pulmonary and Sleep Disorders Unit
- School of Medicine, University College Dublin, Dublin, Ireland
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Murphy DJ, Donnelly R. The Ground Truth Is Out There: Improved Coronary Artery Luminal Stenosis Evaluation with Photon-counting Detector CT. Radiology 2023; 309:e233066. [PMID: 38051189 DOI: 10.1148/radiol.233066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- David J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland; and University College Dublin School of Medicine, Dublin, Ireland
| | - Ryan Donnelly
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland; and University College Dublin School of Medicine, Dublin, Ireland
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7
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O'Brien H, Franciosi AN, Murphy DJ, McCarthy C. Bronchopleurocutaneous Fistula. Am J Respir Crit Care Med 2023; 208:1126-1128. [PMID: 37487112 DOI: 10.1164/rccm.202303-0390im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/24/2023] [Indexed: 07/26/2023] Open
Affiliation(s)
| | - Alessandro N Franciosi
- Department of Respiratory Medicine and
- School of Medicine, University College Dublin, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; and
| | - Cormac McCarthy
- Department of Respiratory Medicine and
- School of Medicine, University College Dublin, Dublin, Ireland
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8
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Sikora A, Zhang T, Murphy DJ, Smith SE, Murray B, Kamaleswaran R, Chen X, Buckley MS, Rowe S, Devlin JW. Machine learning vs. traditional regression analysis for fluid overload prediction in the ICU. Sci Rep 2023; 13:19654. [PMID: 37949982 PMCID: PMC10638304 DOI: 10.1038/s41598-023-46735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based modeling approaches to identify clinically meaningful fluid overload predictors. This was a retrospective, observational cohort study of adult patients admitted to an ICU ≥ 72 h between 10/1/2015 and 10/31/2020 with available fluid balance data. Models to predict fluid overload (a positive fluid balance ≥ 10% of the admission body weight) in the 48-72 h after ICU admission were created. Potential patient and medication fluid overload predictor variables (n = 28) were collected at either baseline or 24 h after ICU admission. The optimal traditional logistic regression model was created using backward selection. Supervised, classification-based ML models were trained and optimized, including a meta-modeling approach. Area under the receiver operating characteristic (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were compared between the traditional and ML fluid prediction models. A total of 49 of the 391 (12.5%) patients developed fluid overload. Among the ML models, the XGBoost model had the highest performance (AUROC 0.78, PPV 0.27, NPV 0.94) for fluid overload prediction. The XGBoost model performed similarly to the final traditional logistic regression model (AUROC 0.70; PPV 0.20, NPV 0.94). Feature importance analysis revealed severity of illness scores and medication-related data were the most important predictors of fluid overload. In the context of our study, ML and traditional models appear to perform similarly to predict fluid overload in the ICU. Baseline severity of illness and ICU medication regimen complexity are important predictors of fluid overload.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1120 15th Street, HM-118, Augusta, GA, 30912, USA
| | - Tianyi Zhang
- Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA
| | - David J Murphy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1120 15th Street, HM-118, Augusta, GA, 30912, USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Xianyan Chen
- Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA
| | | | - Sandra Rowe
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - John W Devlin
- Northeastern University School of Pharmacy, Boston, MA, USA.
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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9
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O'Callaghan M, Duignan J, Tarling EJ, Waters DK, McStay M, O'Carroll O, Bridges JP, Redente EF, Franciosi AN, McGrath EE, Butler MW, Dodd JD, Fabre A, Murphy DJ, Keane MP, McCarthy C. Analysis of tissue lipidomics and computed tomography pulmonary fat attenuation volume (CT PFAV ) in idiopathic pulmonary fibrosis. Respirology 2023; 28:1043-1052. [PMID: 37642207 DOI: 10.1111/resp.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE There is increasing interest in the role of lipids in processes that modulate lung fibrosis with evidence of lipid deposition in idiopathic pulmonary fibrosis (IPF) histological specimens. The aim of this study was to identify measurable markers of pulmonary lipid that may have utility as IPF biomarkers. STUDY DESIGN AND METHODS IPF and control lung biopsy specimens were analysed using a unbiased lipidomic approach. Pulmonary fat attenuation volume (PFAV) was assessed on chest CT images (CTPFAV ) with 3D semi-automated lung density software. Aerated lung was semi-automatically segmented and CTPFAV calculated using a Hounsfield-unit (-40 to -200HU) threshold range expressed as a percentage of total lung volume. CTPFAV was compared to pulmonary function, serum lipids and qualitative CT fibrosis scores. RESULTS There was a significant increase in total lipid content on histological analysis of IPF lung tissue (23.16 nmol/mg) compared to controls (18.66 mol/mg, p = 0.0317). The median CTPFAV in IPF was higher than controls (1.34% vs. 0.72%, p < 0.001) and CTPFAV correlated significantly with DLCO% predicted (R2 = 0.356, p < 0.0001) and FVC% predicted (R2 = 0.407, p < 0.0001) in patients with IPF. CTPFAV correlated with CT features of fibrosis; higher CTPFAV was associated with >10% reticulation (1.6% vs. 0.94%, p = 0.0017) and >10% honeycombing (1.87% vs. 1.12%, p = 0.0003). CTPFAV showed no correlation with serum lipids. CONCLUSION CTPFAV is an easily quantifiable non-invasive measure of pulmonary lipids. In this pilot study, CTPFAV correlates with pulmonary function and radiological features of IPF and could function as a potential biomarker for IPF disease severity assessment.
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Affiliation(s)
- Marissa O'Callaghan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Elizabeth J Tarling
- Division of Cardiology, University of California, Los Angeles, California, USA
| | - Darragh K Waters
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Megan McStay
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Orla O'Carroll
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - James P Bridges
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | | | - Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Emmet E McGrath
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Murphy DJ, Mayoral M, Larici AR, Ginsberg MS, Cicchetti G, Fintelmann FJ, Marom EM, Truong MT, Gill RR. Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:409-424. [PMID: 37095669 PMCID: PMC11037936 DOI: 10.2214/ajr.23.29104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer continues to be the most common cause of cancer-related death worldwide. In the past decade, with the implementation of lung cancer screening programs and advances in surgical and nonsurgical therapies, the survival of patients with lung cancer has increased, as has the number of imaging studies that these patients undergo. However, most patients with lung cancer do not undergo surgical re-section, because they have comorbid disease or lung cancer in an advanced stage at diagnosis. Nonsurgical therapies have continued to evolve with a growing range of systemic and targeted therapies, and there has been an associated evolution in the imaging findings encountered at follow-up examinations after such therapies (e.g., with respect to posttreatment changes, treatment complications, and recurrent tumor). This AJR Expert Panel Narrative Review describes the current status of nonsurgical therapies for lung cancer and their expected and unexpected imaging manifestations. The goal is to provide guidance to radiologists regarding imaging assessment after such therapies, focusing mainly on non-small cell lung cancer. Covered therapies include systemic therapy (conventional chemotherapy, targeted therapy, and immunotherapy), radiotherapy, and thermal ablation.
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Affiliation(s)
- David J. Murphy
- Department of Radiology, St Vincent’s University Hospital and University College Dublin, Dublin, Ireland
| | - Maria Mayoral
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Medical Imaging Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Anna R. Larici
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giuseppe Cicchetti
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Florian J. Fintelmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Edith M. Marom
- Chaim Sheba Medical Center, Ramat Gan, and Tel Aviv University, Tel Aviv, Israel
| | - Mylene T. Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ritu R. Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115. Address correspondence to R. R. Gill ()
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Murphy DJ, Tee SR. Expectation Meets Reality: AI-powered CT Pulmonary Angiogram Triage in the Real World. Radiology 2023; 309:e232389. [PMID: 37787668 DOI: 10.1148/radiol.232389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- David J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland (D.J.M.); and University College School of Medicine, Dublin, Ireland (S.R.T.)
| | - Syer Ree Tee
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland (D.J.M.); and University College School of Medicine, Dublin, Ireland (S.R.T.)
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12
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Sikora A, Devlin JW, Yu M, Zhang T, Chen X, Smith SE, Murray B, Buckley MS, Rowe S, Murphy DJ. Evaluation of medication regimen complexity as a predictor for mortality. Sci Rep 2023; 13:10784. [PMID: 37402869 DOI: 10.1038/s41598-023-37908-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
While medication regimen complexity, as measured by a novel medication regimen complexity-intensive care unit (MRC-ICU) score, correlates with baseline severity of illness and mortality, whether the MRC-ICU improves hospital mortality prediction is not known. After characterizing the association between MRC-ICU, severity of illness and hospital mortality we sought to evaluate the incremental benefit of adding MRC-ICU to illness severity-based hospital mortality prediction models. This was a single-center, observational cohort study of adult intensive care units (ICUs). A random sample of 991 adults admitted ≥ 24 h to the ICU from 10/2015 to 10/2020 were included. The logistic regression models for the primary outcome of mortality were assessed via area under the receiver operating characteristic (AUROC). Medication regimen complexity was evaluated daily using the MRC-ICU. This previously validated index is a weighted summation of medications prescribed in the first 24 h of ICU stay [e.g., a patient prescribed insulin (1 point) and vancomycin (3 points) has a MRC-ICU = 4 points]. Baseline demographic features (e.g., age, sex, ICU type) were collected and severity of illness (based on worst values within the first 24 h of ICU admission) was characterized using both the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Sequential Organ Failure Assessment (SOFA) score. Univariate analysis of 991 patients revealed every one-point increase in the average 24-h MRC-ICU score was associated with a 5% increase in hospital mortality [Odds Ratio (OR) 1.05, 95% confidence interval 1.02-1.08, p = 0.002]. The model including MRC-ICU, APACHE II and SOFA had a AUROC for mortality of 0.81 whereas the model including only APACHE-II and SOFA had a AUROC for mortality of 0.76. Medication regimen complexity is associated with increased hospital mortality. A prediction model including medication regimen complexity only modestly improves hospital mortality prediction.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1120 15th Street, HM-118, Augusta, GA, 30912, USA.
| | - John W Devlin
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mengyun Yu
- Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA
| | - Tianyi Zhang
- Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA
| | - Xianyan Chen
- Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1120 15th Street, HM-118, Augusta, GA, 30912, USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | - Sandra Rowe
- Oregon Health and Science University, Portland, OR, USA
| | - David J Murphy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
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13
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Sikora A, Rafiei A, Rad MG, Keats K, Smith SE, Devlin JW, Murphy DJ, Murray B, Kamaleswaran R. Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the ICURx common data model. Crit Care 2023; 27:167. [PMID: 37131200 PMCID: PMC10155304 DOI: 10.1186/s13054-023-04437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Identifying patterns within ICU medication regimens may help artificial intelligence algorithms to better predict patient outcomes; however, machine learning methods incorporating medications require further development, including standardized terminology. The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may provide important infrastructure to clinicians and researchers to support artificial intelligence analysis of medication-related outcomes and healthcare costs. Using an unsupervised cluster analysis approach in combination with this common data model, the objective of this evaluation was to identify novel patterns of medication clusters (termed 'pharmacophenotypes') correlated with ICU adverse events (e.g., fluid overload) and patient-centered outcomes (e.g., mortality). METHODS This was a retrospective, observational cohort study of 991 critically ill adults. To identify pharmacophenotypes, unsupervised machine learning analysis with automated feature learning using restricted Boltzmann machine and hierarchical clustering was performed on the medication administration records of each patient during the first 24 h of their ICU stay. Hierarchical agglomerative clustering was applied to identify unique patient clusters. Distributions of medications across pharmacophenotypes were described, and differences among patient clusters were compared using signed rank tests and Fisher's exact tests, as appropriate. RESULTS A total of 30,550 medication orders for the 991 patients were analyzed; five unique patient clusters and six unique pharmacophenotypes were identified. For patient outcomes, compared to patients in Clusters 1 and 3, patients in Cluster 5 had a significantly shorter duration of mechanical ventilation and ICU length of stay (p < 0.05); for medications, Cluster 5 had a higher distribution of Pharmacophenotype 1 and a smaller distribution of Pharmacophenotype 2, compared to Clusters 1 and 3. For outcomes, patients in Cluster 2, despite having the highest severity of illness and greatest medication regimen complexity, had the lowest overall mortality; for medications, Cluster 2 also had a comparably higher distribution of Pharmacophenotype 6. CONCLUSION The results of this evaluation suggest that patterns among patient clusters and medication regimens may be observed using empiric methods of unsupervised machine learning in combination with a common data model. These results have potential because while phenotyping approaches have been used to classify heterogenous syndromes in critical illness to better define treatment response, the entire medication administration record has not been incorporated in those analyses. Applying knowledge of these patterns at the bedside requires further algorithm development and clinical application but may have the future potential to be leveraged in guiding medication-related decision making to improve treatment outcomes.
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Affiliation(s)
- Andrea Sikora
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA USA
| | - Alireza Rafiei
- Department of Computer Science and Informatics, Emory University, Atlanta, GA USA
| | - Milad Ghiasi Rad
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Kelli Keats
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA USA
| | - Susan E. Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA USA
| | - John W. Devlin
- Northeastern University School of Pharmacy, Boston, MA USA
- Brigham and Women’s Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA USA
| | - David J. Murphy
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - MRC-ICU Investigator Team
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA USA
- Department of Computer Science and Informatics, Emory University, Atlanta, GA USA
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA USA
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA USA
- Northeastern University School of Pharmacy, Boston, MA USA
- Brigham and Women’s Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA USA
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA
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14
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Ledwidge M, Dodd JD, Ryan F, Sweeney C, McDonald K, Fox R, Shorten E, Zhou S, Watson C, Gallagher J, McVeigh N, Murphy DJ, McDonald K. Effect of Sacubitril/Valsartan vs Valsartan on Left Atrial Volume in Patients With Pre-Heart Failure With Preserved Ejection Fraction: The PARABLE Randomized Clinical Trial. JAMA Cardiol 2023; 8:366-375. [PMID: 36884247 PMCID: PMC9996460 DOI: 10.1001/jamacardio.2023.0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Importance Pre-heart failure with preserved ejection fraction (pre-HFpEF) is common and has no specific therapy aside from cardiovascular risk factor management. Objective To investigate the hypothesis that sacubitril/valsartan vs valsartan would reduce left atrial volume index using volumetric cardiac magnetic resonance imaging in patients with pre-HFpEF. Design, Setting, and Participants The Personalized Prospective Comparison of ARNI [angiotensin receptor/neprilysin inhibitor] With ARB [angiotensin-receptor blocker] in Patients With Natriuretic Peptide Elevation (PARABLE) trial was a prospective, double-blind, double-dummy, randomized clinical trial carried out over 18 months between April 2015 and June 2021. The study was conducted at a single outpatient cardiology center in Dublin, Ireland. Of 1460 patients in the STOP-HF program or outpatient cardiology clinics, 461 met initial criteria and were approached for inclusion. Of these, 323 were screened and 250 asymptomatic patients 40 years and older with hypertension or diabetes, elevated B-type natriuretic peptide (BNP) greater than 20 pg/mL or N-terminal pro-b type natriuretic peptide greater than 100 pg/mL, left atrial volume index greater than 28 mL/m2, and preserved ejection fraction greater than 50% were included. Interventions Patients were randomized to angiotensin receptor neprilysin inhibitor sacubitril/valsartan titrated to 200 mg twice daily or matching angiotensin receptor blocker valsartan titrated to 160 mg twice daily. Main Outcomes and Measures Maximal left atrial volume index and left ventricular end diastolic volume index, ambulatory pulse pressure, N-terminal pro-BNP, and adverse cardiovascular events. Results Among the 250 participants in this study, the median (IQR) age was 72.0 (68.0-77.0) years; 154 participants (61.6%) were men and 96 (38.4%) were women. Most (n = 245 [98.0%]) had hypertension and 60 (24.0%) had type 2 diabetes. Maximal left atrial volume index was increased in patients assigned to receive sacubitril/valsartan (6.9 mL/m2; 95% CI, 0.0 to 13.7) vs valsartan (0.7 mL/m2; 95% CI, -6.3 to 7.7; P < .001) despite reduced markers of filling pressure in both groups. Changes in pulse pressure and N-terminal pro-BNP were lower in the sacubitril/valsartan group (-4.2 mm Hg; 95% CI, -7.2 to -1.21 and -17.7%; 95% CI, -36.9 to 7.4, respectively; P < .001) than the valsartan group (-1.2 mm Hg; 95% CI, -4.1 to 1.7 and 9.4%; 95% CI, -15.6 to 4.9, respectively; P < .001). Major adverse cardiovascular events occurred in 6 patients (4.9%) assigned to sacubitril/valsartan and 17 (13.3%) assigned to receive valsartan (adjusted hazard ratio, 0.38; 95% CI, 0.17 to 0.89; adjusted P = .04). Conclusions and Relevance In this trial of patients with pre-HFpEF, sacubitril/valsartan treatment was associated with a greater increase in left atrial volume index and improved markers of cardiovascular risk compared to valsartan. More work is needed to understand the observed increased cardiac volumes and long-term effects of sacubitril/valsartan in patients with pre-HFpEF. Trial Registration ClinicalTrials.gov Identifier: NCT04687111.
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Affiliation(s)
- Mark Ledwidge
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Fiona Ryan
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Claire Sweeney
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Katherine McDonald
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Rebecca Fox
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Elizabeth Shorten
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Shuaiwei Zhou
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland
| | - Chris Watson
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, Northern Ireland
| | | | - Niall McVeigh
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Kenneth McDonald
- St Vincent's Screening to Prevent Heart Failure (STOP-HF) Unit, St Vincent's University Healthcare Group, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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15
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Duignan JA, Ryan DT, O'Riordan B, O'Brien A, Healy GM, O'Brien C, Butler M, Keane MP, McCarthy C, Murphy DJ, Dodd JD. Combined autologous blood patch-immediate patient rollover does not reduce the pneumothorax or chest drain rate following CT-guided lung biopsy compared to immediate patient rollover alone. Eur J Radiol 2023; 160:110691. [PMID: 36640713 DOI: 10.1016/j.ejrad.2023.110691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
PUPROSE The purpose of this study was to evaluate a combined autologous blood-patch (ABP)-immediate patient rollover (IPR) technique compared with the IPR technique alone on the incidence of pneumothorax and chest drainage following CT-guided lung biopsy. METHODS In this interventional cohort study of both prospectively and retrospectively acquired data, 652 patients underwent CT-guided lung biopsy. Patient demographics, lesion characteristics and technical biopsy variables including the combined ABP-IPR versus IPR alone were evaluated as predictors of pneumothorax and chest drain rates using regression analysis. RESULTS The combined ABP-IPR technique was performed in 259 (39.7 %) patients whilst 393 (60.3 %) underwent IPR alone. There was no significant difference in pneumothorax rate or chest drains required between the combined ABP-IPR vs IPR groups (p =.08, p =.60 respectively). Predictors of pneumothorax adjusted for the combined ABP-IPR and IPR alone groups included age (p =.02), lesion size (p =.01), location (p =.005), patient position (p =.008), emphysema along the needle track (p =.005) and lesion distance from the pleura (p =.02). Adjusted predictors of chest drain insertion included lesion location (p =.09), patient position (p =.002), bullae crossed (p =.02) and lesion distance from the pleura (p =.02). CONCLUSION The combined ABP-IPR technique does not reduce the pneumothorax or chest drain rate compared to the IPR technique alone. Utilising IPR without an ABP following CT-guided lung biopsy results in similar pneumothorax and chest drain rates while minimising the potential risk of systemic air embolism.
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Affiliation(s)
- John A Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
| | - David T Ryan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Brian O'Riordan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Amy O'Brien
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac O'Brien
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland.
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16
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O’Brien C, Duignan JA, Gleeson M, O’Carroll O, Franciosi AN, O’Toole D, Fabre A, Crowley RK, McCarthy C, Dodd JD, Murphy DJ. Quantitative Airway Assessment of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) on CT as a Novel Biomarker. Diagnostics (Basel) 2022; 12:diagnostics12123096. [PMID: 36553103 PMCID: PMC9776594 DOI: 10.3390/diagnostics12123096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) occurs due to abnormal proliferation of pulmonary neuroendocrine cells. We hypothesized that performing a quantitative analysis of airway features on chest CT may reveal differences to matched controls, which could ultimately help provide an imaging biomarker. Methods: A retrospective quantitative analysis of chest CTs in patients with DIPNECH and age matched controls was carried out using semi-automated post-processing software. Paired segmental airway and artery diameters were measured for each bronchopulmonary segment, and the airway:artery (AA) ratio, airway wall thickness:artery ratio (AWTA ratio) and wall area percentage (WAP) calculated. Nodule number, size, shape and location was recorded. Correlation between CT measurements and pulmonary function testing was performed. Results: 16 DIPNECH and 16 control subjects were analysed (all female, mean age 61.7 +/− 11.8 years), a combined total of 425 bronchopulmonary segments. The mean AwtA ratio, AA ratio and WAP for the DIPNECH group was 0.57, 1.18 and 68.8%, respectively, compared with 0.38, 1.03 and 58.3% in controls (p < 0.001, <0.001, 0.03, respectively). DIPNECH patients had more nodules than controls (22.4 +/− 32.6 vs. 3.6 +/− 3.6, p = 0.03). AA ratio correlated with FVC (R2 = 0.47, p = 0.02). A multivariable model incorporating nodule number, AA ratio and AWTA-ratio demonstrated good performance for discriminating DIPNECH and controls (AUC 0.971; 95% CI: 0.925−1.0). Conclusions: Quantitative CT airway analysis in patients with DIPNECH demonstrates increased airway wall thickness and airway:artery ratio compared to controls. Advances in knowledge: Quantitative CT measurement of airway wall thickening offers a potential imaging biomarker for treatment response.
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Affiliation(s)
- Cormac O’Brien
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - John A. Duignan
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Margaret Gleeson
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Orla O’Carroll
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Alessandro N. Franciosi
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Dermot O’Toole
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Aurelie Fabre
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- Department of Pathology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Rachel K. Crowley
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Department of Endocrinology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Jonathan D. Dodd
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - David J. Murphy
- Department of Radiology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- National Centre for Neuroendocrine Tumours, ENETS NET Centre of Excellence, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Correspondence: ; Tel.: +353-1-221400
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17
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Boyle N, O'Callaghan M, Ataya A, Gupta N, Keane MP, Murphy DJ, McCarthy C. Pulmonary renal syndrome: a clinical review. Breathe (Sheff) 2022; 18:220208. [PMID: 36865943 PMCID: PMC9973488 DOI: 10.1183/20734735.0208-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023] Open
Abstract
The term "pulmonary renal syndrome" describes a clinical syndrome which is characterised by the presence of both diffuse alveolar haemorrhage and glomerulonephritis. It encompasses a group of diseases with distinctive clinical and radiological manifestations, as well as different pathophysiological processes. The most common diseases implicated are anti-neutrophil cytoplasm antibodies (ANCA)-positive small vessel vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Prompt recognition is required as respiratory failure and end-stage renal failure can rapidly occur. Treatment includes a combination of glucocorticoids, immunosuppression, plasmapheresis and supportive measures. The use of targeted treatments has significantly reduced mortality. Thus, an understanding of pulmonary renal syndrome is essential for the respiratory physician.
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Affiliation(s)
- Niamh Boyle
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Marissa O'Callaghan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Michael P. Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - David J. Murphy
- School of Medicine, University College Dublin, Dublin, Ireland,Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland,Corresponding author: Cormac McCarthy ()
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18
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Tzimas G, Ryan DT, Murphy DJ, Leipsic JA, Dodd JD. Cardiovascular CT, MRI, and PET/CT in 2021: Review of Key Articles. Radiology 2022; 305:538-554. [DOI: 10.1148/radiol.221181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Georgios Tzimas
- From the Department of Radiology, University of British Columbia, St. Paul’s Hospital Radiology, Vancouver, Canada (G.T., J.A.L.); Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin D4, Ireland (D.T.R., D.J.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (D.J.M., J.D.D.)
| | - David T. Ryan
- From the Department of Radiology, University of British Columbia, St. Paul’s Hospital Radiology, Vancouver, Canada (G.T., J.A.L.); Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin D4, Ireland (D.T.R., D.J.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (D.J.M., J.D.D.)
| | - David J. Murphy
- From the Department of Radiology, University of British Columbia, St. Paul’s Hospital Radiology, Vancouver, Canada (G.T., J.A.L.); Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin D4, Ireland (D.T.R., D.J.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (D.J.M., J.D.D.)
| | - Jonathon A. Leipsic
- From the Department of Radiology, University of British Columbia, St. Paul’s Hospital Radiology, Vancouver, Canada (G.T., J.A.L.); Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin D4, Ireland (D.T.R., D.J.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (D.J.M., J.D.D.)
| | - Jonathan D. Dodd
- From the Department of Radiology, University of British Columbia, St. Paul’s Hospital Radiology, Vancouver, Canada (G.T., J.A.L.); Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin D4, Ireland (D.T.R., D.J.M., J.D.D.); and School of Medicine, University College Dublin, Dublin, Ireland (D.J.M., J.D.D.)
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19
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Murphy DJ, Shahabuddin Y, Yambasu S, O'Donoghue K, Devane D, Cotter A, Gaffney G, Burke LA, Molloy EJ, Boland F. Digital fetal scalp stimulation (dFSS) versus fetal blood sampling (FBS) to assess fetal wellbeing in labour-a multi-centre randomised controlled trial: Fetal Intrapartum Randomised Scalp Stimulation Trial (FIRSST NCT05306756). Trials 2022; 23:848. [PMID: 36195894 PMCID: PMC9531493 DOI: 10.1186/s13063-022-06794-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery. METHODS A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group. DISCUSSION If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections. TRIAL REGISTRATION ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.
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Affiliation(s)
- D J Murphy
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland.
| | - Y Shahabuddin
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland
| | - S Yambasu
- Academic Department of Obstetrics and Gynaecology, Coombe Women & Infants University Hospital & Trinity College, University of Dublin, Dublin, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics & Gynecology, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - D Devane
- University of Galway, School of Nursing and Midwifery, HRB-Trials Methodology Research Network, Evidence Synthesis Ireland and Cochrane Ireland, Galway, Ireland
| | - A Cotter
- Department of Obstetrics and Gynecology, University of Limerick, Limerick, Ireland
| | - G Gaffney
- Department of Obstetrics and Gynaecology, University of Galway, Galway, Ireland
| | - L A Burke
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - E J Molloy
- Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
| | - F Boland
- Data Science Centre and the Department of General Practice, RCSI, Dublin, Ireland
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20
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Murphy DJ, Lane-Fall MB. Leveraging Robust Mixed Methodologies to Advance Implementation Research and Practice. Crit Care Med 2022; 50:1159-1161. [PMID: 35726982 DOI: 10.1097/ccm.0000000000005551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David J Murphy
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine; Department of Medicine; Emory University, Atlanta, GA
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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21
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Almeamar H, Cullen L, Murphy DJ, Crowley RK, Toumpanakis C, Welin S, O'Shea D, O'Toole D. Real-world efficacy of lutetium peptide receptor radionuclide therapy in patients with neuroendocrine tumours. J Neuroendocrinol 2022; 34:e13138. [PMID: 35485450 DOI: 10.1111/jne.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
Lutetium peptide receptor radio nuclide therapy (Lu-PRRT) is an effective treatment for progressive, metastatic, somatostatin-receptor-positive, well-differentiated neuroendocrine tumours (WD-NETs). Here, we report a single centre experience of real-world efficacy, long-term side effects, and challenges of this treatment. This was a retrospective analysis. All patients linked with our centre who had Lu-PRRT were included. Clinicopathological data were analysed using descriptive statistics, Kaplan-Meier, and Cox regression. A total of 45 patients had Lu-PRRT, of those 30 (67%) were males, and 13 (29%) were more than 65 years old. The primary site was small intestine in 30 (67%) patients, pancreas in seven (16%) patients, and lung in three (7%) patients. The tumor was grade 1 in 15 (35%) patients, grade 2 in 22 (48%) patients, and grade 3 in six (13%) patients. A total of 41 (91%) patients had liver metastasis, and 20 (44%) patients had carcinoid syndrome. Lu-PRRT was the second-line therapy in all patients. Krenning's score was 4 in 36 (80%) patients and 3 in nine (20%) patients. The median waiting time to start Lu-PRRT therapy was 87 days. The median follow-up was 41 months. A total of 23 (51%) patients had a partial response, 18 (40%) patients had stable disease, and four (9%) patients had progression. None of the patients had a complete response. The median progression-free survival (PFS) was 38 months (95% CI: 25.8-50.1). The median overall survival (OS) was not reached. Nine patients died during follow-up (death from any cause). Prior treatment with targeted therapies or high dose somatostatin analogues were negative predictors of Lu-PRRT outcome (p-values of < .001 and < .045, respectively). There were two serious haematological toxicities, one patient developed acute myeloid leukaemia (AML), and the other developed chronic myeloid leukaemia (CML). Lu-PRRT is an effective second-line treatment for metastatic WD-NETs. The effect of targeted therapies on Lu-PRRT outcome was significant and needs to be clarified in further studies.
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Affiliation(s)
- Hussein Almeamar
- National Centre for Neuroendocrine Tumours, ENETS Centre of Excellence, St. Vincent's University Hospital, Dublin, Ireland
| | - Lisa Cullen
- National Centre for Neuroendocrine Tumours, ENETS Centre of Excellence, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
- UCD School of Medicine, Dublin, Ireland
| | - Rachel K Crowley
- National Centre for Neuroendocrine Tumours, ENETS Centre of Excellence, St. Vincent's University Hospital, Dublin, Ireland
- UCD School of Medicine, Dublin, Ireland
| | | | - Staffan Welin
- Department of Endocrine Oncology, ENETS Centre of Excellence, Uppsala University Hospital, Uppsala, Sweden
| | - Donal O'Shea
- National Centre for Neuroendocrine Tumours, ENETS Centre of Excellence, St. Vincent's University Hospital, Dublin, Ireland
- UCD School of Medicine, Dublin, Ireland
| | - Dermot O'Toole
- National Centre for Neuroendocrine Tumours, ENETS Centre of Excellence, St. Vincent's University Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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22
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Melgar M, Haston J, DeCuir J, Cheng Q, Arnold KE, Meng L, Murphy DJ, Overton E, Hollberg J, Tobin-D’Angelo M, Patel P, Campbell AP, Godfred-Cato S, Belay ED. Multisystem Inflammatory Syndrome in Adults: Case Finding Through Systematic Review of Electronic Medical Records. Clin Infect Dis 2022; 75:1903-1911. [PMID: 35442436 PMCID: PMC9383808 DOI: 10.1093/cid/ciac303] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged during April 2020-January 2021 from 4 Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A coronavirus disease 2019 (COVID-19) hospitalizations were identified using International Classification of Diseases, Tenth Revision, Clinical Modification encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the 2 cohorts, and described clinical characteristics of MIS-A patients. RESULTS We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5755 COVID-19 hospitalizations (ratio 1:523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs 26.1%, P < .01) and to be non-Hispanic Black (81.8% vs 50.0%, P = .04). Ten patients with MIS-A (90.9%) had at least 1 underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, 8 (72.7%) required mechanical ventilation, 2 (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice. CONCLUSIONS MIS-A is a severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk.
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Affiliation(s)
- Michael Melgar
- Correspondence: M. Melgar, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA ()
| | - Julia Haston
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer DeCuir
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Qi Cheng
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Arnold
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lu Meng
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David J Murphy
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA,Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA
| | | | - Julie Hollberg
- Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA,Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Melissa Tobin-D’Angelo
- Acute Disease Epidemiology Section, Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Pragna Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela P Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ermias D Belay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Franciosi AN, McCarthy N, Gaffney B, Duignan J, Sweeney E, O'Connell N, Murphy K, Áinle FN, Butler MW, Dodd JD, Keane MP, Murphy DJ, Curran KM, McCarthy C. Extended D-dimer Cut-offs and Machine Learning for Ruling Out Pulmonary Embolism in individuals undergoing CTPA. Eur Respir J 2022; 59:13993003.00075-2022. [PMID: 35236722 DOI: 10.1183/13993003.00075-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Denotes joint first authorship
| | - Nicholas McCarthy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Denotes joint first authorship
| | - Brian Gaffney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - John Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Eamon Sweeney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Niall O'Connell
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Karen Murphy
- Department of Haematology, St Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala Ní Áinle
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Haematology, Mater Misericordiae Hospital, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland .,School of Medicine, University College Dublin, Dublin 4, Ireland
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24
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O'Brien AC, MacDermott R, Keane S, Ryan D, McVeigh N, Durand R, Ferre M, Murphy DJ, Teekakirikul P, Keane D, McDonald K, Ledwidge M, Dodd JD. Cardiac MRI e-prime Predicts Myocardial Late Gadolinium Enhancement and Diastolic Dysfunction in Hypertrophic Cardiomyopathy. Eur J Radiol 2022; 149:110192. [DOI: 10.1016/j.ejrad.2022.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
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25
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Auld SC, Harrington KRV, Adelman MW, Robichaux CJ, Overton EC, Caridi-Scheible M, Coopersmith CM, Murphy DJ. Trends in ICU Mortality From Coronavirus Disease 2019: A Tale of Three Surges. Crit Care Med 2022; 50:245-255. [PMID: 34259667 PMCID: PMC8796834 DOI: 10.1097/ccm.0000000000005185] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the association between time period of hospitalization and hospital mortality among critically ill adults with coronavirus disease 2019. DESIGN Observational cohort study from March 6, 2020, to January 31, 2021. SETTING ICUs at four hospitals within an academic health center network in Atlanta, GA. PATIENTS Adults greater than or equal to 18 years with coronavirus disease 2019 admitted to an ICU during the study period (i.e., Surge 1: March to April, Lull 1: May to June, Surge 2: July to August, Lull 2: September to November, Surge 3: December to January). MEASUREMENTS AND MAIN RESULTS Among 1,686 patients with coronavirus disease 2019 admitted to an ICU during the study period, all-cause hospital mortality was 29.7%. Mortality differed significantly over time: 28.7% in Surge 1, 21.3% in Lull 1, 25.2% in Surge 2, 30.2% in Lull 2, 34.7% in Surge 3 (p = 0.007). Mortality was significantly associated with 1) preexisting risk factors (older age, race, ethnicity, lower body mass index, higher Elixhauser Comorbidity Index, admission from a nursing home); 2) clinical status at ICU admission (higher Sequential Organ Failure Assessment score, higher d-dimer, higher C-reactive protein); and 3) ICU interventions (receipt of mechanical ventilation, vasopressors, renal replacement therapy, inhaled vasodilators). After adjusting for baseline and clinical variables, there was a significantly increased risk of mortality associated with admission during Lull 2 (relative risk, 1.37 [95% CI = 1.03-1.81]) and Surge 3 (relative risk, 1.35 [95% CI = 1.04-1.77]) as compared to Surge 1. CONCLUSIONS Despite increased experience and evidence-based treatments, the risk of death for patients admitted to the ICU with coronavirus disease 2019 was highest during the fall and winter of 2020. Reasons for this increased mortality are not clear.
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Affiliation(s)
- Sara C Auld
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
- Office of Quality and Risk, Emory Healthcare, Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Kristin R V Harrington
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Chad J Robichaux
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
| | | | - Mark Caridi-Scheible
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Craig M Coopersmith
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - David J Murphy
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Office of Quality and Risk, Emory Healthcare, Atlanta, GA
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26
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Saha R, Ryan DT, McVeigh N, Garvey JF, Ryan S, Murphy DJ, Fabre A, McCarthy C, Keane MP, Dodd JD. Unclassifiable interstitial lung disease on HRCT: aggressive progressive disease with macrocystic lung destruction. QJM 2022; 114:812-814. [PMID: 34002222 DOI: 10.1093/qjmed/hcab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Saha
- From the Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D T Ryan
- From the Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - N McVeigh
- From the Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J F Garvey
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Irelandand
| | - D J Murphy
- From the Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Irelandand
| | - A Fabre
- School of Medicine, University College Dublin, Dublin 4, Irelandand
- Department of Histopathology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Irelandand
| | - M P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Irelandand
| | - J D Dodd
- From the Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Irelandand
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27
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Murphy DJ, Ryan DT. The Lung-to-Tumor Interface for the Evaluation of Tumor Hypoxia. Radiology 2021; 302:457-459. [PMID: 34783599 DOI: 10.1148/radiol.2021211926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David T Ryan
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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28
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Gaffney B, Lynn E, Dodd JD, Keane MP, Murphy DJ, McCarthy C. The utility of gallium-68 DOTATOC PET/CT in lymphangioleiomyomatosis. ERJ Open Res 2021; 7:00397-2021. [PMID: 34708113 PMCID: PMC8542959 DOI: 10.1183/23120541.00397-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
Abstract
Somatostatin receptor functional imaging is of limited utility as an imaging biomarker in LAM, but other PET/CT modalities may be of use https://bit.ly/3l6BVZp.
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Affiliation(s)
- Brian Gaffney
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,Dept of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Evelyn Lynn
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Jonathan D Dodd
- Dept of Radiology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - David J Murphy
- Dept of Radiology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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29
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Ross-Driscoll K, Esper G, Kinlaw K, Lee YTH, Morris A, Murphy DJ, Pentz RD, Robichaux C, Vong G, Wack K, Dickert N. Evaluating Approaches to Improve Equity in Critical Care Resource Allocation in the COVID-19 Pandemic. Am J Respir Crit Care Med 2021; 204:1481-1484. [PMID: 34624203 PMCID: PMC8865705 DOI: 10.1164/rccm.202106-1462le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katherine Ross-Driscoll
- Emory University School of Medicine, 12239, Department of Surgery, Atlanta, Georgia, United States
| | - Gregory Esper
- Emory University School of Medicine, 12239, Department of Neurology, Atlanta, Georgia, United States.,Emory Healthcare, 14360, Office of Quality and Risk, Atlanta, Georgia, United States
| | - Kathy Kinlaw
- Emory University, 1371, Center for Ethics, Atlanta, Georgia, United States.,Emory University School of Medicine, 12239, Department of Pediatrics , Atlanta, Georgia, United States
| | - Yi-Ting Hana Lee
- Emory University School of Medicine, 12239, Health Services Research Center, Atlanta, Georgia, United States
| | - Alanna Morris
- Emory University School of Medicine, 12239, Department of Medicine, Atlanta, Georgia, United States
| | - David J Murphy
- Emory University School of Medicine, 12239, Department of Pulmonology, Allergy, and Critical Care, Atlanta, Georgia, United States
| | - Rebecca D Pentz
- Emory University, 1371, Winship Cancer Institute , Atlanta, Georgia, United States
| | - Chad Robichaux
- Emory University School of Medicine, 12239, Department of Biomedical Informatics, Atlanta, Georgia, United States.,Georgia Clinical and Translational Science Alliance, Atlanta, Georgia, United States
| | - Gerard Vong
- Emory University, 1371, Center for Ethics, Atlanta, Georgia, United States.,Emory University School of Medicine, 12239, Department of Medicine, Atlanta, Georgia, United States
| | - Kevin Wack
- Emory Healthcare, 14360, Clinical Ethics, Atlanta, Georgia, United States
| | - Neal Dickert
- Emory University School of Medicine, 12239, Division of Cardiology, Atlanta, Georgia, United States;
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30
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Hayes-Ryan D, Khashan AS, Hemming K, Easter C, Devane D, Murphy DJ, Hunter A, Cotter A, McAuliffe FM, Morrison JJ, Breathnach FM, Dempsey E, Kenny LC, O'Donoghue K. Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland). BMJ 2021; 374:n1857. [PMID: 34389547 PMCID: PMC8361324 DOI: 10.1136/bmj.n1857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing neonatal morbidity. DESIGN Stepped wedge cluster randomised control trial from 29 June 2017 to 26 April 2019. SETTING National multisite trial in seven maternity hospitals throughout the island of Ireland PARTICIPANTS: Women with a singleton pregnancy between 20+0 to 36+6 weeks' gestation, with signs or symptoms suggestive of evolving pre-eclampsia. Of the 5718 women screened, 2583 were eligible and 2313 elected to participate. INTERVENTION Participants were assigned randomly to either usual care or to usual care plus the addition of point-of-care PlGF testing based on the randomisation status of their maternity hospital at the time point of enrolment. MAIN OUTCOMES MEASURES Co-primary outcomes of composite maternal morbidity and composite neonatal morbidity. Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects (with robust standard errors) by intention-to-treat. RESULTS Of the 4000 anticipated recruitment target, 2313 eligible participants (57%) were enrolled, of whom 2219 (96%) were included in the primary analysis. Of these, 1202 (54%) participants were assigned to the usual care group, and 1017 (46%) were assigned the intervention of additional point-of-care PlGF testing. The results demonstrate that the integration of point-of-care PlGF testing resulted in no evidence of a difference in maternal morbidity-457/1202 (38%) of women in the control group versus 330/1017 (32%) of women in the intervention group (adjusted risk ratio (RR) 1.01 (95% CI 0.76 to 1.36), P=0.92)-or in neonatal morbidity-527/1202 (43%) of neonates in the control group versus 484/1017 (47%) in the intervention group (adjusted RR 1.03 (0.89 to 1.21), P=0.67). CONCLUSIONS This was a pragmatic evaluation of an interventional diagnostic test, conducted nationally across multiple sites. These results do not support the incorporation of PlGF testing into routine clinical investigations for women presenting with suspected preterm pre-eclampsia, but nor do they exclude its potential benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT02881073.
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Affiliation(s)
- D Hayes-Ryan
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - A S Khashan
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - K Hemming
- University of Birmingham, United Kingdom
| | - C Easter
- University of Birmingham, United Kingdom
| | - D Devane
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- HRB Trials Methodology Research Network
- National University of Ireland, Galway, Ireland
| | - D J Murphy
- Trinity College Dublin & Coombe Women & Infants University Hospital Dublin 8, Republic of Ireland
| | - A Hunter
- Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
| | - A Cotter
- University Maternity Hospital Limerick & University of Limerick
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics & Gynaecology, National University of Ireland Galway
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square W, Dublin 1, Ireland
| | - E Dempsey
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - L C Kenny
- Department of Women's and Children's Health, Liverpool Women's Hospital, University of Liverpool, UK
| | - K O'Donoghue
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
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Gaffney B, Chawke L, Larkin M, Qsous G, Healy D, Keane MP, Fabre A, Murphy DJ, McCarthy C. Atypical cause of bronchial cut-off sign. Thorax 2021; 77:422-423. [PMID: 34353922 DOI: 10.1136/thoraxjnl-2021-217708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Brian Gaffney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Liam Chawke
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Michaela Larkin
- Department of Pathology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Gaith Qsous
- Department of Cardiothoracic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - David Healy
- Department of Cardiothoracic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
| | - Aurélie Fabre
- Department of Histopathology, St Vincent's University Hospital, Dublin 4, Ireland
| | - David J Murphy
- Department of Radiology, St.Vincent's University Hospital, Dublin 4, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin 4, Ireland .,School of Medicine, University College Dublin, Dublin 4, Ireland
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Hawkins P, Doyle A, Gavin L, Fabre A, Murphy DJ, Dunican E, McCarthy C. A 33-Year-Old Man With Dyspnea, Chest Pain, and a Massive Pleural Effusion. Chest 2021; 159:e39-e43. [PMID: 33422239 DOI: 10.1016/j.chest.2020.08.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 10/22/2022] Open
Abstract
CASE PRESENTATION A 33-year-old white man presented to the ED with 1-month history of worsening dyspnea. He experienced gradual onset of right-sided scapular pain and shortness of breath on exertion that progressively worsened over the course of 1 month. He had a mild nonproductive cough and intermittent subjective fevers and reported weight loss of approximately 2 kg over 1 month. He had a history of two episodes of acute pancreatitis that was thought to be autoimmune in origin. He was a never smoker; he denied illicit drug use or recent alcohol consumption. He had no known TB exposure, but his mother had a history of sarcoidosis.
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Affiliation(s)
- Padraig Hawkins
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Aoife Doyle
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Leo Gavin
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - David J Murphy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Eleanor Dunican
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
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33
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Detmold W, Illa M, Murphy DJ, Oare P, Orginos K, Shanahan PE, Wagman ML, Winter F. Lattice QCD Constraints on the Parton Distribution Functions of ^{3}He. Phys Rev Lett 2021; 126:202001. [PMID: 34110196 DOI: 10.1103/physrevlett.126.202001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
The fraction of the longitudinal momentum of ^{3}He that is carried by the isovector combination of u and d quarks is determined using lattice QCD for the first time. The ratio of this combination to that in the constituent nucleons is found to be consistent with unity at the few-percent level from calculations with quark masses corresponding to m_{π}∼800 MeV. With a naive extrapolation to the physical quark masses, this constraint is consistent with, and more precise than, determinations from global nuclear parton distribution function fits through the nnnpdf framework. It is thus concretely demonstrated that lattice QCD calculations of light nuclei have imminent potential to enable more precise determinations of the u and d parton distributions in light nuclei and to reveal the QCD origins of the EMC effect.
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Affiliation(s)
- William Detmold
- Center for Theoretical Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Marc Illa
- Departament de Física Quàntica i Astrofísica and Institut de Ciències del Cosmos, Universitat de Barcelona, Martí i Franquès 1, 08028 Barcelona, Spain
| | - David J Murphy
- Center for Theoretical Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Patrick Oare
- Center for Theoretical Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Kostas Orginos
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23187-8795, USA
- Jefferson Laboratory, 12000 Jefferson Avenue, Newport News, Virginia 23606, USA
| | - Phiala E Shanahan
- Center for Theoretical Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Michael L Wagman
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - Frank Winter
- Jefferson Laboratory, 12000 Jefferson Avenue, Newport News, Virginia 23606, USA
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Shantha JG, Auld SC, Anthony C, Ward L, Adelman MW, Maier CL, Price KW, Jacob J, Fashina T, Randleman C, Xu LT, Barnett J, Sadan O, Kandiah PA, Varkey JB, Kraft CS, Rouphael N, Linderman S, Ahmed R, Drews-Botsch C, Waggoner JJ, Weinmann M, Murphy DJ, Yeh S. Retinopathy and Systemic Disease Morbidity in Severe COVID-19. Ocul Immunol Inflamm 2021; 29:743-750. [PMID: 34464544 PMCID: PMC8562588 DOI: 10.1080/09273948.2021.1952278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19. DESIGN Retrospective, observational cohort study. METHODS Adult patients hospitalized with severe COVID-19 who underwent ophthalmic examination from April to July 2020 were reviewed. Retinopathy was defined as one of the following: 1) Retinal hemorrhage; 2) Cotton wool spots; 3) Retinal vascular occlusion. We analyzed medical comorbidities, sequential organ failure assessment (SOFA) scores, clinical outcomes, and laboratory values for their association with retinopathy. RESULTS Thirty-seven patients with severe COVID-19 were reviewed, the majority of whom were female (n = 23, 62%), Black (n = 26, 69%), and admitted to the intensive care unit (n = 35, 95%). Fourteen patients had retinopathy (38%) with retinal hemorrhage in 7 (19%), cotton wool spots in 8 (22%), and a branch retinal artery occlusion in 1 (3%) patient. Patients with retinopathy had higher SOFA scores than those without retinopathy (8.0 vs. 5.3, p = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (p < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy (p = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, p = .03). Multivariate logistic regression modeling showed an increased risk of retinopathy with higher peak D-dimers (aOR 1.32, 95% CI 1.01-1.73, p = .04) and male sex (aOR 9.6, 95% CI 1.2-75.5, p = .04). CONCLUSION Retinopathy in severe COVID-19 was associated with greater systemic disease morbidity involving multiple organs. Given its association with coagulopathy and inflammation, retinopathy may offer insight into disease pathogenesis in patients with severe COVID-19.
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Affiliation(s)
| | - Sara C Auld
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Casey Anthony
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Max W. Adelman
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Cheryl L. Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kenneth W. Price
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Jesse Jacob
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Tolu Fashina
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Casey Randleman
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Lucy T. Xu
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Joshua Barnett
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Ofer Sadan
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA
| | - Prem A. Kandiah
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA
| | - Jay B. Varkey
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Colleen S. Kraft
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Susanne Linderman
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA
| | - Carolyn Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Jesse J. Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Max Weinmann
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - David J. Murphy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
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Broe MP, Ryan JPC, Ryan EJ, Murphy DJ, Mulvin DW, Cantwell C, Brophy DP. Spermatic vein embolization as a treatment for symptomatic varicocele. Can Urol Assoc J 2021; 15:E569-E573. [PMID: 33999803 DOI: 10.5489/cuaj.7077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Varicocele is a relatively common condition in men that causes pain in approximately 10% of cases. There have been few studies to date assessing the improvements in both pain and quality of life parameters associated with spermatic vein embolization (SVE) as a treatment for patients with symptomatic varicocele, so we aimed to assess this. METHODS A review was carried out of consecutive SVE procedures performed at our institution from 2013-2019. Only patients with painful varicocele were included after other causes of testicular pain were excluded. The technique employed was a combination of distal coil embolization of the spermatic vein with 4-6 mm coils at the level of the inguinal canal, as well as sclerotherapy to prevent reflux of sclerosant. Furthermore, a prospective validated Pain Impact Questionnaire-6 (PIQ-6) was performed to assess for improvement in quality of life. A matched pair Student two-tailed t-test was used to compare mean scores pre- and post-treatment, with 95% confidence intervals presented as T scores and their associated p-values. RESULTS Over six years, 62 SVE procedures were performed for symptomatic varicocele. Success rate was 95%, with a median follow up of nine months. Two patients had a failed procedure on two occasions requiring subsequent surgical ligation. There was one clinically significant recurrence. All components of PIQ-6 score showed a statistically significant reduction post-SVE, most noticeably pain severity and impact on leisure activities. CONCLUSIONS SVE is a safe, effective, and well-tolerated treatment for symptomatic varicocele, improving pain and quality of life.
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Affiliation(s)
- Mark P Broe
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - James P C Ryan
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eanna J Ryan
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David W Mulvin
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Colin Cantwell
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
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36
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Pettrone K, Burnett E, Link-Gelles R, Haight SC, Schrodt C, England L, Gomes DJ, Shamout M, O'Laughlin K, Kimball A, Blau EF, Ladva CN, Szablewski CM, Tobin-D'Angelo M, Oosmanally N, Drenzek C, Browning SD, Bruce BB, da Silva J, Gold JAW, Jackson BR, Morris SB, Natarajan P, Fanfair RN, Patel PR, Rogers-Brown J, Rossow J, Wong KK, Murphy DJ, Blum JM, Hollberg J, Lefkove B, Brown FW, Shimabukuro T, Midgley CM, Tate JE, Killerby ME. Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March-April 2020. Emerg Infect Dis 2021; 27:1164-1168. [PMID: 33754981 PMCID: PMC8007327 DOI: 10.3201/eid2704.204709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.
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Clifford SM, Murphy DJ. Non-alcoholic fatty liver disease and coronary atherosclerosis-does myocardial glucose metabolism provide the missing link? J Nucl Cardiol 2021; 28:621-623. [PMID: 31201689 DOI: 10.1007/s12350-019-01783-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022]
Affiliation(s)
- S M Clifford
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D J Murphy
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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38
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McVeigh N, Murphy DJ, McKone E, Dodd JD. Obliterating Airway Bronchus Sign of Occult Malignancy in Sarcoid Conglomerate Fibrotic Masses. J Clin Imaging Sci 2021; 11:12. [PMID: 33767904 PMCID: PMC7981934 DOI: 10.25259/jcis_103_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a multiorgan disease which presents in up to 95% of cases with lung involvement, a proportion of which develops conglomerate fibrotic masses (CFMs). CFMs typically progressively increase in size overtime. The development of a lung malignancy within a CFM is rare and difficult to diagnose within the underlying lung fibrosis. Here, we describe the obstructing airway bronchus sign in CFMs as an important part of assessing CFMs overtime on computed tomography, which when it occurs should raise suspicion of an occult underlying carcinoma.
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Affiliation(s)
- Niall McVeigh
- Department of Cardiothoracic Surgery, St. Vincent's University College, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Edward McKone
- Department of Respiratory Medicine, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
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da Silva JF, Hernandez-Romieu AC, Browning SD, Bruce BB, Natarajan P, Morris SB, Gold JAW, Neblett Fanfair R, Rogers-Brown J, Rossow J, Szablewski CM, Oosmanally N, D’Angelo MT, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, Sewell W, Owens J, Lefkove B, Brown FW, Burton DC, Uyeki TM, Patel PR, Jackson BR, Wong KK. COVID-19 Clinical Phenotypes: Presentation and Temporal Progression of Disease in a Cohort of Hospitalized Adults in Georgia, United States. Open Forum Infect Dis 2021; 8:ofaa596. [PMID: 33537363 PMCID: PMC7798484 DOI: 10.1093/ofid/ofaa596] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemiological features and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) have been described; however, the temporal progression and medical complications of disease among hospitalized patients require further study. Detailed descriptions of the natural history of COVID-19 among hospitalized patients are paramount to optimize health care resource utilization, and the detection of different clinical phenotypes may allow tailored clinical management strategies. METHODS This was a retrospective cohort study of 305 adult patients hospitalized with COVID-19 in 8 academic and community hospitals. Patient characteristics included demographics, comorbidities, medication use, medical complications, intensive care utilization, and longitudinal vital sign and laboratory test values. We examined laboratory and vital sign trends by mortality status and length of stay. To identify clinical phenotypes, we calculated Gower's dissimilarity matrix between each patient's clinical characteristics and clustered similar patients using the partitioning around medoids algorithm. RESULTS One phenotype of 6 identified was characterized by high mortality (49%), older age, male sex, elevated inflammatory markers, high prevalence of cardiovascular disease, and shock. Patients with this severe phenotype had significantly elevated peak C-reactive protein creatinine, D-dimer, and white blood cell count and lower minimum lymphocyte count compared with other phenotypes (P < .01, all comparisons). CONCLUSIONS Among a cohort of hospitalized adults, we identified a severe phenotype of COVID-19 based on the characteristics of its clinical course and poor prognosis. These findings need to be validated in other cohorts, as improved understanding of clinical phenotypes and risk factors for their development could help inform prognosis and tailored clinical management for COVID-19.
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Affiliation(s)
- Juliana F da Silva
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alfonso C Hernandez-Romieu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Beau B Bruce
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pavithra Natarajan
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sapna B Morris
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robyn Neblett Fanfair
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Rossow
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | | | - Cherie Drenzek
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - David J Murphy
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julie Hollberg
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - James M Blum
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
| | | | - David W Wright
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | | | - Jack Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia, USA
| | | | - Frank W Brown
- Georgia Clinical & Translational Science Alliance, Atlanta, Georgia, USA
- Emory Decatur Hospital, Decatur, Georgia, USA
| | - Deron C Burton
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Timothy M Uyeki
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Priti R Patel
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Brendan R Jackson
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
| | - Karen K Wong
- CDC COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service
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Abstract
Lymphangioleiomyomatosis (LAM) is a diffuse cystic lung disease. There are two main types of LAM: sporadic, and LAM associated with the tuberous sclerosis complex (TSC), which is caused by mutations in the TSC1 and TSC2 genes. LAM is characterised by cystic lung disease resulting in progressive dyspnoea, renal angiomyolipomas and lymphatic complications. Pneumothorax occurs frequently (70%) and definitive management with pleurodesis is recommended as the risk of recurrence is high. Characteristic thin-walled cysts are seen on computed tomography and the presence of elevated serum levels of a vascular endothelial growth factor-D has good diagnostic specificity. Currently, no single clinical or serological factor has been shown to predict prognosis. However, over the past decade, significant advances in our understanding of the pathophysiology of LAM has led to improved recognition of this rare disease and identification of treatment options. Mechanistic target of rapamycin inhibitors slow the rate of lung function decline and can resolve chylous effusion and regress angiomyolipomas. Life expectancy in patients with LAM is favourable, with a mean transplant-free survival >20 years from the time of diagnosis. Continued advances in understanding the molecular basis of LAM will lead to improved therapeutic targets and the development of more robust prognostic indicators. Educational aims To illustrate the clinical features, common presentations and radiological features of LAMTo outline the diagnostic approach to LAM, including the role of VEGF-DTo review the current prognostic indicators in LAM, and outline the impact of lung function, hormonal status, VEGF-D and clinical presentation on outcomeTo inform clinicians on the management options for LAM both pharmacological and nonpharmacological.
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Affiliation(s)
- Anne M O'Mahony
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,These authors contributed equally
| | - Evelyn Lynn
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,These authors contributed equally
| | - David J Murphy
- Dept of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Aurelie Fabre
- Dept of Histopathology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Dept of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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41
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Hess CB, Buchwald ZS, Stokes WA, Nasti T, Switchenko J, Weinberg BD, Rouphael N, Steinberg JP, Godette KD, Murphy DJ, Ahmed R, Curran WJ, Khan MK. Immunomodulatory Low-Dose Whole-Lung Radiation for Patients with COVID-19-Related Pneumonia. Int J Radiat Oncol Biol Phys 2020; 108:1401. [PMID: 33427662 PMCID: PMC7671923 DOI: 10.1016/j.ijrobp.2020.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C B Hess
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Z S Buchwald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - W A Stokes
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - T Nasti
- Department of Microbiology/Immunology, Emory University, Atlanta, GA
| | - J Switchenko
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | - K D Godette
- Glenn Family Breast Center, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - R Ahmed
- Department of Microbiology/Immunology, Emory University, Atlanta, GA
| | - W J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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42
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Kelly A, Keane MP, Keane D, Dodd JD, Murphy DJ, McCarthy C. Sequential FDG-PET in the management of multiorgan sarcoidosis. Thorax 2020; 76:316-317. [PMID: 33177227 DOI: 10.1136/thoraxjnl-2020-215202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/13/2020] [Accepted: 10/15/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Alan Kelly
- Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Michael P Keane
- Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - David Keane
- Cardiology, St. Vincent's Uiversity Hospital, Dublin, Ireland
| | - Jonathan D Dodd
- Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland .,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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43
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Fleming H, Clifford SM, Haughey A, MacDermott R, McVeigh N, Healy GM, Lavelle L, Abbara S, Murphy DJ, Fabre A, McKone E, McCarthy C, Butler M, Doran P, Lynch DA, Keane MP, Dodd JD. Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI. Eur Radiol Exp 2020; 4:61. [PMID: 33141269 PMCID: PMC7641295 DOI: 10.1186/s41747-020-00187-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. Methods Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. Results There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4–31.0 versus 5.3, IQR 5.0–8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0–20.0 versus 25.0, IQR 15.0–26.3, p = 0.038) and honeycombing (5.0, IQR 0.0–10.0 versus 20.0, IQR 10.6–20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5–15 versus 15.0, IQR 5–15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. Conclusion LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.
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Affiliation(s)
- Hannah Fleming
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Simon M Clifford
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aoife Haughey
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Niall McVeigh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Gerard M Healy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Lisa Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Hospital, Dallas, TX, USA
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward McKone
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Marcus Butler
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Peter Doran
- UCD Clinical Research Center, University College Dublin, Dublin, Ireland
| | - David A Lynch
- Department of Radiology, National Jewish Medical and Research Center, Denver, CO, USA
| | - Michael P Keane
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. .,School of Medicine, University College Dublin, Dublin, Ireland.
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Hernandez-Romieu AC, Adelman MW, Hockstein MA, Robichaux CJ, Edwards JA, Fazio JC, Blum JM, Jabaley CS, Caridi-Scheible M, Martin GS, Murphy DJ, Auld SC. Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study. Crit Care Med 2020; 48:e1045-e1053. [PMID: 32804790 PMCID: PMC7448713 DOI: 10.1097/ccm.0000000000004600] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019. DESIGN Retrospective cohort study. SETTING Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia. PATIENTS Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56-75 yr). Seventy-six patients (43.4%) were intubated within 8 hours of ICU admission, 57 (32.6%) between 8 and 24 hours of admission, and 42 (24.0%) greater than or equal to 24 hours after admission. Patients intubated within 8 hours were more likely to have diabetes, chronic comorbidities, and higher admission Sequential Organ Failure Assessment scores. Mortality did not differ by time to intubation (≤ 8 hr: 38.2%; 8-24 hr: 31.6%; ≥ 24 hr: 38.1%; p = 0.7), and there was no association between time to intubation and mortality in adjusted analysis. Similarly, there was no difference in initial static compliance, duration of mechanical ventilation, or ICU length of stay by timing of intubation. High-flow nasal cannula use prior to intubation was not associated with mortality. CONCLUSIONS In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
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Affiliation(s)
- Alfonso C Hernandez-Romieu
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Maxwell A Hockstein
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Emory Critical Care Center (ECCC), Atlanta, GA
| | - Chad J Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Georgia Clinical and Translational Science Alliance, Atlanta, GA
| | - Johnathan A Edwards
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Georgia Clinical and Translational Science Alliance, Atlanta, GA
| | - Jane C Fazio
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - James M Blum
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Biomedical Informatics, Emory University, Atlanta, GA
- Georgia Clinical and Translational Science Alliance, Atlanta, GA
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Emory Critical Care Center (ECCC), Atlanta, GA
| | - Mark Caridi-Scheible
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Emory Critical Care Center (ECCC), Atlanta, GA
| | - Greg S Martin
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David J Murphy
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Office of Quality and Risk, Emory Healthcare, Atlanta, GA
| | - Sara C Auld
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
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45
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O’Carroll O, Cullen J, Fabre A, Murphy DJ, Dodd JD, Keane MP, McCarthy C. Phenotypic Variation of Birt-Hogg-Dubé Syndrome Within a Single Family. Chest 2020; 158:1790-1791. [DOI: 10.1016/j.chest.2020.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022] Open
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46
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Jackson BR, Gold JAW, Natarajan P, Rossow J, Neblett Fanfair R, da Silva J, Wong KK, Browning SD, Bamrah Morris S, Rogers-Brown J, Hernandez-Romieu AC, Szablewski CM, Oosmanally N, Tobin-D'Angelo M, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, SeweSll WM, Owens JD, Lefkove B, Brown FW, Burton DC, Uyeki TM, Bialek SR, Patel PR, Bruce BB. Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19. Clin Infect Dis 2020; 73:e4141-e4151. [PMID: 32971532 PMCID: PMC7543323 DOI: 10.1093/cid/ciaa1459] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions. Methods We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death. Results Compared with age <45 years, ages 65–74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47–6.60; aOR 2.79, CI 1.23–6.33) and the strongest predictors for death (aOR 12.92, CI 3.26–51.25; aOR 18.06, CI 4.43–73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03–3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03–3.55) were associated with death. Conclusions After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
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Affiliation(s)
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response.,Epidemic Intelligence Service, CDC
| | | | - John Rossow
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC
| | | | | | - Karen K Wong
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Alfonso C Hernandez-Romieu
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Emory University School of Medicine
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Georgia Department of Public Health, Atlanta, Georgia
| | | | | | | | | | | | - James M Blum
- Emory University School of Medicine.,Georgia Clinical & Translational Science Alliance, Atlanta, Georgia
| | | | - David W Wright
- Emory University School of Medicine.,Grady Health System, Atlanta, Georgia
| | | | - Jack D Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | | | - Frank W Brown
- Emory University School of Medicine.,Emory Decatur Hospital, Decatur, Georgia
| | - Deron C Burton
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | | | | | - Priti R Patel
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
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47
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Auld SC, Caridi-Scheible M, Blum JM, Robichaux C, Kraft C, Jacob JT, Jabaley CS, Carpenter D, Kaplow R, Hernandez-Romieu AC, Adelman MW, Martin GS, Coopersmith CM, Murphy DJ. ICU and Ventilator Mortality Among Critically Ill Adults With Coronavirus Disease 2019. Crit Care Med 2020; 48:e799-e804. [PMID: 32452888 PMCID: PMC7255393 DOI: 10.1097/ccm.0000000000004457] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine mortality rates among adults with critical illness from coronavirus disease 2019. DESIGN Observational cohort study of patients admitted from March 6, 2020, to April 17, 2020. SETTING Six coronavirus disease 2019 designated ICUs at three hospitals within an academic health center network in Atlanta, Georgia, United States. PATIENTS Adults greater than or equal to 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease who were admitted to an ICU during the study period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 217 critically ill patients, mortality for those who required mechanical ventilation was 35.7% (59/165), with 4.8% of patients (8/165) still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 30.9% (67/217) and 60.4% (131/217) patients have survived to hospital discharge. Mortality was significantly associated with older age, lower body mass index, chronic renal disease, higher Sequential Organ Failure Assessment score, lower PaO2/FIO2 ratio, higher D-dimer, higher C-reactive protein, and receipt of mechanical ventilation, vasopressors, renal replacement therapy, or vasodilator therapy. CONCLUSIONS Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.
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Affiliation(s)
- Sara C Auld
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
- Emory University Hospital, Emory Healthcare, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Office of Quality and Risk, Emory Healthcare, Atlanta, GA
| | - Mark Caridi-Scheible
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - James M Blum
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
| | - Colleen Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Jesse T Jacob
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Craig S Jabaley
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | | | - Roberta Kaplow
- Emory University Hospital, Emory Healthcare, Atlanta, GA
| | - Alfonso C Hernandez-Romieu
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Greg S Martin
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Georgia Clinical and Translational Science Alliance (CTSA), Atlanta, GA
| | - Craig M Coopersmith
- Emory Critical Care Center (ECCC), Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - David J Murphy
- Emory Critical Care Center (ECCC), Atlanta, GA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Office of Quality and Risk, Emory Healthcare, Atlanta, GA
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48
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Liddy S, Mallia A, Collins CD, Killeen RP, Skehan S, Dodd JD, Subesinghe M, Murphy DJ. Vascular findings on FDG PET/CT. Br J Radiol 2020; 93:20200103. [PMID: 32356457 PMCID: PMC7465845 DOI: 10.1259/bjr.20200103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.
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Affiliation(s)
| | - Andrew Mallia
- Division of Nuclear Medicine, Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | | | | | | | - Jonathan D Dodd
- Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland
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49
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McCarthy C, Savinelli S, Feeney ER, Butler MW, O'Broin C, Ryan S, O'Neill L, Murphy DJ, Gallagher CG, McKone EF, Waqas S, Cotter A, Doran P, Keane MP, Mallon PW. Tocilizumab therapy in individuals with COVID-19 infection and hyperinflammatory state. Respirology 2020; 25:1090-1094. [PMID: 32696570 PMCID: PMC7404856 DOI: 10.1111/resp.13912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Stefano Savinelli
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Eoin R Feeney
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Cathal O'Broin
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Silke Ryan
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Lorraine O'Neill
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Charles G Gallagher
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Edward F McKone
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Sarmad Waqas
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife Cotter
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland.,Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
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Killerby ME, Link-Gelles R, Haight SC, Schrodt CA, England L, Gomes DJ, Shamout M, Pettrone K, O'Laughlin K, Kimball A, Blau EF, Burnett E, Ladva CN, Szablewski CM, Tobin-D'Angelo M, Oosmanally N, Drenzek C, Murphy DJ, Blum JM, Hollberg J, Lefkove B, Brown FW, Shimabukuro T, Midgley CM, Tate JE. Characteristics Associated with Hospitalization Among Patients with COVID-19 - Metropolitan Atlanta, Georgia, March-April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:790-794. [PMID: 32584797 PMCID: PMC7316317 DOI: 10.15585/mmwr.mm6925e1] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The first reported U.S. case of coronavirus disease 2019 (COVID-19) was detected in January 2020 (1). As of June 15, 2020, approximately 2 million cases and 115,000 COVID-19-associated deaths have been reported in the United States.* Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the virus that causes COVID-19) describe high proportions of older, male, and black persons (2-4). Similarly, when comparing hospitalized patients with catchment area populations or nonhospitalized COVID-19 patients, high proportions have underlying conditions, including diabetes mellitus, hypertension, obesity, cardiovascular disease, chronic kidney disease, or chronic respiratory disease (3,4). For this report, data were abstracted from the medical records of 220 hospitalized and 311 nonhospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 from six acute care hospitals and associated outpatient clinics in metropolitan Atlanta, Georgia. Multivariable analyses were performed to identify patient characteristics associated with hospitalization. The following characteristics were independently associated with hospitalization: age ≥65 years (adjusted odds ratio [aOR] = 3.4), black race (aOR = 3.2), having diabetes mellitus (aOR = 3.1), lack of insurance (aOR = 2.8), male sex (aOR = 2.4), smoking (aOR = 2.3), and obesity (aOR = 1.9). Infection with SARS-CoV-2 can lead to severe outcomes, including death, and measures to protect persons from infection, such as staying at home, social distancing (5), and awareness and management of underlying conditions should be emphasized for those at highest risk for hospitalization with COVID-19. Measures that prevent the spread of infection to others, such as wearing cloth face coverings (6), should be used whenever possible to protect groups at high risk. Potential barriers to the ability to adhere to these measures need to be addressed.
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