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Nadeem I, Ul Munamm SA, Ur Rasool M, Fatimah M, Abu Bakar M, Rana ZK, Khatana UF, Jordon L, Saqlain M, Mahdi N, McLoughlin H. Safety and efficacy of Sinopharm vaccine (BBIBP-CorV) in elderly population of Faisalabad district of Pakistan. Postgrad Med J 2023; 99:463-469. [PMID: 37294716 DOI: 10.1136/postgradmedj-2022-141649] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 02/10/2022] [Accepted: 04/06/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The first case of novel SARS-COV-2 (COVID-19) in Pakistan was detected on 26 February 2020. Pharmacological and non-pharmacological strategies have been tried to lessen the mortality and morbidity burden. Various vaccines have been approved. The Drug Regulatory Authority of Pakistan gave emergency approval for Sinopharm (BBIBP-CorV) COVID-19 vaccine in December 2021. The phase 3 trial of BBIBP-CorV included only 612 participants aged 60 years and above. The primary aim of this study was to assess the safety and efficacy of BBIBPP-CorV (Sinopharm) vaccine within the Pakistani adult population aged 60 or above. The study was carried out in the Faisalabad district of Pakistan. METHODS A test negative case-control study design was used to assess safety and efficacy of BBIBP-CorV in individuals aged 60 and above against symptomatic infection, hospitalisations and mortality due to SARS-CoV-2 among vaccinated and unvaccinated individuals. ORs were calculated using logistic regression model at 95% CI. ORs were used to calculate the vaccine efficacy (VE) by using the following formula.VE= (1-OR) ×100. RESULTS 3426 individuals with symptoms of COVID-19 were PCR tested between 5 May 2021 and 31 July 2021. The results showed that Sinopharm vaccine 14 days after the second dose was efficient in reducing the risk of symptomatic COVID-19 infection, hospitalisations and mortality by 94.3%, 60.5% and 98.6%, respectively, among vaccinated individuals with a significant p value of 0.001. CONCLUSION Our study showed that BBIBP-CorV vaccine is highly effective in preventing infection, hospitalisations and mortality due to COVID-19.
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Affiliation(s)
- Iftikhar Nadeem
- Department of Respiratory Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
| | | | - Masood Ur Rasool
- Department of Respiratory Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, UK
| | | | - Muhammad Abu Bakar
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Usman Feroze Khatana
- Department of Respiratory Medicine, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | | | - Muhammad Saqlain
- Department of Endocrinology, Addenbrooke's Hospital, Cambridge, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
| | - Hilary McLoughlin
- Department of Respiratory Medicine, Portiuncula Hospital Ballinasloe, Ballinasloe, Ireland
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Mahdi N, Nadeem I, Ur Rasool M, Ul Munamm SA, Khatana UF, Rashad F, Babu A. Pulmonary hypertension due to pulmonary embolism secondary to COVID-19: A district general hospital experience from the UK. J R Coll Physicians Edinb 2023; 53:9-12. [PMID: 36705094 PMCID: PMC9884629 DOI: 10.1177/14782715231152677] [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] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Preliminary data suggest that the prevalence of pulmonary hypertension (PH) in patients with COVID-19 is around 13%, but its prognostic role remains unclear. Approximately 3% of patients develop chronic thrombo-embolic pulmonary hypertension (CTEPH) following diagnosis of acute pulmonary embolism (PE). It is recommended that patients are screened for CTEPH if they remain symptomatic 3 months following diagnosis of PE. AIMS The primary aim of the study was to assess the chances of persistent PH following PE secondary to COVID-19. METHODS We conducted a retrospective cohort study at a District General Hospital (DGH) in the United Kingdom. All patients diagnosed with COVID-19 and PE between April 2020 and October 2021 were examined. Patients were divided into two groups:·COVID-19 and PE with comorbidities (excluding pre-existing PH) and·COVID-19 and PE without comorbidities. We compared the ECHO features suggestive of PH between the two groups at the time of diagnosis of PE and at 3 months following treatment. RESULTS 80 patients were included in the study (49 with comorbidities and 31 with no comorbidities). Average age of comorbidities and no comorbidities groups were 73 years and 70 years, respectively. Average PaO2/FiO2 ratio for comorbidities and no comorbidities groups were 170 and 195, respectively. Fourteen patients (13 with comorbidities and 1 with no comorbidities) died in total. Results showed that risk of persistent PH and subsequent mortality following PE in COVID19 is 4.17 times and 1.32 times more in comorbidity group as compared to no comorbidity group, respectively (p < 0.001). CONCLUSION Patients with comorbidities are at high risk of persistent PH and mortality due to PE secondary to COVID19.
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Affiliation(s)
- Noor Mahdi
- Royal Papworth Hospital NHS Trust,
Cambridge, UK
| | - Iftikhar Nadeem
- Royal Papworth Hospital NHS Trust,
Cambridge, UK,Iftikhar Nadeem, Royal Papworth Hospital
NHS Trust, Cambridge, UK.
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Karampitsakos T, Phuong Diep P, Loth DW, Nadeem I, Khurtsidze E, Wijsenbeek MS, Wuyts WA, Bargagli E, Froidure A, Spagnolo P, Veltkamp M, Molina-Molina M, McCarthy C, Antoniou KM, Kreuter M, Moor CC. ERS International Congress 2022: highlights from the Interstitial Lung Diseases Assembly. ERJ Open Res 2023; 9:00584-2022. [PMID: 37077550 PMCID: PMC10107062 DOI: 10.1183/23120541.00584-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
This article contains a selection of scientific highlights in the field of interstitial lung diseases (ILDs) presented at the hybrid European Respiratory Society (ERS) congress 2022. Early Career Members of Assembly 12 summarize recent advances in translational and clinical research in idiopathic interstitial pneumonias, ILDs of known origin, sarcoidosis and other granulomatous diseases, and rare ILDs. Many studies focused on evaluation of diagnostic and prognostic (bio)markers, and novel pharmacological and non-pharmacological treatment options for different ILDs. Besides, new insights in clinical, physiological, and radiological features of various rare ILDs were presented.
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Ul Munamm SA, Nadeem I, Mahdi N, Saqlain M, Rana ZK, Khatana UF, Bhatty UM, Navayogaarajah V, Khan FM, Ur Rasool M. Comparative analysis of mRNA and inactivated COVID-19 vaccines: A study from Faisalabad district of Pakistan. J R Coll Physicians Edinb 2022; 52:240-246. [PMID: 36222203 PMCID: PMC9557273 DOI: 10.1177/14782715221131409] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pakistan has vaccinated over 122 million people. The two vaccines in widespread use are inactivated (BBIBP-CorV & Sinovac) and mRNA forms (BNT162b2 & mRNA-1273). The primary aim of this study was to compare these two forms of vaccines against unvaccinated individuals collectively and then to see which one is more efficacious. METHODS Case-control study design was used to compare the efficacy of inactivated and mRNA vaccines against symptomatic infection, hospitalisations and mortality due to Severe Acute Respiratory Syndrome Coronavirus 2 between vaccinated and unvaccinated individuals. We derived recovery time from illness for both vaccines. Furthermore, we also compared the vaccines against similar parameters (symptomatic disease, hospitalisations and mortality). We calculated crude odds ratios for each dependent variable. p value of 0.05 or below was considered significant. RESULTS Vaccinated individuals were significantly protected from hospitalisations and mortality compared to unvaccinated individuals (p < 0.001). There was no difference in protection from symptomatic disease (p = 0.28), hospitalisations (p = 0.59) and mortality (p = 0.53) between two forms of vaccines. mRNA vaccine had better recovery time than all other vaccines (p < 0.001). DISCUSSION Our study showed that vaccinated individuals are at low risk of hospitalisations and mortality even without a booster and both vaccine forms are equally effective at preventing hospitalisations and mortality.
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Affiliation(s)
| | - Iftikhar Nadeem
- Specialty Trainee Respiratory Registrar, East of England Deanery, UK
| | - Noor Mahdi
- Specialty Trainee Respiratory Registrar, East of England Deanery, UK
| | | | - Zaid Khalid Rana
- Basic Specialist Trainee, Royal College of Physicians of Ireland, Ireland
| | | | | | | | | | - Masood Ur Rasool
- Specialty Trainee Respiratory Registrar, East of England Deanery, UK
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Nadeem I, Ul Munamm SA, Ur Rasool M, Fatimah M, Abu Bakar M, Rana ZK, Khatana UF, Jordon L, Saqlain M, Mahdi N, McLoughlin H. Safety and efficacy of Sinopharm vaccine (BBIBP-CorV) in elderly population of Faisalabad district of Pakistan. Postgrad Med J 2022:7127847. [PMID: 37073563 DOI: 10.1136/postmj/postgradmedj-2022-141649] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/06/2022] [Indexed: 04/20/2023]
Abstract
INTRODUCTION The first case of novel SARS-COV-2 (COVID-19) in Pakistan was detected on 26 February 2020. Pharmacological and non-pharmacological strategies have been tried to lessen the mortality and morbidity burden. Various vaccines have been approved. The Drug Regulatory Authority of Pakistan gave emergency approval for Sinopharm (BBIBP-CorV) COVID-19 vaccine in December 2021. The phase 3 trial of BBIBP-CorV included only 612 participants aged 60 years and above. The primary aim of this study was to assess the safety and efficacy of BBIBPP-CorV (Sinopharm) vaccine within the Pakistani adult population aged 60 or above. The study was carried out in the Faisalabad district of Pakistan. METHODS A test negative case-control study design was used to assess safety and efficacy of BBIBP-CorV in individuals aged 60 and above against symptomatic infection, hospitalisations and mortality due to SARS-CoV-2 among vaccinated and unvaccinated individuals. ORs were calculated using logistic regression model at 95% CI. ORs were used to calculate the vaccine efficacy (VE) by using the following formula.VE= (1-OR) ×100. RESULTS 3426 individuals with symptoms of COVID-19 were PCR tested between 5 May 2021 and 31 July 2021. The results showed that Sinopharm vaccine 14 days after the second dose was efficient in reducing the risk of symptomatic COVID-19 infection, hospitalisations and mortality by 94.3%, 60.5% and 98.6%, respectively, among vaccinated individuals with a significant p value of 0.001. CONCLUSION Our study showed that BBIBP-CorV vaccine is highly effective in preventing infection, hospitalisations and mortality due to COVID-19.
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Affiliation(s)
- Iftikhar Nadeem
- Department of Respiratory Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
| | | | - Masood Ur Rasool
- Department of Respiratory Medicine, West Suffolk Hospitals NHS Trust, Bury Saint Edmunds, UK
| | | | - Muhammad Abu Bakar
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Usman Feroze Khatana
- Department of Respiratory Medicine, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | | | - Muhammad Saqlain
- Department of Endocrinology, Addenbrooke's Hospital, Cambridge, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK
| | - Hilary McLoughlin
- Department of Respiratory Medicine, Portiuncula Hospital Ballinasloe, Ballinasloe, Ireland
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Nadeem I, Jordon L, Rasool MU, Mahdi N, Kumar R, Rehman Z, Tilley CJ, Kang S, Rai A, Lok S, McMillan A. Role of advanced respiratory support in acute respiratory failure in clinically frail patients with COVID-19. Future Microbiol 2021; 17:89-97. [PMID: 34915735 PMCID: PMC8734119 DOI: 10.2217/fmb-2021-0226] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The main aim of this study was to assess the efficacy of advanced respiratory support (ARS) for acute respiratory failure in do-not-attempt cardiopulmonary resuscitation order (DNACPR) COVID-19 patients. Methods: In this single-center study, the impact of different types of ARS modality, PaO2/FiO2 (PF) ratio, clinical frailty score (CFS) and 4C score on mortality was evaluated. Results: There was no significant difference in age, type of ARS modality, PF ratio and 4C scores between those who died and those who survived. Overall survival rates/hospital discharge of patients still requiring ARS at 5 and 7 days post admission were 20 and 17%, respectively. Conclusion: Our study showed that ARS can be a useful tool in frail, elderly and high-risk COVID-19 patients irrespective of high 4C mortality score.
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Affiliation(s)
- Iftikhar Nadeem
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Louise Jordon
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Masood Ur Rasool
- Department of Respiratory Medicine, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Ritesh Kumar
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Zahra Rehman
- Department of Internal Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Craig J Tilley
- Department of Internal Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Simran Kang
- Department of Internal Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Amrita Rai
- Department of Internal Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - She Lok
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
| | - Alison McMillan
- Department of Respiratory Medicine, East & North Hertfordshire NHS Trust, Stevenage, UK
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Nadeem I, Anwar A, Jordon L, Mahdi N, Rasool MU, Dakin J, Lok S. Relationship of D-dimer and prediction of pulmonary embolism in hospitalized COVID-19 patients: a multicenter study. Future Microbiol 2021; 16:863-870. [PMID: 34319144 PMCID: PMC8317973 DOI: 10.2217/fmb-2021-0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/15/2022] Open
Abstract
Aim: COVID-19 is a known risk factor for pulmonary embolism (PE). In this retrospective, multicenter study, we aimed to determine an optimal D-dimer cutoff to predict PE in hospitalized patients with COVID-19. Materials & methods: A total of 193 patients underwent computerized tomographic pulmonary angiography imaging and were classified into PE positive and negative groups. Physiological, radiological and biochemical parameters were compared and receiver operator curve analysis was conducted to determine a predictive D-dimer threshold. Results: An optimal D-dimer cutoff of 2494 ng/ml was selected (Youden index: 0.906), giving a sensitivity of 100% (95% CI: 100–100) and specificity of 90.62% (95% CI: 90.5–90.8) for predicting PE. Conclusion: We propose that in the absence of other clinical signs, a D-dimer threshold of 2495 ng/ml could be used with high sensitivity and specificity to predict PE in hospitalized patients with COVID-19.
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Affiliation(s)
- Iftikhar Nadeem
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Asad Anwar
- Department of Respiratory Medicine, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Louise Jordon
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Masood Ur Rasool
- Department of Respiratory Medicine, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - Jonathan Dakin
- Department of Respiratory Medicine, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - She Lok
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
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Nadeem I, Issar A, Brown A. Abstract No. 155 Automating the collection of quality metrics in percutaneous interventions for permanent hemodialysis access via natural language processing. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.161] [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] [Indexed: 10/21/2022] Open
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Nadeem I, Light A, Donaldson C, Khatana UF, Bagmane D, Thomas E, Azher M. Use of DECAF scoring system to facilitate early discharge in acute exacerbation of COPD patients: a quality improvement project at a district general hospital. Future Healthc J 2021; 8:e123-e126. [PMID: 33791490 DOI: 10.7861/fhj.2020-0097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction DECAF is a scoring tool that can predict severity in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0-1 are candidates for early discharge. Methods Plan, do, study, act (PDSA) methodology was used. Patients with AECOPD and a DECAF score of 0-1 were included. Notes were retrospectively reviewed for patients for DECAF score, length of stay, 30-day re-admission and 30-day mortality (PDSA cycle 1). A framework to facilitate early discharge for patients was subsequently established. Awareness was increased through teaching sessions, posters and targeted emails. To evaluate our improvements, the same parameters were collected prospectively (PDSA cycle 2). Results DECAF score was assessed for no patients in PDSA cycle 1 (n=20) but was assessed for all patients in PDSA cycle 2 (n=14). Hospital stay was significantly decreased in PDSA cycle 2 (mean 0.29±0.45 days) compared with PDSA cycle 1 (mean 3.71±2.69 days; difference p<0.00001). Thirty-day re-admission and 30-day mortality was not significantly different between two groups. Conclusion DECAF protocol is safe and feasible in the district general hospital setting and can facilitate early discharge for patients with low severity AECOPD without any worrisome effects.
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Ur Rasool M, Nadeem I, Khatana UF, Hand S. An unusual case of breathlessness. Breathe (Sheff) 2021; 17:200344. [PMID: 34295405 PMCID: PMC8291917 DOI: 10.1183/20734735.0344-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
We present the case of an asthmatic patient who continued to present with breathlessness and received multiple courses of steroids for her presumed asthma exacerbations. After multiple investigations, we made the diagnosis of TBM secondary to relapsing polychondritis. https://bit.ly/3b8Uw1O.
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Affiliation(s)
- Masood Ur Rasool
- Dept of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, UK
| | - Iftikhar Nadeem
- Dept of Respiratory Medicine, Lister Hospital, Stevenage, UK
| | | | - Sadiyah Hand
- Dept of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, UK
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McLoughlin H, Coughlan G, Nadeem I, Burke E. Severe Obstructive Sleep Apnoea Leading to Raised Intracranial Pressure Hydrocephalus in a Patient with Aqueduct Stenosis. Eur J Case Rep Intern Med 2021; 8:002229. [PMID: 33585345 DOI: 10.12890/2021_002229] [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: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/05/2022] Open
Abstract
We present the case of a patient with severe obstructive sleep apnoea (OSA) and hypoventilation syndrome who had hydrocephalus and acquired aqueduct stenosis. A link between these conditions in our patient is postulated. We discuss the mechanisms through which this might have occurred and the potential problems which might arise in applying non-invasive ventilation to a patient with hydrocephalus. LEARNING POINTS Patients with severe obstructive sleep apnoea (OSA) and hypoventilation require AVAPS-AE ventilation to deal with obstructive and central events which may occur.Arterial blood gas analysis and MRI of the brain are indicated in the assessment of patients with severe OSA.Hydrocephalus may develop in patients with severe OSA if there is a structural brain abnormality but may resolve with OSA treatment.
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Affiliation(s)
| | | | | | - Emma Burke
- Portiuncula University Hospital, Ballinasloe, Ireland
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Martinelli AW, Ingle T, Newman J, Nadeem I, Jackson K, Lane ND, Melhorn J, Davies HE, Rostron AJ, Adeni A, Conroy K, Woznitza N, Matson M, Brill SE, Murray J, Shah A, Naran R, Hare SS, Collas O, Bigham S, Spiro M, Huang MM, Iqbal B, Trenfield S, Ledot S, Desai S, Standing L, Babar J, Mahroof R, Smith I, Lee K, Tchrakian N, Uys S, Ricketts W, Patel ARC, Aujayeb A, Kokosi M, Wilkinson AJK, Marciniak SJ. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J 2020; 56:2002697. [PMID: 32907891 PMCID: PMC7487269 DOI: 10.1183/13993003.02697-2020] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients). METHODS Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival. RESULTS 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5±7.7% versus females 68.4±10.7%; p=0.619). Patients aged ≥70 years had a significantly lower 28-day survival than younger individuals (≥70 years 41.7±13.5% survival versus <70 years 70.9±6.8% survival; p=0.018 log-rank). CONCLUSION These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible.
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Affiliation(s)
- Anthony W Martinelli
- Addenbrooke's Hospital, Cambridge, UK
- CITIID, University of Cambridge, Cambridge, UK
- Both authors contributed equally
| | - Tejas Ingle
- The Lister Hospital, Stevenage, UK
- Both authors contributed equally
| | | | | | - Karl Jackson
- Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Nicholas D Lane
- Respiratory Medicine, The Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Anthony J Rostron
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Aldrin Adeni
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | - Nick Woznitza
- NHS Nightingale Hospital, Royal Docks, London, UK
- Canterbury Christ Church University, Canterbury, UK
| | | | - Simon E Brill
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - James Murray
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Amar Shah
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Revati Naran
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Samanjit S Hare
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Oliver Collas
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Sarah Bigham
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Michael Spiro
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | | | | | | | | | | | | | | | | | - Ian Smith
- Royal Papworth Hospital, Cambridge, UK
| | - Kai Lee
- King's College Hospital, London, UK
| | | | | | | | - Anant R C Patel
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | | | | | - Stefan J Marciniak
- Addenbrooke's Hospital, Cambridge, UK
- CIMR, University of Cambridge, Cambridge, UK
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Abstract
Extrapulmonary sarcoidosis accounts for only two percent of the total sarcoid cases. Sarcoidosis affecting the musculoskeletal system alone is even rarer. Diagnosis is based on suggestive history, clinical features, imaging followed by confirmation of non-caseating granulomas on a biopsy. Steroids form the first line of treatment for patients where musculoskeletal system is involved. We report the case of a 26-year-old gentleman who presented with right foot pain and unintentional weight loss. A magnetic resonance imaging (MRI) scan of feet confirmed bilateral stress fractures of both feet. After a battery of investigations and resultant myriad constellation of investigation findings, the diagnosis of sarcoidosis was confirmed on a tissue biopsy obtained via bronchoscopy. This case report discusses the complex journey from presentation to diagnosis and subsequent treatment while also exploring important differentials that need to be ruled out in such scenarios.
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Nadeem I, Khatana U, Rasool MU, Wasil A, Azher M. Lessons of the month 2: Chronic eosinophilic pneumonia (CEP): A rare manifestation of infliximab therapy. Clin Med (Lond) 2020; 20:435-437. [PMID: 32675153 DOI: 10.7861/clinmed.2020-0271] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a rare and unusual case of 22-year-old man who was on infliximab therapy for his uncontrolled ulcerative colitis. Infliximab was stopped as he didn't get any benefit from it and he ended up having subtotal colectomy and ileostomy. He presented with shortness of breath and eosinophilia and underwent a number of investigations and finally a diagnosis of chronic eosinophilia secondary to infliximab was made.
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Affiliation(s)
| | | | - Masood Ur Rasool
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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15
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Nadeem I, Rana ZK, Burke E, McLoughlin H. PJP infection in a patient with high output ileostomy and selective IgA deficiency. QJM 2019; 112:445-446. [PMID: 30887041 DOI: 10.1093/qjmed/hcz067] [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: 03/05/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Nadeem
- Respiratory Department, Portiuncula University Hospital, Ballinasloe, Co., Galway H53 T971, Ireland
| | - Z K Rana
- Respiratory Department, Portiuncula University Hospital, Ballinasloe, Co., Galway H53 T971, Ireland
| | - E Burke
- Respiratory Department, Portiuncula University Hospital, Ballinasloe, Co., Galway H53 T971, Ireland
| | - H McLoughlin
- Respiratory Department, Portiuncula University Hospital, Ballinasloe, Co., Galway H53 T971, Ireland
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Nadeem I, Kennedy MP. Bronchiolitis Obliterans without Joint Disease. A rare non-articular manifestation of Rheumatoid Arthritis. Ir Med J 2018; 111:813. [PMID: 30547528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- I Nadeem
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - M P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
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