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Tsakok MT, Watson RA, Lumley SF, Khan F, Qamhawi Z, Lodge A, Xie C, Shine B, Matthews P, Jeffery K, Eyre DW, Benamore R, Gleeson F. Parenchymal involvement on CT pulmonary angiography in SARS-CoV-2 Alpha variant infection and correlation of COVID-19 CT severity score with clinical disease severity and short-term prognosis in a UK cohort. Clin Radiol 2021; 77:148-155. [PMID: 34895912 PMCID: PMC8608596 DOI: 10.1016/j.crad.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 01/08/2023]
Abstract
AIM To determine if there is a difference in radiological, biochemical, or clinical severity between patients infected with Alpha-variant SARS-CoV-2 compared with those infected with pre-existing strains, and to determine if the computed tomography (CT) severity score (CTSS) for COVID-19 pneumonitis correlates with clinical severity and can prognosticate outcomes. MATERIALS AND METHODS Blinded CTSS scoring was applied to 137 hospital patients who had undergone both CT pulmonary angiography (CTPA) and whole-genome sequencing of SARS-CoV-2 within 14 days of CTPA between 1/12/20–5/1/21. RESULTS There was no evidence of a difference in imaging severity on CTPA, viral load, clinical parameters of severity, or outcomes between Alpha and preceding variants. CTSS on CTPA strongly correlates with clinical and biochemical severity at the time of CTPA, and with patient outcomes. Classifying CTSS into a binary value of “high” and “low”, with a cut-off score of 14, patients with a high score have a significantly increased risk of deterioration, as defined by subsequent admission to critical care or death (multivariate hazard ratio [HR] 2.76, p<0.001), and hospital length of stay (17.4 versus 7.9 days, p<0.0001). CONCLUSION There was no evidence of a difference in radiological severity of Alpha variant infection compared with pre-existing strains. High CTSS applied to CTPA is associated with increased risk of COVID-19 severity and poorer clinical outcomes and may be of use particularly in settings where CT is not performed for diagnosis of COVID-19 but rather is used following clinical deterioration.
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Affiliation(s)
- M T Tsakok
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK.
| | - R A Watson
- Weatherall Institute of Molecular Medicine, Oxford, Oxfordshire, UK
| | - S F Lumley
- Department of Clinical Medicine, University of Oxford Nuffield Oxford, Oxfordshire, UK; NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, London, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - F Khan
- Oxford Medical School, Oxford, Oxfordshire, UK
| | - Z Qamhawi
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - A Lodge
- Oxford Medical School, Oxford, Oxfordshire, UK
| | - C Xie
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
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- Department of Clinical Medicine, University of Oxford Nuffield Oxford, Oxfordshire, UK
| | - B Shine
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - P Matthews
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - K Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - D W Eyre
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - R Benamore
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
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Tsakok MT, Qamhawi Z, Lumley SF, Xie C, Matthews P, Gleeson F, Benamore R. COVID-19 CT pulmonary angiogram examinations and reported pulmonary embolism incidence: comparison between peak first wave and early second wave. Clin Radiol 2021; 76:310-312. [PMID: 33610286 PMCID: PMC7862906 DOI: 10.1016/j.crad.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Affiliation(s)
- M T Tsakok
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Z Qamhawi
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S F Lumley
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - C Xie
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - P Matthews
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - F Gleeson
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Benamore
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Chetan MR, Tsakok MT, Shaw R, Xie C, Watson RA, Wing L, Peschl H, Benamore R, MacLeod F, Gleeson FV. Chest CT screening for COVID-19 in elective and emergency surgical patients: experience from a UK tertiary centre. Clin Radiol 2020; 75:599-605. [PMID: 32593409 PMCID: PMC7301066 DOI: 10.1016/j.crad.2020.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
AIM To determine the incidence of possible COVID-19-related lung changes on preoperative screening computed tomography (CT) for COVID-19 and how their findings influenced decision-making. To also to determine whether the patients were managed as COVID-19 patients after their imaging findings, and the proportion who had SARS-CoV2 reverse transcriptionpolymerase chain reaction (RT-PCR) testing. MATERIALS AND METHODS A retrospective study was undertaken of consecutive patients having imaging prior to urgent elective surgery (n=156) or acute abdominal imaging (n=283). Lung findings were categorised according to the British Society of Thoracic Imaging (BSTI) guidelines. RT-PCR testing, management, and outcomes were determined from the electronic patient records. RESULTS 3% (13/439) of CT examinations demonstrated findings of classic/probable COVID-19 pneumonia, whilst 4% (19/439) had findings indeterminate for COVID-19. Of the total cohort, 1.6% (7/439) subsequently had confirmed RT-PCR-positive COVID-19. Importantly, all the patients with a normal chest or alternative diagnoses on CT who had PCR testing within the next 7 days, had a negative RT-PCR (92/407). There was a change in surgical outcome in 6% (10/156) of the elective surgical cohort with no change to surgical management was demonstrated in the acute abdominal emergency cohort requiring surgery (2/283). CONCLUSION There was a 7% (32/439) incidence of potential COVID-19-related lung changes in patients having preoperative CT. Although this altered surgical management in the elective surgical cohort, no change to surgical management was demonstrated in the acute abdominal emergency cohort requiring surgery.
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Affiliation(s)
- M R Chetan
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - M T Tsakok
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK.
| | - R Shaw
- Department of Clinical Infection, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - C Xie
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - R A Watson
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - L Wing
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - H Peschl
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - R Benamore
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - F MacLeod
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK
| | - F V Gleeson
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 HDU, UK; Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
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Ominde M, Sande J, Ooko M, Bottomley C, Benamore R, Park K, Ignas J, Maitland K, Bwanaali T, Gleeson F, Scott A. Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya. PLoS One 2018; 13:e0200715. [PMID: 30044834 PMCID: PMC6059459 DOI: 10.1371/journal.pone.0200715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/15/2017] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability and reliability of paediatric CXR interpretation using percent agreement and Cohen's Kappa and the validity of field readings against expert review in a study of the impact of PCV on pneumonia. METHODS CXRs were obtained from 2716 children admitted between 2006 and 2014 to Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians and radiologists attended a three-day training course on CXR interpretation using a WHO standard. All CXRs were read once by two local primary readers. Discordant readings and 13% of concordant readings were arbitrated by a panel of three expert radiologists. To assess repeatability, a 5% median random sample was presented twice. Sensitivity and specificity of the primary readers' interpretations was estimated against the 'gold-standard' of the arbitrators' results. RESULTS Of 2716 CXRs, 2 were uninterpretable and 159 were evaluated twice. The percent agreement and Kappa for RCP were 89% and 0.68 and ranged between 84-97% and 0.19-0.68, respectively, for all pathological findings. Intra-observer repeatability was similar to inter-observer reliability. Sensitivities of the primary readers to detect RCP were 69% and 73%; specificities were 96% and 95%. CONCLUSION Intra- and inter-observer agreements on interpretations of radiologically-confirmed pneumonia are fair to good. Reasonable sensitivity and high specificity make radiologically-confirmed pneumonia, determined in the field, a suitable measure of relative vaccine effectiveness.
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Affiliation(s)
- M. Ominde
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Aga Khan University Hospital, Nairobi, Kenya
| | - J. Sande
- Aga Khan University Hospital, Nairobi, Kenya
| | - M. Ooko
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - C. Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - R. Benamore
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
| | - K. Park
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
| | - J. Ignas
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - K. Maitland
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Imperial College, London, United Kingdom
| | - T. Bwanaali
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - F. Gleeson
- Oxford University Hospitals Foundation NHS Trust, Oxford, United Kingdom
- Oxford University, Oxford, United Kingdom
| | - A. Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Oxford University, Oxford, United Kingdom
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Fraser E, Blirando K, St.Noble V, Benamore R, Hoyles R, Benlahrech A, Ho LP. S50 Monocytes from IPF patients show pre-conditioned pro-repair features. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kendrick YK, Repapi E, Helm E, Cole SL, Hoyles R, Benamore R, Ho LP. P39 CTAS – a ct score to quantify disease activity in pulmonary sarcoidosis. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.182] [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: 11/03/2022]
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Fraser E, Noble VS, Benamore R, Hoyles R, Ho LP. P284 Identifying patients at risk of acute exacerbation of ipf using the cpi score. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.427] [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: 11/04/2022]
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Kendrick YR, Helm EJ, Benamore R, Ho LP. S96 A combination score of raised sACE, lymphopenia and hypergammaglobulinaemia correlates with active disease on thoracic CT scan of patients with pulmonary sarcoidosis. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.433] [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: 11/04/2022]
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Rahman NM, Singanayagam A, Davies HE, Wrightson JM, Mishra EK, Lee YCG, Benamore R, Davies RJO, Gleeson FV. Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound. Thorax 2010; 65:449-53. [DOI: 10.1136/thx.2009.128496] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Taylor WRJ, Burhan E, Wertheim H, Soepandi PZ, Horby P, Fox A, Benamore R, de Simone L, Hien TT, Chappuis F. Avian influenza--a review for doctors in travel medicine. Travel Med Infect Dis 2010; 8:1-12. [PMID: 20188299 PMCID: PMC7106094 DOI: 10.1016/j.tmaid.2009.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Received: 10/29/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/29/2022]
Abstract
First identified in humans in Hong Kong, influenza A/H5N1, known commonly as avian influenza, has caused human disease in 15 countries around the world. Although the current number of confirmed patients is tiny compared to seasonal and the recently emerged H1N1 'swine' influenza, H5N1 remains a candidate for the next highly pathogenic influenza pandemic. Currently, H5N1 has very limited ability to spread from person-to-person but this may change because of mutation or reassortment with other influenza viruses leading to an influenza pandemic with high mortality. If this occurs travellers are likely to be affected and travel medicine doctors will need to consider avian influenza in returning febrile travellers. The early clinical features may be dismissed easily as 'the flu' resulting in delayed treatment. Treatment options are limited. Oral oseltamivir alone has been the most commonly used drug but mortality remains substantial, up to 80% in Indonesia. Intravenous peramivir has been filed for registration and IV zanamivir is being developed. This review will focus on the epidemiological and clinical features of influenza A/H5N1 avian influenza and will highlight aspects relevant to travel medicine doctors.
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Affiliation(s)
- W R J Taylor
- Oxford University Clinical Research Unit, National Institute for Infectious and Tropical Medicine, 78 Giai Street, Hanoi, Viet Nam.
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Abstract
This report describes the results from a study of thoracic radiographs taken on a sample (n = 20) of pet macaque monkeys (Macaca) on the Indonesian island of Sulawesi. We present findings relating to general thoracic health, as well as describe our field methods and outline some of the challenges of conducting thoracic radiography in remote areas of the developing world. Examination of the radiographic images identified six possible cases of cardiac enlargement, and one case of minor lung consolidation possibly consistent with tuberculosis. The study did not identify major radiographic evidence of significant respiratory illness in the monkeys as might be expected based on the intense exposure to human respiratory diseases. These largely negative findings may be in part a consequence of image quality which seems to be influenced by power output and incomplete inspiration during film exposure.
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Affiliation(s)
- Michael A Schillaci
- Department of Social Sciences, University of Toronto Scarborough, Toronto, ON, Canada.
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Park AJ, Scerri GV, Benamore R, McDiarmid JG, Lamberty BG. What do plastic surgeons do? J R Coll Surg Edinb 1998; 43:189-93. [PMID: 9654882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The image of plastic surgery as portrayed by the media is of concern to all plastic surgeons. In order to assess knowledge about the specialty, a questionnaire was devised and given to five groups of participants: general practitioners, medical students, nurses, plastic surgical out-patient attendees, and the general public. The results revealed that general practitioners, nurses and medical students in the Cambridge area are, on the whole, knowledgeable about the role of plastic surgery. However, the general public are not so well educated and 23.7% of them could not think of five conditions treated by plastic surgeons, and felt that burns and cosmetic problems were the commonest conditions dealt with. Improved liaison with general practitioners, other specialties and more teaching of undergraduates, coupled with more effective promotion of the skills on offer might permit better use to be made of the specialty.
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Affiliation(s)
- A J Park
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, UK
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