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2.
Gut ; 71:A4, 2022.
Article in English | EMBASE | ID: covidwho-2005336

ABSTRACT

Introduction Iron deficiency anaemia (IDA) can be a sign of serious underlying disease but often overlooked. Recently updated guidelines of the British Society of Gastroenterology (BSG) recommend male and postmenopausal female patients with IDA should be screened for coeliac disease and undergo dual endoscopy (or CT). Aims This project looked to assess current adherence to these guidelines at the Queen Elizabeth Hospital in Birmingham. Methods A retrospective audit was performed using health informatics for patients who attended AMU/CDU from April 2018 to March 2021. The number of patients with IDA in this time frame was identified. A further analysis of this group was made to determine the proportion of patients with IDA who had IgA TTG measured as well as those who had OGD and colonoscopy/CT colonoscopy requested. Results There were 67797 patients in this study period. 32422 (47.8%) were anaemic (Hb < 120g/dl for women, <130g/dl for men as per WHO guidelines) of which 6357 (19.6%;9.38% of total) had a microcytic anaemia (MCV <83 as per University Hospitals Birmingham laboratory reference range). Ferritin was tested in 3337 (52.5%) of this group, and of those, 1041 (31.2%) were found to have overt IDA (ferritin <30 mg/mL). Rate of investigation The patient cohort with confirmed IDA comprised 334 males (32.0%), 556 post-menopausal females (53.4%, defined as age ≥45) and 151 pre-menopausal females (14.5%). A further analysis was made to explore how male and postmenopausal female cases were investigated, and if the rate of investigation was affected by the COVID-19 pandemic from 1st March 2020 onwards in this subgroup. Results are shown in the table below. In general, only a minority of patients underwent further investigation with males more likely to undergo OGD than females. Surprisingly, apart from increased TTG check latterly, little difference was seen after onset of the COVID-19 pandemic. Conclusions This large-scale study found that only a small minority of patients with IDA underwent further investigation. Whilst the study period includes the pandemic era, our results don't suggest this made a significant impact on practice. Nevertheless, these findings indicate a strong need for increased awareness and quality improvement about optimising IDA investigation according to BSG guidelines.

4.
Journal of Crohn's and Colitis ; 16:i223-i232, 2022.
Article in English | EMBASE | ID: covidwho-1722313

ABSTRACT

Background: Vitamin D, a key regulator of immune response, is known to be lower in Inflammatory Bowel Disease (IBD) patients than the general population. Disparity in the incidence of deficiency between ethnic groups has previously been demonstrated. We measured vitamin D in a unique multi-ethnic inception cohort to correlate this with traditional IBD scores and patient reported outcome measures including the 'IBD Disk'. Methods: Data regarding demographics, ethnicity, faecal calprotectin (FCAL) and baseline blood results including Vitamin D was collected prospectively from January-October 2021, from adults presenting with suspected IBD. Montreal classification, Harvey-Bradshaw Index or Partial Mayo score, endoscopic disease severity indices and IBD Disk score were documented in those with confirmed diagnosis at endoscopy. Vitamin D deficiency was defined as <50nmol/l. Results: 179 patients had a Vitamin D level recorded;58 Ulcerative colitis (UC), 58 Crohn's disease (CD), 53 non-IBD controls and 10 still awaiting diagnosis. 44(76%) CD, 32(55%) UC and 28(53%) non-IBD control patients were Vitamin D deficient at first presentation. Median levels were lowest in CD, with a significant difference between CD and non-IBD (median 35nmol/l;IQR 24.05 vs. median 48.9nmol/l;IQR 49.1;p=0.004). Regression analysis demonstrated patients with Crohn's disease were four times more likely to have Vitamin D deficiency compared to UC (OR 4.08;95% CI 1.35-12.36) at diagnosis. No correlation was seen between absolute vitamin D levels or vitamin deficiency state and faecal calprotectin when controlled for various factors regardless of the IBD subtype. The cohort distributions are demonstrated in Figure 1. Within the IBD cohort, Vitamin D levels were significantly lower in Black or Asian patients vs White patients (median 28.5;IQR 20.85 vs median 43.3;IQR 33.95;p=0.004). Figure 2 provides an overview of the cohort distributions. Vitamin D levels at presentation, as demonstrated in Table 1, did not correlate with Disease activity markers (DAMS) whereas baseline haemoglobin did, albeit weakly. Interestingly, Vitamin D and Haemoglobin correlated without reaching statistical significance (Spearman's rho 0.149;p=0.08). Conclusion: Our inception dataset demonstrates high rates of Vitamin D deficiency comparable to prior studies in IBD patients. Both CD and Black or Asian ethnicity were strongly associated with Vitamin D deficiency. Baseline Vitamin D did not correlate with disease activity markers whereas anaemia showed consistent weak association. Our study demonstrates the problem of hypovitaminosis D and the importance of measurement and supplementation, particularly in Black and Asian CD patients, from diagnosis.

5.
Journal of Urology ; 206(SUPPL 3):e520-e521, 2021.
Article in English | EMBASE | ID: covidwho-1483623

ABSTRACT

INTRODUCTION AND OBJECTIVE: The pandemic has resulted in increased pressures on waiting times for elective cancer surgery due to significant cancellations during national lockdowns, which has adversely impacted on patient care. Treatment of patients with high-risk bladder cancer (HBC) is time-critical. They often also require adjunctive treatment following their index transurethral resection of bladder tumour (TURBT) including intravesical immunotherapy or cystectomy, thus any delays may result in disease progression and adverse outcomes. We conducted a service improvement project to prioritise patients with newly diagnosed HBC on the waiting list. METHODS: We collected data on all patients with newly diagnosed bladder tumours at the Haematuria Clinic from July 2020 to January 2021 at our District General Hospital, paying particular attention to the following parameters: time interval from flexible cystoscopy (FC) to TURBT;quality of bladder tumour assessment at diagnostic FC;differences in time interval between low-risk bladder cancer (LBC) and HBC. We excluded patients operated on in the emergency setting, those with equivocal findings at FC and those with recurrent bladder cancer. We developed a risk stratification tool based on the NICE guidelines, in order to help triage patients at the Haematuria Clinic into low-risk and high-risk with a view to expediting treatment for those with suspected HBC. On the waiting list request form, those with suspected HBC are listed as Category 2A, and those with low/ intermediate risk as Category 2B. RESULTS: 45 patients had newly diagnosed bladder tumours during that seven-month period. There was a male preponderance overall, with a median age of 73 in the low-risk group, 79.5 in the intermediate-risk and 71.5 in the high-risk group. 60% of patients were inadequately risk-stratified at the time of their index FC. The mean interval from FC to TURBT was 30 days in the low-risk group, 26 in the intermediate-risk group and 31 days in the high-risk group. CONCLUSIONS: A significant proportion of newly diagnosed bladder cancer patients were inadequately risk-stratified at FC. Moreover, patients with HBC are waiting just as long if not longer than patients with LBC disease for their TURBT. By designing and implementing a simple risk stratification tool to be used at the Haematuria Clinic we have prioritised those with suspected high-risk disease to the top of the waiting list in order to avoid delays and optimise their care. We currently await the outcome of a re-audit of our practice.

7.
Journal of Endoluminal Endourology ; 4(2):e20-e27, 2021.
Article in English | EMBASE | ID: covidwho-1355348

ABSTRACT

Introduction: Elective waiting lists have become more stretched because of the COVID-19 pandemic and patients have evidently been waiting longer for treatment. Patients with high-risk bladder cancer require timely treatment and there is strong evidence to suggest that delay in treatment contributes to a risk of disease progression, metastases and death. Studies have shown that bladder tumour appearances at flexible cystoscopy (FC) can accurately predict high-risk disease on histopathology following transurethral resection. An opportunity for service improvement resulted in a review of the practice followed by the authors and the development of a risk stratification tool for the haematuria clinic which aimed to prioritise the pathway of those with high-risk disease. Materials and methods: A risk stratification tool was developed for patients with newly diagnosed bladder tumours at the haematuria clinic. A tumour assessment carried out at FC is used to predict patients with high-risk disease, thus allowing those patients to be prioritised over those with low-risk disease on the waiting list. It also includes a reminder to request staging investigations for those with suspected high-risk disease. A closed loop audit was carried to review the following: the quality of tumour risk assessment at the haematuria clinic;time from FC to transurethral resection of bladder tumour (TURBT);concordance between tumour assessment at FC and histopathology after TURBT;efficiency of arranging early staging investigations for those with suspected high-risk bladder cancer;time from FC to staging CT scan. Results: A risk assessment was carried out for 93% of patients in the second cycle compared with 40% in the first cycle. Concordance was noted in 83% of those with confirmed high-risk non-muscle invasive bladder cancer (NMIBC) and 83% of muscle invasive bladder cancer (MIBC) in the first cycle, and in 100% of patients with high-risk NMIBC and MIBC in the second cycle. The interval from FC to TURBT decreased from 27 days in the first cycle to 21 days in the second cycle in those with high-risk NMIBC, and from 27 to 13 days in those with MIBC. Time from FC to staging CT for patients with high-risk bladder cancer was 6 days in the first cycle and 3 days in the second cycle if the request was made from the haematuria clinic. If the CT scan was requested later, the interval increased to 39 days in the first cycle and 22 days in the second cycle. Conclusion: There is a high degree of concordance between tumour risk assessment at FC and final pathology following TURBT which is supported by several series. Performing risk assessment and requesting staging investigations at the haematuria clinic for patients with newly diagnosed high-risk bladder cancer can minimise delays in their treatment pathway and improve patient outcomes.

8.
Current Research in Green and Sustainable Chemistry ; : 100114, 2021.
Article in English | ScienceDirect | ID: covidwho-1240271

ABSTRACT

The Covid-19 pandemic is a major catastrophe in recent times that has taken a toll over the global scale in terms of the casualties, economic impact, and human beings' lifestyle. Scientists and researchers worldwide are dedicated to counter this issue using large-scale drug discovery and analysis to explore both the vaccination and the cure for Covid-19. However, almost all of the tested medicinal options cover allopathic medicines. A major issue associated with the above approach is the side effects that present a lacuna in arriving at an agreeable solution. To date, there are a total of >150,000,000 Covid-19 cases have been reported. However, to date, there is no report available on the scope and application of natural medicines in the treatment of the Covid-19. This review aims to target this area while covering the economic and other impacts of the Covid-19 on human life, the significance of greener solutions in countering drug development, and the possible solutions of the Covid-19 using herbal drug treatment.

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