Ulster Medical Journal最新文献

Introduction: The older population has been most affected by COVID-19, with mortality rates of around 27%. The Acute Care at Home (ACAH) team aims to improve outcomes in the older population by preventing hospital admission or facilitating early discharge, allowing patients to be treated in their own environment. During the COVID-19 pandemic, the ACAH team administered oxygen therapy, antibiotics, anticipatory medications and other vital interventions to combat the ill effects of COVID-19.

Method: An observational approach has been used in this study. Patients were included if they were admitted to ACAH during March-June 2020 for treatment of COVID-19. Biochemistry, oxygen saturations and co-morbidities are among the studied parameters. Lymphocyte count and serum magnesium were compared with a non-COVID-19 cohort. Trends within parameters and associated mortality were analysed and tabulated.

Results: 70% of admissions were lymphopenic, whilst 54% were hypoxic. There was a 28-day mortality rate of 35%, with an 18% increase in mortality rate when comparing residence in long-term care facilities (LTCF) to personal residence. All patients had existing co-morbidities.

Conclusion: The data indicates that hypoxaemia, hyperferritinaemia and hypermagnesaemia are associated with early mortality in the older population infected with COVID-19. National Early Warning Score and frailty score are predictive of mortality in this cohort, with higher scores correlating to worse outcomes. Those living in LTCF are at an increased risk of mortality. However, ACAH mortality rates are comparable to those admitted to hospital, validating the concept of ACAH. The highlighted trends can be used to improve outcomes in future admissions.

Antimicrobial resistance (AMR) has now emerged as a major global public health problem. Certain bacterial pathogens, particularly Gram negative organisms associated with patients with cystic fibrosis (CF), have become resistant to several classes of antibiotics resulting in pan-resistance, which creates a clinical treatment dilemma. This study wished to explore the production of antibacterial extracellular metabolites from plant pathogenic fungi. Fungal Culture Extracts (FCEs) were prepared from 10 fungi (Armillaria gallica, Clitocybe nebularis, Fusarium coeruleum, Fusarium oxysporum, Fusarium poae, Hymenoscyphus fraxineus, Nectria fuckeliana, Phytophthora infestans, Phytophthora ramorum, Postia placenta), which were tested for activity against the CF pathogens, Pseudomonas aeruginosa (PA) (n=8), Burkholderia cenocepacia (n=2) and Stenotrophomonas maltophilia (n=2). In addition, FCE were assessed for their ability to alter antibiotic susceptibility in PA (n=8), with six antipseudomonal antibiotics (ceftazidime, ciprofloxacin, colistin, meropenem, piperacillin/tazobactam, tobramycin). None of the FCEs showed inhibitory activity to the 12 bacterial isolates tested, with the exception of the FCE from Postia placenta, which showed inhibition against all 12 bacteria. An antagonistic interaction was observed, where a statistically significant decrease in mean zone sizes was noted with Armillaria gallica (p=0.03) and Phytophthora infestans (p=0.03) FCEs and their interaction with the fluoroquinolone antibiotic, ciprofloxacin. Given the increase in clinical morbidity and mortality associated with chronic lung infections with Pseudomonas aeruginosa, Burkholderia cenocepacia and Stenotrophomonas maltophilia, coupled with the difficulty in treating such chronic infection due to overwhelming antimicrobial resistance, any novel substance showing inhibition of these organisms merits further investigation as a potential future antimicrobial agent, with potential clinical therapeutic application.

Background: During the COVID-19 pandemic of Spring 2020, Belfast City Hospital functioned as Belfast's Nightingale facility. Evidence published during this time focused mainly on the acute management of the condition. Guidance on follow up and long-term management for patients recovering from COVID-19 was sparse. A specialist COVID-19 follow up service was devised in Belfast City Hospital led by a respiratory physician with physiotherapy and psychology input.

Methods: Data was collected on all patients admitted to Belfast Nightingale unit. Patients admitted to Intensive Care at any stage in their admission were followed up separately by Intensive Care. Initial consultation was via telephone call for all eligible patients six weeks post discharge, followed by face-to-face consultation for those with symptoms at next available appointment, and a further face-to-face consultation at twelve weeks post hospital discharge. Patients were seen by respiratory physician, physiotherapy and psychology at each appointment. All patients who had initial changes on chest radiograph had 12 week follow up radiograph requested as per British Thoracic Society guidelines.

Results: 29 patients were followed up after hospitalisation with COVID-19. Of these, 10 were brought for face-to-face consultations. Patients at clinic were all functionally independent with a median Medical Research Council dyspnoea score of 2 and a subjective assessment of their current health of median 50, on a visual analogue scale 0-100. Fatigue was common with all patients. Depression, anxiety and post-traumatic stress disorder were all reported from psychological review. Chest radiograph showed signs of improvement in 100% of clinic attendees. 90% of patients seen in clinic had normal or chronic obstructive patterns on spirometry, with one patient having a reduced transfer factor.

Conclusion: Majority of patients did not require face-to-face review and were recovering well. Of the 10 patients seen in the respiratory led clinic, the main issues reported were fatigue and psychological issues. Respiratory symptoms were significantly improving in 9 out of the 10 patients seen. All patients have been introduced to psychology service whilst at clinic and will continue to receive necessary support.