Knowledge Hub @ Bedfordshire Hospitals NHS FT
The Knowledge Hub, managed by the Danielle Freedman Library is a digital repository - a central location for Bedfordshire Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.
The Knowledge Hub replaces the academic report previously published by Research & Development.
Some items are added to the repository automatically by the library team, if you do not find your item or you would like more information about submitting your work to the Knowledge Hub please contact library@ldh.nhs.uk
Recent Submissions
Item Predicting COVID‐19 infection risk in lymphoma by immune monitoring.(2023-06)ntroduction: Patients with B‐cell lymphoma have poorer antibody responses to COVID‐19 vaccines compared to patients with other malignancies. However, the immune responses are heterogeneous and its association with clinical outcomes are poorly understood. Here, we study the association between antibody and cellular re sponses with the outcomes from COVID‐19 infection from the PROSECO study. Methods: THE UK PROSECO study is a prospective observational cohort study evaluating COVID‐19 vaccine response in people with lymphoma. Peripheral blood antibody titres (anti‐spike (S) IgG by Mesoscale Discovery), antibody avidity (surface plasmon resonance) and IFNγ T‐cell responses (ELISpot) against spike protein after two to four COVID‐19 vaccines, and clinical outcomes data were collected. Results: 524 patients (92 Hodgkin lymphoma, 180 aggressive B non‐ Hodgkin lymphoma (B‐NHL), 234 indolent B‐NHL and 18 peripheral T‐cell lymphoma) were included: 334 (84·3%), 315 (79·5%) and 266 (67·1%) participants were eligible for post‐two, three and four vac cine dose analysis, respectively. Breakthrough infections (BTI) occurred in 20 (5.9%), 40 (12.7%) and 36 (13.5%) participants after two, three and four vaccine doses. Of 96 participants with BTI, 12 (12.5%) needed hospitalisation. No deaths were observed due to COVID‐19 infection. No differences were observed in T‐cell re sponses between BTI and non‐BTI groups, but 4/9 (44.5%) hospital ised BTI cases had undetectable cellular and antibody responses. There was no association between antibody titres and infection ep isodes after two vaccine doses, but antibody titres were associated with lower BTI risk after three or four vaccine doses on multivariable analysis. Intriguingly, the antibody threshold associated with infec tion risk was lower after four than three vaccine doses (41 vs. 820 BAU/mL). We also observed stronger antibody binding avidity to SARS‐CoV‐2 spike receptor‐binding domain (RBD) proteins from Wuhan and Omicron BQ.1 variants, with increasing vaccine doses, i. e., fourth versus third dose: 10‐fold increase (p: <0.01); fourth versus second dose:100‐fold‐increase than the second dose (p: <0.0001) (see Figure). Conclusion: Anti‐S antibody titres can predict the risk of COVID‐19 infection after three or more vaccine doses in patients with lym phoma. Repeated COVID‐19 vaccination drives antibody affinity maturation and consequently improves the strength of antibody binding to virus spike proteins. Nearly half of participants who required hospitalisation for COVID‐19 had undetectable antibody and cellular immunity to vaccination. Altogether, these data show the importance of booster vaccine doses and immune monitoring post COVID‐19 vaccination to identify lymphoma patients who still continue to be at risk from severe COVID‐19, and thus the best prophylactic and therapeutic strategies. 606 - SUPPLEMENT ABSTRACTS The research was funded by: the Blood Cancer UK Vaccine Research Collaborative, which is led by Blood Cancer UK in partnership with Myeloma UK, Anthony Nolan and the British Society for Haematol ogy; a Cancer Research UK Advanced Clinician Scientist Fellowship to SH Lim; Cancer Research UK/National Institute for Health Research (NIHR) Southampton Experimental Cancer Medicine Cen ter; NIHR Southampton Clinical Research Facility (Southampton Research Biorepository) and NIHR Southampton Biomedical Research Center; NIHR Great Ormond Street Biomedical Research Center and the NIHR Oxford Biomedical Research Center and CRUK Experimental Cancer Medicines Center.Item Pre-op localisation of impalpable breast lesions with a radiofrequency identifier device (RFID)(2023-05)Impalpable breast lesions are traditionally localised with a wire to facilitate surgical removal. This method of localisation is associated with a number of logistical problems, the main one being the requirement to do the localisation on the day of surgery. More recently, a number of non-wire techniques have been introduced. We evaluated the performance of a RFID (LOCalizerTM) in this context.Item A case study experience of natrox wound oxygen therapy: Should this be part of regular conservative wound management in diabetic foot ulcer?(2023)A 46 year old gentleman, with history of type 2 diabetes, diagnosed 11 years ago, presented with new onset right 14645491, 2023, S1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/dme.15048 by Test, Wiley Online Library on [11/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License | CLINICAL CARE AND OTHER CATEGORIES POSTERS: CASE REPORTS 101 of 185 foot ulcer with black discoloration of dorsum of foot, in volving the fourth toe and 4/5th web space. He was diag nosed with ascending cellulitis and superficial gangrene with non-viable right fourth toe. After he was seen by diabetes foot multidisciplinary team (MDT), the patient underwent surgical debridement of ulcer and fourth right toe amputation. CT angiogram right lower limb showed tight stenosis distally of the right pop liteal with multilevel disease and angioplasty was done. MDT suggested for trans-metatarsal amputation which he declined. He opted for conservative management. He had maggot therapy followed by Natrox wound oxygen therapy. He was discharged on vacuum assisted closure dressing. Follow up appointments showed significant im provement with wound healing. This case study showed a favourable outcome of diabetic foot ulcer where Natrox was used. This device delivers up to 98% of humidified oxygen directly to wound bed;stimu lating wound healing. Recent NICE guidance summarises Natrox therapy is beneficial as adjunct therapy in grade II/III diabetic foot ulcers. Our local centre has limited use of this. We propose increased usage of Natrox oxygen therapy as an adjunct to other conservative measures to augment wound healing. This will need further educa tion, funding and reports of its usage in multiple centres.Item Safety and efficacy of Sinopharm vaccine (BBIBP-CorV) in elderly population of Faisalabad district of Pakistan(2023-06)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.Item Pulmonary hypertension, pulmonary embolism and COVID-19: A district general hospital experience from the UK(2023-01)Background: 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. 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 COVID-19 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 COVID-19.
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