Barts Health NHS Trust

About: Barts Health NHS Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 3483 authors who have published 3807 publications receiving 81829 citations.

Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns

Abstract: The worldwide impact of COVID 19 continues to be felt as hospitals in all countries reduce elective and non-urgent cases to allow staffing and resources to be deployed elsewhere. Urgent gynaecological and cancer procedures are continuing, and it is imperative all theatre staff are protected and risks of SARS-CoV-2 viral transmission reduced when operating on asymptomatic, suspected or confirmed COVID 19 patients. In particular, there are concerns relating to the transmission of COVID 19 during gynaecological laparoscopic surgery, arising from the potential generation of SARS-CoV-2 contaminated aerosols from CO2 leakage and the creation of smoke from the use of energy devices. The aim of this paper is to review all the up to date evidence, including experiences from China and Italy, to guide the safe management of such patients when undergoing gynaecological procedures.

COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies

Abstract: Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated cardiac injury has been postulated secondary to several mechanisms. While tissue diagnosis is limited during the acute illness, postmortem studies can help boost our understanding and guide management. Objective: To report the cardiac tissue autopsy findings in coronavirus disease 2019 (COVID-19) decedents. Evidence Review: Articles published in PubMed and Embase reporting postmortem cardiac pathology of COVID-19 decedents till September 2020. We included adult studies excluding preprints. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports was used to assess quality. We extracted gross and histology data as well as the incidence of myocarditis, cardiac ischemia, thrombosis, and dilatation. We also looked at the reported cause of death (PROSPERO registration CRD42020190898). Findings: Forty-one relevant studies identified including 316 cases. The deceased were mostly male (62%) and elderly (median age, 75; range, 22-97 years). The most common comorbidities were hypertension (48%) and coronary artery disease (33%). Cardiac pathologies contributed to the death of 15 cases. Besides chronic cardiac pathologies, postmortem examination demonstrated cardiac dilatation (20%), acute ischemia (8%), intracardiac thrombi (2.5%), pericardial effusion (2.5%), and myocarditis (1.5%). SARS-CoV-2 was detected within the myocardium of 47% of studied hearts. Conclusions and Relevance: SARS-CoV-2 can invade the heart, but a minority of cases were found to have myocarditis. Cardiac dilatation, ischemia, mural, and microthrombi were the most frequent findings. The systematic review was limited by the small number of cases and the quality of the studies, and there is a need to standardize the cardiac postmortem protocols.

Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging.

Abstract: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10-20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities-IVUS and OCT-and discuss the expected potential of the novel hybrid IVUS-OCT catheter system in the clinical field.

Endometrial Carcinoma, Grossing and Processing Issues: Recommendations of the International Society of Gynecologic Pathologists.

Abstract: Endometrial cancer is the most common gynecologic neoplasm in developed countries; however, updated universal guidelines are currently not available to handle specimens obtained during the surgical treatment of patients affected by this disease. This article presents recommendations on how to gross and submit sections for microscopic examination of hysterectomy specimens and other tissues removed during the surgical management of endometrial cancer such as salpingo-oophorectomy, omentectomy, and lymph node dissection-including sentinel lymph nodes. In addition, the intraoperative assessment of some of these specimens is addressed. These recommendations are based on a review of the literature, grossing manuals from various institutions, and a collaborative effort by a subgroup of the Endometrial Cancer Task Force of the International Society of Gynecological Pathologists. The aim of these recommendations is to standardize the processing of endometrial cancer specimens which is vital for adequate pathological reporting and will ultimately improve our understanding of this disease.

Outcomes in UK patients with hospital-acquired bacteraemia and the risk of catheter-associated urinary tract infections

Abstract: Purpose There is lack of contemporary outcome data on patients with hospital-acquired infections that cause bacteraemia. We determined the risk factors for 7-day mortality and investigated the hypothesis that, compared with central venous catheter (CVC)-associated bacteraemic infections, catheter-associated bacteraemic urinary tract infections (UTIs) were significantly associated with 7-day mortality. Methods From October 2007 to September 2008, demographical, clinical and microbiological data were collected on patients with hospital-acquired bacteraemia. Patients were followed until death, hospital discharge or recovery from infection. Risk factors for 7-day mortality were determined and multivariate logistic regression was used to define the association between catheter-associated bacteraemic UTIs and likelihood of death. Results 559 bacteraemic episodes occurred in 437 patients. Overall, there were 90 deaths (20.6%) at 7 days and 153 deaths (35.0%) at 30 days. Among patients with catheter-associated bacteraemic UTIs, 7-day and 30-day mortalities associated with each bacteraemic episode were 25/83 (30.1%) and 33/83 (39.8%), respectively. Within this subgroup, the commonest isolates were Escherichia coli , 36 (43.4%), Proteus mirabilis , 11 (13.3%) and Pseudomonas aeruginosa , 9 (10.8%). There were 22 (26.5%) multiple drug-resistant isolates and, of the E coli infections, 6 (16.7%) were extended spectrum β-lactamase producers. In univariate analysis, the variables found to have the strongest association with 7-day mortality were age, Pitt score, Charlson comorbidity index (CCI), medical speciality and site of infection. Compared with CVC-associated bacteraemic infections, there was a significant association between catheter-associated bacteraemic UTIs and 7-day mortality (OR 4.16, 95% CI 1.86 to 9.33). After adjustment for age and CCI, this association remained significant (OR 2.90, 95% CI 1.19 to 7.07). Conclusions Compared with CVC-associated bacteraemic infections, catheter-associated bacteraemic UTIs were significantly associated with 7-day mortality. Efforts to reduce these infections should be prioritised.