Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study

BACKGROUND

Various complications have been reported in patients with COVID-19 including pneumomediastinum.

METHODS

The primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum. We undertook an observational, retrospective, single-centre, cohort study of patients with COVID-19 admitted to Northwick Park Hospital.

RESULTS

74 patients in the first wave and 220 patients in the second wave met the study criteria. Two patients during the first wave and eleven patients during the second wave developed pneumomediastinum.

CONCLUSIONS

The incidence of pneumomediastinum changed from 2.7% during the first wave to 5% during the second wave and this change was not statistically significant (p value 0.4057). The difference in mortality rates of patients with pneumomediastinum in both waves of COVID-19 (69.23%) versus patients without pneumomediastinum in both waves of COVID-19 (25.62%) was statistically significant (p value 0.0005). Many patients with pneumomediastinum were ventilated, which could be a confounding factor. When controlling for ventilation, there was no statistically significant difference in the mortality rates of ventilated patients with pneumomediastinum (81.81%) versus ventilated patients without pneumomediastinum (59.30%) (p value 0.14).

A genome-led study on the pathogenesis of Fusobacterium necrophorum infections

Fusobacterium necrophorum causes a range of mild to life threatening infections and there is uncertainty in terms of diagnosis and treatment due to the lack of knowledge on their pathogenic mechanisms. This study characterised genomes of F. necrophorum to compare their virulence factors and investigate potential infection markers. 27 isolates of F. necrophorum from patients with pharyngotonsillitis were subjected to whole genome sequencing and compared with 42 genomes published in the NCBI database. Phylogenomics, pangemome, pan-GWAS and virulome were analysed to study strain variations with reference to virulence factors. Core genome based phylogenomic tree exhibited three clades of which Clade A belonged to F. necrophorum subsp necrophorum, clades B and C were F. necrophorum subsp funduliforme. Pan-GWAS and Pan-Virulome suggest some marker genes associated with clinical sources of isolation that needs further validation. Our study highlights some interesting features of the pathogenesis of F. necrophorum infections. Although the animal isolate genomes had some marker genes, the genomes of human isolates did not exhibit clear correlation to their clinical sources of isolation. This prompts to think of other mechanisms such as co-infections or host factors that can be involved in the pathogenesis.

Pneumomediastinum in patients with COVID-19 undergoing CT pulmonary angiography: a retrospective cohort study

BACKGROUND

Various complications have been reported in patients with COVID-19 including pneumomediastinum.

METHODS

The primary objective of the study was to determine the incidence of pneumomediastinum in COVID-19 positive patients who underwent CT pulmonary angiography (CTPA). The secondary objectives were to analyse if the incidence of pneumomediastinum changed between March and May 2020 (peak of the first wave in the UK) and January 2021 (peak of the second wave in the UK) and to determine the mortality rate in patients with pneumomediastinum. We undertook an observational, retrospective, single-centre, cohort study of patients with COVID-19 admitted to Northwick Park Hospital.

RESULTS

74 patients in the first wave and 220 patients in the second wave met the study criteria. Two patients during the first wave and eleven patients during the second wave developed pneumomediastinum.

CONCLUSIONS

The incidence of pneumomediastinum changed from 2.7% during the first wave to 5% during the second wave and this change was not statistically significant (p value 0.4057). The difference in mortality rates of patients with pneumomediastinum in both waves of COVID-19 (69.23%) versus patients without pneumomediastinum in both waves of COVID-19 (25.62%) was statistically significant (p value 0.0005). Many patients with pneumomediastinum were ventilated, which could be a confounding factor. When controlling for ventilation, there was no statistically significant difference in the mortality rates of ventilated patients with pneumomediastinum (81.81%) versus ventilated patients without pneumomediastinum (59.30%) (p value 0.14).

Cybersecurity, Data Privacy and Blockchain: A Review

In this paper, we identify and review key challenges to bridge the knowledge-gap between SME’s, companies, organisations, businesses, government institutions and the general public in adopting, promoting and utilising Blockchain technology. The challenges indicated are Cybersecurity and Data privacy in this instance. Additional challenges are set out supported by literature, in researching data security management systems and legal frameworks to ascertaining the types and varieties of valid encryption, data acquisition, policy and outcomes under ISO 27001 and the General Data Protection Regulations. Blockchain, a revolutionary method of storage and immutability, provides a robust storage strategy, and when coupled with a Smart Contract, gives users the ability to form partnerships, share information and consent via a legally-based system of carrying out business transactions in a secure digital domain. Globally, ethical and legal challenges significantly differ; consent and trust in the public and private sectors in deploying such defensive data management strategies, is directly related to the accountability and transparency systems in place to deliver certainty and justice. Therefore, investment and research in these areas is crucial to establishing a dialogue between nations to include health, finance and market strategies that should encompass all levels of society. A framework is proposed with elements to include Big Data, Machine Learning and Visualisation methods and techniques. Through the literature we identify a system necessary in carrying out experiments to detect, capture, process and store data. This includes isolating packet data to inform levels of Cybersecurity and privacy-related activities, and ensuring transparency demonstrated in a secure, smart and effective manner.