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Huntley CC, Patel K, Mughal AZ, Coelho S, Burge PS, Turner AM, Walters GI. Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis. Occup Environ Med 2023; 80:580-589. [PMID: 37640537 DOI: 10.1136/oemed-2022-108632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
The aetiology and pathophysiology of sarcoidosis is ill defined-current hypotheses centre on complex genetic-immune-environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81 aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis.
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Affiliation(s)
- Christopher C Huntley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ketan Patel
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - P Sherwood Burge
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth I Walters
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mughal AZ, Subramanian T, Jones R, James D, Ogboli M, Soccorso G. Evaluating the use of laparoscopic-assisted gastrostomy tube feeding in children with epidermolysis bullosa: A single-center retrospective study. J Pediatr Surg 2022; 57:39-44. [PMID: 34876295 DOI: 10.1016/j.jpedsurg.2021.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/21/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake compounded by mucosal fragility. Gastrostomy tube feeding is effective in improving nutritional status however there is limited data on the safety and tolerance of this technique in EB children. We aim to review the effectiveness and morbidity of our minimally invasive two-port laparoscopic-assisted gastrostomy (LAG) approach using Seldinger techniques with serial dilatations in children with EB. METHODS A retrospective, observational cohort study was conducted on all consecutive EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported. RESULTS 32 EB patients underwent LAG placement. Median age at insertion was 7.3 (IQR ± 6.3) years, with 8 (25.0%) and 3 (9.4%) of patients also undergoing oesophageal dilatation and fundoplication, respectively. Minor complications arose in 58.1% of patients including: peri-stomal overgranulation (25.8%), gastrostomy infection (22.6%), pain (22.6%), mild gastrostomy leakage (16.1%), blockage (9.7%) and device failure (3.2%). 2 patients (6.5%) developed major complications with extensive gastrostomy site leakage. Improvements in growth were reflected in mean height Z-scores (-1.99 to -1.71). Mean weight Z-scores improved in patients aged 0-10 years (-2.30 to -1.61) and mean BMI Z-scores increased in patients more than 10 years (-2.71 to -1.46). No cases of gastrostomy-related mortality were reported. CONCLUSION LAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain the long-term implications of gastrostomy feeding.
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Affiliation(s)
- Aishah Z Mughal
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
| | - Thejasvi Subramanian
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - Rosie Jones
- Department of Dietetics, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - Dawn James
- Department of Dermatology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - Malobi Ogboli
- Department of Dermatology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
| | - Giampiero Soccorso
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
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Huntley CC, Patel K, Bil Bushra SES, Mobeen F, Armitage MN, Pye A, Knight CB, Mostafa A, Kershaw M, Mughal AZ, McKemey E, Turner AM, Burge PS, Walters GI. Pulmonary function test and computed tomography features during follow-up after SARS, MERS and COVID-19: a systematic review and meta-analysis. ERJ Open Res 2022; 8:00056-2022. [PMID: 35642193 PMCID: PMC9035766 DOI: 10.1183/23120541.00056-2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background The COVID-19 pandemic follows severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remain unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19. Methods This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random-effects model) and proportion of CT features (Freeman-Tukey transformation random-effects model) were performed. Findings Persistent reduction in the diffusing capacity for carbon monoxide following SARS and COVID-19 infection is seen at 6 months follow-up, and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity, linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation are reported less often. Severe/critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/moderate infection. Interpretation Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome. It is yet to be determined if this is a regressive or progressive disease.
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Affiliation(s)
- Christopher C. Huntley
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK,Corresponding author: Christopher C. Huntley ()
| | - Ketan Patel
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | - P. Sherwood Burge
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK
| | - Gareth I. Walters
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell AM, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Brown S, Kawka M, Mclean K, Savva N, Wilkinson P, Sam AH, Singal A, Chia C, Chia W, Ganesananthan S, Ooi SZY, Pengelly S, Wellington J, Mak S, Subbiah Ponniah H, Heyes A, Aberman I, Ahmed T, Al-Shamaa S, Appleton L, Arshad A, Awan H, Baig Q, Benedict K, Berkes S, Citeroni NL, Damani A, de Sancha A, Fisayo T, Gupta S, Haq M, Heer B, Jones A, Khan H, Kim H, Meiyalagan N, Miller G, Minta N, Mirza L, Mohamed F, Ramjan F, Read P, Soni L, Tailor V, Tas RN, Vorona M, Walker M, Winkler T, Bardon A, Acquaah J, Ball T, Bani W, Elmasry A, Hussein F, Kolluri M, Lusta H, Newman J, Nott M, Perwaiz MI, Rayner R, Shah A, Shaw I, Yu K, Cairns M, Clough R, Gaier S, Hirani D, Jeyapalan T, Li Y, Patel CR, Shabir H, Wang YA, Weatherhead A, Dhiran A, Renney O, Wells P, Ferguson S, Joyce A, Mergo A, Adebayo O, Ahmad J, Akande O, Ang G, Aniereobi E, Awasthi S, Banjoko A, Bates J, Chibada C, Clarke N, Craner I, Desai DD, Dixon K, Duffaydar HI, Kuti M, Mughal AZ, Nair D, Pham MC, Preest GG, Reid R, Sachdeva GS, Selvaratnam K, Sheikh J, Soran V, Stoney N, Wheatle M, Howarth K, Knapp-Wilson A, Lee KS, Mampitiya N, Masson C, McAlinden JJ, McGowan N, Parmar SC, Robinson B, Wahid S, Willis L, Risquet R, Adebayo A, Dhingra L, Kathiravelupillai S, Narayanan R, Soni J, Ghafourian P, Hounat A, Lennon KA, Abdi Mohamud M, Chou W, Chong L, Graham CJ, Piya S, Riad AM, Vennard S, Wang J, Kawar L, Maseland C, Myatt R, Tengku Saifudin TNS, Yong SQ, Douglas F, Ogbechie C, Sharma K, Zafar L, Bajomo MO, Byrne MHV, Obi C, Oluyomi DI, Patsalides MA, Rajananthanan A, Richardson G, Clarke A, Roxas A, Adeboye W, Argus L, McSweeney J, Rahman-Chowdhury M, Hettiarachchi DS, Masood MT, Antypas A, Thomas M, de Andres Crespo M, Zimmerman M, Dhillon A, Abraha S, Burton O, Jalal AHB, Bailey B, Casey A, Kathiravelupillai A, Missir E, Boult H, Campen D, Collins JM, Dulai S, Elhassan M, Foster Z, Horton E, Jones E, Mahapatra S, Nancarrow T, Nyamapfene T, Rimmer A, Robberstad M, Robson-Brown S, Saeed A, Sarwar Y, Taylor C, Vetere G, Whelan MK, Williams J, Zahid D, Chand C, Matthews M. The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey. Med Teach 2022; 44:574-575. [PMID: 34428109 DOI: 10.1080/0142159x.2021.1962835] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Damir Rafi
- School of Medicine, Imperial College London, London, UK
| | - Sam Brown
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michal Kawka
- School of Medicine, Imperial College London, London, UK
| | - Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kenneth McLean
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amir H Sam
- School of Medicine, Imperial College London, London, UK
| | - Nicos Savva
- Division of Management Science and Operations, London Business School, London, UK
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- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - T Ball
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - W Bani
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Elmasry
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - F Hussein
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Kolluri
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - H Lusta
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Nott
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M I Perwaiz
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - R Rayner
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Shah
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - I Shaw
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - K Yu
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | | | | | - S Gaier
- Queen Mary University of London
| | | | | | - Y Li
- Queen Mary University of London
| | | | | | | | | | - A Dhiran
- St George's Hospital Medical School
| | - O Renney
- St George's Hospital Medical School
| | - P Wells
- St George's Hospital Medical School
| | | | - A Joyce
- The Queen's University of Belfast
| | | | | | - J Ahmad
- The University of Birmingham
| | | | - G Ang
- The University of Birmingham
| | | | | | | | - J Bates
- The University of Birmingham
| | | | | | | | | | - K Dixon
- The University of Birmingham
| | | | - M Kuti
- The University of Birmingham
| | | | - D Nair
- The University of Birmingham
| | | | | | - R Reid
- The University of Birmingham
| | | | | | | | - V Soran
- The University of Birmingham
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Soni
- The University of Cambridge
| | | | | | | | | | - W Chou
- The University of East Anglia
| | | | | | - S Piya
- The University of Edinburgh
| | | | | | - J Wang
- The University of Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - C Obi
- The University of Leicester
| | | | | | | | | | | | | | | | - L Argus
- The University of Manchester
| | | | | | | | | | | | | | | | | | | | | | | | | | - B Bailey
- University of Brighton and Sussex
| | - A Casey
- University of Brighton and Sussex
| | | | - E Missir
- University of Brighton and Sussex
| | - H Boult
- University of Exeter Medical School
| | - D Campen
- University of Exeter Medical School
| | | | - S Dulai
- University of Exeter Medical School
| | | | - Z Foster
- University of Exeter Medical School
| | - E Horton
- University of Exeter Medical School
| | - E Jones
- University of Exeter Medical School
| | | | | | | | - A Rimmer
- University of Exeter Medical School
| | | | | | - A Saeed
- University of Exeter Medical School
| | - Y Sarwar
- University of Exeter Medical School
| | - C Taylor
- University of Exeter Medical School
| | - G Vetere
- University of Exeter Medical School
| | | | | | - D Zahid
- University of Exeter Medical School
| | - C Chand
- University of Hull and the University of York
| | - M Matthews
- University of Hull and the University of York
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