Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
ObjectiveTo investigate the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term.SettingHomerton University Hospital, an inner-city district general hospital in East London.DesignA single-centre retrospective observational study.ParticipantsAll adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital from 4 February 2020 to 30 April 2020 (n=402).Outcome measuresWe analysed demographic and biochemical data collected from the patient record according to the primary outcome of death at 28 days during hospital admission.MethodsTroponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5 ng/L for females, >34 ng/L for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death.ResultsMean age was 65.3 years for men compared with 63.8 years for women. A χ2 test showed survival of patients with COVID-19 was significantly higher in those with a negative troponin (p=3.23×10−10) compared with those with a positive troponin. In the multivariate logistical regression, lung disease, age, troponin positivity and continuous positive airway pressure were all significantly associated with death, with an area under the curve of 0.889, sensitivity of 0.886 and specificity of 0.629 for the model. Within this model, troponin positivity was independently associated with short-term mortality (OR 2.97, 95% CI 1.34 to 6.61, p=0.008).ConclusionsWe demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital.
The global disparity of magnetic resonance imaging (MRI) is a major challenge, with many low‐ and middle‐income countries (LMICs) experiencing limited access to MRI. The reasons for limited access are technological, economic and social. With the advancement of MRI technology, we explore why these challenges still prevail, highlighting the importance of MRI as the epidemiology of disease changes in LMICs. In this paper, we establish a framework to develop MRI with these challenges in mind and discuss the different aspects of MRI development, including maximising image quality using cost‐effective components, integrating local technology and infrastructure and implementing sustainable practices. We also highlight the current solutions—including teleradiology, artificial intelligence and doctor and patient education strategies—and how these might be further improved to achieve greater access to MRI.
Objective: We performed a single-centre retrospective observational study investigating the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term. Methods: All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital (HUH) from 04.02.20 to 30.04.20 were eligible for inclusion. We retrospectively analysed demographic and biochemical data collected from the physical and electronic patient records according to the primary outcome of death at 28 days during hospital admission. Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5ng/l for females, >34 ng/l for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death. Results: Mean length of stay for all 402 hospitalised COVID-19 patients at HUH was 9.1 days (SD 12.0). Mean age was 65.3 years for men compared to 63.8 years for women. A chi-squared test showed that survival of COVID-19 patients was significantly higher in those with a negative troponin (p = 3.23 x10-10) compared to those with a positive troponin. In the multivariate logistical regression, lung disease, age, troponin positivity and CPAP were all significantly associated with death, with an AUC of 0.8872, sensitivity of 0.9004 and specificity of 0.6292 for the model. Within this model, troponin positivity was independently associated with short term mortality (OR 3.23, 95% CI 1.53-7.16, p=0.00278). Conclusions: We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital.
Current NICE guidance recommends CT coronary angiography (CTCA) as first line for investigation of new onset stable chest pain, however; CTCA is not yet readily available in all UK centres. DSE remains recommended in current ESC guidance and provides a readily available, low cost alternative (1). Indeed, a negative test has been demonstrated to have an excellent negative predictive value in the region of >98% (2). Aim We sought to evaluate the rate of cardiac events within two years of a negative DSE. Methods We performed a retrospective data interrogation of all DSE's performed in the Mater Hospital Cardiac Investigations Department between 2017 and 2019. MACE was evaluated at two years. Data were extracted using local electronic healthcare records. Statistical analysis performed using SPSS software.Results 302 DSE's were performed during the study period. The mean age was 64.1±10.4years with 41.7% male. Of the population, 16.2% had a prior history of IHD with 19.2% being diabetic. All tests were requested by the Cardiology team on an outpatient. 15 patients had a positive test. At two years the negative predictive value of a negative DSE was 98.3%. A positive test had a sensitivity for predicting coronary artery disease of 86.7% with a false positive rate of approximately of 13.3%. The overall complication rate was low at 0.7%. Using a combined endpoint of time to ACS or revascularisation; there was a significant difference (p<0.001) in event free survival between groups (figure 1).Conclusion DSE is a safe test with a high sensitivity for detecting coronary artery disease. Furthermore, compared to a positive test, a negative test has a strong negative predictive value for cardiac events at two years.
Introduction Fluorescence Guided Surgery (FGS) using 5-ALA is recommended for patients undergoing resection of suspected high grade glioma and this type of surgery is increasingly being used in more units throughout the UK. We report on our experience of introducing 5-ALA guided surgery for suspected HGG in a regional neurosciences unit. Methods Consecutive series of the first 24 patients in our unit to receive 5-ALA guided surgery for suspected HGG from June 2017 to October 2018. Data was prospectively collected. Results 5-ALA fluorescence guided surgery was used for a range of histologically confirmed WHO grade III-IV gliomas. All but 1 tumour (GBM) fluoresced with 5-ALA, with strong fluorescence in recurrent GBM and anaplastic foci of grade 3 tumours. EOR varied according to the eloquence of the lesion with 70% of cases achieving gross total resection. 40% of cases used awake mapping or intraoperative neurophysiology. 5 patients (20.8%) had temporary neurological deficits which resolved in all cases. Individual surgeon learning curves resulted in 2 styles of practice- complete FGS with fluorescence used throughout the case, and intermittent use of fluorescence as an adjunct often at the end of debulking under white light. Conclusions Adopting 5-ALA use comes with specific challenges in terms of service organisation, learning curves and complication avoidance. Our experience is that it is useful both to improve EOR and as an adjunct to identify tumour tissue in eloquent region tumours with monitoring of function. This is possible through a day admission pathway in line with GIRFT.
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