Suresh Pillai

Objective: Patients with Chronic Obstructive Pulmonary Disease (COPD) often develop exacerbations that could be infective or non-infective and are prone to develop thrombosis. To assess thrombogenicity in this group, a functional biomarker of clot microstructure namely fractal dimension ( d _f ) is utilised. This sub-group analysis intent to compare the changes in d _f between infective and non-infective exacerbation of COPD. Methods: 85 patients with acute exacerbations of COPD were recruited from the Emergency Department. Blood samples were taken to determine biomarkers of inflammation, haemostasis and rheology at four time points (0 h, 4–6 h, 24 h and 3–7 days). Results: The biomarker of clot microstructure did not attain significance in the infective group when compared to the non-infective group at four time points. Conclusions: The study demonstrates that exacerbation caused by infection does not cause more thrombogenicity compared to non-infective causes utilising clot microstructure.

Coronavirus disease 2019 (COVID-19) has caused substantial global health and economic disruption, and identifying factors associated with adverse outcomes remains essential. This study is a first-wave observational study and examined risk factors and outcomes among patients admitted with COVID-19 to a non-acute hospital during the first wave of the pandemic, with particular focus on social deprivation and frailty. We conducted a retrospective review of clinical notes for 205 patients admitted between December 2019 and June 2020. Frailty was assessed using the Clinical Frailty Score and the Charlson Comorbidity Index, and social deprivation was evaluated using the Welsh Index of Multiple Deprivation. Although more women than men were admitted, mortality rates were similar across sexes. Older age was associated with increased mortality, and ischaemic heart disease was the most common comorbidity, occurring more frequently among patients who died. Those who died also demonstrated greater frailty, reflected in higher frailty and comorbidity scores. Most patients, irrespective of survival, were from less deprived areas, and greater social deprivation was not associated with increased admission or mortality. These findings indicate that older age, frailty, and ischaemic heart disease are important predictors of mortality in non-acute hospital settings, while social deprivation did not appear to influence admission risk or outcomes in this cohort. As this cohort predates widespread vaccination and antiviral therapy, these findings provide insight into baseline risk factors for COVID-19 mortality in frail populations during the first pandemic wave.

Physiological proteins such as fibrinogen and albumin are key biomarkers in diseases like chronic obstructive pulmonary disease (COPD), cardiovascular conditions, and sepsis. Studying the rheology of these proteins not only enhances clinical understanding but also provides a valuable framework to test polymer physics theories, particularly those describing flexible polymers in biologically relevant conditions. However, experimental characterization, especially of elasticity, remains limited due to measurement challenges. In this study, we employ the μ-rheometer microfluidic rheometer to systematically investigate blood plasma with varying fibrinogen concentrations and bovine serum albumin solutions. We found that the protein data can either be described by models for suspension of rigid spheres or by models for flexible polymers. We further demonstrate the clinical utility of these rheological parameters by applying them as rheological biomarkers to patients with acute exacerbation of COPD (AECOPD) in a UK tertiary hospital. Our study effectively connects fundamental polymer physics concepts with clinical diagnostics, underscoring the potential of protein rheology research to enhance healthcare monitoring and therapeutic strategies.

Background Chronic Obstructive Pulmonary Disease (COPD) patients are prone to thrombogenic events, particularly during exacerbations. Fractal dimension (d f), a functional biomarker of clot microstructure is useful in assessing thrombogenicity in other diseases. The aim of this study was to compare the changes in d f during acute exacerbation of COPD with stable disease. Methods This prospective study recruited 30 patients with stable disease from the chest clinic and 85 patients with acute exacerbations from the Emergency Department. The stable group had blood samples taken at one time point, whilst the exacerbation group were sampled at four time points (0 hours, 4-6 hours, 24 hours and 3-7 days). Biomarkers of inflammation, haemostasis and rheology were determined. Results At presentation, the acute exacerbation group had significantly elevated d f when compared to the stable group (1.71 ± 0.06 vs 1.69 ± 0.05, p=0.03) but with no significant changes in d f over the four time points (p=0.28) sampled. The patients who died in the acute exacerbation group had significantly elevated d f when compared to those who survived (1.76 ± 0.03 vs 1.71 ± 0.06, p=0.02) with additional logistic regression analysis confirming that d f was a significant predictor of mortality (p=0.024). Conclusions Clot microstructural analysis demonstrates that COPD patients during acute exacerbation are more thrombogenic when compared to those with stable disease. This thrombogenic state is not aggravated with appropriate treatment on admission. Patients who died during exacerbations were in a significantly enhanced thrombogenic state when compared to those who survived as demonstrated by significantly elevated d f.

Introduction: Smoking is known to be harmful to health, contributing to increased severity in respiratory infections such as influenza. The impact in COVID‐19 remains controversial. Social deprivation and inequality are associated with worse outcomes in infectious disease and may impact on mortality in COVID‐19. Methods: A retrospective cohort study in a tertiary hospital general adult Intensive Care Unit (ICU). 174 patients with COVID‐19 confirmed by polymerase chain reaction (PCR) testing between March 21st 2020 and May 15th 2021 included. Data collection was by retrospective review of clinical notes. Patients were grouped into three categories: current smokers, former smokers (ex‐smokers) and never smokers. Statistical analysis carried out on IBM Statistical Package for Social Sciences (SPSS) for Windows, version 28.0 (Armonk, NY:IBM Corp). Values reported as means, standard deviation (SD), median and interquartile ranges (IQR). Comparisons with the Mann–Whitney U test for median and IQR and two sample t ‐test for mean and SD. Survival analysis was performed using Kaplan–Meier. Results: Of 174 patients, 11 were current smokers (6.3%), 51 were former smokers (29%) and 112 were never smokers (64%). Current smokers were younger and frailer, with longer hospital and ICU length of stay (ICULOS). Welsh Index of Multiple Deprivation (WIMD) scores were collected using UK postcodes and ranked 1909 areas, showing current smokers from the most deprived areas. Kaplan–Meier survival analysis showed current smokers are less likely to survive. Discussion: Despite 6.3% prevalence of smoking in patients with severe COVID‐19 in the ICU, smokers had increased hospital and ICU LOS with reduced survival. The relationship between COVID‐19 and deprivation is multifaceted and complex and may relate to demographic, socioeconomic and environmental factors; health‐related risk factors; and practices. From our data we can see that current smokers admitted to ICU with severe COVID‐19 were from the most deprived areas in Wales, with a higher mortality risk.

Introduction: Methamoglobinemia is a condition characterized by impaired oxygen delivery to the tissues due to the formation of methemoglobin (Met‐Hb). Diagnosis is established when Met‐Hb levels exceed 5%. Levels over 30% are associated with severe symptoms and can be life‐threatening. Pulse oximetry may provide misleading readings, often reporting oxygen saturation around 85%, irrespective of actual oxygenation levels. Management involves discontinuing offending agents, providing supportive care, and use of specific treatment agents. Most commonly, cases report a quick and effective recovery following treatment. Case Presentation: We describe a case of a patient requiring four separate admissions over a 9‐month period, all for methemoglobinemia, where the cause remained uncertain. A 25‐year‐old female was admitted to the intensive care unit (ICU) with sudden onset shortness of breath and cyanosis, and Met‐Hb level 55.5%, suspected due to dapsone. She was treated with 1 mg/kg of methylene blue intravenously. Met‐Hb levels remained persistently above 20% for a number of days, and reaccumulated following initial decline. Repeated doses of methylene blue were required, and activated charcoal was given. She was readmitted 3 days later, with reaccumulation of Met‐Hb. This was again thought secondary to dapsone, given the long half‐life of dapsone and potential for enterohepatic recirculation. She had a third admission with methemoglobinemia almost 2 months after the first admission, and again 8 months later. Suggestion was that azathioprine could be the causative agent; however, this has not been reported previously. Discussion: We report a case of a 25‐year‐old female with repeated admissions with methemoglobinemia. This case highlights the potential for refractory methemoglobinemia requiring repeated treatment, and the importance of longer periods of close observation. It is important to consider the diagnosis in patients without a clear trigger for methemoglobinemia, as an identifiable cause may not always be clear.

Introduction Simulation is an effective teaching method with increasing growth and recognition and refers to the artificial representation of a real-life scenario. The aim of this study was to compare simulation with and without the use of a simulated observations monitor and to investigate differences in students’ impression of realism, engagement, learning, and enjoyment. Methods Simulation sessions were delivered to second and third-year Swansea University Medical Students, and a total of 15 students were included. Students carried out 2–3 scenarios each with and without the use of a simulated observations monitor. Data collection was conducted via student surveys and a joint interview. Results All students had an increased sense of realism with the use of the simulated observations monitor, feeling a closer resemblance to what would be experienced in clinical practice. They felt this improved their learning, making them more prepared for the real-life scenario. The monitor was more dynamic, responding to their interventions, helping them maintain focus and engagement throughout. A key theme was the reduction of interruptions or deviations from the scenario to communicate with the examiner or ask for observations. The visual and audible affects provided additional stimuli, adding to the realistic nature of the simulation. Discussion Simulation has been shown to be a useful education tool, but there is less evidence to support the use of higher fidelity over lower fidelity simulation. The terms are often used inconsistently, and many factors affect the students’ perceived sense of realism. This study shows that the addition of a simple device such as the simulated observations monitor can produce a higher level of fidelity, particularly in terms of the stimuli provided and student perceptions of realism, which may be effective in improving engagement with the simulation, learning, and aid recall when presented with similar scenarios in a real-life situation.

Introduction: Chronic obstructive pulmonary disease is an inflammatory condition of the lungs characterised by irreversible airway obstruction and impairment of gas exchange. Acute exacerbation is associated with an increased incidence of venous thromboembolism. The main aim of the study was to investigate whether patients with acute exacerbation were thrombogenic utilising the functional biomarker of clot microstructure, the fractal dimension (df).

Introduction Simulation is an effective teaching method with increasing growth and recognition and refers to the artificial representation of a real-life scenario. The aim of this study was to compare simulation with and without the use of a simulated observations monitor and to investigate differences in students’ impression of realism, engagement, learning, and enjoyment. Methods Simulation sessions were delivered to second and third-year Swansea University Medical Students, and a total of 15 students were included. Students carried out 2-3 scenarios each with and without the use of a simulated observations monitor. Data collection was conducted via student surveys and a joint interview. Results All students had an increased sense of realism with the use of the simulated observations monitor, feeling a closer resemblance to what would be experienced in clinical practice. They felt this improved their learning, making them more prepared for the real-life scenario. The monitor was more dynamic, responding to their interventions, helping them maintain focus and engagement throughout. A key theme was the reduction of interruptions or deviations from the scenario to communicate with the examiner or ask for observations. The visual and audible affects provided additional stimuli, adding to the realistic nature of the simulation. Discussion Simulation has been shown to be a useful education tool, but there is less evidence to support the use of higher fidelity over lower fidelity simulation. The terms are often used inconsistently, and many factors affect the students’ perceived sense of realism. This study shows that the addition of a simple device such as the simulated observations monitor can produce a higher level of fidelity, particularly in terms of the stimuli provided and student perceptions of realism, which may be effective in improving engagement with the simulation, learning, and aid recall when presented with similar scenarios in a real-life situation.