Imperial College London

Dr Michael Fertleman MD(Res)

Faculty of EngineeringDepartment of Bioengineering

Visiting Professor
 
 
 
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m.fertleman

 
 
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Cambridge WingSt Mary's Campus

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Summary

 

Publications

Publication Type
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74 results found

Varma S, Wilson MSJ, Naik M, Sandhu A, Ota HCU, Aylwin C, Fertleman M, Peck Get al., 2022, The associations of psoas and masseter muscles with sarcopenia and related adverse outcomes in older trauma patients: a retrospective study, Aging Clinical and Experimental Research, ISSN: 1594-0667

BackgroundThere is an emerging role for radiological evaluation of psoas muscle as a marker of sarcopenia in trauma patients. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross-sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes.MethodsPatients aged 65 or above, who presented as a trauma call over a 1-year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analysed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan–Meier plots were used to determine association of sarcopenia with outcomes.ResultsThere were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Pearson’s correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2 years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001).ConclusionSarcopenia, defined by PLVI, is predictive of increased in-patient and 2-year mortality. Our study did not support prognostic relevance of M-CSA.

Journal article

Parkinson M, Doherty R, Curtis C, Dani M, Fertleman M, Kolanko MA, Soreq E, Capstick A, Barnaghi P, Sharp D, Li Let al., 2022, Exploring interactions between traumatic brain injury, Association of British Neurologists

Conference paper

Hudson M, Koizia L, Fertleman M, 2022, We must consider a growing opioid epidemic in older people, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 13, ISSN: 2151-4585

Journal article

Hudson M, Luo R, Reese G, Koizia L, Fertleman M, Sritharan TGet al., 2022, Limited geriatrician input is better than none: Geriatrician led team meetings improve understanding of frailty and medical management of older general surgical patients, meeting NELA standards of care., Association of Surgeons of Great Britain & Ireland

Conference paper

Hudson MAJ, Atkin J, Lumley G, Singh S, Varma S, Shenoy D, Morgan C, Peck G, Fertleman M, Koizia Let al., 2022, 694 IMPROVING OPIATE PRESCRIBING IN OLDER ADULTS WITH HIP FRACTURES TO COMBAT THE IATROGENIC FALLOUT, Publisher: OXFORD UNIV PRESS, ISSN: 0002-0729

Conference paper

Hillier M, Dani M, Fertleman M, Purkayastha S, Koizia Let al., 2022, Weight loss surgery in the elderly: is this the future, Clinics in Surgery, Vol: 7, Pages: 1-5, ISSN: 2474-1647

The UK population is ageing rapidly, and the proportion of people living with obesity is increasing.Obesity is a risk factor for diabetes, coronary artery disease, stroke and cancer. Older patientsare admitted for obesity related complications at a similar rate compared to younger patients.However, the operations for people over 70-years are extremely infrequent. In this scoping reviewwe summarize the recent data on bariatric operations in people over 70-years and the possible riskbenefit ratio of bariatric surgery for this population.

Journal article

Vali S, Jones BP, Saso S, Fertleman M, Testa G, Johanesson L, Alghrani A, Smith Ret al., 2022, Uterine transplantation: Legal and regulatory implications in England, BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 129, Pages: 590-596, ISSN: 1470-0328

Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein.

Journal article

Fertleman M, Pereira C, Dani M, Harris B, Di Giovannantonio M, Taylor-Robinson Set al., 2022, Cytokine changes in cerebrospinal fluid and plasma post-emergency orthopaedic surgery, Scientific Reports, Vol: 12, ISSN: 2045-2322

Neuroinflammation after surgery and its contribution to peri-operative neurocognitive disorders (PND) is not well understood. Studying the association between central and peripheral cytokines and neuroinflammation is a prelude to the development of treatments for PND. Here, we investigate the hypotheses that there is a greater cytokine response in cerebrospinal fluid (CSF) than plasma after orthopaedic surgery, and that plasma cytokine levels are directly related to CSF cytokine levels, indicating that plasma cytokine levels may have potential as biomarkers of neuroinflammation. Patients admitted with a fractured neck of femur were invited to participate in this study. Participants had a spinal catheter inserted just prior to induction of anaesthesia. Samples of blood and CSF were taken before, immediately after, and on the first day following emergency surgery. The catheter was then removed. Samples were analysed for the presence of ten cytokines by immunoassay. A spinal catheter was successfully inserted in 11 participants during the 18-month study period. Five plasma cytokines (IL-4, IL-6, IL-10, IL-12p70 and IL-13) rose significantly following surgery, whereas all ten CSF cytokines rose significantly (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IFN-γ and TNF-α) (adjusted-p < 0.05). Central (CSF) cytokine levels were consistently higher than their peripheral (plasma) counterparts after surgery, with some patients having a particularly marked neuroinflammatory response. The greatest increases occurred in IL-8 in CSF and IL-6 in plasma. There were significant, strong positive correlations between several of the measured cytokines in the CSF after surgery, but far fewer in plasma. There was no significant correlation between cytokine levels in the plasma and CSF at each of the three time points. To our knowledge, this is the first study to analyse paired samples of plasma and CSF for cytokine levels before and after emerg

Journal article

Oleribe O, Olawepo O, Ezechi O, Osita-Oleribe P, Fertleman M, Taylor-Robinson Set al., 2022, Describing the epidemiology of COVID-19 in Nigeria: an analysis of the first year of the pandemic, Journal of Health Care for the Poor and Underserved, Vol: 33, Pages: 33-46, ISSN: 1049-2089

We report the COVID-19 experience across Nigeria from March 2020 to March 2021. Demographics were obtained from Nigerian Center for Disease Control. By 21 March 2021, 161,737 people were confirmed positive for SARS-COV-2. Overall, testing rates were 0.8% of the population, with positivity rates of 9.6%, complete recovery rates without long-term sequelae of 91.4%, and case fatality rates of 1.3%. Most Nigerian regions contributed to figures for recent cases and deaths in 2021. The picture may change as testing is scaled-up to include community testing. Given so-called “pandemic fatigue” among the general population, various conspiracy theories being prevalent, and the recent introduction of COVID-19 vaccines in Nigeria, we assume that Nigeria is at a pivotal stage of the outbreak. Effort must be made by government to learn successful strategies in other countries to adapt to prevent a rise in case numbers and deaths.

Journal article

Rosadas C, Khan M, Parker E, Marchesin F, Katsanovskaja K, Sureda-Vives M, Fernandez N, Randell P, Harvey R, Lilley A, Harris BH, Zuhair M, Fertleman M, Ijaz S, Dicks S, Short C-E, Quinlan R, Taylor GP, Hu K, McKay P, Rosa A, Roustan C, Zuckerman M, El Bouzidi K, Cooke G, Flower B, Moshe M, Elliott P, Spencer AJ, Lambe T, Gilbert SC, Kingston H, Baillie JK, Openshaw PJ, G Semple M, ISARIC4C Investigators, Cherepanov P, O McClure M, S Tedder Ret al., 2022, Detection and quantification of antibody to SARS CoV 2 receptor binding domain provides enhanced sensitivity, specificity and utility, Journal of Virological Methods, Vol: 302, ISSN: 0166-0934

Accurate and sensitive detection of antibody to SARS-CoV-2 remains an essential component of the pandemic response. Measuring antibody that predicts neutralising activity and the vaccine response is an absolute requirement for laboratory-based confirmatory and reference activity. The viral receptor binding domain (RBD) constitutes the prime target antigen for neutralising antibody. A double antigen binding assay (DABA), providing the most sensitive format has been exploited in a novel hybrid manner employing a solid-phase S1 preferentially presenting RBD, coupled with a labelled RBD conjugate, used in a two-step sequential assay for detection and measurement of antibody to RBD (anti-RBD). This class and species neutral assay showed a specificity of 100% on 825 pre COVID-19 samples and a potential sensitivity of 99.6% on 276 recovery samples, predicting quantitatively the presence of neutralising antibody determined by pseudo-type neutralisation and by plaque reduction. Anti-RBD is also measurable in ferrets immunised with ChadOx1 nCoV-19 vaccine and in humans immunised with both AstraZeneca and Pfizer vaccines. This assay detects anti-RBD at presentation with illness, demonstrates its elevation with disease severity, its sequel to asymptomatic infection and its persistence after the loss of antibody to the nucleoprotein (anti-NP). It also provides serological confirmation of prior infection and offers a secure measure for seroprevalence and studies of vaccine immunisation in human and animal populations. The hybrid DABA also displays the attributes necessary for the detection and quantification of anti-RBD to be used in clinical practice. An absence of detectable anti-RBD by this assay predicates the need for passive immune prophylaxis in at-risk patients.

Journal article

Patel KP, Treibel TA, Scully PR, Fertleman M, Searle S, Davis D, Moon JC, Mullen MJet al., 2022, Futility in transcatheter aortic valve implantation: a search for clarity, Interventional Cardiology: Reviews, Research, Resources, Vol: 17, Pages: 1-10, ISSN: 1756-1477

Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.

Journal article

Oleribe OO, Idigbe IE, Osita-Oleribe P, Olawepo O, Musa ZA, Aikhuomogbe S, Ezechi OC, Fertleman M, Salako B, Taylor-Robinson SDet al., 2021, Perceptions and opinions of Nigerians to the management and response to COVID-19 in Nigeria., Pan African Medical Journal, Vol: 40, Pages: 1-11, ISSN: 1937-8688

Introduction: we present a qualitative analysis of opinions of the Nigerian general public as to how successful healthcare strategies have been in containing the COVID-19 outbreak. Methods: an online qualitative survey was conducted, consisting of 30 semi-structured questions. Results: four hundred and ninety-five (495) respondents participated, ranging in age from 18 to 59 years. Over 40% of all respondents were critical of public health information. Participants saw provision of social support measures (n = 83), lack of economic, financial and social support (n = 65), enforcement of restrictions on movement outside the home, availability of face-masks and social distancing (n = 53) and provision of COVID-19 testing (n = 48) as the major things that were handled poorly by the government and health authorities. Conclusion: we advocate coordinated forward planning for public safety until vaccines are widely available; while social distancing should continue. Policymakers need to be adaptable to changing conditions, given fluctuating case numbers and fatality rates.

Journal article

Hudson M, Atkin J, Lumley G, Singh S, Varma S, Shenoy D, Morgan C, Peck G, Koizia L, Fertleman Met al., 2021, Improving opiate prescribing in older adults with hip fracture to combat the iatrogenic fallout, British Geriatrics Society

Poster

Patel V, Levy S, Malik I, Fertleman M, Koizia Let al., 2021, Takotsubo cardiomyopathy in elderly female trauma patients - a case series and mini-review, Journal of Medical Case Reports, Vol: 15, Pages: 1-7, ISSN: 1752-1947

Takotsubo cardiomyopathy is a syndrome characterised by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality. Here we describe three cases of Takotsubo cardiomyopathy occurring in three elderly trauma patients and the impact on their clinical course.

Journal article

Park C, Sugand K, Aframian A, Morgan C, Pakroo N, Gibbons C, Fertleman M, Nathwani D, Bhattacharya R, Sarraf KMet al., 2021, Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative, Irish Journal of Medical Science, ISSN: 0021-1265

Introduction:COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals.Materials and methodsA multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019.Results:A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years.Conclusion:The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

Journal article

Kelani T, Lee A, Walker M, Koizia L, Dani M, Fertleman M, Kedgley Aet al., 2021, The influence of cervical spine angulation on symptoms associated with wearing a rigid neck collar, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 12, Pages: 1-7, ISSN: 2151-4585

Introduction:Rigid cervical spine collars can be used to maintain the position of the cervical spine following injury or surgery. However, they have been associated with difficulty swallowing, pressure sores and pain, particularly in older patients. We aimed to investigate the relationship between cervical spine angulation, a rigid neck collar and neck pain in healthy young and older adults.Methods:Twenty healthy young adults aged 25 ± 3 years and 17 healthy older adults aged 80 ± 8 years were tested. Magnetic resonance imaging scans of their cervical spines were taken before and after the rigid neck collar was worn for 1 hour. Measurement of vertebral angulation involved digitization of the scans and joint angle calculations using image processing software. Pain was quantified before and after the collar was worn, using a visual analogue scale.Results:Pain scores increased in the young group after the collar was worn (p = 0.001). The older group showed no difference in pain score after the collar was worn. Statistical tests showed no significant correlations between the change in cervical angles and the change in pain scores after the collar was worn.Discussion:The aging process may contribute to the changing distribution of subcutaneous tissue and increase risk of symptoms associated with wearing a collar. Oesophageal compression is not a result of collar use.Conclusion:There is no correlation between cervical spine vertebrae angulation and symptoms associated with wearing a neck collar. Generally, older individuals have greater cervical lordosis angles, and more straight and lordotic neck shapes. Older individuals may be more prone to skin-interface pressures from the neck collar than younger individuals.

Journal article

Rosa A, Pye VE, Graham C, Muir L, Seow J, Ng KW, Cook NJ, Rees-Spear C, Parker E, dos Santos MS, Rosadas C, Susana A, Rhys H, Nans A, Masino L, Roustan C, Christodoulou E, Ulferts R, Wrobel AG, Short C-E, Fertleman M, Sanders RW, Heaney J, Spyer M, Kjaer S, Riddell A, Malim MH, Beale R, MacRae J, Taylor GP, Nastouli E, van Gils MJ, Rosenthal PB, Pizzato M, McClure MO, Tedder RS, Kassiotis G, McCoy LE, Doores KJ, Cherepanov Pet al., 2021, SARS-CoV-2 can recruit a heme metabolite to evade antibody immunity, Science Advances, Vol: 7, Pages: 1-14, ISSN: 2375-2548

The coronaviral spike is the dominant viral antigen and the target of neutralizing antibodies. We show that SARS-CoV-2 spike binds biliverdin and bilirubin, the tetrapyrrole products of heme metabolism, with nanomolar affinity. Using cryo–electron microscopy and x-ray crystallography, we mapped the tetrapyrrole interaction pocket to a deep cleft on the spike N-terminal domain (NTD). At physiological concentrations, biliverdin significantly dampened the reactivity of SARS-CoV-2 spike with immune sera and inhibited a subset of neutralizing antibodies. Access to the tetrapyrrole-sensitive epitope is gated by a flexible loop on the distal face of the NTD. Accompanied by profound conformational changes in the NTD, antibody binding requires relocation of the gating loop, which folds into the cleft vacated by the metabolite. Our results indicate that SARS-CoV-2 spike NTD harbors a dominant epitope, access to which can be controlled by an allosteric mechanism that is regulated through recruitment of a metabolite.

Journal article

Pereira C, Harris B, Di Giovannantonio M, Rosadas C, Short C-E, Quinlan R, Sureda-Vives M, Fernandez N, Day-Weber I, Khan M, Marchesin F, Katsanovskaja K, Parker E, Taylor G, Tedder R, McClure M, Dani M, Fertleman Met al., 2021, Antibody response to SARS-CoV-2 infection is not associated with Post-COVID-19 Syndrome in healthcare workers, Journal of Infectious Diseases, Vol: 223, Pages: 1671-1676, ISSN: 0022-1899

It is currently unknown how Post-COVID-19 Syndrome (PCS) may affect those infected with SARS-CoV-2. This longitudinal study reports on healthcare staff who tested positive for SARS-CoV-2 between March-April 2020 and follows their antibody titres and symptomatology. Over half (n=21/38) had PCS at 7-8 months. There was no statistically significant difference between initial RT-PCR viral titres or serial antibody levels between those who did and did not develop PCS. This study highlights the relative commonality of PCS in healthcare workers and this should be considered in vaccination scheduling and workforce planning to allow adequate frontline staffing numbers.

Journal article

van der Kruk E, Silverman AK, Koizia L, Reilly P, Fertleman M, Bull AMJet al., 2021, Age-related compensation: Neuromusculoskeletal capacity, reserve & movement objectives, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290

Journal article

Koizia L, Dani M, Brown H, Lee M, Reilly P, Fertleman Met al., 2021, Does the weather contribute to admissions of neck of femur fractures?, Geriatric Orthopaedic Surgery and Rehabilitation, Vol: 12, Pages: 1-6, ISSN: 2151-4585

Background: The effects of weather on overall mortality are well documented. Anecdotally, icy conditions are perceived to result in more falls and admissions for neck of femur (NOF) fractures. The aim of this pilot study was to determine whether relationships could be extracted or at least not ruled out by analysing a small dataset, and so give impetus to a larger project. Methods: Seven trauma units across North West London were identified and NOF fracture data extracted for five years. Visual inspection of the time series, consideration of the weather on specific days and correlation analysis were used to assess associations between fracture numbers and a variety of weather parameters (temperature, rainfall, wind and ice risk). Results: Overall, 10929 individuals with hip fractures were admitted over the five-year period. The highest number of admissions in a day was 14. No clear association was found between a weather parameter and daily admissions. However, when accumulated to a weekly timescale, a negative relationship with maximum temperature was found. No seasonal cycle was detected.Conclusion: The lack of a daily relationship and presence of a weekly relationship points to a possible delayed response to weather or insufficient daily data to extract a signal. The inconclusive results also indicate a larger data sample is required in future studies. In addition, even in cold weather an urban environment may not create icy conditions, being ameliorated by the heat island effect and gritting.

Journal article

Koizia LJ, Dani M, Brown H, Lee M, Fertleman MBet al., 2021, DOES THE WEATHER CONTRIBUTE TO ADMISSIONS OF NECK OF FEMUR FRACTURES?, AGE AND AGEING, Vol: 50, ISSN: 0002-0729

Journal article

Chauhan A, Morgan C, Fertleman M, Koizia Let al., 2021, Face coverings Mask Effective Communication, Open Access Journal of Gerontology & Geriatric Medicine, Vol: 6, Pages: 144-144, ISSN: 2575-8543

Journal article

Rosa A, Pye VE, Graham C, Muir L, Seow J, Ng KW, Cook NJ, Rees-Spear C, Parker E, Dos Santos MS, Rosadas C, Susana A, Rhys H, Nans A, Masino L, Roustan C, Christodoulou E, Ulferts R, Wrobel A, Short C-E, Fertleman M, Sanders RW, Heaney J, Spyer M, Kjær S, Riddell A, Malim MH, Beale R, MacRae JI, Taylor GP, Nastouli E, van Gils MJ, Rosenthal PB, Pizzato M, McClure MO, Tedder RS, Kassiotis G, McCoy LE, Doores KJ, Cherepanov Pet al., 2021, SARS-CoV-2 recruits a haem metabolite to evade antibody immunity., medRxiv

The coronaviral spike is the dominant viral antigen and the target of neutralizing antibodies. We show that SARS-CoV-2 spike binds biliverdin and bilirubin, the tetrapyrrole products of haem metabolism, with nanomolar affinity. Using cryo-electron microscopy and X-ray crystallography we mapped the tetrapyrrole interaction pocket to a deep cleft on the spike N-terminal domain (NTD). At physiological concentrations, biliverdin significantly dampened the reactivity of SARS-CoV-2 spike with immune sera and inhibited a subset of neutralizing antibodies. Access to the tetrapyrrole-sensitive epitope is gated by a flexible loop on the distal face of the NTD. Accompanied by profound conformational changes in the NTD, antibody binding requires relocation of the gating loop, which folds into the cleft vacated by the metabolite. Our results indicate that the virus co-opts the haem metabolite for the evasion of humoral immunity via allosteric shielding of a sensitive epitope and demonstrate the remarkable structural plasticity of the NTD.

Journal article

Radia U, Malietzis G, Dani M, Fertleman M, Koizia Let al., 2021, The difficulty of managing recurrent sigmoid volvulus in a frailpatient, Journal of Surgery, Vol: 6, Pages: 1-4, ISSN: 2575-9760

Abdominal pain is a common cause for presentation of the older patient to healthcare services. Sigmoid volvulus is one of the leading causes of acute large bowel obstruction in adults. It affects older, comorbid, frailer and institutionalized patients.In this report, we highlight some of the clinical and ethical dilemmas clinicians face when caring for patients with recurrent sigmoid volvulus. We endorse early involvement of geriatricians and palliative care services in these individuals to ensure maximum patient comfort, quality of life and dignity.

Journal article

Harris BHL, Zuhair M, Di Giovannantonio M, Rosadas C, Khan M, Short C-E, Thaventhiran T, Quinlan R, Taylor A, Calvez R, Taylor GP, Tedder RS, McClure MO, Fertleman Met al., 2021, Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a rehabilitation facility: evolution of the presence of nasopharyngeal SARS-CoV-2 and serological antibody responses., Journal of Infectious Diseases, Vol: 223, Pages: 192-196, ISSN: 0022-1899

At the start of the UK coronavirus disease 2019 epidemic, this rare point prevalence study revealed that one-third of patients (15 of 45) in a London inpatient rehabilitation unit were found to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but asymptomatic. We report on 8 patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral reverse-transcription polymerase chain reaction (RT-PCR) burden, and their antibody levels over time, revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS-CoV-2 showed that 100% of our asymptomatic cohort remained seropositive 3-6 weeks after diagnosis.

Journal article

Harris BHL, Zuhair M, di Giovannantonio M, Rosadas C, Short C-E, Thaventhiran T, Quinlan R, Taylor A, Calvez R, Taylor GP, Tedder RS, McClure MO, Fertleman Met al., 2021, Asymptomatic COVID-19 in a rehabilitation facility: evolution of the presence of nasopharyngeal SARS-CoV-2 and serological antibody responses, The Journal of Infectious Diseases, Vol: 223, Pages: 192-196, ISSN: 0022-1899

At the start of the UK COVID-19 epidemic, this rare point prevalence study reveals ⅓ of patients in a London inpatient rehabilitation unit were found to be infected with SARS-CoV 2, but asymptomatic (n=15/45). We report on eight patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral RT-PCR burden and their antibody levels over time revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS40 CoV-2 (anti-RBD) showed 100% of our asymptomatic cohort remained seropositive between 3 to 6 weeks post-diagnosis.

Journal article

Chauhan D, Varma S, Dani M, Fertleman M, Koizia Let al., 2021, Nasogastric tube feeding in older patients: a review of current practice and challenges faced, Current Gerontology and Geriatrics Research, Vol: 2021, ISSN: 1687-7063

Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in olderinpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events”related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, whichsubsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way.Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updatedreview on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correctplacement, and innovative solutions for improving safety and outcomes in older patients.v

Journal article

Moledina S, Maini A, Gargan A, Harland W, Jenney H, Phillips G, Thomas K, Chauhan D, Fertleman Met al., 2020, Clinical characteristics and predictors of mortality in patients with COVID-19 infection outside intensive care, International Journal of General Medicine, Vol: 2020, Pages: 1157-1165, ISSN: 1178-7074

Background/introductionThe Coronavirus Disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from Level 1 (general medical wards) through to Level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome. MethodsThis was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March – 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded. Results229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality. ConclusionUrea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.

Journal article

Oleribe O, Ezechi O, Osita-Oliberi P, Olawepo O, Zaidat M, Omolabi A, Fertleman M, Salako B, Taylor-Robinson Set al., 2020, Public perception of COVID-19 management and response in Nigeria: a cross-sectional survey, BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055

Objectives: A study designed to assess the public perception of the response of government and its institutions to the COVID-19 pandemic in Nigeria. Setting: Self-selecting participants throughout Nigeria completed a self-administered questionnaire through an online cross-sectional survey. Participants: 495 Results: The majority of respondents were married (76.6%), were males (61.8%), had tertiary level education (91.0%), were public servants (36.8%), Christians (82.6%), and resident either in the Federal Capital Territory (Abuja) (49.1%) or in the South-East Region of Nigeria (36.6%). Over 95% of the respondents had heard of COVID-19 (98.8%) and knew it is a viral disease (95.4%). The government and its institutions response to the pandemic were rated as poor, with the largest rating as poor for Federal President’s Office (57.5%). Communication (50.0%) and prevention messages (43.7%) received the highest perception good rating. Female respondents and those less than 40 years generally rated the governmental responses as poor. Conclusions/Recommendations: It is recommended that as a public-private partnership approached was efficiently used to more effectively disseminate public health communication and prevention messages, the Nigerian Government should expand this collaboration to improve the quality of services provided in other areas of COVID-19 outbreak management.

Journal article

Koizia LJ, Dani M, Sritharan G, Peck G, Fertleman MBet al., 2020, Collaborative working on a 7-day rota reduces length of stay., Future Healthc J, Vol: 7, ISSN: 2514-6645

A 7-day consultant-geriatrician-led service across five surgical wards, with integrated working among surgeons and physicians, was implemented in response to the COVID-19 pandemic. Our model has shown to increase discharge rates and improve MDT wellbeing. Embedded physician working with surgeons could be key in the recovery to COVID-19.

Journal article

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