Imperial College London

Prof Michael Fertleman

Faculty of EngineeringDepartment of Bioengineering

Professor of Practice
 
 
 
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Contact

 

+44 (0)20 7594 9046m.fertleman

 
 
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Location

 

6.24Building E - Sir Michael UrenWhite City Campus

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Summary

 

Publications

Publication Type
Year
to

87 results found

Hudson MAJ, Ehsanullah J, Lee A, Macpherson N, O'Gilvie A, Shrestha A, Tsang K, Morgan C, Peck G, Koizia LJ, Fertleman MBet al., 2023, In healthy volunteers the Miami-J® cervical collar causes swallow dysfunction. This may increase the risk of aspiration; of particular potential consequence in older people with neck injury, Interdisciplinary Neurosurgery, Vol: 33, Pages: 1-6, ISSN: 2214-7519

Background: In young healthy volunteers a cervical hard collar has been shown to change swallowing physiology. The risk of aspiration pneumonia increases with age. Methods: In this open prospective dual-arm controlled trial without randomisation there were 23 patients divided into two cohorts: 11 older (mean age 84) and 12 younger (mean age 25). A series of video fluoroscopy (VF) swallow studies were performed without a cervical collar, followed by the same series of VF with a Miami-J® cervical collar fitted. The Modified Barium Swallow Impairment Profile (MBSImPTM©) and Penetration-Aspiration Scale (PAS) were used to define and score swallow function and level of aspiration without and with the collar fitted. Results: An increase in the median MBSImPTM© score amongst all participants in the oral phase of swallow (p = 0.01) and combined oral and pharyngeal phase of swallow (p = 0.006) was seen when volunteers were fitted with the Miami-J® collar, compared to no collar. When wearing the collar deterioration in swallow function and small increases in PAS level were more marked in the older cohort, but these latter findings were not statistically significant. Conclusions: Cervical hard collars change swallowing physiology in younger and older volunteers. Whilst we did not measure a statistically significant difference in the PAS level pre- and post- collar wearing, we feel it is important to highlight these changes in swallowing physiology and speculate that with collar use there is a potential risk of aspiration associated with these changes. Potential risk of aspiration should be carefully balanced with the benefit gained from collar use in the management of cervical spine injury (both in conservative and postoperative management). Although this is a small study it is important to highlight an area of concern of particular importance in the older population who have physiological changes to the swallow that occur with age (presbyphagia) and where ba

Journal article

Parkinson M, Doherty R, Curtis F, Soreq E, Lai HHL, Serban A-I, Dani M, Fertleman M, Barnaghi PJ, Sharp DM, Li Let al., 2023, Using home monitoring technology to study the effects of traumatic brain injury in older multimorbid adults, Annals of Clinical and Translational Neurology, Vol: 10, Pages: 1688-1694, ISSN: 2328-9503

Internet of things (IOT) based in-home monitoring systems can passively collect high temporal resolution data in the community, offering valuable insight into the impact of health conditions on patients' day-to-day lives. We used this technology to monitor activity and sleep patterns in older adults recently discharged after traumatic brain injury (TBI). The demographics of TBI are changing, and it is now a leading cause of hospitalisation in older adults. However, research in this population is minimal. We present three cases, showcasing the potential of in-home monitoring systems in understanding and managing early recovery in older adults following TBI.

Journal article

Parkinson M, Dani M, Fertleman M, Soreq E, Barnaghi P, Sharp D, Li LMet al., 2023, Using home monitoring technology to study the effects of traumatic brain Injury in older multimorbid adults: protocol for a feasibility study, BMJ Open, Vol: 13, ISSN: 2044-6055

Introduction:The prevalence of Traumatic Brain Injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interacts with age-related conditions such a multimorbidity. Despite this, TBI research in older adults, is sparse. Minder, an in-home monitoring system using developed by the UK DRI Centre for Care Research and Technology, uses infra-red sensors and a bed mat to passively collect sleep and activity data. Similar systems have been used to monitor the health of older adults living with dementia. We will assess the feasibility of using this system to study changes in the health status of older adults in the early period post TBI.Methods and analysis:The study will recruit 15 inpatients (>60 years) with a moderate-severe TBI, who will have their daily activity and sleep patterns monitored using passive and wearable sensors over 6 months. Participants will report on their health during weekly calls, which will be used to validate sensor data. Physical, functional, and cognitive assessments will be conducted across the duration of the study. Activity levels and sleep patterns derived from sensor data will be calculated and visualised using activity maps. Within participant analysis will be performed to determine if participants are deviating from their own routines. We will apply machine learning approaches to activity and sleep data to assess whether these changes in these data can predict clinical events. Qualitative analysis of interviews conducted with participants, carers, and clinical staff will assess acceptability and utility of the system.Ethics and dissemination:Ethical approval for this study has been granted by the London - Camberwell St Giles Research Ethics Committee (REC number: 17/LO/2066). Results will be submitted for publication in peer review journals, presented at conferences and inform the design of a larger trial assessing recovery after TBI.

Journal article

Parkinson M, Doherty R, Curtis F, Dani M, Fertleman M, Kolanko M, Soreq E, Barnaghi P, Sharp D, Li LMet al., 2023, 1415 Novel approaches to post discharge care.remote healthcare monitoring systems following traumatic brain injury in older adults, British Geriatrics Society Autumn Meeting 2022, Publisher: Oxford University Press, ISSN: 0002-0729

Conference paper

Curtis F, Li L, Kolanko M, Lai H, Daniels S, True J, Del Giovane M, Golemme M, Lyall P, Raza S, Hassim N, Patel A, Beal E, Walsh C, Purnell M, Whitethread N, Nilforooshan R, Norman C, Wingfield D, Barnaghi P, Sharp D, Dani M, Fertleman M, Parknson Met al., 2023, 1362 Anticholinergic prescribing habits and its associations in a community population of people living with dementia, British Geriatrics Society Autumn Meeting 2022, Publisher: Oxford University Press, ISSN: 0002-0729

Conference paper

Shrestha A, Dani M, Kemp P, Fertleman Met al., 2022, Acute sarcopenia after elective and emergency surgery, Aging and Disease, Vol: 13, Pages: 1759-1769, ISSN: 2152-5250

AbstractSarcopenia is an increasingly recognised condition of loss of muscle mass and function. The European Working Group on Sarcopenia in Older People 2 (EWSOP2) updated their definition in 2018, emphasising the importance of low muscle strength in diagnosis. Acute sarcopenia has been arbitrarily defined as sarcopenia lasting less than 6 months. This review highlights the pathophysiology involved in muscle wasting following surgery, focussing on hormonal factors, inflammation, microRNAs, and oxidative stress. Biomarkers such as GDF-15, IGF-1 and various microRNAs may predict post-surgical muscle loss. The impact of existing sarcopenia on various types of surgery and incident muscle wasting following surgery is also described. The gaps in research found include the need for longitudinal studies looking in changes in muscle strength and quantity following surgery. Further work is needed to examine if biomarkers are replicated in other surgery to consolidate existing theories on the pathophysiology of muscle wasting

Journal article

van der Kruk E, Strutton P, Koizia LJ, Fertleman M, Reilly P, Bull AMJet al., 2022, Why do older adults stand-up differently to young adults?: investigation of compensatory movement strategies in sit-to-walk, npj Aging, Vol: 8, ISSN: 2731-6068

Functional motor redundancy enables humans to move with distinct muscle activation patterns while achieving a similar outcome. Since humans select similar strategies, there seems to be an optimal control. However, older adults move differently to young adults. The question is whether this is this due to an altered reinforcement scheme, altered sensory inputs, or due to alterations in the neuromusculoskeletal systems, so that it is no longer optimal or possible to execute the same movement strategies. The aim of this study was to analyse natural compensation strategies in the vital daily-life-task, sit-to-walk, in relation to neuromuscular capacity and movement objectives in younger (27.2 ± 4.6 years, N = 27, 14♀) and elderly (75.9 ± 6.3 years, N = 23, 12♀) adults. Aspects of the neuromuscular system that are prone to age-related decline and feasible to quantify were assessed (i.e. strength, nerve conductivity, fear of falling). Kinematics and muscle activity were recorded and joint kinetics were estimated using biomechanical models. Elderly men consistently used their arms when standing up. This strategy was not associated with a lack of or a reduction in strength, but with a reduction, but no lack of, ankle joint range of motion, and with increased fear of falling. The results show that humans preferentially maintain a minimum threshold of neuromuscular reserve to cope with uncertainties which results in compensation prior to coming up against physical limitations. Smaller base of support while standing up, a compensatory strategy with possibly greater risk of falls, was associated with muscular weakness, and longer nerve conduction latencies.

Journal article

Parkinson M, Curtis F, Dani M, Fertleman M, Kolanko M, Soreq E, Barnaghi P, Sharp D, Li Let al., 2022, EXPLORING INTERACTIONS BETWEEN TRAUMATIC BRAIN INJURY AND COGNITIVE CO-MORBIDITY: DESCRIPTIVE CASE ANALYSIS FROM REAL-WORLD MONITORING, Association-of-British-Neurologists (ABN) Annual Meeting, Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050

Conference paper

Parkinson M, Curtis F, Dani M, Fertleman M, Kolanko M, Soreq E, Barnaghi P, Sharp D, Li Let al., 2022, MTBI PREDICT: A PROSPECTIVE BIOMARKER STUDY TO PREDICT OUTCOMES IN MILD TRAUMATIC BRAIN INJURY, Association-of-British-Neurologists (ABN) Annual Meeting, Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050

Conference paper

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

Pereira C, Perera AH, Rudarakanchana N, Harris BHL, Di Giovannantonio M, Taylor-Robinson SD, Dani M, Fertleman Met al., 2022, Cytokine changes in cerebrospinal fluid following vascular surgery on the thoracic aorta., Scientific Reports, Vol: 12, Pages: 1-8, ISSN: 2045-2322

There is growing evidence that surgery can drive an inflammatory response in the brain. However, the mechanisms behind this response are incompletely understood. Here, we investigate the hypotheses that 1. Cerebrospinal fluid (CSF) cytokines increase after vascular surgery and 2. That these changes in CSF cytokines are interrelated. Patients undergoing either open or endovascular elective surgery of the thoracic aorta were invited to participate in this study. Cerebrospinal fluid samples were taken before surgery and on the first post-operative day. These were analysed for the presence of ten cytokines by immunoassay to examine for post-operative changes in cytokine levels. After surgery, there were significant increases in six out of the ten measured CSF cytokines (IL-1β, 2, 6, 8, 10 and 13). This included changes in both putative pro-inflammatory (IL-1β, 6 and 8) and putative anti-inflammatory (IL-2, 10 and 13) cytokines. The greatest increases occurred in IL-6 and IL-8, which showed a 63-fold and a 31-fold increase respectively. There was strong intercorrelation between CSF cytokines after the operation. Following surgery on the thoracic aorta, there was a marked increase in CSF cytokines, consistent with a potential role in neuroinflammation. The ten measured cytokines showed intercorrelation after the operation, indicating that a balance between multiple pro- and anti-inflammatory cytokines may be present.

Journal article

Selmi H, Davies A, Walker J, Heaton T, Sabharwal S, Dani M, Fertleman M, Reilly Pet al., 2022, Consent for orthopaedic trauma surgery during the COVID-19 pandemic, BMJ Open Quality, Vol: 11, ISSN: 2399-6641

INTRODUCTION: The COVID-19 pandemic has brought a series of new challenges to the management of surgical patients. The consent process relies on a foundation of open and non-coerced discussion between clinician and patient, which includes all the potential risks of surgery. This must be updated to incorporate the additional risks of surgery during the pandemic including infection with the SARS-CoV-2 and increased risks of complications with the potential requirement for intensive care support. AIM: The aim of this multi-cycle quality improvement project was to ensure all patients were fully informed of the risks of developing COVID-19 and the possible need for intensive care unit (ICU) support. METHODS: We investigated the quality of the consent process for patients undergoing surgery for trauma at our major trauma centre. Our baseline data collection included a review of all orthopaedic trauma consent forms over a 4-week period in March 2020. We subsequently undertook three further Plan-Do-Study-Act (PDSA) cycles over separate 4-week periods. First, in June 2020, after education measures and presentation of baseline data, second in July 2020 after further education and regular digital reminders were sent to staff, and third in September 2021 after the implementation of an electronic consent form. RESULTS: At baseline, only 2.6% of consent forms mentioned the risk of COVID-19 and none mentioned the risk of requiring ITU support. Through three PDSA cycles this increased to 97% of cases where consent forms displayed the additional risks of COVID-19 and the potential need for ITU admission. CONCLUSION: Our quality improvement project improved the informed consent procedure at our trust. By incorporating these additional risks into the template of an electronic consent form, we hope to achieve sustained improvement in practice.

Journal article

Luo R, Hudson M, Cepeda V, Reese G, Sritharan G, Peck G, Morgan C, Koizia L, Fertleman Met al., 2022, 1029 Even limited geriatrician involvement reduces length of stay for all - age acute general surgery patients, British Geriatrics Society Abstract, Publisher: British Geriatrics Society, Pages: 1-1, ISSN: 0002-0729

Conference paper

Pereira C, Dani M, Taylor-Robinson S, Fertleman Met al., 2022, Putative involvement of cytokine modulation in the development of peri-operative neurocognitive disorders, International Journal of General Medicine, Vol: 15, Pages: 5349-5360, ISSN: 1178-7074

Following surgery, local cytokine-driven inflammation occurs, as part of the normal healing process. Cytokines in thecentral nervous system such as IL-6 and IL-8 may also be elevated. These cytokine changes likely contribute to neuroinflammation,but the complex mechanisms through which this occurs are incompletely understood. It may be that perioperative changes in pro- andanti-inflammatory cytokines have a role in the development of perioperative neurocognitive disorders (PND), such as post-operativedelirium (POD). This review considers the current evidence regarding perioperative cytokine changes in the blood and cerebrospinalfluid (CSF), as well as considering the potential for cytokine-altering therapies to prevent and treat PND.

Journal article

Park C, Sugand K, Aframian A, Morgan C, Pakroo N, Gibbons C, Fertleman M, Nathwani D, Bhattacharya R, Sarraf KMet al., 2022, 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, Vol: 191, Pages: 1005-1012, 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

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, Vol: 34, 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 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

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

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

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